Operation Saving Nipuna

~ Doctors at Lady Ridgeway Hospital recently performed pioneering heart surgery to save a 13-day-old baby.

By Kumudini Hettiarachchi, Pic by M. A. Pushpa Kumara

The tiny babe's eyes are wide open. He puckers up his face and opens his mouth in a wide yawn. What 18-day-old Nipuna Nethranjana Tennekoon, tenderly being cradled in the arms of a nurse of the Lady Ridgeway Hospital in Colombo, is oblivious to is that he is a trailblazer in the state health sector. For at just 13 days, he went under the scalpel, for open heart surgery to correct the wrong positioning of two major vessels bringing in and taking out blood from his tiny heart.

Baby Nipuna being tenderly cradled at the Paediatric Heart Surgical Unit of the Lady Ridgeway Hospital.

Calling it a "complicated and meticulous" procedure to correct the Transposition of the Great Arteries, Consultant Cardiothoracic Surgeon Dr. Gamini Ranasinghe explains that they were compelled to perform it as otherwise the child would have died. It was a challenge they could not let go because in their hands lay the life of Nipuna.

This surgery performed at the Paediatric Heart Surgical Unit of LRH was the first-ever such heart operation done in a state-sector hospital, The Sunday Times understands. Although some infants had undergone this procedure in a fee-levying state hospital and one private hospital, the success rates of those operations could not be verified by The Sunday Times.

It is touch and go, adds Consultant Cardiothoracic Surgeon Dr. Kanchana Singappuli, stressing that one small stitch in the wrong place would have spelt disaster. "We needed to do it properly and the stitches had to be very precise."

Yes, they were nervous before they started, but as soon as the incision was made on the tiny chest of Nipuna their skills and expertise came to the fore and it was absolute concentration from then on during the whole of the eight-hour operation. Taking into account the vulnerability of an infant and the size of the minute vessels, this procedure is considered to be more complex than a coronary by-pass.

The objective and sole purpose of setting up LRH's Heart Surgical Unit was to handle such procedures, says Dr. Singappuli, explaining that the hope was to get into such operations in about one and a half year. However, eight months after the opening of the unit, a dedicated team not only comprising surgeons and anaesthetists but also a Perfusionist and nursing staff have become the pioneers.

The medical team that saved Nipuna’s life.

Relief is the only emotion on the face of G.K. Jacintha, the 43-year-old mother of Nipuna, when last Monday she is told that the baby is ready to be released from the ICU to the ward, while she attempts to explain to The Sunday Times the immense joy of giving birth to the baby boy on September 18 and the depths of despair when informed that he had a problem with his heart.

Nipuna came into the world through a Caesar on a rainy morning at the Gampaha Hospital. By evening, the baby didn't look too good, says Jacintha, adding that next morning to her dismay "baba nil wela thibba". (The baby had turned blue.) Transferred from Gampaha to the Lady Ridgeway Hospital, Jacintha who was still at Gampaha came to know that the baby needed an urgent operation to save his life. She also heard that it could be done only in the private sector and would cost about Rs. 8 lakhs. Where were they to find that kind of money?

Begging the doctors to discharge her even before the caesarean stitches were removed and promising that she would get it done elsewhere, she and her husband were on a search…….a search for money to save their little one. It was then that LRH's Heart Surgical Unit team sat them down and informed them that they would carry out the operation but also gently told them about the risks.

Jacintha: A grateful mother

This procedure - the Dis-Transposition of the Great Arteries - needs to be done immediately, ideally within 7-10 days of birth or before 14 days, The Sunday Times learns."If not, the heart cannot adjust to the changes," explains Consultant Cardiac Anaesthetist Dr. Anoma Perera, adding that soon after the baby was brought to LRH a small procedure to maintain life was carried out by Cardiologists Dr. S. Narenthiran and Dr. K. Rajakanthan.

Although Sri Lanka has been performing heart surgery even on children, for a long while now, until the LRH Unit was set up there has been no proper paediatric back-up, says Dr. Perera.

"The cardiologists kept Nipuna running until definitive surgery could be performed," says Consultant Cardiac Anaesthetist M.S.M. Nawaz. The authorities have provided us the facilities we need, although like in other fields of medicine we are short-staffed. However, we must give of our best to the patients with the facilities because we have the capability and the skills, stresses Dr. Perera, urging more training in specialized fields. "We must either send our people abroad for training or get experts to come here, so that we keep updating our knowledge."

Smiling through her tears, Jacintha is full of praise for the "devivaruwage dosthara mahaththurunta" and the team who have cared diligently for Nipuna, bringing hope where there was only desperation and despair. October 1 is indeed a red letter day for Sri Lanka, not only proving once again that the country has the expertise but also the will to look beyond the money and give of its best to the most needy.

Have a heart: Make a donation

Eight months on, the one and only Paediatric Cardiac Surgical Unit in the country based at LRH, is seeking support to help the poorest of the poor.In a country where over 90% of the people can hardly make ends meet, the state health sector has been the only lifeline for thousands of men, women and children, who simply cannot afford to go to private sector hospitals. The Rs. 500 million unit needs your help What the Heart Surgical Unit, which has in just eight months performed more than 200 life-saving operations, needs urgently is "consumables", the stuff that can be used only once and have to be discarded after each individual heart operation. "We do not accept money, but anyone who can lend a helping hand could select from a list of items that are running short, we prepare every week for the next and purchase and donate them. It will benefit a little child, desperately in need of heart surgery," says Consultant Cardiothoracic Surgeon Dr. Iresh Wijemanne. The list of suppliers of these consumables is also available for easy reference and purchase to fit the purse of any donor. And the efforts of the paediatric heart team is not only evident from the pioneering procedure which saved Nipuna's life but also from the routine operations that are being performed day in, day out on children who are as young as one day. "Starting with basic operations now we have come to the stage where we are venturing into complex ones," he says. The unit was set up on January 17, this year, seeing the acute need of children, as up to that time they had to be treated at the Cardiology Units run for adults at the National Hospital in Colombo or the Karapitiya Teaching Hospital in Galle. "There were limitations," says Dr. Wijemanne, explaining that now children are referred to the LRH Unit from the far corners of the land such as Jaffna, Batticaloa, Bandarawela, Moneragala, Puttalam, Polonnaruwa and Mannar. Going back to the time before the LRH Heart Unit, he says that 2,500 new children with heart disease are detected yearly, of whom about 2,000 need surgical intervention. Those days, the private and state sector put together could deal with only about 750 patients. "So about 1,250 child patients with heart problems get added to the waiting list every year. If operated on time the child will be cured. If not the condition becomes acute and unfortunately some of them will die. This was a pointer to the necessity of the LRH Unit," he says, adding that in the private sector a surgical intervention would cost around Rs. 250,000 or more. Dr. Wijemanne "How many can afford this," he asks. At the LRH Unit set up by the government at a cost of Rs. 500 million, every procedure is done free of charge. However, unlike some other disciplines of medicine, heart surgery is very expensive. Consumables such as canula, oxygenators, cardio-pulmonary tubing and medication to name a few, for each intervention would amount to about Rs. 75,000-100,000. The unit was supplied with three-months of stock by the Health Ministry when it opened and is now running with donations from people. And those who have donated consumables range from top business establishments to the humble hawker, according to Dr. Wijemanne. But they are running low on stocks and that's why this appeal for help goes out from the Heart Unit. Those wishing to extend support may contact: Nishantha Sendanayaka, Coordinator of the Donation Programme on 0716272781 (mob), fax: 011-2691521 or e-mail: irewije@hotmail.com