“The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, and political belief, economic or social condition,” says the WHO constitution in its preamble.
Access to quality healthcare is a major challenge worldwide and particularly more important in low-middle income countries (LMICs) like Pakistan. These challenges are further compounded in “high cost” diseases like heart diseases.
Pakistan is going through a significant economic crisis where many cannot afford an “out of pocket” healthcare delivery model due to poverty and lack of universal healthcare insurance coverage. Many patients skip their preventive health checks or cannot afford medications for hypertension and diabetes that can lead to heart diseases. Many patients do not have vehicles or cannot afford transportation to access care for health, they perform multiple jobs and are unable to take time off to travel to health centers located in city centers.
The National Institute of Cardiovascular Diseases (NICVD) was founded back in the 1960s when the population of Karachi was less than two million. It has catered to cardiac needs of the city ever since. During this time period, the population of Karachi grew to more than 20 million. Pakistan is going through a heart-related health crisis. According to a WHO report, heart disease is currently the leading cause of death in Pakistan. There is one heart attack happening every four seconds and bewildering 46 deaths with every passing hour. This is compounded by the fact that in a city like Karachi with heavily congested neighborhoods, there might be unnecessary delays for a patient seeking timely care. These economic and transportation issues might have compounded the tragedy that more people are dying of heart diseases.
Chest Pain Units model
The Chest Pain Unit (CPU) model at NICVD is an innovative and cost-effective approach to providing emergency care to heart attack patients in heavily congested areas. By utilising mobile units that were originally intended for mammography screenings, the NICVD has been able to provide life-saving care to thousands of patients who might have otherwise been unable to access timely care due to transportation and economic barriers. The strategic placement of these CPUs in key areas has also ensured that patients from all socio-economic backgrounds have access to quality care.
“Time is Muscle” in heart attacks where every passing minute can lead to irreversible heart damage. When patients arrive in these CPUs, they are seen by a doctor, ECG is performed to diagnose a major heart attack or it is ruled out. If the patient is suffering from a major heart attack, blood thinners are administered and then the patients are promptly taken to the hospital for the primary angioplasty procedure. These CPUs are also equipped with patient resuscitation tools. CPUs are, in true a sense, small emergency rooms without a huge capital cost incurred.
The NICVD now has 24 CPUs throughout Sindh, with 17 of them in Karachi serving a city of 20 plus million people. Since 2017, one million patients have been seen in the CPUs and thousands of lives have been saved. All the care provided at these facilities is free of cost subsidised by the Sindh government. The NICVD’s approach to tackling heart disease is an example of low cost. Local solutions can make a significant impact in addressing major health challenges. The success of the CPUs can serve as a model for other LMICs (low to middle income countries) facing similar healthcare barriers. Additionally, the future plans to expand these units to include preventive cardiology clinics and telehealth services can further improve the patient’s outcomes and access to care.
Overall, the NICVD’s approach to addressing the heart disease crisis in Pakistan highlights the importance of innovative and cost-effective solutions in fulfilling the fundamental human right to access quality healthcare, regardless of socio-economic status.
The following 17 chest pain units are located in Karachi: under Gulshan-e-Chowrangi Flyover; under Malir Halt Flyover; under Qayyumabad Chowrangi, under Nagan Chowrangi flyover; on I.I. Chundrigar Road; in Landhi; under Karimabad Flyover; in Orangi Town; under Gizri Flyover; in New Karachi; at Moosa Lane, Lyari; under Manzil Pump Flyover (Quaidabad); at Cantonment; in Keamari; at ASF, Medical Centre; at Malir Cantonment; and at Karachi Institute of Heart Diseases.
The following chest pain units are located outside Karachi: one each in Ghotki, Tando Bago (Badin), Jacobabad, Umerkot, Tando Allahyar, Mirpurkhas, and Shikarpur
The writer is MD, MHCM (Harvard), current chief operating officer of the NICVD and a practising cardiologist. He also has a master’s in Healthcare Management from the Harvard University
