The development of cardiac surgery in West Africa - the case of Ghana

Abstract

West Africa is one of the poorest regions of the world. The sixteen nations listed by the United Nations in this sub-region have some of the lowest gross domestic products in the world. Health care infrastructure is deficient in most of these countries. Cardiac surgery, with its heavy financial outlay is unavailable in many West African countries. These facts notwithstanding, some West African countries have a proud history of open heart surgery not very well known even in African health care circles. Many African health care givers are under the erroneous impression that the cardiovascular surgical landscape of West Africa is blank. However, documented reports of open-heart surgery in Ghana dates as far back as 1964 when surface cooling was used by Ghanaian surgeons to close atrial septal defects. Ghana's National Cardiothoracic Center is still very active and is accredited by the West African College of Surgeons for the training of cardiothoracic surgeons. Reports from Nigeria indicate open-heart surgery taking place from 1974. Cote D'Ivoire had reported on its first 300 open-heart cases by 1983. Senegal reported open-heart surgery from 1995 and still runs an active center. Cameroon started out in 2009 with work done by an Italian group that ultimately aims to train indigenous surgeons to run the program. This review traces the development and current state of cardiothoracic surgery in West Africa with Ghana's National Cardiothoracic Center as the reference. It aims to dispel the notion that there are no major active cardiothoracic centers in the West African sub-region.

Outcome of patients undergoing open heart surgery at the Uganda heart institute, Mulago hospital complex

“…Increasing patient volumes in cardiac surgery is essential in boosting confidence of operating teams and refining critical skills that would enhance the development of centers for cardiac surgery and help to improve outcomes 8 . Access to needed cardiac surgery can be increased if locally based private foundations directly contribute to costs of open heart surgery program 7 together with greater direct government funding.…”

“…Edwin et al reported mortality rates of 3% among patients with congenital heart disease undergoing open heart surgery, with a reduction in mortality with increase in the volumes of patients operated 8 . The low postoperative morbidity encountered in this study could be attributable to rigorous patient selection.…”

The Scope of Cardiac Surgery at a National Cardiothoracic Center of Excellence (NCTCE) in Nigeria: A 3-Year Review

“…In Ghana, Nigeria's West African neighbour, the first open heart surgery was done in 1964 using the technique of surface cooling by a team led by professor C. O Easmon, just few years after Gibbon did his famous ASD using CPB [19]. Later, political instability and economic downturn affected this developmental work.…”

“…Later, political instability and economic downturn affected this developmental work. With the return of a German trained Ghanaian, Professor Frimpong Boateng, the cardiac surgery became reawakened in 1989 and the establishment a cardiac center in Ghana in 1992, created a watershed in the practice of cardiac surgery in the West African subcontinent [19]. Between 1992 and 1995, Edwin et al 2009 emphasized that about 100-120 cases of cardiac operations were carried out in the center averaging of about 25-30 cases per year and by the year 2008, about 464 operations had been done, with intra-cardiac operations constituting about 25% [20].…”

Conotruncal Heart Defect Repair in Sub-Saharan Africa

“…6,23 His leadership and long-term vision for health care in Africa have been the primary ingredients for the program's success.…”