Project
Center for Cardiovascular Surgery in Togo.
Geographical, demographic and socio-economic context
Togo is a Western African country, bordered by Burkina Faso to the North, by the Atlantic Ocean to the South, by Benin to the East and by Ghana to the West.
With its elongated shape, Togo has a length of 362.82 miles, a width of about 37.28 miles and an area of 56.600 sq km (13987000 acres).
The country consists of six medical regions: Maritime, Lome Commune, PIateaux, Centrale, Kara, Savanes.
Togo has a very young population; 50% of the whole population are under 20 years old and only 5% of them are over 65 years.
The average life expectancy is 56 years (55 years for men and 59 years for women).
Chart #1: demographic indicators, year 1996
Indicator Level
Infantile mortality: 80 on 100,000 births
Expected life at birth (men) 55
Expected life at birth (women) 59
Expected life at birth (total) 56
Real mortality 13 %
Actual birth rate 45 %
Natural increase 3.2 %
Number of live births = 186.300 / year
Source: Unit of Population Planning, National Department of Planning and Development.
Nosologic context
Out of 200,000 live births every year there are 59 birth defects, that is 30 per 100,000 live births each year.
About 30% of congenital malformations are cardiac, meaning 10 per 100,000 live births each year.
The hospital frequency of people with congenital heart disorders is about 1% with a majority of left-right shunts (79%)
IVC = 20-57% of people with congenital heart disease
IAC = 10%
Ductus arteriosus (DA) = 4%
Atrio-ventricular communication = 7%
TOF (tetralogy of Fallot) = 10%
Health care
The current situation on medical matters in Togo is the following (from the Yearbook of health statistics 1996):
15557 inhabitants / doctor
3855 inhabitants / nurse or obstetrician
* The financial means of parents are very modest, most children never get to the hospital, because they die before the family has found the money needed for the trip.
* The means for a clinical assessment are also limited: only the central hospital has an ultrasound, while in Regional Hospitals the diagnosis lack in instrumental screening (so the diagnosis is mainly based on clinical observation). Sometimes the children must travel about 310 miles to get a diagnosis and appropriate treatment, especially those affected by heart disease.
* Angiography cannot be done in Togo because of lack of equipment.
* The CAT scan can be done only in the Capital (at the university hospital or privately).
Beneficiary groups
In Togo, among 200,000 live births each year, more than fifty malformations are counted, of which one third are cardiac.
To date, these patients were sent to Switzerland (50%), to France or to the Ivory Coast, but the majority is doomed to die.
A Center for Cardiac Surgery in Togo would be important not only for the Togolese population but also for patients from neighboring countries:
Benin (5.6 million inhabitants)
Burkina Faso (10.6 million),
Niger (9.4 million),
Mali (11.1 million)
for a total of 41,2 million inhabitants.
Impact of the project on the social economic situation of the beneficiaries:
For a family having a child suffering from heart disease in this social situation it is a really dramatic problem. Even though the pediatric hospital frequency of this disease is 1%, it is morally and ethically necessary to provide the right assistance to patients and their families.
Nevertheless, a middle-aged adult affected by heart disease is not able to support his family and is emarginated from the active society which will then loose a valuable expertise.
The most wealthy are obliged to go abroad for treatment while others are helped by non-governmental bodies in order to be treated for free in Switzerland or France.
In all these cases, children are separated from their parents and from their natural living environment for several months (from 6 to 18 months).
As a result, after all those months spent away from home and in a very different environment, these children have become foreigners in their native environment and it often becomes difficult to reintegrate them in their own family.
Therefore the physical problem also generates psychological problems that are not less harmful for such delicate human beings.
Hence it is our priority to organize in our Country a Hospital not only for the 6 million people from Togo but also for the other 40 million people living in the neighboring countries.
In order to provide a good cardiological assistance it is compulsory to ensure a healthy pregnancy, a safe delivery, a healthy childhood by supplying instrumental and biological monitoring during the whole period of pregnancy, educational programs for families and constant pediatric screening.
Being able to treat these children in their natural environment means giving them and their parents and the whole community a real help, because it allows all of these children to avoid psychological trauma in addition to their physical disorders.
Aims and objectives
a. General purpose:
Promoting health and wellbeing of the people in West Africa, especially children, by supplying them a more equipped infrastructure for the diagnosis and treatment of heart diseases.
b. Operational objectives:
1 – Increase the Units that deal with cardiovascular diseases and build them closer to the patients
2 - Identify the various cardiovascular pathologies in the West African Countries.
3 - Reduce child mortality and disability associated with cardiovascular disease.
4 - Reduce the incidence of cardiovascular disease especially those related to infections.
Strategy
Building a hospital consisting of:
- A unit of reception and outpatient treatment.
- A unit for biological tests.
- A unit for X-rays and ultrasound examinations.
- A confinement unit.
- A surgery room.
- A room for resuscitation and/or intensive unit care.
Making the structure completely operational:
Ensuring the continuity in management and maintenance of the structure.
Run medical screenings as:
a-cardiac echography
b-angiography
c-tomodensitometry (CAT) etc…
Developing cardiological and surgical assistance.
Establishing international cooperation in order to provide continuous education for medical staff and ensure the collaboration of highly skilled surgeons and cardiologists :
Periodically welcoming surgeons from abroad for complex operations in Togo.
Follow up the patients operated in Togo or abroad.
Assistance by the Volunteers of “The Precious Hands“ in order to give moral and physical support to patients.
Resources needed
Human resources: staff for building, medical staff, administration staff and management.
Equipment and materials
- Non-perishable materials to be used several times.
- Perishable materials
Time (constant monitoring of schedule and timeline) - The beginning of the work will coincide with the acquisition of funding.
- Activities to be programmed (Gant chart).
Funds needed to build and then run the hospital
Supporting research
Any other useful resource
Resources already in place
- Crop land owned by The Precious Hands suitable for building the hospital
Operational phases of realization
The duration of the building project has been estimated by engineers as 2 years approximately.
After five years of activity, the Center will get an autonomy of at least 30%.
The management of the center, in our view, should be mixed: private and public. In this way the hospital will be economically autonomous.
The main goal will be to get at least a 70% autonomy in 15 years of activity.
For that, we must do everything possible to treat people with limited means by having the most skilled personnel.
Expenses for the activities of the first year
a) ultrasound:
b) electrocardiograph:
c) information technology equipment
In order to support this project from the start, we wish to establish an association of volunteers willing to contribute to the project constantly.
What we are expecting from the Association:
following the creation of the Center, trying to find the right solutions to all the different problems that may arise.
Searching for funds and for "resource people" in different areas important for the development of the Center.
Thinking about the treatment of patients, especially those with limited means, from the administration’s point of view.
Thinking about how to treat patients who have to come from another country or go to Europe for the treatment.
Thinking about the development of the Center, especially about the strategy in order to ensure a range of at least 75% autonomy within fifteen years.
In order to establish a similar association, we are going to look for members both in Italy and in Togo and other countries interested in our project.
We will have to write the statutes and internal rules of our association.
This is an"onlus" (non-profit) type association with unlimited duration.
Amount of work
We calculate a monthly amount of work of the center:
visits = 200 patients per month
admissions = 80 per month
Subsequently, the surgery can be done on site:
Surgered patients: 12-15 cases per month
Cost of treatment (example of Abidjan)
The center of Abidjan (Ivory Coast) opened in 1976, treats about 280 children a year.
Examples:
Budget pre-surgery = 450,000 FCFA
Pace maker = 2,000,000 FCFA
Surgeries without changing valve = 2,300,000 FCFA
Valve replacement = 5,500,000 FCFA
Method of operation
It advisable to involve local people in the whole project from the building of the hospital to the medical and general work.
The Association will also estimate when a family is not able to pay for treatment and help them find a solution.
SUMMARY OF THE BUDGET
Currently the approximate budget needed for the construction of the hospital is 4,000,000 Euro
Secondly, other funds will be needed for the general functioning of the hospital, for medical equipment and instruments and human resources.
Total Project = 10 million €.
Project written by Dr. Edem Koffi
Contacts: info@theprecioushands.com
Bibliography:
1 - National Yearbook of sanitary Statistics of Togo 1996
2 - Essay Akitani 1991: Heart disease in children of Togo.