Auscultating Cardiac Surgery in the DR Congo

Article by Ulrick S. Kanmounye Email: ulricksidney@gmail.con

One might wonder why it is important for the Democratic Republic of Congo (DRC) to have cardiothoracic surgical services. First and foremost, the DRC has an estimated 77.8 million inhabitants, most of whom are poor. This means there is a need for 23,340 cardiac surgeries per year (Zilla et al. Unpublished data). Secondly, the country has been the theatre of wars, Ebola and cholera epidemics, tuberculosis, HIV, and malaria endemics. These infectious diseases have diverted attention and resources to the detriment of surgery in general and of cardiothoracic surgery in particular. The two aforementioned reasons also explain the high prevalence of rheumatic heart disease among Congolese children. Finally, congenital heart diseases (CHD) are a major public health issue in this country. According to data from the Kinshasa University Clinic, during the early 2000s, an estimated 2,000 children were born with CHD yearly in the capital city Kinshasa. Therefore, there is an urgent need for cardiac surgery equipment, interventions, and workforce in the DRC.

The evolution of cardiac surgery in the DRC has known three distinct phases. The first phase was characterised by the practice of cardiac surgery by Belgian surgeons and a lack of Congolese cardiothoracic surgeons. This phase began back in 1956 when the University of Kinshasa (formerly known as Lovanium) was run in partnership with Belgians from the Free University (Université Libre). Teams of cardiothoracic surgeons from Belgium would travel to Kinshasa and perform closed-heart surgeries. Fifteen years later, things changed when the first Congolese cardiothoracic surgeons returned home. First in 1970, with Dr André Beloy (Kinoise Clinic and Ngaliema Clinic) and later on in 1971 with Pr Joseph Kabemba (Kinshasa University Clinic). Then came the second phase which was marked by a major recession of cardiothoracic activities. This phase lasted more than 30 years. During this era a few professors did their best to keep cardiothoracic activities going but they faced too many difficulties. These were Professors Kabemba, Kiula, Mushegera, and Muteba. Unaided, their efforts were not sufficient to maintain cardiothoracic activities. Finally, towards the end of the first decade of the 2000s, a few Congolese doctors took upon themselves to make things change. It is this collective movement that constitutes the last phase. During this period, Congolese doctors from within and from without the borders of the DRC have organised themselves in groups to rekindle the light of Congolese cardiothoracic surgery.

There are two major groups of doctors that have contributed to this new cardiothoracic era. The first of both groups is the NGO “Les Chaines de l’Espoir RD Congo”. This NGO is made up of Pr Shiku Diayisu (Cardiopaediatrician – Kinshasa University Clinic), Dr Nyakabasa Mutijima (Paediatrician – Ngaliema Clinic) and Dr Etienne Tshionyi (Surgeon – Ngaliema Clinic). Together, they have been able to operate 120 children in the DRC (Patent Ductus Arteriosus and first phase of Tetralogy of Fallot) and 70 children in Belgium with the help of Pr Jean Rubay (Université Catholique de Louvain). The greatest achievement has been the construction of a 2 million USD cardiopaediatric centre at the Ngaliema Clinic site. They were able to achieve such a fit thanks to the sponsorship of the first lady of the DRC, Mrs Olive Kabila. This centre has 2 operating rooms: one for open-heart surgery and another for neurosurgery. To perform these interventions, a team of 8 Ngaliema Clinic staff went to Christian Barnard Memorial Hospital, Cape Town where they were trained by Dr Susan Vosloo. Once they returned in 2017, the team performed open heart surgeries on two patients (Ventricular Septal Defect and Mitral Valve Replacement). Despite major financial support, both patients found it difficult to pay the remaining 300 USD for their interventions. Unfortunately, no other interventions have been performed since then.

Ngaliema Clinic Cardiopaediatric Centre

The second group is an Association of Alumni of the University of Kinshasa’s Medical School (AFMED – Association des Amis et Anciens Eudiants de la Faculté de Médecine de Kinshasa). Two diasporan members of AFMED have been operating patients at the Monkole Hospital Centre and Kinshasa University Clinic during the summer. These two are Dr Alphonse Nzomvuama (Cardiothoracic Surgeon – France) and Dr John Nsiala (Anaesthesiologist – France). Together, they have operated nine Patent Ductus Arteriosus and two Chronic Constrictive Pericarditis between 2012 and 2015. In addition, AFMED works outside the operating room as it organises a yearly conference during which Congolese doctors from all around the world come together to share their experiences with their local colleagues. During the first AFMED conference in 2012, Dr Nzomvuama talked about the current state and future of cardiothoracic surgery in the DRC. He has been to major local television and radio stations every year to call for changes in local health policies.

Cardiac surgery was once the spearhead of Congolese medicine. Today, it is struggling to re-establish itself. Fortunately, a lot has been done locally by doctors to shake things up. These modern day heroes are not equipped to win this battle. However, they will stand a chance if they receive help from fellow colleagues and global surgery advocates.