The complexities of cardiothoracic surgery are, simply put, mind blowing. It takes surgeons and anesthesiologists anywhere from two to eight hours to repair physiologic systems that are immediately responsible for the maintenance of human life. I just rounded up a cardiothoracic surgery elective at the Duke University Medical Center – needless to say, these guys are good. The technical skill of the surgeons left me drooling as I marveled at how comfortably they navigated through the bodies of other human beings. Even though I was occasionally allowed to help with the procedures, I always felt like a spectator watching an impeccably rehearsed rendition of a Mozart piece. Despite the thousands of years of residency/fellowship training, cardiothoracic surgery is now a serious career consideration for me.
As impressive – arguably more impressive – is the equipment required to make these operations possible. Cardiothoracic procedures incorporate state of the art technologies that to most are unavailable and/or expensive. Intricately linked to equipment is the issue of power. I’ll go out on a limb and say that the absence of a dependable power source is a contraindication to cardiothoracic surgery; any procedure would be an all-round horrible idea in the setting of full dependence on NEPA/PHCN. Considering these factors, the important concern is the feasibility of providing these services in Nigeria. For a surgeon in private practice, start-up costs would be humongous. The public sector doesn’t seem to offer much promise either – Obtaining government support for a project of this magnitude would be, put mildly, painful.
It turns out however, that Nigeria already has some established programs in cardiothoracic surgery. Although the University Of Nigeria Teaching Hospital (UNTH) in Enugu set the pace for the rest of the country (completing the first heart surgery on Nigerian soil in 1974), one of the leading initiatives today is provided through the Lagos state government at the Lagos State University Teaching Hospital (LASUTH) where surgeons have been performing heart surgery since 2004. A report in the Lagos Indicator Online highlights that the project, started by Dr. Joe Nwilo from Atlanta, catered to 5 patients in its first year. Much of the initial expertise came from expatriate surgeons, but Nigerian providers have soon taken over. 58 heart surgeries have been completed at the center since 2006, including the first tube repair that was performed earlier this year. Although these numbers don’t quite match up to standards in some other parts of the world (at Duke, surgeons perform 3 – 4 cardiac surgeries every day), the effort is truly remarkable.
Cost, cost, cost…. where do I start? Even in Nigeria, cardiac surgery costs anywhere from $4000 to $9000, more money than many Nigerians make in their entire lifetimes. The Lagos state government (in collaboration with some local heart foundations) has done a great job funding some of these procedures, but it is clear that the current model is not sustainable. An interview in the Nigerian Journal of Health with Dr. Bode Falase – a LASUTH Cardiothoracic Surgeon and Senior Lecturer who currently heads the Cardiac Center – highlights the fact that program faces significant financial challenges. The interview – a quick but good read – highlights the need for Nigerian patronage for the survival of the program. Evidently, the program would benefit from a public enlightenment campaign if it is to attract wealthy Nigerians who are currently electing to travel abroad for their surgical needs. Public awareness is only one part of the solution. The economics of the operation must be modified to ensure that surgical costs appropriately reflect the financial climate in Nigeria. As some of the world’s fastest growing economies – in India and China – teach us, mass production maximizes efficiency. The health sector would not be the only beneficiary of a high output industry in healthcare technology. The jobs created, retention of health care consumers and potential for international trade would provide a strong stimulus for the Nigerian economy. I wonder what’s holding us back….