Review by The Eye

Uganda’s First Open Heart Surgery

International Hospital carried out the first two cases of open heart surgery in Uganda in Aril this year. These were the repair of Atrial-Septal Defects (ASD) commonly known as a hole in the heart.

The first person to have open heart surgery performed was Atwine Mark, a thirteen year old boy from Bushenyi, who was diagnosed with a hole in the heart four years ago. The second case was David Kalenjera, a seventeen year old boy, diagnosed six years ago in January 2001. Both families had been unable to raise the money to have the procedure carried out abroad and had looked on helplessly as their children failed to thrive, progressively become weaker and fell behind at school.

The surgery was carried out under the auspices of Hope Ward – the charity wing at International Hospital, funding for which has come from fund-raising events, corporate sponsors and IHK itself.

The cardiac team was led by Dr Clement Akomea Agyin, a consultant cardiac surgeon, currently working in St Anthony’s Hospital London. Dr Clement is a British National of Ghanian extraction, who is married to a Ugandan. The heart lung by-pass machine was operated by a perfusionist Mr John Francis Nelson, who accompanied Dr Clement. The rest of the team was Ugandan.

Dr Ian Clarke, Dr Moses Galukande and Dr Clement Agyin have been developing this project over the past eleven months. The project became feasible when Dr Clement obtained a heart - lung by-pass machine from St Anthony’s hospital. IHK procured the other necessary monitoring, anesthetic, theatre, intensive care and laboratory equipment and sent a small team of theatre nurses to Mulago to gain experience in cardiac surgery.
The significance of this first open heart surgery in Uganda is not only that scores of patients who have been awaiting this procedure can now be treated within their own country, but that a benchmark has been established. IHK have been working steadily over the past number of years to reach the standards necessary to perform such high level surgery.

During surgery the patient was constantly monitored by both invasive monitoring devices and external monitoring, for intra-arterial pressure, central venous pressure, ECG and BP, core body temperature, acid base balance, blood gases. During the procedure the blood is diverted from the heart through the heart lung by-pass machine, the heart is then paralysed, opened and the hole in the heart repaired, as the blood is circulated through the rest of the body by the by-pass machine. At the end of the surgery the paralysis of the heart is reversed and the circulation is restored to the heart. After surgery the patient is closely monitored in Intensive Care Unit.

IHK plans to carry out open heart surgery several times per year, through Hope Ward. The anticipated cost of each case is in the region of $6,000. IHK hopes to raise these funds through donor organizations, fund raising events, contributions from patients and well wishers. A further seven cases will be carried out later this year. Mark and David are doing well and will now have a normal life expectancy.

Although this has been a milestone for International Hospital and the medical team involved, they do not intend to stop there, but have plans to continue to source more sophisticated equipment in order that other high level procedures can be carried out within Uganda. This will result, not only in benefit to the individual patient, but will increase the capacity of the medical profession in Uganda thus closing the gap between third world and first world medicine.