Healing heart defects: Indigent parents cry out for help

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By SOLA OGUNDIPE

Mercy Ogbosu was distraught when she took her 10-year-old daughter, Christiana, to the Lagos University Teaching Hospital (LUTH), Idi-Araba, in August 2010, and was told the little girl had a hole in the heart. Mercy, a mother of five was beside herself with worry at this news.

“I was so shocked by this development I just burst into tears. I cried and cried and cried. It was like my daughter was dead already and it felt like my world had come to an end,“ she told Sunday Health Report. Mercy was so confused she didn’t know what to do.

Although she confessed the little girl had been sickly since birth, she never, in her wildest dreams, imagined her baby would turn out to be a hole-in-the-heart patient. “We had earlier taken her to a doctor at Ejigbo and she had been referred to LUTH over and over many times.

They checked her and did test after test, but discovered nothing. But our doctor insisted we had to take her back to LUTH. She wrote something on a paper and gave to us. We took her back to LUTH, they checked her heart and told us she had a hole in the heart.  We are poor and my husband and I really feared for our daughter.”

But then someone who heard about the problem advised them to write to Governor Babatunde Fashola for help. They did just that and before long  were contacted.

“My husband went to the Governor’s office in Alausa, Ikeja, where he was given a letter authorising him to take Christiana to the Lagos State University Teaching Hospital (LASUTH). We took her but she could not be attended to because the doctors were on strike at that time. We were given a date on which we were to bring her back. We came back later and met Dr Michael Sanusi who later became her doctor, helping to carry out all the necessary tests free except for  echocardiogram and others we had to go and do outside the hospital.”

The anxious parents later learnt  that some Indian doctors were coming to the hospital on June 26, 2011. That day, more tests were carried out on Christiana. They gave blood and yet another echocardiogram was done among other tests. Finally, Christiana was ready for surgery which was carried out the following Thursday. Mercy relives the experience. “My mind was in my mouth throughout the day. The surgery took five hours. By 4.00 p.m. I was allowed to see my child. She was able to speak and asked for water, but I was advised not to give her  yet. I thank God she is recovering fast.”

Abdulateef’s case is no different. It was not until he was five months old before his mother, Hamidat, began to suspect there was something wrong with him. “Whenever I backed him, I noticed he wasn’t breathing properly so I brought him to LASUTH,” she narrated. A quick scan showed the little infant had an abnormal condition. There was a hole in his heart. Hamidat was crestfallen. “He is my last born and I was very sad at this news. How it could have occurred baffled me. I was told the most likely possibility was that he had been born with the abnormality. We were then referred to LUTH where  an echocardiogram was performed and Absulateef was eventually admitted as an emergency patient.”

For 14 days, he was on admission, receiving blood and everything until one Dr Animashaun explained in detail that only surgery could correct the problem. The confused parents were hopeful that all hope was not lost, but when they learned the corrective surgery would cost up to N500,000, even this last shred of hope vanished into thin air.  We kept giving him drugs and treatments.
Hamidat  said: “It was only through providence that Governor Fashola stepped in and came to our rescue. It was a long battle, and only God could have brought the healing. Only God gave the doctors the success and the victory.

Christiana and Abdulateef are two of a kind. They are  two of the dozens of Nigerians with congenital heart problems who have sought succour from the Critical Care Unit (CCU) at LASUTH.
In the view of Dr. Bode Falase, an experienced cardiothoracic surgeon at the Unit,over the last three years, no  fewer  than 24 corrective heart surgeries have been carried out at the unit. “The CCU is essentially an effective life support facility incorporating a theatre for advanced surgery, an intensive care unit and an amenity ward facility. It includes facility for admission of critically ill-patients while managing post-operative patients with different types of complications from other units from within and outside the hospital, in Lagos and other states.

“Christiana suffered from Atrial Septal Defect (ASD) which is more commonly called a hole-in-the-heart. He observed that the defect occurs quite commonly in this environment. In a chat with Sunday Health Report, he said “Christiana had a hole in the top two chambers of her heart. Blood from the left side of the heart under high pressure was being shunted to the right side of the heart. The end result of this is that there was more blood on the right side which was going through her lungs a condition which, overtime, could lead to right-sided heart failure, hypertension in the pulmonary arteries and eventually death if nothing is done.”

He said though the hole in Christiana’s heart was small, if it had not been closed, her condition would have got worse over time. “When we first saw her, she was in good state of health and had been well-managed medically, and she was assessed as someone who would benefit from corrective heart surgery. It was a relatively small hole, we put a patch over it and she recovered uneventfully. The surgery itself took less than an hour, but all the preparations stretched the whole process to about three hours.

Speaking on Abdulateef’s case, Dr. Michael Sanusi, also a consultant paediatrician and  cardiothoracic surgeon in the unit, confirmed the boy was recommended by the Medical Board. “He was evaluated to have a Ventricular Septal Defect (VSD), which is essentially a hole between the lower pumping chambers of the heart. He needed to have open heart surgery immediately. The Ministry of Health paid fully for the procedure, and the visiting medical team did an excellent job.”

Essentially, ASD and VSD are among the commoner conditions in children with congenital heart disorders. They are among the easier defects to correct and have generally good outcomes. According to Falase: “There are many children out there with this problem and with the current set up here, the output is very good. The disorders which are seen in around 15 per cent of patients in the critical care unit can be adequately managed, with the right facilities and funding in place.

Abdulateef, Falase remarked, had a hole in the lower part of the heart. If surgery hadn’t been done his heart would have also failed. The condition is congenital, and there is no known way of predicting its occurrence. It is like this, if there are 1,000 births, me to five may have it.

Some defects are caused by drugs or pregnancy, and most times there is no clear cause, they just occur during the formation of the baby. If the defects are major, the baby may not be born at all.”

Falase, who leads the cardiac surgical team at CCU, confirmed that there is on offer a comprehensive list of healthcare specialists and other personnel, backed by a well equipped laboratory with facilities for blood analysis and other investigations. Challenge is funding.  “We see many patients coming forward with these complaints, but we do not have the funds to assist. Even for this girl, the family didn’t have the money; the state government had to step in. This surgery would have cost N1.2 million.

Usually when   we see the patients they plead inability to raise money. Since we do not want to run the risk of rejecting patients because they are unable to pay, we ask them what they can afford. What we are trying to do is to encourage patients to come early for treatment  so that we can assess them. The risk of surgery is low. The chances of death for closing up a hole in the heart are about one to two per cent. Falase, an experienced cardiothoracic surgeon, said at the moment, the cost for the  operation Christiana and Abdulaeef had is N1.2 million each. For most patients, the challenge has not been that of availability of treatment, but that of raising funds for the surgery.

Lamenting challenges of  CCU, he noted that it was set up to be self -sustaining in offering critical care health services, and not primarily for profit. “The Lagos State Government invested a lot in resources, equipment, manpower, training, and we are now at a point where the straightforward simple procedure that could benefit people requires funding. Most patients cannot afford the funds. The biggest challenge now is that there are patients that we can help but without funds we are handicapped because there are no funds to do so. The way out is to look for avenues to get funds.”
Falase argued for a pool of fund which must be regularly replenished so all that is left to worry about is assessment of the patient, ensuring there is no high risk, and tapping into the pool to get the surgery done. “Insurance could come in, It could be more of a combination of solutions, but for the poor patients, what they need is access to the funds.”

Stressing the fact that the cardiac programme is at the cross road, he said: “Government gave us money last year and so far we have successfully done 24 cases. The money was N35 million, each surgery cost N1.2 million. We have been able to stretch the money further than it could have gone, even then we have spent N27 million, but the number of cases we can continue to do is limited. We are currently only trying to see how many more we can do before the money runs out. Without proper replenishment, we are at risk of not being able to carry on with this programme.”

Giving a run down of the situation, Falase observed: “Right from getting ready for the surgery, blood, tests, and others are estimated at about N250,000. Consumables are imported at high cost for one operation alone is N350,000-N5,00,000; drugs N100,000; oxygen, compressed air, anaesthetic drugs, ventilation, etc N300,000-N500,000; During surgery, the hospital incurs costs running generators and inverters. Everything is costed.

“When we started, each procedure was N1.5 millon (about $6,000), and we are still trying to bring the cost further down. It is still  cheaper than what it would cost in the US and in the UK, where the average heart operation costs about $12,000;  in the US it is about $18,000; in India, these surgeries cost $7,000 – $8,000, and with the added cost of having to travel.

There are no less than 45 patients in the wards now who require surgery but cannot be attended to because of lack of funds.”

Falase said there are many units trying to set up surgery for cardiac surgery. “Where do the funds come from,” he asked. “We either say people do not need the surgery, and if they do, we fund it. It is either they don’t deserve it, or they do. The point is we either want to say we can provide cardiac surgery and we can fund it or we note that only the lucky few who have the funds can be brought for surgery.”

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