Weekend Argus (Saturday Edition)
Life-saving partnerships
Critically ill children born with congenital heart defects can be treated
CHILDREN should not have to die because they were born with congenital heart disease, says paediatric cardiologist at the University of Cape Town and Red Cross War Memorial Children’s Hospital, Associate Professor Rik de Decker.
“The tragedy is that almost all cardiac lesions can be fixed now,” he said.
“A lot of what causes the deaths are easily repaired in the cardiac catherisation laboratory (cathlab), easily repaired operations and (the children) live a full and rich life.”
De Decker and the team of paediatric cardiologists from the Red Cross Children’s Hospital (RCCH) spearhead a unique collaboration with two Eastern Cape hospitals, which ensures that critically ill children who are born with structural heart defects, can be treated.
For decades, specialist physicians and surgeons from Red Cross have been consulting with and treating newborn babies and older children in bi-annual clinics at Frere Hospital in downtown East London and Cecilia Makiwane Hospital (CMH) in Mdantsane about 25km away.
It is a carry over from our country’s convoluted past – before 1994 when the cities were both part of the Cape Provincial Administration under the National Party government.
Under apartheid, CMH was technically excluded from the CPA because Mdantsane was located in what became the Ciskei bantustan under Lennox Sebe in 1981. CMH was formerly known as Mdantsane Hospital.It was renamed in 1977 by then-Ciskei health minister Chief Mqalo in honour of the first black nurse to qualify in South Africa.
RCCH, now 61 years old, was started as a memorial to those who died during World War II. Until Nelson Mandela Children’s Hospital was commissioned, it was the only hospital of its kind in subSaharan Africa.
Through the commitment of doctors and administrators and an agreement between the post-1994 provincial governments of the Eastern Cape and Western Cape, the work continues.
Twice a year, a team of paediatric cardiologists travels from Red Cross to do clinical assessments of children. These range from newborns and young children who have recently been diagnosed and referred by the resident paediatricians at the local hospitals, to older teenagers whose conditions were treated surgically in Cape Town many years ago and who come for annual check-ups.
These essential services and professional connections between the two centres are life-saving.
Over the years, hundreds of children from the eastern part of the Eastern Cape have been successfully treated in this collaboration. Frere Hospital paediatrician Maurice Levy said: “There are very few congenital heart defects which are not correctable, but they should be detected early.”
Watching visiting doctors – John Lawrenson and George Comitis – and their hosts interact with their young patients is inspiring. The children are examined in tandem in adjacent beds in a ward filled with files and pieces of electronic equipment. There is close communication between the doctors, the child and the parent during the process; from time to time, the doctors will “cross-examine” each other’s patient as a second opinion is sought on a scan image or X-ray. Junior doctors and interns both contribute during assessments and gain valuable knowledge as well.
At the right time, RCCH facilitates transport of the mother and child from the Eastern Cape to Cape Town and provides accommodation for the mother for the time the child is admitted. The hospital also has a teacher who assists young patients to keep up with their studies while away from school. Reports are even provided to the school the child usually attends.
De Decker says research in South Africa “totally” underreports mortality of children from heart disease, because “unless you go to the mortuary and do a post-mortem on every child, look to see if it is the heart, you don’t get it”.
“We know that one-in-ahundred children who are born will have something wrong with their heart – it’s a fact around the world. Of those, 60% must have something done to the heart or they will either die (now) or later on. Half of the 60% are critical, they must be (treated) within the first few weeks or they will die.”
He compares attitudes toward heart disease, road deaths and tuberculosis.
“If one-in-a-hundred people who drive out there has an accident, there would be carnage on the roads. Onein-a-hundred is the number of people who have TB in SA, and TB is rife in SA, everybody knows that. But nobody would say that CHD is rife in SA, it’s the same number, the same number.”
De Decker says that a big reason for under-reporting is misdiagnoses.
“This is a problem of children who are ill who actually have problems with their heart but who present with pneumonia or septicaemia (blood poisoning) or something else. There are lots of undiagnosed, underdiagnosed children who don’t make it here.”
The Eastern Cape’s government hospital system has one paediatric cardiologist based in Port Elizabeth, and some children are referred there.
However, RCCH still sees the bulk of young local patients with heart disease who require surgical or cathlab interventions.
Dr Adele Greyling is the only paediatric cardiologist in the Eastern Cape’s public health system, heading up the unit at Port Elizabeth’s hospital complex which includes Provincial and Dora Nginza hospitals.
General paediatricians in East London – Maurice Levy at Frere Hospital and Felicity Goosen at Cecilia Makiwane Hospital – work closely with the Red Cross team. “Both of them can do echocardiography – an ultrasound of the heart – very well. They know what’s going on and they know how to manage their patients,” said De Decker.
“We (can) do 23 procedures in the cathlab without opening the child at all – these procedures would have been done previously through open heart surgery.”