Cardiac Surgery Capacity in Sub—Saharan Africa: Quo Vadis?

Yankah, Charles
Fynn-Thompson, Francis
Antunes, Manuel
Edwin, Frank
Yuko-Jowi, Christine
Mendis, Shanthi
Thameur, Habib
Urban, Andreas
Ralph, Bolman III

¹Department of Thoracic and Cardiovascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
²Department of International Relations, Afrika Kulturinstitut e.V, Berlin, Germany
³Department of Cardiac Surgery, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts, United States
⁴Department of Cardiothoracic Surgery, University Hospital of Coimbra, Coimbra, Portugal
⁵Department of Cardiothoracic Surgery, National Cardiothoracic Centre, Accra, Ghana
⁶Department of Pediatric Cardiology, University of Nairobi and Mater Hospital, Nairobi, Kenya
⁷Department of Management of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
⁸Department of Cardiac Surgery, Clinique Internationale Hannibal, Tunis, Tunisia
⁹Department of Pediatric Cardiac Surgery, International Operation Centre for Children, Asmara, Eritrea
¹⁰Department of Cardiac Surgery, Brigham and Women's Hospital, Boston, United States

Address for correspondence Charles Yankah, MD, PhD, Department of Thoracic and Cardiovascular Surgery, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, Berlin 13353, Germany, [email protected][email protected]

received April, 17, 2014

accepted after revision May, 31, 2014

published online June, 23, 2014

Acknowledgments

We highly acknowledge the support of the following institutions and colleagues. Contributors of data: CTSNet, Chicago, Dr. Maria Beatriz Ferreira, Cardiologist, Maputo Heart Institute, Instituto do Coração (ICOR), Maputo; Prof. David Anderson D, Director, Evelina Childrens Hospital at Guys and St Thomas' Hospital, London; Dr. Aubyn Marath, Pediatric and Adult Cardiothoracic Surgery, Oregon Health & Sciences University, Portland, Oregon, United States; Dr. Joseph Mucumbitsi, Pediatric Cardiologist, King Faisal hospital, Kigali; Dr. Henning Du Toit, Consultant Cardiac Surgeon, Windhoek Central Hospital & Roman Catholic Hospital, Windhoek; Prof. Fathi ElGhamari, Chief of Cardiovascular Surgery, Tajoura National Cardiac Centre, Tripolis; Dr. Gwila Taha, Tajoura National Cardiac Centre Tripolis; Prof. Stephen W.O. Ogendo, Cardiac Surgeon, University of Nairobi, Kenyatta National Hospital, Nairobi; Dr. Kifle Tondo, Cardiac Surgeon, Klinikum Braunschweig, Braunschweig; Prof. Mohand Amrane, Chief Cardiac Surgeon, Alger; Prof. Paul Simon, Former Director Cardiac Surgery Program, Aga Khan University Hospital, Nairobi; Prof. Amal Drissi Kacemi, Chief Cardiac Surgeon, Rabat; Dr. Michael Oketcho, Cardiac Surgeon, Uganda Heart institute, Kampala; Dr. Mondo Charles Kiiza, Consultant Cardiologist, Uganda Heart Institute, Kampala; Prof. Bahir J. Nyangassa, Cardio-Thoracic Surgeon, National Heart Centre, Muhibili National Hospital, Dar es Salaam; Manuel Pedro Magalhães, Director, Heart Team to Angola, Clínica Girassol, Luanda; Prof. Dr. Kwabena Frimpong-Boateng, former Head, National Cardiothoracic Centre, Accra, Pat Ceeya Patton-Bolman, Coordinator Team Heart, Boston; Mike Belliere, Founder/Director, Medical Education and aid to Kenya (M.E.A.K), United Kingdom. Promoters of the study: African Cultural Institute, Berlin, Pan-African Society for Cardio-Thoracic Surgery (PASCaTS), Prof. Dr. h.c. mult. Roland Hetzer, Chairman, Deutsches Herzzentrum Berlin; Dr. Carlos Mestres, Senior Consultant, Cardiovascular Surgery, University Clinic Barcelona; Prof. Dr. Jose Luis Pomar, Deputy Director, the Thorax Institute, University Clinic Barcelona; Dr. Jonathan O. Nwiloh, Cardiovascular Surgeon, Atlanta, Georgia; Prof. Dr. Francis Smit, Chief Surgeon, Department of Cardiothoracic Surgery, University of Free State, Bloemfontein; Dr. Willie Koen, Cardiac and Transplant Surgeon, Christiaan Barnard Memorial Hospital, Cape Town; Dr. David Harris, Cardiac Surgeon, University of Tygeberg, Cape Town; Dr. JaBaris D. Swain, Brigham and Women's Hospital, Boston, Massachusetts, United States. The authors also thank Ms. Anne Gale, for editorial assistance; Astrid Benhennour, for bibliographic support; Carla Weber and Helge Haselbach, Deutsches Herzzentrum Berlin, Germany, for graphic design work.

The Thoracic and Cardiovascular Surgeon 62(5):p 393-401, August 2014. | DOI: 10.1055/s-0034-1383723

Abstract

Background

Current data on cardiac surgery capacity on which to base effective concepts for developing sustainable cardiac surgical programs in Africa are lacking or of low quality.

Methods

A questionnaire concerning cardiac surgery in Africa was sent to 29 colleagues—26 cardiac surgeons and 3 cardiologists in 16 countries. Further, data on numbers of surgeons practicing in Africa were retrieved from the Cardiothoracic Surgery Network (CTSNet).

Results

There were 25 respondents, yielding a response rate of 86.2%. Three models emerged: the Ghanaian/German model with a senior local consultant surgeon (Model 1); surgeons visiting for a short period to perform humanitarian surgery (Model 2); and expatriate surgeons on contract to develop cardiac programs (Model 3). The 933 cardiothoracic surgeons listed by CTSNet translated into one surgeon per 1.3 million people. In North Africa, the figure was three surgeons per 1 million and in sub-Saharan Africa (SSA), one surgeon per 3.3 million people. The identified 156 cardiac surgeons represented a surgeon to population ratio of 1:5.9 million people. In SSA, the ratio was one surgeon per 14.3 million. In North Africa, it was one surgeon per 1.1 million people. Open heart operations were approximately 12 per million in Africa, 2 per million in SSA, and 92 per million people in North Africa.

Conclusion

Cardiothoracic health care delivery would worsen in SSA without the support of humanitarian surgery. Although all three models have potential for success, the Ghanaian/German model has proved to be successful in the long term and could inspire health care policy makers and senior colleagues planning to establish cardiac programs in Africa.