Timely intervention could save young lives

Little ‘Vikasitha’ who is diagnosed with a hole in the heart is only a few months old. He was found by the authorities lying in the cold concrete floor at the Fort railway station. After being admitted to an orphanage ‘Vikasitha’ was referred to the Lady Ridgeway Hospital, the only medical facility in the country which is dedicated to Paediatric heart surgery.

After undergoing successful surgery to correct the defect in his heart, Vikasitha had to spend a further six months in a ward at the hospital for further treatment. According to the doctors he would reach adulthood without any further complications. The two year old ‘Sumudu’ from Medirigiriya is not so lucky.

Diagnosed with a congenital heart defect in his early childhood, he has gone from hospital to hospital with his parents in search of advanced treatment. He has been in the waiting list for a number of years.

His parents were not in a position to afford treatment at a private hospital or take their child abroad for surgery. Today his defect is beyond treatment, his heart cannot be fixed by surgery and it is inoperable.

Sumudu would not reach adulthood; his budding life would be severed before it reaches its prime. If his parents could have afforded the high costs to seek timely intervention at a private hospital or in an overseas medical facility his life would have been spared.

Future

The cost involved in Vikasitha’s surgery and after treatment at an overseas medical facility would have been over Rs.2 million. The average cost of a heart surgery at a private institution in Sri Lanka is considered to be beyond Rs.400,000 and can go up to millions. How many parents who bear children with congenital heart defects could afford such costs in this country?

“Ninety nine per cent who are referred to us can’t,” says Dr. Iresh Wijemanna, Cardio thoracic surgeon at the LRH. “We see them and listen to them everyday, not once or twice but 10-15 times on some days,” he adds.

In Sri Lanka for every 1,000 new births there are 6-8 born with congenital heart problems. Around 2,000-2,500 children are born every year with heart defects and 2\3 (1,400-1,600) of this will need surgery/intervention for their heart lesions.

With timely intervention and proper treatment 90 per cent heart patients could be CURED and would reach adulthood without further complications.

According to Dr. Wijemanna 30-40 new patients are added every week to the waiting list, which is already bursting at it seams.

Even though there are three other State run cardio thoracic units which deals with both adult and children’s heart defects, namely Colombo, Kandy and Galle, all the complex cases are referred to the LRH from all corners of the country including the north and east.

Already the waiting list at the LRH has gone beyond the 1,500 mark. Without timely interventions some of these precious lives would be lost to their parents and the nation in general.

In Sri Lanka there are only nine fully fledged cardio thoracic surgeons, out of which two are based at the LRH, Dr. Mahendra Munasinghe and Dr. Iresh Wijemanne.

There are two basic reasons which make Heart surgery unique and very complex, compared to other major specialties of surgery.

One is that all other organs could be completely immobilised or stopped during an operation, but not the heart. It has to keep ticking because if the heart is stopped all the organs of the body perish , brain first after only 3 minutes.

The other related problem is that the heart is filled with blood and a large volume of blood goes through it every second. If the heart is not emptied during an operation, the surgeon becomes handicapped because his vision gets limited by blood, to do the delicate operation.

This is the primary reason why heart surgery got delayed to start in comparison to other specialties involving other major organs, until surgeons and biomedical engineers got together to invent the heart-lung machine.

The functions of the heart, including blood flow and oxygenation, are rerouted through a heart-lung machine, so that the heart can be safely stopped during a heart operation.

The first open heart surgery in the world was done in 1953, supported by a Heart-Lung machine, to close a hole in a small child. Before that there was a popular belief among doctors that operating on the heart is not possible. Heart surgery kept advancing with leaps and bounds with the help of technology and bold surgeons, but Sri Lanka was a late entrant as the country did not possess the necessary technology and qualified surgeons.

Defects

A few years back, heart defects was considered as the number 1 child killer in the country. Fortunately this trend has decreased over time with the introduction of new facilities.

The paediatric cardiology unit first commenced operation at the LRH in the late 1990s, initially as a eco-cardiography unit. Later a cardiology ward was introduced in 2001 and a catheterisation laboratory in 2005. Later the cardiac surgery unit and the ICU were added in January 2007 at a cost of Rs.500 million.

In 2007 the LRH saw 24,338 patients and out of them 2079 was admitted, the bed occupancy rate stood at 95 per cent. During the year 2007, 340 surgeries with 289 major surgeries were performed. In 2008 up to now 437 surgeries have been performed including 327 major , complex surgeries at the LRH Cardio thoracic unit with a success rate of 91.3 per cent. From 2005 up to now the LRH Cardiologists have performed 1,181 interventions with a success rate of 95 per cent.

These figures are on par with best in the world says US Cardiac surgeon DR Jeremy Torsveit.

The State health sector has been the only lifeline for thousands of children in this country, who are born with congenital heart defects and who simply cannot afford to go to private institutions or seek treatment abroad.

The limitations mainly have been due to the enormous costs involved. Thus State alone is finding it difficult to come up with necessary funds to initiate further expansion. The main bottleneck preventing more surgeries done is the fact that there are not enough ICU facilities in the unit.

The High Dependency Unit (intermediate ICU) which is under construction at the LRH has been stalled, due to lack of funds. And with the completion of this new unit with necessary equipment, instruments and staff would increase the capacity and output of the LRH at least by about 50 per cent.

This would mean a drastic reduction in the waiting list and timely intervention to save more lives, of thousands of future flag bearers of this country.

LRH is the only hospital in Sri Lanka which engages in the most complex paediatric heart surgeries. The Unit was set up by the Government at a cost of Rs. 500 million. Every procedure here is done free of charge.

But consumables alone for the heart lung machine such as cannulas, oxygenators, tubing set and also sutures, medication to name a few, for each surgery would amount to over Rs.100,000.

The only dedicated Paediatric Cardiac Surgical Unit in the country based at LRH, is seeking public support to help save lives of the less affluent children in the country. Thus the staff at the LRH is up in arms, not to wage war, but to save lives, through public support.

They are not confined to engaging in routine duty in order to pocket their salary and go home at the end of the month. But are committed to saving lives of the poorest of the poor children in this country.

Wellwishers can directly contribute to a special account opened at the People’s Bank branch in Borella or they could select from a list of items that are running short. List of these items and the suppliers are prepared every week so that donors can purchase and donate them directly. It will benefit a little child, desperately in need of heart surgery,” says Dr. Munasinghe.

And those who have donated range from top corporate establishments to the humble hawker, “Some even have donated RS.100 to the trust according to their capability”.

Frauds

In a country where various frauds are the order of the day in search of quick cash, the dedication of the LRH staff in finding funds to the cause of saving young lives should be considered as an outstanding effort.

Your support too would be vital in saving precious young lives, whose time may run out without timely intervention. “speak for those who do not have a voice” Can we make a change?