Huge milestone in heart surgery
It costs the government up to N$4 million per patient to send them abroad for this specific procedure.
Namibia has reached a significant milestone in healthcare with a breakthrough in the treatment of congenital heart conditions which will save the government millions of Namibia dollars every year.It costs the government up to N$4 million per patient to send them abroad for the procedure in question. Last week, a Namibian team of specialists led by the head of the department for paediatric and congenital cardiology at the Windhoek Central Hospital, Dr Fenny Shidhika, performed nine complex congenital heart surgeries. This includes several highly complex neonatal surgeries.
Some of the young patients included babies aged 18 days and three weeks, as well as one aged 13 months who had been dependent on oxygen since birth. These operations in particular are extremely complex because babies have immature organs that are extremely vulnerable after exposure to the heart-lung pump machine.
In the same breath, they also have a small heart that is comparable to the size of a walnut and equates to technical complexity that requires higher precision and careful handling.
The local team of Dr Alfred Mureko and Dr Ismail Awala was supported by a surgeon from the Newcastle Upon Tyne Hospital in Britain.
Dedicated budget
Shidhika, Namibia's first female paediatric cardiologist, says the country is privileged that the government has allocated a dedicated budget for cardiovascular services. The latter is part of the overall expenditure on health and consists of 8% to 9% of the gross domestic product (GDP).
She explains the financing model follows a tax-based approach to healthcare similar to the Beveridge system by covering more than 90% of the population without private insurance. Currently, the budget is only about seven to eight million which is insufficient for the needs of both the adult and paediatric population who require specialised care.
Shidhika recently completed her MSc in Health Economics, Outcomes and Management in Cardiovascular Sciences from the London School of Economics and Political Science.
"The Namibian government bears a significant part of the national burden of heart disease. As a result, the Namibia Children's Heart Trust was established to ensure accessible, affordable and equal care for all children and adults born with heart disease regardless of their socio-economic status. The trust is run on the principle that quality healthcare is driven by need and not by ability to pay for it," Shidhika explained.
Surgical team
The surgical programme for congenital heart disease in Namibia was started in September 2018 and includes Dr Alfred Mureko, the first Namibian adult cardiothoracic and congenital heart surgeon and Dr Ismail Awala, an adult cardiothoracic surgeon.
Also part of the highly skilled team is Dr Nicolaas Feris, the first Namibian cardiac anaesthetist and Siphamandla Simelane, a South African cardiovascular perfusionist responsible for the management of the cardiopulmonary bypass machine. The team is supported by specialists Dr Kaiser Fitzwanga and Dr Tjiandjeua Kandetu who specialises in the care and treatment of paediatric patients in intensive care.
"The Namibian government has invested significantly in training and developing the skills of specialists. It costs the government an average of N$7 to N$10 million to train one sub-specialist, mostly in South Africa, and which covers salaries and expenses for training. The investment is essential to build a skilled, multi-disciplinary team that can meet the country's needs for heart health," says Shidhika.
Significant saving
According to the Ministry of Health and Social Services Executive Director Ben Nangombe, the breakthrough will save the government millions of Namibia dollars in logistics and operations carried out outside the country.
"We spend millions of dollars on these operations in South Africa, Zimbabwe or Kenya. We have to pay for air ambulances and for the patients we send for their accompanying family members, the operation, as well as aftercare for the patient. It can cost up to N$4 million for one patient. We also need to think about the anxiety and uncertainty we now reduce when we send patients across the country's borders for surgery. Imagine a person having to fly three or four hours for such an operation. Sometimes patients have to travel as far as Germany or Austria and these can be people who have never been outside the country's borders," Nangombe says.
Furthermore, flying for long hours for an operation can have a significant impact on the patient's health. However, Nangombe says there may still be exceptional cases that are still being treated abroad.