Health Practitioners’ Seek Govts’ Intervention on Cardiac Care in Nigeria

By Sharon O. Isaalah

Experts in cardiac care have appealed to the Federal and State Governments to be more responsive to the demands of treating and managing Cardiovascular Diseases (CVDs) in Nigeria.

According to them, it will help to save more lives and reduce brain drain.

The experts made the appeal in separate interviews with newsmen on Monday in Lagos.

According to the World Health Organization (WHO) Cardiovascular Diseases (CVDs) are a group of disorders of the heart and blood vessels.

They include coronary heart disease (disease of the blood vessels supplying the heart muscle) and cerebrovascular disease (disease of the blood vessels supplying the brain).

Others include peripheral arterial disease ( a disease of blood vessels supplying the arms and legs), rheumatic heart disease (damage to the heart muscle and heart valves from rheumatic fever caused by streptococcal bacteria).

Congenital heart disease (birth defects that affect the normal development and functioning of the heart caused by malformations of the heart structure from birth) and deep vein thrombosis and pulmonary embolism (blood clots in the leg veins, which can dislodge and move to the heart and lungs).

WHO says CVDs account for 17.9 million deaths globally in 2019 and 85 percent of these deaths are due to heart attack and stroke.

The Federal Ministry of Health (FMoH) also noted that CVDs are issues of public health concern responsible for 11 percent of more than two million non-communicable diseases deaths in Nigeria annually.

According to the ministry CVDs are responsible for a high burden of morbidity and disability.

Risk factors for CVDs present in individuals include raised blood pressure, elevated blood glucose, high blood lipids, overweight and obesity.

Sometimes, surgical operations are required to treat CVDs, especially if other treatments fail or cannot be used.

These operations include coronary artery bypass; balloon angioplasty (where a small balloon-like device is threaded through an artery to open the blockage), valve repair and replacement, heart transplantation and artificial heart operations, among others.

On the development of heart surgery in Nigeria, Dr Bode Falase, a Consultant Cardiothoracic Surgeon and Head, Cardiothoracic Division, Lagos State University Teaching Hospital (LASUTH) told newsmen that 13 centers at present conduct heart surgeries in Nigeria.

According to him, the centers are at LASUTH, Obafemi Awolowo University Teaching Hospital, Ile-Ife; University College Hospital, Ibadan; Reddington Hospital, Ikeja; and First Cardiology Consultants, Ikoyi, Lagos.

Others are Tristate Heart and Vascular Center, Babcock University Teaching Hospital, Ilishan-Remo, Ogun; Nizamiye Hospital, Abuja and Lagoon Hospitals, Lagos, among others.

Falase further reveals that 200 heart surgeries were carried out across the centers in 2021.

He noted that it was gratifying that the surgeries were done by local expertise in institutions conducting the surgeries, adding that these would allow for skills transfer and eliminate patients’ waiting time.

“If we are waiting for visiting foreign teams to conduct the surgery, you can’t train people or pass on the skills and you will have a long list of patients waiting endlessly for surgery,” he said.

Falase noted that although cardiac specialists and stakeholders were proud of the current surgical procedures, the number was low compared to the country’s disease burden.

According to him, Nigeria has the expertise and facilities but the cost of surgery is high for most patients.

“WHO estimates that for Nigeria’s size, we should be doing 40, 000 surgeries yearly, however, we’ve only managed to achieve 200 cases in 2021.

“We have the facilities and expertise in the country, but most patients cannot afford the cost of surgery.

“In western world, the government takes the burden of funding to fill the gap through effective health insurance coverage of the citizens.

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“For example, in LASUTH, if the government says it can fund 100 cases a year and we know the money is there, then we are not just assessing patients, but also having surgery.

“If we have 100 surgeries planned for a year, imagine the number of training that goes on for surgeons, nurses, and other cadres involved in the procedure,” he said.

Falase said that performing more surgeries would address the challenge of brain drain since many cardiac professionals were interested in staying in the country.

He, however, said many opted to travel outside Nigeria to train due to the low number of cardiac surgeries currently performed in the country.

According to him, there are 75 cardiac surgeons registered in Nigeria while about 12 of them had left the country.

Falase also noted that financing of surgery was a challenge that impeded patients from surgery, adding that a majority of the patients were indigent.

According to him, the cost of average valve replacement operation at LASUTH is N3.2 million while a regular `hole in the heart surgery’ ranges between N2.5 and N2.7 million.

The surgeon appealed to philanthropists and non-governmental organizations to assist in funding surgical interventions for cardiac patients in LASUTH, noting that the government alone could not do it.

Falase maintained that the success recorded in its heart surgery was driven by the competence of the cardiac surgical team, in collaboration with the cardiology unit, supported by the hospital’s management.

Also, Dr Setemi Olufemi, Cardiothoracic Surgeon at LASUTH, noted that prices of consumables which are mostly imported and single user based were responsible for the cost being charged for heart surgeries.

Olufemi expressed optimism that establishment of more cardiac centers would lead to more demand and assist to reduce cost of consumables utilized for heart surgeries in Nigeria.

Olufemi, who noted that diagnostic tests were fundamental to diagnosing and managing cardiac problems, however, said that currently, few diagnoses were carried out in Nigeria.

According to him, diagnosis of heart diseases are not guesswork but highly specialized diagnoses, with some done in a cardiac catheterisation laboratory (Cardiac Cath Lab).

Cardiac Cath Lab is a specialized area in the hospital where doctors perform minimally invasive tests and advanced cardiac procedures to diagnose and treat cardiovascular disease.

He said that there were 10 functional Cardiac Cath labs in Nigeria, with the LASUTH Cath lab expected to start in a month.

Similarly, Dr Okechukwu Ogah, National President, Nigerian Cardiac Society, noted that the country’s advancement in heart surgery had been tremendous in the last few years.

Ogah, who is a Cardiologist at the University College Teaching Hospital (UCH), Ibadan, said that the government should be interested in cardiac care through scaling of facilities at existing centers and establishment of new ones.

He called for increased investment in advanced training for cardiologists, cardiac surgeons and allied professionals associated with cardiac care.

He said that efforts should be made to subsidize cardiac care through development of an effective and sustainable health insurance system that would cater for treatment of most diseases.

Ogah also said that difficulties experienced during importation of health equipment should be reduced for the country to have a vibrant cardiac care programme.

He proposed the implementation of tax incentives to encourage more investment in cardiac care in addition to funding of research to advance cardiac services in Nigeria.