UNVERSITY OF NIGERIAN TEACING HOSPITAL: ADMINISTRATIVE UNITS.

HISTORICAL PERSPECTIVES: Forty Years of Cardiothoracic surgery In Black Africa.


1 EARLY BEGINNING AND FOUNDATION
The concept of, and desire for, a modern Cardiothoracic Medicine and Surgery was developed in 1973 by Prof. F.A.A.O. Udekwu,then Head of  Surgery, University of Nigeria. He met Consultant Cardiac Surgeon,Mr. Magdi H. Yacoub(now Sir Prof.Magdi H. Yacoub)and Mr. C.H. Anyanwu at a Cardiology Course  in London in 1973 after which he visited their Centre at Harefield Hospital,Uxbridge,Middlesex,a regional Cardiothoracic Centre in United Kingdom.
Prof.Udekwu there observed the surgical service and expertise available and expressed his desire of inviting them to Enugu, Nigeria to attend the proposed Conference of the International College of Surgeons(Nigeria Chapter)in early 1974.The skepticism of the Duo on the invitation was matched by Prof. Udekwu’s enthusiasm.
Serious discussions on the invitation then ensued around the clinical facilities, equipment and staff at Enugu before Prof. Udekwu returned to Nigeria.
Mr. D.C. Nwafor,a Registrar in the Unit from Nigeria on the visit further provided more firsthand information on clinical facilities and social conditions at Enugu. These of course, raised much more doubts about the proposed invitation to Enugu.
However,Prof. Udekwu followed his invitation with more enthusiasm and promises for achieving success despite the identifiable daunting problems. As the Senior Registrar and Chief Assistant to Mr.Yacoub,Mr. C.H Anyanwu was the anchor of the proposed plan on whom Prof. Udekwu relied. He prepared a list of essential equipment and facilities to be provided at Enugu.
Dr H.N.C. Ihenacho,a Cardiologist at Birmingham/Coventry region was contacted and he consented to participate. Permissions from the respective Hospital authorities in UK were obtained. Frenzied preparations both at Enugu and at Harefield were made culminating in Mr. George Wiggins, the Chief Pump Technician, travelling to Enugu with necessary Cardio-pulmonary-Bypass(CPB)equipment a week before Mr.Yacoub,Mr. C.H. Anyanwu, Dr. Ihenacho,Mr. Nwafor joined him on January 30,1974 on a bold and risky surgical adventure to a recent war zone. The entourage was received and taken to the UNTH to assess the patients, the theatre,ICU facilities, and other the equipment.Mr. Wiggins had arranged for the scrubbing and disinfection of the theatre twice before arrival of the Team. Standby water and electricity supply were provided; a 5th Year Medical Student (Mr. Okezika Okereke, later a Cardiac Surgeon)had harvested and sterilized some  cadaver heart valves based on the practice/instruction from Harefield Hospital.
Despite the numerous challenges including frequent electricity outages, was then successfully performed the first open-heart operation in black Africa on February 01,1974 with Prof. Nwachukwu as Consultant Anaesthetist,and Miss P. Anyakora as Chief Scrub Nurse.The operation was witnessed by many delegates of the on-going Conference of the International College of Surgeons including Sir Samuel Manuwa,an eminent Surgeon and former Chief Medical Officer of Nigeria. A second open heart operation was successfully performed the next day, February 02.
Mr.Yacoub and George Wiggins returned to UK on February 03 while Mr. C.H Anyanwu, Mr Nwafor and Dr. Ihenacho remained at Enugu to supervise the full recovery of the operated patients. There was immense co-operation, joy and admiration from all UNTH staff including senior colleagues such as Prof.Kodilinye (the UNN Vice Chancellor), Prof. C. Nwokolo,Prof. G. Onuaguluchi,Prof. O.K. Ogan,Prof.L Ekpechi,Dr. R. Eruchalu,Dr. F.C. Adi,Dr. P.I. Okolo and others.UNTH Enugu was instantly launched on the World map of Cardiac Surgery.


2   PERIOD OF PIONEERING AND ESTABLISHMENT OF THE CENTRE (1974-85)

Following the successful surgical visit to Nigeria,Mr. C.H. Anyanwu returned in October 1974 to pioneer the Unit.Dr Ihenacho was given appointment at Unn as lecturer/Consultant Cardiologist; this was followed later by Dr. E.O. Okoroma (from USA)as Paediatric Cardiologist in 1975.Dr. D.C Nwafor returned to the Department of Surgery in 1975 followed by Dr.Martin Egbue from UK as Senior Registrar in Surgery.The unit attracted international interest and staff were employed form India(Dr. Ashok Swarup,Senior Registrar, Surgery),(Dr.Antao Cardiology registrar),South America/UK (Cardiac Technician)and other Technicians.Mr Akpan returned from Harefield;ICU Nurses,Theatre Nurses, Cardiac Technicians were sent to the UK and other centres for full of short/refresher courses.
Open-heart and other cardiovascular system and Thoracic Surgical and Cardiological procedures were commenced after adequate preparations and investigations of patients.

M-mode echocardiography and cardiac catheterization were performed jointly by Cardiologists, Surgeon and Mr. Akpan (Theatre/Pump Technician) with radiological technical assistance. Dr Vincent Ikeh joined the Unit in late 70s as Physician Cardiologist. Prof. Nwachukwu, Dr. B. Umeh and Dr. C. Okechukwu were the main Anaesthetists while Mr. Akpan managed the CPB machine.

 

This period was marked by successes in clinical care, landmark Cardiovascular treatments, elevation of the standard of clinical care generally (notably in ICU), active participation in local and International Scientific Conferences by members of the Unit and publications in Scientific Journals. A visitation from the Health Committee of the National Assembly in 1982 recommended the designation of UNTH as a National Centre of Excellence for Cardiovascular diseases and donated initial sum of N200, 000.00.

In January 1984, the new General Buhari/Idiagbon Military Government pronounce the designation of UNTH, Enugu as a Centre of Excellence for Cardiovascular Diseases. During this period, the Centre started to attract keen interest of Resident doctors in UNTH and from other hospitals in Nigeria some of whom were admitted into training programmes for Cardiology and Cardiothoracic surgery at the UNTH and abroad. These included Drs Okezika Okereke and Martin Aghaji (Cardiothoracic Surgery) and Drs. Basden Onwubere, Eugene Ugwu and Clement Odigwe (Cardiology). Moreover, intensive in-house and overseas training of ICU, Theatre and Cardiology Nurses and Technicians was commenced. Consequently, Mrs. Gladys Umeh, Mrs. Gertrude Agi and Mrs. Pauline Ajuga were sent to Harefield Hospital, UK at different periods for ICU nursing courses while Mrs. Ngozi Ezedum went to the same Hospital for Theatre Cardiothoracic Nursing course. Mr. Josephs was sent to Westminster Hospital, London for Cardiovascular technical training.

3. PERIOD OF HOPE AND PROGRESS (1986-96)    
Late in 1985 and early 1986, the Centre happily welcome the return from training overseas of 2 graduates of the UNTH Medical School viz:-
Dr. Okezika Okereke (1975 set) and Dr. Martin Aghaji (1977 set) who were appointed Consultant Cardiothoracic Surgeons. More Cardiology Residents trained locally and /or overseas also joined the Centre. Dr. Basden Onwubere, Dr. Eugene Ugwu, and Dr. Clement Odigwe returned from overseas training in Cardiology and joined the team. There was a resurgence of clinical and operative services encouraged and supported by a readily available 2-D Echo Machine which provided desirable and reliable cardio logical diagnosis in the absence of a Cardiac Catheterization laboratory.Dr. T. Eziashi, Dr. K.Izuora and Dr.H. Ezike were the Anaesthetists at various periods while Dr.Izuora and Mr. Akpan managed the CPB Machine.Dr.Val Chikwendu and Benedict Anisiuba were later trained in Echocardiography techniques.

Serious attempts were made by the Centre and UNTH Management to actualize the Centre and upgrade the facilities through the promised Federal Government funding. Comprehensive list of equipment and financial estimates were defended at the Federal Ministry of Health, Lagos.Initial clinical successes and progress was adversely affected by:-
A- Prolonged delay and inadequacy in re-equipping the facilities.
B -Socio-economic environment encouraging the “brain-drain” syndrome.
C -Non-availability of 2-D Echo for a period.

However, the Centre was sustained while major resuscitation was awaited. This period also witnessed a gift of a large sum from the First Bank plc for a Chair in Cardiovascular Medicine; regrettably, this gift was not been utilized as planned.

 

4. PERIOD OF RELATIVE INACTIVITY (1997-2002)
Adverse socio-economic milieu persisted despite attempts at, and signs of, rejuvenation.The long planned cardiothoracic building was completed, commissioned and equipped. This raised the morale of staff, students and patients. New 2-D Echo Machine was acquired to improve diagnosis and treatment; ICU was modernized, more theatre space and equipment were provided but the Catherization laboratory, a Philips equipment continued to be non functional after installation.A C-arm was, however used for peacemaker insertions and procedures. Though closed heart and general thoracic procedures were routinely performed, the rate of open-heart operations declined. This period also marked the formal establishment of the Post-basic Cardiothoracic School of Nursing to which nurses from all parts of Nigeria and some African countries were admitted, trained and certified. Members of the NCTCE have continued to play important roles in the School’s academic and professional programmes.
At the end of this period, several postgraduate doctors had successfully completed their training in Cardiothoracic Surgery and Cardiology; many are consultants in various Nigerian Teaching Hospitals and outside Nigeria.


5. PERIOD OF APPRECIABLE REVIVAL AND PROGRESS (2003-2012)
This period was significantly heralded by the surgical visitation from USA organized and sponsored by the Kanu Heart Foundation. A Team of Surgeons, Anaesthetists, cardiopulmonary  bypass Technicians, ICU Nurses,
Physiotherapists, Cardiologists and Theatre Technicians, successfully performed many open-heart procedures on Nigerian children within a period of 3-4 days.They were assisted by the local staff who used the opportunity to update their professional experience. The public, the medical professionals, the Governments at State and Federal levels and the information media were all sensitized and impressed. The visiting Team donated unused equipment to the Centre. Subsequently another surgical Team from Ivory Coast visited and assisted the local staff to perform more successful open-heart operations. The Centre of Excellence was thereby appreciably revived and rejuvenated.

The original plan to retain the Centre of Excellence at the old site of UNTH was jettisoned by the Federal Government directive that ordered immediate closure and re-location to the new site of UNTH where no facilities for modern cardiothoracic services were provided. The staff then had to improvise to maintain essential minimal services as the Hospital Management, the Federal Government and staff of the Centre continued to make strenuous efforts to upgrade the Centre to the expected international standards.

IMPORTANT MILESTONES OF OPEN HEART SURGERY IN NIGERIA

1- 1974- FIRST OPEN HEART SURGERY IN WEST AFRICA-DONE AT UNTH ENUGU
2-1986 DECEMBER 16TH-FIRST PROSTHETIC MITRAL VALVE REPLACEMENT IN NIGERIA-PERFORMED AT UNTH.IN THIS NOVEL OPERATION-THE MITRAL VALVE OF THE HEART WAS REPLACED WITH A MECHANICAL PROSTHESIS-STAR-EDWARDS VALVE-THIS PATIENT LIVED NORMALLY FOR 26 YEARS AFTER.
3-1987 MARCH-FIRST PROSTHETIC AORTIC VALVE REPLACEMENT IN NIGERIA DONE AT UNTH.THE AORTIC VALVE OF THE HEART WAS REPLACED WITH A BJORK-SHIRLEY HEART VALVE.

4-1992-JUNE- THE FIRST MITRAL VALVE REPLACEMENT OPERATION-IN NIGERIA WAS PERFORMED AT UNTH.REPLACING A DAMAGED PROSTHETIC HEART VALVE IN A PATIENT WHO HAD A PROSTHETIC VALVE IMPLANTED EARLIER,HAS SEVERAL CRITICAL CHALLENGES.INTHIS OPERATION,A CAMEROONIAN LADY-WHO HAD A TISSUE VALVE 5 YEARS EARLIER BY ITALIAN MISSIONARIES-HAD-A CUCCESSFUL RE-IMPLANTATION AT UNTH WITH A BJORK-SHIRLEY VALVE.SHE WAS WELL AND FOLLOWED UP FOR 19 YEARS WHEN SHE EMIGRATED TO EUROPE.

5.1996- FIRST TOTAL CORRECTION IN NIGERIA OF TETRALOGY OF FALLOTS-THE BLUE BABY COGENITAL HEART DISEASE-DONE AT UNTH.

6.-1999 MAY-FIRST-DOUBLE HEART VALVE REPLACEMENT IN NIGERIA-DONE AT UNTH.IN THIS OPERATION, BOTH THE AORTIC AND MITRAL VALVES WERE REPLACED IN AN 18 YEAR OLD GIRL-BOTH VALVES WERE REPLACED WITH ST JUDES MECHANICAL VALVES.THIS LADY IS NOW 33,MARRIED AND RAISING A FAMILY IN KADUNA-15 YEARS AFTER THE DOUBLE VALVES IMPLANTATION.

 

 

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