Why heart operation referrals are costing Ugandans billions

A doctor attends to a heart patient at the heart institute at Mulago recently. PHOTO BY FAISWAL KASIRYE

It had been two weeks since Joan Asiimire was referred for a heart operation in India when this reporter met her at the Uganda Heart Institute (UHI) in January.

Her uncle, Mr Emmanuel Twinamatsiko, had taken her to the hospital after she developed excessive pain and could hardly sit without being supported.

Asiimire, 21, was diagnosed with rheumatic heart disease—a condition in which the heart valve gets damaged.

Doctors at the institute referred her for an urgent operation in India if her life was to be saved. Dr Peter Lwabi directed Mr Twinamatsiko to an NGO – Action for Disadvantaged People, located in Kampala.

The NGO advised Mr Twinamatsiko that the hospital they could connect him to needed $12,000 (Shs31m) to conduct the operation but they could only provide him $5,000, meaning he had to look for an additional $7,000 (Shs18m) within the quickest time.
The Daily Monitor’s compassionate page run Ms Asiimire’s story within a week to try and raise more funds. “People did call me and made offers of which I was grateful but time was running out and I had only raised very little money,” Mr Twinamatsiko recalls.

In the week that followed, Asiimire died from heart failure. 
Asiimire is certainly one in many patients who have died waiting for funds to have a heart operation carried out abroad.

Although there is no exact data from the heart institute about the number of patients who are referred abroad for operations, Mr Twinamatsiko says in the short period he spent searching for money, he met several people with the same predicament.

The institute director, Dr John Omagino, while meeting President Museveni in March to lobby for equipment, said the country has been losing $20m (Shs50b) annually on travel alone, for heart patients seeking treatment abroad. Yet if these operations were carried out locally, it would cost $4m a year.

It was only last year when government fully equipped the institute’s cardiac catheterisation unit–a specialised medical setting in which doctors can visualise heart structures, diagnose the precise nature of cardiac diseases, and perform minimally-invasive, corrective heart procedures.

But the institute lacks the expertise to carry out heart operations except what a source described as ‘simple heart congenital anomalies’. 
According to the source, most of the surgeons at the institute have not undergone super specialised training to become cardiothoracic surgeons and as a result lack the necessary experience, are not confident and end up referring most of the cases they are not comfortable operating on.

The source said these surgeons are mostly general surgeons, who attended a course for two years or less after their bachelors in medicine, yet a cardiothoracic surgeon is supposed to have undergone six extra years of training after the five years in medical school.

The chairman of the institute, Mr Robert Ssebunya, however, disputes such claims and says referrals abroad are as a result of Ugandans not appreciating the services that the institute offers.

“There is no reason why Ugandans would look for $15,000-$20,000 to take a patient abroad when you have the UHI. Before we had a problem of equipment but today we have no excuse in the sense that we have a number of surgeons with a lot of experience, and are carrying out open heart surgery at the institute,” Mr Ssebunya says.

“We equipped the heart institute about a year ago with a state-of-the art catheterisation unit and started using it eight months back meaning we can do most complicated operations,” Mr Ssebunya explains. 
Patients at the UHI are operated on at a fee, usually much less than what one would pay abroad. A child at the UHI, depending on the complication may pay about Shs5m ($1900) and an adult Shs10m ($3800).

Mr Twinamatsiko, however, says nobody at the institute ever suggested or told him about options of having an operation carried out here.
But then again, another problem still hangs over the institute – government’s lack of recognition of the available expertise.
This, Mr Ssebunya says, has led to a number of surgeons seeking greener pastures. According to Mr Ssebunya, the institute has four cardiothoracic surgeons but he is worried they might go to neighbouring countries where they are paid according to their level of specialisation.

“The government and the Ministry of Health have not fully recognised super specialised training and paying the specialists with money which would keep them here,” Mr Ssebunya says.


President Museveni, in a meeting with members of the institute, said he would look into the issue of the structure of the Ministry of Public Service to ensure that it accommodates special human resource requirements of specialised staff to work in the unit and also consider their terms to retain them.
The President also said government would support the institute to procure urgently needed equipment worth $4.5m (about Shs11.8b) to operationalise a newly-installed multi-billion heart operation theatre unit which if completed, would have the capacity to facilitate 1,000 operation procedures per year.

But until then, perhaps more patients will have died waiting for funds from well-wishers to have an operation abroad.


Anthony-Claret Onwutalobi
Anthony-Claret is a software Engineer, entrepreneur and the founder of Codewit INC and CEO of Portia Web Solutions. Mr. Claret publishes and manages the content on Codewit Word News website and associated websits. He's a writer, IT Expert, great administrator, technology enthusiast, social media lover and all around digital guy.

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