How we revived heart surgery at UNTH – CMD Amah

Could you let us into the genesis of the open heart surgery at the UNTH? Apart from South Africa, the first place that open heart surgery was done in Sub-Saharan Africa is in the UNTH, and that was in 1974 by the late Professor Fabian Udegbu who led the team. From 1974, open heart surgery […]

Could you let us into the genesis of the open heart surgery at the UNTH?
Apart from South Africa, the first place that open heart surgery was done in Sub-Saharan Africa is in the UNTH, and that was in 1974 by the late Professor Fabian Udegbu who led the team. From 1974, open heart surgery continued in this hospital till 2003. Remember in 2003 Kanu Nwankwo Heart Foundation brought some foreign teams that equally operated but soon after that episode in that same year, there was a hitch and the programme stopped. This was further complicated by the movement of the hospital from the former site to its permanent site in Ituku-Ozalla where there was then no dedicated facility for open heart surgery because you don’t do open heart surgery in ordinary operating theatre for other cases. No.
This is a very high-tech procedure that requires specialized, dedicated facilities. So, when the hospital finally moved to this permanent site without those facilities, the programme just completely shut down and remained so until 2013.
This current administration, which by the grace of God, I am the chief servant, the CMD (Chief Medical Director); came in May 2011 but then it became a priority for us.

Why did you make it a priority?
It was made a priority because this is the flagship programme of this hospital. This is the programme that gave this hospital name. By the way, in 1983 or 84, this hospital was designated by the federal government a national Centre of excellence for cardiothoracic medicine and surgery. And the flagship programme that earned us this recognition was the open heart surgery. That was why when we came on board in May 2011, among many other things we did, we felt that it is a priority to regain the past glory of this hospital and move it further.

How were you able to transit from the old setting to the new one in preparing to revive the open heart surgery programme?
The place we have now as the cardiac centre was just a post-natal ward but we created another ward where we relocated the patients to. And by then we had established collaboration with some overseas partners. One of them is the VOOM Foundation USA and another one is based in the U.K, “Save a Heart in Nigeria.”
So, we invited these people and they gave us specification of designs and everything and how to make sure that we are getting a centre that meets international standard. That was how we renovated and re-equipped the place and got what we have today as a cardiac centre which is of international standard.
Of course, all the equipment there came through two sources, largely from donations we got from our overseas partners and then secondly, at a time, the university through the ETF (Education Trust Fund) got some money, about N360m, and bought equipment to commence the cardiac centre and that was it. In March 2013, we re-launched the programme.
Now, between March 2013 and as I speak with you, we have done about 110 or 115 open heart surgeries on both children and adults. This number far out-numbers the record of what was done from 1974 till 20013 when it stopped. And more importantly, it’s not only heart surgery that we do, a lot of emphasise is placed on training of the local team, skills transfer, exchange programme – some of our foreign collaborators take our people to their centres abroad where they undergo some  training; not just doctors, we are training pharmacists as well.
Last year, 2014, for instance, we sent three pharmacists on a training programme in Texas Heart Centre for six weeks. We have dedicated pharmacy for the open heart surgery because we use specialized kind of medication. If you bring pharmacists from elsewhere, they’d need to undergo training to be able to run that pharmacy. So, we are building capacity and transferring skill.
In fact, the last mission we had here, you won’t believe it; there were only two foreigners, the rest of the people in the medical team were our local people here. And that tells you how far we have gone in terms of transferring skill. Of course, at a time, it was all local team doing it but because the programme stopped for about ten years, their knives got blunt, their hands got blunt, and some left. So for us to re-sharpen them, we needed those our overseas partners. That is why it is very important that we have that collaboration. We have not only recovered the lost glory, we have pushed far, farther than where we left off.

Many Nigerians travel abroad for medical treatment which costs a lot of money. How can traveling overseas for medical attention be reduced in Nigeria?
That’s what we are doing here. We know that it has become an embarrassment to our governments and to our nation, the amount of capital flight that leaves this country by way of medical tourism to the U.S., U.K. and even to India. And now it’s business for a lot of people to send patients to India and then get whatever. We hear the good sides but we don’t hear the bad sides of it. Some of the cases we have done here were re-operations of cases done in India. You don’t know what they go through and the amount of money they spend. All these are monies leaving the shore of this country. The maximum amount patients have ever paid to have open heart surgery done in UNTH is N1.5m. Everything including investigation is N1.5m. At a time, they paid N1m. At a time, we have brought it as low as N750, 000 and even N600, 000 and even N500, 000 because our overseas partners bring a lot of support and they do it on the bases of charity, so we also allow that charity to rub off on the patients so that they will know that the charity works they are doing are getting to the indigent patients.
In the last mission we had during which the president of Rotary International came here himself, patients paid as low as N300,000 because Rotary International took care of the flight tickets of the volunteers, their hotel bills, so many of their expenses. So for that reason, we crashed the surgery fee to as low as N300, 000. It’s almost unquantifiable the amount of money and trouble we have saved our people and this country. And I think we are happy to say that this is University of Nigeria Teaching Hospital, so we are doing what we are called to do. We are saving our country from this embarrassment of going to India, US, UK. Does it mean you don’t have a place you can do open heart surgery in Nigeria? So this is the shame we have removed this country from.

Now, what would you advise the average Nigerian to do in respect of his heart?
Nigerians should go for regular checks which I know our people are not used to doing. People go to hospital only when they feel sick. If you are entering school now, there is a health check you should do because some of these diseases are inbuilt in the system. That health check you do is meant to detect some illnesses early. You are entering university; you want to gain employment; you want to join the armed forces or police or any of the paramilitary organizations, you must undergo health checks to determine if you have any health problem. But you know in our country, some of these things are not taken seriously. Somebody wants to gain admission into a school and you give him a form to fill for the health check. He takes the form to a medical doctor and says please fill and sign the form for me. He is in a haste hence he doesn’t want to do the health checks. And you notice that some doctors will just sign the form that everything is NAD, which means No Abnormality Detected. And by so doing they have missed an opportunity to detect an ailment early enough in that person.
Do you still remember the clear case of international footballer, Kanu Nwankwo. If not that he was playing football overseas where they insist on a regular check; I think at the time, Kanu was to enter a new team and they subjected him to medicals and they now realized that he had a hole in the heart. If it was not detected, this is the sort of things that cause a footballer to slump and die in the field of play. It was detected and he had an open heart surgery and went through rehabilitation and still went on playing football.
Now, I didn’t even tell you that Kanu Nwankwo Heart Foundation is part of what we are doing here. They now send their patients to us; they don’t send their patients to India any more. Some of the patients we operate here are from Kanu Nwankwo’s Heart Foundation because I brought him here and he saw some patients we have operated on, and he became convinced and said ‘why are we sending patients to India’? They send their patients here and pay for them partly. Then we also have an understanding with the NHIS – National Health Insurance Scheme – for some patients who cannot pay. If those patients are enrolled into the scheme, they pay for them; because out of pocket payment is still a huge problem in this country; they are not many who can afford it, honestly.