Shisong 2002 to 2008
Screening examinations
279
persons suffering from congenital heart diseases were diagnose –predominantly isolated ventricular septal defect
321
persons suffering from acquired rheumatic heart diseases were diagnosed
The majority of patients has no financial resources and depends therefore on external financial assistance.
_________________________
45 % of the population lives under the poverty line
Average life expectancy
Female 50 years
Male 51 years
There is no public health insurance
45 % of the population is under 15 years old
19 % of the children under 5 are malnourished
Sources:
1. Cameroon Poverty Reduction Strategy Paper 2009 www.imf.org
2. www.cuorefratello.org
3. Cardiavasc J Afr 2010; 21: 15-17 www.cvja.co.za
Facts
In developing countries there is a high occurrence of congenital and acquired heart diseases. With regard to the situation in Cameroon, prevalence data from epidemiological studies on heart diseases and their management are not available. However, there exist data from screening examinations in the Cardiac Centre of Shisong (CC) between 2002 and 2008 showing that there is a significant number of patients with diagnosed or undiagnosed heart diseases in the rural area of Cameroon3 (see box).
In industrialised countries most of the congenital heart diseases are detected by prenatal screening allowing surgical interventions in the neonatal age and giving these children the chance to grow up normally and healthy2.
In the southern world, especially in most countries of Africa, only a small number of people is able to cover the expenses for diagnosis, medical treatment or surgical correction of congenital or acquired heart diseases. For people living in rural areas the situation is even worse because of limited access to basic healthcare3.
The situation aggravates through following facts:
Level of education: More than 50% of the rural population has only a primary school education level.
State of health: Especially in the rural areas of Cameroon there is a high incidence of infectious diseases, rheumatic fever, tuberculosis and diseases caused by malnutrition – all of them may contribute to heart conditions.
Financial resources: The majority of the population lives on subsidiary farming, traditional hand craft or other small businesses. The little income is never enough to cover the expenses for a surgical intervention.
Archbishop Paul Verzekov Memorial Heart Foundation (APAVMEHEF)
In Cameroon, as in many African countries, a governmental health insurance does not exist. In 2010 the Heart Foundation was created in Shisong-Kumbo to raise funds to subsidize the cost of surgery for the underprivileged cardiac patients. But, despite the costs for a surgical intervention and the pre- and post-treatment is only a fivefold of the costs in Europe, the financial assistance that can actually be given through the foundation is not enough to cover all the necessary expenses. Children’s parents and patients are willing to contribute financial wise and collect therefore money in their communities or try to get credits. But anyhow, according to the 2012 statistics of the CC, 60% of the operated patients depended fully or partially on external financial assistance for their surgery.
The urgency of the operation for a patient is the primary criteria for the CC Team in making the decision “who is next to be operated”. But also the payment capability of patients remains still a big challenge in decision making. (See Interview April 8, 2013)
Questions and Answers, Etica Mundi (EM) und Cardiac Center Shisong (CC) - April 8, 2013
EM: How many patients are actually waiting for an operation?
CC: Presently there are 91 adults and 70 children. It is on the increase every day. After our screening tours this month, this number may increase by 15 or 20.
EM: Is there a waiting list?
CC: Yes; we compile a waiting list classified for children and adults.
EM: Do patients have to give a deposit for being listed on the waiting list?
CC: No. When a patient is diagnosed to require surgery, he is placed on our waiting list:
EM: How much are people usually able to contribute? (minimum and maximum)
CC: Based on their economic status, the contributions of the patients vary from 50,000 to the required 3 and half million FCFA. According to our 2012 statistics, about 60 percent of operated patients depended on external assistance fully or partially for their surgery. Additionally some sign commitments to pay after operation and don’t respect the engagements.
EM: What happens if someone cannot contribute anything?
CC: If someone cannot contribute anything, and we cannot find a sponsor for him, it would be difficult to proceed with surgery. At this stage we cannot afford to operate free of charge due to the cost of acquiring the material and running cost.
EM: Who decides which person comes first to be operated and which criteria are used to make the decision?
CC: It is usually a joint decision by the diagnosing cardiologists, the surgeon and the management based on the following:
- Urgency of the operation for the patient
- Expertise of the surgeon (some of our visiting surgeons perform surgeries for congenital heart diseases, and others on rheumatic heart diseases)
- Of course ability to pay the surgery fee
EM: How many patients can be operated in one year and how many should be operated?
CC: Considering the technical potentials of the Cardiac Center and the probability of the availability of personnel (surgeon, anesthesiologist, etc.) the cardiac center can operate 250 to 300 patients a year. However; since we did not have the permanent team as well as the difficulty of paying surgery fee, we have been operating an average of 100 patients every year since 2010. According to some cardiologist conferences in Africa; the mean of 150 surgeries is recommended for Cardiac Centers in Africa.
EM: If people cannot be operated, is it only because of the money or also because of the fact that there are not enough doctors?
CC: Before 2013, the Center depended solely on visiting surgeons so some patients even if they paid their fee, had to wait for months to be operated. After working with the resident cardiac surgeon since January, the acute problem is that of the inability of patients to pay the fee. Some just give up and wait for their time to die.
EM: Do you have in the meantime a stable operation team in Shisong or do you depend on the foreign operation teams?
CC: We have a resident cardiac surgeon, but the anesthesiologists have to come from Italy or elsewhere before he can operate. Arrangements are in place to have them coming on short missions (2 weeks to 1 month). Our way forward is to enroll local guys into training as anesthesiologists by the second half of the year.
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