Middle East

Mission to mend broken hearts

Australian generosity is helping save hundreds - even thousands - of lives in one of Africa's poorest nations. SBS correspondent Brett Mason reports from Tel Aviv.

Despite more than 150,000 Tanzanian children being diagnosed with heart conditions requiring surgery, the country has no paediatric cardiac surgeon.

But that could soon change, as SBS correspondent Brett Mason reports.

Her small hands fiddle nervously with the oversized green hairnet slumped awkwardly across her tiny head, her curious eyes innocently examining each of the unfamiliar men and women hurriedly pushing her hospital bed through the sterile, cold corridors of Israel's Wolfson Medical Centre.

Six-year-old Salma Saidi Issack is a long way from home.

She has travelled from a small village in Tanzania here, to surgical theatre seven, in Tel Aviv.

She left behind her mother and father, younger sister and older brother to take her first ride in an aeroplane, an elevator, and now, a hospital bed.

(Photo: Tanzania's first paediatric heart surgeon, Doctor Godwin Godfrey Sharau, wheels six-year-old Salma Saidi Issack into theatre at the Wolfson Medical Centre in Tel Aviv, Israel.)

But someone from home is waiting, with a smile, to meet her – Tanzania's first paediatric heart surgeon, Doctor Godwin Godfrey Sharau.

"Everyone loves Doctor Godwin,” an Israeli theatre nurse tells me. “He motivates us all to do better."

As masked medical staff assemble an array of shiny instruments, Dr Godwin calmly comforts his young patient, helping her slide gently onto the operating table.

Salma is in primary school and loves to learn. It is her dream to become a teacher.

Her favourite game is skipping with friends, but she has to stop after just a minute or two, because it makes her sick.

And that is why she finds herself here, alone, on an operating table, slowly drifting to sleep in a room filled with strangers.

(Photo: Tanzania's first paediatric heart surgeon, Doctor Godwin Godfrey Sharau, prepares six-year-old patient Salma Saidi Issack for open heart surgery at the Wolfson Medical Centre in Tel Aviv, Israel.)

Salma has a hole in her heart. And multiple blockages, which clog up her narrow arteries.

No matter how hard her tiny heart beats, it cannot pump enough oxygenated blood to her lungs.

In the lottery of life, Salma lucked out. Twice.

Born in one of the world's poorest countries, with a heart that doesn't work.

Today though, Salma has hit humanity's jackpot. Her heart is about to be fixed.

Without this surgery, she will certainly die before her 21st birthday.

Now anesthetised, Salma has been much braver than this anxious grown up, who finds himself scrubbed up and masked up, ready to watch Doctor Godwin perform his life's passion.

(Photo: Tanzania's first paediatric heart surgeon, Doctor Godwin Godfrey Sharau, works alongside Save A Child's Heart Chief Surgeon Dr Lior Sasson, during open heart surgery on six-year-old patient Salma Saidi Issack at the Wolfson Medical Centre in Tel Aviv, Israel.)

Born in the village of Moshi, at the base of Mount Kilimanjaro, the gifted surgeon moved to Tel Aviv five years ago, firmly focused on fulfilling his dream of leading Tanzania's first dedicated paediatric heart unit.

Despite more than 150,000 Tanzanian children being diagnosed with heart conditions requiring surgery, in a country of 45 million people, not one is a paediatric cardiac surgeon.

“Looking after children with heart problems, we really don't have any programs in place and these patients, their fate, most of the time, is usually death,” says Dr Godwin.

“All these patients, you just see them die in front of you.

“When you see a patient like Salma, you know it is just a matter of time before the patient dies.

“That makes me feel so bad.”

I ask the husband and doting dad of two year-old son William, how many Tanzanian children have died needlessly at his hospital because there has been no-one capable of helping them?

(Photo: Dr Godwin Godfrey Sharau's eyes during surgery.)

“On average, on any day, you can have five or six children dying.”

“If 24 hours passes and we have one death or two deaths - this is actually like a surprise, and every doctor feels very good that at least we didn't have many children like usual dying,” he says emotionally.

Now working in Israel, six months can often pass without a fatality.

“It's really a very sad feeling and very depressing as a doctor…seeing all this death every day – two, three, four children a day.”

The surgeon and his six-member Tanzanian medical team – paediatric cardiologist Naiz Majani, paediatric cardiologist Godfrey Mbawala, paediatric intensive care doctor Josephat Mukama, anesthetist Benard Kanemo, cardiac anesthetist Kimaro Ernestina and perfusionist Thomas Kimani - have come here to learn from the Israel-based charity Save A Child's Heart (SACH).

Their tuition has been funded entirely by Australia's high-profile Pratt Foundation, while sponsorship from across the globe allows SACH to fly-in young patients, like Salma, for the medical team to operate on using their state of the art equipment.

Dr Godwin has performed close to 1,000 cardiac surgeries at the hospital where he lives and is on-call 24 hours a day.

He has operated on children of all nationalities and religions and alongside foreign medical teams who are undergoing similar training to achieve similar goals.

Once their placement is complete in October this year, they will return, as a team, to Bugando Medical Centre, where they will begin the task of repairing and rebuilding broken hearts.

Together, they have twice climbed Mount Kilimanjaro, raising more than $1 million for equipment and training.

Nothing though, compared to the enormity of the challenge waiting for them when they return home.

Nearly half of Tanzania's population is below the age of 15, 20 per cent live below the poverty line and there is, on average, just one doctor for every 25,000 patients.

The country has no paediatric cardiac surgeons, paediatric intensive care specialists or paediatric cardiologists.

“We are just beginning to do open heart surgery for the children and in our list of paediatric cardiology we have already more than 400 patients waiting” says Dr Godwin.

“So you can realise what a difficult situation this is.”

While this training is essential, the life-saving techniques the medical team is perfecting will sadly come too late for many young Tanzanians.

“It's very upsetting how many children who are on our waiting list for cardiac surgery have died,” the doctor says.

“It's very depressing.”

“It's always very depressing to telephone to schedule these children and hear the parents on the other side say 'we're very sorry because he passed away two months or maybe four months ago'

"Every time we make a call we are really terrified because we don't know what will be the reply on the other end.”

(Photo: The scene in theatre seven at the Wolfson Medical Centre, as Tanzania's first paediatric heart surgeon, Doctor Godwin Godfrey Sharau, performs open-heart surgery on six-year-old Salma Saidi Issack.)

According to Dr Godwin, most of the physicians in Tanzania have either left to practice medicine abroad or are working in well-funded public health programs, including those tackling HIV and malaria.

“The one thing that has always been plentiful is the patients, but there are constant shortages of everything from space in the operating rooms to sterile theatre gowns to skilled staff to sential drugs and blood products,” says Dr Godwin.

He shares stories of colleagues in remote villages operating in terrible conditions, where surgeries are routinely carried out on wooden tables by candlelight, using whatever medical equipment the doctors and nurses can scrounge.

“Many of these families can't afford a meal for the day” he says.

While 150,000 children have been diagnosed with congenital heart disease, Dr Godwin believes the number is much higher, possibly as many as half a million.

In 2011, Dr Godwin led a SACH team on a medical mission to his hometown hospital, where doctors were able to successfully operate on 12 Tanzanian children and screen 300 more for heart disease.

These are the vital first steps, says Dr Godwin, in what he knows will be a lifelong journey to create an efficient and effective paediatric cardiac program.

Since Save A Child's Heart was founded in 1995, some 3,200 children from 46 developing nations have undergone lifesaving heart surgery.

(Photo: Dr Godwin Godfrey Sharau, examines the heart of six-year-old patient Salma Saidi Issack at the Wolfson Medical Centre in Tel Aviv, Israel.)

More than half are from the Palestinian Authority, Jordan, Iraq, Morocco and Syria.

“It means a lot for me” says Asmaa Haboush El-Khaleli as she cradles her four-and-a-half month old daughter Rose.

They have travelled to Israel from their home in Nasser on The Gaza Strip.

Rose has been diagnosed with tetralogy of the fallot – the same condition as Salma.

“The circumstances between the Israeli people and the Arab people back in Palestine are not so good.”

“It's very nice of them that they ignore the race or the religion.”

“They just treat you as a patient only.”

“I didn't think that they are this kind and they have so much humanity” says the mother of two.

Thirty per cent of SACH patients are from Africa while the remainder travel to Israel from Asia, Eastern Europe and South America.

In 2011, the organisation received United Nations special status on the Economic and Social Council (ECOSOC) and is now an official United Nations Non-Government Organisation.

SACH Director Simon Fisher says the charity is completely dedicated to the idea that every child deserves the best medical treatment available, regardless of the child's nationality, religion, race, gender or financial situation.

During the recent armed conflict between Israel and the Palestinian Authority, medical teams from both nations worked side-by-side in operating theatres.

(Photo: Executive Director of Save a Child's Heart, Simon Fisher, in the paediatric cardiac unit at Wolfson Medical Centre in Tel Aviv, Israel.)

“Of the more than 3,000 children we've treated over the years more than half have been Palestinian children who come to Israel on a weekly basis, actually, I would say daily basis, from Gaza and the West Bank” said Mr Fisher.

“We believe that through the actions of SACH we create bridges between nations.”

“Our children are our common interest and I truly believe that through the hearts of our patients we can make the Middle East a better place for our children to live in.”

Dr Godwin is just one of 83 physicians trained by SACH, putting to use these life-saving skills in their own communities.

For five hours I watch on in awe as the physicians, shadowed by an experienced surgical team, carefully repair Salma's heart and clear her arteries.

Our surgical masks crinkle in unison as we smile at the sound of Salma's natural heartbeat echoing across the operating room.

Her surgery has been a success.

“Dr Godwin is an extremely talented surgeon and I am so proud that I have been able to pass away some knowledge to help, especially because he is going back to Tanzania” says SACH Chief Surgeon, Doctor Lior Sasson.

“There are so many children with congenital heart disease in need and they die miserably in many cases, between the age of five and twenty, and when he goes back with his team and the expertise they have acquired here, he will be able to save so many children”.

(Photo: A parent holds a sick baby's hand.)

Doctor Sasson anticipates his student will be able to perform 85 per cent of the paediatric heart surgeries required by patients in Tanzania, while the charity remains committed to helping carrying out more advanced procedures in Israel, where Godwin and his team will continue to have access to specialist equipment.

Less than a day after her operation, Salma is discharged from the intensive care unit.

The next morning she is sitting up in bed on a ward shared with other young patients from Gaza, Iraq and China, who all bear the same distinctive chest scar.

Salma is sore. Sleepy. And a little stroppy. But she will survive.

Thousands of other young Tanzanians won't.

And Dr Godwin knows it.

“Absolutely, and they really need our help," he says. "This is what motivates me to go back (to Tanzania) and work there.”

“Tanzania is where I want to be. It's where I want to make a difference. I have to go back and make a change.”

One doctor. One-hundred-and-fifty-thousand broken hearts.

Isn't he daunted by the weight of his nation's expectations?

“When you look at a child you've operated, like Salma, and you know that they maybe had a year of two years to live, and you see that you've given this child another 40 years or 50 years, this is enough.

“You say 'should I let 100 die or should I try and even out of the 100 save 5 or 10' and I think the choice becomes clear.

"It's better to save the 10 than let 100 die, because every life is important. And every life is priceless.”

IN THEIR OWN WORDS: The doctors who mend broken hearts

Doctor Godwin will travel to Australia in late August to personally thank the Australian donors who have helped make his dream become a reality. He hopes to carry out Tanzania's first pediatric open-heart surgery by Christmas.

World News Australia travelled to Israel as a guest of Save a Child's Heart.