Dr Elijah Miner is the Chief Medical Director of Garki Specialist Hospital in Abuja, Nigeria. In this 2 part interview with Ndidi Chukwu of Health Reporters, he bares his mind about Kidney Surgeries and other interesting health care delivery system.
When did you start Heart Surgeries, in Garki Hospital and how has it been for you?
Dr Elijah; we started doing open heart surgeries in November 2013, we worked together with some of our colleagues based in Huston, USA and those that are based in Lagos, we got ourselves together and could see the huge need for such intervention. We started doing what is called cardio vascular problems which includes things like cuticle neurism and anything that is related to vascular surgeries. We were able to do femoral popliteal by-pass which we do for patients with diabetes or smokers where the vessels on their legs get clocked-up and they can easily lose a leg. We just do a by-pass operation for that. Having said that, last year again which is 2014, we did 7 pediatric (children) open heart surgeries and we did 2 adult patients. You will be interested to know that one of the adult patients had had a heart attack and the reason for the heart attack is that one of the blood vessels supplying the blood to his heart had blocked off, so we were able to remove it and do a by-pass surgery, that is what is called a coronary artery by-pass and that is the first one that has been done here in Abuja. This year we were able to do 11 children open heart surgeries running from holes in the heart to more complex types of what I call congenital heart problems that children are born with and also those who have traumatic heart disease.
Cardiac surgeries are considered one of the most complex and risky surgeries to do, what mechanism did you put in place to successfully conduct such operations?
Dr Elijah; safety is the first thing we took cognizance of before inviting anyone or asking any patient to come forward for surgery. We ensure the safety in several ways, by providing the equipment necessary so that we will be able to do the surgery safely, I will name a few things, patient monitors that check the heart beat as they are being operated, heart rate and also what I call arterial blood gases, so many complicated things that we had to put in place in our Intensive Care Unit, secondly we have ventilators which help the patient to breath, sometimes after an operation the patient won’t be able to breathe on his own immediately and will need help for a day or two and we have the machine that help them breath. Coming into theatre we have what is called the heart long machine, which you cannot do any open heart surgery without it, what it does initially is to drain the blood away from the heart so that the heart will be dry and you will be able to open it up and do whatever heart surgery you need and then pump the heart back on again, they are very sensitive machines and we made sure that we got some of the latest ones. Again you will find that as part of our safety measures we made sure that we use personnel that are not just beginning to do cardiac work, these are people that have a huge experience behind them, a lot of them are Nigerians based in America, we have one in particularly who has been in America for 30 years just doing heart surgeries. Anesthiologists are people that put patients to sleep and are very experienced in cardiac work as well. Also the personnel regarding the actual surgery itself are very experienced people. The last case we did we had a surgeon that came, he is a Nigerian I’m proud to say, he came from one of the largest hospitals in Europe and where they do regular heart surgeries on children, so those were the kind of measures that were taken so we are not giving our people anything less than what they will get if they were in the developed countries.
Already you have had two series of the pediatric open heart surgeries, do you intend to continue, and what does it cost to have a heart surgery?
Dr Elijah; we have done two series of the pediatrics surgery but we have done three of the adults which we haven’t mentioned, our intention is to continue doing if we have all the funding we will do some every month, the demand is high. A lot of people have it, what constraints a lot of people is the funds and when we are talking about funding, we are not talking about making a profit, we are talking about just breaking even. I tell you from the surgeries we have had, we haven’t broken even yet, we have always suffered some financial loss and so as we go along we have to adjust how much we a charging just to see that it covers the amount of specialized equipment that has to come and there are some that the moment they drop on the ground or they are not the right size you abandon them because you have open them up. If we have the opportunity, and our colleagues abroad have the time, this is something that we will do it on a monthly basis, the NGO which is working with us is attempting to do the surgeries for 100 children and 100 adults within a year. It is possible but it is possible if we can get the finances for the patients to pay for their surgeries.
What will it cost for a cardiac surgery?
Dr Elijah; it depends on the type, but I will give you a range, it is anything between 1.5 to 2.5 million naira. If you look in the context of those that have been going out on medical tourism, for some, that amount is just what they need for hotels and air tickets not to talk about having a surgery. So we are working on it and always looking for ways to reduce cost and at the same time stay safe. If you cut corners you will be able to do things at a lower price but we don’t and I have insisted since we started it that the same standard that are used in England and America are used here and that way we will be able to get good results. So that people can be able to trust us and we give them what they will get from abroad.
The Nigerian doctors who participated, was it about passion to save lives or they were paid to return to work in Nigeria?
Dr Elijah; Thankfully it was really passion, we spoke to them but the moment we did, they said yes they will be happy to come down to Nigeria to work. Remember for the personnel that came to Nigeria, are not being paid, they are doing it out of their own free will. What we have to pay for is their transport both local and international, their feeding and accommodation and the consumables which is where the money comes in, buying the consumables that we can use safely for their surgeries. Otherwise it has been great to work with people that are really passionate about the lives of children and adults but how this will become sustained is important for us.
A lot of Nigerian medical personnel work abroad but the nation has serious human resource deficit, especially those specialties that are very complex, does it bother you that these people are out there and the nation’s health system is lacking their support?
Dr Elijah; it is easier for me to respond to this because I was abroad for number of years as well before I decided to come back and when I was coming back people thought I was crazy. They said you’ve got a permanent job but why aren’t you staying and doing it. I said no, I grew up at a time when things were going well in Nigeria, my memories have always been there and I have always looked at it that whatever you do for your own people you may not get the equivalent in monetary terms but just the blessings and the prayers that you get out of it I think that covers more than what money will do for you. What we have been trying to do putting this kind of programme together is that I have been able to reach some of my colleagues that are still out there and for one reason or the other may not be able to come back permanently to Nigeria to volunteer and they have been very happy and willing to come. We are still trying to provide the enabling environment for them.
