Cardiovascular Journal of Africa: Vol 28 No 6 (November/December 2017)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 6, November/December 2017 408 AFRICA
Khartoum, what a location for the joint congress of PASCAR, the Sudan
Heart Society and the Pan-African Interventional Cardiology Course
(PAFCIC)! The PAFCIC ) took place alongside
the main congress and presented the practicalities of interventional
procedures. The African summit of the World Heart Federation was
also held in proximity to the congress (proceedings documented at
).
The joint congress was housed in the Friendship Hall, in Khartoum,
next to the Blue Nile, a kilometre or so from the confluence of the
two Nile rivers. The opening by General Bakris Hassan Saleh, first
vice-president of the republic and national prime minister of Sudan
was magnificent. Proceedings were in Arabic, but one could follow a
translation into English on small headsets.
After a few words from Prof Bongani Mayosi, president of
PASCAR, delegates were introduced to the guest speaker, Prof AA
Gehani from the Heart Centre, Cornell Medical Centre, Qatar. Prof
Gehani advanced a well-supported hypothesis that Ibn-Nafis, a 13th
century Arabic scholar, described the pulmonary circulatory system
about four centuries before William Harvey did. He also explained
how Harvey may have read this, having had access to Arabic sources
that had been translated into Latin. This theory is not new and appears
in a letter to the Cardiovascular Journal of Africa in 2009; 20(5): 299.
The main themes of the congress were around diseases endemic
to Africa: rheumatic heart disease, hypertension and heart failure,
but a fair share of the programme revolved around ischaemic heart
disease and related interventions. Some space was also allotted to
congenital and arrhythmic heart disease.
Presentations were almost along the lines of taking stock: ‘What
cardiovascular disease do we see? How frequent is it? What is available
to diagnose and manage it? How do we compare among each other
and compared to developed countries, and is what we do appropriate
for Africa?’ For example, Bongani Mayosi, stated that rheumatic
heart disease is still endemic in all parts of Africa, major parts of
Asia and in some pockets elsewhere in the world. He explained how
some countries have managed to decrease its prevalence through
increasing awareness and prevention. Eighty per cent of premature
cardiovascular disease and death occurs in developing countries, a
very significant proportion of which is Africa.
Karen Sliwa addressed the issue of whether Africa can meet the 25 ×
25 goal of the United Nations to achieve a 25% reduction in premature
mortality from cardiovascular disease by 2025. Others speakers, Ibtisam
Ali, Anastase Dzudie, Albertino Damasceno, Elijah, Salim Yusuf and
Gerald Yonga talked about how to address the major risk factors, such as
hypertension, smoking and others. A major issue is the cost and quality
of medication and the payment thereof. Three ministers of health, who
are important for formulating and implementing public health policies
with regard to smoking, sugar consumption, hypertension and more,
unfortunately did not put in an appearance.
The work of Salim Yusuf from Canada is fascinating. His group
has been studying cardiovascular disease on a global scale by asking
simple questions such as: ‘Is the incidence and prevalence of events
the same? If a myocardial infarction or stroke occurred, are the “risk”
factors the same? Are the outcomes of events the same or different in
different settings?’ On this last question, Yusuf asked, ‘If one finds
oneself having chest pain in an area where primary percutaneous
coronary intervention (PPCI) is not timeously available, if at all, and
even appropriately given thrombolysis may not be available, what
should one do?’ He ventured an idea for self-treatment; to carry an
emergency ‘cocktail’ of aspirin, an ACE inhibitor, a β-blocker and a
statin. This makes sense, even in Khartoum.
Ahmed Suliman gave an overview of the situation in Sudan.
Even in Khartoum, with many private and some public cardiac
catheterisation laboratories (CCL), you are likely to get timely
PPCI only if you pay privately. In the public system, at primary
care facilities, after first dealing with issues of payment, the window
of opportunity will have passed, and even thrombolysis will not be
done. According to Toure, in Niger there is no CCL. Some other
countries are in a similar situation and Habib Gamra has compiled
a very useful interventional map for Africa.
The cardiac surgery situation in Sudan is interesting. Besides the
Sudanese facilities, elaborated on by Kamal Khoghali, there is also a
major centre, the Salam Centre, funded by an NGO and expounded
on by Alessandro Salvati, which undertakes surgery and follow up
at no cost.
Representatives of both the Cardiovascular Journal of Africa and
the Sudan Heart Journal (SHJ) had the opportunity of giving an
overview. Siddiq Khalil, the editor of SHJ, gave an excellent review
on the origin of the journal in 2011, its policies, growth and aims. He
also spoke about the history of Sudan and the conquering of Sudan
by General Horatio Kitchener in 1898. This is a name we in South
Africa can identify with, thinking of the role Kitchener played in the
Anglo–Boer war two years later.
The foreign delegates were well treated by a number of friendly
young doctors who helped us into and out of Sudan, as well as getting
us to where we needed to be. The evening outings to some excellent
restaurants were very enjoyable despite the absence of alcohol.
PA Brink
Congress News
Left to right: Anastase Dzudie (Cameroon), Paul Brink (South
Africa), Ahmed Suliman (Sudan), George Nel (South Africa)
Opening of congress: General Bakri Saleh in white turban
sitting on stage
Additional photos on page 396