MANAGEMENT OF CLINICAL CASES: University of Nigeria Teaching Hospital, Enugu (UNTH) was designated National Cardiothoracic Center of Excellence (NCTCE) in 1984 by the Federal Government of Nigeria for being the first hospital to perform open heart operation (OHS) in Nigeria precisely in February 1st 1974, among other feats. From 1974 to 1981, it performed 46 cases of cardiac surgeries in children with age range (6 months-16 years). Out of this 46, 25 were for congenital heart defects while 21 were for acquired heart disease. By the year 2000, 102 OHS and 48 cases of closed heart surgeries involving both adults and children had been carried out. Currently the number of OHS performed is over 300. Apart from OHS, thousands of major cardiothoracic and oesophageal operations are routinely carried out, both as elective and emergency. Between 2007 and 2019, a total of 1883 major thoracic cases were operated at the NCTCE.
Adult and paediatric cardiology units attended to thousands of patients and carried out 2D-Echocardiography. Also, cardiac catheterization and cardiac pacemaker insertion as the case may be started lately. Since the activation of the cath lab in 2017, between 2019 and 2021, 59 patients had such interventions. All cases of hypertension, heart failure and others are routinely managed. NCTCE is the referral centre for south East, South South and North Central geopolitical zones.
MANPOWER DEVELOPMENT: Activities of NCTCE helped UNTH to get accreditation. Therefore resident doctors have been receiving fellowship training at NCTCE to the level of award of fellowship of the national and regional West African postgraduate colleges. NCTCE started surgical training in 1985 and has produced 30 cardiothoracic surgeon fellows who are in Nigeria and beyond in the service of humanity with the skill they acquired at the centre.
Table 1. NCTCE’S supervision of postgraduate medical doctors for the award of fellowship of the regional West African College of Surgeons (FWACS) and National College of Surgeons (FMCS).
|S/No||NAME OF DOCTOR||CURRENT LOCATION|
|1||Dr O. C. Nzewi FMCS||UK|
|2||Dr Ojimba FWACS||UK|
|3||Prof. J. C. Eze FWACS||UNN/UNTH|
|4||Dr V. A. Okwulehie FWACS||UNN/UNTH|
|5||Dr. Emmanuel Ocheli FWACS||Uniport/UPTH, Port Harcourt|
|6||Dr Femi Thomas FWACS||Lagos|
|7||Dr. Francis O. Chukwuani FWACS||USA|
|8||Prof. Ndubueze Ezemba FWACS||UNN/ UNTH, Enugu|
|9||Prof Peter Adeoye FWACS||UITH, Ilorin|
|10||Dr. Wesam Mohammed FWACS||UK|
|11||Dr. Yahaya Adamu FWACS||National Hospital Abuja / MD, FMC, Keffi.|
|12||Prof. Sunday Edaigbini FWACS||ABU/ABUTH, Zaria|
|13||Dr. E.E. Ekpe FWACS||Uniuyo / UUTH, Uyo|
|14||Dr. Ikechukwu A. Nwafor FWACS||UNN / UNTH, Enugu|
|15||Dr. Muhammadu B. Aminu FWACS||ABU/ABUTH, Zaria|
|16||Dr. Chidiebere Onwuta FWACS||FMC, UMUAHIA/ Saudi Arabia|
|17||Dr. Kenneth Etukokwu FWACS||UNIZIK/ NAUTH/ Saudi Arabia|
|18||Dr. Obinna Orakwe FWACS||FMC, Asaba/ Saudi Arabia|
|19||Dr. Daberechi Ngwu FWACS||FMC, Umuahia / Saudi Arabia|
|20||Dr. Stephen A. Ezeanwu FWACS||FETHA/ Saudi Arabia|
|21||Dr. U. C.Adikwu-Brown FWACS||UK|
|22||Dr. Chukwuma Ngene FMCS||UNTH/ESUT, Enugu|
|23||Dr. Stanley Okubo FWACS||UNIBEN/ UBTH, Benin|
|24||Dr. Chidiebere P. Echieh FWACS||UCTH, Calabar|
|25||Dr. Stephen Ogudu FWACS||UCTH, Calabar|
|26||Dr. Aniefiok Akpan FWACS||UUTH, Uyo|
|27||Dr. Ikechukwu Alioke FWACS, FMCS||FMC, Abuja|
|28||Dr. Francis Idoko FWACS||FMC, Bida, Niger State|
|29||Dr. Onyi Arua FWACS||FETHA, Ebonyi State|
|30||Dr. Johnbull M. Akerele FWACS||Irrua Specialist Hospital, Irrua, Edo State|
Cardiology unit has equally done the same for both adult and paediatric residents. In early 90s Post Basic School of Cardiothoracic Nursing was opened with annual intake of about 30 nurses with basic qualification for one-year training. These nurses that went through this school are among the nurses that man intensive care units (ICU) in our hospitals in Nigeria and abroad. As there is no institution in Nigeria to train clinical perfusionists, NCTCE had to send 2 medical laboratory scientists to India in 2010 for training and as result achieved self sufficiency in personnel for perfusion during OHS. Other staff such as 4 cardiac anaesthetists, some ICU nurses, a cath lab nurse and 4 perioperative nurses, a theatre technician and 2 interventional cardiologists also went to India for training at different times.
Currently our cardiologists can adequately handle all echocardiographic investigations. In addition, our adult cardiologists are able to handle all forms of cardiac pacemaker insertions, coronary angiography and occasional coronary artery stenting (under supervision). Our surgical team can handle all non-open heart cardiac procedures and some OHS procedures like repair of Atrial Septal Defects (ASD), occasional repair of some Ventricular Septal Defects (VSD), excision of some types of intra-cardiac tumors and occasional replacement of the mitral valve, albeit on an irregular basis.
COLLABORATION: The former Vice Chanchellor of UNN, Professor Batho Okolo, was given a list of equipment for cardiothoracic surgery under the 2009 Special Intervention by Educational Trust Fund (ETF), now known as Tertiary Education Trust Fund (TETFUND). NCTCE explored the option of requesting for teaching and learning equipment and cardiothoracic surgery was transformed by that intervention at an estimated cost of three hundred and sixty two million naira only (N362m). Between 2013 when majority of the equipment were supplied and 2019, two hundred and sixty six (266) OHS were done with vital help from foreign missions while the local team has independently done 9 since 2019. See table 2 for our major collaborators. Foreign cardiac teams bring equipment and consumables as well as experts.
TABLE 2: LIST OF COLLABORATORS IN OHS PROGRAMME
|1||Kanu Heart Foundation (KHF) of Nigeria/International Children’s Heart Foundation (ICHF)|
|2||Texas Heart Institute (THI) of USA|
|3||University of Nigeria, Nsukka (UNN)|
|4||Dr Ewuzie, Anaesthesiologist from UK|
|5||Dr Achiluhu, Cardiologist from USA now at Abuja|
|6||Innova Children Heart Hospital (ICHH) India|
|7||Mr Nwanneka Okoro, Clinical Perfusionist from USA|
|8||VOOM Foundation of USA|
|9||Save A Heart Nigeria of UK|
|10||Rotary Club, Nigerian Chapter|
|11||Norvic Cardiac Alliance of USA|
|12||Cardiostat of USA|
|13||Pobic International of Italy|
|14||Syri Sai Sathya Sanjeevani of India|
PUBLICATIONS: Many of the activities and achievements have been published in both local and international professional/peer-review journals of repute with resultant effect that UNTH is visible in the world because of her cardiovascular services over the years. These publications had enabled academic staff of the UNN, who provided clinical services at UNTH to readily meet the creative output requirement for promotion at the university. Also, major breakthroughs of NCTCE in OHS form local news in print and electronic media from time to time thereby creating awareness of cardiovascular diseases and available solution.
ORGANIZATION OF NCTCE: NCTCE has a chairman appointed by UNTH Management and all the different departments post the staff of related unit to NCTCE. These are cardiothoracic unit of surgery, cardiology unit of internal medicine, cardiac anaesthetists and theatre technicians of anaesthesia, cardiology unit of paediatrics, ICU and perioperative nurses unit of Nursing Services Division. Others are from pharmacy, haematology, chemical pathology, perfusion, radiology, central sterilizing and stores department, nutrition and dietetics, administration, accounts and finance, domestic service unit, works and biomedical engineering departments as well as health visiting unit and social works unit.
It is an established fact that our healthcare field has been experiencing inter-professional conflicts. The surgical team managing the heart disease is included. However, NCTCE has been able to achieve some level of cohesion due to mutual respect and esprit de corps that engender teamwork that has resulted in the recorded achievements.
CONCLUSION: The NCTCE at UNTH is being sponsored by the federal government of Nigeria which is the central government. Successive UNTH Managements and Boards had applied the tripod of staff training, equipment procurement and restructuring of hospital wards to create ICU and theatres which brought about increased activity at NCTCE. In 2001, a restructured orthopaedic ward 7 and theatre become the physical space for the NCTCE for the first time at UNTH, Old Site but later abandoned in 2007 due to movement to the UNTH, Permanent Site. At the permanent site, another restructuring took place in order to accommodate the NCTCE. In 2011, NCTCE building was started by the FMOH and is yet to be completed.