Improved cardiac surgery training to save heart patients

A decade ago, disturbing media reports revealed heart surgery patients had been on a surgical waiting list for up to two years to get life-saving intervention. The country’s main challenge at the time was a combination of a shortage of heart surgeons (cardiothoracic surgeons) and theatre facilities.

Although some progress has been made in both areas since then, the situation remains desperate. Kenyan population requires 100 heart surgeons for delivery of adequate heart surgery services; we need to train 15 to 20 heart surgeons per year to deliver this service in a sustainable manner. Currently, we only  train four or five.

Given the extensive time and knowledge required to train them, as well as the fact that Kenya has not had a local cardiac surgery training programme for a long time, it is not surprising that Kenya has a scarcity of cardiothoracic surgeons.

This is despite cardiovascular disease accounting for approximately 25 per cent of all hospital admissions and is the second leading cause of death after maternal and perinatal deaths, according to the Ministry of Health. Furthermore, according to a World Heart Federation report on Kenya’s cardiac health situation, cardiovascular disease accounted for 13.8 per cent of all deaths in 2019.

With the increase in demand for cardiovascular disease interventions, including cardiothoracic surgery, there is an urgent need to scale up cardiac surgeon training, and efforts in this direction are commendable. For example, the University of Nairobi, which has been running a thoracic and cardiovascular surgery programme for nine years now, can be credited with the country’s ability to produce five locally-trained cardiothoracic surgeons each year.

Another commendable example is Gertrude’s Children’s Hospital’s recent announcement that it will open the East African Simulation Centre for Cardiovascular Surgery, which will include a skills lab and is expected to increase number of surgeons.

This is a positive step, especially given the private-public partnership model used by the corporates to improve surgical students’ skills. Previously, trainees could only learn by operating  on live patients, repeating surgeries until they learned something new, but the new centre hopes to shorten the learning curve.

The need for specialisation and enhanced skills is especially evident at children’s hospitals, where, according to reports, a third of paediatric surgery cases are not addressed due to their complexity, forcing families to seek treatment for children abroad. Those who can’t afford to fly children abroad have to contend with bleak prognoses (death).

Over time, hospitals have steadily improved their ability to detect heart problems early, in the hope patients can seek treatment in a timely manner. Unfortunately, surgery is the only treatment for many heart diseases, and with the current shortage of skilled cardiothoracic surgeons, the waitlist is likely to keep growing.

The benefits of the new simulation and training centre are expected to be felt throughout the region. Kenya has already been in charge of training heart surgeons from other African countries, who have gone on to provide much-needed expertise in their home countries.

Ensuring everyone has access to high-quality healthcare is critical to meeting development objectives. Only a healthy population can contribute to the nation’s development. As a result, it is critical that we as a nation chart our course forward by developing strategies to train and grow specialist healthcare providers at home. After all, any specialty in the healthcare industry relies on skilled individuals to provide services to those in need as quickly as possible.

Looking at the big picture, WHO recommends 21.7 doctors and 228 nurses per 100,000 people, but Kenya only has 14 doctors and 42 nurses per 100,000 people. This stresses the importance of increasing training for healthcare systems to provide the desired and adequate care. For the time being, we can only celebrate positive progress toward providing high-quality, comprehensive healthcare to those in greatest need.

— Dr Ngwiri is a pediatrician, Gertrude’s Children’s Hospital while Dr Awori is a senior lecturer of paediatric and congenital cardiovascular surgery at UoN