Dr Krubin Naidoo is a Cardiothoracic Surgeon and ECMO Specialist at the Nelson Mandela Children’s Hospital (NMCH). Dr Naidoo launched an extracorporeal membrane oxygenation (ECMO) facility at NMCH which is helping save lives in the paediatric facility’s Cardiac Centre.
How did your journey in paediatric cardiothoracic surgery begin?
I completed my cardiothoracic surgery training in Johannesburg. However, being partial to congenital heart surgery and there being slim opportunities in the country for training I decided to pursue this goal abroad. I was accepted for a post-graduate fellowship in paediatric cardiovascular surgery in Edmonton, Alberta Canada. It was a very busy, comprehensive programme, but I only realised when I got back to South Africa how much knowledge and experience I had gained.
What are the biggest challenges in the paediatric cardiac surgery in South Africa?
I think a lot of congenital heart and lung conditions are undetected. Reports show that about 12 in 1 000 children throughout the world, are born with a congenital heart problem. We face a challenge of many of these children who are waiting for surgeries and additionally there are many more who remain undetected.
Why is it that we’re not detecting these cases?
Unfortunately, a lot of the children who present with congenital heart diseases for the first time present symptoms of a cold or flu and are treated as such, with many not being investigated further. Another problem is that once the patient is in the system, the waiting time for surgery is too long for a multitude of reasons. Due to a complex healthcare system highly specialised services like cardiothoracic surgery are competing with other priorities.
The other scenarios are that when we treat some children, a lot of them maybe advanced to a stage that they may be inoperable or even if we do intervene, sometimes we can’t change the course of the disease.
What can be done to change this?
Earlier detection and easier access to healthcare. Once the children get healthcare we need to accelerate them through the system to surgery and follow up with great postoperative care. There’s a lot more we can do than what we are doing, and through our Cardiac Centre and the support that we receive from the government and the public, we can make more of a difference.
Tell us about the ECMO.
A few years ago, I started a facility called ECMO (extracorporeal membrane oxygenation).
This service provides cardiac and respiratory support to allow the heart and lungs to rest and recover, if it’s a recoverable condition.
It’s a very involved, very intense intervention and it runs 24/7. It can run for months at a time depending on the patient’s condition. But if it’s successful then you save a life.
Tell us about some of the success stories?
As mentioned, we’re the only centre that (offers ECMO) or predominantly lung failure to public patients in Sub-Saharan Africa.
We also recently had an infant who was diagnosed with HIV as well as opportunistic infections. She contracted pneumocystis jiroveci pneumonia (a common opportunistic infection in HIV-infected patients) and was placed on a ventilator for a day, however, her condition showed no change. Doctors then escalated her ventilation, but her condition continued deteriorating. We then instituted ECMO in the intensive care unit. After twenty days we removed ECMO support and the patient is since doing really well.
This month, you can commit to supporting our Cardiac Centre to ensure that more children born with complex heart conditions can get the care that they need. Click here to find out how you can donate.