https://orcid.org/0000-0002-8272-0911
Introduction
Professor Karen Sliwa, Director of the Cape Heart Institute (CHI) at the University of Cape Town (UCT), met with her long-time collaborator, Professor Ana Mocumbi, Vice-President of the Mozambican Institute for Health Education and Research (MIHER) on a recent visit to Mozambique (June 2021).
Their collaboration, which goes back more than a decade, has been formalized by a Memorandum of Understanding between UCT and MIHER. This important regional partnership aims to build capacity for the design and implementation of research in chronic cardiovascular diseases. They work on several collaborative research projects and initiatives, through which they link the Department of the Universidade Eduardo Mondlane and the Division of Non-communicable Diseases at the National Health Institute (Instituto Nacional de Saúde, Mozambique) with the CHI, to promote regional partnerships for cardiovascular research and capacity building.
The Mozambique Institute for Health Education and Research
The MIHER is a research support centre which has been created to catalyze and mobilize resources to improve the training of health professionals, develop biomedical research and to support health programs. It is a non-profit organization (established in 2011), which carries out its activities with various partners, including national universities, regional and international government institutions, NGOs, and bilateral cooperation agencies.
One of the key factors for the creation of MIHER was to address the enormous health professional shortages in Saharan Africa, which constitutes one of the major challenges in global health, and to ensure equity in healthcare to populations. Indeed, while Africa has 24% of the disease burden in the world, it has only 3% of health workers, and <1% of the financial resources, available to healthcare worldwide. Overall, one-third of vacancies available for lecturers in African medical schools are not filled, or lecturers must find alternate ways to supplement their income. In terms of scientific production, only 10% of clinical teachers/lecturers in African universities are involved in research. Mozambique is no exception, with only 4 doctors per 100 000 inhabitants, compared to countries like the USA where the ratio is 280 doctors per 100 000 inhabitants. In Mozambique, of the doctors who qualified between 1980 and 2006, 25% had left the public sector by 2010 and, of these, 62.4% went to the private sector in the country. MIHER strives to promote good biomedical research governance and administration and serves as a research support centre for Universidade Eduardo Mondlane, while also supporting the administration of projects implemented by the Instituto Nacional de Saúde and Mozambique’s National Health Service.
The Cape Heart Institute
The Cape Heart Institute (recently renamed from Hatter Institute for Cardiovascular Research in Africa) is a formally UCT accredited Institute and is housed in the Chris Barnard Building, Faculty of Health Sciences. Through its bridge position between laboratory-based research and clinical research the CHI sees itself as an institution fostering translation. The Cape Heart Institute creates a modern, consolidated and vibrant environment between a number of shared laboratories, facilities, and expertise, in which scientific excellence is pursued within a number of laboratory groups, each headed by a scientist of international stature and facilitated by an efficient and effective infrastructure, centralized facilities and minimum bureaucracy, thereby enabling local research capacity to prosper in Africa. The CHI has currently 8 research groupings, >60 staff and students and is led by Prof. Karen Sliwa, who is also the immediate past president of the World Heart Federation.
Partnerships
Prof. Ana Mocumbi and Prof. Karen Sliwa formed their partnership to create capacity for cardiovascular research in Mozambique, and to foster regional networking and collaborations within the African region. Their partnership has been initially developed via joint research projects and publications but also a strong mutual respect and friendship.
They have linked their academic institutions and have fostered regional and global partnerships that are paramount to support the training of the next generation of cardiovascular clinicians and researchers in Africa (Figure 1). This has been achieved through joint mentorship of higher-degreed students from Mozambique (NM, KJ, EL, AN), formalization of partnership (MoU MIHER and UCT, South Africa) and leadership in design and implementation of joint regional projects (e.g., Pulmonary Hypertension Cohort Study, the Pan African Cardiac Society Rheumatic Heart Disease Taskforce, the World Heart Federation Rheumatic Heart Disease Advocacy Mozambique Program, VIGIFER).
Signing of Memorandum of Understanding, Cardiac Disease in Maternity Symposium, Cape Town, Training of ObGynae on ultrasound.
In addition, through their strong regional and global network, they provide career development guidance for junior researchers, particularly females. They have established scientific meetings, seminars and workshops which take place at least twice a year, involving the faculties of their institutions (Maputo Cardiovascular Research Seminar and Cardiac Maternity Meeting in Cape Town), to which they invite senior researchers from around the world (Figure 1). These meetings are used mainly to share results of research and to support early career researchers. They focus on key areas for service delivery and research in Mozambique, such as neglected cardiovascular diseases, women’s cardiovascular health and arterial hypertension.
Since 2017, Professor Sliwa has regularly visited the Universidade Eduardo Mondlane and Instituto Nacional de Saúde, where she meets with young researchers (who she jointly mentors with Prof Mocumbi), to define their individual developmental plans and evaluate the progress of their academic projects. During these visits, she has also delivered keynote lectures on Heart Disease in Pregnancy (2019), Acute and Chronic Heart failure (2020) and Cardiovascular Health and COVID (2021). Audiences are comprised of basic scientists, clinicians, lecturers and public health specialists. Reciprocally, Prof Mocumbi has visited HICRA/CHI to contribute to Cardiac Maternity Seminars, Addressing Emerging Challenges Through South-South Collaboration (2018) and Community Care for Women with Cardiovascular Disease (2019). Exchanges between early career researchers have recently commenced but were, unfortunately, halted due to COVID-19. However, preparations to launch a virtual link between the two institutions are being finalized. This will enable researchers to participate in weekly meetings/journal clubs and reinforce mentorship channels, which will improve the research environment and support mentee’s networking needs. In addition, it will assist in the dissemination of research outputs by Mozambicans, who will also have the opportunity to improve their English oral and written communication skills.
Ongoing partnerships
Reproductive Health Services for Women with Cardiovascular Disease
Mozambique and South Africa have a long experience of task-shifting of competences for obstetric care, with nurses and non-specialists performing obstetric risk stratification, which includes ultrasound done by maternal and child health nurses. As part of the efforts within the Pan African Cardiac Society Taskforce for Rheumatic Heart Disease (RHD) for women with cardiovascular disease, one joint project includes the empowerment of reproductive health professionals to perform cardiac ultrasound. Formal training of screening echocardiograms of obstetricians has commenced in Groote Schuur Hospital, Cape Town, in 2010.
In Mozambique RHD screening using standardized algorithms is being used to support screening of schoolchildren and women of reproductive age in this highly endemic setting. Building on the experience of the Cape Town Maternity Cardiac Clinic, a joint cardiac-obstetric clinic has been implemented in Mozambique. Through a 20-hour training workshop (3/4 hands-on supervised sessions) 21 obstetricians/residents and maternal/child health nurses were trained to screen for RHD, using the revised Jones criteria for diagnosis of acute rheumatic fever and the World Heart Federation (WHF) criteria for echocardiographic screening (Figure 1). Diagnostic algorithms and referral pathways within the Mozambique health system were established, and patients living with RHD were trained to deliver inter-personal counselling to patients attending the weekly joint cardio-obstetric clinic. These interactive health education sessions (overseen by health researchers who summarize key lessons and challenges for each session) use illustrations focused on: (i) signs and symptoms of RF/RHD; (ii) long-term secondary prophylaxis; and (iii) chronic care.
The ‘COLOURS TO SAVE HEARTS’ Program
Prof. Ana Mocumbi’s research team at MIHER designed an awareness campaign involving school- and health facility-based activities initiated around ‘World Heart Day’ in 2019—when Prof. Karen Sliwa was WHF president (Figure 2). During these school-based activities 40 teachers were trained (6-h training workshop) to impart knowledge on prevention, diagnosis and management of rheumatic fever and RHD. Large outdoor walls were painted with illustrations for use in educational activities, and students were involved in colouring activities, watching videos and discussing messages in the RHD walls. We distributed 375 sets of books, boxes of crayons for colouring, and T-shirts with the theme of the day, to children aged 6–12 years (grade I–V). Grade VI classrooms (357 students) watched an educational video and grade VII children (232) received education outdoors, using the RHD walls. Major local stakeholders (representing the Ministries of Health and Education) participated in these activities.
Educational event Mavelane and movie and teaching.
Following on from the 2019 activities, together we designed an advocacy movie on RHD in peripartum women which conveyed strong advocacy messages. This film, The Beat of Change: Rheumatic Heart Disease in Mozambique, tells the story of a young mother struggling with the consequences of RHD. It was selected as the winner of the special prize for Health Equity in the World Health Organization’s Health for All Film Festival (Figure 2). Furthermore, in early 2021, the project Colours to Save Hearts in Mozambique, which expands on the work in schools with a colouring book for children to learn about rheumatic heart disease, is being supported by the World Herat Federation.
Many more projects of this productive South–South Partnerships in Cardiovascular Research in Africa are ongoing and in planning, with the goal of empowering the next generation of cardiovascular researchers.
Conflict of interest: none declared.
