Recently, a team of Zimbabwean and Egyptian cardiac specialists successfully conducted open heart surgeries on 10 children below the age of 14 at Parirenyatwa Group of Hospitals. Sifelani Tsiko (ST), Herald Innovations Editor, speaks to team leader and specialist cardiovascular and thoracic surgeon Dr Simukayi Machawira (SM) to share new insights on life-saving operations which are gaining traction in Zimbabwe.
Can you tell us briefly about the operations? Were there any deaths or complications you encountered?
The children we operated on had defects or holes in the heart that resulted in abnormal blood flow. Four had atrial septal defect, four had ventricular septal defect and two had tetralogy of fallot (varying and common heart defects present at birth). All the patients operated on did well and have since been discharged.
Open Heart Surgeries(OHS) in Zimbabwe and most other African countries face numerous challenges, including lack of financial resources, equipment and consumables as well as inadequate health infrastructure. What is the importance of collaboration with other experts from Africa and other countries in addressing some of these challenges?
SM: Collaboration with African countries promotes the twinning of institutions. African countries understand the challenges we experience and have more insight. We have similar disease patterns and patient profiles. The majority of literature is predominantly based on West and East experience which does not necessarily reflect what is on the ground in Africa. The teams then have a better performance and the problem solving is easier.
ST: Which organisations supported you to carry out the special joint Zimbabwe-Egypt surgical camp?
The Government gave us the initial grant that enabled us to resume open heart surgery in June 2023 and most of the consumables we used were bought using this fund. The National Oil Infrastructure Company of Zimbabwe (NOIC) has also significantly assisted with funds. This is based on a relationship we have had with them since 2017 when they gave similar funding. Avenues Clinic has stepped in and has been supportive. They have assisted with nursing personnel, equipment, food and beverages. Simbisa Brands came in with food for the staff during the camp. The Gift of Life International and Rotary Club Harare Central also supported us immensely for this surgical camp to succeed. We are so grateful for their unwavering support.
The support motivated the staff. It has made some of the issues that would have impeded the progress made easier to overcome. Most patients would not have been able to afford the surgery without the donors. It has helped retain specialist personnel and projected that the local team can also do sophisticated surgery.
Every year more than 4 000 children in Zimbabwe are born with congenital heart conditions that require open-heart surgery. The country has a waiting list of up to 600 adult patients that need medical procedures. How much do you think the country needs to be able to assist these patients?
SM: The world standard is to keep a single cardiothoracic surgeon competent. They need to operate on 150 cardiac patients annually. If we look at America and Western Europe they perform about 1 300 cardiac surgery per million which is where I think we should aim for. To really get a functional cardiac unit we need something between US$12 and US$15 million. We once made a proposal and Government floated a tender which came to about US$12 million. For us to keep operating and to increase our numbers we need to upgrade the equipment, the units, the machinery and other equipment. But we want to continue operating even as we are. We can still do a lot. The most important thing is that we must show the country and the world that we can do it locally.
What is your estimate of the number of specialist cardiothoracic surgeons that Zimbabwe needs to fully carry out medical procedures on local patients?
The specific number of surgeons is difficult to say. There are a lot of complementary specialties that are necessary as well for optimum services. I believe each provincial hospital should have a cardiothoracic surgeon based there.
Open heart surgeon Dr Hisham Shawky and his team from Egypt supported the successful procedures which were done on 10 children. What is your comment on this special collaboration? What are some of the experiences you gained from such collaboration?
The collaboration was indeed a great success. All the patients did not require ventilator support after surgery, this shortened the ICU/HDU (High Dependence Unit) and hospital stay. This resulted in minimal complications and no death. The most important lesson was the value of a committed team.
How much does the country save when the procedures are done locally? How much does it cost to do the surgery in South Africa, India and other countries? One average, how much does it cost to conduct the procedure locally?
The cost is much less when performed locally. The patient and family have easier access to each other. In India, we are looking at costs of between US$12 000 and US$15 000 and for South Africa it's over US$20 000. The majority of cases done locally are between US$4 000 and US$7 000.
Are you charging local patients for the procedures? How much has the Government provided to support your team?
The sustainability of the programme is dependent on the funding, for the average patient the cost is catastrophic. Government gave a grant, thus patients have been treated on the basis of this grant. NOIC has donated funds to the programme, this fund is directed specifically at OHS. We account for each and every patient for continued support. The patient should still contribute something towards their health. We also urge other industries and non-governmental organisations to come on board to ensure the programme is sustainable.
What is the ideal size of medical teams you need to conduct a procedure? How long does it take on average to carry out a procedure?
he OHS team is a multi-disciplinary team. Overall for optimum performance we need a team of about 30-50. Ideally we should have an independent ICU and HDU. The average procedure is about 4 - 6 hours this includes the anaesthesia and operation time.
What are some of the complications you encounter when doing procedures on patients?
he more common challenges are with the obsolete or unavailable equipment, consumables and medications. The operation specific complications are bleeding, stroke, kidney failure and infection.
On the latest procedures you conducted, were there any complicated cases worth sharing with us? Tell us briefly about it.
Two of the patients were particularly challenging. There was a child who had a double chamber in the left atrium, we had to remove a membrane that was causing the double chamber. There was a child who had a ventricular septal defect that was sub-arterial, the main challenge was access. We had to open the aorta and the left atrium to be able to assess and repair the defect.
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Have you recorded any deaths on the 10 patients you operated on? What is your general comment on the patients now?
All our patients survived and nine were discharged within a week of surgery. The patient who delayed discharge had diarrhoea which was not related to the surgery. The outcomes of all the patients were remarkable.
At present the Parirenyatwa Group of Hospitals is the only institution conducting open heart surgeries in Zimbabwe. What is your comment on this?
SM: Zimbabwe is under economic blockade, this is reflected by the fact that OHS collapsed in 2002, resumed in 2016 collapsed again in 2018 before resuming in 2023. There needs to be a deductible fund, with the Government being the primary benefactor. Unfortunately, Parirenyatwa Hospital is the only centre in the country performing OHS. The reason is not by design, it has been doing surgery before. There is need to ensure it is sustainable before spreading out to the rest of the country. The danger of premature spread of such specialised care is poor outcomes and abandonment of the programme.
Looking ahead, how do you see the open heart surgery landscape moving in Zimbabwe and in Africa as a whole?
SM: Non-communicable diseases account for 40 percent of mortality in Africa. More than 40 percent of Africa's population is under 20 years. The future for OHS is bright in Zimbabwe. Gauteng Province in South Africa, with a population of 10 million has at least 17 centres that offer OHS. There is a need to make it a priority and with African countries' collaboration we should make a big difference.
