Little hearts – big heroes

The world celebrated World Heart Day on 29 September and many of us did a mental rundown of what is happening heart- and health-wise. Blood pressure okay? Check. Cholesterol okay? Check. Blood sugar okay? All good. Yet how many of us consider the health of our children’s hearts?

When people hear you’re a paediatric cardiologist, the first thing they say is: “But surely children don’t get heart problems? That’s an old people problem.” And yes, heart disease in adults is rapidly becoming a health epidemic in our country, linked as it is to so-called lifestyle problems such as obesity, diabetes, hypertension and high cholesterol. But children definitely get heart problems too; theirs are just mainly congenital – something they are born with due to a structural fault while the heart is developing in the womb. Happily, while many adult heart problems can only be managed, the majority of children’s heart defects can be repaired, leaving the child with a normal quality of life and a normal life expectancy and a normal future contributing to society. One in every 1 000 children is born with a significant heart defect. However, we have to find these children in order to treat them, and have trained specialists to do so. Yet, while this need is large, the number of specialists that are available is low.

Paediatric cardiologists are a rare commodity, with less than 40 qualified specialists in South Africa. This is partly because it takes a long time to train one: six years of medical school, two years of internship, four years of paediatric training and three years in a cardiology fellowship. However, it is mainly because there are very few training sites and very few training posts available. Training can only happen in an accredited government facility with a government post, unless the doctor secures outside funding through bursaries from institutions such as Discovery Health or Netcare. In South Africa, there are currently only seven cardiac units training fellows in paediatric cardiology, and the majority of these trainees are funded privately, and not by government.

At the University of Pretoria’s Paediatric Cardiology unit, based at Steve Biko Academic Hospital, we currently have three qualified consultants, and we are training three fellows. Our unit treats children from four of the nine provinces in South Africa: Limpopo, Mpumalanga, North West Province and Northern Gauteng, and we have more than 10 000 children that we follow up on a regular basis.

Some congenital heart defects can only be surgically repaired via open-heart surgery, and children need admission thereafter to ICU or high-care wards for seven to 14 days. Other heart defects we are now able to repair with minimal intervention via access through a vein or artery, and the child can go home the next day. As technology advances, we are able to help more and more children without operating. In a resource-constrained public health system, this means fewer children waiting for surgery, fewer children waiting for limited ICU beds, shorter hospital stays, and ultimately more children that can be helped.

In 2018, our unit performed over 250 heart catheterisations, including interventions on 83 children that would otherwise have needed open-heart surgery. We closed holes that needed to be closed, and opened valves that needed to be opened, and we were able to save six months’ surgical and ICU resources. But the saving of resources isn’t what gives us our job satisfaction. It’s going to the family after the intervention and saying: “The procedure went well. We were able to close the hole in his heart. We’ll observe him overnight and you can take him home tomorrow.” Our greatest reward is seeing tired, sickly children transformed into energetic little hooligans, running up and down the hospital passages in their Spiderman or Batman t-shirts, and watching them over the years as they grow to their full potential. We help as many children as we can, and no-one is turned away. Yet we, and other units like ours, could help so many more if we had more trained paediatric cardiologists. We need our government to allocate funds to the cardiac teaching units to train more specialists to care for our country’s children.

Next year on World Heart Day, make sure you check your cholesterol, sugar and blood pressure levels, and support all South Africans living with heart conditions. But especially, celebrate all our little superheroes that are conquering their heart problems and that inspire us to carry on doing the best we can.

* Dr Lindy Mitchell is a paediatric cardiologist, working in the Paediatric Cardiology unit at Steve Biko Academic Hospital for the last 15 years. She is also the Vice-president of the Paediatric Cardiac Society of South Africa.