AT YOUR SERVICE: Dr. Nkoane- Kelaeng
She’s one of the youngest Cardiologists in Botswana
The best part about Dr. Boitumelo NkoaneKelaeng’s job is experiencing the joy of seeing her patients recover, and being able to lead active lifestyles.
Dr. Nkoane- Kelaeng, 39, is an Internal Medicine Physician and Adult Cardiologist. Born in Thamaga, she is a dual- trained specialist, having completed her Internal Medicine and Cardiology training in Sydney, and Canberra Hospitals in Australia.
She is a General Cardiologist with experience in managing patients with various Cardiac conditions. Her core skills range from performance and interpretations of Transthoracic Echocardiogram ( TTEs), Transoesophageal Echocardiogram ( TOEs), Exercise Stress Test ( ESTs), to diagnostic coronary angiography, both the femoral and radial approaches.
Her special interests include Heart failure, Coronary artery disease, Hypertension, Echocardiography, and all its modalities, as well as community health education.
As an Adult Cardiologist, she deals with heart problems, including heart failure, hypertension, coronary artery disease, valvular heart disease, where any valve in the heart has been damaged or has a disease, and abnormal heart rhythms, as well as congenital heart disease, where a patient has a defect or hole in the heart.
The procedures she performs include a coronary angiogram, in which they examine the arteries to see if there is any disease. Other tests include Echo, which is an ultrasound scan of the heart and nearby vessels, and ECGs, and exercise on the treadmill test to see how the heart is beating and see if there are underlying diseases. She explains that the most common diseases in Botswana include heart failure, hypertension, and Valvular heart disease because of the prevalence of rheumatic heart disease in Botswana. “A rheumatic heart disease is a condition that people get when they are young. It is an infection but then later on it can manifest, causing problems with your valves in the heart,” she explains, adding that it can be detected when one is sick, but that the Valvular disease comes later. “Hypertension and heart failure are big,” she says.
Most of her patients from the ages of 20 to 30 years upwards have hypertension. There is no specific cause for this phenomenon. Most hypertension cases are what is called essential hypertension where there is no specific cause. Patients here get it earlier and the rest have specific causes which could be hormonal, or thyroid abnormalities among others, which luckily are not so common in Botswana. “Ninety percent of the people have essential hypertension, and there is a small percentage that has specific causes,” Dr. NkoaneKelaeng says. As she turns 40 this December, it brings her joy to see a patient who on their first visit to her clinic in Bokamoso Private Hospital struggled to walk but subsequently is able to and even assume an active lifestyle.
“The best part about my job is seeing a patient with hypertension, especially which is difficult to control and seeing them respond to therapy. That makes me happy,” she explains.
She is pleased when her heart failure patients with swollen legs and who can’t walk because of shortness of breath, get better after treatment.
“That’s what makes my day really. The best part of my job is meeting all of our patients from different backgrounds,” she says.
For the good doctor, she sees her patients as more than the diseases they have. She also appreciates her patients from different backgrounds as she gets to interact with and meet new people every day. “When I look at them, I see human beings and not their disease,” she says.
This affords her the opportunity to give each patient enough time to educate them about their conditions. She does not want instances where a patient will walk out of her clinic with a blank look on their face, or where in some extreme cases, a
patient will ask family members what the doctor was saying. That is how passionate she is.
Her passion is felt, and the atmosphere in her office changes when she starts sharing about her fulfilling profession. When she talks about one of the procedures she performs at the clinic, pacemakers, her face lights up. As soon as she starts explaining how a pacemaker works, its role, and its importance, you can see her persona changing. She gets animated and almost jumps to her cabinet to grab a sample to demonstrate how it works, and where it is inserted. She equally takes time to explain other procedures such as Angiogram, which ordinarily takes an hour to complete. She also explains Valve Diseases caused by congenital conditions, for example in the case where a patient is born with a hole in the heart, as well as other causes.
In the past, Pacemakers were known to be implanted in patients who were in their 60 and 70s. But in recent times, younger people in the age range of 20, 30, and 40 years old are also getting them. A pacemaker is handy when a patient has an irregular heart rhythm. On average a heartbeat ranges between 60- 100 beats per minute.
“If your heart beats slowly, one can collapse,” she says. On average, she sees 10 patients on Mondays, Tuesdays, Wednesdays, and Fridays, which is around 40 outpatients per week. And at least every week, one of her patients has a Pacemaker implanted. “I take time to educate my patients, and I put enough time to talk them through their conditions. I don’t want to hurry them through consultation,” she explains.
Her Thursday is reserved for Cath Lab procedures. Cath Lab is where tests and procedures including Angiogram and implantation of pacemakers are conducted. Usually, a patient is awake during some of these procedures.
“We do the Angiograms and open up people’s arteries. We also insert pacemakers, which are batteries. We put a lot of those batteries every week, we put at least one every week, because Batswana seem to have a lot of these conduction diseases, which is more than I had anticipated,” she explains.
An Angiogram is a diagnostic procedure that uses imaging to show the Doctor how a patient’s blood flows through their blood vessels or heart. When one has a conduction disease, one’s heart beats slowly hence the battery is implanted to supplement the heart.
“I am sure there are people with these batteries and no one knows, it is that common,” she adds. The battery is inserted into the skin and the wires go into the heart.
“When the electrical system of your heart is not working, then these wires give your heart electrical activity to normalise it,” she highlights, noting that the pacemaker is kind of a safety net.
The batteries are changed every eight to 10 years. The older we get; she explains that the electrical system of the heart seems to degenerate. But in Botswana, they are putting these in younger people. “We are putting them in 18, and 20 years- olds,” she says. Other procedures that she performs include Coronary Angiogram, which is done in theatre. For a coronary angiogram, she looks at the arteries to see if they are blocked. Interestingly they do this through the groin or wrist. “Go through the artery with a needle, and you go through this tiny hole. And you can unblock without cutting a person,” she says, highlighting that this is for patients with heart attacks and that they get to live longer.
“It is fun right,” she says laughing. A patient is admitted for this particular procedure, and if the arteries are normal, the procedure can take less than an hour, or more if they are blocked.
On a daily basis, she juggles seeing out- patients and in- patients including those in ICU. When there is an emergency, she leaves her clinic to attend to patients. On a routine day, she reports for work at 0800hrs, and leaves around 1900hrs.
“As a doctor, you must be available 24/ 7,” she notes. She started off as a General Physician and loved how it allowed her to have a wider scope, as she could treat a patient as a whole instead of focusing on a specific organ. Cardiology came from her love for it, and she finds it very interesting. There is a lot that she can do to treat a patient.
“I have always loved cardiology,” she says. In total, she has nine years of specialisation, six years to become a physician, and three years to become a Cardiologist, plus five years to study medicine, making a total of 14 years of study.
Almost daily, she attends to emergencies of people presenting acute heart failure, and chest pains, who can present themselves at any time. Her job is demanding, and because of its nature, she can be called to attend to a patient at any time.
With lots of conferences held annually, there are positive developments in the medical field. One is the introduction of drugs for diabetic patients in Botswana that can benefit them in the event of heart failure. “That is new and exciting,” she points out.
Her advice to those who might consider going into medicine is to take the specialist route as Botswana needs more specialists. She also calls on her peers to go into her field, as there is a need to attend to patients with cardiovascular conditions.
“I would encourage other doctors to pursue cardiology because there is a lot of cardiovascular disease burden in Botswana and the expertise is limited. And yes it takes time to train but the reward is beyond you,” she notes.