Dr-Adenle-2kkDr. Adebisi David Adenle is a Minnesota, USA-trained cardiologists and Chief Medical Director, Biket Medical Centre, Oshogbo, Osun State. Recently, he conducted many heart surgeries, especially on children who have holes in their heart. He spoke to DANIEL ANAZIA on the challenges of operating upon children born with the disease.

 

The number of young people who have holes in their hearts has been on the rise in Nigeria. Why is this so?

 

Hole-in-the-heart is common in any population of the world. It’s a structural defect as a result of mal-development of walls that separate the chambers of the heart. We have it in America, in Europe, Asian and in Africa. Unfortunately, it is now that we have the state-of-art equipment to detect these problems and that is why it appears as if it’s becoming a household name. When we discover this problem, the only suggestion for the mothers and relatives of the patient is for them to close it up, otherwise, the muscles of the heart will be overloaded. When the muscles are overloaded, it stretches beyond its elasticity and will malfunction. When one of the hearts is overloaded, especially the right, it pumps more blood in the lungs. The lungs will then be flooded with water or fluid and the resultant effect is that air cannot move freely.

 

    The blood, which should have gone to the body properly, sometimes, from the left to the heart and to the body, is denied that passage. As a result, the whole body becomes short of nutrients. We have two parts of the heart, the right and the left sides. The right carries all the blood that has gone through tissues of the body. In most cases, good things like oxygen have been taken away from them and it returns to the heart for purification. Carbon-dioxide is taken from the body in an exchange for oxygen and it passes through the left side of the heart to the body. But when there is a hole in the heart, and the left heart is stronger, the blood is shunted from the left to the right and each shunted blood now over-floods the lungs. At this point, an unfortunate child is presented with cough and inability to breathe among others.

 

     Initially, it might be misconstrued to be ordinary cough but when it’s frequent, then try to see a doctor, and through a process of echocardiography, it will be detected. Without treatment, the child cannot survive adulthood. Sometimes, they won’t even survive the first year or even the fifth birthday. Unfortunately, we don’t have enough centres in Nigeria where this could be treated. Most times, we send them to India. And one must actually praise some of these institutions that champion the surgical management of these problems. We have come on board because we do much investigation and management of the heart. Sometimes, when we see this problem, we feel impotent, not being able to offer solution. This is why we have invested in the surgical management of this problem. We invested money in this because to open the heart and close the hole is not an easy task. 

 

     For you to do that the heart must not be beating and you must use a heart-lung machine. The exchange of gasses in the body will be taken over by the machine. It’s like you killed the patient, you stop the heart and lungs. Their functions are taken over by a machine and now you are able to close the hole and once that is done, you recharge the heart with blood again, and it begins to pump. All these are simple ways of treating it but a very complex procedure, needing a quite other equipment to support the work of a surgeon. It looks daunting, but with the cooperation of some of our colleagues at the University of Ife and Ibadan, we are able to start. 

 

Have you at any point in time ventured into open heart surgery as a private practitioner?   

 

Of course, we did the first one and at that time, they were eight patients. Some of them have holes in the lower chamber of the heart, while other at the upper chamber. Some were at the level of big vessels, emanating from the heart. Out of eight cases, we lost one of them. The reason was not because the surgery was not done properly but the hole had gone too far. And once it has gone too far, the chances of getting a good result becomes very difficult. This is why we are encouraging people to get this surgery done early enough when it has not affected the walls of the heart badly. Apart from that, the seven others were successful and still alive today. We have been following them up and they are doing fine. We were encouraged by this result and we did another mission, where we have five cases and all the five cases came out fine from the theatre and are still alive today. We are about to do another one this year November, and we are looking at, at least, 15 cases. We are quite optimistic that they will, as usual, be successful. We have been careful in the choice of the patients. Those that have gone too far that are not likely to do well; we have not attempted to put them in the list. 

 

This task is capital intensive and quite challenges. What spurred you into it?

 

  Well, I trained in 1979 in Minnesota in USA, and during my stay in the school, I found out that this is not beyond us. So, it has always been in my mind that I will get to a stage where I can solve these problems. Since 1979, I have been engaged in it. But it was only in the last 10 years that we decided to garner resources and make sure that we get the equipment of international standard needed for it. And when the Israelis working alongside our local experts, came for one of the missions, they were amazed at what they saw. One of them said this is equipment that one can get in any centre in Israel. When other people from India came, they were also surprised and that is why we were able to record big success in the practice. That’s why they have not denied us audience each time we invite them.  If our equipment are not good, they will not want to come again. 

 

Do you have any form of financial assistance except the technical support you got from India and Israel for the mission?

 

Now, what we have done was to borrow money from the bank at ridiculous interest rates to do these. We are still grappling with the interest on such loans. Apart from that, the hospital has invested money to support the mission and this is the reason we have recorded certain degree of success. But as you know, the consumables used in open heart surgery are extremely expensive, but if we are able to remove the cost of transportation for both the child and parent, it would go a long way in reducing the cost of treatment. And we are trying to reduce the cost of treatment so that the surgery becomes possible within the environment of the patients. If you have to go to America, for instance, you will secure visa, transportation and all that. Though I’m not saying that some cases will not be referred to India but it has to be more complex cases. We have to start somewhere to do the less complex cases so that we would have all the experiences to do more complex ones. We have also partnered with Kims Hospital in India. Apart from the technical help, we are still hoping to get some funds, which have to do with buying of equipment or paying for the consumables. 

 

   In the last two missions, there were quite a number of patients that were unable to pay. We have committed ourselves and patients admitted. Some said they were coming with the money but when they got to the hospital, we discovered that they were not able to pay. There was a case of a boy who had only N20, 000, and you know that such is nothing in open heart surgery. Before we knew this, we had taken him to the theatre. We tried to take him back again but the surgeon said he was going to operate on him. Then we have donations from people around and still couldn’t offset his bill. There are other cases that have not paid a dime but we operated upon them because they were already within the hospital. But certainly, we need help from philanthropists, governments, well-swishers, corporate organisations, religious groups, associations, social clubs and politicians among others because this project should mature to a stage where it would create jobs for doctors, nurses and lives are saved. 

 

What kind of help do you intend to get?

 

 Well-wishers could come whenever this mission is on, identifying with and donating for the surgery of some of the patients that could not pay their bills. Governor of Osun State has done a number of that in some cases. He had paid for three patients out of the cases in our records. And we are grateful to him. We have a number of patients that the government cannot continue to pay for. So, we need religious organisations, banks to help. In India, in one of the surgical homes, I was told that banks actually donated money to their organisation to ensure that unfortunate patients are treated. Banks, churches, politicians can do same here. This will give them their lives back. We have Biket Medical Heart Foundation, wired along this organisation but run on a different account in Oshogbo. We are on internet and websites. One can come to Oshogbo to see what we are doing. You cannot donate your heart as in the case of kidney, but you can donate your heart by paying to relieve an individual that is afflicted.

 

Based on these staggering challenges, how do you hope to embark on November mission?

 

 Again, we are praying because our target is to have at least 15 cases. So, you can be sure that we are going to be operating three patients per day for five days. And by grace of God, we will be able to meet this target. Some religious organisations have indicated interest to pay for some patients. Unique FM in Ilesha has taken it as a challenge collecting money to pay for one of their patients. If many people or organisations are doing this, we will not be where we are now. 

 by Daniel Anazia