One of the lucky 1% to get a heart transplant
Sadly, the poor will be left to die
ON OCTOBER 11, I received a donor heart in a transplant operation at the private Christiaan Barnard Memorial Hospital in Cape Town. I was the 216th heart recipient to come through the hospital’s heart transplant programme.
I’ve blogged my journey through heart failure to healing at www.wordpix.co.za.
Many will appreciate one description of my experience – surreal, a word voted by Merriam-Webster dictionary as their best word for 2016 and which I used when I first tried to communicate what I was going through six months ago.
But, my family and I are cognisant that what has taken place in our lives is best-described as a miracle, aided by awe-inspiring medical skills and reflecting the sacrifice of my donor (and her or his family).
I am alive, with a heart in my chest that beats strongly, allowing me to breathe deeply and satisfyingly, to activate my entire body. I have a destiny beyond simply making it to the next place where I can stop for rest and respite. With that comes also the obligation to ensure this gift of life is not wasted. It is necessary to talk much more about heart failure and possible treatments in the context of the growing occurrence of heart disease in our community and with the World Health Organisation (WHO) reporting that almost one in three global deaths are attributable to heart disease.
I’ve realised, sadly, I am one of a few – an exclusive group that Califor nia cardiologist Dr Michelle Kittelson terms the “one percent club” – who will experience this life-giving treatment in South Africa, because of:
The lack of health-care resources – especially tertiary health facilities – for the majority, poor and rural people.
The high costs of the transplant procedure and the post-op tests and medicines required on an ongoing basis to support the recipient’s new heart.
Poor socioeconomic conditions that militate against the level of essential physical care required after transplantation.
Low rates of organ donation.
When only one in 10 South Africans is likely to enjoy the benefits of general cardiac surgical skills, let alone transplantation treatment, there can be no virtue for me in membership of a privileged club.
While I will forever be thankful private medical aid resources enabled me to re- ceive a donor heart at CBMH, I have become increasingly concerned about fellow South Africans who are cut off from this life-giving treatment.
Without access to medical aid, most cannot afford the high costs – at least R750 000 – of a heart transplant in a private hospital, which does not include the high monthly cost of ongoing medication and tests. The cost of a new artificial heart – also now available at CBMH – can cost up to R2 million.
It’s easy to think those who have heart disease are simply guilty of over-indulgence in food and drink and lack exercise. That may be an underlying reason why the government scaled back on heart transplants in the public sector, the assumption being this illness is self-inflicted and the state should not pay for poor lifestyle choices.
But cardiovascular disease can also be genetic or the result of viral infection. Many children are born with congenital heart defects every day. That is why the government must continue to resource organ transplant programmes, despite the necessary focus on primary health care.
By saying transplants are an unnecessary financial burden on society, we are saying to ill children in poor communities “you are not worthy of receiving the best health care our society has pioneered for the benefit of all humankind – and you must simply get ready to die”.
That is what the Groote Schuur Hospital (GSH) and University of Cape Town (UCT) cardiovascular unit said a few years ago in a review of the decline of its services. In a 10-year review in 2014, the unit found it had suffered more drastic cuts in state funding than other specialist units as the government shifted tertiary health-care resources to primary treatment to avoid benefiting a “few patients at significant cost”.
This year marks the 50th anniversary of the first heart transplant at the unit by Professor Chris Barnard but, since democracy, the unit has lost its edge to the private sector, as government’s health-care focus changed.
Of the few hundred thousand operations undertaken in the world since December 1967, a tiny fraction were in South Africa and in recent years most were done in private hospitals.
In 2015, nine heart transplants were performed in the Western Cape, according to the Organ Donor Foundation, which does not provide figures for individual hospitals.
Changing focus to primary health care cannot mean people who depend on the public health sector and need other treatments must simply disappear – or die. There is almost zero-access to heart surgery for poor people in rural areas of the Western Cape, who typically die without treatment, according to the GSH-UCT unit’s self-assessment.
It is worse in the Eastern Cape, where they are “doomed to endure their heart disease without appropriate treatment, eventually dying without access to proper cardiac care”.
In Statistics SA’s 2015 mortality report, the cause of one in five deaths is unspecified and listed as “other natural causes”. How does the government purport to provide effective health care when it does not have proper numbers for disease?
South Africa bequeathed to the world a world-class solution to heart failure in 1967. We must ensure children who are born with this disease are given the best chance to live.