As pure luck would have it, or as destiny may have provided, a group of heart specialists from the U.S. planned a bone fishing expedition on Christmas Island in Kiribati two months ago, just after it had become obvious to our Pacific Islands Medical Aid pediatrics team that several children there needed urgent life-saving surgery, but required diagnosis. The six-man team, led by cardiologist Dr. Steven Compton, from the Alaska Heart Institute, agreed to stage a heart clinic at the small hospital on the island and brought all the portable equipment necessary to do the job. They saw 20 patients and identified four children who’s medical problems warrant immediate heart surgery. Here is Dr. Compton’s story.
By Steven J. Compton, MD
Cardiologist, Alaska Heart Institute
Pacific Islands Medical Aid seems to catalyze its own activities. Recently, PIMA sent a United States surgical team to Kiritimati. Dr. Kirsten Randall was one of the visiting anesthesiologists. She returned to her practice in Anchorage, Alaska, where I practice cardiology, and happened to mention her experiences with PIMA and providing medical services to the people of Kiritimati.
Coincidentally, I had already scheduled a fishing trip to Kiritimati with a group of friends, many of whom happened to be cardiologists. Dr. Randall put me in contact with Carlton Smith, PIMA director, who informed me of the need for cardiology assistance. Our group was excited to help out, and we set a date for a heart clinic to be held during our visit.
Although a stethoscope can provide much of the information we need, we knew that we could diagnose problems more accurately using electrocardiogram (ECG) and echocardiogram (echo) data. Christopher Lawson, RN, was able to hunt down an ECG machine that could be integrated to a personal computer. Chris generously donated both the ECG machine and a personal computer to the cause.
I had assumed that an echo machine would be out of the question, because the machines we use in clinic weigh about 200 pounds and cost over $80,000. I was surprised to find a new machine that fits in a lab coat pocket, and costs a tenth of a conventional machine. Although the smaller machine does not have many fancy features, we would be able to define the severity of a heart valve problem or congenital abnormality in order to assess the need for surgery.
Our team met in Honolulu and caught the regular Tuesday flight to Kiritimati. After settling in at Sharks Camp, and a fabulous day exploring the fishing around Kiritimati, we cleaned ourselves up for Cardiology Clinic at Ronton Hospital, in London. Our team was composed of Drs. Rick Klein, Jack Lasseter, and myself, with Nurse Chris Lawson, and Volunteers David Lyon and John Enquist. We met Dr. Teraira, the Ronton Medical Director, who gave us with a tour of the Ronton facility before settling us into the X-Ray building where we would hold clinic. The Ronton nursing staff was very enthusiastic and helpful.
Over the course of the day we saw 20 patients, over half of whom were children. We were able to interview them and their parents with the assistance of the nursing staff (who translated), before examining them and proceeding with EKG and echo studies. We were also very impressed with the quality of chest X-rays that we obtained from the Ronton radiology facilities.
By the end of the day we had identified four patients whose medical problems warranted immediate heart surgery, and a number of others whose therapies can be adjusted and improved. As I write, we are helping to coordinate transfer of the first four patients to the United States for surgical repair of their heart problems. We are happy to report that most of the problems we’ve found have been detected early enough to allow an excellent prognosis following prompt surgical management.
Although our group had been lured to Christmas Island by the famous fishing opportunities, we all agreed that our clinic day was the absolute highlight of our trip. We very much enjoyed getting to meet the islanders, and appreciated the chance to work with Dr. Teraira and his staff at Ronton. We are especially impressed with the Pacific Islands Medical Aid and with Carlton Smith’s enthusiasm and organizational skills. We appreciate the opportunity to be helpful, and hope to return. Many thanks to Carlton Smith, Dr. Teraira, and the Ronton staff.