Heart bypass surgery in India for Kenyan patients: what to expect

Your cardiologist in Nairobi, Mombasa or Kisumu has looked at your angiogram and said the word bypass. Maybe they offered surgery at home and the waiting time was long, or the cost was out of reach, and someone in the family suggested India. This article covers what happens from that point until you are back home with your own doctor.

Coronary artery bypass grafting, or CABG, is an operation that takes a healthy blood vessel from your chest, leg or arm and uses it to carry blood around a blocked part of a coronary artery (one of the arteries that feed the heart muscle). It is a major operation, and the plan is always made by the surgeon who will do it.

Reports to send before anything else

The surgeon's opinion and every hospital quote depend on your reports. Send these:

• The angiogram on CD or as DICOM files, with the written report. DICOM is the standard file format for medical images. The surgeon will want to watch the moving pictures of your arteries, not only read the summary. Ask the hospital that did the angiogram for a copy of the full study.
• Echocardiogram report (an ultrasound scan of the heart), which shows how well the heart muscle pumps.
• ECG (the tracing of the heart's electrical activity), recent if possible.
• Blood tests: kidney function (creatinine), blood sugar or HbA1c if you have diabetes, full blood count and any recent cholesterol results.
• Chest X-ray if you have one.
• A list of every medicine you take, with doses. Blood thinners matter most, because the surgical team will decide whether and when you stop them. Do not stop any medicine yourself.
• Other conditions: diabetes, kidney disease, a past stroke, lung problems. These change the plan and sometimes the cost.

Once your reports are in, our team gets a medical opinion and partner hospitals send their quotes. You compare them and choose. A quote based on a full set of reports is far less likely to change later.

Visa and flights from Nairobi

The High Commission of India in Nairobi states that Kenyan nationals can apply for either an e-Visa or a regular visa. Most patients use the e-Medical Visa, applied for online at indianvisaonline.gov.in with a letter from the Indian hospital. Up to two family members can come on e-Medical Attendant Visas. If you apply for a regular medical visa at the High Commission instead, its checklist asks for a hospital invitation letter with your illness, treatment length and estimated cost, a referral from your local doctor, proof of funds and proof of the relationship between you and each attendant.

Some airlines fly direct from Nairobi to Mumbai. For other Indian cities you usually connect once, either inside India or through a hub such as Dubai, Doha or Addis Ababa. We book around the admission date the hospital gives you, and we tell the airline in advance if you need a wheelchair at either end.

The first days in India

A driver or representative we book meets you in the arrivals hall with a board showing the patient's name. We send you their name and number before you fly. They take you to your room near the hospital. In the first day or two, the hospital usually repeats some tests: blood work, an ECG, an echo, a chest X-ray, and checks of your lung and kidney function. Sometimes the surgeon wants a fresh angiogram if yours is old or unclear. The anaesthetist meets you, and you sign the consent forms. An interpreter arranged by the hospital can sit with you in these meetings, and your coordinator can join by phone, so that you understand what you are signing.

Surgery and the ICU

After the operation you wake up in the intensive care unit (ICU). For the first hours you may have a breathing tube, drips, drainage tubes from the chest and a lot of monitoring wires. This is normal. The US National Heart, Lung, and Blood Institute says patients usually stay in the ICU for a day or two and in hospital for about a week, longer if other procedures were done at the same time.

Family visits to the ICU are short and controlled. Your attendant can wait near the unit, and the coordinator passes on updates from the team.

Recovery before the flight home

After discharge you move back to the room near the hospital. Each day you walk a little more, do the breathing exercises the physiotherapist shows you, and keep the wound clean. You return to the hospital for a check, where the team looks at the wound, your heart rhythm and usually an X-ray or echo. NHLBI puts full recovery at about 6 to 12 weeks after leaving hospital, so you will still be healing when you get home.

The surgeon decides when you are fit to fly. Ask for this estimate before you book the return ticket. Some airlines ask for a medical clearance form from the doctor, so we check the airline's rules and get the form signed before your last visit. On the flight, wear loose clothes, drink water, and get up and walk when the crew allows.

Follow up from Kenya

Before you leave, collect the discharge summary, the operation note, your medicine list and copies of all scans. Hand these to your cardiologist in Kenya at your first visit.

After you go home, our team stays in touch. If a question comes up, send it to your coordinator and we pass it to the treating team, or arrange an online consultation with the doctor. Your local doctor manages day to day care, and you should go to a local emergency department at once for chest pain, breathlessness, fever, or a red or leaking wound.

When your angiogram and echo are ready, send them to us. That is where every quote starts.