Sierra Leone’s first permanent cardiac pacemaker operation

Ahmed Sahid Nasralla (De Monk): Sierra Leone Telegraph: 16 September 2018:

Since February 2018 several permanent cardiac pacemaker operations have been successfully performed at the Choithram Memorial Hospital, Hill Station, Freetown, led by Sierra Leonean Cardiologist Dr. James Russell and his team.

This approach of implanting transvenous cardiac pacemakers has been successfully performed for the first time in the small West African country by the local team of Choithram’s Hospital Staff.

Aminata Mahoi was one of eight patients that benefitted from the free-of-cost surgical procedure and her surgery was done on 12th February 2018.

According to Aminata Mahoi in the Krio language….  “I feel good, my breathing is normal,” she said during follow-up check on Thursday 13th September at Choithram Memorial Hospital, about six months after her operation.

“Since then I thank God I can now do things I never used to do. Unlike before, now I can carry a bucket of water to the bathroom and wash without any help. I thank Dr. James Russel and Choithram Hospital. I did not pay a cent for the operation. Everything was free including food and drinks. And the doctors were so serviceable.”

Aminata almost passed out when she got the attack and was brought to Choithram Hospital, but the doctors were swift to revive her and performed the procedure.

Similarly, another patient – Mohamed Kamara, said he’s feeling all right and breathing normal; yet he is concerned about the future. (Photo: Dr.-James Russell and patient Mohamed Kamara).

“For now there’s no problem, but I fear what will happen after the five years stipulated for the pacemaker program,” said Mohamed with a look of concern. “If I have to do this operation in Ghana it will cost around US$7000, excluding air tickets and feeding…”

Implanting the pacemaker device is one thing, but regular follow-up check is another, noted Dr. Russell.

“People go to Ghana or Senegal, for example, to get the surgical implantation of the device and come back home; but the question is who will do their follow-up if a problem arises? So, what we have done at Choithram is to create a system whereby every six months the patients will come for follow up and we closely monitor their progress.

“During the follow up visit, we interrogate their implanted pacemaker, and this will tell us how long the battery will last for. So, six months before the battery expires completely, the patients will come to the hospital and do a box change with a new pacemaker procedure that last for 30-minutes.”

The Intracardiac pacemaker implantation surgery usually takes about one-and-half to two hours, whereby the heartbeat is regulated to the patient’s activity.

It’s a team job involving the cardiologist, the assistant operator, the scrub nurse, the pacemaker technician who monitors the activity of the heart during operation, the radiographer and others.

When the pacemaker is programmed in the heart, it monitors the heart beat and paces the heart. If the heart is dependent on the pacemaker entirely, it depletes the battery of the pacemaker device.

If the battery is allowed to expire completely the patient might collapse with deleterious outcomes. Hence the need for regular follow-up.

According to Dr. Russell, a team of expert cardiologists from the University of Cardiff, U.K and Michigan University, U.S.A arrived in Freetown in February, about three weeks before the March 2018 elections; they assessed the facilities at Choithram Memorial Hospital including theater and the staff, and even examined patients who needed the pacemaker procedure. When they were satisfied with all the requirements the operations started and eight pacemaker devices were surgically implanted in patients. Since then the local team on the ground have done five successful operations.

“We successfully operated five patients and they are testimony to the fact that we have gone one stage ahead in our own practice. We are proud because not all countries in West Africa are doing this surgery” said Dr. Russell.

Before now, this procedure was not done in the country. When patients had such problems, the doctors would make the diagnosis and would refer them abroad to places like Ghana or Senegal for the implant.

“So it’s a big plus for our country. It’s a big step we have taken in the field of medicine. This country, in terms of healthcare, will not just develop in standards like America overnight. It’s a gradual process; we just need to encourage the specialists we have in our various areas of medical discipline and give them the much needed support,” said Dr. Russel.

“All is not lost in this country in terms of healthcare. We all have our little corners from where we provide service to our nation. For us in the heart area, we are gradually transforming the practice of cardiology significantly. From the time when we don’t even have a heart scanner in the entire country and don’t even have the capacity to do all the basic tests relating to issues of the heart. But from collaboration with institutions such as Choithram Memorial Hospital, we now have a heart scanner and almost all the major instruments of equipment we need to make effective diagnosis. And we know that making diagnosis is a key, not just the treatment aspect.”

Dr. Russel paid tribute to his late Professor Bongani Mawethu Mayosi, whom he said played a significant role in helping the people of Sierra Leone in the area of Cardiology.

“He was the first man to donate a heart scanner in 2007 just to help me in my field of specialization/practice,” he revealed.

But how long will this philanthropy gesture from partners last, considering the huge cost involved?

Dr. Russell said for now they have a concrete agreement with the University of Michigan in the United States of America, represented by Professor Crawford Thomas and the University of Cardiff in the United Kingdom represented by Professor Zaheed Yusuf. So far, he said there’s that pledge to supply the devices.

“Yes, even though it is costly but through humanitarian services they are ensuring that we are getting continuous supply of the devices. But apart from the supply of the devices there is also the hospital facility through which the service is provided. The Choithram Memorial Hospital has agreed to support where there’s a legitimate case of the patient not able to afford the operation. So for the issues of providing the service, getting the supply, the manpower on the ground we have trained people. In fact, we have one of our nurses who traveled to South Africa to benefit from this training,” explained Dr. Russel.

Meanwhile, Mohamed Kamara can breathe a sigh of relief and as his fears have been allayed as long as the service is free-of-cost and reports for regular follow-up check.

Moreover, some of his counterparts with pacemakers in South Africa have lived with the pacemaker device for over 40 years.