Doctors in dilemma over baby's heart surgery

By MARTIN JOHNSTON health reporter

Doctors are trying to decide whether to give a Pacific Island baby a life-saving operation that would be available as a matter of course to New Zealanders.

Five-week-old Karen Mandan was brought to the Starship children's hospital from Vanuatu with a heart defect that is likely to kill her in months unless treated.

But the long-term care necessary after the operation may be next to impossible in the remote village where the family live in a bamboo hut with no power or running water.

The sick baby's twin, Margaret, also had an inherited heart defect, but had surgery last week to fix it after the twins flew to Auckland with their mother.

Karen's care could cost more than $70,000.

The case has reopened the question of whether foreigners from Pacific Islands should receive taxpayer-funded surgery here, effectively reducing the amount of healthcare available to New Zealanders.

The hospital's head of children's heart surgery, Dr Kirsten Finucane, said last night that surgery for babies with Karen's condition could improve their lives, "but we can't restore the circulation to normal, so the baby doesn't have a normal outlook". They also needed continuing drugs and medical supervision.

"Where she's going back to I don't think it's going to be easy to supervise her. It's probably going to be impossible."

Doctors would decide this week whether to go ahead with the surgery.

The twins' mother, Julie Mandan, 39, left her village knowing only of Margaret's heart problem, bringing Karen so she could continue breastfeeding.

Margaret's transposed arteries were fixed on Friday in open-heart surgery that, with related care, will cost $35,000 to $40,000. She is recovering well.

In New Zealand, Karen was diagnosed with heart problems more complicated to repair.

Only one of her heart's pumping chambers works properly, and she has no spleen, making her vulnerable to infections.

The NZ doctor who brought the twins to the Starship, Dr Derek Allen, said last night that to obtain immigration approval he had had to personally guarantee that the health board would be paid.

It is not the first time he has dipped into his own pocket for the villagers of Vanuatu, where, as the only doctor in 2400 sq km, he works at a basic hospital caring for 35,000 people.

His bank account is $16,000 overdrawn, and he still owes the health board $10,000 for a $46,000 heart operation on a Vanuatu boy.

Dr Allen is paid about $15,000 a year in Vanuatu and says he would earn far more in New Zealand.

"If the worst comes to the worst I will toss my job in in Vanuatu and come back to New Zealand ... and earn some money to pay the debt."

Starship general manager Kay Hyman said: "We would have to look at the circumstances, but we are not going to make a decision that's going to imperil somebody's life."

Health Minister Annette King said through her spokesman that it was a humanitarian issue.

"Once they are here, there's nothing else you can do but operate on them. You couldn't have sent them back again."


FREE HEALTHCARE

New Zealand citizens and residents, Britons and Australians are generally eligible for taxpayer-funded healthcare.

People from other nations usually have to pay.

Through its aid programme, NZ can pay for sick Pacific Island people, including those from Vanuatu, if their prospects are good.

Since last October, new foreign fee-paying students have been excluded from state-paid healthcare.