Taming heart diseases through surgeries

Gov’t Not Doing Enough – Amah
Recently, some parents from across the country besieged the medical examination unit of the Open-heart surgeries department of the University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu. They were all carrying children aged four and above. And their mission was to seek solution to their children’s heart related diseases.

The Guardian observed that 75 children were waiting for medical examination to prepare them for free heart surgeries being conducted by an Italian based organisation, Public Open Heart International.

Looking malnourished, with some of them in pains, it was obvious the heart diseases had gravely affected the children’s health. Unfortunately, only 12 cases said to be acute received attention of the medical team, which spent five days at the facility. Others were referred to a later date.

The children were among the 390 patients that have so far received heart surgeries since March 2013, when the open-heart programme commenced at UNTH.

However, UNTH is not the only federal tertiary health institution that offers open-heart surgeries. The University Teaching Hospital, Ibadan and Lagos University Teaching Hospital (LUTH), among others, are also designated for the purpose. This is in apparent response to the growing need of Nigerians on issues of heart surgeries.

But while UNTH has continued to offer the service, other hospitals seem to have gone into coma. Indeed, they have been referring patients requiring heart surgeries to UNTH. Sources said the development might not be unconnected with lack of state of the art facilities, and that funds were required to subsidise bills to enable patients cope financially.

The source stated that heart surgery is complex and requires specialists, who may not be available to undertake the exercise.

It was gathered that the programme has continued at UNTH because of the collaboration it established with foreign donors, who have continued to sponsor medical missions, as well as provide required equipment and consumables at the facility. Free treatments are sometimes offered children, which is why patients always besiege the facility.

In 1984, the Federal Government designated UNTH the centre of excellence in cardiothoracic surgery. This was based on a feat performed by a team of Surgeons at the medical facility that included M. Yacoub; F.A Udekwu; D.C Nwafor and C.H Anyanwu in 1974. Prof. Martin Aghaji later joined the team. By 2000, a total of 102 heart surgeries had been successfully carried out at the hospital.

In 2003, Dr. William Novick’s International Children’s Heart Foundation, invited by Kanu Nwankwo Heart Foundation (KHF), paid a working visit to Enugu. From the records then, the foundation had registered 2,555 patients that needed open-heart surgery.

When in 2007, the Federal Government moved UNTH to its permanent site in Ituku-Ozalla, it failed to provide infrastructural facilities for Open-heart surgery, which made it impossible for the hospital to continue the programme.

Realising the deficiency, government commenced building of a centre at the permanent site for the programme, but till date, the centre has remained under construction, raising questions about government’s readiness to combat the scourge.

However, Dr. Christopher C. Amah, who became the Chief Medical Director of UNTH in 2011 decided to confront the challenge. He created space in the antenatal wards, and through collaboration with some foreign partners like the Voom Foundation, USA; Save-a-Heart, United Kingdom; Cardiostart USA and Rotary International, among others, he was able to restart the open-heart programme in 2013. Ever since, there has been no looking back.

Conducting The Guardian round the facility, Amah explained that it had helped reverse the trend of medical tourism in the country, as many patients that would have travelled abroad for heart surgery, now go for treatment/surgery at UNTH.

He said: “Through the overseas collaborations, we have been able to attract about 11 free containers of medical equipment/consumables to UNTH. This has greatly helped to enhance facilities and services at the cardiac centre, in addition to improving hospital services generally. We have done more heart surgeries than any other hospital in the country.

“The foreign collaborators see it as charity. They feel the pains of our people and are offering their services, knowing how rampant and common this disease has become in Nigeria. We have received a lot of equipment and consumables mainly from Voom Foundation. They frequently send containers to us. We have received three mobile x-ray machines from them, which cost millions. We have received brand new hospital beds, ultra-sound machines, and many hardware and other things that go with it. However, we don’t use these things only at the cardiac centre, they are also used in such other places as the wards. This is the 20th time Voom Foundation visited this hospital. The benefits are many, as UNTH has done a lot in curbing medical tourism.”

Amah identified congenital heart disease, coronary artery disease and heart valve disease as some of the heart diseases prevalent in the country, explaining that high blood pressure, rheumatic fever, obesity, smoking and stress, among others, as causes of heart disease.

He said: one major challenge facing the programme was the little interest Federal Government has shown towards it. Aside support received from overseas collaborators, we have relied on our internally generated revenue to provide some of the things we need.

“This is a capital intensive project. If we had not received some of the machines from our overseas friends, there is no way we could afford it with our IGR. The foreign experts are also training our local experts because many of them have not been active, due to the long period we stayed without heart surgeries. If you are a surgeon, you have to keep operating or you will lose your skill.

“Some of our best hands left Nigeria the moment we stopped the programme. This is a complex area in medicine that requires every bit of care. You must have the right personnel and equipment to go into it. You have to stop the heart, while doing it and restart it as soon as you are done. It is not an easy thing. We have steady power supply, because once the surgery starts, you don’t put off the generator.

“So, I expect the government to show some support. The cost of open-heart surgery is too high. Government needs to shoulder part of the bill, so that our people can come and get cured. There are many cases out there, and unless there is a medical mission from foreign organisations, these people may not get cure.
“As a result of the heavy financial outlay for surgical treatment, cardiac patients must pay more, on average, than other patients in the hospital. Many of these patients and their relatives cannot afford the bill.

“We have been able to send some of our experts overseas and expect that they will take over fully from our overseas partners, but you know that they require the facilities to work to be able to perform effectively.

“Over the years, we have built capacity, but there is still a lot to be done. We have some persons on training at UK and until we finish those ones, we cannot say we have really taken over. We will still continue to need these foreign partners.”

He conducted reporters through the refurbished neurosurgical ward, with a ceiling mounted operating Microscope, which was recently acquired through the Swedish Association of Neurosurgeons.

“With this kind of equipment, we are able to operate very complex, deep seated brain regions, as well as handle problems in the base of the skulls, brain stem and spinal. So, the Swedish people sent this machine.

“There are so many brain challenges. Some of them are congenital, while some others are acquired, meaning someone was born normal, but in the course of life, he/she develops a brain disease. Majority of the brain diseases is not amendable to operative surgery, but a significant number can benefit from operative surgery. These are the ones addressed by the neurosurgeon. Some of the cases can be by infection, trauma and tumours.”

Amah, who is set to bow out as the Chief Medical Director, following completion of his eight years in office, said his administration also improved on other services at the facility. “For instance, the oxygen generating plant has been fully resuscitated, as well as the Radiotherapy facility for the treatment of cancer,” he explained.

Onyekwele Nzewi, a cardiac Surgeon said Nigeria required deliberate efforts to combat cases of heart diseases. 
He stated that the disease rate was high in Nigeria because most people diagnosed of it would prefer to live and die with it because of the huge financial involvement.

“But this can be brought down, if government adequately funds the health sector.  It can come down if philanthropists and wealthy individuals support the programme,” he said.
Prof Basden Onwubere, head of Cardiac Unit at UNTH, said there was a growing list of patients that visit the facility daily, and that without adequate facilities and enough trained manpower, many Nigerians would continue to die from the scourge.”