In the late 1970’s the Heineman Foundation of Charlotte recognized a great need in Guatemala, a Central American Republic with most of its population of about 12 million deprived of medical care and having a high rate of disease, especially cardiovascular conditions.


The Heineman Foundation established the Guatemalan heart surgical program and during the years of cooperation, it developed into the Guatemalan Heart Institute (UNICAR). UNICAR, located in Guatemala City, is the only health institute in Central America fully dedicated to cardiology and cardiac surgery and one of the two locations on the subcontinent where cardiac surgery is performed.

UNICAR could easily increase its volume of treating cardiac patients; however Guatemala’s rural hospitals lack even the most basic diagnostic technology, which would allow screening of patients with suspected cardiac conditions.  Thus many patients, especially children whose heart conditions could be treated effectively if diagnosed, receive no treatment at all.  To send patients en mass to UNICAR for basic studies is just not feasible.   UNICAR has an additional problem: It is relatively isolated from the world of medicine without the possibility of consulting complex cases or participating in scientific and clinical conferences.

Virtual Communications Portal

During the last four years, the International Medical Outreach (IMO) Program has taken on the task of bringing Guatemalan cardiac care into the digital age. Atrium Health donated a Siemens picture archiving and communication system (PACS) that was used to establish a digital communication-bridge between UNICAR in Guatemala and Sanger Heart and Vascular Institute in Charlotte, North Carolina. The bridge allows the transfer of images such as echocardiograms and provides immediate consultation with Charlotte-based cardiologists and cardiac surgeons, as well as participation of Guatemalan counterparts in common clinical and scientific conferences. This service is free and available 24-hours a day.

“The bridge represents a major advancement in the quality of care received by our Guatemalan patients suffering from various heart conditions,” said José Raúl Cruz Molina, M.D., Director of UNICAR and cardiologist trained at Carolinas Medical Center. “It brings our hospital system one step closer to offering leading-edge medical solutions to our communities.”

Echocardiography Training and Services

The IMO is using this bridge to connect 14 rural hospitals in Guatemala and El Salvador identified by UNICAR to establish the Guatemalan networking echocardiographic program. As part of this program, health providers (nurses or technologists) are sent to Sanger Heart and Vascular Institute in Charlotte, where they undergo 3 months of intensive training in echocardiography.

Upon their return home, the technicians are further trained on the local equipment and then moved to one of the networking villages. When the technicians are ready, the hospital is provided with an echo-laboratory where the tests may be performed. The completed tests are digitally forwarded to UNICAR’s already installed PAC-system, interpreted by UNICAR cardiologists, after which appropriate action such as clinical treatment or transfer to UNICAR, may be taken.

The first city connected to the networking program was Quetzaltenango. The public health sector in Quetzaltenango, the second largest city in Guatemala, previously had absolutely no public access to echocardiography with the only machine located in a private clinic which is too expensive for the general population. The only way to obtain the necessary test was to travel by bus 5-6 hours to the capital. Now, having been able to install a high capacity Siemens imaging unit in the regional public hospital of the Hospital de San Juan de Dios, which serves the two million Guatemalans living in the northern part of the country, and placing a Charlotte-trained Guatemalan technician to operate it, the population has free access to echo studies.

Echocardiography Laboratories

By late October 2013, the Program helped establish four echo labs in rural hospitals in Guatemala (Hospital of Cuilapa-Santa Rosa, Hospital San Benito Petén and Hospital Totonicapán) and El Salvador (Hospital Pro-Familia).

In November 2014, the Program continued its mission to enhance cardiac services in Central America with the opening of two echo labs in regional hospitals in Zacapa and Quiché, in Guatemala.

Heineman and System officials were joined by the First Lady of Guatemala, Rosa María Leal de Pérez, who over the past year has worked with Heineman to equip hospitals and clinics in Guatemala with medical services and supplies. Heineman donated echocardiography machines to the two hospitals and helped train technicians to operate the machines and to work with cardiologists to identify patients with heart ailments.

“The echo labs provide access to healthcare for thousands of patients, bring cardiac diagnosis into the modern age for millions and facilitate the delivery of life-saving cardiac services at very low or no cost,” said Francis Robicsek, MD, PhD, president of Heineman, who received an award from Guatemala’s First Lady in May 2014 for his philanthropic work in Guatemala. “We look forward to continuing our mission to develop sustainable cardiac care in Central America, promoting quality care and healthier communities.”

The echo lab openings in Zacapa and Quiché are part of an Echo Lab Network project launched in 2010 by Heineman and Atrium Health – through the International Medical Outreach (IMO) Program – and by Guatemala’s cardiac center, UNICAR. The project, supported by the Dickson Family Foundation and Edwards Lifesciences Foundation, aims to provide 13 rural hospitals in Central America with fully-functional echo labs. In Guatemala, eight rural hospitals now have these labs and have provided more than 14,000 echocardiograms to thousands of patients.

“The network represents a major advancement in the way we provide cardiac care to patients with heart ailments in Guatemala,” said José Raúl Cruz Molina, MD, medical director of UNICAR. “We are proud to have worked with the IMO program for more than four decades on innovative projects like this one, and we look forward to our continued partnership, which allows us to leverage the resources of medical experts in Guatemala and at Atrium Health.”

The echo machines were transported by Chiquita Brands vessels to Guatemala. Since May 2013, the IMO program and Chiquita have collaborated to distribute medical and computer supplies to hospitals, clinics and public schools throughout Central America. They have together transported more than 20 containers that have provided 11 hospitals and rural clinics with medical equipment and delivered more than 7,500 computers to 500 public schools.