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Developing Health Care in Developing Nations 


Sitting in an office in Kingston, Jamaica, lined with framed diplomas and certificates, Dr. Ernest Madu hands me a leaflet showing a four-month old baby. She was born with a disrupted valve in her aorta, and the poster advertises a community campaign to raise $60,000 to fly her to Miami for surgery. “I heard that she died,” he says, a somber look overtaking the usual brightness in his eyes.

“If that child had been born in the US instead of Jamaica,” says Madu, who is from Nigeria but practiced medicine for many years in Tennessee, “she would have grown up to do what she wanted to do in life. Go to school, get married, have children, have a career. She died because she was Jamaican. Every life is valuable,” Madu says, with rising passion in his voice. “A person in Indonesia is as important as one in Germany. Unfortunately, we live in a world now where if a person lives in a poor country, it’s okay that their health is not as good. We need to find ways so that health and survival are equitable around the world.”

For Madu, access to medical care in the developing world is not simply an abstract issue of fate and fairness. It is a matter of life and death, one that he faces every day in his work as CEO of the Heart Institute of the Caribbean (HIC). He and Dr. Dainia Baugh, his wife, founded HIC four years ago to prove that it’s possible to provide high-quality health care in a poor country like Jamaica. It’s their hope that the hospital becomes a model that spawns similar facilities throughout the global south to save lives.

This is a hugely ambitious goal that powerful figures concerned about global health issues such as Bill Gates, Bono, and Bill Clinton have not dared to propose. But when shaking hands with Madu, a powerfully built man with an even more powerful presence, you sense he possesses the charisma, determination, and first hand experience to make it happen.

People in developing nations die needlessly, Madu explains, because their countries lack basic medical services that patients in even the most impoverished or remote communities in North America and Europe take for granted. Before the Heart Institute of the Caribbean opened there was no chance in Jamaica of receiving routine cardiology procedures like a stress test, an electrocardiogram (ECG or EKG), or angioplasty.
“People have been indoctrinated to believe that good medical care can’t happen in a place like Jamaica,” Madu says. It’s simply assumed that ill people must go abroad for good treatment—that is, if they can afford it and live long enough to make the trip. “It’s a mindset we have to get beyond if we want to improve health,” he says. “Fifty percent of people having heart attacks die within 24 hours without the proper medical treatment. Even if you are rich enough to own a plane, it may be too late.

The rising tide of modern diseases
Patrick Walsh, a 47-year-old Kingston resident, declares that he would not be alive today if not for the Heart Institute of the Caribbean. “I’ve come back from sudden cardiac arrest twice because of the defibrillator they implanted in me. It shocked me back to life.” Walsh was referred to HIC from another physician complaining of swollen legs and shortness of breath. He was diagnosed with congestive heart failure and was surgically outfitted with a defibrillator, a device incorporating a pacemaker that responds to a rapid or arrhythmic heartbeat with a shock so that the pacemaker can continue to work. Such surgery was not available in Jamaica until HIC opened.

“Dr. Madu assisted me by knocking a balance of $9,000 off the bill,” Walsh adds. “I am very grateful for that.”

The hospital also treats many poor patients through its policy of not turning anyone away who needs help. “We charge only what they can afford to pay,” Madu says. “Jamaicans are proud people, so many times the whole family, or the brother who is cab driver in Los Angeles, will send us money.” Madu proudly notes they provide more than $1 million a year in free or reduced-rate care.

HIC does not yet have the capacity for pediatric cardiac operations, such as replacing the disrupted aortic valve in the little girl’s heart, but Madu estimates that with the proper equipment and medical expertise, the operation could be performed in Jamaica for less than $10,000, increasing the chances for that little girl and others to live.

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