Damacline Nyakundi looks tired.
As she flops onto a seat at the Nation Centre, it is easy to tell she is out of breath.
Speaking slowly in a voice that sometimes fades to a whisper, you have to listen carefully to catch every word she is saying.
Damacline, 28, has just marked a fifth year living with rheumatic heart disease.
Damacline, an orphan, started feeling unwell in August 2013.
FATIGUE
“I started experiencing fatigue, night sweats and difficulty in breathing. Trips to several doctors yielded nothing conclusive as they each made different diagnoses,” she said.
It is only when she went for an electrocardiogram (ECG) at the Kenyatta National Hospital that she able to find out what the condition was.
A further echocardiogram (ECHO) scan revealed she had cardiomegaly, meaning there is a swelling in the heart.
She was admitted at KNH for a fortnight and after a series of tests, the doctors discovered she had rheumatic heart disease.
After the diagnosis, the doctors prescribed medication for Damacline to help her manage the condition.
SH2,000
“I take Aldactone which costs Sh250 per packet; Enaril which costs Sh20, twice a day; Warfarin which costs Sh100, once a day; Carnedilol which costs Sh100 twice a day, and Furosemide, (which causes diarrhoea after I take it), once a day. In total, I spend around Sh2,000 on medication every week. Additionally, I get an injection every month which is one of the most painful experiences I have to undergo. In 2017, after I had my first jab, I had a stroke,” she says.
These drugs, however, only manage the condition temporarily.
“When I did not improve, I was referred to Mater Hospital in January for open heart surgery. The operation costs between Sh1.2 million and 1.5 million,” said Damacline.
“She requires open heart surgery for mitral valve replacement. Unfortunately, the heart-lung machine is currently not working at KNH and she may have to have the surgery elsewhere,” says a hospital letter signed by consultant cardiologist Dr Nyaga.
REVENUE
An internet search of the machine that is used to help the patient breathe during open heart surgery reveals that a brand made by Allfine Medlab costs about USD 53,599 or Sh5.4 million.
It is a machine that KNH can easily afford given the amount of revenue it generates annually.
According to Clinical Services Director Peter Masinde, the existing machine broke down six months ago, forcing the hospital to order for a new one.
He attributes the delay in procuring a new one to the tendering process that is subject to several legal processes, including competitive bidding, vetting by the tender committee and the purchase of the machine itself which he says will be done in abroad.
SH3 MILLION
“The machine is likely to be bought in Germany or Japan. If an aggrieved party does not challenge the tender award in court, which will delay its purchase and arrival, then we should be having a new heart-lung machine up and running in the hospital by the next two months,” said Dr Masinde.
He said the machine costs about Sh3 million.
Dr Masinde said open heart surgeries had, however, not been suspended at the hospital, adding that KNH has been carrying out the procedure using a heart lung machine borrowed from Mater Hospital since its own machine broke down six months ago.
HEAVY TOLL
The condition has taken a heavy toll on Damacline, a former sprint athlete
“Going up a flight of stairs is difficult. Sleeping is hard as my heart beats so fast, leaving me scared and breathless,” she says.
“I have lost weight and I am a shadow of my former self. Were it not for my facial features, many of my friends and relatives would not recognise me today,” she said.
She says a conversation with a cardiologist at KNH made her take her condition seriously.
“Dr Nyaga told me, ‘Young lady, you need to get an operation to fix your problem as soon as possible.’ He looked me straight in the eye and said, ‘You’re too young to die!’”
CONSTRAINTS
She should have had the operation in January but has been prevented by financial constraints.
The operation whose cost has been significantly inflated by the private facility referral, would have cost about Sh600,000 at KNH, a sum within the range of her NHIF cover but a broken down heart-lung machine stands in the way of the procedure being affordable.
But Damacline will not give up the fight just yet.
“I’m still fighting to overcome this disease despite the steep financial challenges I face. I know I am five months late but if I get assistance and the operation is done, I will still be around for a long time to see my child grow into an adult,” the mother of a seven-year-old daughter says.
SORE THREAT
“I currently live with my sister in Kasarani. She and her husband have simply been amazing, shouldering the burden of taking care of me despite my frequent episodes of sickness.”
Rheumatic heart disease is a complication caused rheumatic fever in which the heart valves are damaged.
It is an inflammatory disease caused by an autoimmune response to a throat infection caused a group of bacteria called A streptococcus or strep bacteria.
The bacteria can cause many illnesses, including sore throat (strep throat) and skin sores.
INFLAMMATORY
When the body’s immune system gets confused as it reacts to the bacterial infection, the result is a generalised inflammatory illness that doctors call acute rheumatic fever.
It can affect connective tissue throughout the body, especially in the heart, joints, brain and skin.
Although rheumatic fever can strike people of all ages, it is most common in children aged between five and 15 years. The best way to prevent rheumatic fever is to treat strep throat with antibiotics.
ARF can last for several weeks with significant joint pain, fevers and other symptoms requiring hospitalisation. Its symptoms do not usually damage the brain, joints or skin, though the damage to the heart valves may remain once the ARF is treated.
HEART TISSUE
This damage to the heart valves is known as rheumatic heart disease. Recurrent strep infections and episodes of acute rheumatic fever cause further damage to heart valves.
Speaking at the Aga Khan Hospital’s Heart Symposium recently, consultant cardiologist Mzee Ngunga named RHD as one of the three cardiovascular diseases that are on the rise countrywide.
“Cardiac arrest, high blood pressure and rheumatic heart disease are the three major heart problems bringing Kenyans to hospital,” said Dr Ngunga.
He said more effort is required to tackle rheumatic heart disease which results from unresolved throat infections that spread to the heart tissue.