Can We Reignite SA’s Eminence in Heart Care?

Fifty years ago, unbeknown to the world, the country stood poised to breach one of the most significant frontiers in medical science, the transplantation of a human heart from one person to another. Such a procedure – already perfected in the laboratory using animals – could ensure there was hope for survival for those whose hearts were too diseased to effectively pump the blood needed to keep the rest of the body alive.

The operation, performed by Prof Christiaan Barnard at Groote Schuur Hospital on December 3, 1967, would astound the world, for its audacity. Albeit that Barnard had already been doing brilliant and far-reaching laboratory and clinical work in the preceding decade and that his team had spent many years honing their respective crafts, it was a surprising development.

Many teams of cardiac specialists had been working around the world and mainly in the United States, to achieve this. But that an un-heralded South African team had managed to take out a heart – regarded over the centuries, if you like, as the magical organ, a holy grail of body parts – from one human body and inserted it into another human being to recreate life in that second body, was spectacular.

The plaudits were well-directed and remain so today. I have absolutely no hesitation in acknowledging the brilliant research and clinical work in Cape Town alongside the competence of the entire team, which accompanied the first transplant. It is also important to acknowledge the ancillary benefits which flowed from Barnard’s passionate approach to medicine such as the introduction of intensive care protocols in post-operative patients.

But, South Africa has literally fallen off any of the world health charts that Barnard succeeded in placing us on in December 1967.

When I was diagnosed with end-stage heart disease just over a year ago, I was aghast to be told in my information-gathering for my own treatment, that the heart transplant programme in the public sector had ground to a halt. This turned out to be incorrect but, clearly, it is a reflection on the collapse of cardiac treatment in our country.

Currently only two transplants are performed per year at Groote Schuur.

Understandably, our country focus today is on primary healthcare of the entire population, as opposed to the narrow scope of the apartheid-era. But it is difficult to simply accept willy-nilly that there is no place for tertiary healthcare alongside the essential primary health programmes. It does not have to be an either-or situation.

World Health Organisation figures – underscored by StatsSA reports – points to growing deaths from non-communicable diseases such as heart disease.

The problems of attending to our growing heart disease problem are not restricted to proper budgeting, resourcing, partnering. It is evident in the attitude of politicians and officials at the highest levels of healthcare management.

Efforts to get the attention of the national department of health under Minister Aaron Motsoaledi this year deteriorated into a banal exchange of emails with the Ministerâ’s point man on cardiac health programmes, Dr Terence Carter.

I have suggested minimum steps that government can and must take on an ongoing basis:

• Providing relevant information to all communities in our country on heart disease and available treatments;
• Promoting on effective recording of deaths in order to get an accurate account of the causes of death and the burden of disease;
• Leading the national discussion on solid organ donations to spread the message to potential donors, which currently is generally left to organisations like the Organ Donor Foundation;
• Initiate a Green Paper on an “opt out” organ donor policy, offering opportunities to sound out local attitudes towards what many other countries regard as a very positive experience, but which may not be appropriate in South Africa;
• Tapping into private sector goodwill and resources to augment meagre public sector programmes, especially in respect of children with congenital heart conditions.

There has been no response to my communication. I am still waiting for a clear statement from anyone in the department on what our country’s policy is in relation to resourcing organ transplantation. Basic questions of fact have not been answered despite numerous requests.

Even at Groote Schuur, the hospital at the centre of this year’s anniversary, a simple effort to confirm numbers of transplants in recent years was stymied by medical and spin doctors. At best, we know from a published paper of surgeons in the cardiothoracic division at Groote Schuur-University of Cape Town that 537 transplants have been undertaken in the 50 years since 1967.

Groote Schuur-UCT hosting of an international conference to coincide with the December 3 anniversary brings together the top professionals in the world to talk about historical, current and future issues in research and the clinic.

The organisers hope the conference will kick-start a process of reinstating Cape Town among the leading cardiac research and clinical locations in the world. But it is highly unlikely this will re-ignite an essentially moribund public sector transplantation programme.

I have questioned the absence in the anniversary celebrations of a South African case study, or innovative local research to show the world that we are still among the best 50 years later. Where is the reflection on the legacy bequeathed to our country on that momentous Sunday in December ‘67? Where the reflection on current policies within South Africa that are a blot on Barnard’s achievement?

Perhaps the absence of such a focus on the conference programme is intended by the organisers to jolt us into realising that not much is happening in this field in South Africa today. If this intention were true, it would be very unfortunate, but we should all hang our heads in shame.

Each of us has a role to play in healthcare. But the primary role in our society must always be government’s, for legal, socio-political and ethical reasons.

In one of his more strident moments – perhaps reflecting some disillusionment with the profession that had brought him such rich rewards – Barnard noted that health is “far too serious to be left solely in the hands of the health professionals”.

I think he was right.