Special Report by Eugene Nforngwa produced with funding from the African Story Challenge
Getting to St Elizabeth Cardiac Center is not an easy task even for someone with a healthy heart. But for most patients, overcoming the bumpy roads is their only chance of ever getting the high quality and inexpensive care provided by Cameroon’s most sophisticated but remotely located cardiac center.
St Elizabeth Cardiac Center, a Catholic medical outstation in this remote part of the world, claims to offer the best heart care in Central Africa at unbeatable cost.
“Some hospitals in Europe are still having or preparing to have the kind of equipment and infrastructure we have here,” says the nun who runs the center.
“In all of Cameroon, there is none like us – no other hospital performs pediatric open heart surgeries,” says Sister Jethro Nkenlefac.
The theatres and intensive care unit – fitted with interlacing tubes, screens, giant hanging lambs and beeping gadgets – look like the set of a Hollywood medical drama.
Last year, the center administered the country’s first ever implantable cardioverter defibrillatos (ICD) – a small battery-powered electrical impulse generator that is implanted in patients who are at risk of sudden cardiac death.
There are plans to bring in more cutting-edge equipment, including a Computerized Tomography or CT scan, which uses a computer that takes data from several X-ray images of structures inside a human’s body and converts them into pictures on a monitor.
“Other theaters in the country were adapted for cardiac surgeries but we were built as a cardiac center,” says Sister Jethro.
“We were constructed solely to take care of cardiac patients, whose care is very complex and needs advanced technologies, equipment and consumables.”
For the first time in Cameroon, surgeons and doctors are performing procedures that were only possible out of the country.
Since it went operational in 2009, St Elizabeth Cardiac Center has carried out more than 350 open heart surgeries on both adult and infant patients.
In addition to clinical treatments and open heart surgeries, the center also performs invasive procedures and has begun implanting pacemakers.
Hospital records show that it has received patients from Nigeria, Equatorial Guinea, Chad, Gabon, DR Congo and even Ethiopia.
Here is the bad news: The center is so remotely located that it’s not the first place doctors elsewhere in the country think about sending patients to.
In mid-February 2014, Pierre-Jules Ghuenze was recovering in Ward 4, a compact room with three beds.
His breath had stabilized but every word he said was accompanied by a gush of air and a faint wheezing sound.
Ghuenze’s eyes appeared oversized for his sunken temples. The dry cold air had done damage to his lips, leaving them cracked up.
He wore a white hospital garment that draped around the neck to reveal a pile of plaster and gauze, where doctors had cut to reach his heart and replace a valve and repair another.
When his heart began failing several years earlier, no one told Ghuenze help was available only a bus ride away, on the other side of the Western plateaus.
Instead, doctors’ advice took him miles away from his hometown in Foumban to Douala and Yaounde to see the country’s “best” cardiologists.
They only confirm what he already knew: that he urgently needed surgery to fix problems he had lived with since birth.
At the University Hospital Center in Yaounde, he was told he could be treated in Germany, an option that would cost about CF40 million or $80,000.
The second option, the Hôpital Georges Pompidou in France, also came with a large price tag.
Ghuenze was doomed, until his pastor mentioned St Elizabeth Cardiac Center. One and a half months later, he got the operation he could not get in nine years.
And, he paid only CFA3.5 million or $7,000.
“You see this bed?” he said with a weak but brilliant smile. “It can be folded up, but I don’t have to. When I lie down now I can breathe perfectly.”
Before he came to St Elizabeth Cardiac Center, Ghuenze says he needed to get out of bed many times at night because he kept running short of breath.
Stories like this repeat themselves from ward to ward and expose the complex problem of availability and accessibility of cardiac care in Cameroon.
The true situation of heart diseases in the country is hard to pinpoint because data collection is either weak or dispersed in individual hospital records.
But it is generally believed to be on a sharp rise because risk factors like diabetes, obesity, overcrowding and poor sanitary conditions are rampant.
“A common syndrome that led us to begin this center was that of people dropping and dying or sudden deaths in the villages where we worked,” said Sis. Jethro.
Across the country, there are about 30,000 patients with pediatric heart diseases awaiting surgery, says cardiac surgeon Dr Charles Mve Mvondo of St Elizabeth Cardiac Center.
“We are working in a developing country and the most common cases we see are rheumatic heart diseases in young patients,” says Dr Mvondo. “This represents about 60% of our patients.
“We are also seeing congenital heart diseases, which are diseases that people are born with and are not the result of a lesion or infection.”
Both administrators and doctors at the St Elizabeth Cardiac center agree that they cannot bridge the gap between the demand for cardiac care and the existing offer.
In addition to challenges of inadequate diagnosis, poverty and superstition, bad roads stand in the way of access to the best available service in the country.
Getting to St Elizabeth Cardiac Center is not an easy task even for someone with a healthy heart.
There is only one truly motorable road that links it to the rest of the country through the regional capital Bamenda.
In mid-February, sections the Bamenda-Kumbo highway were under repair and the drive only less bumpy than during previous years.
All other roads that lead to the center are, in the best of times, windy rugged paths through hills and valleys.
When it’s dry, the journey can last an entire day for some patients. When it’s wet, it’s common for travelers to be stuck in knee-deep mud and do 50 to 100 kilometers in two to three days.
The location of the center was picked for several strategic reasons, says Sis Jethro.
Shishong already had a Catholic hospital that could donate some services, staff and land.
With temperatures dropping to four degrees Celsius at times, the climate suited the kind of care they sought to provide.
Above all, the Tertiary Sisters of St Francis, the religious congregation that created the center, only work among poor people, “in remote areas where no one goes”.
But for patients, the choice came at a huge cost.
The front of the hospital resembles a village market square. Overloaded cars with reinforced suspensions drop off patients and ferry others out, down a steep slope of brick-red dust.
Some arrive and leave perched clumsily behind Chinese-made motorbikes.
It’s hard to believe that some of the patients have hearts that could fail at any moment.
Asked if the jumpy state of the roads was a problem, Sis. Jethro pauses for a several seconds, sighs as if she was helpless and plumps backward into her chair.
“It is not easy for a cardiac patient to travel these our roads,” she says, barely audibly. “By the time they arrive [here], they are too tired even to help themselves.”
When Assana Mfout, the 13-year old patient in Ward Five, first came to hospital, she could not walk for more than five minutes without being gripped by a fit of panting.
“Her heart used to beat violently and got worse when she was 12,” said her elder sister and guardian, Aicha Alfa Pekariekoue.
“We thought it was witchcraft and gave her traditional medicines because that is a common problem in our community.”
As the problem persisted, Mfout was sent away from school because she was fainting two to three times a week, says Pekariekoue.
But her trip to the hospital was a bumpy uphill ride through one of the most broken roads in the country, from Foumbot to Kumbo.
“We feared she would die on the way,” says Pekariekoue, with watery eyes.
BEATING THE ROADS
The bad state of the roads in this part of the country has kept many away. It is difficult to say how many. But some heart patients simply cannot make it, says Sis Jethro.
Some have chosen to stay at home, hoping that the center’s community outreach workers will come to them with medication.
Yet, some must make the difficult journey, which in many ways is partly an adventure and partly a pilgrimage to a place of healing.
More than a few times, some rich people have come by helicopter.
“We started crying about the road when we just opened in 2009,” said Sis. Jethro. “We had to do a lot of advocacy.”
To help those who cannot make the journey to Kumbo, the St Elizabeth Cardiac Center now runs mobile clinical activities in the big cities.
The program involves transferring the entire out patients department to a partner hospital where cardiologists, pharmacists, nurses are brought in to consult people on the spot.
People here believe the roads have been abandoned for political reasons. The North West is an opposition stronghold.
More than 20 years ago, President Paul Biya promised to “personally supervise” the building of the Ring Road, the highway that includes the Bamenda-Kumbo road.
Some work only began last year and Sis. Jethro fears the section that links the hospital to the main highway will not be done.
At the regional headquarters in Bamenda, the chief of public works refused to comment. He hadn’t been authorized by the minister and was not sure what we were up to.
in 2013, the center employed its first resident cardiac surgeon to reduce the wait time for patients
His office oversees construction works across the North West and determines priority areas. We wanted to find out why it’s taken so long for the road to such an important health facility to be built.
Joachim Mbede, a health economists and coordinator of Healthy Tomorrow, a non-profit based in Douala, says there is a direct link between bad roads and poor access to health care.
“A good facility like the Shishong Cardiac Center is as good as inexistent if people cannot get there because of the state of the roads”, he says from the other side of a huge desk with little room for a recorder.
“One of the problem with the public health policy is that it does not pay attention to the problem of accessibility.
“For heart patients, sometime the difference between life and death depends on how quickly they are seen by a doctor.
“That is why you have these people collapsing and dying. Even if they wanted to, many cannot get to hospital on time.
“There has not been coordination between the ministry of works and the ministry of health,” he says.
A REGIONAL PROBLEM
A study published in 2010 exposed the lethal combination of poverty and bad governance in hindering access to heart care across sub-Sahara Africa.
“In the majority of developing nations, and especially in most countries in the African continent, only a small and insignificant portion of the population can afford the cost of diagnosis, medical treatment and/or surgical correction of congenital heart diseases,” conclude the researchers.
“The situation is even worse for those living in rural areas where access to basic healthcare is already a serious issue.
“Despite their wealth in natural resources, rural areas in developing countries are usually the poorest regions in terms of financial resources.
“These regions depend entirely on the availability of public health funding to finance and support their healthcare. Most of the time these funds do not reach them or are simply not provided.”
According to Dr Mvondo, citing a WHO report, “the incidence of heart diseases in the world is high and still progressing because local policies are not adequate to put in place preventive measures”.
Because of these wide ranging factors, available services like the St Elizabeth Cardiac center could be running below capacity.
Sis Jethro estimates that the output of her center is about 60 to 65 % of its intended capacity.
With two theatres and 12 beds in the ICU, the hospital can perform two surgeries a day, ten per week, forty per month and 400 each year.
But hospital records show that it’s only able to do around 100 cases per year.
“Even if we did two surgeries every day, we will not be able to handle everyone who needs surgery in 10 years,” said Dr Mvondo