The Volcano

Montserrat Hearts 2012 has many more posts for the readers to follow. There are countless stories and aspects of the trip that we want the world to hear about. But it's time to deal with the culprit - the Soufriere Hills volcano. SHORT HISTORY LESSON

"After laying dormant since prehistoric times (pre 1632 for Montserrat), the Soufrière Hills Volcano in the southern part of the island began erupting on 18 July 1995 with a phreatic explosion (steam and ash) following a 3 year period of seismic (earthquake) activity which began in 1992. The first large event occurred in August 1995 blanketing Plymouth in a thick ash cloud which brought almost complete darkness for about 15 minutes. Shortly afterwards the first evacuation of southern Montserrat was initiated. Plymouth itself was finally abandoned the following year. It now lies buried under layers of volcanic debris deposited by pyroclastic activity and mudflows - each time it rains here in the Emerald Isle, a little more of the former capital disappears forever. 1997 is probably uppermost in people's minds when they recall the eruption to date, and saw pyroclastic flows and surges sweep down the north-eastern flanks of the volcano causing the abandonment of the W H Bramble Airport. By this time more than half of Montserrat's inhabitants had been moved away after their homes and businesses were destroyed and the island's tourism industry was also adversely affected. Since then an Exclusion Zone encompassing the Soufrière Hills Volcano has been in place and life has refocused to the north. "

These are just words to most of us who didn't witness the devastation to this beautiful Emerald Island. On Thursday, August 2, 2012, the team went up to see the volcano in a helicopter and were able to see the infrastructure and land below the volcano - or whatever was left of it. The land was baron and covered with soot. The plethora of buildings including the newly built hospital, the government headquarters, churches, stores and homes were covered to the rooftops. It's difficult to articulate the emotion we all felt seeing the remains of this mass devastation.

It is so hard to put into words so pictures are attached.

Blood Pressure Screenings on Montserrat

This year, Radio Montserrat assisted our team by announcing all of the screening sites during the week of our trip. Nadines, the St. Peters Schoolhouse, the Cudgoe head Police Station, the Montserrat Cultural Center and the Government Headquarters were the sites of the screenings. Over the four days, despite the tropic storms that hit the island, over 200 people came out and had their blood pressures taken. We plan to analyze the results over the next few weeks. It appears that diabetes is still prevelant on the island.

I did what the doctor ordered......

Tuesday, July 30 August 2011...Note to diary..I just returned from seeing Dr. Fergus, the NY Cardiologist visiting Montserrat and she told me that I am having so many health issues because I am over weight. She told me that if I changed my eating habits, the weight loss would follow. She told me to start taking out "Me time" to concentrate on the task ahead, my goal of loosing at least 75 pounds.

Dr. Fergus gave me so many reasons to do it, but I know in my heart, I need to do it for me!!!! /">............About one year later . . . . . Dear Diary... I saw Dr. Fergus today and I was so excited to show her the new, great, beautiful and improved me!!! So far I have dropped over 40 pounds of weight........... How many of us have been told this and actually listened? Delmaude Ryan is living proof!! After nearly a year, Delmaude is a different person. She is confident and she is full of self esteem. Delmaude has a few rules to live by. She didn't want to go on a "diet", she wanted to modify her life style. The old Delmaude would leave the house in the morning and usually eat nothing for breakfast. Sometimes she would make up for it at lunch, and sometimes she would just gorge herself at dinner. In her discussion with Dr.Fergus, Dr. Fergus touched on diet and exercise. She also explained which foods were the ones to stay away from, so Delmaude took it in her own hands. At 5:30 AM. each morning she starts off with a 90 minute walk, followed with a good breakfast, lunch and dinner. She does little or no snacking during the day and she stopped eating three house before bed. After a while, her 90 minute walk only took 60 minutes. Her clothes were falling off her. Delmaude has a wonderful outlook. There are monments during the day where she will call her "me"time. This seems to help her refocus on the next deeds on hand. She also steps away from her desk at lunch time and eats her lunch somewhere else. She found that she was "inhaling" the food and not enjoing it, so now she sits outside by the office buildings and relaxes. When asked for the trick to loosing that much weight that quickly, Delmaude said "you just open your eyes one day and say "I am going to do it and I am doing it for me!!! Delmaude just had her year celebration in a skinnier body and she is loving life. She is truly inspiration to all. Before

First Day Medical Experience

Good morning.. today is our second day of work on Montserrat. Yesterday, Dr. Scobie performed 17 echocardiagrams on patients. While most results showed evidence of hypertension, there were some that showed great need for further medical attention. "It was very gratifying to perform good quality echos on people who needed them. People were not only grateful and thankful for this service, they were most interest in learning about what their results. We had a great first day!" This message was posted by Dr. Janice Scobie, Cardiologist, Mount Sinai School of Medicine.

St. Patrick's........Island Church

Pictures of the Countryside

Today is the first day to see patients.  Drs Fergus, Scobie and Sumner will spend their day seeing about 30 patients for echos, ekgs and exams.  But first, they will test out the island equipment to familarize themselves with the equipment and to set standarized protocols.  . Having not just one, but having two more cardiologists on this health mission, will extend the great care we are able to provide. Dr. Fergus, who is the lead physician, will see the patients, many for a second time, in two years.  Drs. Scobie and Sumner will run the Echos and will assist in the interpretation of results.  Dr. Sumner, who has been practicing medicine for over thirty years, is also an engineer, so we are hopeful that if there is an equipment malfunction, Dr. Sumner will be able to work through that challenge.

Yesterday, the team attended mass at St. Patrick's church. The congregation welcomed our team and gave blessings to our work.  The music was an amazing blend of carribean and traditional religious hymn that echoed through the countryside.

Dear Colleagues;

We are about to embark on our second medical mission this Saturday, July 28th, 2012. Thanks to Dr. Sharma for providing the funds to make this possible. The mission is now registered as part of the Mount Sinai Global Health Initiative, thanks Dr. Landrigan. I would like to thank Dr. Anne Sumner from the NIH and Drs Bonnie Green and Priscilla Dass Bailsford from Georgetown University for their assistance in creating a wonderful post traumatic stress tool to be used as part of our community outreach. Thanks to Drs Fuster, Narula and Landrigan for their guidance and support. I know Dr Narula really wanted to come but due to obligations at Sinai he couldn't.

The team will consist of Drs Janice Scobie, Jon Sumner, Nancy Thomas, Gilda Caputo Hansen and myself.

We arrive Saturday late evening with the final leg of the trip being a ferry ride from Antigua to Montserrat.

On Sunday, July 29th - members of the team will attend religious services on the island, we will then have lunch at Olvestion House ( former home of Sir Elton John) and debrief for our week ahead.

Monday  and Tuesday, July 30th and 31st - I will begin seeing patients at the hospital, there are 30 follow up patients. Echo scans will be performed by Janice and Jon. Nancy and Gilda will go around the island, adminstering the questionnaires and checking blood pressures.

Wednesday, August 1st - The same activities will occur until Mid day. Then we will host a mini symposium geared towards education of lay people and primary practitioners about Cardiometabolic risk factors. Questionnaires and screening will occur at this venue as well. There are 200 invited guests.

Thursday, August 2nd - There will be a helicopter tour around the island including to the peak of the volcano, for those brave enough to venture on this trip. This will be followed by a jeep tour around the island. The after will be spent with government and health officials where we will be informed of the current health situation on the island and plans for the future.

Friday, August 3rd -  will be a repeat of Monday and Tuesday; there will be local entertainment for the team in the evening.

Saturday, August 4th, will be a day of relaxation and a visit to a carnival in "Cudjoe Head".

Sunday, August 5th -  we return home.

Please visit the blog at www.ashoutreach.blogspot.com<http://www.ashoutreach.blogspot.com> for further details and a day to day update when we are there.


Warmest regards

Icy Fergus

Montserrat Hearts 2012

It's Friday, July 20, 2012 and we are 8 days and counting until we leave on our second annual Heart Mission to Montserrat.  In 2011, our team started with Dr. Icilma Fergus, Nancy Thomas, and Gilda Caputo-Hansen.  We have now grown by two; Dr. Janice Scobie and Dr. Jon Sumner will be joining us on our expedition to Montserrat.  They are both cardiologists and will be a great addition.

This year, we will see patients in the hospital, and on Wednesday, August 1, 2012,  we will present
 "Cardio Medabolic Risk Factors: What we need to Know
 to the medical professionals and the public at an educational symposium held at the Montserrat Cultural Center.  We will cover topics including Hypertension, Diabetes and Coronary Artery Disease.  We will also screen blood pressures an hour before and after the session.

Throughout the week, Nancy Thomas and I will  once again travel the island to take blood pressures at several locations including:  the Lookout Community Centre, Old Salem Primary School, Nadine's Grocery, Old St. Peter's School, the Old Police Station in Cudjoe Head.  The final major health screening will be held in the Montserrat Governmental Headquarters Building.

We will record data about the participant's cardiovascular wellness, as well as data that deals with the emotional effects the volcanic eruption had on their lives.

What will we find? Higher rates of hypertension and diabetes than we saw last year?  Will we see a dramatic drop?  Will there be any significant changes?

We are looking forward to our week on this mission to discover the answers to these questions.

Montserrat Hearts 2012  

Stay tuned for our daily reports and updates.
Author - Gilda Caputo-Hansen
Director, Hypertension Community Outreach
American Society of Hypertension, Inc.

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.

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

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"

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!

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.

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!

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.