Nigerian Journal of Cardiovascular & Thoracic Surgery

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Background: Open heart surgery is nonexistent or undeveloped in many African countries due to the prerequisite for specialized multispecialty teams, expensive equipment, and consumables. This review aims to outline strategies for facilitating local skilled workforce training, improve patients' access, and sustain heart surgery in Africa's most populous nation. Methods: We reviewed the demographic, socioeconomic, and health metrics published by the United Nations, the World Health Organization (WHO), the World Bank, and other relevant sources for the top three African economies – South Africa, Nigeria, and Egypt. Results: South Africa classified as upper-middle-income nation with gross national income [GNI] $12,475–$4126 spends 8.8% of gross domestic product (GDP), while Egypt and Nigeria both classified as lower-middle-income nations GNI $4125–$1046 spends 5.6% and 3.7% of GDP, respectively, on health care. Egypt performed 45%, South Africa 39%, and Nigeria 0.1% of their WHO projected annual heart surgery volume in 2015. These capacities are consistent with the human development index (HDI), thoracic surgeon-to-population ratio, and health insurance coverage ranking of these countries. Conclusion: Although gross income per capita is comparable, the HDI - a better discriminator of development is higher in Egypt with 0.69 against 0.51 in Nigeria, as evidenced by their respective heart surgery capacities. While the WHO projected 72,000 cases/annum for Nigeria is unattainable with the present workforce, the Pan African Society for Cardiothoracic Surgery (PASCATS) 40/1 million population projection of 7200 cases/annum appears a more realistic goal. However achieving even this modest target will require government political willpower and increased budgetary allocation for expanding insurance coverage. PASCATS advocates three mentorship models: resident senior local consultant, mission teams and senior expatriate consultant, with centralization through regional referral centers as viable pathways to develop cardiac surgery in sub Saharan Africa. Regionalization optimizes the scarce workforce and resources and therefore by combining assets can fast track skill acquisition by trainee surgeons.

Background: Video-assisted thoracoscopic surgery (VATS) has been increasingly advocated as the preferred treatment for the first episode of primary spontaneous pneumothorax (PSP), in contrast to the current guidelines of the American College of Chest Physicians and the British Thoracic Society recommending tube thoracostomy. Materials and Methods: We retrospectively reviewed the medical records of our patients who underwent VATS for primary or secondary SP from January 2005 to December 2015. Results: There were 36 patients, with the mean age of 43.6 ± 20.5 years, and 72.2% of them were male and 66.7% with PSP. 75.0% of SSP patients had chronic obstructive pulmonary disease versus 0% for PSP (P = 0.001). 50% of PSP and 66.7% of SSP patients had experienced previous SP. About 16.7% (PSP) and 0% (SSP) of patients with index pneumothorax and 75.0% (PSP) and 25.0% (SSP) of patients with multiple pneumothoraces underwent early VATS, while the remaining had delayed VATS for a prolonged air leak. Postoperative air leak occurred in 1 (4.2%) PSP patient, which healed with doxycycline pleurodesis, and in 4 (33.3%) SSP patients, which required thoracotomy in three patients and redo-VATS in one patient for control. Operative mortality was 0% versus 8.3% for PSP and SSP, respectively (P = 0.351). In patients with extended follow-up, ipsilateral recurrence occurred only in one SSP patient at 36 months. Conclusion: Index SP was mostly treated by the tube thoracostomy, except for recent years, when VATS was recommended to young adult patients with index PSP, because of zero operative mortality, lower recurrence, and less time away from work or school. However, for SSP patients, VATS was reserved primarily for persistent air leak or recurrence.

Little information was written or acknowledged by the American medical establishment on the contributions of black Americans to medicine in the United States (US) till after the civil rights revolution of the 1960s. This review is an attempt to recount some of the small corps of Black surgeons' trailblazers who helped establish the black identity in American surgery, thereby paving the way for succeeding generations.

Online since 21^st July, 2016