Where the Heart Isby Marc Engelhardt

December 7, 2012 | Kumbo, a town in rural northwestern Cameroon, is home to the only cardiac clinic in Central Africa. Ten hours away from the capital, patients get the same attention as they would in Europe. The hospital’s flagship: a state-of-the-art catheterization laboratory from Siemens.


Derick Fonyuy was 12 years old when he noticed a pain in his chest. “I didn’t know what was happening,” says the now 21-year-old Cameroonian. “I had lost all my energy, my nose bled, and I was sick time and again.” When Derick’s parents took their son to the doctor in a nearby hospital, they soon received shattering news. “They told us there was a problem with the valve on the right side of my heart and that the valve had to be replaced – a measles infection had left it damaged,” says Derick. The doctors were clear: Without surgery, Derick wouldn’t survive. His parents were shocked – but they were lucky. “At the last minute, they found a charity that paid for me to go to Paris, live with a host family, and have the operation I needed there.” Derick, who now studies medicine himself, still remembers how scared he was then. “I was alone in a foreign country, and I thought I was going to die.” But Derick lived – and returned home.
Nine years after his first heart surgery, the pain returned. The doctors diagnosed a blockage of the same valve. “They told me again that I needed surgery, and fast.” But this time, everything was different. Instead of flying abroad, Derick just had to take a bus to the far west of his home country. Here, in a small town called Kumbo, the doctors at the new Cardiac Center of Shisong Hospital took care of him. “All went well, and I feel great,” he says, smiling. Three months later, he returned for a routine check-up. “All this is possible now without paying for horrendously high air fees – it’s a miracle.”


If miracles happen in Shisong Hospital, the town of Kumbo with some 80,000 inhabitants gives no sign of it. Small houses of concrete or clay bricks line the dusty unpaved streets. Market vendors display their produce on blankets or in wooden shacks. The sound and smell of rusty moto-taxis fill the air. Getting into or out of Kumbo is the biggest problem: The road connecting the town to the rest of Cameroon is so bad that the 100-kilometer (62 miles) trip to the regional capital of Bamenda could take five hours in the rainy season. If anything makes Kumbo feel like a special place, it’s the beautiful location and mild climate: Surrounded by mountains and greenery, and located almost 2,000 meters (1.25 miles) above sea level, it hardly ever gets hot here.
As to why the nuns who run Shisong Hospital decided to establish the modern cardiac clinic here must seem a mystery to any outsider. “Our order, the Tertiary Sisters of St. Francis, settled here in Kumbo in 1935,” says Sister Appolonia Budzee. They started off with a small maternity ward. Today, Shisong General Hospital has 300 beds, plus 67 in the Cardiac Center.
“It’s the only facility of its kind in all of Central Africa,” Sister Appolonia beams. “People come here for treatment of cardiovascular diseases from all over Cameroon, from the neighboring countries, and even from as far away as Ethiopia.”
The sisters have a reputation for good work. Bit by bit over the decades, they have enlarged and modernized the hospital. So when a priest in Milan was looking for an African hospital to receive donations for a cardiac wing, Shisong was an almost obvious choice – not despite, but because of its location. “When you want decentralization, you mustn’t build all modern facilities in just the largest cities like Yaoundé or Douala,” Sister Appolonia says. “Yaoundé is Cameroon’s political capital, Douala the capital of trade – and Kumbo can become the capital for medical treatment.”


This vision is surely already a reality with regard to the Cardiac Center. The extension to the general hospital was officially opened in 2009, after five years of construction time. Everything inside is state-of-the-art: The intensive care unit and two operating theaters are – like the rest of the cardiac wing – sealed off from the dusty environment outside. Oxygen and air supply come from tabs in the wall, a rarity in African hospitals.
The flagship of the Cardiac Center, though, is its catheterization laboratory (cath lab), which boasts a Siemens AXIOM® Artis dFC all-digital, single-plane, ceiling-mounted C-arm angiography system installed in a specially fitted room that was jointly planned by Cameroonian architects and Siemens. Not only does it look like a set from Star Trek, its technical features also border on the futuresque. The AXIOM Artis enables cardiologists and cardiac surgeons for the first time in this region to offer quick and detailed diagnoses. Sharp and detailed X-rays, intravascular ultrasound-images, and angiocardiograms are the basis for the microinvasive heart treatment that Shisong offers its patients, while at the same time limiting exposure to radiation thanks to a special Siemens-package called CARE (Combined Applications to Reduce Exposure). While the AXIOM Artis with its three big screens right above the operating table give guidance to the surgeon, all the data is stored simultaneously in real time on the AXIOM Sensis XP Lite data center, an integral part of the cath lab. “In collaboration with the Italian association ‘Bambini Cardiopatici nel Mondo,’ we decided deliberately to go for the latest model,” says Sister Appolonia. The nuns of Shisong had always made clear that they wouldn’t want to go for outdated technology. “It might seem cheaper in the beginning, but then it gives you trouble later.”
The nuns and Siemens agreed early that Siemens would train local technicians and engineers on how to maintain and repair the high-tech machine. “I assisted from day one,” says Shisong Hospital’s Lionel Djankou. “I am an electronic technician and an ICT-expert by training, so I knew how the machine would work in principle – the concrete bits I was taught by Siemens.” And, he learned so well that in the past two years, Djankou has been able to fix all of the few glitches that occurred. If necessary, he communicates with Siemens in Belgium, which is also where Djankou orders those spare parts he doesn’t keep in his inventory. Probably the most frequent problem involves power cuts. “We had 4,000 blackouts alone last year,” says Djankou. Doctors and patients never noticed a single one of them, though – thanks to two giant batteries that keep the whole Cardiac Center going until the generators kick in.

Patient Demand vs. Qualified Staff
Jean-Claude Ambassa, MD, is one of the two resident cardiologists at Shisong Hospital. The 44-year-old studied in Romania and Italy, but, unlike many fellow students from Africa, he returned to his home country afterward. “When I came back, I noticed that almost everyone focused on infectious diseases only,” says Ambassa. “They said that people have no heart problems in Africa, which of course is not true.” The cardiologist soon found that most heart diseases were simply never diagnosed, due to the absence of specialists. When he looked more closely, he found a worrying trend. “Cardiovascular diseases have the potential to become the number one killer in Cameroon if nothing is done,” he says. Ambassa blames that fact partly on poverty and late diagnoses, and partly on lifestyle choices. “Whoever is able opts for the European lifestyle – eating more fat, not engaging in sports, and working in offices – that creates lots of heart problems,” he explains. He reports that since the new Cardiac Center opened two years ago, more than 10,000 patients have come in for consultation, adding, “That shows how big the need really is.”

Ambassa is convinced that even more people would have made their way to Shisong were it not for the medical fees. “We don’t have health insurance in Cameroon, and the government is not assisting the needy patients at all,” he notes. But despite the lack of funds, he is convinced that modern medical technology as used in Shisong has a place in Africa. “Microsurgery helps you to operate faster and more accurately, it shortens reconvalescence, and it’s more aesthetic,” he says. If there is one wish Ambassa has, it’s that he wants to see the Siemens cath lab used more efficiently. “We have problems finding qualified personnel,” he explains. We finally found a resident cardiac surgeon, but we are still looking for an anesthetist who is willing to work here instead of abroad.” Until the team is complete, surgeries can only be performed when physicians from abroad come for surgical missions; for more than half of the time, the valuable equipment remains unused. And that is more than unfortunate, both for the hospital and for the potential patients who could be helped, because with the cath lab’s inherent efficient workflow, doctors could treat 15 patients a day easily, rather than the eight treated within a week right now.


Finding Solutions for Affordability
Sister Jethro Nkenglefac is aware of this and other problems. The General Manager of the Cardiac Center, a 32-year-old with a master’s degree in business administration, probably has the toughest job in Shisong. “We’re not a for-profit organization, but we mustn’t make losses either,” she says. “Therefore, finance is my biggest worry.” The cost of running a cardiac facility in the middle of nowhere is high. Almost all special equipment has to be ordered in Europe and sent to Cameroon by ship. With the financial crisis affecting most of the suppliers, Sister Jethro has to pay up front for everything the hospital utilizes on a daily basis.
“Since customs procedures in Cameroon are so lengthy, we have to order at least six months ahead – that means quite some money goes into this.”
Every day, Sister Jethro says, she struggles to find new ideas in order to keep the hospital going. “That’s how I came up with the outreach screening program, which helps people be diagnosed and helps us find new patients,” she says. Outreach teams go to the more remote areas of western Cameroon, which none of the 12 hospital’s permanent health posts can reach. Once people learn of the Siemens cath lab and the possibilities the Cardiac Center offers for diagnosis and treatment, they are eager to come to Kumbo. “The list of those who need surgery is long,” Sister Jethro knows. “But only every other one on the list can actually go into surgery – not only because of our current lack of surgeons, but also for financial reasons.”
Sister Jethro admits that in the past, she sometimes used to cry when she realized not every sick person could be treated because they lacked the funds. “Now, I still have sympathy, but I am using my energy to make things better,” she says. Already, patients like Derick Fonyuy use the opportunity to pay for their surgery in installments. The clinic has also started a heart fund to subsidize needy clients, adding to the few international charities, such as the Italian “Cuore Fratello” association, Shisong has won over to cover part or all of the cost of many surgeries. Next, Sister Jethro notes, is a blood bank that is needed to supply the Cardiac Center with urgently needed plasma and blood cells. And, after years of nagging from Shisong Hospital, the government has even begun to improve the road. Sister Jethro’s eyes light up when she talks about these things. She knows there is still a long way to go, but eventually, Kumbo will surely become central Africa’s medical capital. After seeing Shisong Hospital, its staff, and the cath lab in action, there is no doubt about it.