On centre of excellence for cardiac care

The Ministry of Health plans to embark on a project to develop a centre of excellence for cardiac care following the death of former president Bingu wa Mutharika due to cardiac arrest on April 5 2012. The ministry’s spokesperson is on record, according to The Daily Times of October 16, 2012, as having said that the centre will help to reduce costs incurred on external referral of patients with cardiac problems (problems relating to the heart).

The spokesperson further said the ministry is still consulting and getting feedback from different quarters. In response to this call, this article examines the justification of such a multi-million kwacha project in light of the present state of health services in the country, especially critical care, and offers suggestions on the appropriate course of interventions.

Firstly, the ministry should be commended for this ambitious proposal which suits the dream-in-colour concept as championed by the former head of State. Should this dream come to reality, the country would indeed save taxpayers’ money which is spent on referral of patients with cardiac problems to other countries for further treatment.

Secondly, the proposal comes at a time when non-communicable diseases (NCDs) such as cardiovascular (heart and blood vessels) problems are on the rise in Africa. It is estimated that NCDs will cause 3.9 million deaths in the African region by the year 2020 (World Health Organisation, 2010). No wonder, these diseases are included in the country’s Essential Health Package (EHP) which acts as a basis for pooled funding for the health sector.

However, there are many ordinary Malawians who suffer from life-threatening conditions emerging from trauma resulting from accidents, complications of child birth, diabetes, infection among others apart from heart problems. My observation is that most deaths arising from these emergencies would be preventable with better emergency and critical care services which are obviously substandard at present.

There are only four intensive care units (ICU) in public referral hospitals with an average of four to five beds in each unit. An intensive care unit is a designated hospital unit where specially trained health professionals care for critically ill or severely injured patients by using special equipment. Due to limited bed space in these units, many critically ill patients who would benefit from intensive care are admitted to general wards.

Lack of equipment such as proper cardiac monitors, suction machines etc is another major challenge. It is even sad to note that none of the ICUs has an arterial blood gas machine which is critical for monitoring blood gases (oxygen and carbon dioxide), power of hydrogen (pH) and other elements in patients especially those receiving mechanical ventilation (on life support machine).

Although these units are neglected, they are very important in the management of patients with life-threatening conditions. While some people may have the privilege to be flown to other countries for treatment in times of emergency, either through medical scheme or other means, urgent resuscitation is vital prior to external referral if good treatment outcome is to be achieved. This necessitates the need to build capacity for these units.

There is need to expand ICUs in the country and furnish them with necessary equipment. Additionally, facilities such as Trauma and Emergency Unit at Queen Elizabeth Central Hospital should be considered for the other public referral hospitals. All this would help to reduce preventable deaths from emergency conditions. This is possible only if there is commitment from authorities and also with input from those with expertise in the field of emergency and critical care.

By focusing on centre of excellence for cardiac care, the approach is setting precedence that should we lose another high profile individual to any other condition, the response will be to develop another centre of excellence for the management of that condition. For the benefit of all Malawians, I propose that the ministry should take a holistic approach by improving emergency and critical care services before embarking on the so called centre of excellence for cardiac care.

—The author is a lecturer in medical and surgical nursing at Kamuzu College of Nursing.