HRS2017: How pro bono work can turn ordinary cardiologists into global citizens

While atrial fibrillation (AFib) and heart disease continue to plague patients globally, some cardiologists have made it their mission to help underserved communities in foreign countries as they look for ways to use their specialties for good.

Cynthia Tracy, MD, a cardiac electrophysiologist at George Washington University Hospital in Washington, D.C., has worked for the last seven years to serve impoverished heart patients in Honduras. Working with the local government, she has been able to make a difference in patients’ lives that normally would not have access to cardiothoracic care, she said during a session on the issue at this year’s Heart Rhythm Society conference in Chicago.

The presentation featured three other cardiac electrophysiologists doing similar work, including Sri Sundaram, MD, of South Denver Cardiology Associates, Uma Srivatsa, MD, of UC Davis Health in Sacramento, California, and Behzad Pavri, MD, of the Thomas Jefferson Heart Institute in Philadelphia.

“In Honduras, if you have money, you can afford to have things done,” Tracy said. “If you don’t have money, you’re pretty much out of luck.”

Since 2010, Tracy said has placed more than 230 devices and has treated more than 1,500 patients. She has traveled to the country regularly every year to treat patients with AFib and bradycardia.

“For these people to receive these devices free and all the care that comes with it, is just a spectacular opportunity for these people,” Tracy said. “The gratitude they show us has really changed my life.”

Donations of supplies and medical devices, like pacemakers and defibrillators, from corporations and government organizations influence how many patients doctors like Tracy are able to treat.

“There is such a tremendous need for devices,” Tracy said. “Every year, a handful of people will die in the week or two before we get down there because they just can’t hold on until you arrive with your equipment.”

To help streamline equipment to developing countries that need it, physicians like Pavri work to collect expired and even used devices.

About 1-3 million people die globally every year simply because they don’t have a pacemaker, even though conditions like bradycardia are entirely preventable. Many patients in the U.S. are only alive right now because of a pacemaker, which on average, costs anywhere from $4,500 to $8,000, too much for the average person in an impoverished country.

Providing these types of patients with brand new medical devices is unrealistic, but recycling old ones by resterilizing them for reuse is possible, and is a mission Pavri has dedicated himself to.

“There have been many reports over the past three decades that have proven that careful cleaning, resterilization and reuse of implanted devices is safe and effective for patients who would otherwise have absolutely no means of obtaining such a device,” he said at the panel.

Research shows that implanting used devices in patients yields the same benefits, except for a shorter battery life for the device. But there is no increase in the chance of an infection developing, Pavri said.

Another way to get underserved patients the medical devices they need is through the donation of expired shelf products. Most companies discard their expired products, Pavri said, but he tries to get them to donate it to his cause.

“What we can do to prevent death and dying in impoverished nations is actually a lot,” Pavri said.

Some medical device companies might hesitate to allow the reuse of their devices, believing it could cause them to lose out on potential profit. But Pavri said because the patients getting used devices had no chance of buying them to begin with, it’s not even a sector of the market these companies would normally profit from.

Each panelist agreed that their work is worth it, especially when they return to countries and see their former patients thriving.

“At some point in everyone’s career, if you can get to a place where you can do something like this, do it,” Tracy said. “You will never, ever regret it.”