Bongani Mayosi: targeting heart diseases of poverty in Africa

Abstract

A childhood spent in his doctor father's jeep while he visited patients in the remote Eastern Cape province of South Africa made medicine seem like the natural path to follow for the young Bongani Mayosi. “I sat in the back seat with the medicines as my father drove to patient after patient along very ragged, bumpy roads”, Mayosi recalls. “Such experiences left a huge mark on me.” But the path that Mayosi ultimately followed took him away from rural rounds in the Eastern Cape and to the heart of academic medicine in South Africa.After a medical degree at what is now the Nelson R Mandela School of Medicine at the University of KwaZulu-Natal, Mayosi left Durban, in 1990, for Port Elizabeth with his wife Nonhlanhla, a dermatologist whom he had met during his studies. They both did house jobs at Livingstone Hospital before moving to Cape Town, the place that would become their home and where Mayosi's interest in cardiology would be nurtured. Working at Groote Schuur Hospital and hospitals affiliated to the University of Cape Town, he came under the tutelage of Patrick Commerford and Robert Scott Millar, cardiologists who were to prove key influences in his career. “I was so impressed by their very thorough and elegant approach to diagnosis—the way they took a history and examined their patients. In rich countries, cardiology today is very technical, but in Africa we still need to rely on history and examination to make a diagnosis”, he says.Mayosi has seen that difference in the way cardiology is practised at first hand, having spent time outside Africa. After working as a registrar in Cape Town in the mid-1990s, he went to the UK for a fellowship at the University of Oxford, where, under eminent cardiologist Hugh Watkins, he studied the genetics behind cardiovascular risk factors, specifically analysing cardiac hypertrophy in response to blood pressure. Mayosi and his family returned to South Africa in 2001, where he assumed research, teaching, and clinical responsibilities in internal medicine and cardiology at the University of Cape Town and Groote Schuur Hospital.Mayosi's research focuses on three diseases that are rare in high-income countries but still all too common in Africa: rheumatic fever, tuberculous pericarditis, and idiopathic cardiomyopathy. Each of these has required its own unique approach: with cardiomyopathy, Mayosi heads a laboratory group dedicated to exploring underlying causes and risk factors. He is running a clinical trial on tuberculous pericarditis (the IMPI trial), recruiting 1400 patients across eight African countries and treating them with steroids to reduce the fluid around the heart. Mayosi hopes success in this study will establish whether steroid treatment should be the standard of care. With rheumatic fever, a population-wide approach that includes education has been essential. In this disease, a simple sore throat caused by streptococcus in youth can, if left untreated, lead to rheumatic fever and early death. Treatment with penicillin is all that is required—yet Mayosi explains that large-scale studies proving disease burden were necessary to get ministers to throw their weight behind South Africa's Stop Rheumatic Fever campaign. “A study in Soweto showed how big a problem this condition really is”, says Mayosi. “Ministers started listening, and the wheels of primary health care started to turn.”With a distinguished record of research behind him, Mayosi became Professor and Head of the Department of Medicine at the Groote Schuur Hospital and the University of Cape Town in 2006 at the age of 38—the first black person to achieve this position. “It was and continues to be a huge honour”, he told The Lancet. Mayosi's role is important for the future of medicine in Africa says George Mensah, Chairman of the Cardiovascular Diseases Expert Group of the Global Burden of Diseases: “Bongani is a visionary with a deep sense of purpose and a healthy respect for what history has taught us, best shown by his unfailing commitment to find ways to address the legacy of apartheid through education and training of the next generation of clinician-scientists for all of sub-Saharan Africa.”Mayosi is acutely aware of Africa's changing demographics, which will see diseases of poverty, such as the heart diseases he studies, coexisting with the cardiovascular diseases common in high-income countries. “This is a dangerous cocktail, but we can work to ameliorate it”, says Mayosi. He believes that Africa requires strong academic leadership to tackle all its health problems, including those related to HIV/AIDS, tuberculosis, and malaria. In a Lancet Review, Mayosi and his colleagues assess progress made since The Lancet's landmark 2009 Series on South Africa and outline key health issues facing the country's health system.Along with other leaders in African and international health, Mayosi is supporting a drive to create 1000 PhD students across Africa. He echoes the sentiments of Dan Ncayiyana, immediate past Editor of the South African Medical Journal, commenting that “Only when a critical mass of African researchers are working on African soil addressing African issues can the continent start addressing its many health problems.” According to Lionel Opie, a former Director of the Hatter Institute for Cardiovascular Research at the University of Cape Town, Mayosi is well placed to meet this challenge: “Despite local and international fame, he has retained his gift of interacting closely at the personal level. He is one of the very best of our Professors of Medicine, and his long-term aim is to promote both bedside excellence and the development of clinical scientists.”This online publication has been corrected. The corrected version first appeared at thelancet.com on February 1, 2013 A childhood spent in his doctor father's jeep while he visited patients in the remote Eastern Cape province of South Africa made medicine seem like the natural path to follow for the young Bongani Mayosi. “I sat in the back seat with the medicines as my father drove to patient after patient along very ragged, bumpy roads”, Mayosi recalls. “Such experiences left a huge mark on me.” But the path that Mayosi ultimately followed took him away from rural rounds in the Eastern Cape and to the heart of academic medicine in South Africa. After a medical degree at what is now the Nelson R Mandela School of Medicine at the University of KwaZulu-Natal, Mayosi left Durban, in 1990, for Port Elizabeth with his wife Nonhlanhla, a dermatologist whom he had met during his studies. They both did house jobs at Livingstone Hospital before moving to Cape Town, the place that would become their home and where Mayosi's interest in cardiology would be nurtured. Working at Groote Schuur Hospital and hospitals affiliated to the University of Cape Town, he came under the tutelage of Patrick Commerford and Robert Scott Millar, cardiologists who were to prove key influences in his career. “I was so impressed by their very thorough and elegant approach to diagnosis—the way they took a history and examined their patients. In rich countries, cardiology today is very technical, but in Africa we still need to rely on history and examination to make a diagnosis”, he says. Mayosi has seen that difference in the way cardiology is practised at first hand, having spent time outside Africa. After working as a registrar in Cape Town in the mid-1990s, he went to the UK for a fellowship at the University of Oxford, where, under eminent cardiologist Hugh Watkins, he studied the genetics behind cardiovascular risk factors, specifically analysing cardiac hypertrophy in response to blood pressure. Mayosi and his family returned to South Africa in 2001, where he assumed research, teaching, and clinical responsibilities in internal medicine and cardiology at the University of Cape Town and Groote Schuur Hospital. Mayosi's research focuses on three diseases that are rare in high-income countries but still all too common in Africa: rheumatic fever, tuberculous pericarditis, and idiopathic cardiomyopathy. Each of these has required its own unique approach: with cardiomyopathy, Mayosi heads a laboratory group dedicated to exploring underlying causes and risk factors. He is running a clinical trial on tuberculous pericarditis (the IMPI trial), recruiting 1400 patients across eight African countries and treating them with steroids to reduce the fluid around the heart. Mayosi hopes success in this study will establish whether steroid treatment should be the standard of care. With rheumatic fever, a population-wide approach that includes education has been essential. In this disease, a simple sore throat caused by streptococcus in youth can, if left untreated, lead to rheumatic fever and early death. Treatment with penicillin is all that is required—yet Mayosi explains that large-scale studies proving disease burden were necessary to get ministers to throw their weight behind South Africa's Stop Rheumatic Fever campaign. “A study in Soweto showed how big a problem this condition really is”, says Mayosi. “Ministers started listening, and the wheels of primary health care started to turn.” With a distinguished record of research behind him, Mayosi became Professor and Head of the Department of Medicine at the Groote Schuur Hospital and the University of Cape Town in 2006 at the age of 38—the first black person to achieve this position. “It was and continues to be a huge honour”, he told The Lancet. Mayosi's role is important for the future of medicine in Africa says George Mensah, Chairman of the Cardiovascular Diseases Expert Group of the Global Burden of Diseases: “Bongani is a visionary with a deep sense of purpose and a healthy respect for what history has taught us, best shown by his unfailing commitment to find ways to address the legacy of apartheid through education and training of the next generation of clinician-scientists for all of sub-Saharan Africa.” Mayosi is acutely aware of Africa's changing demographics, which will see diseases of poverty, such as the heart diseases he studies, coexisting with the cardiovascular diseases common in high-income countries. “This is a dangerous cocktail, but we can work to ameliorate it”, says Mayosi. He believes that Africa requires strong academic leadership to tackle all its health problems, including those related to HIV/AIDS, tuberculosis, and malaria. In a Lancet Review, Mayosi and his colleagues assess progress made since The Lancet's landmark 2009 Series on South Africa and outline key health issues facing the country's health system. Along with other leaders in African and international health, Mayosi is supporting a drive to create 1000 PhD students across Africa. He echoes the sentiments of Dan Ncayiyana, immediate past Editor of the South African Medical Journal, commenting that “Only when a critical mass of African researchers are working on African soil addressing African issues can the continent start addressing its many health problems.” According to Lionel Opie, a former Director of the Hatter Institute for Cardiovascular Research at the University of Cape Town, Mayosi is well placed to meet this challenge: “Despite local and international fame, he has retained his gift of interacting closely at the personal level. He is one of the very best of our Professors of Medicine, and his long-term aim is to promote both bedside excellence and the development of clinical scientists.” This online publication has been corrected. The corrected version first appeared at thelancet.com on February 1, 2013 This online publication has been corrected. The corrected version first appeared at thelancet.com on February 1, 2013 This online publication has been corrected. The corrected version first appeared at thelancet.com on February 1, 2013 Health in South Africa: changes and challenges since 2009Since the 2009 Lancet Health in South Africa Series, important changes have occurred in the country, resulting in an increase in life expectancy to 60 years. Historical injustices together with the disastrous health policies of the previous administration are being transformed. The change in leadership of the Ministry of Health has been key, but new momentum is inhibited by stasis within the health management bureaucracy. Specific policy and programme changes are evident for all four of the so-called colliding epidemics: HIV and tuberculosis; chronic illness and mental health; injury and violence; and maternal, neonatal, and child health. Full-Text PDF Department of ErrorKirby T. Bongani Mayosi: targeting heart diseases of poverty in Africa. Lancet 2012; 380: 1985—In this Profile (Dec 8), the first part of the last sentence should have read: “According to Lionel Opie, a former Director of the Hatter Institute for Cardiovascular Research at the University of Cape Town…” This correction has been made to the online version as of Feb 1, 2013. Full-Text PDF