Mulago can now handle open heart surgery

By Robert Ssebunnya

There has been serious concern and a great deal of exchange of ideas about the state of affairs of health service delivery in Uganda touching on lack of drugs in the Government health centres, super specialist training, and the ability and capacity for some health institutions in the country to handle complex cases so as to reduce the number of patients being referred abroad for treatment.

Generally, the state of our health services is not so bad compared to other countries. 

However, in this connection the provision of health services in Uganda has always been guided by a clear strategic framework to ensure all actions are aimed at improving the health of the people in a manner that is responsive to the legitimate health needs and also ensure fairness in financing of services being accessed.

Thus, the Government of Uganda, being aware and recognising the importance of health in transforming the quality of life of Ugandans, developed the Health Sector Strategic Plan (HSSP) to guide the health sector investments towards achieving medium term goals to health. 

Among the many sector priorities is the cardiovascular diseases control and management.

I developed an interest in this area after our late father, John Ssebunnya Kasule, the founder of Democratic Party and the first Secretary General of DP, had a serious heart attack and died in 1978.  I was in South Africa at the time of his death in pursuit of financial and military assistance to topple Idi Amin. 

Our late father, I am sure, did not know that he had a heart problem and his death revealed to me that there are many Ugandans who succumb to this kind of death with no knowledge of it. This, therefore, inspired me together with other colleagues and decided to start the Uganda Heart Foundation, one of the four original partners and sponsors of Uganda Heart Institute.

Uganda Heart Foundation, with a backing of Rotarians and well-wishers in Uganda and abroad, initiated a number of information programmes related to cardiovascular diseases, prevention, treatment and funding Uganda Heart Foundation conducted Radio and TV talk shows, wrote newspapers articles, etc in addition to organising a number of sensitisation workshops in the country.

Due to increasing number of referrals, especially children with heart defects, the Uganda Heart Foundation and its other partners, the Ministry of Health, Makerere University and Mulago Hospital Complex, resolved to start a Cardiac Clinic at Mulago with its first director being Prof. Francis Omaswa who later became Director General of Health Services and now Chancellor of the Busitema University in Tororo.  The second Uganda Heart Institute Director was Prof. Roy Mugerwa.

Earlier on, in 1958, a Cardiac Clinic was started in a small office in Old Mulago Hospital.  The aim was to ensure that Ugandans with heart disorders were checked and given supplies of life sustaining drugs without break.

In 1962, when Uganda attained Independence, the National and Grindlays Bank donated British Pounds Sterling 8,000 as an “Uhuru Gift” to the Cardiac Clinic to help purchase the Cardiac Catherization machines which was installed in the Department of Medicine and named the “Cardio-Pulmonary Laboratory”. 

The unit by then grew steadily and by 1966, it was a fully-fledged Cardiology complete with Catherization laboratory able to manage closed heart surgery.

By 1968, Cardiac surgery was well established as a unit within the Cardiac Clinic under the management of Dr. Lindy Grigg.  In the 70’s the Cardiac Clinic’s Surgical Unit successfully performed a few open heart surgical procedures under circulatory arrest and profound hypothermia.

The progression of this Cardiac Clinic created great opportunities and by 1972, at least five Research Fellows had undertaken specialist training and these included Prof. Paul Darbella, Prof. Kanyerezi and the young ones were Prof. Francis Omaswa who later became the first African Cardiologist Surgeon in East, Central and Southern Africa, Prof. Roy Mugerwa, Dr. Batambuze and Dr. George Zirimbuzi.

This was the core team expected after their specialised training to man the Cardiac Unit but unfortunately following the Idi Amin’s coup in 1971, the Cardiac service dwindled progressively as the Clinicians left the country such that by 1978  there was no more specialised Cardiology services.

It was not until the Uganda Heart Foundation, Ministry of Health, Makerere University and Mulago Hospital Complex resolved to establish the Uganda Heart Institute in the late 1988 that the Cardiology services resurrected.

Special buildings and wards were earmarked for the comprehensive Cardiology services and Ward 1C at Mulago Hospital Complex was allocated to Uganda Heart Institute for its operations.

Today, the Uganda Heart Institute recognising its potential growth in medical care to patients with Cardiovascular and thoracic diseases is the first and the only facility of its kind in Uganda offering specialised health services to patients with Cardiovascular and thoracic diseases.

Having given you a synopsis background of the history of Cardiovascular Clinic and the subsequent establishment of the Uganda Heart Institute, let me now turn to the current status of the Uganda Heart Institute, what it is capable of doing, and why Ugandans should be proud of their Institutions, patronise them and effectively support them to the till.

As Chairman of Uganda Heart Institute, who has been there since it started and witnessed its growth, I am proud to say that the Uganda Heart Institute is a wonder to the people of Uganda. A landmark in the development of Cardiovascular disease treatment that Ugandans should be proud of.

What do you find at the Heart Institute today

·         The Uganda Heart Institute is enhanced in its service delivery by its total commitment of its management, the board, the clinicians under its director, Dr. John O.O. Omagino, his deputy, Dr. Peter Lwabi, backed by the chief surgeon, Dr. Tom P. Mwambu and others

·         The dedication of the nurses both in the wards and intensive care units

·         Commitment of staff in auxiliary units such as accounts, pharmacy, security, administration and human resources

·         Ensuring of quality and first class services and the patient care

·         Quick and prompt handling of patients and ensuring maximum attention to our clients

To ensure that the above is achieved and implemented, the Uganda Heart Institute probably has the best management team in the region with patriotic approach and the desire to serve the people of Uganda. 

Again, to ensure that Uganda Heart Institute reflect positively and implement the Strategic Development Plan, the Uganda Heart Institute probably has the best and experienced people as board members under its Chairperson, Hon. Robert Ssebunnya and Rtn Sam Owori Vice Chairman, Prof. Francis Omaswa, Prof. H. Mayanja, Prof. Paul Darbella, Dr. Lawrence Kagwa, Dr. Sam Zaramba, Dr. Amandua, Prof. Gordon Wavamunno, (Mulago Hospital) Dr. Omagino and Dr. Lwabi.

This Board is charged to ensure smooth management of the Institute and ensuring that proper services are given to Uganda at the Institute in addition to ensuring that the five year development plans are realised and achieved. The board is also responsible for the formulation of policies, guidelines and governance issues.

 Can Uganda Heart Institute handle complex operations?

Yes it can, currently the Uganda Heart Institute growth has provided the following:

a)    The best diagnostic services in cardiovascular thoracic diseases comparable to developed countries;

b)    Provide treatment for patients with Cardiovascular and thoracic diseases in both medical and surgical;

c)    Carry out research in Cardiovascular diseases in Uganda;

d)    Provide teaching/training in cardiovascular;

e)    Provide Uganda communities with health education and create awareness in cardiovascular thoracic and other related diseases;

f)     Human Resource – Ugandans are probably not aware that the Uganda Heart Institute has got the best, experienced, young and well trained dedicated doctors in the region capable of carrying out surgical operation of even complex nature. The challenge in this area is the lack of recognition of the super specialisation and the low salary scales. This is a great challenge which must be looked into otherwise the few super specialists will have no alternative but to leave.

g)    Equipments – The Uganda Heart Institute today boasts of its state-of-the-art equipment with its recent addition of the Cath lab as the only type of its kind found in only three countries in Africa, Egypt, South Africa and Uganda. The recent acquisition of the Cath lab places the Uganda Heart Institute at the same level of these developed Cardiac Centres in the world, and this has turned Uganda Heart Institute to attract high profile Surgeons to visit Uganda frequently and carry out complex operations, an opportunity that gives our doctors a hands-on experience.

In addition, the Institute will be able to perform diagnostic coronary angiograms studies and intervention like stinting of stenotic coronaries devise closure of congenital defects, electrophysiological studies and radio frequency ablation. The operative open heart surgery procedures with complexity will be stepped up and substantially reduce the need for referrals abroad.

Equipping of the Institute with state-of-the-art equipment has done Uganda a lot of good in that the Uganda Heart Institute has entered and signed a number of Memoranda of Understanding with several visiting teams from renown and respected hospitals in Europe, Asia and America, who have agreed to come and operate on Ugandans and handle complex cases. 

MoUs has concretely provided an opportunity to carry out open heart surgeries on more than 100 Ugandans every year.  We are also seriously considering inviting over collaborating partners from renowned heart institutions abroad to come and handle more complex operations on Ugandans, should there be need for those cases requiring that kind of management.

Just last week, a visiting team from America did 13 open heart surgeries and about 16 stinting procedures. Last year, 2012, about 60 Ugandans benefitted from the open heart surgery and we want to assure fellow countrymen that these kind of arrangement will continue.

All these operations are carried out by Ugandan surgeons with our visiting specialist giving guidance at the operating table.  To us, this is the best training of our doctors with real hands on experience, which is otherwise not available when our doctors train at those Cardiac institutions abroad. It is incumbent upon Ugandans to appreciate what our Ugandan doctors are doing, support them and be proud of their Institutions. 

Those Ugandans crying out to go out for open heart surgery go to the institution where these visiting doctors come from.  Imagine the cost of operation is about $10,000 to $15,000 depending on the complexity of the case plus the air ticket, hospital and hotel bills – these amount to a lot of money, whereas these operations can be done here. 

Sir Magib, an Egyptian, British born and renowned Cardiac Surgeon ranked Uganda Heart Institute Surgeons as good as any other Cardiac Surgeon you will find in Europe or America.  The equipment we have may not be easily found in many Cardiac Clinics abroad.

The support from these visiting teams is enough to give Ugandans hope and assurance that Ugandan Doctors at Uganda Heart Institute can actually handle these complex operations. President Museveni has gone out of his way to support Uganda Heart Institute and we appreciate this invaluable gesture. 

He has personally expressed his concern to his minster and to me about the growing number of Ugandan patients being referred abroad for open heart surgery. Uganda Heart Institute can handle these operations especially now when the Uganda Heart Institute has got its own dedicated theatre.

I am appealing to Ugandans, especially Civil Servants, to be proud of what we have at the Institute and to feel safe that the Ugandan Doctor’s hand can save your life through open heart surgery. Give them a chance to prove that they can make a difference in this area. 

There are operations at the Institute every day and we have not witnessed any casualty so far. Those Ugandan children and adults numbering over 150 so far operated by our doctors are fit and healthy.

I would like to see the medical board approving these referrals to work with the management of Uganda Heart Institute before referring them abroad. Do not forget that, if it is a complex case, those very doctors, who would operate on you abroad, can also fly in and handle you at the Uganda Heart Institute thereby saving Uganda’s foreign currency and building confidence in your Institution. The equipment they use on you abroad are the very equipment if not better we have here.

Finally, there are challenges that are outlined in our five-year strategic development plans.

These we will solve and find solutions to them as we move on and develop; what is important now is that Uganda Heart Institute needs your full support in our process to grow and develop.

The writer is the chairman and founder of Uganda Heart Institute (UHI)