South Africa may have to forego its high-tech medical achievements in order to meet the needs of its many citizens. Rehana Rossouw reports
Have a heart, says the head of Groote Schuur Hospital’s transplant unit, Dr Del Khan, to health authorities who are considering clamping down on high-tech surgery across the country.
“Most people might think that a heart transplant costs a hell of a lot, but it’s probably cheaper than treating a child with burns or a patient with TB,” said Khan, who supervises 36 transplant operations a year.
“I am not disputing that primary care was severely neglected in the past, but the situation can’t be improved by taking money and resources away from tertiary care.”
Khan’s appeal for the continued funding of tertiary medicine at state hospitals followed the furore sparked off by Dr Fanus Serfontein, who recently broke a moratorium on heart transplants by Guateng health authorities when he performed a successful heart and lung transplant on a 22-year-old student.
South African health authorities are battling to balance the tricky equation between its wealthier communities who suffer the highest incidence of cardio- vascular disease in the world, and its poorer communities where children still die of preventable and curable diseases.
Health Ministry representative Vincent Hlongwane said Minister Nkosazana Zuma was concerned about the high cost of tertiary care and would issue a directive soon on how much of it South Africa could afford.
“A lot of people still do not have access to the most basic levels of care, and the Ministry has to improve that situation. The aim is not to deliberately disadvantage any person requiring a transplant, but to improve the levels of primary care.”
Surprisingly, if Zuma decides to curtail the amount of sophisticated surgery performed in South Africa, she will have the whole-hearted support of Rika de Ruiter, executive director of the Heart Foundation of Southern
“We should be spending more money and time on preventative programmes rather than transplants,” said De Ruiter. “It makes absolute sense that the government spends more on primary health care.”
“The reality is that more white people benefit from heart transplants than black people. South Africa is now this so-called rainbow nation and its health focus and budget should reflect rainbow needs.”
This viewpoint is strongly contested by the Organ Donor Foundation. Foundation representative Gudrun Clark said transplants were not crippling the health budget as long-term chronic care was as expensive.
“To keep a person on dialysis could cost as much as R60 000 a year. It would make more sense to for the patient to have a kidney transplant which has become an almost routine
“There is a major problem at the moment with providing transplants for patients who live in shacks and are illiterate. For instance, a Transkei girl had a heart transplant and her family was unable to assist with post-operative care,” Clark said.
“There was no-one at home to make sure that she took her medication every day to prevent rejection of the organ, and in the end the girl was transferred to a convalescent home where she will have to stay until she can take responsibility for herself.
“So the little girl was given a new lease of life after the transplant, but what kind of life is it, if she has to live in an institution for years?
“Politicians can’t will medical equity into existence, they have to acknowledge that there are severe problems with medical aftercare in poorer communities.”
Khan warned that unless South Africa’s transplant programme was retained, the country will not only lose patients — and therefore their revenue — to foreign countries, but its medical staff as well.
“If doctors are not allowed to perform this type of surgery, there is a possibility they will emigrate to other countries and we will see a decline in the standard of medicine in South Africa,” he said.
The agony before the transplant
It’s a slow and miserable death if you can’t get a trasnplant, says Jacques Magliolo,whose life was saved by a ‘new’ kidney
Without organ transplantation, life on dialysis is unpleasant, painful and ultimately short.
Time is one factor organ sufferers do not have. After a period of time on a machine, your “healthy” organs begin to deteriorate to a point where — and there is simply no euphemistic way of saying it — you die slowly and excruciatingly.
The nurse comes around with tea and coffee and you are, at least during dialysis, able to enjoy a full cup. Without kidneys your system has no means of getting rid of liquid, so it enters the blood stream where it remains until dialysis removes it. Of course, there are problems which accompany this increase in fluid. Your heart has to expand to accommodate the additional liquid and so doctors restrict your total liquid intake to 500ml per day. Anything more and you could suffer more than mild chest pains, I was told by the renal
Renal patients are on a strict diet, which precludes practically anything edible, but under all conditions excludes more than 500g of protein per day. In the nine months of dialysis my weight had dropped from 75kg to 50kg, my hair had fallen out in clumps, I had gone grey-yellowish in colour and literally smelled like rotting meat.
By the fourth hour of dialysis the machine begins to clear not only impurities out of the system, but also essential “salts” and liquids which should not be removed. These are supplemented back into your system manually through the machine. It isn’t an exact science, and this is done by calculating your weight between sessions. In this manner the nurse is able to work out — more or less — how much excess liquids you have in your system, and estimate how much to return to your body.
If too much salt is returned, you vomit; if too little, you feel faint.
But I was lucky — my mother was unselfishly donating a kidney — so I didn’t have to wait five years for an organ or face further physical deterioration. I was to have the transplant the next day, which meant that I was being given two pints of blood. This would increase my haemoglobin level and prepare me for
Once dialysis had been completed, the nurse removed the needles and told me to wait a while before standing up. She then took my weight and helped me onto a wheelchair and pushed me to the transplant ward.
Within the hour the nurse had come into my room and filled in charts on my progress. When she left I picked up the board and looked for my createnine level, which is a means of determining the level of waste product in your system. Any person with normal kidneys should a level of between 60 and 120. I forget what my creatine was prior to dialysis, but the level after being on the machine for four hours was still an unbelievable 1013.
In December it will be 10 years since my transplant. I intend to take my family to Cape Town on holiday and to finally climb Devil’s Peak.