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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