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28 August 2023 | Story Andre Damons | Photo Andre Damons
Dr Kgomotso Moroka
Dr Kgomotso Moroka, Acting HOD: Cardiology in the UFS Faculty of Health Sciences, recently graduated from Maastricht University with a Diploma of Advanced Studies in Cardiac Arrhythmia Management (DAS-CAM).

A staff member from the University of the Free State (UFS) is hopeful her newly acquired skills and knowledge, following her graduation with a Diploma of Advanced Studies in Cardiac Arrhythmia Management (DAS-CAM) and completion of a electrophysiology fellowship, will contribute to the improvement of cardiovascular services in the Free State and Sub-Saharan Africa.

Dr Kgomotso Moroka, the Acting Head of Department (HOD) for Cardiology in the UFS Faculty of Health Sciences, recently graduated with a DAS-CAM in June 2023. This distinctive postgraduate programme is offered by Maastricht University in collaboration with the European Heart Rhythm Association and the European Society of Cardiology. This is a two-year programme and Dr Moroka was part of the third cohort which comprised 32 electrophysiologists selected from over 20 countries worldwide.

Her achievement places her as the sole   DAS-CAM graduate in Sub-Saharan Africa and the Free State region. 
Electrophysiology, which studies the electrical influences and patterns of the heart is vital for treating patients with abnormal heartbeats caused by irregularities in the heart’s electrical pathway, resulting in either unusually slow or fast heartbeats.

Seizing a valuable opportunity

Dr Moroka emphasises that currently, there is a lack of electrophysiology services provided in both the public and private sectors within the Free State. She therefore anticipates that her newly acquired skills and knowledge will play a pivotal role in enhancing and improving the cardiovascular services offered in the province. She is also optimistic about contributing to the establishment of a department dedicated to Electrophysiology Training. 

“I could not pass up the opportunity to engage with, learn and gain insights from seasoned world-class great minds of electrophysiology, who write the books we read and the very guidelines that we utilize in our daily practices. There was also an opportunity to be guided in research and the state-of-the-art cardiac clinical electrophysiology while also obtaining insights into how to develop a cardiac arrhythmia centre, biostatics, health economics, leadership skills and health technology assessment,” Dr Moroka explains regarding her motivation to enrol in the program. 

“It was a challenging and exciting program that allowed participants to engage with the world-renowned experts in electrophysiology not only on a professional but also personal level. This program served not only to educate participants on clinical cardiac electrophysiology but served to empower us to fulfil roles as future leaders in electrophysiology and in our day-to-day roles,” she continued.

Addressing the diverse burden of cardiac diseases

Dr Moroka believes that this qualification will significantly contribute to local efforts to establish and develop a much-needed unique service, thereby advancing her career development locally and on the international platform. This qualification enables her to expand her clinical research pursuits on multiple fronts.

Dr Moroka underscores the substantial burden of ischemic heart disease with the associated risk factors such as uncontrolled high blood pressure, diabetes, elevated cholesterol levels and smoking. “There is a measurable burden of heart failure and valvular heart disease. In addition, from the research that we hope to embark upon, we hope to clearly define the burden of rhythm problems such as atrial fibrillation and other arrhythmias which are serious conditions. With the available skills and knowledge, we can begin to offer alternative adjunctive treatment that would have a significant positive effect on the morbidity and/or mortality of our patients.”

Dr Moroka points out that with the advent and advances in machine learning and digital health technology, we are in an exciting era of possibilities of obtaining valuable biological data and biometric parameters that would assist in the reduction of risk and prevention of a diversity of cardiovascular diseases and to guide clinical practice guidelines. 

“The current focus is risk reduction, prevention of cardiovascular diseases and the establishment and development of personalized health care, with a growing interest in cardiovascular genetics and gene therapy.  Who knows what the future will bring, but for now the focus is to work towards good health and disease alleviation,” she says. 

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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