Health Page - Issue 19

19 - May 8th thru May 14th 2000, Vol X

Millions Dollars Spent on Treatement Abroad
Cardiac Centers Need Support

Jalal Al-Shar'abi,
Yemen Times
Statistics show that the number of cardiac patients sent abroad for treatment steadily increases despite the current critical economic situation in Yemen.
Incidence of heart diseases is not the only predicament in Yemen. About 1 million people are afflicted with malaria and more than 4 million with Hepatitis B. Others suffer from malnutrition, anemia, bilharzia and other enteric diseases. Cancer, high blood pressure and Aids cases are increasing sharply as a result of carelessness and absence of an official health monitoring policy.
However, the most serious diseases relate to heart. Cardiac centers in Yemen, unfortunately, do not receive any kind of support or encouragement from the government. Cost of medicine as well as travel allowances are reimbursed to high ranking people and their relatives to make medical check ups abroad while for the common man treatment in governmental hospitals inside Yemen remains a distant dream.
Heart diseases, as well as those related to blood vessels are among the most potent causes of deaths among Yemenis. People afflicted with heart diseases can be divided into three groups:
1- Rheumatic heart patients (impact of lungs fever). A significant number of such patients need surgical operations either to widen their heart valves or to implant manufactured ones.
2- Patients suffering from coronary athero sclerosis which lessens coronary perfusion leading either to a heart clot or death. These patients need either to widen their coronary arteries by catheterization or by exchanging them with arteries of lower limbs at an early age.
The Supreme Medical Committee sends abroad about 800 cardiac patients every month for treatment. About 1000 patients exchange hard currency in the Yemen Central Bank every month, out of whom 40% are cardiac patients.
This means that about 8640 patients go abroad for treatment every year. If we consider other countries like Jordan and Egypt, 16 million people in Yemen need 9000 surgical operations and more than 20 thousand need cardiac catheterizations every year.
The expenditure involved in check ups or treatment abroad is much more than that inside the country. Unfortunately, there are only two cardiac centers in Sanaa which lack the most basic equipment necessary to do surgical operations of the heart. Despite appeals to authorities concerned to support cardiac centers in Yemen, there has so far been no positive response.
Dr. Yahya Mohammed Al-Haddad, founder and director of the Modern Cardiac Center & Specialized Surgery and Assistant Professor for heart diseases in Sana'a University, said that the center does only 700 surgical operations and 2500 catheterizations in a year which is less than 10% of what is really needed. "We can treat 80% of the cardiac problems. However, 20% needs surgical operations and the equipment to do such operations are unavailable in Sana'a," he added.
As far as causes of cardiac diseases Dr. Al-Haddad said that they are many such as, sufferance, artery pressure, increase in cholesterol ratio, diabetes, smoking and genetic causes. There are also low level of living standards, malnutrition, pollution and shammah. Qat is an important factor causing heart diseases due to the chemical substances used to help it grow.
"Foreigners do trust us. Many members of foreign companies and immigrants come to us for treatment," he said confidently. However, he complained about the absence of any kind of cooperation from the authorities concerned. There are only two cardiac centers in Sana'a while in Amman which is smaller than Sanaa, there are 9.
A cardiac physician who requested anonymity said that there were many hurdles coupled with administrative bottlenecks responsible for not granting license to such centers. Corrupt practices such as bribery also plays a significant role. Even after opening the center, blackmail by taxation and customs authorities dampened our spirits.
"Instead of spending a lot of money on sending cardiac patients abroad, the government can support cardiac centers inside the country. Catheterization costs only US$ 500 in Yemen compared to US$ 700 in Jordan, let alone the fatigue and the money spent on traveling and accommodation," he said.
Dr. Sami Al-Bakari deplored patients arriving in the last phase of the disease which put doctors in a very difficult situation, especially due to the absence of specialized centers for heart surgery. However, "Yemenis do not have confidence in the local cadre. This is a wrong attitude. We have treated many patients who then traveled abroad and found the same thing there," Al-Bakari concluded.
The most frequent cases faced by cardiac doctors according to Dr. Khaled Azzeer are:
1- Rheumatic heart disease
2- Ischemic heart disease
3- Heart diseases
4- Hypertension
5- Congenital heart disease
Certain cases required the patients to lay in hospital. Such cases relate to Myocardial infarction, dilatial cardiac myopathy, rheumatic heart disease and infection endo corditis, Dr. Ebtihal Abdullah said. Laying down, said Dr. Ebtihal depended on the health condition of the patient. "For example, Patients of myocardial infarction lay in the intensive care unit for 3-5 days. Then they are taken to the general ward," she concluded.
Will the government provide specialized hospitals for the public to save them and save million dollars spent on medical treatment abroad? I hope so.

OPHTHALMIC EDUCATION (1)
Understanding CATARACT

By Dr. Mohfoud Bamashmous
What is Cataract?
A cataract is clouding of a part of the eye called the lens. The vision becomes blurred or dim because light cannot pass through the clouded lens to the back of the eye. Over half of those over 65 have some cataract development and most cases can be treated successfully with surgery.

The lens:
The lens is a transparent body behind the iris, the colored part of the eye. The lens bends light rays so that they give a clear image to the back of the eye - the retina.

What causes a cataract?
Cataract can form at any age, but most often it develops as people get older. In younger people they can result from an injury, certain drugs, long-standing inflammation or illness such as diabetes.

Some symptoms:
"I can not see as well as I used to".
What can be done to help?
The most effective treatment for cataracts is an operation to remove the cloudy lens and replacing it with a plastic intraocular lens implant.

What is an intraocular lens implant?
After removing the cloudy lens surgically, it is usually replaced by a plastic lens so that the eye can focus properly. Occasionally a doctor will decide whether someone's eye is suitable for a lens implant. In these cases not suitable for implant special glasses are prescribed instead.

When should the cataract operation be done?
Usually the patient decides when he or she wants to have the operation. In the past, eye specialists often waited until the cataract became 'ripe' before suggesting it to be removed. Nowadays, with modern surgery the operation can be carried out at any stage of the cataract's development. If visual impairment interferes with the patient's ability to read, to work, or to do the things they enjoy, then they would probably have to consider surgery.

What happens after the operation?
The patient's sight usually improves within a few days, although complete healing may take two months.

Routine eye exam by an eye specialist is very important.
It is your sight and your eyes need every care they deserve.

Mahfouth A Bamashmus FRCSEd, FRCOphth
Consultant Ophthalmic Surgeon
Ibn Al-Haitham Clinic
University of Science & Technology, Sana'a