Witnessing beating heart surgery

Medical tourism boom in Ukraine

JARED MORGAN
Last updated 10:45 05/04/2013
surgery - Southland Times use only
ARTEM MIRONENKO/Supplied

Surgeons working on a patient in Ukraine, Russia.

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Jared Morgan is a former Southland Times journalist working for What's On Kiev in Russia.

The sound of a heart pumping blood is literally visceral, a constant, rhythmic "squelch".

We're witnessing open-heart surgery, known as the most-invasive medical procedure a person can endure, in a state-of-the-art hospital in a city, in a country not commonly associated with quality health-care.

We have been invited inside Kyiv City Heart Centre, a hospital that, along with a multitude of clinics in the city, has opened its doors to foreigners for anything from a dental bridge to a heart valve replacement.

"Come back on Monday, I'll show you something very interesting," Kyiv Heart Centre director Professor Boris Todurov says, carefully considering his English before speaking. "Be here at 9am."

Definitions are subjective and Todurov's idea of "very interesting" will later differ from my and photographer Artem Mironenko's interpretation. It's an understatement characteristic of Todurov, his manner is more humble than heroic, yet in the cardio surgery world he can be likened to a rock star.

In April, Todurov was named Doctor of the Year in the Pride of the Country awards, which annually recognise ordinary Ukrainians for exceptional courage and commitment.

The honour is justified - the 48-year-old is a pioneer, philanthropist and patriot. Todurov has conducted all Ukrainian heart surgery firsts, including the first transplant in 2000.

Between 1999 and 2006, he led charitable missions to Cairo in Egypt, the Iraqi capital Baghdad, Pristina in Kosovo and the Nagorno-Karabakh region of Azerbaijan, performing a total of 26 operations on children with congenital heart disease to raise the profile of Ukrainian surgeons.

A treatment for heart failure he developed is internationally recognised as one of the best. His pedigree is such that returning on Monday is less an invitation and more a command.

Enough to Set Your Heart Racing
Usually, a hospital of this calibre would be centrally located in a city, a source of municipal and national pride. Not in Kyiv.

Instead, the state-of-the-art Kyiv City Heart Centre - the largest and most modern cardio hospital in Ukraine is on the left bank in the Dniprovskiy District, where it stands out like a gleaming oasis amid lines of carbon-copy Soviet apartment blocks.

Inside, we take a seat outside Todurov's office, where several patients wait for consultation.

There's a production line like efficiency to this process and our wait is short.

At this point, we are still not exactly sure of what we are going to see, it becomes clear when Todurov tells us he will be performing five heart surgeries today, calls a senior nurse, tells us to go with her and he will join us soon.

The nurse escorts us to a lift that takes us to the surgical floor, leads us to a room and - after a quick visual appraisal of our sizes - presents us with surgical scrubs.

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There's little time to consider what is coming, although the knot in my stomach and Artem's "oh, I don't know, I don't know" pay testament to our nerves.

The nurse spots this and makes soothing noises before instructing us to strip to our underwear and put on the scrubs ... a short while later we are standing in full surgical kit in a corridor outside the hospital's five operating theatres.

At the Heart of Things
It is a hive of activity as surgeons and nurses whisk past, entering and exiting the theatres via doors that could have been transplanted from the Starship Enterprise. Windows afford a glimpse of what is going on inside.

In one, a broken leg appears to be being pinned, judging by the series of calliper-like implements attached to it. It is at this point my squeamishness gives way to curiosity.

Todurov arrives and gives us a quick brief on what we are about to witness; it's a triple bypass and will be what is known as "beating heart surgery".

It's a confronting sight yet strangely clean and anonymous. Unlike what TV dramas would have us believe the patient is completely covered, mummy-like, in deep green blankets - with the exception of his open chest and the sight and sound of his beating heart.

The contrast between this and the "Hollywood" version is stark. Fact is, this wouldn't make good TV, the surgeons are intensely focused, but maintain a steely calm - there is none of the frenetic pace, none of the barking of orders at nurses, no mopping sweaty brows and perhaps most surprisingly, little blood.

Yet this is painstakingly complex surgery, a rewiring, or replumbing, of tiny arteries to replace those that have failed, connecting them via miniscule stents and tiny stitches to 2 millimetre incisions on a - still beating - heart.

Operating on a beating heart is "difficult", Todurov says, but in terms of outcome for the patient it is ideal.

Despite his concentration or maybe because of it, Todurov's English leaps from being laboured to almost fluent as he walks me step-by-step through the procedure.

This is a man in his element.

Hi-tech Hub
The three surgeons and team of nurses work with the latest technology.

The heart monitor is controlled by remote control as well has having a touch-screen.

Other screens detail other vital stats such as core body temperature, through to the arterial and ventricular function of the heart.

Meanwhile, a camera installed in the surgical lamps records the surgery and plays it in real-time on a wall mounted television.

In what is the only similarity to Hollywood a LED display on the wall controls lighting, climate and key to any dramatic portrayal - audio.

The technological stakes ramp up when after about an hour and 45 minutes we leave the two assisting surgeons to close the patient's chest and move on to Todurov's second surgery, a triple bypass and aortic valve replacement.

This surgery, as Todurov tells it, is more complex and in contrast to the first the heart will be cooled to 5 degrees Celsius, effectively frozen, its function replaced by a complex heart/lung machine. "When the heart is stopped, surgery is easier, beating heart surgery is more difficult, but for the brain it is safer," he says. "But replacing an aortic valve is impossible when the heart is still beating."

Are They Medical Tourists?
Despite the access we are given, the identity of the patients undergoing surgery remains a mystery, but there is a possibility they come from the ranks of the 30,000 medical tourists who descend on Ukraine every year.

That's the number breakdown given by Medicare4U Business Development Director Pavel Oltarzhevskyy.

His company provides a one-stop service for anything from dental, fertility and eye treatments, heart, orthopaedic, corrective and plastic surgery, cancer therapies and even treatments not available elsewhere such as the controversial stem-cell treatment.

Most of the treatments are offered in Ukraine with the company also working with some clinics in central Europe. And all, Oltarhevskyy says, offer treatment at rates that undercut other medical tourism hotspots such as India.

When asked how it is possible, Oltarzhevskyy is quick to answer. "Wages," he says simply before explaining that medical professionals in Ukraine are paid at the level of any other state employee and that, unfortunately, is unbelievably poorly.

Add to that no waiting lists and access to treatments that could possibly be denied a person at home and the attraction becomes clear.

Especially when it comes to those looking for a discrete nip or tuck, Oltarzhevskyy says. "Many people are afraid of plastic surgery, but it's actually very simple."

The analogy he makes illustrates his point, where a quick procedure to remove bags under a person's eyes could be likened to filling a car with gas, heart surgery is like replacing the engine.

"For a skilled surgeon, cosmetic procedures are very, very easy."

A Growing Business
A quick tour of Kyiv City Heart Centre with Oltarzhevskyy shows business appears to be booming.

"We can't go into any of the private rooms," he tells me.

"They are completely booked for the next three weeks."

His description of those rooms makes them sound like a hotel.

"They are all fitted with flat-screen TVs, have Wi-Fi and a mini-bar..."

Oltarzhevskyy's company's client base spans the globe with Kyiv playing host to medical tourists from across Europe and the United Kingdom, the Middle East, the United States and even South America.

Controversially, some of those clients seek treatment health services their home countries would never allow them to have and it is a situation that has seen Oltarzhevskyy feel the sting of a media storm.

In 2009, 66-year old UK resident Elizabeth Adeney gave birth to a son in Cambridge, following IVF treatment in Ukraine.

When asked about her treatments, Adeney said: "It's not physical age that is important - it's how I feel inside. Some days I feel 39. Others, I feel 56."

That's a sentiment Oltarzhevskyy supports and despite the criticism levelled at him at the time, he says the decision to treat her was about supporting the patient's wishes and age should not be a barrier.

It is something Todurov also agrees with, the oldest patient he has performed heart surgery on is 97, and conversely the youngest was a baby weighing a mere 800 grams.

From a celebrity smile, the bust you've always dreamed of, the child life or circumstances denied you, to a second stab at life, they're all available in Kyiv and it seems business is only set to grow.

- The Southland Times

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