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Kenya has made good progress in training of heart surgeons

Doctors at Tenwek Mission Hospital conduct heart surgery. [Gilbert Kimutai, Standard]

Ten years ago, disturbing media reports revealed that heart surgery patients had been on a surgical waiting list for up to two years before receiving 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.

Kenya requires 100 heart surgeons to deliver an adequate heart surgery service to its population; we need to train 15 to 20 heart surgeons per year to deliver this service in a sustainable manner. Currently, we only train four to five surgeons per year.

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 the country has a scarcity of cardiothoracic surgeons.

This is despite the fact that cardiovascular disease accounts 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. University of Nairobi, which has been running a thoracic and cardiovascular surgery programme for the past nine years, 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 the number of surgeons.

This is a positive step especially given the private-public partnership model used by Gertrude's and the University of Nairobi 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. For instance, every day a trainee spends at the centre will be filled with new challenges and opportunities to learn new skills.

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

Over time, hospitals have steadily improved their ability to detect heart problems early, in the hope that 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 wait list is likely to keep growing.

The benefits of the new simulation and training centre are expected to be felt not just in Kenya, but throughout the region, as the name implies. Kenya has already been training heart surgeons from other African countries who have gone on to provide much-needed expertise in their home countries.

However, the regional centre still has a long way to go before it can compete with some of its peers. Algeria, for example, has adopted a three-step training strategy. The training begins with hands-on training with animal hearts and progresses to a virtual reality simulator.

Finally, before operating on humans, the trainees practice veterinary surgery on live animals to get a better sense of what it is like to work when someone's life is on the line.

These simulations increase a surgeon's confidence and understanding of minor nuances of their craft, which can only be gained through direct experience, while removing the risk for patients. It also helps them hone their instincts, resulting in a legion of competent teachers ready to pass on their knowledge to future generations.

Ensuring that everyone in the country has access to high-quality healthcare is critical to meeting any 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 own course forward by developing strategies to train and grow our specialist healthcare providers at home. After all, any speciality in the healthcare industry relies on skilled individuals to provide services to those in need as quickly as possible.

Looking at the big picture, the World Health Organisation 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 in order for our healthcare systems to provide the desired and adequate care.

For the time being, we can only celebrate positive progress towards providing high-quality, comprehensive healthcare to those in greatest need.

 -Dr Ngwiri  is a pediatrician and Head of Clinical Services, Gertrude’s Children’s Hospital. Dr Awori is a consultant surgeon at Gertrude’s Hospital and a senior lecturer of paediatric and congenital cardiovascular surgery at University of Nairobi