Heart Attacks in Embu

“You have chest pain. It might be a heart attack. How do you get an ambulance in Embu?” asked the lecturer. The events room at the Isaak Walton Hotel was silent. I didn’t like to say that I have one sitting in front of my house, on standby.

Someone mumbled that there was an ambulance at a private hospital in town. Another person said that there was one at the “Level 5”, Embu Government Hospital 200 metres away across the Nairobi-Meru Highway. There is even Collo Rescue Team ambulance, in Kirimari Ward, Embu.

“But what’s the number you need to call?” Dr Mo Jeilan, consultant cardiologist at the Aga Khan University Hospital in Nairobi.

No one shouted an answer. A few people flipped through screens on their smartphones. There is no 999, or 911 or even 111 emergency number in Kenya.

“Well, you had better write this number down. It could save your life one day!”

Dr Jeilan’s next slide showed the main entrance of Glenfield General Hospital in Leicester. “This is where I trained to be a cardiologist,” he said. I turned to a colleague and whispered, “My home is about 5 kilometres from there.”

“Now you have your ambulance, what now?”

“Get an ECG!” shouted a doctor in the audience.

“Do ambulances carry electrocardiograph machines in Embu?” asked Dr Jeilan. “They don’t. So where is the nearest ECG?”

My colleague chipped in, “Level 5 in the Diabetic Department, but no one knows how to operate the machine when the ECG technician is on holiday.”

“Yes,” said Dr Jeilan, “the ECG is usually considered so precious that it is locked away in a cupboard at nights and weekends. And the nurse who has the key has gone home.”

Everyone smiled. It was so laughable, but it was true.

“You have your ECG. Can you read it? Let’s say it is an NSTEMI, a non-ST elevation myocardial infarct. What do you do now?”

Someone shouted out “Troponin!”

“It takes an hour for the troponin levels to rise in a heart attack and another two hours to process the test. Meanwhile, your heart muscle is dying, starved of oxygen.”

Dr Jeilan told us he gets SMS and WhatsApp messages every day from doctors all over Kenya, asking his opinion about an ECG tracing. “A colleague from Meru telephoned me with chest pain. His ECG showed a possible NSTEMI so I asked him how long it would take to get the result of a troponin test. He said two days. Two days! How come? The test has to go all the way to Nairobi to get tested.”

“It’s not like this in Leicester,” he explained, going on to tell the story of a middle-aged man who developed chest pain on the golf course. It didn’t go away after five minutes, so he called an ambulance. The ambulance got there in eight minutes. An ECG showed a heart attack and the patient was being wheeled to the cardiac catheter lab twenty minutes later. Within an hour, the clot in his right coronary artery had been sucked out and a stent inserted to keep the lumen patent. Job done.

“What’s that circular thing on the Xray?” asked Dr Jeilan. I thought it was the metal part of a patch for an ECG lead connection. “No, it’s a nipple ring,” he said. “Men do strange things over there in England.”

“That man’s heart muscle was saved. I see some Kenyans who have had chest pain for days, when it is too late to prevent the muscle from dying and going black, like gangrene.”

There are no cardiac catheter labs in Embu. There are no facilities for “clot-busting” streptokinase either. So what do we have? Chew an aspirin. But the news is that there are two local volunteer cardiac champions who are about to start training.

The next slide showed a scientific paper published just after Kenya gained her independence in 1963. It reported that a Kenyan man had suffered from a heart attack, a previously undocumented event. Fifty years later, the numbers of Kenyans having heart attacks is skyrocketing. The next slide showed a seated man sporting a huge belly. Obesity, the new epidemic, leading to diabetes and cardiovascular disease.

I turned to the surgeon sitting on my right. He was a big man. He looked worried.

Dr Jeilan ended the lecture and handed over to a local doctor whose brief was to talk about diabetes. Unfortunately, the meeting started over an hour late – African time – so the diabetic talk had to be seriously curtailed, or we would have missed supper. The lecturer got a bit flustered, flipped forward and back through his slides. None of the fancy modern drugs to treat diabetes he was talking about is available at the government hospital, unfortunately.

The sponsors of the meeting took the stage to talk about nutritional supplements, antioxidants and micronutrients, then we filed out of the hall to queue outside the dining room. Everyone was chatting excitedly. I eavesdropped and heard that the first ever kidney transplant in Embu was in progress at Level 5. A team from Eldoret had removed a kidney from a live donor that afternoon and it was being transplanted into his brother, who had end-stage renal disease. A historic moment. I wonder how long it will take before the first angioplasty takes place here?