daniel chigunwe
For a long time, for many Zimbabweans a heart operation required one to travel to India or other countries. There were no resources to provide optimal cardiac surgery care in the country. Fast forward to 2023, the country now has the capacity and expertise to do that here. Patients should now start traveling to Zimbabwe from abroad for treatment instead, something that could enhance medical tourism in the country. In this report, Sifelani Tsiko (ST) Herald Innovations Editor speaks to Dr Wilfred Muteweye (WM), a cardio-vascular and thoracic surgeon on how they managed to bring high quality treatment close to home for the poor with limited resources. His team of cardiac health care specialists have taken a team approach to achieve excellent clinical outcomes.
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ST: What motivated you and your team to resuscitate open-heart surgery (OHS) in the country in June this year after more than five years with no such service in Zimbabwe?
WM: A number of factors motivated us to resuscitate open heart surgery. Firstly, our patients were being forced to travel outside Zimbabwe for open heart surgery. Not many were able to afford the fees in foreign countries as a result they would deteriorate and die at their respective homes. Secondly, we have the skill to offer the service locally so to us it made sense to push for the reintroduction of the service. Thirdly, when we mooted the idea to the ministry of health, they embraced it and gave their weight towards resumption.
ST: Dr Muteweye, it was not easy and cheap for you and your team to resuscitate open heart surgery in Zimbabwe. Can you share your experiences with us? What kept you focussed and determined to bring back open heart surgery to the poor and struggling heart patients?
WM: A number of reasons kept us focused. Firstly, we have a well-trained team of surgeons, anaesthetists, perfusion and critical care cadres. We knew that given the good support structures the program was going to be successful. In addition, we knew that once the programme took off, the beneficiaries were going to be Zimbabweans, irrespective of their political affiliations. Who knows who is going to be the next patient? Any person can have a cardiac emergency and hence benefit from the program. Therefore, for those reasons and many others, the programme had to recommence.
ST: The successful operation on 12 cardiac patients at Parirenyatwa Group of Hospitals in the capital, Harare was seen as a major milestone for the country’s healthcare sector. How do you feel about the success? What are your critics saying now?
WM: We are enthused by the results that we have so far, of course we know we have just scratched the surface. Many more patients are still desperately waiting for open heart surgery. The results that we have speak for themselves and we will continue to build on them.
ST: Can you briefly tell us about the history of open heart surgery in Zimbabwe right from the first case in 1959 up to 2023? How do you see the country moving in terms of cardiac surgery development?
WM: The first case of open heart surgery in Zimbabwe was reported in 1959. The surgeons then (Doctors NJ Micklem and GVS Wright) did not use a heart-lung machine but used external body cooling methods to stop the heart and reduce the metabolic rate. They were able to successfully operate on a 15 year -old boy who had a diseased pulmonary valve. In the 1970s and 80s, a philanthropic team from Loma Linda University, California, USA used to visit Zimbabwe and they would do open heart surgery. The team then managed to set up the local team which operated from 1988-92. Open heart surgery program became a kind of permanent feature from 1994, being run by the likes of Dr David Chimuka and Dr William Mahalu. However, in 2003, the program ceased due to lack of foreign currency to purchase the consumables. Over 400 patients had benefited. In 2016 the program resumed under the leadership of Dr Chimuka and ran until October 2018. Again the reason for cessation was difficulties in procuring consumables. On 22 June 2023, we operated the first of the 12 patients that we have done so far. The current resumption has been led by Dr Simukayi Machawira.
ST: What are some of the common services you offer to heart patients at present in the country?
WM: Most of the patients that we have operated had rheumatic heart valve disease and we replaced their valves. We are also capable of operating less complex congenital heart lesions in children who are born with heart lesions.
ST: What were some common health issues you encountered with the 12 patients you treated with heart surgery?
WM: At the moment we have operated nine patients with rheumatic heart valve disease, we replaced their valves. We also operated on one who had a heart tumour (called an atrial myxoma), another young man who had valve disease due to a connective tissue disease and another young man who had heart trauma with ruptured heart chambers and ruptured aortic valve (traumatic atrial and ventricular septal defects, traumatic aortic valve cusps dehiscence).
ST: Tell us more about your first patient and how her bravery inspired your team. What were some of your achievements for the first batch of heart patients? Any major issues of interest you may want to share with our readers?
WM: When we started recruiting patients it was not easy to get the first patient. Many were scared and developed cold feet. Our first patient was a young lady with rheumatic heart disease which had damaged one of the heart valves. She had suffered a stroke two years prior due to the disease. This lady was very brave, we explained to her all the possible complications of the procedure, including death, but she had no qualms about it. She even encouraged the second and third patients who were at the time scared of undergoing open heart surgery. We operated on her successfully, however on day four after the surgery she developed abdominal problems with infection in the abdomen and had to have emergency abdominal surgery. She succumbed to the infection on day 12 and the post mortem revealed that she had died of sepsis due to the abdominal infection. To date, she is the only patient that we have lost
ST: Most patients cannot afford open heart surgery and less than 10 percent of the population is on medical insurance. How much does cardiac surgery cost for a single patient? What do you think needs to be done to ensure the poor too have access to open heart surgery?
WM: Indeed, open heart surgery is expensive and out of reach for most of the patients. A single valve surgery costs around US$6 000 whilst double valve surgery is about US$9 000. So far the government has waived the fees for all the 12 patients, no one has been asked to pay. Going forward we need continued government support. In addition, we need support from the corporate sector and medical aid societies in assisting these patients. Furthermore, I think having a national health insurance scheme can go a long way in ensuring that the population is covered. I have noticed the success of such a scheme in Kenya. It is also important to note that these patients will continue to have lifelong financial requirements after surgery. Most will need to be on blood thinning tablets for life and to have regular tests to check for adequacy of these medications. This post operative cost is not steep but can be a financial burden for some patients.
ST: Some of the major bottlenecks that hinder the scale-up of surgical programs include lack of financial resources, economic sanctions, lack of equipment, training, consumables and brain drain. What do you think needs to be done in the immediate term and in the longer term to ensure the successful development of cardiac surgery in Zimbabwe?
WM: In as much as our country has many competing needs, I think the government needs to continue increasing funding to the health sector. A healthy nation is a wealthy nation. We also need partnerships and collaborations with other nations and institutions who have successful programs.
ST: Zimbabweans have been spending thousands of dollars seeking treatment abroad. Do you think the locals are getting a fair deal abroad? Do you think people now have confidence about your competence and suitability of facilities in the country?
WM: It’s not an easy question to answer. Many patients have been outsourcing surgical procedures outside and a number of them have received good services out there. However, some have received suboptimal treatment and have succumbed either while out there or immediately after coming back. Some have even had to have revision of their surgeries done locally. It’s not always true that foreign services are better. I think people need to develop confidence in local systems. I am sure any local surgeon in Zimbabwe irrespective of their area specialty knows our strengths and weaknesses, what we can do locally and what we cannot do. It is good to consult local expertise first before shopping for services outside Zimbabwe.
ST: Brain drain is still a major problem for Zimbabwe and this can easily derail the country’s open heart surgery programme. What can the country do to minimise the loss of skilled manpower and to sustain the survival of the cardiac surgery programme in the country?
WM: The government needs to find ways to incentivise the few health professionals that have remained within the system. Currently, we have three cardiac surgeons who are running the open heart surgery program in Zimbabwe but I will tell you that outside Zimbabwe we have more than five Zimbabwean heart surgeons working in the diaspora. All things being equal, home is always best. Monetary and non – monetary benefits need to be availed. This applies to all the health sector professionals and not just for open heart surgery.
ST: Looking ahead, what do you hope to achieve in terms of open heart surgery healthcare delivery in Zimbabwe? Do you have any plans to do complex heart surgery and expand healthcare to the rest of the country and region?
WM: To us the sky is the limit. Given the continued support in terms of medical consumable and equipment, we see ourselves expanding the open heart program to include complex cases like aortic arch cases, complex thoraco-abdominal aneurysm, complex paediac cardiac cases. Even heart transplants! For us to expand to the rest of the country we need more manpower. As our caseload of operations increases we are going to start training more personnel for open heart surgery. At the moment the training is being done outside Zimbabwe.
Online Reporter