Teaching and Medical Missions for Pacemaker Implantations
Despite universal needs which increase in developing countries due to lengthening life expectancy, such countries cannot routinely carry out pacemaker implantations. STIM développement proposes to initiate and develop cardiac rhythm management (CRM) in the framework of a partnership with developing countries, aiming at giving them a leadership role and making them able to educate neighboring countries. The commitment to our goals requires a strong sense of organization, human competence, material and time.
STIM développement has carried out missions since 1996 thanks to diversified areas of assistance. Voluntary cardiologists conduct pacemaker implantation theoretical and practical training. Their journey is entirely financed by people who donate to our appeals, as well as by private donations. Volunteers are provided accommodation by the local hospital. Pacemakers and electrodes are collected at no cost; they may also be bought at low prices thanks to private donations or granted by an agreement with manufacturers.
Each mission is initiated by an invitation from the country’s Ministry of Health and from the selected medical institution. Such institution must be committed to develop its own cardiac rhythm management (CRM) activity and the project leader must be identified. STIM développement deals with administrative authorizations such as visas, work authorizations and customs formalities. French rhythmologists must be accustomed to struggle with “adverse conditions”, compared with hospitals’ daily comfort in developed countries. The local team rhythmologist must identify his/her healthcare team.
Patients eligible for implantation are selected by the local cardiologist and indications are validated by the mission health physician. Hospitals must be equipped with all the required healthcare materials for such surgical procedures. These medical interventions must be carried out in fully-equipped health facilities with appropriate staff and monitoring devices. Medical files must be reviewed prior to the arrival of patients, healthcare materials must be checked, especially fluoroscopy.
Training consists of theoretical and technical teaching. Medical and paramedical teams are trained to these techniques according to imposed requirements. They receive instructions in order to adjust pacemakers and follow-up patients. They become fully autonomous after 2 to 4 missions on site. The priority, beyond saving lives, is to boost the level of knowledge in countries lacking knowledge, in order to save more patients. Senegal and Ivory Coast take part to this development which is based around South-South cooperation as a result of North-South cooperation.
Up to now, 61 missions in 14 African countries have made it possible for 502 patients to have a pacemaker implanted. A pacemaker was implanted for the first time in eleven of these countries. Patients had been waiting for about 8 months, in most cases since an atrioventricular block diagnosis. Almost 50% of them died before the mission. Single chamber Pacemakers have mostly been implanted.
Tetouan, Morocco - 2004 - Dr. Ph. Ricard - Click here to read the report
Cotonou, Benin - 2005 - Dr. Ch. d'Ivernois - Click here to read the report
Abidjan, Ivory Coast - 2009 - Pr. X. Jouven - Click here to read the report
Oujda, Morocco - 2010 - Pr. N. Saoudi - Click here to read the report
Diop IB, Ba S, Underwood P, Diack B, Damourou JM, Kane A, Sarr M, Thiam O, Diao M, Ba A, Diouf SM. Permanent cardiac stimulation in Senegal: preliminary experience at the Cardiology Clinic of Dakar. Dakar Med. 2000; 45(1): 101-4.
Jouven X. Cardiac pacing in Western Africa. Ann Cardiol Angeiol 2003; 52(4): 204.
Mond HG, Proclemer A. The 11th world survey of cardiac pacing and implantable cardioverter-defibrillators: calendar year 2009 - a World Society of Arrhythmia's project. Pace 2011; 34: 1013-27.
Yayehd K, Ganou K, Tchamdja T, Tété Y, N'cho Mottoh MP, Pessinaba S, Damorou F. Management of high-grade atrioventricular block in Lomé, Togo. Med Trop 2011; 71(6): 637-8.
Jouven X. Initiative: Cardiology and Development. Circulation : European Perspectives 2012 ; f52-3. Click here to read the article
Tantchou Tchoumi JC, Foresti S, Lupo P, Cappato R, Butera G. Follow up in a developing country of patients with complete atrio-ventricular block. Cardiovasc J Afr. 2012; 23(10): 538-40.
Nava S, Morales JL, Marquez MF. Reuse of pacemakers. Comparison of short and long term performance. Circulation 2013; 127: 1177-83.
Ikama SM, Makani J, Jouven X, Kimbally-Kaky G. Permanent cardiac pacing: first Congolese experiment. Pan Afr Med J. 2015; 20: 381.
Jouven X, Sagnol P, Marijon E, Dodinot B. 20 années de stimulation cardiaque en Afrique sub-saharienne. Rythmologies 2015; 17: 12-4. Click here to read the article