"Wheels of Hope" Outreach Programme - Posted on 07 Jul 2011


The Wheels of Hope Outreach Project initiated by Prof Francis Smit, Head of the Department of Cardiothoracic Surgery at the University of the Free State, is aimed at heart and lung disease of the adult and paediatric populations of Central South Africa.
The project focuses on heart disease and the most important debilitating diseases of the chest.
 “Projects like this never seat within one department, but is the result of co-operation between different role players. We are thankful for the support of Life Health Rosepark Hospital in Bloemfontein, , John Williams Motors Bloemfontein and Barloworld , the Department of Health of the Free State and the Department of Paediatric Cardiology and other departments at the Medical School” says Smit.
Heart disease remains the most important cause of death worldwide. Ischemic heart disease caused 7.2 million deaths annually between 2000– 2002 according to the World health Organisation. Coronary artery disease is expected to be the number one killer in the developing world by 2020, (with   HIV/Aids expected to be at number seven!). There is a major epidemiological shift happening in disease profiles in the developing world. As primary health programs have provided for vaccination programs,   treatment of diarrhoea and antibiotics, a marked reduction of early deaths due to communicable disease have been seen in Africa. There has been a shift towards Western diets and a reduction of exercise in this population and combined with obesity and widespread hypertension, we are sitting on an ischemic heart disease time bomb. Despite appalling life expectancies in Africa, the actual numbers of people reaching the age of 60 plus years are increasing.
Africa is also home to by far the majority of people affected by rheumatic valvular disease. Over a million people live with rheumatic valvular disease in Sub Saharan Africa , compared to 37 500 in the whole f the industrialized world. 
This is to some extend a preventable disease, and surgery can be prevented if effective penicillin prophylaxes programs can be implemented. Unfortunately this does not happen and many young adults die or have debilitating heart valve disease requiring surgery as young adults.
We are currently performing less than 80 heart operations per million of the population dependent on the state health system in South Africa. A conservative estimate is that closer to 400 per million would be a minimum requirement. In comparison in 2002,the USA performed 1222 procedures per million of population and Australia 786/million.
4-6 children per thousand life births have serious congenital heart diseases requiring corrective surgery. Although there are some children with very serious heart defects, most of the children can live a normal and productive life after cardiac surgery.
 It is estimated that less than one percent of children born with heart disease in Africa, has access to surgical correction.
Despite these staggering figures, no co-ordinated program exists in South Africa or Central South Africa to begin gin to address these challenges.
Treatment options and cardiac surgery has traditionally been viewed as expensive , complicated and unaffordable , but the impact of these diseases are so great on life expectancy and quality of life, that they cannot be ignored by healthcare planners of the future.
It is also well known that there is a TB/HIV explosion in South Africa with thousands of patients requiring the services of a chest surgeon. Lung cancer and oesophagus cancer are among the top five killers of all cancers in South Africa and the inadequate treatment of chest trauma, both sharp and blunt, causes untold misery in our trauma prone population. All these debilitating disease only exacerbate the effects of disease induced poverty, as these diseases affects economically active people with families.
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