Heart patients dying due to delayed surgery

Kampala. With her feet swollen, struggling to breathe and suffers constant chest pain, Kalista Nakalembe, 2, was months old when Uganda Heart Institute (UHI) in 2017 detected that she had a heart defect.

However, despite her parents securing Shs19m to fund her surgery, the toddler had to spend the whole of 2018 fighting for her life as she waited for other patients on the institute’s long list of pending surgery to undergo the procedure before she could be booked in.

“We had to wait till March, this year, when the operation was done. She would cry every time,” her mother Catherine Anyime, 24, said.
She added: “The delays also mean spending more money treating other illnesses that come pending surgery, from the little we would raise from friends and family.”

Such delays have worsened many surgery outcomes for patients, according to UHI officials, citing space constraint.
The 52-bed capacity facility handles patients referred with super-specialised cases. It also manages patients who walk in with emergencies induced by other conditions.
Just like Nakalembe, there are currently more than 500 other patients on UHI list, and each has to wait for a minimum of a year before undergoing actual procedure.

The condition
Dr Peter Lwabi, the UHI deputy executive director, says the facility has got only four Intensive Care Unit (ICU) beds, which is essential for a patient’s stable recovery.
“Being on the waiting list comes with risks because your condition may deteriorate further and there are actually patients we have called after getting a slot only to find that they have passed on,” Dr Lwabi said.

An ICU bed is a high dependency bed where patients are monitored after the procedure with various sophisticated equipment that can help you manage your patients’ heart rate, oxygen levels and blood pressures --- all important after the procedure.
Dr Lwabi declined to share the number of heart patients who have died while awaiting surgery, although he said majority were children.

Statistics
The institute receives 20,000 patients in its four departments; adult surgery, pediatric surgery, adult interventional cardiology and paediatric interventional cardiology. Each of these requires an ICU, but the departments share the four available against a minimum 14 beds threshold.

The space problem at the institute started four years ago when the UHI 12-bed ICU was handed over at the beginning of the Mulago hospital rehabilitation project with the hope it would be handed back better after two years.
Consequently, the number of procedures done by the surgical team are limited that each department has since dwindled to one.
Right now they do not operate at optimum capacity as only 400 procedures are conducted a year despite their potential to do up to 1,000 procedures if there was enough space and resources.

Intervention
The institute is also in the process of finding a potential donor to fund the establishment and equipment of a 200-bed hospital expected to house at least 40 ICU beds and be able to offer comprehensive services. The project is expected to cost Shs170b and the ministries of Finance and Health approved it.
Once the funds are found, the hospital will be established in Upper Mulago Hospital side where space has been availed as preliminary work and feasibility study have since been done. One in every four adults in Uganda has a heart problem, the survey reveals.

Funding gaps

The issue of space.
ICU will only help to step up the number of operations conducted, but not solve all problems if the funding gap is not addressed, according to Dr John Omagino, the UHI executive director.
“We have limitations in terms of space and operational budget. Many people are looking for money to access treatment here…” he told this newspaper last year.
Although they have the capacity to treat more than 85 per cent of all heart defects detected at the Institute, Dr Omagino said they are handicapped by insufficient funding.
He states that the Shs4.7b that UHI receives to finance its operations each year is a “drop in the ocean” due to increased demand for their services.
The debt-saddled facility requires Shs19 billion for its operations, according to Dr Omagino.

Cost of surgery. Each heart surgery costs $5,000 dollars (Shs18m), meaning that if they are to operate to their full capacity of conducting surgeries for 1,000 patients a year, the Institute would require $5m (Shs18b), excluding spending on general patients with heart failure and hypertension.
The levies at UHI are lower than the $6,500 (Shs23m) charged in India, the choice country with heart patients seeking treatment abroad.
An estimated 15,000 babies in Uganda are born with heart defects, according to UHI statistics, and half of them require surgery.

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