Mind boggling! Probably, that is how you would have explained the situation when a team of surgeons at Jakaya Kikwete Cardiac Institute (JKCI) faced a challenging and a unique case during their work recently.
A young man, Ayoub Ngonyani (24) was brought at the institute in early August this year with shortness of breath and fatigue. He could not sleep flat.
He had to take rest after walking some few steps. He was weak. Upon thorough evaluation and investigation, it was found that Ayoub was suffering from rheumatic heart disease with a damaged aortic valve. There are four valves in the heart and the aortic valve on the left side is a major one because it is through it that the blood goes to the entire system of the body.
Ayoub’s valve was completely damaged beyond repair. To save his life, a major open heart surgery was in the cards. His aortic valve had to be replaced with a metallic one. But, here arose a challenge. Ayoub had a card on which it was inscribed: ‘no one should dare to inject somebody else’s blood in my veins.’
But, to be successful, a surgery procedure that was to be conducted needed blood. Ayoub divulged to a team of perplexed doctors that he was not only a Jehovah’s Witnesses member but a staunch believer and that as a matter of faith even a single drop of blood cannot enter his body.
According to Jehovah Witnesses’ literature, their refusal of transfusions of the whole blood or its four primary components—red blood cells, white cells, platelets and plasma—is a non-negotiable religious stand and that those who respect life as a gift from God should not try to sustain life by taking in blood, even in an emergency situations like this young man from Mbeya region was in.
“It was a big challenge. A puzzle had to be solved by a panel of doctors. The discussion was deep. A life had to be saved and yet a faith was to be cherished,” says Prof Mohamed Janabi, the JKCI Executive Director. At that point, balancing between science and a patient’s faith posed a real challenge.
Normally, with such a big operation doctors do what is called on-pump procedure where all the blood is taken outside the body in cardio- pulmonary machine. Here, surgeons have a chance to repair a heart that is not pumping blood.
It is this process that necessitates additional blood to a patient after surgery because some amount of blood is lost in the machine. The riddle was solved. With such a challenge on the table, the surgeons decided to respect the patient’s belief and opted for off-pump procedure where experts allow the heart to continue beating while they are operating.
“We managed to do that successfully and we did not use a single drop of blood,” explains Prof Janabi. Ayoub stayed in the ICU for five days before being transferred to a normal ward. He is back home feeling much better and doctors expect that in two months, he will be back to his normal life routine.
According to the professor, with off-pump procedure, operations are much shorter and more economical but with more meticulous techniques. The institute conducts more on-pump procedures compared to off-pump ones. “As the institute is developing, we hope to see more off pump procedures taking place,” he notes.
It took the team of experts five hours to complete the operation conducted on 12th August 2020. Professor Janabi says the successful procedure has helped create more confidence to surgeons at JKCI and sends a message of readiness to accommodate people of different faiths from Tanzania and from other parts of the world.
The Institution, he says, will strive to strengthen such procedures in the future. “If patients come on time and get treated through such procedures, a lot of blood will be saved and this will be a huge progress for our institute and Tanzania as well,” he notes.
The requirement of blood for different procedures at the institute and the rest of hospitals in Tanzania and Africa at large is still huge and challenging compared to countries in the developed world. Partly, this is because patients in the developing world attend hospital at a terminal stage of their diseases.
Mr Godliving Makundi, one of the leaders for Jehovah’s Witnesses in Tanzania and working at the church’s Hospital Liaison Committee department, says the achievement on Ayoub has strengthened their faith on God and on health services offered in Tanzania.
“We thank the entire institute for their dedicated work spirit and understanding of other people’s unique needs,” he said during a brief thanksgiving event at the institute recently.
He explained that the church, through its Hospital Information Services department, was ready to work with the JKCI by way of information sharing on successful events in health circles, consultations and that going forward more Jehovah’s Witnesses patients will be directed to the institute.
Prof Janabi assured Jehova’s Witnesses faithful and people of other beliefs of cooperation and high quality services. “I really thank all the team for saving my life and honouring my faith,” Ayoub said earlier. Currently, JKCI is the second after South Africa in doing a lot of heart surgeries in terms of number and safety levels in Sub Saharan Africa.
Only 10 patients have died at the institute among 4,300 patients who have undergone cardiac catheterisation within the past five years. On average, the institute loses between 5 to 8 per cent patients who undergo open heart surgeries per annum.
The range conforms to international standards that require a hospital to self-evaluate when deaths surpass 13 per cent. From 2018, the institute ventured into widely known complicated heart procedures such as artery and vein transplantation and arterial switch for children. Such procedures may take between 8-10 hours to complete.
The institute is slowly attracting and winning confidence of patients from neighbouring countries such as Zambia, Zimbabwe, Rwanda, Kenya, Uganda, Burundi, Comoro, Ethiopia and Malawi.
@ Emmanuel Rubagumya writes about science, technology and innovation. Email: firstname.lastname@example.org