Thursday, September 22, 2011

Staggering Initial Findings

In a preliminary review of the data we collected in Montserrat, it is apparent that the prevalence of Hypertension and Diabetes in Montserrat is higher than the general prevalence that is usual in the Caribbean islands, and  is notably higher than in urban areas of the United States or in African Americans. This is especially interesting since smoking is very low to non-existent on the island, there is increased physical activity ( there is a lot of uphill walking) and lower obesity prevalence.

Is this due to Post Traumatic Stress Syndrome from the volcano or increase in inflammatory processes which are contributing to these higher percentages compared with neighboring islands and the United States? Please follow the blog for further information.

Monday, September 5, 2011

Thanks and appreciation from Mount Sinai Heart Cardiovascular Disparities Center

As we came to the end of the first "Blood Pressure without Borders" medical mission in Montserrat, I realized that it was actually a beginning, we have really just skirted the tip of the iceberg. The initial invitation from the Minister of Health, Colin Riley, was simply to come to island to provide cardiac care to patients who had no access to such care without leaving the island. Knowng the impact that the ASH community outreach committee has had in the New York neighborhoods, I knew that a collaborative effort would be phenomenal and it indeed it was.

As Director of the Mount Sinai Cardiovascular Disparties Center, I would like to thank the president of ASH, Dr George L. Bakris for his vision, the Chair of the ASH Community Outreach Comittee, Dr. Keith C. Ferdinand for his leadership, Gilda Caputo Hansen for her tireless energy and organizational skills and the entire committee for their support. I would also like to thank Nancy Thomas - coordinator for Mount Sinai Heart CDC for her hard work and committment, our community partners the Association of Black Cardiologists (ABC) and the American Heart Association (AHA) for their contributions. I would like to thank the leadership at Mount Sinai Heart and Medical Center (Dr. Valentin Fuster, Dr. Samin Sharma and Dr. Jagat Narula) for believing in me. Last but certainly not least, I would like thank all the people of Montserrat especially the Chief Minister Reuben Meade, Deputy Governor Sarita Weekes, Chief Medical Officer Dr Michael Owen, Minister of Health Colin Riley and former Ambassador to the United States Laurine Fenton, for their wonderful reception of the team, for their optimism and appreciation.

This is just the beginning, we hope to be back next year for another epic event, this time we hope to include a community based eduational program. Looking forward to everyone's feed back and comments.


The volcano with the destroyed town "Plymouth"

L-R Dep Gov Sarita Weekes, Robert Rowe, Dorothea Hazel, Chief MInister Reuben Meade, Dr. Fergus, Laurine Fenton, CMO Dr. Michael Owens

Gilda and Dr Fergus at the farewell celebration
                                                              Happy Labor Day to all!
                                                              Dr. Icilma Fergus Rowe

Saturday, September 3, 2011

Some Pictures of the Health Screening

The ASH table of give-away goodies!!

Dr. Fergus-Rowe thanking Dorothea Hazel for her work on the project.
Gilda and Nancy presenting the President of the
 Montserrat Diabetes Association
with a Blood Pressure Monitor

Colin Riley, Minister of Health giving remarks at
Opening Ceremony of Health Screening

The infamous Bull charging the "girls"

Friday, September 2, 2011

Heading Home

I can't believe the week is over. I am sitting in the Antigua airport where I will wait about four hours until I continue my journey home.  It's funny how dramatically things can change in a week.  Last Saturday when I arrived, the task at hand seemed so insurmountable and overwhelming.  I was walking into a new country and culture and frankly, it was a little scary.  Six days later, as I leave this beautiful and tragic island, I run into so many people who have opened their arms so widely to embrace us and the message we bring to the island.  I am touched how we have been welcomed into their homes and their hearts.  They are so gracious with their hospitality.  While they don't have much, they are willing to share it as they are so thankful for the time we have spent on the island trying to help them.

I thought it might be fun to provide the reader with our top ten observations of our stay on Montserrat:

Top Ten Observations
1. Not many (if any) people smoke cigarettes on Montserrat - in fact, they scowl when you ask them if they do smoke (a question on the demographic piece of the screening.)
2. A significant number of people reported that they were diabetic.
3.  It seemed nearly impossible to find a diet beverage anywhere.
4.  A large can of mosquito repellent will go a long way to providing comfort.
5.  Horn Honking is a greeting - not some way to communicate that you aren't pleased with a fellow-driver's capabilities
6.   When you go to a restaurant, you are not given bread and butter.
7.   It is possible to learn how to drive on the opposite side of the road from how you were originally taught.
8.   It is amazing how lost you can get, even when there is only one main road.
9.  Contrary to popular belief, you don't need air conditioning to survive the heat - a good ceiling fan will due.
10.  It is true that the water on Montserrat is one of the best tasting waters in the world!!!

So now we head back and will review the results.  We hope to report back soon on the findings soon.

Gilda Caputo-Hansen



Health Screening - Huge Success!!!! Screened 145 People!!!

Yesterday at the Montserrat Island Health Fair, the American Society of Hypertension, with the help of local Island nurses, screened 145 people for blood pressure.  At 10 AM, the opening ceremony included comments from the Minister of Health, Colin Riley, Chief Medical Officer, Dr. Michael Owen, and Dr. Icilma Fergus-Rowe, head of the Disparities Center out of Mount Sinai Hospital, New York City.

Following the ceremony, the health screening, that ran from 10:30 AM to 6:00 PM,  provided a host of information for the local residents including chronic disease screening, breast cancer exams, prostate cancer exams,  information of different types of fire fighting; resuscitation; and general nutrition, health and exercise.
We even had people show up who we screened on Monday and Tuesday to be retested!

Local residents came out in droves on this beautifully hot summer day.  Radio Montserrat provided island music and held interviews for the radio broadcast from the health fair all day.

ASH gave out home blood pressure monitors, the Blood Pressure and Your Health brochures, ASH designed mouse pads; and ASH Hypertension Community Outreach T-Shirts.  Those people who received monitors were trained on how to use them.

As I drove around the island today to do more screening and to work at the hospital with Dr. Fergus, each place I stopped, I had people come up to me again to thank me for talking to them at the health screening.  I am touched by how appreciative the islanders are for this health mission.

I am sad to say that today was my last day on the island as I head home to NY tomorrow morning.  It is exciting to note that we have data on nearly 200  people from the island and that number may indeed grow as Dr. Fergus will see patients all day tomorrow.  This has been an amazing experience - and we have met so many people who have touched our lives.

Good bye for now- Montserrat!!Hope to be back soon!



Wednesday, August 31, 2011

Half Way Point on our Medical Mission

Good evening folks! I am bone tired but feeling full filled - another packed day of activity on our medical mission with many accomplishments. On Monday and Tuesday, I spent my time seeing and treating patients at the hospital out patient clinic while Jill, Nancy and the girls canvassed the country side visiting the local bars, shops and grocery stores to measure blood pressures and educate the clientele of these vistas. More than 80% of people had not just elevated blood pressures but extremely elevated blood pressures.

Meanwhile at the hospital, I was humbled and challenged as I became a family cardiologist - attending babies to nonogenarians. I had to pull out my medical school knowledge, the island has no cardiac specialist and thus I was it. I  heard an interesting array of murmurs; discovered pericardial efffusions and cardiomyopathies that were unsuspected. People were waiting two to four years just to have an echocardiogram, the choice is travelling to another island and paying an astronomical sum of money.

Resources are very little and compromises have to be made as the economy is even harder here. We take many things for granted as health care providers in the US. For example, the only type of nitrate available is Nitroquick spray, Plavix is not available many times. There is no CT scanner on the island or echo machine. Everyone is so thankful and cordial for the limited services that we provided from the nurses to the ancillary staff and patient's families.

Today we broke to be part of the health fair (although I had to perform echoes intermittently throughout the day at the hospital with the portable machine we brought with us). The health fair was a tremendous success, we screened 140 people for blood pressures and filled out health assessment questionnaires. Other stations provided screening for blood sugar and BMI's. There were local healthy foods, demos and entertainment. The island's officials including the Chief Medical Officer, Assistant Governor and the Minister of Health were in attendance and recognized the team. Great fun was had by all.

We returned to the villa tired and had a meal of some grilled fish that were seasoned and dropped off by a neighbor. We also had a gift of home made Ginger Beer which was very tasty. We topped off our dinner with a sorbet we made from local grown mangoes. 

Tomorrow is sure to be another interesting and challenging day, I say "Bring it on".
Dr. I Fergus Rowe

High Blood Pressure Looms Everywhere!

Greetings from Montserrat
We are two days into our island screenings and we have learned so much about this island and its people. In the midst of such beauty, it is so hard to believe that the threat of another volcanic eruption looms everywhere and could again devastate the lives of so many.

But you wouldn't know it just by talking to islanders along the way.  Everyone smiles and says good day and honks their horn "hello".  We have become quite lost on the winding roads around the island, but somehow, there is always an islander to set our course straight.  The lifestyle is much different here.  It's not about rushing around - its about enjoying the time on this earth.

We were working with Dr. Fergus this afternoon, helping her screen patients and one gentleman needed some help stepping up on an old analog bathroom scale.  So of course we lent a hand in stabilizing him  - and instead of being defensive or indignant or even embarrassed, he just turned to us and said, "I an so lucky to have four beautiful girls taking care of me".

Everywhere we go, we are welcomed with open arms.  While the level of knowledge of hypertension seems almost non-existent, people are willing to spend some time with us and are eager to learn.  Out of the people  we screened, more than two-thirds had blood pressures over 120/80.  This sample was in a variety of age groups and genders representing the different towns on the island.

One of the nurses said to us, "since you are working with us, you are one of us!"  Tonight, someone stopped by with freshly caught fish and two roasted chickens. Another person came over with  a cake. While there may not be many material things, there is a lot of heart and love.

The picture below is the Montserrat Airport.



This picture is the Montserrat Diabetes Association that is on the same property as the hospital.



This is the Main office of the Montserrat Hospital.  The island hospital was destroyed in the last volcanic eruption.

Sunday, August 28, 2011

Were those really Bulls we just saw ??????

What a Day!!!!!  I am the proud owner of a three-month Montserrat drivers license -It has been about eight hours since I changed over to driving on the "other" side of the road.   So far so good  - I felt like I was really getting the hang of it.  The true test was how I did driving after dark.  We ventured out to dinner and it seemed like we were doing fine and it was like any other ordinary night.  As I continued along staying calm and trying to find my way back, what do I see?   SIX HUGE BULLS  charged along side my RAV 4!!! No really --  they were BULLS and they were BIG   But as I always see things on the bright side . . . at least the car wasn't RED!!

Tomorrow is another day!!  



Getting Geared up for Blood Pressure Without Borders despite Hurricane Irene

Even Hurricane Irene couldn't stop our dedicated team of troopers as we get geared up to start our Blood Pressure Without Borders Program in Montserrat. Although Irene related travel issues hampered us in getting to the Island, we are off to a galloping start tomorrow travelling around the island to the "hot spots" where we will measure blood pressures and provide educational tips as well as monitors to the natives. We plan to refer those with elevated blood pressures to be further evaluated and treated this week while on the island.
I, personally am looking forward to meeting and talking with patients about their blood pressures and other cardiac risk factors. One of the high lights will be our health fair on Wednesday, August 31 where we will screen and talk to even more people. Making a difference in the health lives of people on this volcano ravaged island is truly a rewarding mission.

Dr. Icilma Fergus Rowe

We Arrived in Montserrat - 18 Hours after Leaving Irene-threatening NY!

After 18 long hours and many modes of transportation, Nancy and I arrived in Montserrat with over 10 suitcases of blood pressure monitors, blood pressure pamphlets and a host of other teaching materials.  We lugged our supplies through several different customs agencies and thank goodness, someone was watching over us and our bags and we made it through at each stop.  Some interesting observations along the way - we noticed on the ferry going over to Montserrat, several of the "locals" had buckets of fried chicken and french fries from American Fast Food chains. - we also noticed several of the fast food chains were resident in Antigua.  Since lifestyle and eating habits are a big piece of the awareness portion of hypertension, we know we have our work cut out for us this week.  We are off now to get driver's licenses - since it is a British Territory, we have to learn (quickly) how to drive on the left side -

So stay tuned for more info on our journey.

A special note goes out to all of the families in the Northeast, especially those in NY, NJ and Long Island who have been attacked by Hurricane Irene.  We hope all are safe!





Tuesday, August 23, 2011

ASH OUTREACH PROGRAM TRAVELS TO MONTSERRAT FOR ITS NEXT COMMUNITY OUTREACH!


Blog from Gilda Caputo-Hansen, Director of the ASH Hypertension Community Outreach Services

Dr. Icilma Fergus-Rowe ,  MD,  Nancy Thomas, (both from Mount Sinai Medical Center), and I will travel to the Island Of Montserrat, on August 27, 2011 – for Blood Pressure without Borders.  As guests of the Minister of Health, Colin Riley and Chief Medical Officer, Dr. Michael Owens, our mission is to raise awareness of Hypertension and other cardiovascular related diseases as we visit the residents of the Island. 

In 1995, and again in 2010, the people of Montserrat suffered through devastating volcanic eruptions of its previously dormant Soufriere Hills Volcano.  Much of the island was destroyed and about two-thirds of its population was forced to flee their homeland.  Now, in 2011, in the wake of the last volcanic eruption that destroyed Bramble Airport and their Major Hospital, their medical infrastructure has been retrofit to an old school building, until a new one can be financed and built.  

Unfortunately, there are very few specialized medical professionals resident on the Island.  Dr. Fergus-Rowe, who is a Cardiologist, an Associate Professor of Clinical Medicine, and Director, Cardiovascular Disparities Center, at Mount Sinai Medical Center, New York, NY,  will meet with and examine patients with uncontrolled high blood pressure and other cardiovascular maladies.  

While Dr. Fergus-Rowe is seeing patients,  Nancy  and I will travel around the island to educate residents about Hypertension and related cardiovascular diseases.  We are targeting shop keepers, barbershops, restaurants and beverage establishments.   We will bring home blood pressure monitors, Blood Pressure and Your Health patient information pamphlets, and other educational tools to teach the owners about blood pressure.   We will take their blood pressure and we will teach them how to use the home monitors so that they may, in turn, take their customers’ blood pressures.  We will talk about what the numbers mean, and about ideal blood pressure.  Our hope is that they will pass this information on to others.

Our message will be . . . . . .

   Controlling Your Blood Pressure is a Check Away, so Start Today!!
               
Check your blood pressure
                Eat Less Salt
                Eat more Fruits and Vegetables
                Exercise – take a walk
                Don’t Smoke

Stay tuned for more stories and pictures from our journey.