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Okay. Hello. Good evening, everyone. Can you get me, please? Hi. Good evening. Okay. So, uh, I'm going to be a presenter for today, so give me one second, Please. Let me clear my screen. Okay? Facing some some difficulties to share my screen. I don't know if someone could help me with that. Please, uh, Mr to me, please. Can you help me with how I can share my screen, please? Uh huh. Good evening. And, uh, good evening, everybody. Hope you're having a very warm evening. Um, I'm full. I'm full of some. Well, as you can see on this slide, I'm a medical students from the Catholic University of Cameroon, and I'm going to be doing the presentation for this evening. So sorry for all the inconveniences, I had some difficulties. Well, I'm going to be presenting a very interesting paper titled Six billion people have no access to see timely and affordable carjack surgical care, as you can see on the slides. So this is, uh, research carried out by a group of, uh, scientist medical doctors who wanted to expose how one of the main difficulties cataract surgeries, visiting now and yeah. So why did this got my attention? Well, I mean, I'm a cardiac surgery enthusiast, and also doctor dominant vote is recommended to me. So that's the main reason. So next night, peacemaking. Um, Beckett next slide. Okay. Thank you. So if at any point you're you're not getting me, please let me know. So, um, this is a brief description of our paper, um, cardiac surgery or cardiovascular surgery. Is surgery on the heart or great vessels performed by cardiac surgeons? Basically, that's how we can define cardiac surgery. Any surgical operation, um, carried out on the heart or great vessels of the human body when you say great vessels mean the inferior vena cava, superior vena cava, aorta or any other great vessels and, uh, usually cataract cataract surgery is used to treat heart disease is Obviously you cannot carry out the surgery for funds. It must be for a reason for because there is a disease. Um, and you can see some cardiac diseases mentioned here. It also includes heart heart transplantation. Yeah, for people who have, um, damaged hearts, they require heart transplantation. And if you have to get back a little bit in the store, you know that uh, the first heart transplant ever was done in South Africa. Just that's just on that side. Next. Like that, please. Okay. Introduction. So this article was published by a team of healthcare professionals to raise awareness on the alarming situation of cardiac surgery worldwide. And believe me, the situation is more than alarming. Alarming is an understatement. And as we've been going forward with representation, you come to realize how deplorable the the condition of cardiac surgery is right now. Globally. Um, this article was published by CVS. Very, very pronounced and reputed. Right now on behalf of American College of Cardiology Foundation in 2022 is a very recent paper, too. Okay, So, back to the next side, please. Okay. The background of the paper. Six billion people lack access to safely. Sorry that safely, timely and affordable cardiac, surgical, cardiac care and cardiac surgical care globally story. So you can imagine the the amount of people dying in the world because the lack, um, cardiac surgical care. And if you if you read often, you would know that one out of three people suffer from cardiac disease, require surgery. Yeah, and if you were to sum of all the people will lack access to cardiac surgery would be having over six billion people. That's huge, right? So cardiovascular diseases are the leading cause of morbidity and mortality worldwide. We all know that non communicable diseases are the leading cause of death worldwide, but cardiac disease, cardiovascular disease at the top. But then we still have a large gap in the cardiac surgical workforce. Um, I focus too much on cardiac surgical workforce. Only because we're hearing a in the in the context of surgery, I wouldn't be talking about nonsurgical cardiac here. That would be that would be out of topic. So most cardiovascular diseases Sorry. One third of cardiovascular disease require surgical or interventional kids. Oh, yes. Most, um, cardiovascular diseases are more prevalent in low and middle income countries, whereas the majority of surgeons practicing high income countries ironical right. So you see, the majority of the population lives in low and middle income countries. Most of people suffering from cardiac problems or cardiovascular disease is live in low and middle income countries. But then the majority of surgeons cardiac surgeons are in high income countries, and we'll come to understand some of the reasons why? Um, there is this gap, Kay, Next plate, please. Okay, so here are some statistics. Sorry. Over 100 countries and territories lack cardiac surgeons globally. Um, I don't know if you can get me. I hope so. Okay, So although over the majority of the population lives in low and middle income countries, most cardiac surgeons practice in high income countries. Um so this is a sort of comparison between high income countries and low and middle income countries. In high income countries, you have 7.57 point 15 cardiac surgeons per million population, which is quite much are supposed to low and middle income countries where you have 0.4 cardiac surgeons. Pen, medium population, which is extremely, um, minor. Compared to the high income countries in pediatrics cardiac surgery, you have 9.51 pediatrics, cardiac surgeons per million pediatric population. So and supposed to 0.7 pediatric cardiac surgeons per million pediatric population. And so you see Children with the etiology of a load or any other heart disease risk of dying in low and middle income countries. So you see how bad the situation is next. Like please. Mm. So sorry. So this was actually supposed to be a map that would show us rich countries are termed high income countries and which countries are terms low and middle income countries, Because some of us are not too good, anything geography. So that so that we have an an idea of which country we're talking about. But it's not very, very clear here. Also. Sorry for that, uh, high income countries. We look at the United Kingdom's Canada, the United States of America and most European countries. Um, back in next five days. And when we see low and middle income countries, we mostly look at Africa and South America. Some aphasia. Okay, so, um, one of the problems facing in cardiac surgery, gender inequality, gender inequality so you can see gender inequality affect almost all the means. We know gender inequality affects health, but it affects cardiac surgery as well. So sad. Um, so for sustainable development, global enthusiasts just on this side, um, let's try to see how we can try to breach this inequality in cardiac surgery because you must always start from somewhere. So, yeah, women are highly on on the represented in the cardiac surgery workforce, 6% in the US A. And 11% in Canada. So out of 100 cardiac surgeons in America have six women. That's I don't have a term to describe it, but that's really that's a really heartbreaking Uh, and in Canada, you have about 11 female cardiac surgeon out of 100. That's really bad. A review of the cardiothoracic Surgery Network data base suggest only 3.7% of cardiac surgeons are women in sub Saharan Africa. And we all know that in Africa we have more women than men. But still them women are very, very under represented in the cardiac, uh, surgical workforce. That's really bad. The institution could have been better if, uh, they were more ladies, because we're only in Africa. There are more women than men, obviously. But then women are still highly, um, presented in this to me. Also, women are prevented from getting involved in cardiac surgery due to social onto social norms, cultural norms, especially in Africa. Next slide, please. Okay, Now, let's, um let's try to observe the cardiac. The situation a region that Africa, South America, North America to be able to have an understanding of which areas are better worse than which other ones. So we have Asia Pacific region. Iceland's and states in this region have the world's largest relative. Rheumatic heart disease and other risk factors like diabetes keep on increasing. But currently there is only one cardiac surgeon pay 12 million people across this rhythm. So although in the entire world they have the highest, um, relative rheumatic heart disease and other risk factors like diabetes, they have only one million. One cardiac surgeon paid 12 million people. That's really miserable, as compared to 7.5 cardiac surgeons, million population in high and in high income countries. You can really see the gap right and also the nations in this region. Collaborative facilitated healthcare delivery by investing more in a research by investing in research and and in order to mean that can help better cardiac surgical work force in this region next, like this. Okay, so central and Central and South America, this is North America. Okay? Cardiac surgeons are very unevenly distributed across these two regions, meaning you know, North America is the richest part where you have the United States. You have Canada. Meanwhile, South America is quiet is among the low and middle income countries. So, uh, as a result, you have more cardiac surgeons in the northern part of America and very little cardiac surgeons in the southern part of America. So in Northern America you have 5.4 times more surgeons than Central and Southern and South America combined. So North America alone has 5.4 times more cardiac surgeons than South and Central America. So this is a comparison. South and Central America. They have the the population 650 million. Meanwhile, in North America we have 370 million. The number of cardiac surgeons in South and Central America are not up to not up to 8747. Meanwhile, in North America, you have almost 4000 cardiac surgeons. So you see, um, I don't know if I should call it by us, but no, it's not really by us, but it's an even distribution, which is not very good. Um, next night, please, um, baking. It's like please. Okay, now we have the Middle East, North Africa. It's two regions share a lot of similarities and possess several centers of excellence. Let me see centers of excellence. We look here at the training centers institute institutions where the train, cardiac surgeons. But however, the training system is more research oriented than clinically oriented. If you read the people to refer you to see that, I mean this part the offer it must. They often offer programs with master's in surgery as opposed to residency in surgery. So the programs they are more oriented towards research. Meanwhile, the population needs more of, uh, of clinicians. Yeah, so that's one of the weakness is in this region. Yeah, And next night, please. We have Europe. Educational system is robust, very robust. And generally, um, young practitioners young, uh, medical practitioners from low and middle income countries moved from their countries to to to Europe to get a training, and they prefer returning to their country later on. But most of them even decide to work in high income countries because you see, in low and middle income countries do not have the necessary funds to be cardiac surgeons as much as in high income countries. So obviously those who are those who are driven by don't know Those who are motivated by money by wealth would obviously want to go and work in high income countries. Also, the training is quite expensive. So at the end of their residency, they would all just want to work in a country where it will be paid enough money. So the ability to compensate what they used to to pay their training, their residency program. Okay, so, um, several European countries, our destination for surgeons from low and middle income countries to train and return home. Like I said, not all of them returned home. Uh, everybody loves greener pastures. Almost everybody. Next night, please. We have Asia, South Asia, Southeast and East Asia. This region is homes over half of the world's population, but only 19.4% of cardiac surgeon practice here. So if you have to use percentage is more than 50% of the world's population live in Asia. But not up to 20% of cardiac surgeons practice in this region. I don't know if you feel like the way I feel that I feel cardiac surgery is it's an issue that that should be really looked into. I don't know what w issue has done about it so far. But you should really do something about it because it's really so bad. And the number of of cardiovascular disease patients keeps on increasing the situation is not going to get better any time from now. It's really this the institution really has to be looked into. Okay, um, several centers in India and, um, and China. Sorry, that was supposed to be India and China from the highest annual contact surgery volumes in the world. Next five, please probably be due to the high prevalence of, uh, cardiovascular disease is in this area like you mentioned earlier. The Asia Pacific region, um, have the highest risk of the highest prevalence of rheumatic heart disease and risk factors like diabetes. Next slide, please. Next. Okay, Now, the worst of all, sub Saharan Africa has the lowest workforce density with 0.12 cardiac surgeons per million population. You can imagine very few accredited training programs. Surgeon strains in Africa, most cystic jobs in high income countries to stick high paying jobs. Um, actually, in in Africa, um, in West Africa, the only country where the train cardiothoracic surgeons. Um, my knowledge is, uh, Ghana. In West Africa, you have Namibia. Kenya? Um, in southern Africa, you have South Africa in Central Africa. Actually, there's no country training in graduate thoracic surgery. So I really ask myself, How do the patients the How do they live if we're too big? In the case of Cameroon, for example, the country, my country, there are three cardiac surgeons for over 25 millions of people you can imagine. I can imagine how bad the situation is. And the only cardiac surgeon that that was present in the country is normal, functional due to a social political crisis. So, you see, cardiac surgery is so the situation is so bad, and it really has to be addressed. Um, very, uh, I spoke about that surgeon strains in Africa. Must be sick. Yeah, Like I said, everybody loves greener pastures, almost everybody. And sometimes it's not necessarily because they love greener pastures. Sometimes it's because they get student loans to pay the residential programs and they try to compensate. Yeah, so those are some of the reasons. So the next night, please, that's all. For the original perspective. I hope you have an idea of how, uh which regions, um, have a higher work force. Which ones have a lower workforce. If any of you become the direct W W H. One day, you would know which region to tackle first and according to make sure the sub Saharan Africa or Africa in general. Next, like please, um, I hope you all are enjoying the presentation. Okay, The way forward, like any other problem, is always a solution. There are always solutions. So what's the way forward to bridge the gap in cardiac surgery and increasing the workforce? Um um And in reducing the the rate of mortality and morbidity across the world next night, please, that's the one line description. Next light, please. Okay. Scaling the global workforce of cardiac surgeons requires attention in three main areas. Education, research and funding. Please. If you're listening to this presentation right now and your medical student who is not yet involved in research, please, I don't know how you're going to start. Get a mentor, get close to someone who knows about research. What reduced on YouTube because researches the way forward. I don't think there's there's something you can do in medicine. Something innovative you can do in medicine or in any healthcare domain without research, policy implementation. You need research. New vaccines, new. Almost everything turns around research. So if you're among your healthcare student and you're listening to this right now, please, just a little bit of research is going to help you a lot. So much. And funding. That's a problem that the the health system is faces in almost all countries. You have medical doctors, nurses and other health care workers have the intelligence it needs. You having the motivation. You have the passion. You have everything that requires. But one thing we still don't have in high enough quantities. Funding? Yeah. Funding. Funding. Yeah, Education. We have a team approach to be adopted through educational activities that that team based as opposed to individual based training. So now the term had team. You know, for a cardiac surgeon to be done, they haven't quite, um, dedicate organ because the vascular system is quite tricky. So, um, in order for for cataract surgery to be done effectively, it had an entire team is required. The surgeon, the anesthesia, the anesthesiologist, the the nurse, the attendant so cardiac surgeon doesn't turn around. The cardiac surgeons alone. So the all those who will be part of the hard time in the future would be trained with that at the back of their mind. They should be prepared right from their training, such that when they leave, um, they're training's. They already know where they should be found. Because when an anesthesiologist leaves, um, is a graduate from from school. What's the next? What's the next thing you do you find yourself working in any surgical operation who are. That's what they're trying to highlight here is that, um, all members of a hard time should be trained together. That's how not not together, as in the same environment, know. But with that perspective in mind, they should know that they're being trained to work in a hard time. I think it's better to understand that way. Also, a hard team member should be trained according to the community based approach so that they get adapted to the environment. They will be walking in exactly. Um, I think this is called, um, community based study your community based health engagement and focusing the term Yeah, it's better. You get dreams in the area where you're going to probably work. For example, card. The situation of contact surgery in Africa is different from that of America. So a cardiac surgeon working in Africa in Central Africa, for example, should really have it at the back of his mind. That I'll have to be running between two hospitals will have to be extremely busy to be able to satisfy the entire population, as opposed to a cardiac surgeon who you're operating in. The US who knows that well, there are enough cardiac surgeons. I'm working in one hospital only. So I've been working six days a week only. So that's important to to predispose them to, to help prepare their minds to help prepare them and all the lights. Next, please next, slightly so that that's, um, that's that's it for education. Those are the main areas where emphasis should be later on when it comes to education research. Currently, there is no comprehensive global registry, given a count of the number of cardiac centers and surgeons globally. So it's like you're trying to fight that anymore. It's not really no. It's not really easy to find someone who don't master someone who don't have every little detail about If we want to address these situations seriously, need to know that. Okay, These regions like this amount of cardiac surgeons as compared to the population. So if we're too to allocate funds or resources, we should start there. These results have more surgeons. Maybe we could try to convince the surgeons to go and work in areas where there's lower workforce. So not having a good number of the number of cardiac surgeons and center and cardiac centers throughout the world like fighting an enemy we don't really know. And it's quite difficult. Also, the population have that on cardiac surgical disease, burden, need and care should be provided. So, um, basically, the number of people who need cardiac surgical care should be known or should be made known. The number of people starting from contact diseases here and also the available workforce should be made known to so that we know the level of imbalance between the patients and the workforce. This will help inform policy plans and facility political prioritization. Yes, Like I said, you cannot fight an enemy. Don't really Sorry. Researched remains the report next night, please the funding. Like I said in medicine, we have almost everything in healthcare. We have almost everything. But one thing is still like funding current funding structures which rely on which which really realize on foreign aid, philanthropy and private sector unsustainable. Yeah. Still up to date? Um, the highest amount of funds are allocated to the health domain Come from private, uh, companies. I'm sure you all know about the the the main funder of, uh wh, for example, mostly private companies. Private sector, which is not very sustainable. For example, with the confidence in pandemic, where most private companies have a lot of difficulties with high, eventually tight time. You see, the amount of of funding will obviously decrease because the cans fund the healthcare system and and, uh, and and end up being bankrupt. Government should explore innovative financing instruments to scale contact surgical capacity. Okay, so government should, uh, should leave more emphasis on on funding the hijack. Um, contact surgical capacity. Next slide, please. There's so much to be done. There's so, so much to be done. Uh, we're all hoping for the best. So as a conclusion, cardiovascular diseases are the leading causes of mobility and mortality. Yet political prioritization and awareness to expand the cardiac surgical workforce remains limited, highly limited. Um, let me try to narrate things to Africa, For example. In Africa, the rate of of of stroke, for example, keeps on increasing. I took back in original recently, and it's really crazy. It keeps on increasing as time goes by. I don't have the necessary forms to handle certain diseases. Um um uh, from a from a stroke, for example, the amount of money required to be taking care of is huge, and it's a it's above the it's above the reach of most African populations. Meanwhile, if you look at prevention, prevention is highly. It's affordable, almost free for everybody. So if you have a way of of sensitizing people around you about cardiovascular disease is due especially for Africans. So Claire is for what exists to foster and strengthen hard themes across countries. If considerable socioeconomic return on investment, failing to move forward means that millions of people will continue to die exactly from preventable and treatable cardiac surgical conditions year after year. So sad, right? Preventable and treatable prevention is almost free, if not free. What was the prevention of about healthy diet, healthy lifestyle in general sensitization awareness. All those things prevention is almost free, but the treatment is quite expensive. But still, then people keep on dying from preventable and treatable disease. Is that so? So sad. Next life, please. And, um um, and someone is very passionate about cardiac surgery, cardiovascular disease in general. And each time I have the opportunity to I sensitizing people around me about cardiovascular disease is, um, each time I'm talking to a person who is not related to healthcare, someone who Maybe a banker or one accounting students always tell them, You know, parents may not be present at your graduation ceremony and they're like, What do you mean? I just say, um, that, you know, the present because he would have died of his true before because, hey, in Africa, people live. The lifestyle is still very bad. And at the end, when the when the prevalence of stroke keeps on increasing, people are wondering when someone practices, know physical activity consume a lot of fatty foods contain consumed, relate to Beijing foods reaching fiber. What? What do they expect? Obviously they'll be expecting cardiovascular disease, and the population is still not aware of the gravity of the situation. That that's that's the saddest part of the story. Actually, people are still not aware. And that's one of the greatest weaknesses we feed in Africa. Especially so each other questions. Just enterprise. It's typical around. Please do. It helps. So my personal impression about this journal, it's very interesting. A very good one. But they didn't really give an account of, uh, the nonsurgical work force, which is very limited to Yeah, if you read extensively on cardiac, uh, cardiac care, surgical or nonsurgical, you realize that the non surgical case very limited as well. Um, um, the pizza is very, very good to me. Very so. That's my personal impression. I really love it. And it reminds me of the fact that there is still so, so much to do. Yeah, so I think this concludes the presentation. Next light, please. Yeah. So see, this probably concludes, uh, presentation. Thank you all back. Next time, please. Maybe I'm missing something. I media forgot something. That out. Okay, so I hope you all enjoy the presentation. So, um, for example, medical students at the Catholic University of Cameroon You can always connect on any social media of your choice. And you feel like talking about cardiac surgery or any kind of related or feel free? I'm passionate about that. Even anything related to help shots. So thank you all. So so much for your time for your attention. And I'm really sorry for the inconvenience, because at the beginning, I had some issues, and I hope you all are having a warm evening or the weather is very cold over here. Thank you all so much. Well, have a wonderful evening. Thank you. Becky, to Wow. Wow. I don't know how everyone else thought about that presentation, but I thought that was amazing. Um, I thought you did. Really? Well, um, before I say anything, we're just going to open the floor up to questions and comments. Um, so, in an orderly manner, if you have a victory, had one, he's already put it on the chat box. Um, so if anyone would like to give any comments, critiques. Um, please go right ahead. The floor is open. Um, I'm waiting for someone else to talk about. Maybe I should just start talking. Um, yeah. So, as I said, well done for doing this presentation What I like best about it is that it wasn't just a research paper. I know most journal clubs are known for doing the typical thing, which is, you know, um, to scrutinize research papers. But this was essentially taking a non research where essentially what seems to be it could be like a think peace and and really link that out. That was really wonderful. All of us are somewhat aware most times of the difficulties face by professionals over the world.