Overcrowding at Al-Thawra Hospital Cardiac Center [Archives:2007/1020/Health]
January 29 2007
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For The Yemen Times
For many years, Yemenis suffering any type of heart disease had to travel abroad to receive treatment and pay a lot of money, but those who didn't have enough money to travel abroad were compelled to go to Al-Thawra Hospital in Sana'a to receive treatment for a limited number of specific diseases in only a handful of rooms. “There was only one catheterization room and one operation room, in addition to a few rooms in the medical department,” noted Dr. Abdulkader Abbas, director of Al-Thawra Hospital Cardiac Center in Sana'a.
Cardiac surgeries began somewhat irregularly at the beginning of the 1980s, when many Arab and foreign surgeons from Saudi Arabia, Egypt, Germany and other European countries used to visit Al-Thawra Hospital from time to time, explained Dr. Ali Al-Rabowae, cardiac surgery professor at Sana'a University and consulting surgeon at Al-Thawra Hospital Cardiac Center.
“Surgeries weren't performed regularly; rather, they were performed two or three weeks and then stopped for two or three months,” Al-Rabowae added, “However, cardiac operations have begun being performed regularly since 2000 when some of my colleagues and I decided to establish a cardiac center.”
Because of the sensitive nature of cardiac diseases and lack of an independent facility to embrace as many of the daily-increasing cardiac patients as possible, the Yemeni government decided to build the Al-Thawra Hospital Cardiac Center. Inaugurated in 2002, it consists of three floors dedicated for adults, children and one for cardiac surgery.
“This center has great importance because it's the only place we can perform open-heart surgeries, such as implanting arteries, replacing valves, performing congenital modification operations, therapeutic and diagnostic catheterization. In fact, it's the only well-equipped and prepared center in Yemen in which to perform such operations,” Abbas noted.
Additionally, the center is planning to receive several Arab and foreign delegations, which will assist the Yemeni staff's competence. “We're planning to entertain foreign teams that have more experience than us, especially in those cases that are still difficult for us, in order to continue qualification and training,” Abbas added.
No studies on Yemen
Al-Thawra Hospital cardiac surgeon Dr. Abdulkaliq Anounu said, “Until now, there have been no statistics or studies about the number of those affected by cardiovascular disease in Yemen; however, I can say that the rate of prevalence of cardiovascular disease in developing countries differs from one type to another.
“For example, rheumatic heart disease and valvular heart disease affect 50 percent of Yemeni cardiac patients, while hypertension, coronary artery disease, congenital heart disease and other cardiac diseases represent the other 50 percent of Yemeni heart patients.”
Anounu divides the risk factors that cause cardiovascular disease into types and sub-types. “We can divide the cardiovascular disease risk factors into major and contributing factors. Major factors further divide into non-modified factors that we can't change, such as gender and age. For example, we find that women over age 55 and men over age 45 are greatly exposed to cardiovascular disease.
He continued, “Regarding gender, men have a higher risk of heart attack than women, but the difference narrows after women reach menopause. After age 65, the risk of heart disease is about the same between the genders. Another type of major risk factor is modified factors, or those for which one can make modifications.
“One major modified factor is high blood pressure, which increases the risk of heart disease, heart attack and stroke. In addition to non-modified factors, high blood cholesterol, diabetes, smoking, being overweight, heredity and physical inactivity are considered major risk factors for cardiovascular disease.”
Explaining the contributing risk factors for cardiovascular disease, Anounu noted, “Sex hormones also appear to play a role in heart disease. Heart disease is rare among women younger than 40. Nevertheless, between ages 40 and 65, around the time when most women go through menopause, the chances that a woman will have a heart attack greatly increase. From 65 onward, women make up about half of all heart attack victims. Birth control pills, alcohol and emotional stress are considered contributing risk factors.”
Anounu pointed out that some popular Yemeni dishes contain items contributing to increasing the risk of cardiovascular disease. “Yes, many people add things like ghee and cooking oil to popular dishes, which contribute to infecting people with cardiovascular disease,” Anounu stressed.
When cardiovascular disease risk factors – or even some of them – affect the human body, many symptoms begin to appear. “Symptoms usually are related to efforts. If a person feels chest pain, shortness of breath or any other symptom only while exerting himself, this means his condition isn't dangerous. However, if the symptom appears during rest and directly increases with effort, his condition is dangerous. Actually, there are many symptoms of cardiovascular diseases and some are common with specific diseases,” Anounu explained.
“For example, shortness of breath is common with congenital heart disease, rheumatic heart disease and hypertension, while chest pain is common with coronary artery disease. Additionally, many other symptoms like palpitations provide an awareness of one's heartbeat or a feeling of having a rapid and unusually forceful heartbeat, especially if they last several hours or recur over several days and/or cause chest pain, breathlessness or dizziness.
“Fainting, which is due to insufficient oxygen reaching the brain, is another symptom. Moreover, we can't forget fatigue, which is a common symptom that has numerous causes, including depression,” Anounu added.
The types, risk factors and symptoms of cardiovascular disease are many and varied. It may be difficult to be healed of cardiovascular disease or obtain medicine, but it isn't difficult to protect ourselves from it. As we learn about cardiovascular disease, we can avoid it by avoiding its causes.
Dr. Mohammed Al-Foras of Al-Askari Hospital in Sana'a advises, “People can prevent cardiovascular disease by giving up smoking. We can see that while smoking shrinks more and more every day, it increases daily in Yemen and, as I mentioned, smoking is a major risk factor for cardiovascular disease.
“We also should play sports and try our best to lose weight. Moreover, we must avoid all processed foods labeled 'low fat' or containing polyunsaturated vegetable oils, hydrogenated fats, white flour, refined sugar or additives. Applying these instructions to a good extent can help protect people from cardiovascular diseases,” Al-Foras concluded.
Al-Rabowae related death rates to Yemeni heart patients' late arrival to the hospital. “The success rate for surgeries is very high, but the problem in Yemen is that patients arrive at the hospital late and, consequently, the death rate will be high. But I can emphasize that the success rate is high in comparison to the death rate,” Al-Rabowae noted.
Lack of trust remains
While it's the only cardiac center in Yemen, it offers patients high-standard services. “This center performs all cardiac surgeries except heart transplants,” Al-Rabowae noted, “The competence level of the services this center offers, including the success of operations, is no less than the level of any cardiac center in Europe.”
Heart patient Abdulraqeeb Mahli, 35, explained, “I had surgery 10 months ago to replace a valve and now I never feel in pain in my heart. I'm here to receive treatment for an inflated abdomen, which is unrelated to my cardiac operation. Really, the care here is very good.”
Yahya Al-Marhabi, 43, from Amran governorate, remarked, “I had artery transplant surgery a week ago and I'm completely fine now.”
Despite the fact that Al-Thawra Hospital Cardiac Center can compete with European centers, many Yemenis still prefer to travel abroad for treatment. A patient companion who requested anonymity declared, “I took my wife to Egypt to replace a heart valve because I'm not ready to sacrifice her life by having Yemeni doctors learn on her!”
Accompanying his father, Moneer Al-Homaidi commented, “I took my father to Egypt twice and once to Jordan because he suffers valvular heart disease and needs surgery. I didn't take him to Al-Thawra Hospital because I don't trust the Yemeni doctors.”
Explaining the reasons for such mistrust of Yemeni doctors, Al-Rabowae said, “I believe the trust between doctor and patient is nonexistent. The reason for this is the Ministry of Health and hospital administration ignoring doctors' rights, which, consequently, has led to ignoring patients. Doctors didn't receive their rights properly, thus, patients were neglected completely.
“However, I'd like to stress that the situation has changed and now there's strong observation of everything. Doctors may be interrogated for any wrong they cause. For example, if a patient dies, the doctor must present an immediate report about the cause of death on the same day,” he added.
Other obstacles
Patients and doctors may differ in their judgments about the Al-Thawra cardiac center, but they do agree on one thing – the center's limited capacity and distance from other governorates. “We receive patients from every governorate, but the center can't embrace them all. We daily perform approximately 10-15 therapeutic and diagnostic catheterization operations, six or seven open cardiac surgeries like valve replacements and artery transplants and 70 cardiographic scans. Dozens of patients still need beds and so many other operations,” Abbas noted.
Center administration considers the center's limited capacity as its main and only problem, whereas for patients, it's only one of the problems and difficulties they face.
Patient Tariq Mohammed Bin-Ali remarked, “While this center is very good, it isn't enough. The government must build another center in Aden. I came from Lahj with my father. We suffered a lot from both the traveling and the expenditures. My father has to pay for food, accommodation and transportation, in addition to the cost of medicine. We've been here more than a month and all the money we spend is a debt from our friends and relatives.” He stressed, “The state must build another center in Aden.”
Sa'ada Hassan, 35, commented, “I had valve transplant surgery. I'm fine now, but I really suffered a lot due to the center's long registration procedures until I could have the operation. I have heart disease, so I can't come here and then go home every day for more than a month. Believe it or not, I didn't want to come to the hospital at all. I had to take a taxi every day and then had to wait many hours once I arrived at the center. By the time my turn came, the work day was over.”
Others complain that there's insufficient care for patients. A patient companion who refused to give his name said, “The doctors are competent in performing operations, but the problem is that when we bring in an emergency case, no one hears us. Additionally, after the operation, the doctor's observation of the patient isn't constant. Therefore, we can't find the doctor if something wrong happens to the patient.”
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