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Cardiac surgery in Sincelejo

From the outside, Clinica Santa Maria is somewhat unimpressive. The 1950’s style tile floors and narrow painted wooden doors inside do little to lessen this impression. It seems to be an unlikely home for the esteemed cardiac surgeon, Dr. Cristian Barbosa.

Wooden doors leading to high tech OR
K. Eckland
Dr. Cristian Barbosa, cardiac surgeon
K. Eckland

Advanced technology in a plain brown wrapper

Behind a white painted wooden door on the fourth floor, lies one of the most up-to-date and advanced operating rooms in Colombia. The cardiopulmonary bypass (heart-lung) machine is the latest technology and is capable of managing even the most precarious patients.

Team of excellence

The staff is equally skilled. Dr. Cristian Barbosa Sandoval, cardiac surgeon is the head of the cardiac surgery team. Dr. Cristian Barbosa is a soft-spoken, even-tempered man with the elegant mannerisms reminiscent of a 17th century Spanish gentleman. However, he is far from being the distant, cold surgeon. He is readily accessible to his patients and enjoys his discourse with them. When engaged in discussion about various surgical techniques, patient care or emerging technologies, his eyes twinkle and his whole face lights up with enthusiasm and interest.

Despite all the fancy equipment here, it is Dr. Barbosa; his long -tapered, nimble fingers and quick mind that serve as the basis of the program.

I have followed his work for several years, after interviewing Dr. Barbosa in February 2010 when he was the Chief of Cardiac Surgery at the beachfront Hospital Bocagrande in Cartagena de Indias. When that program closed due to financial difficulties, Dr. Barbosa had his choice of positions, including one at the prestigious Clinica General de Norte in the neighboring city of Barranquilla.

Instead, Dr. Barbosa, along with his close friend and cardiac anesthesiologist, Dr. Sebastian Melano Mendoza chose to come here, to the small city of Sincelejo in the province of Sucre, Colombia. While this former red zone city boasts a population of over 200,000 it is considered somewhat rural by its big city cousins in the neighboring provinces. As such, medical services such as specialty surgery like cardiac surgery often required trips to Cartagena, Barranquilla or even the nation’s capital city, Bogota. This lengthy journey often placed an insurmountable burden on patients and their families, particularly in a city where the most common form of transportation is a motorcycle.

Meet Iris Castro

The perfusionist, Iris Castro Aguilar is particularly talented. It is a testament to her belief in the program that she is here in Sincelejo with Dr. Barbosa. Iris has an excellent reputation for excellent clinical skills and patient outcomes. She is known for her strong background in academia; having written and edited several chapters in a comprehensive textbook on cardiology. She also serves as the primary reviewer for one of the most popular medical journals in Colombia.

Iris has worked with some of the best known cardiac surgeons in Colombia, in Clinica Shaio, Cardioinfantil, Fundacion Santa Fe de Bogota and other large cardiac surgery facilities in Bogota. Now, she has chosen to come here, with Dr. Barbosa, to make a difference in the lives of the people here in Sucre.

Cardiac anesthesia is managed by Dr. Sebastian Melano Mendoza, who is also the director of the cardiac surgery service line. He has been a cardiac anesthesiologist for over ten years and has a wide range of experience.

More than just resumes

But the resumes and credentials of the cardiac surgery team don’t tell the full story; the results do. The majority of patients are discharged home on or before the third post-operative day. These rapid discharges are a result of specific management decisions made as part of a cohesive multi-disciplinary team. “We try to make it easy for everyone,” Dr. Melano explains. “We simplify the treatment plan and streamline the process.”

Fast track surgery
Patients are weaned and extubated from ventilator quickly after surgery. Lines are disconnected, drains removed as soon as possible and patients are up and walking as soon as possible after surgery. All of the extraneous and frequently unnecessary ‘clutter’ of hospitalization is minimized as much as possible. Here in Colombia, the fear of malpractice suits and frivolous lawsuits is minimal so doctors don’t order expensive tests without clear and concise reasons. There is very little of the ‘just in case’ or ‘cover your behind’ testing that consumes so much of American health care dollars, and exposes patients to unnecessary risks.

This means clinicians rely on their clinical assessment skills; by listening to their patients, performing physical examinations and assessing the situation instead of defaulting to more costly radiology procedures.

This philosophy of care appears to be working well. All of the patients thus far have been extubated within just a few hours, out of bed and walking soon after. Patients are usually transferred out of the intensive care unit the day after surgery, and discharged post-operative day two or three.

While the team considers it all in a day’s work; it’s much more to the people of Sincelejo and Sucre, Colombia.

I will be reporting on healthcare in Sucre, Colombia over the next several weeks. This is the first in a series of articles.