When the tiniest hearts break: Behind SA’s shortage of paediatric
The nurse carefully places her stethoscope on the left side of the tiny 10-week-old baby’s chest. She frowns. There is no heartbeat.
She then shifts the device to the right side of the infant’s chest. Finally, she hears his little heart pulsating.
But she’s still worried. His heart is on the wrong side.
“You’ll have to see a doctor urgently,” she tells the baby’s mother.
Zothile Nkabinde brought her son to the local pharmacy for a check-up after he had suddenly started to lose weight.
Lack of appetite and weight loss can be a symptom of a heart disorder known as a ventricular septal defect.
Children who suffer from the condition are born with tiny holes in their hearts. These small perforations occur in the wall that separates the heart’s two lower chambers or ventricles, explains the United States nonprofit research organisation Mayo Clinic. In some cases, these openings can interfere with the normal functioning of the heart, allowing for oxygenrich blood to be pumped back into the lungs, instead of the body, causing the heart to work harder.
Although many small holes of this type can close on their own as children grow, some larger cavities may need surgery, according to information on the Mayo Clinic’s website.
Doctors at Sebokeng Hospital, east of Johannesburg, eventually diagnosed Nkabinde’s son with the disorder and referred the boy to Chris Hani Baragwanath Hospital’s cardiology unit for heart surgery in July. Cardiologists at Chris Hani Baragwanath sent mother and child to the Charlotte Maxeke Johannesburg Academic Hospital.
That’s when Nkabinde’s long wait began. She was told the earliest she could expect her baby could be examined by a surgeon at the hospital was three months later, in October, as one of the hospital’s two specialists was on leave.
Nkabinde explains: “Because my son’s heart is so complicated, they wouldn’t give him to the junior surgeons to work on. So we were waiting for [the] professor ... to look at him and then decide what kind of surgery he needed to do.”
Gauteng only has three paediatric heart surgeons working in the public health sector and both are based at Charlotte Maxeke, according to the provincial health department’s deputy director general of clinical services, Richard Lebethe, and doctors within the department. Additionally, sessional, or part-time private specialists, are also contracted by the state.
The shortage of paediatric heart surgeons isn’t just a Gauteng problem. Nationally, there are fewer than 10 such specialists serving the public sector, says John Hewitson, who heads the University of Cape Town’s paediatric cardiothoracic clinical surgery unit. Eight of these heart specialists work in Gauteng, the Free State and Western Cape. More rural provinces such as the Eastern and Northern Cape don’t have any paediatric heart surgeons, he says.
“A shortage of specialists results in longer waiting lists ... The longer you wait, the less likely that the surgery will be successful,” explains Hewitson.
He says that serious heart defects, such as Nkabinde’s son has, should be treated as soon as possible because they can affect a baby’s growth, including brain development.
At Charlotte Maxeke hospital, for-