How to save more lives and reduce the brain drain— Experts

Governments at all levels have been advised to better respond to the demands for treatment and management of cardiovascular disease (CVD) in Nigeria.

It will help save more lives and reduce the brain drain, ROYAL NEWS reports.

The experts made the call in separate interviews with the Nigerian News Agency (NGA) on Monday in Lagos.

According to the World Health Organization (WHO), cardiovascular diseases (CVD) are a group of disorders of the heart and blood vessels.

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

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

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

The WHO says that CVDs account for 17.9 million deaths worldwide in 2019 and 85 percent of these deaths are due to heart attacks and strokes.

The Federal Ministry of Health (FMoH) also noted that cardiovascular disease is a public health problem responsible for 11 percent of more than two million NCD deaths in Nigeria annually.

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

CVD risk factors present in individuals include high blood pressure, high blood glucose, high blood lipids, overweight and obesity.

Cardiac Care: Open Heart Surgery Underway in Lagos

Surgical operations are sometimes required to treat cardiovascular disease, especially if other treatments fail or cannot be used.

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

On the development of cardiac surgery in Nigeria, Dr. Bode Falase, Consultant Cardiothoracic Surgeon and Head of the Cardiothoracic Division at Lagos State University Teaching Hospital (LASUTH), spoke with .

He said that 13 centers currently perform cardiac surgery 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.

According to Falase, in 2021, 200 heart surgeries were performed at the centers.

He noted that it was gratifying that the surgeries were performed in institutions that perform the surgeries, adding that this would allow transfer of skills and eliminate waiting time for patients.

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

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

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

“The WHO estimates that for the size of Nigeria, we should be doing 40,000 surgeries a year, yet we have only managed to achieve 200 cases in 2021.

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

“In the Western world, the government bears the burden of financing to fill the gap through effective health insurance coverage for citizens.

“For example, at LASUTH, if the government says it can fund 100 cases a year and we know the money is there, then we’re not just testing patients, we’re operating.

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

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

However, he said that many chose to travel outside of Nigeria to train due to the low number of heart surgeries currently being performed in the country.

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

Falase also said he noted that performing surgery was a challenge that prevented patients from undergoing it, adding that most of the patients were indigent.

According to him, the average cost of a valve replacement operation at LASUTH is N3.2 million, while a normal “hole in the heart surgery” ranges from N2.5 to N2.7 million.

The surgeon called on philanthropists and non-governmental organizations to help fund surgeries for heart patients at LASUTH, noting that the government alone could not do it.

Falase maintained that the success recorded in his cardiac surgery was driven by the cardiac surgery team that, in collaboration with the cardiology unit, supported the management.

Additionally, Dr. Setemi Olufemi, a cardiothoracic surgeon at LASUTH, noted that the prices of consumables, which are mostly imported and based on a single user, were responsible for the cost charged for cardiac surgeries.

Olufemi expressed his optimism that the establishment of more heart centers would lead to higher demand and help reduce the cost of consumables used for heart surgeries in Nigeria.

Olufemi, who noted that diagnostic tests are critical to diagnosing and managing heart problems, however, said few diagnostics are currently done in Nigeria.

According to him, the diagnosis of heart disease is not guesswork but highly specialized diagnoses, some performed in a cardiac catheterization laboratory (Cardiac Cath Lab).

The cardiac catheterization laboratory is a specialized area of ​​the hospital where doctors perform minimally invasive tests and advanced cardiac procedures to diagnose and treat cardiovascular disease.

He said there were 10 functional cardiac cath labs in Nigeria, with the LASUTH cath lab expected to start within a month.

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Similarly, Dr. Okechukwu Ogah, national president of the Nigerian Heart Society, noted that the country’s progress in cardiac surgery has been tremendous in recent years.

Ogah, who is a cardiologist at University College Teaching Hospital (UCH), Ibadan, said the government should be interested in cardiac care through expanding facilities at existing centers and establishing 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 the development of an effective and sustainable health insurance system that addresses the treatment of most diseases.

Ogah also said that the difficulties experienced during the importation of health equipment must be reduced for the country to have a dynamic cardiac care program.

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