I applaud the efforts of the Namibian authorities in starting a cardiac program to address the needs of Namibians in this regard. We are often told in Africa that cardiac surgery is a luxury, that malaria and other communicable diseases kill more of the populace than cardiovascular disease and our governments should therefore focus our little resources on combating communicable diseases. While this is true, it is also true that we have a significant burden of cardiovascular diseases that not infrequently require surgical intervention. These patients also need care and must not be side-lined. The cost of caring for them often goes far beyond the means of the majority of these patients. Worse still, setting up centres equipped with facilities and personnel to provide modern cardiovascular surgical care does not appear to be on the priority list of most African governments. The result is that patients requiring cardiovascular surgery in particular only end up with drug treatment, needless reduction in lifespan and quality of life. Indeed, cardiovascular centres that provide surgical care are so rare on the African continent it is no surprise that the author of the article cites only South Africa and Egypt as the only countries providing such care though this view is erroneous. As a cardiothoracic surgeon at Ghana's National Cardiothoracic Centre, I also used to think several years ago that Ghana was only the 3rd country after South Africa and Egypt to offer cardiothoracic surgical services and open-heart surgery. I soon learnt however that there were other cardiac centres in the Ivory Coast, Nigeria, Senegal and Sudan where open-heart procedures are successfully performed. In spite of the many challenges we face, among them poor funding and lack of health insurance cover for cardiothoracic surgery, I consider our situation in Ghana as a blessing: 7 resident qualified cardiothoracic surgeons attending to a population of more than 20 million, a Ghana Heart Foundation (non-governmental) that assists Ghanaian patients with 50% of the cost of surgery and a National Cardiothoracic Centre (under the leadership of Prof. K. Frimpong-Boateng) that has been operating consistently since 1992 averaging about 200 cases a year (mostly rheumatic heart disease and congenital heart disease). I consider therefore the efforts of the Namibian health authorities in setting up the cardiac unit as really commendable. The emphasis on training Namibian surgeons and raising an indigenous team to ultimately provide the care initiated by the South African team is appropriate. Our experience in Ghana suggests that sustainability of such a program is best accomplished with a trained and resident team of care-givers. The South African team also deserve commendation for their efforts; it takes a lot of sacrifice and hard work to start a cardiac program especially if it is not on home soil.

I would also like to line up to congratulate the Namibian government for starting a cardiac unit and being able to offer cardiac surgery to its citizens. Congratulations to you all. I would however like to set the records straight and correct an error in this story. Kenya currently has three functional cardiac units, the oldest have been opened in 1974. This being the Kenyatta National Hospital in Nairobi. Until the opening of this unit in Namibia, patients from Namibia were being operated in Nairobi. Please advise all your Namibian readers that all three units are still very functional and have never closed down. On the contrary we are expecting one other unit (ptivate),to start offering regular cardiac services soon.

Prof Stephen Ogendo Cardiothoracic surgeon Nairobi