SPECIAL REPORT: HEART SURGERY AT MULAGO

By Carol Natukunda and Charles Wendo

THIRTEEN-YEAR-OLD Edward Kasajja was born with a hole in his heart, medically known as atrial septal defect. He needed open heart surgery, during which doctors would cut into his heart and stitch the hole. This could not be done at Mulago Hospital and Kasajja’s parents needed $15,000 (sh26m) to have the operation done in India.

However, luck came Kasajja’s way on Wednesday, when he became the first to undergo open heart surgery at the Uganda Heart Institute, Mulago Hospital. And it was free of charge.

A 44-man team of Ugandan and American experts carried out the operation, which lasted less than three hours.

Dr. John Omagino, the heart institute director, led the Ugandan team while the Americans were led by Dr. Craig Sable from the Children’s National Medical Centre.

At 11:15am the chief surgeon made the first incision into Kasajja’s heart and by 2:00pm he was out of the theatre.

Most of this time was spent on preparing Kasajja’s body for the operation and stabilising his systems thereafter. “The main part of the operation – sealing the hole – took 18 minutes,” says Sable. “Everything went very well. There are a few glitches, but much less than what I had anticipated.”

When Saturday Vision visited the Uganda Heart Institute on Thursday, a day after his operation, Kasajja was being closely monitored in the Intensive Care Unit. Holding a teddy bear, he sat up with less difficulty, and looked around the ward, without emotion. Doctors said he was steadily recovering. He is to stay in hospital for about 10 days then rejoin his family in Rubaga, a Kampala suburb.

On Thursday, the team carried out two more open heart operations, free of charge. According to Sable, they will carry out one to two operations a day for about 10 days – all free of charge. He is confident that after the American team leaves in about a week, the team at Mulago will be able to perform the operations on its own.

“I’m confident the programme will be sustainable. This is my sixth trip to Uganda, and each time it gets better,” says Sable. “It will take some effort from the Uganda heart Foundation and the Ministry of Health.”

According to Omagino, initially his team will carry out two operations per week. For a start, these will be simpler open heart surgeries while the more complicated cases will be sent abroad. He says patients will pay between $5,000 and $6,000 (sh10.4m), which is far less than the $15,000 to $20,000 (sh34.8m) that they have been spending on such operations abroad. “What has been making the bill high are the travel expenses. Now you save about $10,000. Mulago now has specialised services,” he boasts.

Omagino says about 20 patients have been going abroad annually for open heart surgery. These include those supported by the heart institute, the Government and other sources. Since each operation will cost $10,000 less, the country could save $200,000 (sh350m) annually if all the 20 people are treated here.

The breakthrough will also enable more Ugandans to receive heart operations. So far only 10% of Ugandans who need open heart surgery have been able to get it.

The first open heart surgery at Mulago Hospital was carried out in 1967, but the project collapsed during the Idi Amin regime. Preparations to resume heart surgery began in the late 1980s. By 1996, the hospital was able to do closed heart surgery again. However, open heart surgery was not possible until this week.

“It has taken us many years to develop the human resource. We have one of the best teams in the world. We have four cardiac surgeons, three cardiologists and three paediatric cardiologists, who are up to international standard,” Omagino says. “This is teamwork, not only the work of cardiac surgeons. Heart surgery could take one or two hours, but how you care for the patient and ensure that they go back to normal is the most important thing.”

Omagino says the major threat to open heart surgery is the brain drain. For instance, he says, three of the nurses sent abroad for further training did not come back. His fear is that the well-trained team at Mulago might be lured into lucrative jobs abroad.

Robert Ssebunya, the chairman of the heart institute board of directors, said the next step was to build a fully-fledged heart institute with a 200-bed hospital, training and research facilities.

“Ugandans should be proud of these people and should be assured that the programme will continue. Unlike other hospitals that do it once and wait for another five months, this will be a continuous programme effectively managed by Ugandans,” he said.

The Uganda Heart Institute was founded in 1988 by the Ministry of Health, Mulago National Referral and Teaching Hospital, Makerere University Medical School and the Uganda Heart Foundation (a Non-Governmental Organisation composed of philanthropists like Rotarians). It was mandated to serve as a centre of excellence for the Curative Cardiology services, covering a wide range of heart diseases. It offers diagnostic services for most of the cardiac related diseases.