Breaking hearts: Can Nigeria lay claim to breakthrough surgeries?

L—as the patient was named to keep his identity during live updates throughout his six-hour surgery—wasn’t alone in theatre. His surgery was followed live by countless sympathizers on #openheart via social media and the Daily Trust website. Their keen fascination spilled into prayers from the first cut. Tweeted Fareedah Ibrahim on  ‏@fareedahibrahim: “I would give […]

L—as the patient was named to keep his identity during live updates throughout his six-hour surgery—wasn’t alone in theatre. His surgery was followed live by countless sympathizers on #openheart via social media and the Daily Trust website.
Their keen fascination spilled into prayers from the first cut. Tweeted Fareedah Ibrahim on  ‏@fareedahibrahim: “I would give anything to see how this surgery is done. Hope patient L is doing well. How many hours did it take?”
More than six hours, actually.
Complicated
To get a clearer picture of ASD, imagine the heart’s four chambers—two top atrium that fill with blood and two lower ventricles that pump blood. A thin shared wall—called a septum—separates the chambers.
L had a hole in the wall between both his atria, letting blood with oxygen flow from the left atrium to the right, where it mixes with oxygen-deprived blood and increases volume of blood pouring toward the lungs.
L’s condition was congenital but he didn’t get treatment—which could have done years ago—until now. His surgery was labeled “open heart” because his heart was cut open for the procedure.
First diathermy cut split L’s skin, then quickly seals off exposed vessels to prevent blood loss. More cuts pulled apart tissue yellowish fat under the skin, and a drill bit cracked open his chest to reach his heart.
Blood from his heart was run into a heart-lung machine, which keeps it moving and delivers oxygen as well, essentially doing the combined function of the heart and lungs. It stayed there until it was ready to be pumped back into L.
Meanwhile, surgeons deadened his heart to stop it beating while they reached for the hole—and reached too for a further unseen complication, three hours into the surgery. A major vein, the superior vena cava, was wrongly positioned and continued to pump blood into L’s heart. It took two extra hours to locate and contain the complication, before closing the hole.
Bleeding
Two perfusion experts redirected blood from the heart lung machine into L, expecting his heart to begin beating once more. For some instant, it did not. Warm water was poured into a bath through the blood ran, raising its temperature. “Thirty-two degrees,” announced an anaesthesist, manning the vitals monitor. Warm blood pushed up his body temperature. No beat.
Then came the defibrillator. Two thin pads placed on either side of his heart in his open chest, and a shock of electricity.
The jolt wasn’t much, but it was there—a slight upward jerk of L’s chest. Another shock, another jerk. A green line on the vitals monitor ticks upward, bottoms into a trough, ticks upward again, until a rhythm is established.
L’s broken heart, mended, stitched up, beating again. He was one of nearly a dozen to undergo open-heart surgery in April in a continued bid by the hospital to ensure Nigerians know such operations are not the preserve of expensive foreign hospitals.
Meaningless borders
The message is that Nigerian hospitals can lay claim to world-class healthcare and deliver with as much precision as India, where medicine and tourism have combined to make huge business.
Brazil,  Costa Rica, Korea, Malaysia, Mexico, Singapore, South Korea, Taiwan, Thailand, Turkey, United States are among top destinations for medical tourism, according to the group Patients Without Borders. They occupy their positions because of several factors, according to Patients Without Borders:
• Government and private sector investment in healthcare infrastructure
• Demonstrable commitment to international accreditation, quality assurance, and transparency of outcomes
• International patient flow
• Potential for cost savings on medical procedures
• Political transparency and social stability
• Excellent tourism infrastructure
• Sustained reputation for clinical excellence
• History of healthcare innovation and achievement
• Successful adoption of best practices and state-of-the-art medical technology
• Availability of internationally-trained, experienced medical staff
And more often than not, they offer procedures that include: cosmetic surgery, joint and spine surgeries, fertility treatments, cardiovascular procedures. The medical tourism market is valued at $20 billion a year. In 2012, India alone was thought to have made $2 billion from the market to the chagrin of Nigeria’s medical establishment.
Aggressive cost
Medical tourism is big business—and unashamedly so—complete with tradeshows. An industry conference billed for September promises some 3,000 participants and more than 10,000 networking meetings in Washington, DC.
“India earns over $260 million (N40.94 billion) from medical tourism from Nigeria alone”, accounting for more than half the entire income Nigeria loses to medical tourism every year, Dr Osahon Enabulele, former president of the Nigeria Medical Association.
More than 5,000 Nigerians travel to India and other countries every month on medical tourism, and cost the country over $500 million (N78 billion) annually, the Nigerian Medical Association has said, amidst calls for political leaders to increase public confidence in the health system by standing on hospital queues.
“We are at a stage in our country where there is a lot of doubt amongst us professionals,” said Dr Elijah Miner, medical director at Garki Hospital, after the hospital completed a batch of kidney and heart transplants last August. “We look at things and wonder, ‘can this be done?’”
One cardiac centre, Kanu Heart Foundation, run by ex-Eagles player Kanu, who survived a serious heart condition and subsequent surgery at the height of his football career has sponsored 425 surgical procedures for patients with heart problems in the past 13 years in hospitals in Britain, Israel and India.
The patients ranged from children as young as ten months to adults aged 50. An estimated 126 patients are already on the foundation’s waiting list for surgeries to correct heart problems in children as young as four months and adults aged 52.
Other than being the first example of Nigeria’s attempt to hand over sections of previously public health care to private control, Garki doesn’t lay claim to first breakthrough surgeries. But it wants to make the surgeries routine and cut the flow of medical tourism naira out of Nigeria.
“We are committed to say, ‘let’s go ahead and do this, make it an example,” said Dr Miner. “In terms of cost, it is a loss financially, but a major leap for us.” Far from holes draining both blood and money.