APCNA Pacemaker Project

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Wajid Baig, MD

Healthcare for many people in Pakistan is quite limited.  ere are never enough resources available for the multitudes who may need care. Government intuitions are stretched to the limits. Many Charitable Hospitals and Clinics are doing a remarkable job trying to meet the shortfall. It is a credit to the physicians and healthcare workers in Pakistan who are able to provide care for these millions of patients with the limited resources available.  e care for cardiac patients is even more difficult and most often not affordable for the poor.  ere are hundreds of patients who need permanent pacemakers and defibrillators but cannot afford them. Last year Dr.. Suleman and I visited a major Cardiac Center in Pakistan where they had 10 temporary pacemakers, all were in use.  They often wait weeks for a permanent pacemaker to become available. It is commendable that there are many cardiologists who are trying to provide free services and obtain pacemakers from various philanthropic sources.  ere was a dire need to provide these patients professional and financial assistance to make pacemakers available for them. Imagine a deserving patient in Pakistan who can now get a Permanent Pacemaker and Implantable Defibrillator at no cost to the patient! No charge to the patient from the physician, No charge for the device, No charge for the follow up.

The Magnitude of the Need:
There are hundreds of patients who need permanent pacemakers but cannot get it and will die because they cannot afford it. It was noted that even the big pubic cardiac institution had only 10 working temporary pacemakers for the entire patient population they served. Patients had to wait for weeks to have permanent pacemakers implanted. Dr. Azam Shafqat, at NICVD showed some data collected by one of his fellows on the last 150 implants.  e average salary of the patients was about 6000-8000 Rupees ( $100-133) per month.  e average waiting time for a permanent device with a temporary pacemaker in place was about 2 weeks.

Pace Mekrs At today’s rates a Permanent Pacemaker (PPM) implantation costs about Rs. 60,000-120,000 for the complete procedure. An ICD costs about Rs. 600,000 (Rs.6 Lakhs) and a Bivent-Defi – brillator costs about Rs. 800,000 – 1, 200,000 (Rs.8-12 Lakhs), just the Defibrillator leads cost about Rs.100,000. While the pacemakers would be lifesaving measures for many patients the prohibitive costs for it would be unthinkable for many deserving patients to receive it.

Inauguration:  The First Pacemaker Bank in Pakistan ­
The APCNA-Rotary Pacemaker Bank was officially inaugurated on December 18th 2007, in Karachi. ­ e ceremony at the Marriott Hotel was well attended by physicians, philanthropists, press and media. Several Rotary office bearers and members were in attendance. ­ The CEO of Tabba Heart Institute, Ms. Maryiam Tabba, and NICVD’s Consultant, Dr. Azam Shafqat (one of the implanting Cardiologists) were also present. Heartbeat International (HBI) was represented by Director HBI, Mr. Ashraf Hasnain. A message of support and encouragement from the President of HBI, Mr. Wil Mick was read to the attendees. President APCNA, Dr. Rizwan Karatela spoke about the continued commitment of APCNA’s mission to helping the standard of healthcare and cardiology education in Pakistan. ­ e APCNA 

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Pacemaker Bank project director, Dr. Wajid Baig elaborated the APCNA’s initiative in bringing about the establishment of the first pacemaker bank in Pakistan. He pointed out the important contribution it will have for the deserving patients in Pakistan. He reported that so far two PPM’s and one ICD had been implanted. ­ e Karachi Pacemaker Bank will cover all of Karachi as well as the Provinces of Sind and hopefully Balochistan. Dr. Baig further outlined the workings of the Pacemaker Bank and emphasized that the cost of the procedure such as hospital charges, consumable, travel and follow up will be covered by funds raised by the Rotarian’s and our generous members. ­ e fi rst fund raising event is planned for March 2008.

APCNA Message: Press and Media:
To promote awareness of the availability of these devices we undertook a major campaign. ­ e aim has been to spread the word to physicians in the country that the Pacemaker Bank exists and any deserving patient can benefit from this Bank. At the inauguration ceremony, APCNA President Rizwan Karatela, APCNA Board of Trustees, Dr. Javed Suleman, APCNA Pacemaker Project Chairman, Dr. Wajid Baig along with Rotary Club and HBI officers had a Press Conference and answered the questions from the media.

PacerInaugPressConfOn December 19th, 2007 there was a meeting in PMA House Karachi for local physicians followed by press release for the media to disseminate the information of the availability of the pacemakers for deserving patients. Dr. Wajid Baig, was invited to appear on the morning Television Talk shows on Hum TV and Dawn News Morning TV Show. He also had an interview with Indus TV. ­ ere were several reports in the Print media about our program also. Expansion of Pacemaker Project: Reaching out to more Patients: ­ e first pacemaker bank in Karachi would not be enough to meet the enormous demand of such facility for the thousands of deserving patients across the country. In order to further expand this project to other parts of the country we had discussions with Rotarian’s and Physicians eager to setting up similar banks in other parts of the country.

APCNA’s plan is to have a Pacemaker Bank in Islamabad with implant sites in Peshawar (at Lady Reading Hospital by Prof. Hafizullah and colleagues) and Islamabad. ­ ere are plans for another bank in Lahore which will cover Lahore and the whole province of Punjab. Rotarian Ovais Kohari and Mr. Ashraf Hasnain are working on the details and feasibility of this in near future. APCNA’s aim is to cover the whole country one day and “Make weak Hearts beat stronger” ­ e project has just started, we need to continue working hard to maintain the Pacemaker Bank. We in APCNA are fortunate to have a very dedicated team of people from the start and the teamwork is paying off . APCNA members have supported the project wholeheartedly and given us encouragement all the time. APCNA EC members have been at the forefront making sure things go well and have promoted the projected on every occasion in Pakistan. We are thankful to Rotarian Ovais Kohari and Mr. Ashraf Hasnain who continue to spearhead the eff orts to strengthen this Bank and open others.

APCNA’s Collaborative Efforts: 
When APCNA members learned about such need in Pakistan, there was a palpable passion among the members to make a difference in lives of these patients. In March 2005, at the ACC Annual Scientific Sessions in Atlanta the as APCNA team we met Mr. Wil Mick, the President of Heartbeat International; a non-profit organization based in Tampa, Florida, the world’s premier provider of free, cardiac pacemakers, implantable defibrillators and medical care to needy patients around the world. For more than 20 years, they have served the indigent and ill in more than 30 countries, reaching families and hearts around the world. Unfortunately, there was no such pacemaker bank in Pakistan. It was APCNA’s initiative to approach Heartbeat International for establishing the pacemaker bank in Pakistan. It was apparent that the task was monumental, as according to the Heartbeat International, the Pacemaker Banks must adhere to strict operating principles and must comprise of qualified and experienced physicians, an appropriately equipped and staff ed hospital, and a local Rotary club or approved Social Agency. APCNA needed to have partners who could facilitate this task become a reality. Fortunately, we had a good team of dedicated doctors, Dr. Bashir Hanif, Dr. Azam Shafqat and Dr. Zahid Jamal in Pakistan who were enthusiastic to provide such professional services. ­ e Rotary Club of Pakistan provided us the needed support and the local institutions; Tabba Heart Institute and National Institute of Cardiovascular Diseases (NICVD) opened their doors wholeheartedly for this worthy cause. ­ e things then fell into place and, as they say… the rest is history.

Special Note of  Thanks: 
On behalf of APCNA and its members, we are extremely grateful to Mr. Wil Mick and Dr. Meniscalco from Heartbeat International who have guided us all through this process. We now have the help of Mr. Ashraf Hasnain, International Director of Heartbeat International. He has had several meetings with the organizers in Karachi and continues to help us. None of this could have happened without the hard work and dedication of Rotarian Ovais Kohari and his team. None of us are naïve enough to think that this one project will change everything for the patients in Pakistan. ­ is is only a very small attempt to help these patients. It will take many more such projects to make a significant difference. We are proud that APCNA is making a start. What we are doing in Pakistan is just a start in terms of the needs of the deserving patients all over the country. We needed to start somewhere, and we have done so. Trying to improve the lives of even just a few patients will go a long way.

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Project Chairman: 
Wajid Baig MD FACC
Members: APCNA-Rotary Pacemaker Bank Project
Javed Suleman, MD, FACC,
Immad Sadiq, MD, FACC,
Asif Rehman, MD, FACC, and
Wamique Yusuf, MD, FACC

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