Yankah Charles, Fynn-Thompson Francis, Antunes Manuel, Edwin Frank, Yuko-Jowi Christine, Mendis Shanthi, Thameur Habib, Urban Andreas, Bolman Ralph
Department of Thoracic and Cardiovascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.
Department of Cardiac Surgery, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts, United States.
Thorac Cardiovasc Surg. 2014 Aug;62(5):393-401. doi: 10.1055/s-0034-1383723. Epub 2014 Jun 23.
Current data on cardiac surgery capacity on which to base effective concepts for developing sustainable cardiac surgical programs in Africa are lacking or of low quality.
A questionnaire concerning cardiac surgery in Africa was sent to 29 colleagues-26 cardiac surgeons and 3 cardiologists in 16 countries. Further, data on numbers of surgeons practicing in Africa were retrieved from the Cardiothoracic Surgery Network (CTSNet).
There were 25 respondents, yielding a response rate of 86.2%. Three models emerged: the Ghanaian/German model with a senior local consultant surgeon (Model 1); surgeons visiting for a short period to perform humanitarian surgery (Model 2); and expatriate surgeons on contract to develop cardiac programs (Model 3). The 933 cardiothoracic surgeons listed by CTSNet translated into one surgeon per 1.3 million people. In North Africa, the figure was three surgeons per 1 million and in sub-Saharan Africa (SSA), one surgeon per 3.3 million people. The identified 156 cardiac surgeons represented a surgeon to population ratio of 1:5.9 million people. In SSA, the ratio was one surgeon per 14.3 million. In North Africa, it was one surgeon per 1.1 million people. Open heart operations were approximately 12 per million in Africa, 2 per million in SSA, and 92 per million people in North Africa.
Cardiothoracic health care delivery would worsen in SSA without the support of humanitarian surgery. Although all three models have potential for success, the Ghanaian/German model has proved to be successful in the long term and could inspire health care policy makers and senior colleagues planning to establish cardiac programs in Africa.
目前缺乏关于心脏外科手术能力的数据，难以据此制定有效的概念来发展非洲可持续的心脏外科手术项目，或者现有数据质量不高。
向16个国家的29位同事（26位心脏外科医生和3位心脏病专家）发送了一份关于非洲心脏外科手术的调查问卷。此外，从心胸外科手术网络（CTSNet）获取了在非洲执业的外科医生数量的数据。
有25名受访者，回复率为86.2%。出现了三种模式：有资深当地顾问外科医生的加纳/德国模式（模式1）；短期来访进行人道主义手术的外科医生（模式2）；以及签约来发展心脏项目的外籍外科医生（模式3）。CTSNet列出的933名心胸外科医生相当于每130万人中有一名外科医生。在北非，这一数字是每100万人中有三名外科医生，在撒哈拉以南非洲（SSA），每330万人中有一名外科医生。确定的156名心脏外科医生代表的外科医生与人口比例为1:590万。在SSA，这一比例是每1430万人中有一名外科医生。在北非，是每110万人中有一名外科医生。非洲的心脏直视手术约为每百万人口12例，SSA为每百万人口2例，北非为每百万人口92例。
如果没有人道主义手术的支持，撒哈拉以南非洲的心胸医疗服务将会恶化。尽管所有三种模式都有成功的潜力，但加纳/德国模式已被证明长期来看是成功的，可能会激励医疗保健政策制定者和计划在非洲建立心脏项目的资深同事。
