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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 31, No 1, January/February 2020

AFRICA

3

What cardiology training and cardiac procedural training

does Africa need?

In a letter to the editor, Bonny and co-authors (page 3) offer an

appraisal of an article recently published in the

Journal of the

American College of Cardiology

(JACC), which describes the

feasibility and effectiveness of a proctorship-based approach to

the development of African cardiac pacing capabilities, arguing

that three missions (median seven days’ duration) enrolling 10

to 15 patients were able to efficiently train local teams. The

authors of the letter to the

Cardiovascular Journal of Africa

are all experienced cardiologists, knowledgeable in pacing and

electrophysiology and, most importantly, they have first-hand

experience of the reality of medical and cardiac care in many

diverse regions of Africa. They are critical of the content and

conclusions of the JACC article. In particular, they do not believe

that the training described in the JACC article is adequate. The

matter is important and needs further discussion.

There can be no argument that pacemaker implantation

for patients with symptomatic (and some asymptomatic)

bradyarrhythmias is a most important management tool and

should be available for all patients with these conditions.

Unfortunately it is not generally available in many parts of

Africa. Bonny and colleagues have been involved over several

years in ensuring that the admittedly unsatisfactory situation in

much of Africa with regard to cardiac pacing be improved. Their

letter sets out the details of their efforts and in due course I am

sure they will report on the success or otherwise of the project.

They are critical of what they consider to be offered in the

JACC article to correct the situation. They consider it clinically

sub-standard and that it does not meet acceptable international

or African standards.

There can be no doubt that the care of patients with heart

disease in most of Africa, including its most wealthy countries

(except for the lucky few who can afford medical insurance),

leaves much to be desired. How do we correct this? Bonny and

co-authors point out that training in Africa needs to meet the

highest possible standards and we should not ‘cut corners’ simply

because there is nothing else available. We should always be

grateful for the help and mentorship received from other countries

but never compromise our standards in accepting such help.

My perception is that sometimes we in Africa are prepared to

accept a glass half full because the full glass seems too far away.

The letter from Bonny and colleagues should be a clarion call to

strive for the best solution for our patients and trainees and not

to accept second best because that is all that is available. I would

welcome input by means of letters or full articles and opinion

pieces on this matter, which I consider important.

Pat Commerford

Editor-in-Chief

From the Editor’s Desk

Letter to the Editor

Cardiac pacing in sub-Saharan Africa

Aimé Bonny, Olujimi A Ajijola, Mohamed Jeilan, Mahmoud Sani, Zaheer Yousef, Matthew F Yuyun,

Kamilu Karaye, Mervat Aboulmaaty Nahib, Yazid Aoudia, Loreen Akinyi, Marcus Ngantcha, Saad

Subahi, Felix Sogade, Ashley Chin

DOI: 10.5830/CVJA-2020-001

We read with interest the report by Jouven

et al

. describing the

feasibility and effectiveness of a proctorship-based approach to

the development of African cardiac pacing capabilities, arguing

that three missions (median seven days) enrolling 10 to 15

patients were able to efficiently train local teams.

1

The ACC/AHA/HRS has published minimum standards for

pacemaker training, which this on-site training approach does

not meet for proficiency in pacing.

2

We wonder whether this

‘Africa-Pace team’ was able to offer comparable training with

such limited exposure (30–45 procedures, assuming that the