Imagine being a child and not being able to enjoy your childhood. All you do is lie down and have little or no concentration in class. When your friends come knocking on your parents house, calling you out to play, all you do is look at them with puffy eyes because you have no energy to play.
Such was the life of seven-year-old Angel Nyongesa. Angel, the lastborn in a family of six, always complained about being tired.
“I realised that my daughter had a problem in February last year because she kept complaining that her heart was beating too fast, had a high fever and was always tired,” her mother Mary Chajwi said. Up until November last year, Angel used to cover one and half kilometres from home to school. Since she was not feeling well, her parents had to make a few adjustments, since her condition was getting worse by the day.
“During this same month, my husband decided to take her to Coptic Hospital along Ngong Road, where she was diagnosed with heart problem. One of her valves in her right ventricle was not working properly. The cardiologist who attended to Angel referred us to Kenyatta National Hospital for further treatment,” Mary said.
However, they could not get help at Kenyatta because the medics were on strike. They were seeking audience with the government, asking that they sign a collective bargaining agreement to improve their salaries and working conditions.
“When we got to Kenyatta that day, I was very disappointed. I couldn’t afford money to take my daughter to a private hospital, yet she needed care urgently.” Mary said.
Since she could not stay with her daughter at the largest referral hospital in East Africa, she took her back home and opted to buy her the medicines she was prescribed for until the doctors resumed work.
Unfortunately, their strike lasted more than 100 days, and they had no option but to visit Karen Hospital, where a surgery was done. From December last year to August 21, Angel was just home, faithfully taking the medicines prescribed by the doctor.
“I am happy that my child can play with her friends and smile without any struggle,” Chajwi said.
David Macharia, 25, shares a similar script with Angel. He dropped out of high school when he was in form two.
He has similar symptoms to Angel. Unfortunately, when his mother took him to a nearby dispensary, he was diagnosed with tuberculosis. He was put on TB drugs for a close to two years.
“My mother complained to the hospital management and I was transferred to Kenyatta National Hospital, where I was put on the same medicines,” David remembers.
As he shares his story, he vividly remembers how he was at his lowest point in his life and no one could help because he did not have any money to seek a second opinion.
“After months of taking medicines that were not working, one of my mother’s friends called her and told her to take transfer me to the Karen Hospital, where I could undergo surgery and regain my strength,” David said.
After his mum met a few officials in at the hospital, she was convinced that her son’s health would improve. David had lost so much weight and the TB drugs he was taking were only worsening the situation.
He was admitted at the hospital in July 2012, where he was diagnosed with rheumatic heart disease.
“When I arrived at the hospital, I was so happy because I finally knew what was ailing me. My family was scared when the doctor said I have to be operated on, but I told my mother not to worry because I will only be taking a short trip and I’ll be back in a couple of hours,” David said.
To date, David’s family is yet to decide what action should be taken to the dispensary that gave him a wrong diagnosis and wrong medicines. Before the diagnosis, he had been given antibiotics to clear the sore throat he had.
BIGGEST INTERVENTION
According to the World Health Organisation, cardiovascular diseases have been noted as the number one global killer. There have been calls to mitigate the soaring numbers, and one such initiative is the World Heart Day, celebrated on September 29 every year, which seeks to have people across the globe “take part in the world’s biggest intervention against cardiovascular disease”.
The global health agency also says that three quarters of cardiovascular deaths take place in low- and middle-income countries. In Kenya, medics say the most common types of cardiovascular diseases among adults are ischemic heart disease, which is caused by narrowing of the coronary arteries, decreasing blood supply to the heart, and rheumatic heart disease, which is caused by damage to the heart valves.
Among children, the two most common types of heart disease include the congenital ones, where a baby is born with a hole in the heart, and a blue baby, where a newborn lacks oxygen in the blood due to a congenital defect of the heart or major blood vessels.
Cardiothoracic vascular surgeon Premanand Pronoth, who practises at the Karen Hospital, said expectant women need to take care of their health during the first three months of their pregancy because this semester is crucial in the development of a baby.
“When a mother is pregnant, she must ensure she gets no infection during the first three months. Further studies are yet to be done to establish which particular infections are connected to heart conditions in babies,” Premanand said.
Dr Premanand, popularly known as Dr Prem by his colleagues, noted that adults tend to get heart disease later on in life as a result of an untreated throat infection. The infection is caused by the streptococcus group of bacteria, which varies in severity from mild throat infections to life-threatening infections of the blood or organs.
The infection may cause a blockage or leakage in the heart because it goes to the blood slowly and deposits itself on the valve and destroys it if not treated early enough.
“The valves in our hearts are like doors in our houses. They should open one way, but if someone has a problem with his or her valve, the movement is to and fro. This type of disease is common among Africans and Asians,” Prem said.
He added: “A person who has a coronary artery disease is a big-time fellow in a three-piece suit. Whisky glass in the right hand, cigar on the left hand and going through financial magazines while flying first class. Such people are rich and have no time for anything other than eating fatty food and not keeping fit.”
Prem said such patients would usually complain of chest pains that act as a sign that something is wrong with the heart. If the blockage is mild, the patient will be given medicines to relieve the pain. If it is complex, surgery is necessary.
Before the surgery, the patient has to do an echocardiography test to diagnose the patient’s exact heart problem.
He also said that patients need to know their family history, as this will help in preventing any member of the family from knowing if they’re at risk of getting the disease or not.
“If a person comes from a family where almost all the members have a heart disease, he or she should go for a check-up annually. This is because they are potential candidates,” Prem said.
Once the surgeon identifies what is ailing the patient, he can determine which type of surgery technique he is going to use. If the patient has a coronary heart disease, he will conduct the operation on the patient’s heart while it is still beating. If the problem is inside the heart, he would need to stop the heart.
A team of six specialists consisting of the lead neurosurgeon, an anaesthetist, two junior doctors and two nurses are part of the team that helps children and adults be able to enjoy their lives again.
SIMPLE VS COMPLEX SURGERY
A simple surgery takes about three hours, while a complex one lasts about seven hours. During a heart valve repair or replace operation, the surgeon uses a ring to help restore the shape of the valve. When repairing or replacing valves, the right ventricle uses a full ring, while the left one uses half of the ring.
Issues such as gender and age have to be put into consideration when repairing or replacing valves. There are two types of valves: mechanical and tissue valves. Patients who opt to use mechanical valves will be put on medication known as warfarin for the rest of their lives. It prevents blood from clotting because a foreign object has been placed in their body.
Those who have been put on the tissue valves one will be put on warfarin for only three months. The tissue valves are gotten from cows and pigs.
“It also matters, especially in young women who have a heart problem and would want to have children at a later stage life.
If we put the mechanical valve on them, they need to change it during the first three months of their pregnancy, because warfarin is known to have side-effects to the baby’s development,” Prem said.