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ONE YEAR ON, AFTER MY FELLOWSHIP TRAINING IN CARDIOLOGY, SOUTH AFRICA: ITS BENEFIT TO MY COUNTRY SIERRA LEONE. By Dr James B.W. Russell

The world is faced with the emergence of cardiovascular disease as a major health problem and Sierra Leone is no exception. Cardiovascular disease is a chronic illness and it is the leading cause of death in both developed and developing countries. The solution to the problem, disease prevention, cannot be achieved by any single organization or individual but only by coordinated efforts and collaboration between healthcare workers and politicians.

Salvaging the doom and gloom of our beleaguered health system

Sierra Leone is located on the West Coast of Africa and is a developing nation just emerging from a now concluded gruesome rebel war. The creation of an effective health system in a post-war nation like Sierra Leone is a prerequisite for combating/preventing the emergence of chronic illness; it is a daunting task now confronting healthcare workers and policy makers. However, given all the challenges strategic policies and efforts have been established within the nation aimed at salvaging the doom and gloom of our beleaguered health system.

“There is no place like home”

After completion of my postgraduate Fellowship Training in Cardiology under the astute supervision of Professor Bongani M. Mayosi (Professor & Head of Medicine, Groote Schuur Hospital, University of Cape Town, South Africa), I returned home to Sierra Leone (Ministry of Health & Sanitation, College of Medicine & Allied Health Sciences, University of Sierra Leone, Freetown) with mixed feelings. The challenges lying ahead of me were astronomical, this was compounded by the fact that all academic materials collected during my fellowship training were lost by a Cargo Freighting company and these materials have never been retrieved.

Invariably “there is no place like home” and my return to Sierra Leone was a step in the right direction as I aimed to apply the skills and knowledge acquired during my postgraduate training (echocardiography, cardiac electrophysiology, cardiac catheterisation, laboratory research project on cardiomyopathy) to the local setting. I set myself the following objectives of which some have already been achieved:

  • Collaborate, network and integrate with my Alma Mater – The Cardiac Clinic, Groote Shuur, South Africa and other societies working in the area of cardiovascular diseases.
  • Promote intervention programmes aimed at the prevention and control of cardiovascular disease in Sierra Leone.
  • Establish the Sierra Leone National Heart Foundation.

Fighting to get basic cardiology equipment in the hospitals

Practicing cardiology without the existence of basic equipment is like practicing medicine without any patients, and this can be frustrating at times. At the Connaught Hospital (photo 1), it is incredible to mention that there was no electrocardiogram (ECG) machine at the time I took up duty there. However, by collaborating with the South Health Care delivery programme an ECG machine (photo 2) was donated to the Department of Medicine. Being the only ECG machine in the main referring hospital it has been of tremendous use to doctors working not only in the Connaught Hospital but also those hospitals within the surrounding metropolis of Freetown (Capital City of Sierra Leone).

Some of the practical skills that I learnt as part of my postgraduate training could not be applied immediately on my return as, for example, there was no echocardiogram (Echo) machine available neither in my hospital nor the entire country. In view of this, I wrote several proposals to the Ministry of Health in Sierra Leone as well as other non-governmental agencies to try and get an Echo machine for the hospital. After eight months of intense searching and “begging letters” a Hewlett Packard echo machine (1986 model) (photo 3) was donated to the Connaught Hospital by “The Women for Women USA/Sierra Leone”, a non-governmental organization based in the United States of America. Although the Echo-machine is dated and has many limitations in the field of modern cardiology, it has been of immense help to the practice of cardiology in Freetown, Sierra Leone. This said, however, continued efforts are being made to get a modern Echo-machine in Connaught Hospital, which could be used not only for clinical work but also for research and academic purposes.

Passing on learning’s to medical students and the local community

As a staff member of the medical school at College of Medicine & Allied Health Sciences, University of Sierra Leone, I teach medical students in the field of cardiovascular medicine, which has been of tremendous help to them (photo 4). I also played a fundamental role, in collaboration with the Ministry of Health, to build and set up an “Intensive Care Unit” in the Connaught Hospital, which now contains some basic equipment (cardiac monitors, defibrillators, mechanical ventilators, etc.) (photo 5).

As prevention of cardiovascular disease, is fundamental to promoting good health I have recently been engaged in the promotion of “health talk” through our local radio. As an alternative to radio health talks I embarked on a strategy to meet the people who are at risk of cardiovascular disease, directly, which has been appreciated greatly. (Photo 6).

Becoming an award-winning doctor

My work as a clinician and my dedication to salvaging the beleaguered health system of our nation has been recognised and appreciated by the people of Sierra Leone. They voted for me to win the prestigious and coveted prize of Medical Doctor of the Year 2008. I received the award on 28 December 2008 during the “Sierra Leone – All Works Of Life (AWOL) National Award Ceremony” (Photo 7). Winning this award was indeed a great joy to me and my family. I remain indebted and grateful to the World Heart Federation for sponsoring my cardiology training in South Africa, through their Twin Fellows Programme. The knowledge that I acquired enabled me to practice non-invasive cardiology in my country, which significantly increased my chances of winning this award.

Advancing medical research

Several papers on the research I carried out on tuberculous pericarditis with Prof. Bongani Mayosi, whilst on my fellowship programme, have been published in the Cardiovascular Journal of Africa and can be accessed through pubmed (www.pubmed.org). A trial on the Investigation of the Management of Pericarditis in Africa (IMPI) on prednisolone versus mycobacterium w is currently in its early stages and a site for the recruitment of patients will soon be established in Sierra Leone.

Although it has not been possible to fulfil all my objectives, within one year of completing the fellowship, I am still very determined to achieve them. The set up of the Sierra Leone National Heart Foundation is at an embryonic stage and the constitution has been drafted, in collaboration with colleagues. I therefore hope to bring you news of the launch of the Sierra Leone National Heart Foundation, sooner rather than later.

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