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patients with behavioural and
psychological symptoms of
dementia both in hospital and in
the community
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ASET Outreach provides early
recognition of, and intervention
in, the disease process and
promotes and maintains health
in the community
Our team of dementia care nurses
assist with assessments in the
community, run the ‘Living with
Memory Loss Program’ (specifically
designed for people with early stage
dementia) and manage the carers’
support groups.
The Stepping On Program is a
community initiative of the Local
Health District and a free program
for those aged over 65 who are
at risk of falling, and provides
education and exercise programs
to reduce falls. An active over-50
program offers affordable group
exercise classes in Aqua Fitness,
Ballroom Dancing, Gentle Exercise,
Strength Training and Tai Chi.
Classes are available at over 25
Central Coast venues.
Demands for our services are
increasing and will continue to do
so as our population grows and
ages. Our community engagements
play a key role in helping us meet
future demands by treating patients
in their own homes, preventing
unnecessary hospital admissions,
improving lifestyle and health and
helping to empower communities
to take more responsibility for their
own health and wellbeing.
The Challenges and
Opportunities in
providing High Quality
Cardiovascular Care in
the Caribbean Case Study:
Jamaica
This article has been submitted by
Ernest Madu, Edwin Tulloch-Reid,
Dainia Baugh and Lisa D’Oyen to
share information with other Fellows
about the local context in the
Caribbean.
In 2005, the Heart Institute of the
Caribbean (HIC) began operations in
Kingston, Jamaica with the mission
of improving access to and quality
of cardiovascular care to the people
of the Caribbean. We believed, and
still believe, that a global imbalance
exists in the availability of modern
cardiovascular care with 80% of
access available only in the richest
countries where cardiovascular care
accounts for only 20% of global
need. This imbalance has created
an exploitative system where the
poorest countries of the world
depend on care from the richest
countries, often at exorbitant cost.
Citizens from low-resource nations
expend considerable financial
and emotional capital accessing
high quality cardiovascular care
in high-resource nations, further
depleting limited reserves from
low-resource nations. We find this
arrangement inequitable, unjust and
morally unacceptable. This article
provides insight into the challenges
of embarking on the mission to
provide sustainable, high-quality
cardiovascular care in the Carib
bean, as well as the opportunities
that exist despite the challenges.
We believe that lessons learned
and successes attained here can
be replicated in other low-resource
settings and so help alleviate
the access gap in high-quality
cardiovascular care in these regions.
Ensuring patient satisfaction and
improving operational efficiency in
the delivery of sustainable, high-
quality cardiovascular care has not
been an easy mission. Since the
beginning of operations in Jamaica,
HIC has encountered and learned
to negotiate myriad structural,
institutional, socio-economic and
behavioural barriers that have acted
as impediments to the mission.
We believe that these impediments
are to be found in variable forms
in other low-resource nations. In
Jamaica and much of the Caribbean
for example, individuals with the
means and access to the USA
have long depended on facilities
in Florida and other parts of the
USA or Western world to access
cardiovascular services, usually
at excessively high rates. Those
institutions that have benefited from
this arrangement have been active
over decades in promoting such an
arrangement. Even though inimical
to development of sustainable
cardiovascular care infrastructure in
low-resource nations, the practice is
frequently accepted as the norm and
indeed welcomed and appreciated
by a significant and influential
group within these countries.
Challenging this paradigm was
considered radical and was met with
resistance by those who believed
that comparable high-quality cardiac
care (even if desirable) was not
achievable locally and those that
have become too comfortable with
or benefited from the status quo.
We believed that such a system
that was designed to cater for the
few who could afford expensive
care overseas while neglecting the
vast majority of Jamaicans, was not
an appropriate approach and was
detrimental to development and
group progress. We also recognised
that the nature of cardiovascular
disease requires that every society
must ideally have a properly
developed local program as time
is critical in providing proper care
given the highly unpredictable and
often sudden nature of a cardiac
emergency.
This issue was compounded by
low general health literacy with
respect to cardiovascular care
and the obvious information
asymmetry. Many patients relied on
a paternalistic approach to care and
depended solely on their physicians
as the source of information for
their health-related concerns, and
thus did not feel empowered to seek
second or alternative opinions. HIC
sought to change this by raising
awareness of the reality that cardiac
emergencies are life threatening
