“Geographic Injustice” Defines Cardiac Healthcare in SA


November 24 2017, (LtoR)Dr Tim Pennel and Raymond Hartle a heart tranplant recipient seen during a conference held at Life st Dominics in East London picture: MICHAEL PINYANA
Dr Tim Pennel and Ray Hartle a heart tranplant recipient during the conference held at Life St Dominic’s in East London on November 24, 2017. Picture: MICHAEL PINYANA


The 50th anniversary of the first human-to-human heart transplant is an opportunity to celebrate, but South Africans must also wake up to the reality of the dire problems – including “geographic injustice” – which beset treatment of heart disease in the country.

That’s the view of East London cardiologist and president of the SA Society of Cardiovascular Intervention Dr Dave Kettles. He was speaking at a seminar at Life St Dominic’s Hospital organised by heart transplant recipients Ray Hartle and Ali Koekemoer.

And University of Cape Town and Groote Schuur Hospital cardiothoracic surgeon Dr Tim Pennel said the “cardiovascular timebomb was ticking” and called for better co-operation between the public and private healthcare sectors.

Kettles said that “geographic injustice” was rife in South Africa. While Capetonians may get a transplant as a state patient, in East London very few people would be treated for their heart attack, suffering substantial long-term damage as a result.

“Let’s celebrate by all means, but let’s wake up as well to the unacceptably low standard of care offered to our population, and the resultant loss of life.”

Prof Chris Barnard performed the first human heart transplant on December 3, 1967, breaking through then what was one of the firmest frontiers in medical science.

Speaking at an event entitled “Current and Future Frontiers in Heart Disease and Treatment” facilitated by the heart recipients and St Dominic’s, Kettles said that based on the Statistics SA mortality reports, the incidence of cardiac disease among South Africans was growing, unlike in developed countries. Many of these untimely deaths could be prevented. He called for improved detection, prevention and treatment of non-communicable diseases.

However, the country suffered because there are only 200 cardiologists to treat the total population, whereas a country like Brazil had 8000 cardiologists for its 180 million people.

In East London, a state patient could not have an angiogram or have a cardiac operation. The entire Eastern Cape province was served by only two cardiologists in the public sector hospitals.

Pennel said the first transplant under Prof Chris Barnard took place in South Africa because of Barnard’s ambition and drive, the access to knowledge of cardiac research from all over the world and the expertise of the team gathered around Barnard in Cape Town.

However, in a context of inadequate cardiac services, heart transplantation could not be approached in an isolated manner. Less than one percent of people in Africa had access to cardiac surgery compared to 100% in the US.

Innovation was still happening in South Africa, pointing to developments around replacement artificial valves.

However, he said the number of heart transplants had not increased. Over the 50 years, Groote Schuur performed a total of 537 transplants, with current numbers at less than five operations a year and the transplantation programme gradually being taken over by the private sector.

Globally, about 5000 heart transplants are performed a year. The total number of heart transplants in Africa was only 18 per one million population, compared to 786 in Australia and 1222 in the United States.

Heart transplant surgeon at the Christiaan Barnard Memorial Hospital, Dr Willie Koen, said the “western diet” was becoming a big problem in South Africa.

Koen, who has pioneered the use of artificial heart assist devices in South Africa, said that while these pumps were very expensive, they were an effective alternative to transplants.

He said that historically, many heart donations had come from the Eastern Cape, but that he had seen a fall-off in recent years, a fact he attributed to changes in public healthcare system.

On the issue of collaboration between public and private hospitals, Life Healthcare Eastern Cape regional manager Bruce Janssens said the treatment of the treatment of cardiac ailments and disease was a key component of the group’s strategic vision in the province.

“Life Healthcare and the state hospitals have been engaging for a number of years and have assisted each other in a small way in the provision of certain cardiac interventions and renal care.”


“Geographic Injustice” Defines Cardiac Healthcare in SA

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