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26 September 2018
The Cardiac Simulation lab in action

There’s an electric atmosphere in the operating theatre of the Faculty of Health Sciences, as Dr Taha Gwila and his team focus with intense concentration on the fleshy exposed heart beating rhythmically in the opened chest of the patient lying in front of them. The enormous demands of open-heart surgery are evident to everyone looking on. But there’s a catch. 

The patient is faceless and rubberised. The red liquid flowing in the pipes that network from the body is not blood. And the pulsating heart was beating in the body of a pig not too long ago. 

Cutting edge technology
 
This Cardiac Simulation laboratory supplied by Medtronic is the newest addition to the School of Biomedical Sciences’ clinical simulation and skills unit. 

“There’s nothing like this in Africa, and only a few in the world,” says a beaming Prof Francis Smit, Head of Cardiothoracic Surgery at the Faculty of Health Sciences.
He explains that this new cutting edge medical technology will revolutionise the way cardiac surgeons and other health professionals are trained and assessed.

Practicing specific procedures

The simulation facilities give students with various levels of competency the opportunity to practice specific procedures in their own time and at their own pace.
“Traditionally training followed the apprentice model, where surgeons started with simple tasks and worked their way up. They assisted senior personnel and their exposure to procedures depended on the conditions presented by the patients before them,” explains Prof Smit.

The simulation technology now enables them to repeatedly practise a certain procedure without any risk to a patient. A sophisticated electronic grading system gives detailed feedback after each session, so they know in which areas to improve.  

Simulated emergencies

The system also allows trainers to create a medical emergency that the trainees then have to deal with.

“Assisting senior surgeons with high levels of competency means that in the past, trainees would often never get the chance to experience these kinds of complications during operating procedures. Now we give them a chance to build that confidence so they’ll be able to handle different situations.”  

Training hub for Africa
 

The UFS cardiothoracic programme is being designed to become a training hub for the whole of Southern Africa, combining distance learning with an on-site high-fidelity simulation and assessment centre.

“This is 100% real!” says an excited Dr Gwila after successfully completing his first simulation session. “As a Senior Registrar at the Cardiothoracic Department I’ve done similar procedures on real patients and there’s really no difference at all. Every registrar should do this before ever touching a real body.”

News Archive

Heart diseases a time bomb in Africa, says UFS expert
2010-05-17

 Prof. Francis Smit

There are a lot of cardiac problems in Africa. Sub-Saharan Africa is home to the largest population of rheumatic heart disease patients in the world and therefore hosts the largest rheumatic heart valve population in the world. They are more than one million, compared to 33 000 in the whole of the industrialised world, says Prof. Francis Smit, Head of the Department of Cardiothoracic Surgery at the Faculty of Health Sciences at the University of the Free State (UFS).

He delivered an inaugural lecture on the topic Cardiothoracic Surgery: Complex simplicity, or simple complexity?

“We are also sitting on a time bomb of ischemic heart disease with the WHO (World Health Organisation) estimating that CAD (coronary artery disease) will become the number-one killer in our region by 2020. HIV/Aids is expected to go down to number 7.”

Very little is done about it. There is neither a clear nor coordinated programme to address this expected epidemic and CAD is regarded as an expensive disease, confined to Caucasians in the industrialised world. “We are ignoring alarming statistics about incidences of adult obesity, diabetes and endemic hypertension in our black population and a rising incidence of coronary artery interventions and incidents in our indigenous population,” Prof. Smit says.

Outside South Africa – with 44 units – very few units (about seven) perform low volumes of basic cardiac surgery. The South African units at all academic institutions are under severe threat and about 70% of cardiac procedures are performed in the private sector.

He says the main challenge in Africa has become sustainability, which needs to be addressed through education. Cardiothoracic surgery must become part of everyday surgery in Africa through alternative education programmes. That will make this specialty relevant at all levels of healthcare and it must be involved in resource allocation to medicine in general and cardiothoracic surgery specifically.

The African surgeon should make the maximum impact at the lowest possible cost to as many people in a society as possible. “Our training in fields like intensive care and insight into pulmonology, gastroenterology and cardiology give us the possibility of expanding our roles in African medicine. We must also remember that we are trained physicians as well.

“Should people die or suffer tremendously while we can train a group of surgical specialists or retraining general surgeons to expand our impact on cardiothoracic disease in Africa using available technology maybe more creatively? We have made great progress in establishing an African School for Cardiothoracic Surgery.”

Prof. Smit also highlighted the role of the annual Hannes Meyer National Registrar Symposium that culminated in having an eight-strong international panel sponsored by the ICC of EACTS to present a scientific course as well as advanced surgical techniques in conjunction with the Hannes Meyer Symposium in 2010.

Prof. Smit says South Africa is fast becoming the driving force in cardiothoracic surgery in Africa. South Africa is the only country that has the knowledge, technology and skills base to act as the springboard for the development of cardiothoracic surgery in Africa.

South Africa, however, is experiencing its own problems. Mortality has doubled in the years from 1997 to 2005 and half the population in the Free State dies between 40 to 44 years of age.

“If we do not need health professionals to determine the quality and quantity of service delivery to the population and do not want to involve them in this process, we can get rid of them, but then the political leaders making that decision must accept responsibility for the clinical outcomes and life expectancies of their fellow citizens.

“We surely cannot expect to impose the same medical legal principles on professionals working in unsafe hospitals and who have complained and made authorities aware of these conditions than upon those working in functional institutions. Either fixes the institutions or indemnifies medical personnel working in these conditions and defends the decision publicly.

“Why do I have to choose the three out of four patients that cannot have a lifesaving operation and will have to die on their own while the system pretends to deliver treatment to all?”

Prof. Smit says developing a service package with guidelines in the public domain will go a long way towards addressing this issue. It is also about time that we have to admit that things are simply not the same. Standards are deteriorating and training outcomes are or will be affected.

The people who make decisions that affect healthcare service delivery and outcomes, the quality of training platforms and research, in a word, the future of South African medicine, firstly need rules and boundaries. He also suggested that maybe the government should develop health policy in the public domain and then outsource healthcare delivery to people who can actually deliver including thousands of experts employed but ignored by the State at present.

“It is time that we all have to accept our responsibilities at all levels… and act decisively on matters that will determine the quality and quantity of medical care for this and future generations in South Africa and Africa. Time is running out,” Prof. Smit says.
 

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