Inside the world of a cardiac perfusionist

A TYPICAL day for clinical technologist Nelago Embula starts as early as three-o-clock in the morning during her first three months of medical observations.

Embula (24), who completed her studies in South Africa, is the first Namibian-born clinical technologist who specialises in cardiovascular perfusion.

These professionals are responsible for operating extra-corporeal circulation equipment, such as the heart-lung machine, during an open heart surgery.

She is only one of three specialists in her profession who practise in the country, two of whom are foreigners. She is currently shadowing at the Windhoek Central Hospital after she graduated with cum laude at the Tswhane University of Technology in Pretoria.

Although she graduated last year, Embula feels she still needs more practical experience and education before she can confidently own her title.

However, this qualification did not come easy.

She recalls some of the most traumatic surgeries she had faced as a trainee.

During her second year of studies while on “specialisation”, Embula was trained at the Charlotte Maxeke Johannesburg Academic Hospital under the department of cardiovascular surgery and perfusion.

While her supervisors trained her under harsh conditions, she says she has had to prepare herself for death every day.

“When babies would die, I couldn’t make it to work the next day. It’s not something I’m proud of but my first six deaths on the table have traumatised me to the point. It takes from you,” she admits.

She, Embula, who graduated from Westside High School at Swakopmund in 2014, described herself as a bubbly young woman prior to studying, but she noticed that the exhaustion and amount of work she had been doing during her observations took a toll on her mental health.

“I was constantly exhausted. […] there was a time I just slept in my scrubs. As long as I showed up to work,” she says.

She said that she has also battled with depression, and being away from home in Namibia, where her support structure is based, made things worse.

However, despite having dealt with the pressure, she says she eventually learnt how to push through her practicals in order to graduate.

She noted that a lot of her peers could not stomach working and studying under those harsh conditions at the hospital.

“People don’t baby you at all, it’s your responsibility to look for senior specialists to teach you where you need help,” she says.

She said this was important because she had to push herself for the next black child who might want to follow in her footsteps.

“As a black woman, you already go through so much, I try to prove myself to other people who didn’t have to prove themselves as much as I had to,” she says.

As much as she saw her peers dropping out, she did not want to be part of the group that could not endure hardship.

Cardiovascular perfusion is a profession primarily focused on supporting the continued normal functions of the heart and lungs during open-heart surgery, she explains.

She said this allows the heart to be stopped to facilitate cardiac surgery.

Cardiovascular perfusionists are crucial members of the open-heart surgical team whose primary role is to conduct cardiopulmonary bypass using a heart-lung machine and other ancillary equipment, she explains.

“They closely monitor the patient’s blood flow and other vital signs during open-heart surgery and are also responsible for administering intravenous fluids, blood products and anaesthetic drugs,” Embula adds.

Perfusionists are also experts of other life support equipment such as ventricular assist devices and intra-aortic balloon pumps.

A perfusionist or clinical perfusionist is a medical specialist who operates the “heart-lung” machine during open heart surgery, cell saver, extracorporeal membrane oxygenation (ECMO), intra-aortic ballon pump, among other equipment. Perfusionists are not

Embula says the theory and the practical are two worlds apart in this academic discipline.

“When you’re presented with a practical scenario it takes time to understand the physiology behind the case,” she said.

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