A Jamaican farmer who had a life-threatening case of leptospirosis is alive today thanks to the cooperation of two major hospitals in the Cayman Islands.
Following a referral from the government-owned Health Services Authority (HSA), doctors at private tertiary care hospital Health City Cayman Islands performed a pioneering intervention that saved the man’s life.
Clester Christie, a farmer from Jamaica, came to Grand Cayman for work but fell seriously ill a few days after his arrival. Fortunately for the 31-year old, Dr. Nelson Iheonunekwu, an Internal Medicine and Nephrology Specialist at the HSA, recognized that Christie’s vitals were falling fast and quickly referred him to the East End, Grand Cayman facility.
At Health City, doctors confirmed the HSA’s diagnosis that Christie was suffering from a complication of the zoonotic bacterial infection Leptospirosis – Leptospirosis Pulmonary Hemorrhagic Syndrome, which is a rare bacterial disease that forms blood clots in the lungs of the afflicted.
Dr. Binoy Chattuparambil, Health City Chief Cardiac Surgeon and Senior Cardiothoracic and Vascular Surgeon, accepted the emergency case from Dr. Iheonunekwu.
“He came here that time he was in a very critical stage. I would say his oxygen level his saturation level was in the 50s, so if he stayed like that a few more hours he would have arrested…within half an hour we took him to the operating room,” Dr. Chattuparambil said.
The Health City team hooked Christie up to an Extracorporeal Membrane Oxygenation (ECMO) machine via the venovenous route to support his lungs, marking the first time Health City doctors had used ECMO in this manner. For previous patients, ECMO had been used to support both the heart and lungs.
Dr. Dhruva Kumar Krishnan, Senior Consultant in Cardiac Anesthesiology and Intensive Care, further explained that the venovenous ECMO support gives the lungs a rest.
“When the lungs [have] failed to do what [they are] supposed to do, we can rest the lungs by bringing the blood out from the body into the [machine and wash] out the carbon dioxide, [add] more oxygen to it and [bring] it back into the heart. So, this machine [helps] the lungs start to function normally,” he said.
Dr. Chattuparambil said his team’s bronchoscopy examination revealed that “both lungs were packed with blood clots, both sides … the lung…. was…choked – so no blood was going inside.”
With this new information, Dr. Dhruva, as patients call him, performed several complicated bronchoscopies to remove multiple blood clots.
“He had a lot of clots in his lungs so we had to clear them all … at the same time we don’t want fresh bleeding to happen. He slowly improved … but again he started deteriorating when we tried taking this machine off after a couple of days … we had to do repeated bronchoscopy procedures to remove the remaining clots … before he could get better,” Dr. Dhruva explained.
Seeing the patient on the road to recovery was a rewarding experience for the doctors who treated him. “We are very happy for this man, who is doing well now,” said Dr. Dhruva.
Dr. Mahantesh Patil, Medical Intensivist at Health City said, “Mr. Clester, I would say he is very lucky to be on the island at the right time…in my last 15 years of clinical experience I have not seen such a severe form of leptospirosis.”
Dr. Patil also noted that the mortality rate for patients in Christie’s condition is “extremely high, I would say as high as 70 per cent…despite all support and if you don’t have a facility to do multi-organ support, I would say he had no chance to survive.”
Grateful for the care received by Health City, Christie, a father of two small children, said: “If I never came here, I would have died. If I was in Jamaica, I would have died … they don’t have the same equipment like they do (at) Health City to help me.”
HSA’s Dr. Iheonunekwu was deeply moved when he saw his former patient after his recovery: “I was amazed. In fact some of the nurses in critical care who were taking care of him, who knew how gravely sick he was, were in tears when he actually came to pay us a visit … so we were really, really moved and we were very grateful to God that he made it. It was a very amazing story. If only people knew what Health City does, they would appreciate what was done for him. Any other place – if it was in areas where ECMO was not available – he would have died … there is no doubt about that.”
Dr. Binoy, as he is commonly known, noted the severity of Christie’s condition when he arrived at Health City. “We knew that if we didn’t extend help, he was going to die,” he said, adding that the facility got its reward in seeing Christie reunited with his wife and children.
