[HSF] Death on waiting list

Wed Apr 18 00:05:33 EDT 2007

In South Africa I estimate that for a population of 6
million there would be not more than 3000 cases done,
and by about 10 centres. The state run university
hospitals have had their budgets systematically
slashed over the past 10 years, so despite sufficient
surgeons and residents they are on average doing about
400 cases per year, about half of what was done
previously.....despite a growing burdon of very sick
patients with all sorts of heart disease. Even the
paediatric cases have a long wait, despite our
president promising `free medicine to all children
under 5.`
Dave Harris

--- Tina i Mladen Kocica <kocica at sezampro.yu> wrote:

> Thanks Dave and others,
> 
> I've posted this problem just to provide some
> evidence, supported by Dave's
> obeservations. We do not CREATE WLs, but we receive
> them. From whom? From
> the government and from the cardiologists. I am not
> talking about private
> practice, which (one way or another) is independent
> from official state
> health care policy. I don't know if you are aware of
> this, but here, in the
> region of the Eastern Europe (and particularly in
> Serbia), there is true
> epidemic of serious CVD. Rough numbers are: 5000
> surgeries (3 centres, 15
> fully expirienced and 35 less expirienced surgeons,
> more than 6 million
> population) and 3 times more PCIs annualy (still
> increasing). Terrible load
> of advanced CAD (still about 60% of all cases), late
> and difficult valvular
> HD, acute aortic dissections ... Thus, our WLs are
> crowded with seriously
> ill persons, making our position very difficult,
> trying to make the most
> appropriate (or any) triage. 
> Government is trying to explain that such WLs are
> common thing in even more
> developed coutries, and I wanted to provide contra
> argument, because I think
> that main problem is bad organization (small numebr
> and wrong distribution
> of centres, as well as very small number of surgeons
> ... Etc). Moreover,
> there is still no private cardiac sugery here. Seems
> that Francis Robicsek
> was right, asking: "Is cheap medicine good
> medicine?"
> 
> Mladen
>  
> 
>  
> 
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> 
> 
> -----Original Message-----
> From: openheart-l-bounces at lists.hsforum.com
> [mailto:openheart-l-bounces at lists.hsforum.com] On
> Behalf Of David Harris
> Sent: 16. april 2007 23:41
> To: OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] Death on waiting list
> 
> In South Africa the waiting list in the state
> hospitals are anything from 4
> to 10 months, depending on the region...very, very
> frustrating, and I
> estimate the mortality is not more than 10%, from
> the records we kept. It is
> interesting that the patients already have waited 6
> months to a year before
> getting to the cardiology clinic. Patients with
> mainstems, severe coronary
> disease with ischaemic cardiomyopathy, AS with
> gradients in the 100`s are
> more often than not still around after a year. They
> will usually then
> present as emergencies, and then get priority, so
> usually not die.
> 
> In the private sector, where I now do most of my
> work, the wait depends on
> the surgeon. We are pushed to do healthy elective
> patients on the same day
> by the cardiologists,but always wait at least until
> the next day, unless its
> really urgent. We generally try to rather get them
> home for a few days. It
> is good to let the contrast clear out, and our
> feeling is that you may get
> less of a surgical inflammatory response by waiting.
> Just track the
> creatinine and CRP for 3 days.
> We all know about the creat, but watch the CRP go
> over 150 in some cases.
> Also, there is often an enzyme leak post angio,
> usually because the
> cardiologist has been trying to wedge in a stent,
> and this may end up with a
> resus! All without your knowledge. You should hang
> around the cath lab a
> bit, and see how unstable the cardiologists can make
> them. So we wait a bit,
> from what we have seen, a few days does more good
> than harm.
> 
> We often comment on how much easier the patients are
> in private practice,
> and in the state hospital a `routine` case is often
> referred to as a
> `private patient`.
> 
> The long waiting lists are horrific, as patients are
> often cancelled a few
> times due to more emergent cases jumping the list.
> The system is a
> reflection of the state spending less money on
> health, trying to maintain
> control on health systems, and simply the usual
> consequence of a state run,
> inefficient department.
> 
> Dave Harris
> 
>  
> --- Ben Bidstrup <benjamin.bidstrup at bigpond.com>
> wrote:
> 
> > But does that give the team time to fully assess
> the patient?
> > 
> > >In Israel the waiting time is about the time it
> > takes our Blood Bank
> > >to prepare 2 units of cross-matched packed
> cells...
> > >
> > >Jay Lavee
> > >
> > >----- Original Message ----- From: "Salerno,
> Tomas"
> > <TSalerno at med.miami.edu>
> > >To: <OpenHeart-L at lists.hsforum.com>;
> > <OpenHeart-L at lists.hsforum.com>
> > >Sent: Monday, April 16, 2007 7:35 AM
> > >Subject: RE: [HSF] Death on waiting list
> > >
> > >>waiting lists in the USA are in general about
> one
> > hour
> > >>
> > >>TS
> > >>
> > >>________________________________
> > >>
> > >>From: openheart-l-bounces at lists.hsforum.com on
> > behalf of Tea Acuff
> > >>Sent: Mon 4/16/2007 12:32 AM
> > >>To: OpenHeart-L at lists.hsforum.com
> > >>Subject: Re: [HSF] Death on waiting list
> > >>
> > >>
> > >>
> > >>About the only waiting going on in the United
> > States of America (no
> > >>ugly "American" short hand) is over the weekend.
> > Excepting the
> > >>Veterans Administration Hospitals of course.
> > >>tea edward acuff junior medical doctor
> > >>
> > >>
> > >>----- Original Message ----
> > >>From: Tina i Mladen Kocica <kocica at sezampro.yu>
> > >>To: OpenHeart-L at lists.hsforum.com
> > >>Sent: Sunday, April 15, 2007 9:59:59 PM
> > >>Subject: [HSF] Death on waiting list
> > >>
> > >>
> > >>Our heart surgery waiting lists (WL), here in
> > Serbia, are permanently
> > >>growing, with today average of about 1000 people
> > per centre annualy. It
> > >>seems that we do not make them properly, since
> > death rate on WL is also
> > >>permanetly increasing (from 8% three years ago
> to
> > 15% last year).
> > >>Questions:
> > >>1) General opinion about WL for heart surgery
> > (ethics)?
> > >>2) Criteria? Who makes them?
> > >>3) Your annual WL load?
> > >>4) Your WL mortality?
> > >>
> 
=== message truncated ===

Dr. David G. Harris, FCS, MMED,
Cardiothoracic Surgeon        
Suite 207                                
Kuils River Private Hospital,        
PO Box 1200, Kuils River, 7579, Cape Town, South Africa.            
Tel +27-21-9006411             
Fax +27-21-9006412      Mobile +27-83-3309587