A significant partnership between La Chaîne de l’Espoir and the Cuomo Foundation prepared the way for an extraordinary venture, a medical facility devoted to treating and performing children’s heart surgeries. In mid-January, a new purpose-built centre opened its doors in Dakar, Senegal. The story of this remarkable human achievement offers new hope today, to thousands of children.
Report by Marielle Court, Special Envoy to Dakar
“You know, I have a hole in my heart.” With her little black braids, Mariana, bored, twirls in the corridors, smiles, watches. She waits as time passes. Anyone passing by is an opportunity for her to distract herself. In an hour or maybe in ten hours—she has no clue—the doctors will operate on her. Seen from this eight-year-old’s perspective, what this operation means to her remains uncertain… Is she worried? Her gaze is elusive, hands clench, the lips are pressed, and only her body speaks. But, her childhood dreams quickly regain the upper hand, always. “When she grows up, I would like her to be a doctor ” reveals her mother. “I’d like to take care of other children ” adds Mariana.
In January, a state of the art paediatric cardio facility opened in Dakar. The first patient operated on was a young 14-year-old boy, Mouhamadou. Mariana will be the second to benefit from open-heart surgery in the Senegalese capital. She is suffering from atrial septal defect requiring complex surgical procedures and safeguards. This is the beginning of a long enterprise for many.
The white building of 2 500 m² owes its existence to two flawless paths which finally crossed each others: that of La Chaine de l’Espoir led by its fiery founding President, Professor Alain Deloche, and that of Elena Cuomo, head of the Foundation bearing her name.”I fought tooth and nail with the board of Directors for this project to emerge,” she remembers. The commitment is in fact enormous: five years in time and 6 million Euros in financial resources. The grounds were provided by Fann University Hospital. The project will be truly completed with the construction of the Children’s Pavilion, currently under way: a place to shelter families from remote regions
“We have been talking about this venture for a long time with Alain Deloche,” says Professor Mouhamadou Ndiaye, head of the Thoracic and Cardiovascular Surgery Department at the Fann University Hospital.”Be that as it may, the essence was continually missing: the financing”.
With 2 new operating theatres, 10 intensive care and hospitalisation facilities and a whole unit dedicated to medical consultations, the building, built around a central atrium, has a soothing feel. “The facilities found here are much more advanced than those found in many places around the world,” said Gérard Babatasi, head of the Cardiology Department at the CHU in Caen, France. Like all of his fellow surgeons, anaesthetists, nurses, managers and biomedical engineers along with La Chaîne de l’Espoir team, he is there for one specific thing: to accompany and help his Senegalese colleagues to carry out cardiovascular surgeries on youngsters —a discipline non-existent in this part of the world to-date.
Paradoxically, it was not in Europe that the young surgeons of the CCPC were initially trained, but in Vietnam, at the Heart Institute, located in Ho Chi Minh City. Professor Alain Carpentier and Professor Alain Deloche set up the Heart Centre in the 1990s. For these Senegalese doctors, the barrier to Europe was not the visa alone. “In addition, they can almost never touch patients in France”, regrets Dominique Tournay, one of the members of the medical staff supporting the Dakar team. “All they can do is watch, which is not very helpful. It’s becoming very difficult to undertake these type of training programmes in our country,” he says.
It is, thus, in Asia, that Monas Sokhna Diop, a 34-year-old surgeon, with two fellow doctors and three administrators, refined his medical specialism. There he saw a huge advantage: “In Vietnam, you get the same diseases as in Western Africa” he says. “In developed countries, childhood heart problems are most often detected in utero, which can be done very quickly. That which is not the case here or in Vietnam… Furthermore, the Vietnamese staff is very disciplined,” he adds, well aware that this point is crucial for the Dakar unit to function smoothly. Didi Diouf, a nurse, remarks: “Here, what we are trying to do is standardise everything: hygiene, storage, schedule… If everything is not duly followed, it is not worth continuing.”
The current French team who came for the start is only here for a few days. After them, others will assume their positions. Some of the team members are retired; others are on annual vacation leave. They come here for a few days or a few weeks. The Kouchner law, which permits medical facility staff to take fifteen days a year for a humanitarian mission, is, however, increasingly difficult to implement due to incessant constraints of French hospitals.
An incredible challenge
This whole venture is an incredible challenge. “A human adventure,” highlights Professor Deloche. And the term is not a mere hyperbole. On Monday 16 January, the first two operations were scheduled; an open-heart surgery for an adolescent and a closed heart for a 19-month-old. Mariana’s is planned for Tuesday. But getting started is more complicated than anticipated. Blood pockets have not yet been ordered, cartons continue to be unpacked, an Acinetobacter (a bacterium that can cause serious infections) has been flushed from a faucet fixture in one of the operating theatres. “We had to close the whole block and clean everything up,” sighs an anaesthetist. Early in the afternoon, while the mothers of small patients prepare food under the shade of the buildings, medical interventions scheduled for early in the morning have not yet begun. The clock is ticking, ambitions are receding. At 3:00 pm, the thumb up is at long last given. 5:00 p.m.: the operation of Mouhamadou starts. Those who are not in the theatre tense up in front of the retransmission screen set up in the meeting room. Energy and nervousness conflict in an essential battle. A glitch in the main operation would unequivocally be a catastrophe.
6:20 p.m.: the heart has been stopped and the bypass procedures switched on. Emptying blood, cannulas, anticoagulant, oxygenation, heat exchanges, clamper … Doctors comment, the scalpel incises. 6:40 p.m.: “Now we open the right atrium; we are right in front of the hole; we will put the patch and we re-plug,” explains an observer. “For this type of operations, the most important time is that of the bypass. If it lasts less than an hour, there is no problem. Beyond that, the hours count double, even triple.” But everything goes well for the teenager. The procedure is completed in about fifty minutes. The heart begins to beat again, timidly at first, and then it pulsates at full-speed. “We are happy. The operation was perfect. It was entirely led by the Senegalese team, says Gérard Babatasi, but instead of being eight in the block, we were the double. » Meanwhile, the reinforcement generator appears to have a shortage. Locating the failure will take numerous hours. There are various different issues as well, of all shapes and sizes, to be fathomed: the schedule rota of the cleaning work force, the sand that seeps under the entryways, the incentives to dissuade trained personnel from leaving the CCPC to the private sector…
500 operations per year
Nothing, however, truly alarms Professor Deloche. He knows, with Francisco A. Diaz Lison, the Director of the Cuomo Foundation, that the real stake is elsewhere: to ensure that, in five years’ time, the Centre can function independently. The concern is not so much medical. The enthusiasm of Alain Deloche in front of the young African doctors is proportional to what he expects. “It is necessary to push this new generation … I present you the future,” he exclaims, while reminding his young counterparts the demands of the vocation. “Be available day and night, that’s how you get the job and get the job done,” he explains to Amina, a young Moroccan intern in surgery, brimming with self-conviction.
As with all La Chaîne de l’Espoir programmes, the concern is indeed financial. In five years, the Centre must find a balance between families who can pay and those too poor to pay. They are currently being supported by a social fund. “The cost of an open heart surgery in France varies between 15,000 – 30,000 Euros. In Dakar, we try to keep it between 3,000 – 5,000 Euros ” recalls Francisco A. Diaz Lison. Other centres are also being developed, in Mali and Burkina Faso, with Dakar as the referral center. Long waiting lists are everywhere. In Dakar, some 500 operations are planned per year.
Mariana was finally operated on Wednesday. New complications brought her back to the operating theatre until very late during the night. But today, her life got a new lease, with a new heart…
© 2017 Le Figaro | Translation by the Cuomo Foundaiton
Centre Cardio-Pédiatrique Cuomo, Dakar
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