A Mender of Hearts Finds Fulfillment at Home

By NORIMITSU ONISHI

ACCRA, Ghana -- Until one of his residents was promoted a few months ago at the cardiac center he founded here, Dr. Kwabena Frimpong-Boateng was Ghana's only heart surgeon, the only man out of 19 million citizens in this corner of West Africa who could plunge into another's chest and heal.

On a continent whose scientists and doctors often leave permanently for the West, however, Frimpong-Boateng had already distinguished himself by a simple act: coming home. In his late 20s, the doctor, a son of farmers, won a scholarship to Germany, where he mastered cardiothoracic surgery at Hanover Medical School.

Then a decade later, in 1989, the doctor left Europe, its comforts, the predictable arc of a surgeon's career, his specialty's lucrative rewards, tossed all of that for a giant question mark.

This young country had never had an elected leader, only successful coup plotters; it had never had a cardiac center, or a surgeon determined to forge one out of nothing, and for a $300-a-month salary.

Today, Frimpong-Boateng, 49, is hard at work on expanding the National Cardiothoracic Center here in the capital. The center's reputation, as well as his own, has reached beyond Ghana's borders, to countries like Sierra Leone, where there is not even a single heart surgeon.

Every day, letters mailed from other African countries land on his desk and implore Frimpong-Boateng for help.

"We may be poor, but the heart is the same everywhere," the doctor said one recent morning as he returned to his office from an inspection of the construction site.

He held the blueprint of the expansion that, among other improvements, will move patients from the current colonial-era ward, which has one toilet for 35 patients.

"I don't believe in sub-Saharan standards," he said. "I believe we have international standards. Heart surgery is like an airline. We're not a TWA or Pan Am with a large fleet, but the one or two planes we have we must maintain at the same standards."

Before Frimpong-Boateng, Ghana would have sent a "minister or a key professor at the university" overseas for heart surgery, said Dr. Issaka Tinorgah, director of medical services in the Ministry of Health. What would have happened to those not included in this group, to those unable to travel on their own means, was better left unsaid.

For a developing country with limited resources -- Ghana spends about $10 in health care a year per citizen, compared with a range of $7 to $15 in West Africa -- deciding which medical services to offer entailed difficult moral choices, Tinorgah said.

As unseemly as it was to leave patients requiring heart surgery untreated, the hard reality is that the vast majority of people here died of everyday illnesses like malaria, respiratory infections and diarrhea.

As a result, the government focuses almost exclusively on primary care; to Frimpong-Boateng, it gives a location, and pays the utilities and most of his staff's salaries. But everything else, Frimpong-Boateng has paid on his own by raising money through his Heart Foundation.

The Heart Foundation raised about $350,000 last year, mostly by running ads on local radio and television, by focusing on a particular group each month, cab drivers one month, small-business owners the next. He created the center, he said matter-of-factly, to treat the ordinary Ghanaian who would have died otherwise of heart ailments. And so he viewed the foundation as a sort of social contract with the poor and expected most of his funds to come in $1 or $2 donations.

"To a large extent, he's like a missionary," said Tinorgah, who, asked whether Ghana would have a heart center today without Frimpong-Boateng, answered simply: no.

For the freedom he has enjoyed, Frimpong-Boateng has also learned the diplomacy required of being the country's only heart surgeon.

"This voice sounds very familiar," the surgeon recalled thinking when he received a phone call a couple of years ago, and then realized it was the country's longtime president, Jerry Rawlings. "Oh, I thought, my God, what have I done?" A foreign dignitary had suffered a heart attack here.

Keeping the center operating has also meant dealing delicately with the politically connected. On a recent afternoon, two relatives of an 85-year-old man -- a traditional chief in a region where cocoa, Ghana's main export, was grown -- entered the doctor's office. The old man needed a pacemaker, and the entire operation would cost about $5,000. The relatives were clearly hoping that the Heart Foundation would pick up the bill.

Frimpong-Boateng, on hearing that they had never donated to the foundation, shook his finger at them. "When you heard about the Heart Foundation," he said, "you thought it's far off. Now it's come home."

The doctor noted the patient's age. Who knows how long he would live with the pacemaker anyway? "It's a moral question," he said.

"You can't say so," one of the relatives said.

A few days later, the old chief lay on a bed in the doctor's ward; his family had persuaded the local cocoa association to pay for the operation.

Judging from the 17 other patients there, however, most of his patients are dependent on the foundation. On one bed lay a small boy who had swallowed a metal pipe that had been lodged in his chest for some time; his older sister had brought him here from the bush and then disappeared. In the operating room was a woman badly hurt in a car accident the night before; no one knew who she was.

The doctor asked one of the nurses for some X-rays. When she could not find them, he flung his stethoscope in her face. "Sometimes I get so upset with the nurses I don't want to see them for the rest of the day," he said.

Later, he smiled at his own impatience, a smile that conveyed the belief that individual will would always triumph over personal weakness, so long as the greater goal remained clear.

He recalled that on his first day at Hanover Medical School he told his teachers that he had begun working toward his return to Ghana; in fact, he had avoided going to the United States because so many Ghanaian doctors had gone there and never returned.

He feared America might prove too seductive. He had to return to Ghana. Most of his five children were now away in Europe or the United States. But the rest of his family was here, including his aging mother, who had raised him after his father died just before his birth.

"I also wanted to come back to be with her," he said. "I grew up with the woman, and I have never regretted it."

"Somehow," he added, and it was not clear whether his words meant mother or motherland, "your presence alone is enough to make a difference."