Afro Echo Course 2019
History
Dear Colleagues,
It is our great pleasure to invite you to join the InterCor team and to contribute with your clinical experience, wealth of knowledge in cardiology and team spirit by engaging in teaching the young generation Ghanaian physicians to improve cardiovascular healthcare for the underserved communities. This initiative is addressed to active and retired cardiologist volunteers and Chiefs of cardiology centres to support this mentorship program.
Background
Currently, sub-Saharan Africa (SSA) does not have adequate qualified cardiology capacity to cope with the high demand of cardiovascular services. Every third/fourth adult African is confounded with cardiovascular disease risk factors such as diabetes II and hypertension. Physicians in sub-Saharan Africa (SSA) are challenged with early and proper diagnosis and the treatment of congenital heart (CHD) and rheumatic diseases (RHD), tuberculous constrictive pericarditis (CP), endodmyocardial fibrosis (EMF), hypertensive and arryhthmogenic cardiomyopathies at various clinical stages followed by degenerative valve (DVD) and coronary artery diseases (CAD).
The major reasons for this initiative is the alarming situation in cardiology capacity and services in Africa. Ghana has only one board certified paediatric cardiologist and 13 adult cardiologists for the 29.8 million population (11 million under 15 years of age). The situation therefore, demands immediate training programs in echocardiography to improve the capacity and accessibility for echocardiographic diagnostic services for the underserved communities and to support perioperative cardiac care.
Purpose of the Cardiology Missions
To teach clinicians and residents echocardiographic diagnostics. To strengthen cardiology capacity and improve cardiology clinics and services. To bring the underserved population to a stage of diagnosis for proper conservative (Phase II) and surgical (Phase III 2020) therapies of their cardiac diseases.
The cardiology clinics will provide:
Retooling of intensive care unit to manage critically ill patients, develop cardiology emergency training and management and develop an infrastructure for interventional cardiology and postcardiotomy care. Thus saving lives of underserved population with CHDs and RHDs.
Cardiology Missions in 2018/19
While addressing strategies for training programs in cardiology and cardiac surgery for young generation Africans, InterCor has already begun echocardiography courses in Ghana since September and December 2018 to tackle the increasing demand for cardiologists.
The Cardiology teams/Partner clinics 2018
Dr. Andreas Kaestner, Private Paediatric Clinic, Berlin, Dr. Mustafa Yigitbasi, Prof. Dr. Charles Yankah, Deutsches Herzzentrum Berlin and Dr. Himal Dama, Heart Centre, Durban.
The Cardiology teams/Partner clinics 2019
Dr. Andreas Kaestner, Private Paediatric Clinic, Berlin, Dr. Mustafa Yigitbasi, Prof. Dr. Charles Yankah, Deutsches Herzzentrum Berlin, Dr. Ektarina Ivanaskaia, Heart Clinic, Coswig,
Dr. Henning Kuehne, Interventional Cardiologist, Berlin.
Dr. Ulrike Doll, Dr. Sheeraz Habash and Dr. Joerg Shirmeister, Dept of Paediatric Cardiology, Universitätsklinikum Erlangen
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AfroEcho 2019
Bachelor Class & Master Class Intermediate & Advanced Echocardiography Course
Dear Colleagues,
On behalf of the Organizing Committee, it is my great pleasure to welcome you to Afroecho Imaging 2019 at the Cape Coast Teaching Hospital, Ghana. The echo workshop is organized by PASCaTS and African Cultural Institute in collaboration with German Heart Centre Berlin and University Hospital Erlangen and the PASCAR in conjunction with the German/Ghanaian hospital partnership program with Cape Coast Teaching Hospital. The project is designed as a national capacity building program structured in three sessions to take place in March, May, September and November 2019. The courses will provide skill training in bachelor class basic, master class intermediate and advanced echocardiographic imaging techniques. Each course comprises of:
1. Power point presentations on cardiac anatomy and pathology of acquired and congenital heart diseases in the mornings,
2. hands-on echocardiography training sessions on paediatric and adult volunteers and patients in the afternoon,
3. discussions and
4. assessment of the course by the trainees.
The organizers have recruited twelve distinguished cardiologists who will mentor the trainees during the year on rotation. Two tutors will be available at a time for each session, with exception of April with one tutor.
Participation is by invitation. The trainees will interact closely with the tutors who will share their wealth of knowledge in cardiology and clinical skills in the rapidly evolving field of echo imaging. The knowledge and echocardiographic skills acquired during the courses will transform the medical career of the trainees to become better doctors than before. Ultimately, the underserved patients will have more access to echocardiographic diagnostic and benefit from improvement of treatment of their cardiovascular diseases.
The workshop will develop a network for a mutual exchange of ideas, transfer of knowledge and cooperation between the trainees and the faculty.
Yours sincerely.
Charles Yankah
Prof. Charles Yankah, MD, PhD
AfroEcho Course Director
President, PASCaTS & ACI
Professor of Surgery
Charite Medical University Berlin
Cardiothoracic & Vascular Surgeon
CEO & Founder Global Heart Forum
German Heart Centre Berlin
Aims
To grow the field of cardiology in the regions of Ghana with echocardiographers.
To improve cardiology services, accessibility and affordability of echocardiographic services in the communities.
To bring the underserved communities to a stage of early diagnosis that will enable them to pursue to early and proper treatment of their heart diseases.
To strengthen the universal health coverage at the secondary and tertiary level.
Objectives
The objectives of the echocardiography courses are:
To provide training in imaging of cardiovascular system, perioperative diagnostics of acquired and congenital cardiovascular diseases among paediatric and adult populations.
To appreciate the frontiers for conservative treatment of acquired heart diseases.
To define prognosis of acquired and congenital heart diseases.
To learn in particular, the indications and timing for surgical management of acquired and congenital heart disease.
To appreciate the benefits, quality of life and prognostic value after valve repair and replacement.
Goal
The trainees will be able to perform and interprete echocardiograms in children and adults.
Target groups
Physicians, Paediatricians, Adult & Paediatric Cardiologists, Anaesthesiologists, Intensivists, Senior Registrars.
Educational Tracks
Five to seven days of interactive education will be provided by the invited tutors. In the mornings they will present introductory echocardiography lectures on basic principles in echo imaging, handling, maintenance of echo machines followed by hands-on echo training on volunteers and patients under the mentorship of two tutors each with six trainees to a room
Lectures on cardiac anatomy and pathology
The introductory lectures aim at providing the foundation for understanding the anatomy and pathology of the heart and spatial relationships of cardiac structures. The tutorials will take the trainees further from the basics of echocardiographic imaging of normal hearts, simple acquired and congenital malformations through to the more complex cardiac lesions and demonstrations of pre- and postoperative echocardiographic imaging.
Hands-on echocardiography training
The mentors will take the trainees from the basic normal echocardiography (Find the windows, the long axis view, the short axis view, m-mode examination) and common valve lesions through to color Doppler examination. Under the guidance of the mentors the trainees will review patients with congenital and acquired rheumatic valvular heart diseases, learn how to assess heart chambers congenital and acquired valvular heart diseases and estimate pressures, transvalvular gradients and regurge.
Upon completion of the hands-on echo courses in two consecutive years the attendees would be able to:
- learn modern imaging diagnostic techniques in heart failure (e.g. pericardial effusion, valve lesions, dyskinetic heart) for their decision-making for conservative and surgical therapies and better outcomes,
- develop a perioperative management strategy based on echocardiographic evaluation in patients with valvular and congenital heart diseases,
- apply new treatment strategies for referring patients with rheumatic and degenerative valvular heart diseases for early surgery, particularly taking into account timing for valve repair surgery.
Certification/Course Credits
The courses participants will receive credit hours after presentation of their assessment forms and certificates on Bachelor Class Basic, Master Class Intermediate and Advanced echo imaging.
AfroEcho 2019
Bachelor Class & Master Class Intermediate & Advanced Echocardiography Course
Faculty Cardiology Specialists/Mentors
Paediatric Cardiologists & Congenital Heart Disease Specialists
Dr. Ulrike Doll, University of Erlangen, Germany
Dr. Sheeraz Habash, University of Erlangen, Germany
Dr. Lisa-Maria Rosenthal, German Heart Centre Berlin, Germany
Prof. Dr. Christine Yuko-Jowi, University of Nairobi, Kenya
Dr. Hidal Dama, Congenital Heart Centre, Ethekwini Hosp, Durban, SA
Dr. Ebrahim Hoosen, Nkosi Albert Luthuli Central Hosp., Durban, SA
Dr. Andreas Kaestner, Paediatric Heart Clinic, Berlin, Germany
Dr. Mustafa Yigitbasi, German Heart Centre, Berlin, Germany
Adult Cardiologists
Dr. Blanche Cupido, University of Cape Town, SA
Dr. Ekatarina Ivanitskaia-Kuehn, Heart Centre Coswig, Germany
Dr. Henning Kuehn, Berlin, Germany
Dr. Robert Wetzstein, Federal Defence Hospital, Berlin, Germany
Faculty Cardiac Surgeons
Dr. Susan Vosloo, University of Cape Town, SA
Prof. Dr. Charles Yankah, German Heart Centre Berlin, Germany
AfroEcho 2019: Bachelor Class Basic & Master Class Intermediate Echocardiography Course
(Adult and Paediatric)
Curriculum
Educational Tracks
Five to seven days of interactive education in March, May, September and November 2019 provided by experts on basic principles in echo imaging, handling, maintenance of echo machines, anatomy of cardiac structures, standardized examination, assessment of cardiac valves, ventricular functions.
In the mornings the two tutors will present introductory echocardiography lectures followed by comprehensive hands-on echo training in the whole afternoon on volunteers and patients mentored by two tutors each with six trainees to a room.
Curriculum: Echo Course CCTH Staff April 2019
Curriculum: Echo Course (Adult & Paediatric) March, May, September and November 2019
Program Overview
Theorectical Educational Tracks including
Technical Instructions on Echo Machine
Venue: CT Centre Building, Cape Coast Teaching Hospital
Saturday
13.00 hr Registration, 13:30 hr Welcome Address:
14.30-17.30 hr Introductory Echocardiography/ Cardiology & Surgical Lectures:
Sunday
09.00-17.30 hr Introductory Echocardiography/ Cardiology & Surgical Lectures:
Monday-Friday
09.00-12.00 hr Introductory Echocardiography/ Cardiology & Surgical Lectures:
12-13:00 Lunch break.
13:00-17:30: Hands-On Echocardigraphy Training
(On four volunteers and previously registered OPD children and adults with heart diseases, in-patients with congenital and rheumatic heart disease)
Tutors for Group I: 6 participants, Group II: 6 participants
15.00 Coffee/Tee Break
15:30 Hands-On Echo Training (Cont’d)
Tutors for Group I: 6 participants, Group II: 6 participants
Adjourn: 17:30 hr.
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Curriculum in Summary
Basic principles of ultrasound
Setting the echo machine, standard acoustic and transducer positions. Artifacts.
The mentors will take the trainees from the basics of normal to pathological echocardiographic imaging:
(Finding the windows, the long axis view, the short axis view, m-mode examination) and common valve lesions through to color Doppler examination.
Measurement and quantification of heart chambers, Jets, Vena contracta.
RA/LA and RV/LV morphology, dimensions and function.
Assessment of heart valves and valvular heart diseases.
Estimation of pressure, transvalvular gradients and regurge. The loops.
Under the guidance of the mentors the trainees will review normal/asymptomatic individuals and patients with congenital and rheumatic heart diseases.
For further enquiries or more information please contact Prof. Dr. Charles Yankah, Phone: Local: 0260- 922575 or International: +49-172-3020143
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Opportunities & Challenges of Telemedicne
in Low & Middle Income Countries
Prof. Dr. Charles Yankah*
Professor of Surgery, Cardiothoracic & Vascular Surgeon, CEO, Founder Global Heart Forum
German Heart Centre Berlin/Charite University of Medicine Berlin,
President, PASCaTS
Director of RHD Research, Director, Capacity Building in Echocardiography/Cardiology in Ghana, Africa
International Clinical Video Conference 2015
Pediatric Cardiology & Cardiac Surgery Berlin,
Bloemfontein, Ile-Ife, Nairobi
Digital Health: Challenges & Opportunities For Enhancing the Health Systems In Africa
Digital Cardiovascular Health Care
“Tele”: Distance (Greek), “mederi”: to heal (Latin)
Self-Testing and Telemonitoring/Self Management
“Tele”: Distance (Greek), “mederi”: to heal (Latin)
Self-Testing and Telemonitoring/Self Management
Digital Health: Personalized coaching/ disease management program.
Improves treatment adherence, reduce CV complications and mortality
Digital Health: Tele-Echo-Consult
Telemedicine For Enhancing Cardiovascular Health, Education and Training in Underserved Regions
Conclusions
It facilitates personalized coaching/ disease management program.
It enhances public healthcare educational programs (prevention, disease management and aftercare),
It improves treatment adherence, reduce cardiovascular complications and mortality.
Telemedicine For Enhancing Cardiovascular Health, Education and Training in Underserved Regions
Conclusions
It provides collaborative learning opportunities in clinical practice, skill training and clinical science to improve patient care,
It transcends geographical barriers to bring colleagues closer and closer in a network,
It facilitates sharing of clinical experiences and of recent advancements in medicine to improve patient care and outcome.
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TELEMEDICINE: OPPORTUNITIES AND CHALLENGES OF TELEMEDICINE IN LOW & MIDDLE INCOME COUNTRIES
Prof. Dr. Charles Yankah*
Professor of Surgery, Charité, University of Medicine Berlin, Cardiothoracic & Vascular Surgeon, CEO, Founder Global Heart Forum, German Heart Centre Berlin.
President, Afrika Kulturinstitut e.V. & Pan-African Society for Cardiothoracic Surgery (PASCaTS)
Director of RHD Research, Director, Training Centre for Ultrasound Diagnostics (Echocardiography) Cape Coast Teaching Hospital, Ghana in Collaboration with German Heart Centre Berlin sponsored by Edwards Lifesciences Foundation*.
Director, German/Ghanaian Hospital Partnership Program with Cape Coast Teaching Hospital.
1. What is Telemedicine?
“Tele” is a Greek word meaning “distance “and “mederi” is a Latin word meaning “to heal”.
The World Health Organization (WHO) defines Telemedicine as, “The delivery of healthcare services, where distance is a critical factor, by all healthcare professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation and for the continuing education of healthcare providers, all in the interests of advancing the health of individuals and their communities.”
2. Historical background
My clinical experience in telemedicine goes back to 1986 at the German Heart Centre where we monitored rejection episodes of our heart transplant patients by ecg signals from two wires inserted into the myocardium of the transplant connected to pacemaker battery implanted under the abdominal muscle of the patient.
In 14 century the traditional Chiefs of Ghanaian village Anomabu and the Ashanti palace used drums acoustic and smoke signals to warn civilians about disease epidemics.
In the 60’s the NASA was using tele-monitoring system to control the vital signs of their pilots and crew during missions.
3. What can telemedicine offer to promote sustainable programs in healthcare?
- Strengthen the health systems at all levels
- Improve quality care in health education, disease management, patient care, public health, research and administration
4. Our vision
- To define the trends, challenges and opportunities for applying digital health and telemedicine in Africa at primary, secondary and tertiary healthcare.
- How to create secondary and tertiary healthcare impact esp. cardiovascular health in the communities with over 80-90% users of mobile phones in Africa?
- Build a strong cardiology program to strengthen cardiac surgery services for efficient care.
- Advance networking and collaboration in the use of digital technology to improve cardiovascular health outcomes.
5. The Concepts of Telemedicine
Store, Forward and Remote Monitoring of Data (Availability of data at anytime)
To accelerate and improve medical attention and treatment in regions with limited resources and infrastructure
Patients‘ data interpretation service:
Transmission of images and vital parameters: Ecg, BP, Echo, Blood Sugar, INR, CT, MRI other laboratory results for
- Consultation
- Diagnosis (e.g. hypertension, congenital & acquired heart valve and structural diseases)
- Treatment (Medical/Surgery)
- Telemonitoring (pacemaker, AICD, blood pressure, blood sugar ecg etc.)
- Data banking
6. Telemedicine/ Telecardiology/e-Health For Africa
Africa remains the region with the highest costs for health care. The advances in technology in wireless connectivity will provide us important cost-effective new tools for diagnosis and treatment.
Telemedicine/cardiology offers rapid online information and interpretation and reporting services of images such as echocardiogram, MRI, CT scan, vital signs (BP, ecg,HR) and laboratory studies (Blood sugar, INR levels, Creatinin, Urea etc). A team of qualified and experienced experts (cardiologists, radiologists, clinicians and laboratory physicians and scientists) are required to offer a turn around time services between 8 – 22 hours and at emergencies. It will help doctors to evaluate and suggest the right treatment started at the earliest time possible.
7. Objectives of Outreach Videoconference Program
The outreach videoconference program in conjunction with our international cooperation provides an opportunity for promoting a sustainable dialogue between institutions in Asia, Africa and South America in the context of transfer and sharing of knowledge with colleagues on the African continent and world-wide.
Our monthly video conference program on the first Friday of the month at 15:00 hrs (MET) provides a north-south and south-south dialogue in cardiovascular medicine and surgery conceived to realize the objectives of our international cooperation.
7.1.To establish virtual classrooms, inter-hospital and inter-institutional video teleconferencing network.
7.2. To promote outreach educational programs, transfer of knowledge and know-how in cardiovascular medicine and surgery and facilitating multi-site national and continental interactive healthcare education.
7.3.To provide sustainable continuing educational programs for registrars, cardio-thoracic surgeons, cardiologists, cardio-thoracic anaesthetists, intensivists, nurses, perfusionists and other allied professionals.
7.4.To promote sharing of knowledge, stimulating scientific research work and international collaborative research programs.
8. Curriculum and non-curriculum telemedicine training programs in Africa
In 2007 the African Cultural Institute (ACI) and the Global Developing Learning Network (GDLN) of the World Bank started a telemedicine programmme in Ghana with GDLN-based video teleconference network across the African continent (12 countries see map).
The programme was organized at the GDL centres in Accra (2007) and in Dar es Salaam (2008) which bridged the transmissions of live surgery from Germany to the VTC network at Ethiopia, Ghana, Kenya, Mauritius, Tanzania and Uganda.
The programme continued at the German Heat Institute Berlin (Deutsches Herzzentrum Berlin) in 2012. It was initiated to implement various national-level projects and extending telemedicine services to medical institutions in African countries (Kenya, Nigeria and South Africa). It aimed at enhancing quality health systems in collaboration with premier medical institutions and provide healthcare education to strengthening healthcare services in the rural and remote parts of the country.
Telemedicine in African, Carribean and Pacific (ACP) states: ACP with its 79 member states is an ideal setting for tele-cardiology/telemedicine.
9. Collaboration in telemedicine in Africa
There is a need to define the Standards for Telemedicine Systems.
9.1. To promote government and private telemedicine solution providers, societies and associations to actively engage in creating awareness about telemedicine within the ACP countries.
9.2. For enhancing healthcare in women: Tele-sonography (utlrasound diagnostics) is highly beneficial in obstetrics and gynaecology (OB/GYN) for fetal, neonatal and maternal physiology monitoring from a distance. It could provide a detailed fetal and maternal morphological and structural echo images and the heart function from a distance.
9.3. To provide own telemedicine programmes within the context of south-south triangular cooperation.
9.4. To revolutionalise patientcare in remote areas of Africa, where there is no access to a cardiologist, pediatric cardiologist or radiologist.
10. Remote diagnosis to fill the capacity gap in the rural areas. Opportunities for applying telemedicine in Sub-Saharan Africa
In sub-Saharan Africa (SSA), excluding South Africa, with a population of over 1.1 billion people, there are only est. 40 qualified paediatric cardiologists and they are concentrated in the big cities.
A technology that provides screening of patients for whether they need treatment or not.
Patients in remote areas of SSA have no access to a diagnosis. They can't move on to the stage of management because there is no diagnosis, they don’t even know what the problem they have. Traditionally, patients have come to city clinics and hospitals by several means - either by train or bus or a car or on foot – to get an examination and diagnosis.
Application of satellite-based technology and fiber optic cables will provide 70-80 % mobile phone users in Ghana and elsewhere an efficient telecommunication infrastructure for developing patient-doctor, and patient-nurse relation and consultation system for personalized coaching and disease management program to improve treatment adherence, reduce cardiovascular complications and mortality.
A tele-echocardiography, could provide cardiac diagnosis and an appropriate management plan for many patients in remote areas. If they then need some interventions in terms of a heart catheterization or surgeries they can get on a train or bus and go to a specialized centre to have it done.
11. How to implement telecardiology system
11.1. Training of medical technicians/nurses in echocardiography (M-mode, short and long-axis view, two-/four-chamber views etc). InterCore-PASCaTS trained two nurses for itsr RHD research in Ghana to screen 4763 students for RHD.
11.2. Trained technicians performing echocardiography (echo), using the right technique and transferring the proper images to central echo lab for interpretation.
12. Cost: Low cost solution
12.1. Investment for echocardiography machine
12.2. Video phone hooked to the echo machine. The video phone is connected via ISDN and the physician at the central echo laboratory can view the echo images that have been made. It’s a real-time review.
- Running cost/month
- Tele-echo service (transmission of data/findings to patients and practitioner (patient’s physician)
13. Two techniques for transmitting echo images
13.1. One solution is a videoconference. A video phone can be hooked to the echo machine. The video phone is connected via ISDN and the physician in the city echo laboratory can view the echo image that is being done. It’s a real-time review. The echo lab cardiologist looks at the echo image and talk with the remote echotechnician. He also sees the patient or parent and and talks with them when the echo is done. So it has certain advantages.
13.2. Web-based method. With a low-cost software one can plug in from the echo machine (heart ultrasound) straight on to a computer. It’s uploaded onto a server and then it is downloaded to a cardiologist who reviews the images and informs the patient about the diagnosis the same day or next day. This approach is an alternative (asynchronous) solution especially when there is a shortage of cardiologists.
13.3. Telecommunication systems deployed in telemedicine solutions
There is penetration of satellite into all these remote areas.
Although satellite is good for text data and voice, it is not great for images because of the delay time. That’s the problem. ISDN video is a good preferable link but the ISDN connections are limited in small towns in ACP states. Even cable modems are not available in many small towns. One could probably see a boom in this kind of technology in the next decades.
14. Key factors that have made telecardiology work.
Requirements
- Setup protocol for telemedicine solutions
- Bandwidth
14.1. Type of ultrasound device,
- Compatibility (e.g with DICOM etc.)
- In certain situation on-site inspection of the IT manager from the hospital to set it up.
- Once the remote infrastructure is figured out the interconnectivity can be setup.
15. The workflow
15.1. For emergencies the cardiologist will be reached by his cell phone and ask them to review the case in real time.
15.2. For routine echo interpretation the remote echo technician sends an e-mail, sms requesting a review of the echo images via the web-based system.
16. Recommendations to institutions and health authorities that are looking to implement a remote imaging program
16.1. Telemedicine can revolutionize patient care in remote parts of the ACP countries where there is no access to a cardiologist, pediatric cardiologist, or radiologist.
16.2. The project should have low-cost solutions. High-cost solutions are not practical.
16.3. It should be a robust system that is not completely infrastructure dependent; they need to work on an ISDN or cable line.
16.4. If it is used effectively, remote diagnostic imaging can certainly make life much better for patients.
17. Telemedicine benefits in summary
- Personalized coaching/ disease management program.
- Enhances public healthcare educational programs (prevention, disease management and aftercare),
- Improves treatment adherence, reduce cardiovascular complications and mortality
- provides collaborative learning opportunities in clinical practice, skill training and clinical science to improve patient care,
- transcends geographical barriers to bring colleagues closer and closer in a network,
- facilitates sharing of clinical experiences and of recent advancements in medicine to improve patient care and outcome.
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