Vascular Surgery Initiatives in Rwanda, Ethiopia and Zambia

The surgical workforce shortage in sub-Saharan Africa is dire.

The ACS Health Outreach Program for Equity in Global Surgery (ACS H.O.P.E.) has developed regional collaborations focused on surgical workforce training and infrastructure development. The three collaborative hubs are in Hawassa (Ethiopia), Lusaka (Zambia), and Kigali (Rwanda).

Contrary to what some may believe, surgical capacity-building requires subspecialty involvement. This viewpoint article focuses on the need for vascular surgical services in sub-Saharan Africa.

Cardiovascular diseases (CVD) and other noncommunicable diseases account for more than 70% of the mortality in low- and middle-income countries (LMICs). In Africa, the field of vascular surgery is relatively new, and the prevalence of peripheral vascular disease (PAD) in the region has not been well-studied.

In one cross-sectional study in rural South Africa, the overall prevalence of PAD was 6.6% (95% confidence interval, 5.6–7.7).¹ Moreover, a literature review by Kuschner and colleagues indicated that the prevalence of PAD in sub-Saharan Africa may be equal to or higher than that in high-income countries. The authors also noted a higher prevalence of PAD in high-risk patients, smokers, and those affected by diabetes.² 

According to a report by the World Health Organization, nearly 80% of the world’s more than 1 billion smokers live in LMICs. Thousands of women die every year from tobacco-related diseases in Africa, and this number will double by 2030.³ In Africa alone, diabetes affects an estimated 24 million people, and this number is predicted to increase to 55 million by 2045.⁴ 

There are no trained vascular surgeons in Zambia (20 million population) or Rwanda (15 million population). Ethiopia, the second most populous country in Africa (110 million), has only seven vascular surgeons.

The ACS H.O.P.E. collaborative hubs in these three countries provide opportunities for vascular surgeons to volunteer in clinical care, teaching, and research.

Since January 2023, 10 vascular surgeons have traveled to the region and provided more than 600 hours of service. The government of Rwanda has identified two general surgeons to be trained as the first vascular surgeons for the country.

In Lusaka, Zambia, there is an acute need and interest expressed by the University Teaching Hospital for initiating vascular surgery service, and in Hawassa, Ethiopia, there is a newly trained vascular surgeon eager to collaborate on improving vascular care.

ACS H.O.P.E. is committed to creating global learning spaces by providing surgeons of all specialties the opportunities to teach and learn in our collaborative global health communities. ACS H.O.P.E. encourages volunteerism in all subspecialities, and specifically in vascular surgery, to advance the care of vascular patients at our partnership hubs.

For more information, email acshope@facs.org.

Disclaimer

The thoughts and opinions expressed in this viewpoint article are solely those of the author and do not necessarily reflect those of the ACS.

Dr. Girma Tefera is Medical Director for the ACS Health Outreach Program for Equity in Global Surgery. He also is a professor of surgery and vice chair for global surgery in the Department of Surgery at the University of Wisconsin School of Medicine and Public Health in Madison.

References

1. Beidelman ET, Rosenberg M, Wade AN, Crowther NJ, et al. Prevalence of and risk factors for peripheral artery disease in rural South Africa: A cross-sectional analysis of the HAALSI Cohort. J Am Heart Assoc. 2024;13(1):e031780.
2. Johnston LE, Stewart BT, Yangni-Angate H, Veller M, et al. Peripheral arterial disease in Sub-Saharan Africa: A review. JAMA Surg. 2016;151(6):564-572.
3. World Health Organization African Region. Tobacco control. Available at: https://www.afro.who.int/health-topics/tobacco-control#:~:text=Nearly%2080%25%20of%20the%20world%27s%20more%20than%201,13%25%20of%20young%20adolescent%20girls%20use%20tobacco%20products. Accessed July 25, 2024.
4. World Health Organization. Integrated African Health Observatory. Analytica fact sheet. March 2023. Available at: https://files.aho.afro.who.int/afahobckpcontainer/production/files/iAHO_Diabetes_Regional_Factsheet.pdf. Accessed July 25, 2024.