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New heartbeats for cardiac patients

By Rukiya Makuma

Renewed hope for patients as Mulago gets better heart machines

Alvin Olum barely looks his age. At four years, he weighs only 14 kgs instead of at least 20 like his age mates. He was diagnosed with a heart problem when he was one week, which explains his frail and little stature.

“He had difficulties in breathing and I had to take him to hospital where they gave us some medicine, but this was only the beginning of the costly treatment,” says Cissy Ogwal, his mother.

When he made four months, he had his first operation, which cost Shs 2 million.  The condition improved but complications started again when he made three years.

“He developed cough, flu and pneumonia; and the specialists told us that the hole in the heart had started leaking blood and we had to take him to hospital where he was put on admission,” says Ogwal, as she fought back tears.

When he made four years a few weeks ago, the doctors recommended surgery. He was subsequently admitted at the Uganda Heart Institute at Mulago Hospital and he was one of the children who were successfully operated upon at no cost. Ogwal told The Independent on June 14 that the boy had improved as his breathing was now moderate.

“He can now walk around and play, which was so unlike him,” Ogwal says, as she looks at her son affectionately.

Mariam Nantenza, 3, was of the beneficiaries. Hajarah Nalweyiso, her mother is a resident of Mpigi. She told The Independent that the family had to part with between Shs 20,000-30,000 on treatment alone every time her daughter got ill – quite a lot given their low income in a rural area.

Nanteza was diagnosed with a heart problem at one and a half years. She had a hole in the heart one side of the heart was big and some veins could not open. Nanteza was supposed to get treatment after every three months.

Though still recuperating, Nalweyiso says her daughter is much better. “I hope she catches up because her younger sister looks older than her.

Madina Nalubega, the Nurse in charge, says Nanteza had an atrial septal defect while Olum was diagnosed with a ventricular septal defect but the defects were all repaired in the operation.

Natenza and Olum are some of the children who have benefitted from the collaboration between the Uganda Heart Institute and two charity organizations – Gift of Life and Chain of Hope – and other missions, to save the lives of the children who suffer from Endomycardial fibrosis (EMF), a life-threatening condition that causes scarring of cardiac tissue and leaking in the heart’s valves.

John Omagino, a consultant surgeon and director of Uganda Heart Institute, says the number of patients operated upon could double if the institute had the capacity.

Omagino says in Uganda one in every one hundred babies born has a heart problem, which needs attention yet the facility does not have the capacity to help even a quarter of them. According to World Health Organization figures of 2008, cardiovascular diseases are the world’s number one cause of death – claiming 17.3 million lives – with 80% of the deaths taking place in low- and middle-income countries.

Omagino says the institute receives about 100 patients on a daily basis – and these are only those who can afford the costs to Kampala – but many sufferers are out there with no opportunity to get treatment.

He says despite that, the institute is trying to use what they have to ensure that many people can benefit. He says with funding from the government, the institute constructed the Cardiac Catherization facility, which will improve on the capacity of the institute to manage heart patients and reduce the need to refer patients abroad because referrals are too expensive and thus inaccessible to the majority of patients.

Omagino says when fully operational, the facility will handle 300-400 Catherization lab procedures and 200-300 heart surgery operations, which if referred abroad will cost the nation between 10 -14 million dollars. He says besides this, the Catherization lab will act as a training opportunity to local doctors and this will also reduce on the amount of money the government spends on training specialists abroad yet they do not even get an opportunity to get the hands on experience they need. The government spends more than Shs 100 million on training.

The cardiac unit includes patient care, teaching, training and mentoring to young professionals in the field, creating opportunities for conducting research on heart problems and guide on policy formulation by government.

Wilson Abwooli Nyakoojo, a senior cardiologist and head of Cardiac Catherization, says since its installation on May 1, 2012, the theatre has successfully operated on 18 patients. He says optimally the theatre operates on 3-5 patients a day if there are no complications.

Nyakoojo says the institute is yet to equip the dedicated theater, which once equipped, will see Uganda start to carry out open heart surgeries.

Omagino says the institute is driven by its mission to serve as a centre of excellence for the provision of comprehensive medical services to patients with cardiovascular and thoracic diseases and to offer opportunity for research and training in cardiovascular and thoracic medicine at an affordable cost so as to facilitate service delivery and enable continuous development of the institute to also attract clientele from other countries.

Omagino says the institute still faces challenges such as low funding so he calls upon government to bridge the funding gap so as to develop the heart institute because the number of cardiac patients is on the increase. He says last financial year the operational non wage bill given to the institute was Shs 40 million, which is too little to run the institution. He says in the draft budget for 2012/13, the Institute is to receive Shs 540 million, which he says is little to run the operational costs. “There is a need to lobby government to release enough money,” he says.

He adds that they plan to make it an international level self sustaining Institute which is independent of Mulago Hospital at an estimated cost of $64.7 million. Once this is in place, the institute will expand its research programmes and clinical services to cover the country and the region.

Nyakoojo says the institute is also limited by human resource constraints with only one specialist, which limits its capacity to handle the overwhelming number of patients.


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