Government Employees Medical Scheme (GEMS)
29 September 2017
Mbali Mndebele says that her son Monotho has been eating her out of house and home following the successful implantation of his mechanical heart. From Left to right at Netcare Sunninghill Hospital are: Mlungisi Masondo; critical care specialist and paediatrician Dr Saskia Coetzee; Mnotho Mndebele; Mnotho’s mother, Mbali Mndebele; and cardiothoracic surgeon Dr Viljee Jonker.
Pioneering procedure made possible by highly specialised surgeons and GEMS
Today, five-year-old Mnotho Mndebele is a ‘live wire’ with a hearty appetite, playful nature – and a mechanical heart. Earlier this year, his mother scarcely dared imagine such positive changes could be possible in her adored son.
“We are absolutely delighted to hear the remarkable progress that this little boy has made,” says Dr Vuyo Gqola, Chief Healthcare Officer of the medical scheme that provided for the highly advanced healthcare interventions that brought Mnotho back to health, the Government Employees Medical Scheme (GEMS).
Dr Viljee Jonker, a leading paediatric cardiothoracic surgeon who led the team that cared for Mnotho, says that the young boy had been diagnosed with a heart condition known as dilated cardiomyopathy (DCM). “Mnotho’s heart was unable to pump blood properly and he was not able to take part in the same activities that any healthy young child would enjoy daily,” Dr Jonker explains.
“The child was weak and underweight, and earlier this year his health deteriorated to the point where he had to spend four months in hospital in intensive care. Our specialised team at the Maboneng Heart Institute at Netcare Sunninghill Hospital realised that he would need a heart transplant.
“Unfortunately, donor organs for such small children are extremely scarce and the chance of finding a matching donor heart for Mnotho was remote. We identified that there was an option that could benefit this promising young boy in the form of a heart ventricular assist device (HVAD), a type of mechanical heart, implant.
To the best of the medical team’s knowledge, such an operation had never previously been performed on such a small child anywhere on the African continent.
Mnotho’s mother, Mbali Mndebele, works as an emergency care practitioner with the State emergency medical services in Newcastle, KwaZulu-Natal. The highly specialised medical care that Mnotho required and the pioneering HVAD implant operation were costly, however, as a member of GEMS, she knew that she had a strong ally on her side looking after her son’s best healthcare interests.
Dr Jonker helped facilitate the motivations and paperwork for the family’s application to the GEMS’s Ex Gratia Committee. This is a committee that considers applications for special healthcare funding that falls outside of a member’s entitled benefits.
“GEMS’s Ex Gratia application process is perfectly reasonable, particularly when one considers the cost of highly specialised treatment and the fact that the Scheme must ensure that the treatment is appropriate in the case of each individual application,” Dr Jonker says.
“As a healthcare provider, I believe it is our duty to assist patients to get well and sometimes this involves making certain that the paperwork for the medical scheme claim is in order and that the necessary motivations are in place.”
Dr Gqola notes that a key aspect of managing healthcare funds on behalf of medical scheme members is ascertaining the appropriateness of the level of care a member or beneficiary receives. “In Mnotho’s case, we could see that this young child had faced significant health challenges in his life so far.
The extensive claims associated with his time in intensive care would, furthermore, very likely have escalated if he had not received this ground breaking procedure”, she observes.
“In the interests of improving his quality of life and getting him healthy enough to receive a donor heart one day, the Ex Gratia Committee approved the application for funding Mnotho’s HVAD implantation. In the long run, this intervention is also likely to be more cost-effective and therefore makes better use of the resources available to provide for our members’ healthcare,” Dr Gqola adds.
“As GEMS, we are grateful to the healthcare professionals and their staff who are prepared to assist the Scheme in understanding the healthcare needs of our members, their patients, and ensuring that we have sufficient evidence to support claims for their treatment as being the most suitable for their circumstances.
“We thank and applaud Dr Jonker and his team for their active role in securing the correct care for Mnotho, and we trust that he is as overjoyed as we are to hear that his young patient is doing so well following the HVAD implant procedure,” Dr Gqola concluded.
Issued by: Martina Nicholson Associates (MNA) on behalf of GEMS
Contact : Martina Nicholson, Khaya Thwala or Meggan Saville
Telephone: (011) 469 3016