Featured Profile and Interview With Ogadinma Mgbajah, MBBS

Dr Ogadinma Mgbajah is a consultant cardiothoracic surgeon at Lagos State University Teaching Hospital (LASUTH) in Ikeja, Lagos, Nigeria, and the first woman cardiothoracic surgeon in West Africa. Dr Mgbajah earned her MBBS at the University of Ibadan in Nigeria. Following this, she interned at University College Hospital Ibadan. Dr Mgbajah completed her residency training in cardiothoracic surgery and obtained her fellowship from the West African College of Surgeons in 2016. During this time she spent a year training in cardiac surgery at Yashoda Hospital in Hyderabad, India, and six months at the National Cardiothoracic Centre in Korlebu, Ghana, owing to the fact that little cardiac surgery was being performed in Nigeria.

Dr Mgbajah’s clinical interests encompass both adult and pediatric cardiothoracic care. She is involved in efforts to build a complete local team for cardiac surgery at LASUTH. Nearly all open heart surgeries in Nigeria are done through charity mission work, which is insufficient to address the cardiac surgery needs in a country of over 160 million people. Dr Mgbajah’s research interests include affordable cardiac surgery for the poor, heart failure management, congenital cardiac anomalies in adults, and thoracic oncology. She is presently seeking to attract global collaborations with bigger and more established cardiac centers around the world to help build a sustainable cardiac surgery program in Lagos, Nigeria. Dr Mgbajah is passionate about creating more opportunities and enabling an environment for training more female cardiac surgeons.

Claire Vernon for CTSNet: Your training has been very international. What is the most valuable aspect of such a geographically broad experience?

Dr Ogadinma Mgbajah: I was fortunate to train in cardiac surgery in a few countries during my residency program, owing to the low volume of cardiac surgery done in Nigeria. This helped to shape my career. The most rewarding aspect of it has been the open access and communication channels I now have with CT surgeons in various countries, which has created a constant source of mentorship, exchange of ideas, and a benchmark according to which I strive to pattern my practice. The exposure has continued post fellowship. I constantly look out for opportunities to visit and shadow colleagues in other countries with the aim of helping to build a sustainable cardiac practice in Nigeria.

CTSNet: You recently completed a Women in Thoracic Surgery Fellowship, in which you traveled to the US to work with women cardiothoracic surgeons there. Can you tell us more about this experience?

OM: Oh, what an experience! I would like to thank Women in Thoracic Surgery and Korean Women in Thoracic Surgery for the opportunity. I worked with Lauren Kane, a congenital surgeon at Texas Children’s Hospital and Mara Antonoff, a thoracic surgeon at MD Anderson Cancer Center in Houston, Texas. I was exposed to both cardiac and thoracic practice at its highest levels. The work environment was “familiar” given that both surgeons were the only women surgeons in their units, and so they could relate to the peculiar challenges of the lone woman surgeon, especially the constant need to prove oneself. Beyond that, I had the chance to interact, observe, and pick up key strategies to help with transitioning to ”self-sustained” cardiac surgery in Nigeria and to improve on my already existing and growing thoracic practice. I look forward to further opportunities to interact with colleagues around the world, with the aim of adapting their knowledge to my practice in Nigeria. I also was given the opportunity to show the peculiar cases we see here in Africa that are not so common in other climes, hence the plan to birth a blog series (still forthcoming) titled: The African Chest.

Dr Mgbajah's photo from the #ILookLikeASurgeon campaign.

It wasn’t all “heart and lungs” the whole time; I also had a chance to take in the sights and sounds of Houston. I appreciate the efforts of Lauren and Mara to make sure I had a memorable experience. I was also happy to find out that there are several of these grants available to residents, and I have made this known to young residents at my institution.

I was home before Hurricane Harvey wreaked havoc in Houston. My heart goes out to all the Houstonians who lost valuable property and loved ones, and I pray they emerge stronger.

CTSNet: What skills or actions do you find are key to pushing limits in cardiothoracic surgical practice in a resource-challenged setting?

OM: Unreserved Passion tops the list for me. “Cardiothoracic surgical practice” and “resource-challenged” setting are almost parallel lines! It is a super-specialty that requires tons of funding to develop and sustain. It is a very grueling job to provide this service with little or no resources, especially in an environment where healthcare is paid for out of pocket and health insurance is at best a dream for a large proportion of the teeming population. You need very keen interest and resolve in order to keep pushing the limits.

Training and capacity building. In my opinion, CT surgeons in resource-challenged environs should be properly trained and constantly retrained in order to adapt surgical practice to the environment. The better their learning curve, the more proficient they are with the procedures, processes, and techniques, and the easier it is to see “ways around” and alternatives in providing these services with acceptable outcomes.

Pooled resources. Regional centers should be established, as opposed to individual centers scattered around and reaching for the same meagre resources. My thoughts are that the available resources can be harnessed in regions, with one center equipped to international standards to provide these services in each region. The volumes will rise, the local surgeons will become more proficient, and the training environment will be much better for the residents.

Think outside the box, pull in the funds. In the absence of a functional health insurance scheme, other ways of generating funding for the population will need to be explored. International collaborations with charity organization and bodies, further engagement of stake-holders in the government, and public-private partnerships are platforms that can be explored.

CTSNet: Can you talk about the most important steps in establishing local teams for open heart surgery and being able to successfully transition away from relying on foreign teams for these critical procedures?

Dr Mgbajah with Dr Emily Farkas at a recent CardioStart International visit to the cardiac surgery unit at LASUTH.

OM: Cardiac surgery in Nigeria has largely relied on cardiac missions by various organizations such as Save a Heart Foundation, CardioStart International, and VOOM Foundation, among others, and the transition to sustained open heart surgery by local teams has been slow. In my opinion, the major factor that has stalled this transitioning is funding. In a lot of centers in the country, cardiac surgery gets done only during missions, as most of these organizations make available resources, consumables, and hardware aimed at making the surgery free or nearly so for patients who otherwise cannot afford surgery. Beyond the missions, these patients have to pay out of pocket for these procedures. Over time, the local surgeons become disenfranchised, their skills become rusty, and the circle continues.

To transition from relying on foreign teams would require the following steps:

Identification of a team
With scheduled scout visits and interaction with the local team and hospital management, I believe foreign teams can identify local teams who have genuine and keen interest in providing these services in these resource-challenged areas. These would be people who are willing to “work the talk” and concentrate on building and transferring necessary skills with such teams.

Consistency
I think that each local team should be mentored by one or at most two foreign groups, so that the methods and practices are the same each time. I was taught that the key to safe cardiac surgery is consistency, doing it the same way repeatedly. As much as we welcome all cardiac missions, I think that transition will be easier if each local team or region is mentored by one group repeatedly, until they can stand on their own. MOUs can be reached with the hospital management and cardiac missions planned quarterly, milestones set and regularly appraised, with the aim of transitioning within a set period.

Training
I believe this should be emphasized with the young residents. Structured and mentored training opportunities can be designed by these foreign groups so that residents can be given the opportunity to have mentored training in high volume centers in Brazil, USA, India, etc, so that they can be proficient in carrying out cardiac surgery before achieving full qualification. They will form the pillars that will support the local programs in the future. Members of the local teams—surgeons, nurses, perfusionists—should also be exposed to retraining in high volume centers, and they should participate in missions organized elsewhere to keep them busy all the time.

Funding
It will be worthwhile if these foreign groups can seek to interact with or engage government representatives in the region on funding these programs for the long run. Companies that make cardiac surgery consumables, like Medtronic, Sorin, etc, can be asked to do more than they are doing already to support programs in resource-challenged environments.

CTSNet: If you had a magic wand to create the next innovation in CT surgery, what would it be?

OM: That is easy. It wouldn’t be an innovation. It would be a fully equipped cardiothoracic center in Lagos, Nigeria, run by well-trained local team with funding made available to provide this much-needed service to the mass of patients who have no means to get the surgery they so need. I would make that magic happen in a less than a heartbeat!