Bongani Mayosi's legacy: A global drive to save millions
The cardiologist was a driving force behind a worldwide strategy to improve access to lifesaving cardiac surgery
It’s a killer that starts with a sore throat and affects as many people as HIV, and fighting it was the life’s work of University of Cape Town dean of health Professor Bongani Mayosi.
Now the battle against rheumatic heart disease in the developing world is set to be Mayosi’s legacy.
The world-renowned cardiologist was a driving force behind the Cape Town Declaration, a strategy to improve access to lifesaving cardiac surgery. It was published simultaneously in nine leading medical journals on August 3, exactly a week after Mayosi’s suicide.
Professor Peter Zilla, head of the Christiaan Barnard Division of Cardiothoracic Surgery at the UCT medical school, said Mayosi had “alerted the world to the health debacle of rheumatic heart disease”, which affects 33 million people and kills 320,000 annually.Zilla, the corresponding author of the Cape Town Declaration, told Times Select the document had its roots in last December’s 50th anniversary of Barnard’s first heart transplant, performed at Groote Schuur Hospital in December 1967.
“We had the who’s who in cardiac surgery from all over the world in Cape Town, and with the help of Prof Mayosi organised a ‘south-north dialogue’ that led to the pledge of all cardiac surgical societies in the Cape Town Declaration,” said Zilla.The declaration’s aim was “to jointly approach one of the most severe unmet needs of the forgotten billions: the establishment of heart surgery where there is none”, and it had been published in journals in Africa, North America, India, Europe, China, Australia and South America.Zilla said: “Prof Mayosi spearheaded efforts to prevent rheumatic heart disease. As a disease of poverty and crowded living conditions, it starts with a throat infection [also called strep throat].
“The body starts fighting the bacteria [streptococci] which cause it by producing antibodies. Unfortunately, in rheumatic heart disease these antibodies turn against the patient himself and destroy his heart valves, often over decades.
“If treated with penicillin – and particularly if recurrences are prevented by lifelong penicillin treatment – one can prevent full-blown rheumatic heart disease. This prevention strategy was Prof Mayosi’s life work.
“As much as Prof Mayosi’s prevention efforts throughout the African continent have increasingly created political awareness and shown some success, the disease often takes 20 years or more to fully develop, and hundreds of thousands if not millions of patients will still need heart surgery over the next 20 years as the only life-saving remedy.”
The surgery involved repairing or replacing heart valves, said Zilla, but the shortage of surgical facilities and skills meant there was a “gigantic” problem.“In the whole of Africa there is hardly any cardiac surgery available outside South Africa and the Maghreb/Egypt region. As such, thousands of patients die every year without help.
“In South Africa, the private hospitals performing heart surgery for the 17% of patients on medical aid in the two cities of Cape Town and Johannesburg alone are more than all heart hospitals for the 1.2 billion people of the entire continent.”
The signatories to the Cape Town Declaration, who include nearly 100 doctors and researchers in addition to the major cardiothoracic societies, industry representatives, regulatory agencies, legislative bodies and charitable foundations, want to set up an international working group to evaluate and endorse the development of cardiac care in low- and middle-income countries.
Their second aim is to push for the training of cardiac surgeons and other specialised caregivers at these endorsed clinical centres.
“The first goal at a planned meeting of the entire group in Milan in October will be to define the framework conditions for establishing training centres in affected middle-income countries like South Africa to train fellow Africans in surgery for rheumatic heart disease – something they would not see in Europe or the US,” said Zilla.Stepping up open-heart surgery in training countries would have a big local payoff, he said.
“Unfortunately, although South Africa is the only country in sub-Saharan Africa with some degree of heart surgery available for the indigent population, we are the worst in the world among the middle-income countries.
“We operate on [35 people per million population] compared to 560 per million in Brazil and Iran. Even in India, indigent patients have access to four times more open-heart surgery than in SA.
“Part of the solution of the Cape Town Declaration is therefore to find arrangements between donors and the government to be able to step up cardiac surgery in training countries like South Africa.
“It would be a win-win situation by giving more indigent patients in South Africa access to life-saving heart surgery and, at the same time, creating a broader teaching base to train more surgeons from African countries.“It will take some political will, as heart surgery is relatively expensive – although UCT has developed affordable heart valve surgery devices that can treat patients under very simple conditions.”
Keith Naunheim, president of the Society of Thoracic Surgeons, told the Cardiovascular Research Foundation website TCTMD: “We know how to treat rheumatic heart disease and we know how to fix it; it’s just a question of getting the resources to the people.
“In its own way, it’s no different than getting vaccinations, clean water or food to people who need it. This is every bit as lifesaving as those basic needs.”