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When Immaculate Kaleche was admitted at Kenyatta National Hospital on 12 th August, 2005, with severe bleeding after her delivery; she did not know doctors were going to diagnose a totally different ailment that would change.

 

. Her mother had rushed the 22-year-old from Dandora phase IV to the hospital to have the excessive bleeding, the swollen ankles and legs, and other complications that appeared immediately after the delivery, managed.

But after examining her, doctors suspected the swellings to be symptoms of a heart ailment the family did not know about.

They then decided that a test known as Echo Cardiograph be done to determine if indeed there was a problem with her heart and how serious it was. The results were positive: one of Kaleche's heart valves was not functioning properly.

According to Dr James Munene, the head of the cardiac unit at Kenyatta National Hospital (KNH), one of her valves known as Mitral valve was not allowing oxygenated blood to move freely from the left atrium into the left ventricle.

This kind of condition is known as rheumatic heart disease, which is a permanent damage to either one of the four heart valves – mitral, pulmonary, aortic, and tricuspid - as a result of rheumatic fever.

In this case, the damaged heart valve either does not completely close or open when blood flows through it.

Studies show that the fever is an ultimate consequence of untreated sore throat. Areas affected by this fever include connective tissues of the body, especially those of the heart, joints, blood vessels, brain or skin.

Children aged between five and 15 years are said to be at a higher risk of contracting rheumatic heart fever if their sore throats go untreated or are improperly managed. This is what happened to Kaleche.

It is estimated that between 40 and 50 percent of heart surgeries done at KNH are meant to correct rheumatic heart conditions.

But cardiologists like Dr Munene say not everyone suffering from untreated sore throats gets rheumatic heart diseases as is Kaleche's case. There is a strong believe that whether the disease will affect you or not depends on an individual's genetic make-up.

They also warn that many people with heart problems may live with it for a number of years without knowing, despite experiencing all signals that say there is a problem. Kaleche was just one of these people.

“When they told me about the results, I was not very much shocked. I had experienced my heart function funnily, but did not know what the problem was,” says Kaleche, attesting to this.

Besides this, she could feel general tiredness and intense pain in the chest whenever she lifted a heavy object.

Yet, the longer she stayed without the problem being diagnosed, the more her heart degenerated.

To compensate for this degeneration, the heart was forced to pump harder, which sometimes resulted in inadequate blood circulation to the rest of the body. 

When this happens, the excess work the heart has to do weakens it, causing it to enlarge.

At this point, the affected person experiences increased shortness of breath, chest pain, swelling of the ankles and legs, increased fatigue, dizziness, and fainting.

Although Kaleche says she had seen some of these warning signs, she never linked them to a problem with her heart. Even when the doctors told her they had confirmed the cause of the symptoms, she was not perturbed.

“I knew because I had lived with it all these years, the problem would be managed by tablets bought from a kiosk.”

But the hardest and most shocking part came when, a few weeks after the diagnosis, the doctors told her she was to undergo a surgery to rectify the problem. This left her dumbfounded.

That evening, a troubled Kaleche asked a medical student who was on the night shift what they were going to do with her heart.

“He explained to me that they were not going to remove it, but to work on it while in the body. I felt a sense of relief,” she says, smiling coolly. Doctors too counseled her, the way they do to other patients before a heart surgery.

Still, there were other pressing issues. She did not know who was going to foot the cost of the surgery.

“I wondered where my family was going to get the money when what keep us going are the proceeds my mother makes from selling vegetables in a kiosk.”

Her family's monthly income is about Sh 4,000, which is supposed to meet a budget that among other things includes house rent, food, books for her siblings, and other needs.

And yet the surgery was going to require about Sh 200,000 shillings. This money was to be used to purchase an artificial valve that was going to be inserted in her heart to repair the damaged one.

Though slightly bigger than a Sh 20 coin, the valve costs about Sh 81,000. It is made of carbon steel, a durable material that is able to last for 200 years before it starts wearing-out.

This material is the same one used by countries such as the United States to make some of its fighter planes that cannot be detected by any radar when attacking an enemy.

The oxygenation equipment and the tubes that are fitted to a machine that supplies blood to other body organs when surgery is going on, costs more than Sh 50,000.

Like other patients, Kaleche was further expected to foot the expenses of several drugs, which are needed to maintain the heart, the central nervous system, manage the pain, and functioning of the brain while the surgery is going on.

With its meager earnings, Kaleche's family could not afford the service, praying for good Samaritans to come to their rescue.

Luckily for her, when she was just giving up hoping, doctors at Kenyatta National Hospital recruited her to be among 20 patients to benefit from a two-week free open heart surgery project run by United Arab Emirates Red Crescent in collaboration with the hospital.

The project, which ended last week, was funded to a tune of over Sh 15 million shillings by Prince of Hamdan Bin Zayed, Chairman of United Arab Emirates (UAE) Red Crescent and founder of Emirates World Heart.

During the project duration, patients with heart problems were given free consultations and professional service, heart valve and oxygenation machines that would have cost each one of them over Sh 140,000. While75 doctors were trained on cutting-age techniques of modern surgery.

A team of Kenyan doctors working in partnership with 18 doctors from over seven countries- United Arab Emirates, France, Canada, United Kingdom, United States, Egypt, and Yemen – volunteered to do the surgeries.

“We volunteer to help those who cannot afford the service,” says one of the doctors, Prof Morsi Amin, a Cardio Thoracic Surgeon from Egypt.

Besides the patients gaining from this volunteerism, Dr Adel Al shamry from UAE says KNH is also going to benefit from the establishment of the Kenya Resuscitation Council to be used in the training of doctors.

Speaking a few days before he carried out the surgery on Kaleche, the head of the project, Dr Munene, appealed to local corporate world “to come up and help poor heart patients at KNH as part of their social responsibility objective.”

As the doctors aired these sentiments in press-briefings, Kaleche was sleeping quietly in ward 4B assured that everything was on course. But few days to the surgery, something else cropped-up.

Doctors realized she did not have enough blood to take her through the operation. Her mother was tasked to find people with A positive blood group to donate it.

Her younger sister had this type of blood, but doctors said she could not donate it because her weight was below the permitted level.

Two days before the surgery, her mother was not anywhere near finding people willing to donate the blood. But luck was gain on her side. The hospital stepped-in and availed the blood to her from its blood bank.

On the eve of the surgery as I spoke to Kaleche, she was very frightened and her spirits were low.

“I have been told very few people who go to theatre survive it. This has made me have sleepless nights, and now I just want this thing to come and go,” she said with fear written allover her face.

In between the conversation, she forced a smile, but one could easily see she was putting on a brave face.

The following day at exactly 6.45 a.m, she was wheeled from the ward into the theatre for the preparations for the surgery to start. I walked into the theatre waiting room, and she could not even look or talk to me. The fear was now more pronounced.

At 7.10 a.m., the theatre operating team wheeled her in for the operation to begin. The process lasted under three hours, and she was again wheeled out to the Intensive Care Unit, with an artificial valve now controlling the flow of blood in and out of her heart.

Several hours later when I passed the ICU, she had regained her consciousness. She looked at me and smiled, but complained of pain in the chest. She had gone through what she had feared most and came out a life.

But for her, this is just the beginning of another new journey. During the time of healing, particularly while in hospital, she was given medications such as fluid pills, potassium, blood thinners, and others for controlling a rapid or irregular heartbeat.

She will also have to confront other challenges in life as she struggles to protect the artificial valve inside her heart.

When going through a metal detector, the wire used to stitch together the chest cavity after surgery, and which lasts forever inside the body, will produce a warning noise.

For this reason, she will have to carry a doctor's letter explaining her condition to the security men or women manning entrances with such a device.

Her weight will have to be kept within a range that works out well with her age and body frame.

She has to further reduce her salt intake in order to prevent fluid retention that may overload her heart and make it work inefficiently.

And because the surgery was done on her breastbone, she is not expected to lift anything over 10 pounds for the next three months after surgery. This will help it heal properly.

Similarly, Kaleche will have to take drugs for the rest of her life to prevent the blood from clotting when it encounters the artificial valve.