Diseases of heart and blood vessels have risen to become one of the major causes of illnesses and deaths in the country.
Non-communicable diseases, including heart diseases, contribute to 40 per cent of deaths in the country, according to Ministry of Health.
But the country has in response to the rising burden of the diseases, made great strides to improve quality and access to care for the patients, which is curbing deaths. Although there are still challenges.
Establishing Uganda Heart Institute (UHI) as an autonomous body in 2016 and training cardiologists (heart specialists) who are working at the institute and other health facilities across the country underpin the improvement.
UHI started in 1956 as a simple cardiac clinic at Mulago Hospital but has since transitioned to a specialised leading provider of cardiovascular (heart and blood vessels) services in the country.
Dr John Omagino, the director of UHI, which is mandated by government to provide care and promote prevention of cardiovascular diseases, says they have modern equipment to handle various cases.
Dr Omagino, a cardiac (heart) surgeon, says the institute handles more than 20,000 patients with cardiovascular diseases annually, and that they have performed more than 7,000 heart operations since it started open heart surgery in 2007.
Care for the patients is provided by cardiologists who work with other medical workers such as cardio-respiratory physiotherapists, laboratory personnel and biomedical engineers.
Dr Ellias Sebatta, a consultant adult cardiologist at the institute, says a typical day of a cardiologist is characterised by treating patients with heart complications, hypertension and conducting major operations.
“Our work starts from simple interventions such as taking blood pressure measurement, to specialised care where you unblock blood vessels, insert pacemakers to modifying heart rhythm, and you use machines to treat the heart,” he reveals.
A pacemaker is a small electrical device that is fitted in the chest or abdomen to treat abnormal heart rhythms that can cause your heart to either beat too slowly or miss beats.
He says surgery is done by cardiac surgeons who specialise in operating on the heart, its valves and structures, and the important veins and arteries near it.
Becoming a cardiologist
To become a cardiologist, Dr Sebatta says requires one to spend 11 years studying at university.
“In Uganda, you start with a basic medical degree [Bachelor’s Degree in Medicine and Surgery] which takes five years,” the expert narrates.
He adds: “From then, you proceed to do a master’s degree to become a physician or paediatrician which takes three years of studies.”
After this, one goes back to university again to do another master’s degree in cardiology for three years to become a cardiologist, according to Dr Sebatta.
Dr James Kayima, a consultant cardiologist at UHI, who is also a lecturer at Makerere University Medical School, revealed that the country has a total of 18 cardiologists.
“We have 12 cardiologists for adults and six have specialised in treating children. Most of them are based at UHI which is in Mulago. The specialists work in different care centres in the country,” Dr Kayima says.
The consultant reveals that to become a cardiac (heart) surgeon, one takes at least 12 years in university education.
“You have to complete five years in basic medical degree and after this, you go for a master’s degree in surgery which takes another three years. You then proceed for another four years to do a master’s degree in cardiac surgery,” Dr Sebatta reveals.
Dr Sebatta says although most specialists in the country, including himself were trained abroad, UHI is now training cardiologists.
“We are handling 95 per cent of the adult cases that require operations, and 85 per cent of cases among children in Uganda,” Dr Omagino reveals.
The statistics from the institute, indicate that 67 open heart surgeries, 47 closed heart and thoracic surgeries, and 318 catheterisation procedures were performed in the last financial year 2019/2020.
Catheterisation procedure is done to diagnose and treat certain cardiovascular conditions. It involves inserting a thin tube called a catheter in an artery or vein in your groin, neck or arm and threaded through your blood vessels to your heart.
Heart surgery is done to repair or replace damaged areas of the heart.
According to information from adult cardiovascular surgery division of UHI, the operations done at the facility include that to repair or replace heart valves. The valves allow blood to travel through the heart and control the flow.
Other operations done at the UHI include coronary artery bypass graft surgery, repair of congenital heart defects, excision of cardiac tumours, pericardial surgery and cardiac aneurysm repair, among others.
Operating on a patient costs about $5,000 (Shs18m) at UHI, which is several times lower the $20,000 (Shs72m) for operations performed abroad, according to information from the institute.
Dr Sebatta says the heart has many diseases such as abnormalities in heart rhythm and coronary artery disease which occurs when fats build up plaque in blood vessels in your heart and block blood flow.
He reveals that the other common diseases of the heart include diseases of valves that control blood flow in the heart, heart disease one is born with, heart failure and heart attack.
“We are experiencing a rise in heart diseases and this is caused by factors we can control and those that are beyond our powers,” the expert says.
Dr Sebatta says the risks of developing heart diseases increase as one gets older or following family history of heart disease, and that men are at higher risk than women.
“The cause we can control are related to poor diet. The diet which is very high in fats, salt, calories and sugar puts one at higher risk of developing heart and blood vessels diseases,” he reveals.
The expert adds: “People who are overweight and those with obesity are at higher risk of developing heart and blood vessels diseases.”
He says excessive alcohol consumption and smoking are the other risk factors.
Red flags for heart disease
“People who are experiencing palpitation (tremor), chest pain, shortness of breath, fainting, body swelling, dizziness and those who easily get fatigued after a light physical exercise are some of the key alerts of heart diseases,” he says.
Pain, numbness, weakness or coldness in your legs or arms if the blood vessels in those parts of your body are narrowed, are the other alerts of heart disease according to mayoclinic.org.
How can one prevent heart diseases?
Dr Sebatta advises people to cut down on sugar and salt intake.
“For alcohol, you are advised to take moderate amounts, but for smoking, you have to stop completely,” the expert says.
He adds: “The diet has to have less fats, less in sugar, salt and calories. But it has to have more of fruits and vegetables.”
Dr Omagino says organisations and employers should put in place centres where people can do exercise to curb heart diseases.
He appealed to people to go for regular check-ups to know their heart rate and blood sugar.
“Every employer should have a facility for physical exercise. People should be sensitised in all gatherings about the importance of physical exercise and screening for cardiovascular diseases,” the UHI director says.
Access to care
But Dr Kayima says many patients are still failing to get care due to rising burden of heart diseases.
“The waiting list is long, especially in the children’s unit. The services cannot be accessed by all these patients, that is why some people are looking for money to go to other centres [abroad],” he said.
Outpatient attendances at the facility rose from 15,343 in 2018/2019 to 17,583 in 2019/2020 financial year, according to information from the institute.
Other facilities such as International Hospital Kampala and UMC Victoria are among those providing treatment for heart patients.
The ministerial policy statement for 2020/2021 financial year for health sector shows that the institute failed to provide 36 per cent of cardiac interventions that were planned to be performed.
It indicates that “5,783 out of 8,000 planned echocardiography and 4,506 out of 7,000 planned electrocardiography, 54,373 out of 75,000 planned laboratory tests were done in 2019/2020 financial year.” Dr Kayima says the country is grappling with the challenge of few cardiologists who are providing care to ever increasing numbers of patients as disease burden and population size rise.
“We have a lot of patients that should be handled. Ideally, there should be one cardiologist per 20,000 people. But right now we have around 18 cardiologists for the over 40 million people in the country,” he says.
The specialist explains that the disease burden is being driven by lifestyle changes which increase the risk of cardiovascular diseases.
“We know that a third of the population has high blood pressure, and the incidence of diabetes and obesity is increasing, which worsens one’s risk of developing heart diseases. This increased the proportion of patients coming to hospital,” Dr Kayima says.
He adds: “We have only one centre that offers surgery for heart diseases, so that alone is a challenge. But there are some private facilities in Kampala that are treating heart patients.”
Dr Charles Olaro, the director of clinical services at Ministry of Health, says they are decentralising heart care and supporting training of medical workers in hospitals across the country to provide basic care to heart patients.
“We are setting up regional heart centres in Regional Referral Hospitals in the country. In Masaka Regional Referral Hospital, they are already medical workers who have been trained to provide heart care through fellowships from UHI,” he said.
He said the training and setting up of the centres will be done in Mbarara, Gulu, and other facilities.
“We are also running outreaches in regions to sensitise people but also screening for conditions like hypertension and diabetes which are the risk factors for heart diseases,” the director of clinical services said.
Dr Olaro said they are also equipping public health facilities in the country with equipment for echocardiography and electrocardiography which are important in diagnosing heart complications.
He said the ministry had given blood pressure machines and trained medical workers in lower health centres to use for screening but that some equipment got spoiled or lost over time.
Payment for specialists
According to Dr Kayima, the country is losing the few cardiologists and surgeons due to low payment.
Dr Robert Ssebunnya, a former board chairman of the UHI who is also the presidential advisor on Buganda Affairs, in an open letter to the President last year, asked government to review the compensation policy for heart surgeons in the super specialist category to curb the migration to foreign countries.
This, he says, will avert the inevitable brain drain.
He says the country has spent a lot of money training specialists but has failed to put in place structures to retain them.
“An intensivist abroad is paid on average $20,000 (Shs77m) monthly plus other benefits, within Africa $10,000 (Shs38m) per month is the average. In Uganda the Public Service salary scale does not provide for super specialists, so they draw the salary of an ordinary medical consultant which is Shs7m,” Dr Ssebunnya wrote.