Building better heart care in Kenya

December 4, 2015 – DCRI and Duke researchers are working to build stronger systems of cardiovascular care in Kenya and other developing nations.

DCRI and Duke researchers are working with Kenyan partners to build stronger systems of cardiovascular care in the African country.  Together they hope the lessons learned can be applied to other developing nations.

The partnership between the DCRI, Moi University and Moi Teaching and Referral Hospital cynthia-binanay-newsin Eldoret, Kenya, is described in a new article published this month in the Journal of the American College of Cardiology.

Despite the advances in cardiac care made in recent decades, developing nations still struggle to provide adequate cardiovascular care to their citizens. Approximately 80 percent of deaths from noncommunicable diseases, including cardiovascular disease, now occur in low- and middle-income countries. Healthcare resources in these nations are often limited, and those that are available are most frequently deployed to combat infectious diseases such as HIV and malaria.

“The need for cardiovascular care in these countries is great,” said the DCRI’s Gerald Bloomfield, MD, MPH (pictured left), senior author of the article. “There just aren’t enough people to provide the care that’s needed.”

To address this problem, the National Heart, Lung, and Blood Institute and the UnitedHealth Group launched the Collaborating Centers of Excellence (COE) program in 2009 to establish cardiovascular and pulmonary disease clinical research centers in low- and middle-income countries in partnership with institutions in high-income countries. The DCRI and Moi University received funding to create the first of 11 COEs in Kenya.

Applying the experience of similar work to control infectious disease in developing nations, the DCRI/Moi partnership began to build the infrastructure for a more robust cardiovascular care system in Kenya. The process included construction of a new cardiac care unit in Eldoret as well as creation of new models for leadership and governance, workforce training, care delivery, financing, supply chain management, and health information systems.

gerald-bloomfield-news“One of the biggest problems is training,” said Cynthia Binanay, MA, BSN (pictured right), lead author of the article. “It is a constant struggle to train new staff members while still providing needed care to patients.”

Despite challenges, the DCRI/Moi partnership has made a significant improvement in cardiovascular care in Kenya. The cardiac care unit has grown consistently in volume since 2011. COE Kenyan and North American trainees and faculty have led numerous projects to address local cardiovascular issues, including hypertension in rural populations, peripheral arterial disease among diabetics, and task shifting the use of hand-held cardiac ultrasound.

They have also received awards from institutions including the Fogarty International Center of the National Institutes of Health, Fulbright Program, and Doris Duke Foundation.

The primary lesson of the DCRI/Moi partnership is that building relationships is essential to the success of any collaborative, global venture. Where bonds of trust and respect are established, the researchers concluded, public-private projects designed to deliver robust cardiac services can succeed in low- and middle-income countries.

“I would hope that people could use this partnership as a road map,” Bloomfield said. “We think this approach to building sustainable cardiovascular care opens up a sea of possibilities.”

In addition to Binanay and Bloomfield, Duke authors of the article include G. Ralph Corey, MD; John E. Lawrence, MD; and principal investigator Eric J. Velazquez, MD.