The current state of Cardiology in Cameroon

Cameroon, also known as “Africa in miniature” is a Central African country which is now challenged by the triple burden of growing chronic and mainly cardiovascular diseases, together with endemic infectious diseases and very limited resources. Cardiology in Cameroon has significantly changed during the last decade or so particularly in the field of noninvasive cardiology, with the acquisition of echocardiography machines. Unfortunately, like other developing countries, in spite of these huge efforts, Cameroon is watching helplessly the disconcerting increase in the incidence of cardiovascular diseases in a country traditionally known for very low incidence of heart diseases. Important contributing factors include westernisation of dietary habits and lifestyle, and rampant cigarette smoking.

Hypertension, heart failure, RHD and cardiomyopathies are the frequent cardiac diseases1. The prevalence of hypertension is 25.6% in males and 23.1% in females2. However ischaemic heart diseases are rapidly becoming a stressful question though RHD is still a persistent and crucial problem. Manpower in medicine in general and cardiovascular diseases in particular is the second major problem. Indeed 31 specialists in cardiovascular diseases are currently practicing for the 18 million inhabitants, giving a density of 1.7 cardiovascular specialists per million inhabitants.

Struggling to improve the standard of healthcare in cardiology and fighting RHD from upstream

Presently, invasive cardiology is restricted to cardiac pacing and there is no permanent cardiac surgery programme. DGH has no image intensifier, henceforth, on a non-regular base I travel to Yaounde for pacemaker implantation with a senior colleague at the Yaounde University Teaching Hospital where this machine is available. Is it worth mentioning that a majority of patients with indications for cardiac pacing are prone to death because of their inability to afford the cost of pacemakers? With the strong help of a senior colleague, we are setting up an annual humanitarian mission of cardiac pacing so as to reduce the cost of this intervention. This same theorem applies to a majority of young patients with post- rheumatic valvular heart disease. The latter are either evacuated to European countries for appropriate care or can only be operated through humanitarian cardiac surgery missions.

Currently, the cost of a single evacuation for cardiac surgery, which is about 20 folds the gross domestic product (GDP) per capita, is a luxury for patients. Fortunately, the government is supporting the organization of humanitarian cardiac surgery missions. As the right answer to the question of RHD hides in the upstream, colleagues of the Cameroon Cardiac Society and the government are joining our efforts to support and implement a strong local preventive programme to combat RHD.

Capacity building

Besides patient care, as a staff member of University of Buea I teach internal medicine and cardiology at Buea faculty of Medicine. During clinical rounds, I also take the opportunity to pass on bedside skills to our medical students. In collaboration with local or African colleagues, I designed and conducted some epidemiological studies. Some papers on the research I carried out on heart failure or other aspects of cardiology either with Prof. Lantelme or with local or African colleagues can be accessed through pubmed (www.pubmed.org). We are participating in a multicentre study of heart failure in Africa (THESUS) which is currently at the recruitment phase and will give more details on the causes, contemporary treatment and outcome of heart failure in sub-Saharan Africa. This will help in developing an effective strategy for early detection, treatment and prevention of the disease in the continent. Also, with the invaluable contribution of the Cameroon Cardiac Society, the Cameroon project to prevent rheumatic heart disease is its conceptual phase.

World Heart Federation highlights the need for essential funds to be injected into the developing world
After reading about the obstacles that doctors such as Dr Dzudie Tamdja Anastase are facing on a daily basis and the chronic lack of resources and expertise available in developing countries, we highlight the urgent need for donor agencies to allocate funds beyond communicable diseases and equally prioritise non-communicable diseases (NCDs), such as cardiovascular disease, diabetes, cancer and chronic respiratory disease. So that organizations such as the World Heart Federation can continue to provide essential training to those that need it most.

In fact, the World Heart Federation co-hosted an event with the International Diabetes Federation and International Union Against Cancer on 19 May 2009, calling on the international community to address urgently the epidemic of non-communicable diseases, responsible for 35 million deaths a year.

Read about the event and joint statement release, which demanded a substantial increase in funding for NCDs >

Read the experiences of other World Heart Federation Fellows Dr James B.W. Russell >

Dr Barbara Edewele Otaigbe >

Picture legends

Picture 1: An overview of the Douala General Hospital

Picture 2: Echocardiography in a 30 years old pregnant lady who came in with acute pulmonary edema due to severe mitral stenosis.

Picture 3: Clinical round with a colleague, a nurse and medical students


References

1. ^{Dzudie A, Kengne AP, Mbahe S, Menanga A, Kenfack M, Kingue S. Chronic heart failure, selected risk factors and co-morbidities among adults treated for hypertension in a cardiac referral hospital in Cameroon. Eur J Heart Fail. 2008 Apr;10(4):367-72.}
2. ^{Kamadjeu RM, Edwards R, Atanga JS, Unwin N, Kiawi EC, Mbanya JC. Prevalence, awareness and management of hypertension in Cameroon: findings of the 2003 Cameroon Burden of Diabetes Baseline Survey.  J Hum Hypertens. 2006 Jan; 20(1):91-2.}