Under-reporting of Heart Disease in SA’s Children

Cecilia Makiwane statue
A statue of Cecilia Makiwane, the first African nurse to qualify in South Africa, outside the hospital that bears her name.

“One-in-a-hundred children in the Eastern Cape are born with heart disease like everywhere else and they need a cardiology service in the province,” says Red Cross War Memorial Children’s Hospital paediatric cardiologist Rik de Decker, whose team treats young children with congenital heard disease (CHD) from the province.

Two paediatric cardiologists from Red Cross spent last week conducting the latest bi-annual cardiology clinics at State hospitals in East London and Mdantsane.

“We need to build the capacity so that those clinics are not run by us but by Eastern Cape cardiologists, we need to get the MEC for health to build up a team,” De Decker said during an interview at Red Cross.

“We go and do outreach clinics in the Eastern Cape because historically, the Eastern Cape was part of the Cape Province. Patients are triarged [by local paediatricians] in the months before the clinic to be seen by the specialist paediatric cardiologist at the clinic.

“We look at those patients and decide which of those need to come to us to have surgery done. This is a small fraction of how many [need treatment]. We also review the patients who have been here already.

“If there’s anything [special] about paediatric cardiology, it’s team work. You must have a whole team in order to do cardiac care properly. It’s the team work that’s missing in SA.

“There’s no point in having only a cardiologist. You can do with one but really, you need a team, you can’t work in isolation. A cardiologist can tell you ‘you’ve got a hole in the heart, now go find yourself a surgeon’; there’s nothing you can do about that.  It must be absolutely, mind-numbingly painful to make these diagnoses and have to say ‘sorry, I can’t do anything’.

“You need to work with your surgeons and have anaesthetists who can put these children to sleep and bypass technicians. Then you need an intensive care unit that’s happy to receive heart operation patients that – once the child’s heart has been switched on again – keeps the child alive. You must have passionate people. That’s the team and they all have to work together, but those teams don’t exist all over South Africa.”

De Decker says part of the rationale behind the outreach programme from Red Cross into the Eastern Cape is to ensure follow-up consultations with children who have already had one or more procedure at the hospital.

“Certain operations are done in series, you can’t do everything at one time. The willingness of people to come back to the clinic is high level if you tell them, but if they need to go back to Cape Town, that’s just not possible, it’s very expensive.

“They go from here and they disappear, we don’t know what’s happened to them, the follow-up is terrible. That’s why we do outreach, because if we go there, they’ll come around the corner from the next village to come and see the doctor, but they won’t travel all the way to Cape Town and then the child dies.”

Under-reporting of Heart Disease in SA’s Children

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