Muyanalo Margaret Nemutamvuni depends on an oxygen tank to help her breathe, and a wheelchair to move, and yet she remains upbeat. Even as the coronavirus pandemic extends her agonising wait for a lung transplant.

Diagnosed with lupus interstitial lungs disease, pulmonary arterial hypertension and acute reflux in 2016, Nemutamvuni is need of a lung transplant. On the waiting list since December 2019, her crucial surgery has been delayed. The Covid-19 pandemic has disrupted hospital schedules, with most surgeries and procedures put on hold while hospitals respond to the pandemic.

“Knowing that I am valuable to my family, friends and the community keeps me going every day,” says the 53-year-old, speaking over the nasal cannula that brings oxygen to her nose. The procedure would bring a healthy pair of lungs for Nemutamvuni.

A lung transplant is a surgical procedure to replace diseased or failing lungs with a healthy organ, usually sourced from a deceased donor.

“I must fight this battle so that I can be able to look after my children and other 98 vulnerable children that I currently look after,” said Nemutamvuni. “That is the reason I am staying positive and hopeful.”

Born and raised in the small Tshino village in Vuwani district of Limpopo Province, Nemutamvuni draws her strength from the people in her life. Nemutamvuni also supports the Unarine Day Care Centre, a centre for children with disabilities in Tsianda village, outside Thohoyandou.

Pleading with the coronavirus sceptics

As she waits for a transplant, living with a lung disease makes Nemutamvuni vulnerable to the coronavirus. Though she ensures that she is protected at all times from Covid-19, Nemutamvuni says she is concerned about people who still do not believe that coronavirus exists. People who do not respect the Covid-19 preventative measures put in place to help minimise the spread of the virus are potentially dangerous to her.

“It pains me when I see people who still do not believe that Covid-19 is real and that it kills, and it has not only affected those who contracted the virus,” she said. “But it has also affected some of us who are waiting for other medical procedures as they have been put on hold due to the virus.”

“I am pleading with my fellow countrymen and women to follow the Covid-19 preventative measures so that we can end or have this virus under control, so that some of us who are in need of other medical procedures which are on hold due to coronavirus can have another chance at life.”

Coping with an oxygen shortage

Since the start of the pandemic, Nemutamvuni  has also faced difficulties purchasing oxygen. The medical response to Covid-19 has brought with it an oxygen shortage of oxygen as hospitals prioritise Covid-19 patients.

“They are often out of stock as most of them are being reserved for people who have Covid-19 and are having difficulties breathing,” she said.

Her oxygen tank and medication are also a financial strain. A former director in the Limpopo Department of Economic Development, Environment and Tourism, Nemutamvuni has not worked for months. She was forced to take health-induced retirement last year, and while she is still on medical aid, she still has to pay for much of her treatment of out of her own pocket. This makes her even more reliant on others.

“I am unable to do most things for myself and that’s the most difficult thing because most of the times I have to wait for other people do help me with certain things and sometimes they only help at their own time or even forget,” said Nemutamvuni.

Still she remains hopeful that the Covid-19 pandemic will eventually pass and she will be able to find a lung donor, even as she faces other challenges.

Organ donations impacted by tradition and stigma

Before the coronavirus pandemic, Nemutamvuni had to contend with the stigma against organ donations. Some traditional belief systems discourage their adherents from donating organs, or the still healthy organs of their deceased loved ones.

“One of the biggest challenge we have in Africa is that not many people are willing to donate organs, which makes it difficult for people like me to get an organ donation,” she says. “I believe that the lack of donations can lead to unnecessary, preventable deaths, but we cannot blame anyone, because its ones choice to donate organs.”

According to the World Health Organisation (WHO), the procurement of organs for transplantation must follow legal requirements, including the definition of death and consent. According to the Organ Donor Foundation, South Africa has 324 195 registered donors. Just one donor can save up to seven lives.

Still, as she waits for her life-changing surgery through the pandemic, Nemutamvuni remains hopeful. She adheres to her medication and rests often, but also protects her inner-peace just as she protects herself from Covid-19.

“Life is a gift from God, the fact that you’re going through tough time does not mean that you cannot live your life as all you have to do is to adjust to new lifestyle and also the fact that you are sick does not mean that you’re dying.”

A ‘risk calculator’ for surgery

Nemutamvuni is one of thousands of patients around the country whose surgeries have been delayed due to the pandemic. The Organ Donor Foundation says the pandemic has not only disrupted and rerouted hospital services, but also reduced the number of viable donors.

The Association of Surgeons of South Africa has produced a risk calculator for doctors who need to assess patients  for non-emergency surgery in the midst of a pandemic. There are six main recommendations surgeons must take into account. These include:

• Safe reintroduction of surgery in the presence of community transmission of Covid-19 requires assessment of individual patient risk, as well as health facility readiness.
• Surgery with co-existing Covid-19 infection poses an increased risk of morbidity and mortality and should be avoided for non-emergency surgery.
• Pre-operative Covid-19 testing should ideally be performed on all patients scheduled for non-emergency surgery; Surgery must be postponed if positive, for at least 14 days after last day of symptoms or 14 days from test if the patient is asymptomatic.
• Where testing is not available or turnaround time is prohibitively long, patients with Covid-19 symptoms should be postponed for at least 14 days.
• For patients recovered from Covid-19 ( after more than 14 days after last day of symptoms or from test if asymptomatic), assessment for Covid-19 effects must be part of the risk evaluation. Routine repeat PCR testing is not recommended.
• Risks of concomitant and in-hospital Covid-19 infection should be discussed with the patient as part of the consent process.

The risk calculator scores patients based on the above risks in order to decide whether non-emergency surgery should go ahead. You can download the full pdf for assessing patient surgery requirements in a pandemic here.—Health-e News