THEO PANAYIDES meets one of the men behind the snazzy looking American Heart Institute in Nicosia
There’s a 45-minute wait before I can go in to see Dr Christos Christou, MD, FACC at the American Heart Institute in Nicosia. I have an appointment, of course, but that kind of thing means little to a doctor: patients turn up unexpectedly and, especially in his field (interventional cardiology), time is usually of the essence. I don’t mind waiting, however, as it gives me a chance to look around the Institute’s eye-catching building, a sleek private hospital which is brand new (they only moved in last March) and impressively designed.
From above – as revealed by a scale model – it looks like a wedge of pizza with extra crust on both sides. The main triangular section has huge glass panels going all the way up to a high ceiling and a stairway winds up the middle of the space, its sinuous lines contrasting with the vertical glass. The waiting area – the size of an airport lounge – is adorned with trees (actual trees!), a stylish bit of indoor landscaping that must’ve cost a few thousand euros just in itself. The architects were American, Christos explains later, just as the nursing staff initially came from the US to train their local counterparts. “We said, ‘This is what we do in America. Why can’t we do it in Cyprus?’” he explains at one point, ‘we’ being Christos and the other co-founder of the Institute, Dr Marinos Soteriou. “And that’s what we have been doing.”
They’ve been doing it since 1999, when they both came back from the States with the aim – or dream – of improving cardiac services in Cyprus. They put down their marker straight away, buying primary angioplasty equipment that’s state-of-the-art even now, let alone in 1999 (“When we first said we wanted to do this, they thought we were crazy”), and rented premises at the Apollonion Hospital before building their dedicated headquarters. “Now we have a facility that has everything that any Centre abroad has, in Europe or America,” he claims proudly. If you look at statistics from UK hospitals of “infection rates, failure rates or morbidity and mortality for these kinds of patients – assuming all risks are equal – our results are even better than the UK,” adds Christos. “It’s very hard to believe, but that’s what we have.”
It’s a familiar story: Cypriot goes abroad, makes good, comes back, tries to build something world-class in Cyprus. Sometimes it works out; other times it doesn’t, for the simple reason that we’re too small a market to sustain something world-class. State-of-the-art equipment is a big investment; hardware needs maintenance; doctors need to be paid. The AHI has 110 people on its payroll.
‘Can most patients even afford the rates you charge?’ I ask Christos, and he looks slightly discomfited. Rates can vary, he replies, “and once you have more volume, the prices will be less”. This is a sore point – because the current health system in Cyprus is inimical to a big private clinic like the Institute. Around 85 per cent of people are covered by government health care, but there’s no national system: that 85 per cent have to go to a state hospital if they want free care, and can’t choose to come to the Institute instead (unless a state cardiologist refers them; but they get no choice in the matter). This gleaming new facility only caters to a small minority – those who aren’t covered by state health care (the 15 per cent), or else have money and decide to go private.
A national health system was approved by Parliament years ago, he says with a touch of bitterness. It was announced, yet still hasn’t materialised. “They kind of gave incentives to the private sector to establish units like this, and yet the system is not here. So who is responsible for it not being here – and why should we spend so many millions of euros to establish a facility like this, waiting for the health system to be improved? The point is that patients do not have a choice to come here if they don’t have money, or [unless] they’re not covered by the government system. So I think that’s not fair, it’s not fair competition – and not only that, I think that Parliament kind of–” he hunts around for the word – “deceived us, that you’re going to have a new system, that patients are going to have a choice where to go, and you’re going to have a provider to pay for the cost of the procedure. And yet it’s not here… we have been deceived in the way we thought we were going to build a big facility like this, and hopefully the system is going to cover this. And yet there’s no system.”
Like most doctors, Christos Christou doesn’t mince his words – though there’s also something awkward, even slightly inarticulate, about him. He’s not a glib talker. He ‘um’s and ‘ah’s, sitting with his arms tightly folded. He has a narrow face with a prominent jaw-line, a penetrating stare and a big, sunny smile which doesn’t come out very often. His cheeks are stubbled, his hair slicked back and greying slightly. He looks younger than his 52 years – but I also get a sense that he’s not as comfortable with words as he is with physical things, like the delicate work of heart surgery or even the graceful work of playing football. “I played football for money,” he declares unexpectedly at one point. That was in New York, and it got him through college, along with restaurant work and support from a helpful uncle.
“I grew up in America, basically, after 20 years,” muses Christos. When he got there, he was barely out of his teens; when he left, he was 40, with a good life and a thriving medical practice. “We still consider New Jersey home, when we go back,” he adds earnestly (his sister still lives there). Despite his disclaimers about how pleased he is to be back in Cyprus, it seems clear the motherland wasn’t uppermost in his thoughts during his decades abroad, his wife Elena (she’s an orthodontist; they have two daughters, 19-year-old Emily and 12-year-old Nicole) being the one who was homesick. “Honestly,” he admits quite candidly, “if it wasn’t for my wife, I wouldn’t have come back to Cyprus.”
Maybe it’s because his old life had disappeared, his childhood home – in Mia Milia, just outside Nicosia – being occupied by the Turks. It seems strange, in this shiny hi-tech building, to be talking of such things, but in fact Christos was born into a family of quite modest means (which also explains why he worked his way through college). There were seven children (he’s the fifth); Dad was a farmer, and also had a small business. “It was a different era of growing up,” he recalls. “We were seven kids, we used to play in the yard… I used to work in my father’s factory at the age of 10, I used to go and work in the fields. It was fun in the village at that time”.
It may have been fun, but Christos – a good student – “always wanted to do something” with his life. His initial plan was to be a chartered accountant, and indeed he studied Accounting for six months before switching his major to Biology (Medicine is a post-graduate course in America). Before that, there was football, which he played well enough to have turned pro, if conditions had been different. In a different life – had he been born 20 years later – he might’ve made his career as a footballer, and the American Heart Institute might never have existed.
I’m a bit surprised by this roundabout route into Medicine, having always assumed that doctors grow up wanting to be doctors – if only because it’s such a tough job. The hours are brutal: 8am to 8pm (at least), but of course sickness doesn’t keep office hours and doctors are expected to respond at any time – especially in Cyprus. It’s different here than it was in the States, admits Christos; “It’s very demanding, in the sense of being available 24 hours a day, 7 days a week”. It m
akes no difference whether he’s on call, patients ring up anyway; he even gets relatives calling up, asking him to help sick parents or grannies. It’s all he can do to practise what he preaches as a cardiologist by taking regular exercise (45 minutes of walking, four to five times a week is recommended, he says, and 15 minutes in the gym won’t cut it; it’s not about intensity, it’s about duration). What free time is left he spends with his family, watching football, or reading. He’s currently engrossed in a book about the Greeks of Smyrna, forced out of their homes in 1923 – “the same thing that happened to us in 1974”.
He was actually taken prisoner during the invasion, he adds in another surprising twist, together with his parents and most of their fellow villagers. This was in the ‘second invasion’, on August 14, when nearly 200 people were captured by Turkish troops and kept in a nearby church for a few days. Was he very frightened? (After all, he was only 15.) Not really, he replies. “The minute that you realise you are taken, you…” he hesitates, struggling with the words, “you… I mean, obviously it was a war and we kind of had no choice, basically. We said ‘whatever happens is going to happen’.” Awful things did happen; three villagers were singled out by the soldiers and taken away, never to return. But Christos insists he feels no trauma or hatred, thinking back fondly to his father’s Turkish Cypriot employees who gave him sweets and Turkish delight as a child. “The way I see it, it just happened,” he asserts with a doctor’s down-to-earthness. “And that’s the way it is, and I don’t really look back, and I don’t have any hard feelings about anybody.”
Dr Christos Christou doesn’t strike me as the sentimental type. Instead he comes across as an active person, a man of plans and projects. “I wanted to go and study. I wanted to get out, basically,” he recalls of his younger self, and it’s easy to imagine the impatient teenager in Mia Milia, eager to go out into the world – a journey that would take him into medicine, then New Jersey, then finally the American Heart Institute with its snazzy new building.
Does he ever get upset by the suffering he sees? It must be hard being a heart surgeon; patients are in pain, many don’t survive. “It’s very interesting that you mention this,” he replies, looking thoughtful. “I think we do our job, and we’re very proud of what we do. I try to keep the problems here, not to take them home. Of course my wife always wonders, when somebody calls at 3 o’clock in the morning, she keeps asking ‘Who is that? What is the problem? What are you going to do?’”
Does that happen often? Phone calls at 3 in the morning?
“I would say… very often,” he replies – and the big sunny smile comes out, rolling into wry laughter.
“That’s what we do,” shrugs Christos, maybe wishing he’d become an accountant. “But I like my work, and I’m not complaining. I think,” he adds firmly, “the minute I get upset about a phone call at 3 in the morning, maybe it’s time to retire!” Outside, I assume, patients are waiting, sitting among the indoor trees and spectacular glass panels.
