Advancing heart surgery in Nigeria: prospects and challenges

News Analysis by Oluwafunke Ishola and Vivian Ihechu, News Agency of Nigeria (NAN)

According to the World Health Organisation (WHO), Cardiovascular Diseases (CVDs) are a group of disorders of the heart and blood vessels.

They include coronary heart disease (disease of the blood vessels supplying the heart muscle) and cerebrovascular disease (disease of the blood vessels supplying the brain).

The others include peripheral arterial disease (a disease of blood vessels supplying the arms and legs), rheumatic heart disease (damage to the heart muscle and heart valves from rheumatic fever, caused by streptococcal bacteria).

CVDs also include congenital heart disease (birth defects that affect normal development and functioning of the heart, caused by malformations of the heart structure from birth) and deep vein thrombosis and pulmonary embolism (blood clots in the leg veins, which can dislodge and move to the heart and lungs).

WHO says CVDs accounted for 17.9 million deaths globally in 2019. According to the organisation, 85 per cent of the deaths were due to heart attack and stroke.

The Federal Ministry of Health in Nigeria says CVDs are issues of public health concern responsible for 11 per cent of more than two million deaths from non-communicable diseases in the country, annually.

According to the ministry, CVDs are responsible for a high burden of morbidity and disability.

Risk factors for CVDs present in individuals with raised blood pressure, elevated blood glucose, high blood lipids and obesity.

Sometimes, surgical operations are required to treat CVDs, especially if other treatments fail or cannot be used.

These operations include coronary artery bypass; balloon angioplasty (where a small balloon-like device is threaded through an artery to open the blockage), valve repair and replacement, heart transplantation and artificial heart operations.

Over the years, heart surgery techniques have continued to evolve and with mostly positive outcomes, especially when cases are presented and detected early.

Some experts in cardiac care affirm that advancements have been recorded in heart care including surgery, in Nigeria.

They desire that the federal and state governments will be more responsive to the demands of treating and managing heart ailments in the country to save more lives and reduce brain drain.

According to Dr Bode Falase, a Consultant Cardiothoracic Surgeon and Head, Cardiothoracic Division, Lagos State University Teaching Hospital (LASUTH), 13 centres conduct heart surgeries in Nigeria at present.

Falase says the centres are at LASUTH, Obafemi Awolowo University Teaching Hospital, Ile-Ife; University College Hospital, Ibadan; Reddington Hospital, Ikeja; and First Cardiology Consultants, Ikoyi, Lagos State.

The others centres, according to the consultant, are Tristate Heart and Vascular Centre, Babcock University Teaching Hospital, Ilishan-Remo, Ogun; Nizamiye Hospital, Abuja, and Lagoon Hospitals, Lagos, among others.

Falase says that 200 heart surgeries were carried out across the centres in 2021.

He is delighted that the surgeries were done by Nigerian experts in  the institutions conducting heart surgery.

Falase  believes that this will enable skills transfer and eliminate patients’ waiting time.

“If we are waiting for visiting foreign teams to conduct the surgeries, you can’t train people or pass on the skills, and you will have a long list of patients waiting endlessly for surgeries.’’

Falase says that although cardiac specialists and other stakeholders are proud of the current surgical procedures, the number is low compared to the country’s disease burden.

According to him, Nigeria has the expertise and facilities but the cost of heart surgery is high for most patients.

“WHO estimates that for Nigeria’s size, we should be doing 40, 000 surgeries yearly; however, we only managed to achieve 200 cases in 2021.

“We have the facilities and expertise in the country, but most patients cannot afford the cost of the surgery.

“In western world, the government takes the burden of funding, to fill the gap through effective health insurance coverage of the citizens.

“For example, in LASUTH, if the government says it can fund 100 cases a year and we know the money is there, then, we are not just assessing patients, but also having surgeries.

“If we have 100 surgeries planned for a year, imagine the amount of training that goes on for surgeons, nurses and other cadres involved in the procedure,” he says.

Falase is convinced that performing more  surgeries in Nigeria will address brain drain.

He  observes that  many professionals travel outside Nigeria to train due to  low number of cardiac surgeries performed in the country.

Falase notes that 75 cardiac surgeons are registered in Nigeria, adding that about 12 of them have left the country.

According to him, the cost of average valve replacement operation at LASUTH is N3.2 million while a regular hole-in-the-heart surgery costs between N2.5 and N2.7 million.

The surgeon appeals to philanthropists and non-governmental organisations to assist in funding surgical interventions for cardiac patients, noting that the governments alone cannot do it.

Falase believes that successes recorded by LASUTH in heart surgery were driven by the competence of its cardiac surgical team, in collaboration with its Cardiology Unit, supported by the hospital’s management.

Another cardiothoracic surgeon at LASUTH, Dr Setemi Olufemi, blames high prices of consumables, which are mostly imported and single-user-based, for high cost of heart surgeries.

The expert expresses optimism that establishing more cardiac centres will  lead to more demands and help in reducing the cost of consumables for heart surgeries in Nigeria.

He emphasises  that diagnostic tests are fundamental in handling cardiac problems, regretting that only  few of such  diagnoses are carried out in Nigeria at present.

According to the expert, diagnoses of heart diseases are not guessworks but highly specialised, with some done in a Cardiac Catheterisation Laboratory (Cardiac Cath Lab).

Cardiac Cath Lab is a specialised area in a hospital where doctors perform minimally invasive tests and advanced cardiac procedures to diagnose and treat cardiovascular diseases.

He notes that there are 10 functional cardiac cath labs in Nigeria, saying that LASUTH’s cath lab will start soon.

A 63-year-old patient, who successfully went through a heart surgery in one of the facilities in Nigeria is amazed at the level of expertise and care deployed to manage his condition.

“When I was newly-diagnosed of a heart disease and advised on  surgery as the best way out, I lost hope.

” My fears were even more heightened when COVID-19 broke out with its attendant lockdown, restrictions and skepticism. I could not travel outside the country, and my resources were slim.

” At the end of it all, I had the surgery in Nigeria. I must tell you, our people have it. They can compete with confidence  in any  clime.

“Our key challenges are funding, power and equipment; the right environment,” he says.

Dr Okechukwu Ogah, National President, Nigerian Cardiac Society, hails the country’s advancement in heart surgery, saying it has been tremendous in the last few years.

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