A specialist cardiac hospital on the outskirts of Khartoum in Sudan has become a beacon of excellence for Africa, with outcomes that at least match and sometimes better similar centres in Europe and the United Sates.
The Salam Centre for Cardiac Surgery was set up by the Italian medical relief agency Emergency with some funding from the Sudanese government.
Since it opened its doors in April 2007 more than 7500 patients from 11 African countries have been seen by the centre’s doctors, and many of them have benefited from surgery previously unavailable in the region.
The principles that underpin the hospital—equality, quality, and social responsibility—are a blueprint for new health systems for Africa based on human rights and medical excellence, said Gino Strada, an Italian surgeon and head of Emergency. He was speaking at an international conference in Venice on developing health services in Africa, which was attended by representatives from health authorities of several African countries.
“Assuring the same quality of care as in the top centres for cardiac surgery in the world, totally free of charge: that’s a revolutionary idea, that will be an example for the whole African continent,” said Professor Lucio Parenzan, pioneer of Italian paediatric cardiac surgery and director of the International Heart School in Bergamo. “Visiting the Salam centre in Khartoum was a unique experience for me, an important lesson on both technical and ethical grounds”.
An audit of the hospital’s first year activity shows that 7633 outpatients were seen between March 2007 and April 2008, including 3905 cardiac patients, said Enrico Donegani, a cardiac surgeon at the Ospedale Maggiore, the University Hospital in Novara, northern Italy. Dr Donegani performed the first open heart surgery at the Salam centre in April 2007 on a 14 year old girl who needed a valve replacement because of rheumatic fever.
Patients from 11 countries—Sudan, Central African Republic, Congo, Eritrea, Ethiopia, Kenya, Rwanda, Sierra Leone, Tanzania, Uganda, and Zambia—were first screened in their country by a team of specialists sent in by Emergency. Altogether 774 patients were admitted for cardiac procedures or surgery at the Salam centre.
Outcome data show a preoperative mortality rate at the hospital of 1.9% (15 deaths out of 774 patients), a 30 day mortality rate of 2.1% (11 deaths out of 525 operations), and a late mortality rate of 2.9% (some of the 514 patients were lost to follow-up).
The Salam centre was built to the highest technical standards. It includes one of the biggest solar panel fields in the world to meet the hospital’s energy requirements and an air filtering system that is capable of dealing with the region’s frequent sand storms.
“We wanted to build a beautiful and hospitable place, without any waste of money,” explained the architect Raul Pantaleo. “The final cost was around one third of that of a comparable hospital in Europe.”
Many of the African health officials expressed enthusiasm for what has been achieved.
“Our model now shows that providing excellent surgical care in Africa free for patients is possible,” said Dr Strada. “Excellence generates resources. It sets models, increases knowledge, allows the design of effective systems, attracts competent and motivated staff and, finally, attracts donors.”
The next step will be the introduction of a four year postgraduate programme for African doctors on heart surgery, with a degree recognised by the Sudanese government.