Page 1 - SHJ V5 No2 2018
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SHJ Vol 5 No 2, 2018                                              Khalil, Status of cardiac care


                Status of Cardiac Care in Sudan: available venues, alternative routes and
                                                   financial burden.

                                            Siddiq Ibrahim Khalil, Editor-in-Chief

               Fawzia came to see me at a morning clinic. She looked in a good shape and mood. I first saw her
               back in 1982, when she was 16 years old.  It turned out, later, that she was suffering from severe
               mitral  stenosis and  recurring  carditis.  The following  5  years  would  subsequently  be the most
               difficult of her life. She developed endocarditis with ruptured chordae, and was operated on in
               1984, by a visiting team of surgeons to Khartoum. She later, also had to undergo an open-heart
               surgery for mitral valve replacement in Kuwait in 1987. The surgeon who operated on her in
               Kuwait City was Hani Shuhaibir, a cardiac surgeon who is well remembered by the few patients
               who  are  still  living  with  “his”  prosthetic  valves.  Fawzia’s  free  surgery  was  offered  by  the
               Kuwaiti  government  and  the  Bank  of  Sudan  covered  the  cost  of  air  travel  and  subsistence.
                       Today,  after  thirty  years,  Fawzia’s  prosthetic  valve  is  still  in  place  and  functioning
               normally. With  rising rates of coronary heart disease and the unfinished agenda of rheumatic
               heart disease, the pattern of patients travelling abroad for surgery and to seek medical treatment
               has  remained  undiminished,  in  fact  it  has  dramatically  increased  throughout  the  last  three
               decades,  as  people  continue  to  travel  for  coronary  intervention,  coronary  artery  bypass  graft
               surgery  (CABG),  valve  surgery  and  correction  of  congenital  abnormalities.  Some  patients
               receive government support through referrals by Sudan National Medical Commission (SNMC),
               while others travel abroad because they can afford the cost or have no trust in the local health
               providers  and  resources.  And  for  some  of  the  patients  it  is  more  of  a  tradition  rather  than  a
               necessity. Complicating matters even  more, some  government  departments,  at  one time, were
               contracting with hospitals abroad to care for their staff.
               All would agree that the available resources cannot meet the expanding demand created by the
               increasing  rates  of  cardiovascular  disease  (CVD),  and  despite  the  recent  “reinforcements”
               cardiac  services  remain  highly  stretched  and  scarce.  In  this  article,  we  intend  to  appraise  the
               current  issue  of  cardiac  care,  including  the  available  venues  and  the  alternative  routes  for
               treatment abroad.

               The  enormity  of  the  burden  of  heart  disease  requiring  intervention  and  surgery  has  been
               discussed before [1, 2]. Currently, the average prevalence of rheumatic heart disease (RHD) in
               Sudan is 20-30/1000, meaning that there are currently 600,000 patients who are afflicted by one
               type or another of the disease. The situation is also more complicated as children account for
               nearly 40% of the total load of RHD and the prevalence in rural communities reaches 60/1000
               [3]. These figures unveil astounding backlog and burden of disease that await attendance. Most
               patients  with  RHD  end  up  with  chronic  valvular  disease  requiring  either  percutaneous  trans-
               mitral commisurotomy (PTMC) for single valve such as pliable mitral stenosis, or more complex
               surgery for single or multivalvular disease in the majority of patients. It is estimated that there
               are more than 300,000 patients with chronic valvular disease, who will require surgery during the
               next five years (extrapolated from the present statistical data). In 2016, the total cases of patients

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