Dr. Fenny Fiindje Shidhika is a Paediatric Cardiologist with intent to build a comprehensive and holistic paediatric cardiac service delivering accessible, affordable, equitable, effective, efficient, quality, timely, safe, and sustainable care to all, irrespective of their individual socio-economic circumstances. She has a profound passion to change the narrative, to direct and influence policy regarding overall healthcare provision in Namibia and internationally. She is currently a Consultant Paediatric Cardiologist and Head of Department at the Ministry of Health and Social services
Dr Shidhika, what exactly is a Paediatric Cardiologist?
That is a specialist paediatrician further sub-specialised in paediatric cardiology. The latter is a highly specialised field with special emphasis on congenital heart disease and / or heart diseases that patients are born with.
Reading about you one can’t help but be intrigued by your personal journey. Do you mind telling us where you were born and raised?
I was born at Onandjokwe hospital in northern Namibia. Raised in Olukonda, a curious and inquisitive child. I dreamt to study science on the moon when I was 8 to 10 years old.
What role did your parents play in your academic excellence?
My mother used to listen to my chats with shock, I believe. She was a strict disciplinarian who felt the obligation to straighten out my hugely adventurous curiousity. I was perhaps too experimental a child, of course that was interpreted as being a bit naughty. My father possessed the bravery that I happen to inherit. His message was that we were growning up in an independent Namibia, and thus had no excuse but to bring 80 to 100% for school marks every term. I remember one term getting an average of 85% in mid-term exams and 84% at the end of the year, and arriving home to be asked “what happenned to the 1%”?
In summary, they would be the least people surprised by what I am today. They knew what they were raising!
Can you please take us through your educational journey?
I went to Oshigambo High School when I was 11 years old for grade 9 after completing elementary/ primary school education. I was quite withdrawn. I did not read much but perhaps I read wisely, as I ended up scoring all awards for the top perfoming student from grade 1 to 12. My curriculum was science based, one of my favourite subjects was Calculus, especially differentiation and integration. Human biology was second natural best as I had this innate desire to be a doctor. My dream as a 16 years old completing matric was to study medicine at the University of Cape Town. And so it happenned. I arrived in Cape Town at 16, innocent and unfazed. Undergraduate years were growth years with no strict parents and teachers.
In second year, fate met me with the biography of Christiaan Barnard, the surgeon who performed the first world’s human heart transplant. My love for the heart started there. After completing my undergraduate degree I returned to Namibia to do internship. I was mostly inclined to heart patients. My advocacy for heart patients started when I was an intern and junior medical officer.
We were the first medical officers when the first Namibian heart service opened in 2008, through a Namibia- South Africa inter-governmental agreement, facilitated by the University of Cape Town. President Thabo Mbeki and President Pohamba launched the service, coinciding with ground -breaking surgeries on RHD patients by multi-disciplinary team of specialists from UCT. It was at that juncture that the late Professor Bongani Mayosi directed me to my soul career. I had no idea what paediatric cardiology was, but he assured me by saying “ I know what I am doing”. May his brilliant soul continue to rest in peace!
I then later specialised in general paediatrics and further sub-specialised in paediatric cardiology at the University of Cape Town affiliated Red Cross War Memorial Children Hospital. In hindsight, I believe my fate has all been programmed by God himself. Equally, I believe it was his will that I became Namibia’s first indigenous paediatruc cardiologist. I am profoundly humbled by the responsibility he gave me.
You have won quiet a number of academic awards, haven’t you? Do you mind sharing those with us?
Well, they are a couple, correct. Some stand out more than others. I would perhaps focus on the ones associated to paediatric cardiology for the interest of time. As a junior fellow 3 months into the rotation, I was awarded the best presentation award at one of the South African Heart Association congress. I did not expect that, I was too junior and not rightly placed to win such an award.
Paediatric cardiology is one of the most complex specialities, but that was my true passion. I wanted to do well during my training and exit exams. I woul be equally surprised to score 86% in my final oral exams in sub-specialty in cardiology of the College of Paediatricians of South Africa.
Equally, the same year I was awarded a Fellowship award by the British Congenital Cardiac Association, which I did at Birmingham Women and Children Hospital under the supervision of Dr. Oliver Stumper – a well renowned interventional cardiologist. A great experience!
In summary, I have been a little bit lucky in my career!
Currently I am about to complete my Executive MSc. in Health Economics, Outcomes and Management in Cardiovascular Sciences at the London School of Economics and Political Science.
What was your experience like studying at UCT?
An exceptional experience! UCT has competitive advantage! It is unique in calibre and standing, has the privilege of thought leadership and long culture of academic excellence. They made me!
My ex- boss Professor John Lawrenson who I believe is one of the exceptional paediatric cardiologists I have met, served as my inspiration as I trained, and as I practise cardiology today.
Can you talk to us about gender representation in your field of study and subsequently in your line of work here on the continent?
Well, I have been priviledged to not really suffer gender- based discrimination while training or while working.
One has to understand that the stakes are even, and ability generally shares a random distribution, so in essence, it is not gender , race or culturally coded.
And how about internationally?
I have been privileged! I have been given fantastic opportunities overseas, including one of the world leading institutions in congenital heart care in France. Having had my foundation at UCT, which own a reputable, international credibility; has its leverage and perks at the right time.
How many Namibian paediatric cardiologists and surgeons do we have right now and how are we doing in terms of encouraging Namibians to follow that field of study?
I serve the public service constituted of approximately 90% of the population. There is a resident cardiologist at Medipark in the north, who visits Onandjokwe and Oshakati hospitals, and a periodic one visiting Roman Catholic private hospital one week per month.
We have 1 paediatric and congenital trained heart surgeon, Dr. Alfred Mureko, who trained with me at UCT. It helps that we were trained in the same establishment with the same modus operandi and ethical principles.
Please talk to us about the Cardiac centre in Namibia. Is it fully functional and adequate for the country’s needs?
Yes, it is functional. Cardiac services are highly specialised services. They merit sharp administration and thought leadership, met by a good budget! We have been privileged to always have political will. Cardiac services never survive without political will!
We started a sustainable congenital heart surgical programme in Namibia in September 2018. We have now operated on close to 200 patients locally. The COVID- 19 pandemic impaired the service’s growth trajectory, in entirety.
What inspired you to start the foundation?
Egalitarianism, by the principles of vertical equity and social welfariasm.
I always believed that care must never be dictated by need and not by the ability to pay. Thus, our mission is to provide accessible, affordable, efficient , effective ( evidence-based), equitable, patient-centred, quality, timely, safe and importantly, sustainable care to all patientd born with congenital heart disease, in Namibia and surrounds, irrespective of their socio-economic condition.
Are you aware of similar foundations and or initiatives in the country?
It had to be acknowledged that cardiac care is highly specialised and economically costly. But the merits of a sustainable care in Namibia cannot be emphasised! There is no single country in the world where government as a sole entity funds these services without supplemental funding models via conduits namely charitable trusts, foundations and so on.
What role, if any, does government play in assisting children in this regard?
Having drawn reference from the answers above, the government of Nambia is one of the unique governments contributing about 8-9% of its GDP to health care, and with a ring-fenced budget to cardiac services. The budget however needs to be macro-modelled, employing diagnosis related groups ( DRGs) and/ or risk adjusted algorithms. The design needs to be carefully thought off , applying the yardstick competition principles , using institutions in South Africa for instance as a model template. We shall get there in time!
What role, if any, does private sector play in assisting children in this regard?
The private sector has assisted on an ad hoc basis in the past. The Pupkewitz and First Rand foundations have been exemplary. The private sector is obligated to some corporate social responsibility ( CSR) and we shall capitalise on that goodwill.
We believe that your foundation will be launched next week, but we assume it’s been operational for a while?
It was registered only by the master of courts in November 2022, so theoretically, it is still well in its infancy.
How many patients (children) with heart conditions do you get to treat annually?
There is a demand/ned- supply mismatch here. We are limited by skilled capacity! These fields are also known as orphan fields, too specialised and not part of mainstream medicine per se. With one paediatric cardiologist, paediatric cardiac surgeon, paediatric intensivist , one shared cardiac anaesthetist and a general paucity of paediatric cardiac care trained nurses; it is inconcievable that we can do 200-300 operations a year. But in reality, that is the threshold mandatory to dissolve the backlogs. Our surgical outcomes are internationally audited through the Boston Children Hospital’s led International Quality Improvement Collaborative for Congenital Heart Surgery (IQIC).
What are the common heart conditions do you get to treat annually?
This is a whole textbook! Paediatric cardiology not only shares complexity, but extreme heterogeneity! We see it all, including lesions that are not documented in the textbooks! In large volumes than otherwise expected for a not-so-populous population.
What are the most serious?
They are all serious. The right term in this context shall be perhaps the magnitude/ scale of complexity. Hypoplastic Right and Left Heart Syndromes would be the most unfortunate scenarios. But we have mane complex lesions, some too complex that the destination package is what is referred to as a ‘non-interventional paradigm’. Unlike other organs e.g. the lungs and kidneys, humans only possess one pump! Death and tragedy are sadly part of paediatric cardiology, a reality one never gets used to!
What’s the mortality rate in children with heart conditions?
Reference must be made to the previous answer. There are many determinants of mortality ranging from complex genetic errors with in-utero death (miscarriagrs and stillbirth), late presentation, complexity, availability of highly specialised trained capacity etc. While advancing understanding and technology mean improved cumulative survival compared to 50 years ago when the field was still new, these benefits are yet to be enjoyed by most developing countries!
Who are the trustees of your foundation?
The multi- dimensionally skilled team is constituted of;
Dr Solly Amadhila; a paediatrician, with huge business insight and copious amount of wisdom
Dr Oliver Stumper; an internationally renowned paediatric cardiologist and interventionalist, bringing a worth of expert wisdom and market insight
Ms Gida Sekandi; an intelligent lawyer, with huge corporate experience
Ms. Nelago Embula; the first Namibian cardiovascular perfusionist, with postgraduate qualifications in public health and hospital administration
How much money are you hoping to raise at the foundation?
We shall rely on the broader society’ s goodwill. Having said that, I will model minimum operational costs ( inputs) needed per annum to achieve a desired threshold of deliverables ( outputs). We shall abide by the principles of ´ increasing returns to scale’. All donations are tax exempted by NamRA and are going to be subjected to annual audit by SGA.
How can the general public assist the trust?
By activating goodwill through donation of equipments, funds and skilled software
On a lighter note;
o Favourite athlete; Frankie Fredricks was a legend. Kylian Mbappe is my index favourite footballer, after Zinedine Zidane, Ronaldo and Batistuta!
o Favourite team; mmmh, that depends on the coach! My favourite football coaches are Miquel Arteta, Pepe Guardiola and Jose Mourinho
o Favourite holiday destination; These are many! Namibia is a potent tourist destination by itself.
o Most admired person/personality; There are a couple! Depends on the season, albeit, I am fascinated by philosophers, brave advocates, intellects from diverse angles, innovators, philanthropists etc. Career aside, I believe Ukraine’s President Zelensky is a true legend!
o Motto you live by; Go for it! “If you can see the runway, take off”, you will discover and navigate the storm once in the sky and lastly, Namibia is immense potential, may we all collectively capitalise on that critical capital, and advance this country!
