•How cutting-edge tech, innovative treatment cut down on medical tourism
By Omodele Adigun and Henry Uche
Professor Kamar Adeleke is CEO, Tristate HealthCare System. In this interview, he spoke on cutting-edge technology and innovative treatment and their effects on medical tourism. He also examined Nigeria’s healthcare delivery, particularly brain drain, also known as the “japa” syndrome, challenges and solutions.
Excerpts:
Concerns
First, a healthy nation is a wealthy nation. We are troubled by high death rate. Our life expectancy is about 53 while in America and UK it is about 84, because Nigerians do not prioritize health care. Our health sector’s contribution to GDP is less than 1 per cent. But all hope is not lost, if the government, media health enthusiasts, industry watchers and others collaborate.
The approach
We just did a ground-breaking operation. Coronary artery bypasses grafting (CABG) off pump (a minimal invasive procedure performed without the support of a lung and heart machine) and Mitral valve replacement (repair of the valve instead of replacement) was carried out with new techniques by Tristate.
In India, they told me that, since Tristate started, there has been about 75 per cent reduction in cardiovascular tourism from Nigeria to India. You can calculate the value to our economy, how much if we do the same thing for cancer, neuro, thermology, you can imagine. So people do not need to go abroad for all these cases. Nigeria has the best in the world in the medical profession. The problem is deliberate suffocating environment created by the government.
We have been doing open-heart surgery, which is more tasking, time-consuming, with excruciating pains, and risky with multiple possible implications. But we are looking at minimizing these. We want to do the minimum invasive, where we create a tiny hole by the side, just open a little part of the body. For women, it’s actually below the breasts, from there everything is exposed and you are able to go in and do your surgery. At the end, when the breasts are down, you won’t even see point of entry. We have done it here. And we are prepared to do all those operations Nigerians troop abroad to do. We’ve got what it takes.
Goal
To see that every part of Nigeria has a cardiology centre. People in Benin should not be coming to Lagos; people in Ibadan, Abuja and other cities should not be coming to Lagos, and vice versa, because of what I call “60 minutes golden rule.” Time spent in transit often leads to death. By the time I exit this world, every part of Nigeria would have top-notch cardiovascular programmes.
Now we do the Pinhole surgery. It reduces time consumed, cost, risk and length of stay in the hospital. Cosmetically, it’s great for everyone. The other one we did is the beating heart surgery.
Remember, in the traditional one, we stop the heartbeat to zero, though we connect the body to man-made heart, the lung machine. But in this case, we want to let the heart keep beating while we do the surgery, which is more delicate.
In Pinhole surgical technique, we don’t use much pints of blood, say like two or three, unlike in open heart surgery where we use up to 30 pints of blood.You know how much that could be. The last one we did was for someone about 71 years old.
Though I was afraid, we were able to do the minimal invasive. Hours after doing the surgery, while we interacted, the patient asked me when were we doing the surgery; even after 24 hours he still asked me when we would do the surgery, not knowing that we had done it already.
Success rate
Success rate directly correlates with who’s doing it, how many they have done and where they were trained. Then the risk involved. For instance, the risk of a 21-year-old man is lower than that of an 80-year-old man.
Someone with some illnesses is exposed to higher risk, a three-day-old baby has very high risk. So, success rate depends on what you are doing and who you are doing it on. Do I do the surgery successfully? Yes. But then there could be complications. Time taken to arrive in our facility matters a lot.
Someone was supposed to take a flight, but took land route, just as she entered the emergency room, she gave up, principally because of bad roads, which aggravated her heart condition. So, if you ask me the chances of dying in the process, I will tell you 5 percent. It’s not terrible. In sum, our success rate of all invasive we did is 100 per cent.
Cost of surgery
Cardio programme is like a pyramid. I don’t know the total amount because it involves different stages. I’m at the top of the pyramid. But I think we charge about N10 million. Remember, we buy everything in dollars. We don’t even make profit but we must continue the work. We consult experts.
However, what we charge here is lower than what is being charged in India. Remember you would incur cost of flight, hotel; you may hire an interpreter over there, etc.
Why do people decline open heart surgery?
Knowledge gap, lack of money and, sometimes, fear.
Other services
We’re looking at other specialties like neurosurgery, dentistry, GI, that’s gastrointestinal. We already have dialysis. We’re already doing heart disease and stroke. We’re starting cancer care soon in about one month. Orthopedic also; a topnotch orthopedic surgeon in the world, a Nigerian, is coming here on a two-year leave of absence from Johns Hopkins in the U.S.
Risks associated with heart disease
High blood pressure, diabetes, high cholestral, eye problem. So, ophthalmology is huge, even oral disease.
Caution
Once you’re 50, go for regular cancer screening. It’s easier to handle when detected early than treatment when things are already damaged.
Maintenance
Maintenance and follow-up is essential. It determines what happens next. Surgery can be successful but, sadly, people do not follow up. It’s very important to know what patients do after a successful surgery. A lot of diseases people acquire is because of what they did, what they couldn’t do or where they live thereafter. Here at Tristate HealthCare, we follow up accordingly.
Causes of congenital heart defects and prevention
Use of drugs, alcohol, smoking, age of the woman and others issues. But the best of all preventive measures is to be nutrition-minded. Eat right, balanced diet, avoid unrecommended drugs and alcohol. Once you have a baby, he or she must be screened by a competent doctor. Just do the right thing, at the right time and right manner, you will have no problem.
How do we avoid heart attack, other diseases?
It’s simple. Know your numbers. Know your blood pressure. One in three persons in sub-Saharan Africa above the age of 18 would have high blood pressure. Anything less than or equal to 130/85 is okay. High blood pressure is anything greater than or equal to 140/90. If your blood pressure is between 130- 140, you are pre-hypertensive. But a new study done by America says that if your blood pressure is 120, you are better off. High blood pressure is a major cause of stroke, kidney and heart failure and attack, and death. Imagine if you take blood pressure out of your equation, you are good. Nigerians, particularly people living in Lagos, should check their blood pressure regularly.
Next is sugar level. You must know your sugar level and how good and healthy it is. You may be skinny or fat and have sugar problem. These are not expensive. Also check cholesterol level. Check that you are not above your ideal body weight by doing exercise regularly, by doing that you are increasing your life expectancy by three to five years.
Time to complete minimal invasive surgery
It can take one hour to three hours. It depends on what you are doing. If a baby has a hole in the heart, we don’t need to open the heart, we just go through a vessel. We did about 25 within one week.
We fix heart attack within 10 minutes from the beginning to the end. That’s minimal invasive. Some open heart surgery can take us 15 hours, depending. The first bypass we did here took us 12 hours. But if you do it minimally, it takes less time to complete.
Surgery wise, since we started, we have done close to 500 open heart surgery.
We started open-heart surgery in May 22 20922. The one without opening the chest, we have done close to 500 and the risk is about 0.4 percent. I have never lost a patient but recorded about three complications, but they are all alive.
The most important thing is never developed that disease in the first place. The only way to do that is to de-risk factors modification. We have modifiable and non – modifiable risk factors. Male has higher heart disease than female. As men get older, the risk of heart disease increases.
Managing dearth of manpower
World Health Organisation (WHO) recommended one doctor to 450 persons, but here it’s one doctor to 5000 or 10000 persons depending on where you live in Nigeria. How stupid can that be. I don’t know how Nigeria government think.
For me, I have trained five cardiologists, the last one just ‘japa’ five out of six of our promising consultants exited the country. It’s overwhelming me. Bringing experts from abroad is huge money. We can’t afford them. The minimum I’m getting is $20000 per month.
We’re like in the military zone, you go to warfronts, you don’t know if you are coming back alive or not. We’re thinking other ways to reverse this mass exodus- ‘japaism’. We’re working with Sterling Bank to see how we can start our medical school for specialty training. If we train 100 doctors in different specialties, even if 30 leave, we still have 70 consultants.
Sterling Bank is about to raise $100 million for the training for reversal of Japa syndrome and would finance the medical school. You don’t need to come from rich family to be able to attend medical school as long as you are qualified and someone to back you. It would take us more than 100 years to make up what we are losing if we don’t reverse this mass exodus now.
