Fifteen months after its opening:  An Update on the Salam Centre for Cardiac Surgery in Soba, Khartoum.


A Comparison Between Goals and Results

Khartoum, July 2008. The temperature outside is about 45° Celcius (113° Farenheit). The dry heat makes it a bit more tolerable, but it is certainly not advisable to dwell too long outside, even in the garden of the Salam Centre--a place that brings healing to the heart. This is a familiar place even to the patients of the Centre, who have organized a creative alternative to ‘outdoor activities’. Every afternoon, once clinical activities quiet down, a ‘parlor room’ is created alongside the large window which separates the patients’ wards from the outside world. The patients awaiting surgery, and the post-op patients who are able to mobilize, pull up some chairs near this large window, and spend the afternoon chatting there. Beyond the window, one can see the colorful seasonal flowers, the trees, the green lawn and bushes. Beyond, it is known that the Nile flows, and although it cannot be seen, it is “sensed”. From this large window overlooking the garden, light comes in as gazes go out.

For all of those who have followed the progress, and believed in this hospital from the very start, from when it was only a ‘crazy’ idea, it has confirmed the transformation of a utopian dream into a reality ─ one rooted in the daily lives of hundreds of people. I am talking to Raul about this large window. As the architect, he designed the window with the intention of bringing light to the long corridor which faces the patients’ rooms. Now, the patients have chosen it as a place to gather and relax. It has become a case, one could say, of an outcome not anticipated by plans and calculations. The spontaneous use of this area is approved and appreciated by the designer himself, who for the time being does not delve too deeply into the ‘diverse nature’ or ‘outcome’ of intended purposes. This space was transformed by the patients into an area for chatting, a simple act which lightens tensions, favors understanding, and fosters friendships. It is where we often stop to talk with the guests of the Salam Centre.

Barring complications, the average length of stay here in the hospital is about ten days, sufficient time for people to get to know each other. It is amazing to see the transformation in behavior of the patients after the first few days in the hospital. Initially, everyone looks lost, almost afraid. For many, the arrival to the Centre is like being left stranded on the moon. No relatives, or ‘co-patients’ as they are called here, are allowed except to visit on consented days and times. In the other local hospitals co-patients provide most of patient care, from food to laundry, personal care and even medications. Here, on the other hand, are clean pajamas and showers in the rooms, three free full meals per day, doctors and nurses, are all available 24/7. The omnipresent white faces of the khawala ('white’ people) administer to everything. After a few days, patients memorize names, begin to feel comfortable, and even begin to trust the khawala.

Children, in particular, are the ones who develop the most immediate rapport. And, there are many children in our hospital, about 25% of the 937 patients hospitalized at Salam through the end of July 2008 have been younger than fifteen. There is a long list of cases, difficulties and problems, and many solutions that have been researched and found.

The small group of teenagers who have been treated at the hospital since the beginning of July has truly been diverse. Wail, fourteen, arrived from Port Sudan. In addition to his young heart struggling from the damage of recurrent rheumatic heart disease, he suffers from kidney and lung problems, so we anxiously await definitive signs of healing. Enas, is an eleven year old girl who weighed just seventeen kilos (37.5 lbs) when she was initially hospitalized. Our cooks prepared a special diet for her over several days to help her gain a body weight which she probably never had before…and to help her gain a few kilos before surgery. Osman “One” (to distinguish him from Osman “Two”), despite being only ten years old, is a veteran of the Salam Centre. He has been with us since February, and has had treatment for his right ventricle. The right half of his heart wasn’t functioning. Blood taken from the right atrium through a cannula was channeled back with a pump to the pulmonary artery, to reach the lungs for oxygenation. Now he is ready, well enough to go back home to the state of Sinnar, south of Khartoum. He will be accompanied by his grandfather, who was staying in the Centre’s guesthouse during his grandson’s hospitalization.

Then there is the trio from Darfur. Saddam, fifeen, of Genina, West Darfur, urgently hospitalized for a serious heart problem that was cured via replacement of the mitral valve and surgical repair of the tricuspid valve. Curly haired, dark eyed Osmad “Two”, nine, is shy and introverted, and was one of the last of the group to be operated on. After surgery he was received with a round of applause when he was transported from the operating room to the intensive care unit where some of his friends who had already undergone surgery on previous days were recuperating. Ali, the smallest of the group, and only nine years old, is from a small village near Al Fashir, North Darfur. He also needed a mitral valve replacement and surgical repair of the tricuspid valve.

Then, there are Araghes, the Ethiopian, and Sarawit the Eritrean: distant is the world that would like to see them be enemies. The unique atmosphere of the Salam Centre makes sure that not only do ethnic barriers disappear between the beds in the ward, but that also the linguistic barriers between different nationalities are overcome. Proof is the story of Sarawit, a very young girl from Eritrea, hospitalized for a mitral stenosis, and Araghes, an Ethiopian child brought here thanks to the initiative of a group of Italian volunteers who collaborate with a hospital from the congregation of Mother Theresa of Calcutta in Addis Ababa. Araghes speaks only Amharic, hence she had difficulties communicating with the foreign doctors and nurses, as well as with the Sudanese personnel. But, her problems are solved thanks to the help of Sarawit who, besides Tigrinya, also spoke Araghe’s language, and she became her interpreter. They were apart only during surgery and immediately afterward. We suggested that they become ambassadors of their respective governments, which have been at war for about ten years now. We may have been joking, but…their relationship is no longer a joke, it is real.

A lesson from our first balance sheet: something we ‘believed in’, is incredible. After a little over a year since its opening, a draft of the activity report for the Salam Centre is available. Despite the continual necessity for precautions to be taken, and with inevitable problems encountered, we are pleased with the initial results.

Under the circumstances and given the difficulties, in fifteen months we have been able to progress from one to three open heart operations per day. About thirty patients are examined daily for triage. A third of these patients will then need a specialized visit with the cardiologist. Paradoxically, given the enormous distances in this country, news ‘by word of mouth’ has produced unexpected effects. More than 43% of the Sudanese patients in our hospital do not live in Khartoum, but arrive from one of the 25 states that make up the federation. Even going beyond the Centre’s data and statistics, and the daily operational routines, the life of this hospital suggests a very comforting evaluation. From the examination rooms to the office administration, from the labs to the wards, from the kitchen to the laundry rooms, from the operating rooms to the pharmacy, one can clearly feel that the premises itself suggests the sense of being in a special place, in so many unique ways.

More often than not, ‘Incredible!’ is the comment heard over and over by visitors to the Salam Centre for Cardiac Surgery, from the Sudanese people, as well as from foreigners passing through Khartoum for work or vacation. For us this expression ’incredible’ reminds us of a daily effort, which began with an idea, went on to be built, fully equipped and furnished and ultimately completed with the search and assembly of personnel. It is an effort that continues on with a myriad of new and diverse problems (sanitation, logistical, technical) to be overcome each day.

But after a brief pause by the large window that overlooks the garden, and an exchange of a few words in bizarre, improvised “mixed” languages with the national staff and patients, we all become part of the incredible vision sensed by all visitors.

ROSSELLA MICCIO

Translated by ROSALBA PERNA