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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 4, July/August 2018
AFRICA
257
We strongly endorse the position that building local capacity
is the best solution for this serious public health problem.
Many lives have been saved by humanitarian ‘fly-in’ missions,
but these efforts are neither sustainable nor cost effective.
The non-governmental organisations associated with these
programmes are shifting focus towards building long-term
partnerships with host countries to develop autonomous local
services with government buy-in.
7
A massive investment in
new cardiac centres in these regions is unrealistic; globally, an
additional few thousand cardiac centres would be required
to address the unmet needs (Global Unmet Needs in Cardiac
Surgery, unpublished work by Zilla and colleagues).
It is not sufficient for governments and non-governmental
organisations to support the training of cardiologists and cardiac
surgeons from these regions at high-income country facilities,
because they will not be trained in most of the pathologies
awaiting them in their own countries and will be unfamiliar with
resource-constrained circumstances.
There is anurgent need for a concerted effort by all stakeholders
to address the plight of the poor in these regions, who need
cardiac surgery. As signatories and endorsing organisations
of the Cape Town Declaration, we propose a comprehensive
solution with two principal aims.
Aim 1: To establish an international working group (coalition) of
individuals from cardiac surgery societies and representatives from
industry, cardiology and government to evaluate and endorse the
development of cardiac care in low- to middle-income countries.
It is proposed that the international coalition will have two
representatives from each of the major cardiac surgery societies
(the Society of Thoracic Surgeons, American Association for
Thoracic Surgery, European Association for Cardio-Thoracic
Surgery, the Asian Society for Cardiovascular and Thoracic
Surgery), and ideally, two additional committed members. There
will be at least one representative from industry and at least one
appointee to represent cardiology/the World Heart Federation.
The responsibilities of the coalition will include establishing
criteria for centres for clinical care and training as well as
selecting and endorsing the centres. The coalition will derive
metrics of quality and performance for the endorsed centres of
training and clinical care and will encourage standardisation of
care to the extent possible.
The coalition will advocate mutually agreed policies and
prescriptions to relevant governmental bodies. In addition,
the coalition will engage with industry and private sources of
philanthropy for financial assistance with large-scale initiatives.
Aim 2: To advocate for the training of cardiac surgeons and other
key specialised caregivers at identified and endorsed centres in low-
to middle-income countries.
The case has been made above for critical providers obtaining
training in settings and conditions and dealing with the cardiac
pathologies that they will be encountering in their practice in
their countries of origin.
It is preferred that centres endorsed by this coalition be based
on an alliance of four stakeholders: a programme initiator (e.g. a
government, a university, or a non-governmental organisation),
an audited training centre in a low- to middle-income country,
a committed partner institution in a high-income country, and a
consortium of industry that would sign on as benefactors to the
specific programme. Because regional centres in low- to middle-
income countries typically operate within a resource-scarce
environment, resulting in lower case numbers than needed for
the training of outside residents, a facilitated capacity increase to
help achieve higher case numbers would benefit all participants.
Summary: It is imperative that action be taken urgently. A nucleus
of one to three centres should be identified and endorsed, with
co-ordination by global stakeholders, as quickly as possible. The
implementation of this initiative will only be made possible by
the endorsement of all the relevant cardiothoracic societies and
agencies subscribing to clearly defined targets and timelines, and
committing appropriate resources. The time to act is now.
Signatories
For Cardiothoracic Societies (in alphabetical order)
Joseph Bavaria [past-president, the Society of Thoracic Surgeons
(STS), USA]
Friedhelm Beyersdorf (editor in chief,
European Journal of
Cardio-Thoracic Surgery
, Germany)
RMorton Bolman, III [representative, American Association for
Thoracic Surgery (AATS), USA]
Kumud Dhital [representative, Australian and New Zealand Society
of Cardiac and Thoracic Surgeons (ANZSCTS), Australia]
Robert SD Higgins [president elect, the Society of Thoracic
Surgeons (STS), USA]
James Kirklin [representative, American Association for Thoracic
Surgery (AATS), USA]
Robert Kleinloog [president, Society of Cardiothoracic Surgeons
of South Africa (SCTSSA), South Africa]
Bongani Mayosi [past president, Pan-African Society of
Cardiology (PASCAR), South Africa]
Juan Mejia (representative, Brazilian Society of Cardiovascular
Surgery, Brazil)
Jose Pomar [past president, European Association for Cardio-
Thoracic Surgery (EACTS), Spain]
Karen Sliwa [president elect, World Heart Federation (WHF),
South Africa]
Shinichi Takamoto [president, Asian Society for Cardiovascular
and Thoracic Surgery (ASCVTS), Japan]
Wei Wang (representative, Chinese Society for Thoracic and
Cardiovascular Surgery, China)
David Wood [president, World Heart Federation (WHF), United
Kingdom]
Charles Yankah (president, Pan-African Society for
Cardiothoracic Surgery (PASCaTS), Ghana/Germany]
Liesl Zühlke (president, South African Heart Association, South
Africa)
Humanitarian and government organisations (in
alphabetical order)
Alain Carpentier (Alain Carpentier Foundation, France)
Sylvain Chauvaud (La Chaîne de l’Espoir, France)
Afksendiyos Kalangos (President: Kalangos Foundation, Greece)
Richard Kamwi (Past Minister of Health, Namibia)
René Prêtre (Le Petit Coeur, Switzerland)
Nicole Sekarski (Le Petit Coeur, Switzerland)
Magdi Yacoub (President, Chain of Hope, United Kingdom/Egypt)