Nurbanu Somji, from Dar es Salam, in Tanzania, has become the first person on the African continent – outside of South Africa – to have undergone a successful and lifesaving operation where a HeartWare ventricular assist device (HVAD) was implanted to enable her critically damaged heart to continue functioning.
Dr Willie Koen, a cardiac and transplant surgeon who practises at Netcare Christiaan Barnard Memorial Hospital in Cape Town, led the surgical team that implanted the lifesaving HVAD, a type of mechanical heart, recently. According to Dr Koen, Mrs Somji has responded extremely well to the treatment and, with the HVAD battery pack around her waist, she was able to fly home with her husband, Firoz Somji, and family on 1 September, the first day of spring.
Speaking from her home in Dar es Salam, Mrs Somji said that she has not felt so well in a long time, and is telling everyone about the highly advanced heart procedure that is now available in South Africa. Prior to the procedure, she had been confined to a wheelchair; now she is able to take two half-hour walks every day and climb three flights of stairs.
Dr Koen explains the significance of the operation: “It is historic for African heart medicine, made possible by recent advances in cardiac medicine and telemedicine. The procedure also marks the first time that this kind of lifesaving mechanical heart procedure has been made available to a non-South African patient from the continent. This is part of an international collaborative initiative to make the latest cardiac expertise and technology available to African patients suffering from heart failure.
“This project is the culmination of years of international and local collaboration, and an exciting development for medicine in Africa. Considering that the World Health Organization has identified heart disease as a growing epidemic in Africa, it is a critically important one.”
Two months ago Mrs Somji, who is a cancer survivor, was in a critical condition in a hospital in Dar es Salam due to heart failure, and doctors and her family feared she would not recover.
“The turnaround in her condition has been remarkable and the entire family is so grateful to Dr Koen and his team, Netcare Christiaan Barnard Memorial Hospital and its staff, as well as the programme that made this highly specialised treatment possible,” says her son, Fayaz Somji.
“My mother has previously been abroad to have a pacemaker fitted to help her ailing heart but this proved to be a temporary solution. Three years later she was in hospital in Dar es Salam and we were scared we would lose her. We wish we had known that this procedure was available in South Africa.”
Dr Koen, who is a founding member and vice-president of the Pan African Society of Cardio-thoracic Surgeons (PASCaTS), explains that HVAD helps to restore normal blood flow by enabling the left ventricle of the heart to operate properly. The right ventricle of the patient’s heart must be able to function if the system is to be used. If not, another device called the Berlin Heart may be used instead. HVAD is implanted via open-heart surgery and the patient has to wear a small external battery pack to hold the batteries which power the device.
International collaboration to benefit African patients
The German Heart Institute’s Professor Charles Abraham Yankah, who has pioneered the use of mechanical heart devices such as the Berlin Heart and HVAD and is one of the foremost cardiac surgeons in the world, congratulated Dr Koen on the leading role he played in making the procedure possible in Cape Town.
“Dr Koen and I have shared a vision of making the latest in cardiac medicine available to the people of Africa,” adds Prof Yankah, who was born in Ghana. “Since 2003, we have been holding seminars and training sessions in an effort to impart our knowledge of the latest techniques in cardiac medicine and telemedicine, to empower and capacitate medical practitioners on the African continent. We have always regarded the transfer of knowledge to our African colleagues as critical to the success of this initiative.”
“Now for the first time, cutting-edge cardiac medicine can be made available to the people of Africa through the cardiac centre of excellence that has been established by Dr Koen at Netcare Christiaan Barnard Memorial Hospital,” adds Prof Yankah.
“The development of this programme is a major milestone for private medicine on the continent and a vote of confidence in South African cardiac medicine. The country can now be used as a springboard to provide high-tech treatments such as HVAD to patients from other African countries such as Tanzania, Nigeria and Kenya, where they have not previously been available.”
According to Dr Koen, state-of-the-art technology such as HVAD could previously not be used to the benefit of heart patients outside of SA’s borders because these patients require ongoing monitoring and support. The technology, expertise and healthcare infrastructure has simply not been in place on the continent to be able to do this successfully.
”However, with the support and cooperation of the German Heart Institute in Berlin, Pan African Society of Cardio-thoracic surgeons; African Cultural Institute; Netcare Christiaan Barnard Memorial Hospital and the Netcare group, we are now in a position to put in place the necessary infrastructure to enable the close monitoring of a patient like Mrs Somji,” he explains.
Skills transfer and support into Africa
“In the case of Mrs Somji, doctors in Dar es Salam are being trained in the care of HVAD patients and the use of telemedicine and telemonitoring, which will enable them to download logs and pass on information that will allow us to closely monitor the functioning of the HVAD technology, as well as the patient’s health,” notes Dr Koen.
“A nurse from the unit at Netcare Christiaan Barnard Memorial Hospital, Sister Janelle Louis, accompanied Mrs Somji and her family back home. She not only helped to ensure the patient’s safety en route, but spent a week in Dar es Salam training two doctors and support nursing staff in the care of the HVAD patient.”
Dr Koen, a pioneering and highly regarded heart transplant surgeon who is best known, not only on the continent but worldwide, for his groundbreaking work with technology such as the artificial heart, will be following up with a visit of his own in October. His team is, in addition, available to provide any necessary ongoing guidance to doctors and surgeons on the spot via sophisticated communications technology.
Sr Janelle, an experienced critical care nurse who underwent HVAD training in Spain and South Africa, says that she feels honoured to be a part of the groundbreaking outreach programme.
“This was my first visit to Tanzania and it was a fantastic experience. It was most gratifying to be able to assist our African colleagues and to form part of an initiative that has given Mrs Somji’s life back to her. She and her family are wonderful, warm people who are extremely mutually supportive,” she notes.
Dr Koen says that the HVAD is a device which enables patients to wait safely for a heart transplant, preventing further deterioration of their health. However, in some older individuals who may be too weak to survive a transplant, it may be used as a permanent alternative support, providing patients with a greatly enhanced quality of life, as well as improving their lifespan.
One of the advantages of the procedure over a heart transplant is that it eliminates the need for anti-rejection transplant medication, which may have side effects. In Europe and the United States, HVAD procedures are now done twice as often as transplants.
The HeartWare ventricular assist device (HVAD) is fully implanted and assists the heart to pump offering circulatory support. The device's battery is rechargeable and is carried by the patient externally on a belt.
Somji was successfully treated for cancer in 2005. However, her heart later deteriorated to the extent that she could not even walk and was completely bedridden. Fayaz Somji says that her mother’s cardiologist in Dar es Salam was deeply concerned about her condition and was of the opinion that an HVAD would be the best option available to her. The family was delighted to get in touch with Dr Koen, and find that the procedure could be undertaken on the continent.
Mrs Somji thanked her husband, Mr Firoz Somji, her son-in-law, Mr Fayaz Bhojani, her extended family and friends for being so supportive and assisting her to get through her illness. “I would also like to thank Dr Koen and his team for the amazing job they have done. I aim to improve awareness of this development in medicine among people with my condition,” she adds.
Jacques du Plessis, managing director of the Netcare hospital division, wished Somji and her family everything of the best for the future.
“It is immensely heartwarming that through the initiative, Mrs Somji could be given a new beginning. We are delighted that, with local and international support and under the energetic stewardship of Dr Koen, the programme has advanced to the point where it is now possible to make a meaningful difference to the lives of patients on the continent.”
“South Africa has a great tradition of innovation and leadership in the discipline of cardiac medicine. The cardiac medicine hub that has been created at Netcare Christiaan Barnard Memorial Hospital demonstrates that the country has the technology and expertise to continue this tradition and assist to take cutting-edge treatment to more people on the continent,” concludes Du Plessis.
Issued by: Martina Nicholson Associates (MNA) on behalf of Netcare
Contact : Martina Nicholson, Graeme Swinney, Sarah Wilson and Meggan Saville
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