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Need of the hour

According to Cardiothoracic Surgeons at the Lady Ridgeway Hospital for children, the hospital needs a Paediatric Cardiac Surgical Unit or Paediatric Heart Surgical Unit to save the lives of children who unwantedly suffer for want of facilities for surgical treatment in the country.

by Ranga Chandrarathne

A child suffering from a rare cardiac disease .Pix by Thilak Perera

It is not a modern theatre but one with modest facilities. A child of 11-years-old lies on a special bed with a mess of wires plugged onto diverse electronic equipment and monitors that minutely measure the child's unusually high heart beat. The child looks very weak and weary.

He is cyanotic (can be noticed in tongue, lips and fingers with bluish discolouration). He had been diagnosed as suffering from a rare cardiac disease which could have been identified and treated at an early stage, and the complications which have now developed could have been prevented, if there were facilities at the hospital to diagnose the child and to perform the corrective surgery at the appropriate stage.

The hapless parents were referred to various hospitals and visited frequently the Lady Ridgeway Hospital for Children; popularly known as LRH, which is the only paediatric hospital in the country, for the last 11 years.

The problem is so acute that over 2500 children who are born with cardiac illnesses are annually faced with this predicament of endangering their lives, due to the limited availability of facilities for surgical treatment, and thereby developing complications in the latter part of their lives, often resulting in unwanted child mortality.

According to Cardiothoracic Surgeons at the hospital, the hospital needs a Paediatric Cardiac Surgical Unit or Paediatric Heart Surgical Unit, to save the lives of children who unwantedly suffer due to due to the dearth of facilities for surgical treatment in the country. Over 2500 children annually are added to the lot who could not get their cardiac surgeries done at private hospitals because of the high expenditure.

Fact

"Although we do not possess exact figures, it is believed that approximately 2500 children were born annually with congenital heart problems in this country. Most of these children could be cured by surgical operations if they are performed before the development of complications." said Consultant Cardiothoracic Surgeon Dr. Iresh Wijemanne.

"For certain congenital heart defects, corrective surgery should be done within the first two weeks from birth. Otherwise 90 per cent of patients with those defects die at the end of one-year. Even If the surgery was performed later, those patients are highly unlikely to live for a longer period," said Consultant Cardiothoracic Surgeon Dr. Gamini Ranasinghe.

The surgeons are of the view that in some cases, surgery should be performed immediately after the birth, and some patients need to go for a surgery within the first few weeks from birth, and most of the children born with congenital heart surgery need to go for surgery within one year from birth.

It is obvious that under the right conditions children with some kind of congenital heart disease should have some kinds of heart surgery before attending the school.

However, currently there are two Government hospitals where some sort of cardiac surgery is performed; the National Hospital of Sri Lanka in Colombo, and the General (Teaching) Hospital in Karapitiya.

Even those two hospitals are basically catering for adults, and the most common cardiac operation performed at those hospitals are the bypass operations. It is also reported that less than 30 per cent of paediatric cases are handled in those hospitals. Those hospitals have no facilities to deal with surgery on children less than three weeks or one month of age.

Sri Lanka still does not have a Paediatric Cardiac Surgical Unit in any of the Government hospitals and as a result about 200 children die annually for want of surgical care.

The tragedy is that the parents of those children born with congenital heart diseases could not afford private medical care for their hapless children, as most of them belong to the poor segment of the population and come from the poorest of the poor.

The prohibitive costs incurred by paediatric cardiac surgery, approximately Rs. 350,000.00 if performed in a private sector hospital has certainly contributed to the increase of unwanted child mortality which could have been easily prevented if Government hospital had a Paediatric Cardiac Surgical Unit to perform such surgery free of charge, saving the lives of 200 children annually.

It is a prime responsibility not only of the Government, but also the civic-minded population and society to ensure that their newborn citizens won't die simply because of want of medical care.

So far the exact reasons for paediatric congenital defects have not been identified.

However, it is believed that in marriages of close relatives if the mother is infected with a disease such as Rubella during pregnancy, it is likely that the child could get some form of congenital defect.

"Performance of paediatric surgery, specially paediatric cardiac surgery is very expensive even for the Government.

Each and every patient needs a lot of supportive care and equipment, drugs and medication. At present, we have two paediatric cardiac surgeons a consultant Anaesthetist at LRH," said Consultant Cardiothoracic Surgeon Dr. Iresh Wijemanne.

While children born with congenital diseases, die annually without medical care, two Cardiothoracic Surgeons who returned from overseas training are idling at the LRH because there are no facilities to perform paediatric cardiac surgeries so far.

According to the plan, LRH will have Sri Lanka's first ever Paediatric Cardiac Surgical Unit with two theatres, rooms for the theatres and have already been allocated, and it is expected to construct an Intensive Care Unit (ICU) with five beds and a High Dependency Unit (HDU), which will function as an intermediate unit between the ICU and the Ward.

At the initial stage, the hospital is planning to set up an ICU with five beds within the constrains of space and funds. However, the surgeons are optimistic that they would be able to expand the facility with the aid and financial help from prospective donors.

High cost

Although the Ministry of Health has pledged to finance the construction of the Surgical Unit, anyone would understand that the Ministry could not continue to supply funds on their own for the high cost of patient management. A Cardiothoracic Fund is set up to cover the running cost of the Unit on the request of the present Director, Cardiothoracic Surgeons and Medical Officers of the LRH.

The tragedy

It is a tragedy that about 200 children die annually without medical care in a country which boasts of child rights and celebrate annually the World Children's Day. It should be a prime responsibility of each and every Sri Lankan whether=[[and as a nation who are proud of our 2500 old history.

Dr. Anoma Perera, Consultant Anaesthetist in charge of the Unit said, "I was posted to this hospital three years ago, to be in charge of the upcoming Cardiac Unit and for about two years we did not have a surgeon. During that time we worked hard to make this unit ready, as we knew that we would be getting surgeons for this unit in the next two years.

"This hospital had been in existence for nearly 125 years, as the only children's hospital in Sri Lanka. At present, the Lady Ridgeway Hospital has almost all the other paediatric specialties such as plastic surgery, ENT, Orthopedic and we are very proud to have this discipline also included in this program.

I assure the local philanthropists of the safety of the donations made to this Cardiothoracic Fund as it is being handled by the Ministry of Health directly. The hospital administration is vigilant all the time in using these donations economically under the supervision of the Health Ministry," said the present Director Dr. V.S.P. Pannila.

Philanthropists in Sri Lanka and abroad could contribute to the LRH Cardiothoracic Fund functioning under the National Health Development Fund to save the lives of children who die annually.

Funds could be remitted to Account number 5608 of the National Health Development Fund/Cardiac and Cardiothoracic Fund at the Metropolitan Branch of the Bank of Ceylon.

The National Development Investment Bank had already made a contribution in the sum of Rs. 300,000.00.

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