Outstanding Breakthrough in Open Heart Surgery

The sudden demise of two Nigerian coaches, Amodu Shuaibu and Stephen Keshi due to heart-related diseases, has raised questions on the need to find immediate solutions to the silent killer. Christopher Isiguzo writes that the University of Nigeria Teaching Hospital, Enugu, has come to the rescue with the successful conduct of 175 open heart surgeries in a space of three years

“For the past three months, we have been moving from one place to another seeking for assistance from friends, relations and public spirited individuals who could help us with the necessary assistance to enable me to travel to either India, London or any other part of the world where my heart problem could be well treated. After intensive search for all these, I was finally advised by a friend to try it here in Nigeria. After much pressure, I finally succumbed and allow them to bring me to the University of Nigeria Teaching Hospital, (UNTH), Enugu, where I have been successfully operated on and I now feel much better.”

Those were the words of Mr. Anthony Ude from Umuabi in Udi Local Government Area of Enugu State who was last week operated on for Aortic Valve replacement at the UNTH, Enugu. Like, Ude, 21 other persons including adults and paediatrics from across not just the South-east but beyond equally passed through the same process within a space of one week. Last week exercise was the 14th in the series since the reactivation of the open heart surgery exercise in the hospital.

Only recently, a renowned Cardiologist and Head of Cardiology Department of the University of Nigeria Teaching Hospital, Prof. Basden Onwubere, had raised the alarm that over five per cent of the nation’s population may be living with surgically amenable conditions asking government at all levels to map out resources to arrest the situation before it degenerates to an unmanageable level.

He had lamented that research had shown that over five per cent of Nigerians both children and adults live with surgically amenable conditions, urging urgent attention in that regard.

“Five per cent of 170 million is so much, many people who have heart diseases and in need of operation are poor, they just call it rheumatic fever and the person’s valve is terribly damaged, many people are not able to do anything because of money. It costs a lot of money. Now we have the manpower, we need government funding.

“Government has to sponsor people, if every state sponsors 10 patients each year, it would go a long way in reducing the number. If not for our foreign collaborators, it would have been a big issue,” he noted.

With the high rate of deaths on account of heart-related ailments in the country, the latest being the sudden deaths of the nation’s football coaches, Amodu Shuaibu and Stephen Keshi, the intervention of the UNTH has become more than imperative as several lives which perhaps would have been lost are daily being saved in the hospital. At the last count, a total of 175 cases have been successfully handled since 2013 when the open heart surgery programme was resuscitated at the hospital.

Also, another Nigerian-born United Kingdom-based Cardiologist, Dr. Onyekwere Nzewi, an Executive Director of the Save-a-heart Foundation, a non- governmental organisation based in the United Kingdom observed that cases of heart diseases in Nigeria have reached a crescendo as a result of the obvious disregard for local natural food by the people.

The cardiologist insisted that anything short of adequate funding for the open heart surgery programme in the country in order to effectively assist those with the ailments would be counter-productive. He noted that with adequate funding, UNTH alone would have the capacity to carry out hundreds of surgeries annually. He further urged to also take their destinies in their hands by increasing consumption of natural foods as against “junk foods which increase the risk of having heart diseases”.

“Our organisation is registered for the sole purpose of helping, not only coming to do cardiac surgery, but our main aim is to train the locals to be self-sustaining and be able to do the operations themselves, and it is only when they are able to do it themselves that the cost will come down and it will be sustainable.

“There are three aspects of heart problems. Congenital heart disease, whether you are white, yellow, black, it is the same case that cuts across all races and what this is talking about is the development of heart diseases. The same number of congenital heart disease you have in Nigeria is the same that you have in Ireland, Britain or USA.

“The second is rheumatic heart disease and this is caused by simple infection of the heart, throat that is not well treated. So the immunological consequence of that is again deposited in the heart muscle and from the age of 20 -25, the heart muscle becomes thickened and deformed and causes a serious problem. Because of the campaign by the likes of the Nigerian Heart Foundation, Pan African Society, the incident has continued to drop and this is treated by two tablets of penicillin.

“What is rising is Ischemic heart disease and the reason why it is rising is because we have abandoned eating our normal food -cocoa, palm oil and we now depend on fast food and westernised diet. What are the risk factors for this? You are diabetic, you are overweight, you have hypertension and your cholesterol is elevated. All these young people you hear suddenly that died is massive heart attack and until we do something about our eating habit, it is bound to continue.

“There are two ways we can do something about it – change by education, we realise what causes it and change our lives or we make provision for treating it. 75 per cent of all heart operations done in the UK are Ischemia diseases and it is here with us. It is an epidemic waiting to happen and when it happens it is going to wipe the affluence of the society, not the poor,” he warned.

It would be recalled that the hospital had conducted its first open heart surgery in 1974, the first by any hospital in black sub-Saharan Africa. The programme was however suspended following the hospital’s relocation to its permanent site in 2004 as well as the non-availability of the necessary facilities at the new site. It however resumed in 2013.

Addressing newsmen midway into the 14th session of the programme at the hospital in Ituku-Ozala, Enugu, the Chief Medical Director, Dr. Chris Amah, said since the recommencement of the programme in March 2013, the hospital had recorded about 90 per cent success, noting that being a notable heart centre in the country, the hospital could boast of the state-of-the-art facilities that can effectively compete with the best heart centres across the globe.

“This is the 14th mission in the role of Open Heart Charity Mission. They come here on 100 per cent charity. The fees are highly subsidised. What ordinarily should cost as much as N4.5 million in view of the foreign exchange palaver now cost as low as one million naira or at most N1.5 million. This is good news for the country.

“We have our partners from the UK, Dr. Nzewi from Royal Victoria Hospital, UK and a Director with the SHF is leading a team of nine experts on this mission and they are working with our local team. By this weekend, this team will leave and another set of Paediatric Heart Surgeons will arrive to handle the 12 paediatric cases,” he said.

He expressed optimism that doctors from the hospital who had undergone intensive overseas training would be handling the open heart surgeries without assistance from foreign doctors before long. He also noted that several others were on the waiting list for the surgeries stressing however that before anybody is operated on, such a person needed to be prepared psychologically and medically “to know that heart surgery is not a death-trap.”

While describing heart surgery as a “high risk surgery” where up to 20 per cent mortality is acceptable, Amah noted that the hospital had continued to improve by the day. According to him, unlike in the past, the hospital can now handle up to three cases in a day. He expressed appreciation to their partners from the VOOM Foundation led by Dr. Vincent Ohaju who have consistently assisted the hospital with medical equipments running into several millions of naira.

Amah noted that the hospital would want to carry out at least 100 open heart surgeries annually if enabled by funding, noting that because of the huge financial involvement in carrying out the exercise coupled with the fact that most people with heart related diseases were poor, most people were yet to take advantage of the exercise in the hospital.

“I can tell you that if we have improved funding, we can even handle 200 cases per annum and this will save this country huge sums of money that ordinarily would have left the country through capital flight,” he said.

The CMD disclosed that UNTH was in 1986 designated as centre of excellence for cardio-thoracic surgery having performed the first open heart surgery in sub-Sahara Africa in 1974 noting that the open heart surgery programme of the hospital suffered some reversals for 10 years, before it was reactivated by March 2013 through the collaboration of foreign partners.

Another key-member of the Cardiothoracic Surgery team of the hospital, Prof. Martin Aghaji praised the success rate of the programme in the hospital insisting that since 2013, even local hands have continued to improve.

“There is no doubt about it; it has made a lot of difference. The foreign team coming has helped a lot, first and foremost in terms of specialised manpower, too in terms of equipment, and three in terms of money and logistics. And the success rate is encouraging despite the fact that their cases are very, very bad cases.

“The point is that it has to be gradual, at the moment we are doing all closed heart surgery, that’s in between the mid ribs and I can assure you that after this mission we will start doing probably once every week,” he said expressing hope that before long, doctors in the hospital would take effective charge of the programme.

“First and foremost if you look at facilities here, you are looking at facilities just like in Europe, we didn’t have it in the old site. The support is there, the management has been wonderful; mind you that this centre was built as an ordinary ward from direct labour. If it were to be built by government, it would have cost probably 100 times what it costs and finished probably in 100 years,” he said.

Though the hospital had handled only 175 surgeries, the number remains a far-cry compared to the array of people still waiting on the line to take part in the process. There are equally so many others who are obviously inhibited by funds constraints. Despite the seeming small number, it remains a cheery news that at last most Nigerians may have finally found a solution to the constant foreign trips on account of heart-related ailments.