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Cardiac surgery in developing countries THE NEEDS

Prof A. KALANGOS

President

Kalangos Foundation

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How to define a developing country?

• Human development composite index

- Life expectancy - Educational level - Rate of literacy - Rate of scholasticism -Economic power or quality of life - GNP per capita - Purchasing power

Kalangos

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How to define a developing country?

• 20 % of the world global population lives in countries with HDI > 0.7

• 30 % live in borderline countries with

HDI = 0.5 - 0.7

• 50 % in countries with HDI < 0.5

Kalangos

GrindaWorld population

6.6 billion people in 2006

60 % in Asia, 13 % in Africa,

12 % in Europe;

the remaining part 14 % in

America and Australia

Rate of births

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Parameters to determine the needs

• Number of open heart surgery cases per million of inhabitants per year

• Number of cardiac centres per million of inhabitants

• Number of cardiac surgeons per 100 000 inhabitants

GrindaDeveloping countries

Needs in terms of open heart surgery

Optimal open heart interventions

860 cases / million inhabitants / year Adapted from Sem Thorac Cardiovasc Surg 2002;14:298-320

Cox: JTCS 2001

860 60

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GrindaNeeds in terms of cardiac centers

Cox: JTCS 2001

- USA : 1/ 120 000 inhabitants - Europe et Australia : 1/ 1 million - Asia : 1/ 16 million - Africa : 1/ 33 million

4.5 billion of people have no access to cardiac surgery outside of

North America, Europe, and Australia

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Number of surgeons per 100 000population worldwide

• USA 51 • Japan 31 • Canada 26 • Australia 16 • Germany 13 • China 10 • Latin America 7 • Egypt 6 • Sudan 0.6 • Tanzania 0.3

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GrindaPeople less than 18 years : geographical distribution

> 50%

25%-49%

< 25%

85% of this young population live in developing countries 2 billion children

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Cardiac diseases

• Congenital malformations

• Rheumatic valve disease

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Congenital malformations in developing countries

Incidence : 4 - 12 cases / 1000 births 12 – 36 million children with congenital malformations

6 - 18 million children will die of the consequences of their cardiac diseases,

infection, or malnutrition and some of them are already inoperable

Need for cardiac surgery ? 50%

… 6 - 18 million with congenital malformations

Kalangos

GrindaCongenital malformations in developing

countries

6 - 18 million children need cardiac surgery

Incidence : 4 - 12 / 1000 births

130 million births / year

0.5 and 1.5 million neonates with congenital malformations will be added to this total number every year

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Series of Wood: 2000 cases which survived during the neonatal period

2%

14%

17%

22%

45%

L-R shuntR-L shuntno shunt Left sidedno shunt Right sidedmisc

Coarctation: 10% Aortic stenosis: 7%

Pulm stenosis: 13% Ebstein: 1%

Fallot : 10% Eisenmenger: 7% Pulm sten+ASD: 3% TGV: 1% Pulm atresia: 1%

ASD: 24% VSD: 12% PDA: 9%

Chidren who survive ? Kalangos

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Rheumatic valve disease in developing countries

Incidence / 1000 India: 0.4 China: 0.3 Asia : 0.1 Africa: 1.4 South America: 0.2 Middle East: 1.3

Incidence RHD: 0.6/1000

0 - 4 years: 0.1/1000 5 - 18 years: 0.9/1000

1% of children suffer from this disease

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Rheumatic valve disease in developing countries

At least

12 million people involved

2 million children need repeat hospitalization

500 000 deaths / year

1 million people need valve surgery

W.H.O: 1999

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Pediatric cardiac diseases in a population of 10 million inhabitants

Population

10 million

Cambodia

Senegal

Vietnam ( x10)

Mozambique (x 2)

20 000 children with congenital malformations

5 000 children with rheumatic valve disease

25 000 children need cardiac surgery

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How to solve the problem ?

Sustainable programs of pediatric cardiology and cardiac surgery

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• Founded on July 2, 1998 in Geneva by a group of doctors, nurses and perfusionists who participated to the first mission in Erythrea

• Non profit association recognized by the State Council of Geneva

• 350 members do voluntary work

• More than 90% of collected funds are allocated to humanitarian actions

• Affiliated member of WHF in 2009

Hearts for All

GrindaObjectives TRAINING OF LOCAL COUNTERPARTS - Teach modern diagnostic methods as well as

cardiac surgery and anesthesiology - on site training - donor site training (Geneva) CREATION OF FUNCTIONAL STRUCTURES - Build heart institutes or improve local infrastructures for cardiac care in existing hospitals of the host country

HUMANITARIAN MISSIONS - Select patients suffering from heart diseases - Perform open heart surgery in collaboration

with local teams

HEALTH MANAGEMENT - Contribute to the management of these

institutions

PREVENTION Rheumatic fever (in collaboration with WHO)

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Georgia

Mauritius

CamerounAzerbaïdjan

Egypt

Marocco

Ukraine

Russia

Syria

Lebanon

India

Vietnam

Algeria

Madagascar

Moldavia

Tunisia

Erythrea

Mauritenea

Mozambique

Serbia

Roumania

Nigeria Albania

Grinda« Hearts for All » in humanitarian heart surgery 1998-2016

Missions: 17 254 pts

Training: 100 health professionnels

Creation of heart institutes or specific units: Mozambique, Mauritius, Serbia (for GUCH), Cameroun, etc

Improvement of local infrastructures: Georgia, North Lebanon, Morocco, India, etc

GrindaGlobal Forum on humanitarian medicine in cardiology

and cardiac surgery

• Since 2000 in collaboration with all international organizations based in Geneva

• Since 2008 alternation between Geneva and abroad in collaboration with World Heart Foundation

• More than 200 participants

the last meeting in 2015 (11th Global Forum)

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Cœurs pour tous Hellas 2015

32 children operated at Mitera Hospital

24 May 2016

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NEW PROJECT

Humanitarian center of surgical

treatment, training and telemedecine

program at the greek Hospital of

Istanbul

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NEW PROJECT HUMANITARIAN CENTRE

IN KIEV inaugurated on 13th of

may, 2016, surgical treatment centre

Especially for central asian countries

10-12 cases /month

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A waiting list of 16 million children

THANK YOU

GrindaCode of Ethics

Current ongoing Issues

1. Do our international conduct codes work globally?

2. How do we keep patient information confidential?

Solutions

GHN will be starting a dialogue with stakeholders

1. for the validation of an international professional code of ethics adapted on an intercultural level.

2. For the implementation of this code in LMICs with adaptations relative to the situation of the country.

GHN has engaged Nossaman LLP working on the patient information protection solution, http://nossaman.com

GrindaKalangos

GrindaWhich is the ideal long term tactical plan and model?

Altruistic approaches are short-term NGOs and Intern. Org.

Project

Host country

Political support

Administrative and logistical support

Education and teaching

Clinical and research support

Financial support

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GrindaFuture Solution: GLOBAL HEART NETWORKFrom Isolation to Collaboration

The GHN platform is a ‘contribution platform’ committed to fostering communication and collaboration both locally and worldwide to all

stakeholders

We envision the GHN platform as a central space for participants to share project ideas, collaborate, and build upon existing resources,

mechanisms and communities.