By - Clinical and interventional cardiologist at Mogadishu Somali-Türkiye Training and Research Hospital, Somalia.
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“A blocked coronary artery does not wait for transport, referrals or financial arrangements. Every minute matters for survival and recovery.” Dr. Said Abdirahman Ahmed
There is a medical emergency that can turn an ordinary day into a life-threatening situation. A father develops crushing chest pain at work. A mother experiences sudden breathlessness and sweating at home. A younger adult dismisses persistent chest discomfort, believing heart attacks happen only to older people.
In each case, a coronary artery may be blocked, depriving part of the heart of oxygen. This is a heart attack, or myocardial infarction. Its most urgent form, ST-segment elevation myocardial infarction (STEMI), requires rapid treatment to restore blood flow.
In Somalia, the conversation about heart attacks must extend beyond cardiology departments into homes, schools, communities and national health planning. We have made progress in delivering advanced cardiac procedures, but the challenge is ensuring patients reach that care in time.
As an interventional cardiologist in Mogadishu, I believe our next priority should be connecting lifesaving expertise to patients through a faster, more accessible emergency-care system. In heart-attack treatment, time is heart muscle.
Heart attacks are not confined to old age. High blood pressure, diabetes, smoking, high cholesterol and a family history of premature heart disease can increase risk, including among younger adults.
In STEMI, a clot often suddenly blocks a coronary artery. Without timely reperfusion—the restoration of blood flow—the affected heart muscle may become permanently damaged. The consequences can include dangerous heart rhythms, heart failure or death.
One effective treatment is primary percutaneous coronary intervention (PCI), in which a cardiologist opens the artery using a balloon and often a stent. It can save lives. Yet even successful treatment cannot restore heart muscle that has already died.
Imagine a man in Mogadishu who develops severe chest discomfort after work. Thinking it is indigestion, he takes medicine and waits. When the pain persists, his family seeks help at a nearby clinic.
An electrocardiogram (ECG) eventually identifies STEMI, and he is referred to a hospital equipped to perform PCI. By the time his artery is opened, hours have passed. This is an illustrative scenario, not an individual patient’s story.
These delays can occur at every stage—from recognizing symptoms to finding transport, obtaining an ECG and reaching specialized care.
In a study my colleagues and I published in 2024, we examined 103 patients with STEMI who underwent primary PCI at Mogadishu Somali-Türkiye Training and Research Hospital. The median door-to-balloon time—the interval from hospital arrival to the procedure—was 169 minutes, and approximately 61% experienced a delay beyond 90 minutes.
The study identified social and financial obstacles associated with delayed treatment. These findings come from one hospital, not a national survey, but they underline the urgency of improving the pathway to care.
We should measure success not only by whether an artery is opened, but also by how quickly it is opened.
A heart attack does not always look like a dramatic collapse. Warning signs can include chest pressure, tightness or heaviness; pain spreading to the arm, jaw, back or upper abdomen; breathlessness; cold sweating; nausea; or sudden weakness. Women, older adults and people with diabetes may experience less typical symptoms.
New, severe or persistent chest discomfort—especially with sweating or shortness of breath—requires urgent medical assessment. Do not wait for symptoms to become unbearable or assume they are simply gastric pain. Seek emergency assistance and arrange prompt, safe transport to an appropriate hospital.
Public awareness is not a substitute for hospital care. It is what helps patients reach treatment before an opportunity is lost.
Modern catheterization laboratories are an important achievement, but a cath lab cannot help a patient who reaches it too late. People in smaller towns and rural communities may first attend facilities without specialized cardiac services; diagnosis, referral, transport and communication can consume precious time.
Somalia needs a coordinated STEMI network linking emergency departments, regional hospitals, ambulance services and PCI-capable centres. Facilities receiving emergency patients should promptly obtain and interpret an ECG, identify suspected STEMI and activate a clear referral or treatment pathway.
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Guidelines recommend an ECG within 10 minutes of first medical contact for suspected acute coronary syndrome.
Where primary PCI cannot be delivered within the recommended time, appropriately selected patients may need clot-dissolving therapy, provided it is safe and trained teams and transfer arrangements are available.
A coordinated pathway also requires direct communication between referring clinicians and receiving teams, regular training and reviews of transfer times. A clear plan can prevent patients from being moved between multiple facilities without an agreed treatment destination.
We do not need a cath lab in every district. We need every district to recognize a heart attack and connect patients quickly to effective treatment.
Emergency cardiac care can be financially overwhelming. Families may face costs for transport, tests, hospitalization and procedures while a coronary artery remains blocked.
Government institutions, healthcare providers, insurers and development partners should explore sustainable emergency-financing arrangements to prevent avoidable payment-related delays. Clinical urgency—not immediate ability to pay—should determine how quickly a patient receives assessment and indicated treatment.
Fast treatment is essential, but prevention starts long before chest pain. Checking blood pressure, managing diabetes and cholesterol, avoiding tobacco, staying active and following prescribed treatment can reduce cardiovascular risk. Primary healthcare services should help people identify and manage these risks early.
Somalia would also benefit from a national STEMI registry documenting symptom onset, first medical contact, ECG timing, transfer, reperfusion treatment and patient outcomes. Reliable data would reveal where delays occur and help hospitals and policymakers evaluate improvements.
It would also distinguish delays before hospital arrival from those arising after diagnosis, allowing more targeted and accountable solutions.
A heart attack can change the future of an entire household. A parent may not return home; a survivor may live with heart failure and lose the ability to work. The consequences reach far beyond the hospital.
Healthcare leaders should strengthen emergency pathways and training; communities should learn the warning signs; and policymakers should support accessible, timely treatment alongside prevention.
Somalia has developed the expertise to perform lifesaving cardiac interventions. The next step is to build a system that gets patients to them in time.
A blocked coronary artery does not wait for transport, referrals or financial arrangements. Every avoidable delay threatens more heart muscle—and potentially another life.
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*Dr. Said Abdirahman Ahmed, MRCP(UK), is a clinical and interventional cardiologist at Mogadishu Somali-Türkiye Training and Research Hospital, Somalia.
**The views expressed in this article are solely those of the author and do not necessarily reflect the views or editorial position of Dawan Africa.