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The headline was of hyperboles, meant to capture the loyalist eyes and uninformed minds—GPHC says step closer to open-heart surgery. Thus, with wary eyes theirs, further perusal was more of intrigue, than genuine interest;

“The GPHC says it’s now one step closer to providing open-heart surgery, with the return of surgeon, Dr. Pradeep Ramkoomar, who is now the only open-heart surgeon for adults in Guyana.”

But evident it was, on scrutinising the first paragraph, their naked intent was disinformation. For information was denied, on Dr. Pradeep Ramkoomar specialist recognition, or lack thereof, from where he undertook the cardiothoracic fellowship. However, truth be told, standalone fellowships, generally don’t lead to specialisation. That said, if he is a certified cardiothoracic surgeon, which there is no evidence of, then he is certainly not the only one in Guyana, considering Balwant Singh Hospital counts two such.

Cardiothoracic surgery

Notwithstanding, cardiothoracic surgery is the specialty which treats pathologies affecting organs within the chest, principally the heart, lungs and oesophagus. As a specialty, it’s relatively new, nonetheless experienced rapid growth since the first successful open heart procedure in 1953. In fact, such cardiothoracic procedures are often complexly lengthy, requiring support from advanced technology during surgery, and intensive therapy for the patient post-surgery.

As a result, training in cardiothoracic surgery is similarly complex, as the specialty itself. Thus, in the UK, it entails 4yrs of pre-specialisation training, followed by 6yrs of cardiothoracic surgery training, and a further 2-3yrs of post-specialisation training. Which means, the doctor would’ve undertaken at least 12yrs of postgraduate training, before being certified as a cardiothoracic surgeon.

To that end, this training chronology was highlighted, to make the argument that, Dr. Pradeep Ramkoomar 3yr stand-alone fellowship training is grossly inadequate, to qualify him as a cardiothoracic surgeon. In fact, as much was confirmed, on scrutiny of the Indian Medical Register (nmc.org.in), where Dr. Pradeep Ramkoomar isn’t registered as a specialist. For if he isn’t certified a specialist in India, then he cannot be deemed a specialist in Guyana, since such certification is at the point of training, i.e. where he undertook his fellowship.

Moreover, by their very nature, cardiothoracic surgeries are high-risk, involving very complex technologies e.g cardiothoracic bypass machines. Where the safe operations of such machines, mandates highly specialised Perfusionist working in tandem with Anaesthetists. For this was highlighted to reinforce the important point that GPHC, is moons away from undertaking cardiothoracic surgeries, since they lack the necessary skills and technologies, even as they struggle to get the basic right.

Nonetheless, to further reinforce this message, a letter captioned,“Is there a shortage of Eliquis and Sotalol in Guyana?,” penned by one Eric Moseley, will be explored. Where penned by the writer was the experience of searching our 83,000 mi.² to find the aforementioned medicines, at no avail.

But evident is, PPP is aspiring to undertake the complex cardiothoracic surgery, but the basics in providing medicines, they’re struggling to get right. For Sotolol, available since 1992, is a class of heart medicine prescribe to control abnormal heartbeat. On the other hand, Eliquis is important blood thinner, which in conjunction with sotolol, have prevented millions of strokes and cardiovascular deaths. In fact, these basic drugs are prescribed daily around the Caribbean, yet they aren’t available in Guyana, a country aspiring for the complex cardiothoracic surgeries.

Thus, this reminder, GPHC is without a recognised cardiologist and Cardiothoracic surgeon, therefore should disregard complex heart surgeries, and rather focus on getting the basics right. Focus on getting basic medicines and care right, before aspiring for the complex open-heart surgery and coronary stenting. For this is the reality, failing at the basics, means the inevitable failings at the complex, would be catastrophic.