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Chechnya: MSF Treats Cardiac Emergencies
December 15, 2011
Faced with the health system’s inadequacy in caring for cardiovascular disease in Grozny, Chechnya, Doctors Without Borders/Médecins Sans Frontières (MSF) launched a program targeted at cardiac emergencies in late 2010. Within a few months of its implementation, the program had treated nearly 700 patients.
The first coronary thrombolysis—a therapy that dissolves blood clots in coronary arteries—was carried out by the teams in Grozny in early July 2011, and 15 more have been performed since. Without treatment, blocked coronary arteries can lead to a fatal heart attack. "Before the arrival of MSF, this procedure had never been done here. We did not have the necessary equipment or drugs," says Dr. Madina Saidarkhanova, the head of the cardiac intensive care unit.
A Population at Risk
Smoking, poor diet, lack of exercise, hypertension, diabetes, and even post-traumatic stress disorder following years of war have made the Chechen people more susceptible to cardiovascular disease, which affects one person in six in Chechnya. Without the equipment and specialized medical staff to treat them, these diseases are responsible for more than 62 percent of deaths in the Republic. The national average is lower, at 56 percent.
In 2009, the Republican Emergency Hospital (REH) in Grozny registered 1,555 patients who had suffered a heart attack, with 33 percent of the cases fatal. At that time, the cardiology and intensive care unit had no functional defibrillator, electrocardiography machine, or Holter monitor (a portable device used to monitor the heart rhythm), and there was no way of carrying out specialized biochemical examinations or thrombolytic treatment. The only way for a patient with cardiovascular disease to receive treatment was to travel to Moscow, a distance too great for the most urgent cases.
700 Admissions in Just Months
At the end of 2010, MSF opened a cardiology and intensive care program in the surgical and cardiovascular intensive care unit of the emergency hospital in Grozny. Given the weaknesses in the health system and the gaps in the knowledge of the field of cardiology, MSF’s aim was to improve the ability of Chechen cardiologists to diagnose and treat emergency cases.
The first few months were devoted to developing equipment, supplies, and medicines; and training staff on treatment methods specific to cardiology. Consultations with patients then followed. Since February 2011, the emergency unit in the cardiology department recorded almost 700 admissions, with more than 100 patients resuscitated using defibrillators.
A First in MSF History
Aside from medical issues, there have been some challenges. According to Vladimir Najman, MSF head of mission in Russia, "This is the first time that MSF is implementing a project for cardiac emergencies. This is a highly specialized medical activity. However, based on preliminary results, it is a success." By the end of 2011, the mortality rate for patients being treated for heart attacks in the REH had fallen from 33 percent to 7.82 percent.