|LETTER TO EDITOR
|Year : 2013 | Volume
| Issue : 1 | Page : 31-36
The Pan-African Society of Cardiology: A retrospection
Ayodele O Falase1, Olufemi Jaiyesimi2
1 Department of Medicine, Division of Cardiology, University College Hospital, PMB 5116, Ibadan, Oyo, Nigeria
2 Division of Paediatric Cardiology, University College Hospital, PMB 5116, Ibadan, Oyo, Nigeria
|Date of Web Publication||21-Sep-2013|
Ayodele O Falase
Department of Medicine, Division of Cardiology, University College Hospital, PMB 5116, Ibadan, Oyo
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Falase AO, Jaiyesimi O. The Pan-African Society of Cardiology: A retrospection. Nig J Cardiol 2013;10:31-6
Like its counterparts in the Americas, Asia, and Europe the Pan-African Society of Cardiology (PASCAR) espouses activities in cardiology and related disciplines in Africa, be such activities clinical, research, or training oriented. Founded a little over 30 years ago, many of the pioneering members of the society have retired from active cardiology practice; and memories of its genesis are beginning to dim. We therefore deem it essential to document, for the records, the formation of the society.
| Rationale Behind the Establishment of an African Cardiology Society|| |
The idea of a Pan African Cardiology body was mooted at the 1978 World Congress of Cardiology in Tokyo, Japan, when the participants from Africa observed that "Tropical Cardiology" was completely ignored during the congress. Important diseases that affected Africans, such as rheumatic heart disease and the cardiomyopathies, did not feature during the meeting. The meeting focused on coronary artery disease, which at that time was not a major problem in Africans.
African cardiologists who attended the meeting agreed that the time had come for Africa to have a continental cardiology society similar to the European Society of Cardiology, the Inter-American Continental Society of Cardiology and the Asian-Pacific Society of Cardiology. These three continental bodies were the only ones existing at the time and they were grouped under the International Society and Federation of Cardiology (ISFC).
The Presidency of ISFC rotated between the three continental bodies as did the hosting of the World Congress of Cardiology. South Africa, under apartheid rule at the time, and the Arab countries of North Africa were given special status as affiliate members of the European Society of Cardiology. Black Africa was completely left out. Although the Nigerian Cardiac Society was an affiliate of the ISFC, it obviously did not represent the whole of Africa.
Professor Falase's push for attention to cardiac problems in Africa eventually led to the declaration of 1982 as the "Year of Tropical Cardiology." At one of the meetings on the cardiomyopathies, he made a case for greater attention to cardiac diseases peculiar to Africa by investing on research on diseases that "make the cavities of African hearts to disappear without a cause" (endomyocardial fibrosis), "the African myocardium to weaken to the point of failure" (dilated cardiomyopathy), and on those that "cause outpouches to develop on the African myocardium in the absence of ischemic heart disease" (idiopathic ventricular aneurysms). It was during one of those meetings that it was agreed to harmonize the different names under which myocardial diseases of unknown cause were described. A new name "the cardiomyopathies" was agreed upon. That meeting was sponsored by the World Health Organization and the ISFC.
However, despite the greater attention given to cardiac diseases of people residing in the tropics as a result of these efforts, it was still obvious to those of us working in Africa that there was a need for a continental cardiology body that would promote activities related to cardiovascular diseases in the African continent. At this stage, we wish to show our appreciation to Professor John Goodwin, Dr. Celia Oakley, Dr. Peter Richardson and Dr. Eckhardt Olsen who supported us during the push for greater attention to "Tropical Cardiology" at international meetings.
| How PASCAR was Founded|| |
The enabling congress
Professor Falase's election as the President of the Nigerian Cardiac Society gave him further impetus to push for the formation of what was initially called the "African Society of Cardiology." Professor Jaiyesimi also worked assiduously to bring the new continental society, which was eventually called PASCAR, to reality.
The first task was to obtain the approval of the executive committee of the Nigerian Cardiac Society. This was initiated through a letter written to all the members of the committee [Figure 1]. That move enabled us to table the matter at the 9 th scientific meeting of the society, which was held at the University College Hospital, Ibadan on Friday 9 th and Saturday 10 th May 1980. The society formally approved the proposals at its general meeting and gave us the mandate to organize a Pan African Congress of Cardiology during which PASCAR would be inaugurated. Moreover, the society set up a committee to organize the congress. The committee members were:
|Figure 1: Exploratory letter written to executive members of the Nigerian Cardiac Society about the formation of Pan-African Society of Cardiology|
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This committee worked very hard to accomplish the task given to it by the Nigerian Cardiac Society. Meetings were initially held monthly at the Guest Houses of the University of Lagos, but as we approached the count-down to the congress meetings were held at the proposed venue of the congress.
The First Pan African Congress of Cardiology was held at the Administrative Staff College of Nigeria, Badagry, Nigeria between May 4 th and 6 th 1981 [Figure 2] and [Figure 3]. That venue was chosen because it could conveniently house all the delegates from Africa, it had excellent conference facilities, and it offered adequate security.
|Figure 3: Minutes of the inaugural congressional meeting of PASCAR held on Wednesday May 6, 1981|
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Merck Sharp and Dohme (Nigeria and International), a pharmaceutical company, provided practically all the funds required for the congress. Donations were also received from the Nigerian Cardiac Society and the World Health Organization. The congress was attended by 120 delegates from all over Africa, except the then apartheid South Africa [Figure 3]. There were three guest speakers, namely Professor Sukumar from India, Professor Bertrand from Ivory Coast and Dr. Shinebourne, a renowned pediatric cardiologist from England. Merck Sharp and Dohme (Nigeria and International) came with 15 delegates. All the delegates who came from outside Nigeria were sponsored fully for the meeting.
The congress was declared open by the Vice President of the Federal Republic of Nigeria, Dr. Alex Ekwueme. And, quite appropriately, PASCAR was formally inaugurated during the final stages of the congress.
Social activities during the congress included dinner on a boat, which sailed across the length and breadth of the Lagos lagoon, and a visit to Takwa beach on the Lagos Island. The participants also had the opportunity to visit the "point of no return" from where slaves were shipped to the Americas and the West Indies during the slave trade era. A grand dinner at the Federal Palace Hotel marked the end of the congress.
| The PASCAR Constitution|| |
The African Society of Cardiology was the name initially suggested for the proposed continental body [Figure 1], but this was later changed during a committee deliberation to the PASCAR. This new name was unanimously adopted by the first congress of the society.
Aims and objectives
These envisioned research into cardiac diseases of Africans, prevention and treatment of cardiac diseases, promotion, and encouragement of continuing education for medical and paramedical personnel in cardiology and of course, education of the public on relevant cardiac diseases. In this context the word, "cardiology" was defined in its broadest sense to include all disciplines related to diseases of the heart and blood vessels. Thus, the membership embraced adult cardiologists, pediatric cardiologists, cardiac pathologists, physiologists, cardiac rehabilitation specialists, cardiovascular surgeons, cardiac radiologists, and any other related discipline.
A key aim of PASCAR was to be the establishment of an African Heart Foundation, which would fund and coordinate research activities and conferences within the continent.
We also defined how PASCAR objectives were to be achieved through:
Membership of PASCAR
- Congressional business meetings.
- Organization of international, regional, or continental seminars, symposia, workshop, or congress on cardiovascular themes.
- Dissemination of up-to-date knowledge on cardiovascular diseases through the publication of newsletters and/or scientific journals.
- Establishment and administration of research fund.
- Contact and collaboration with other organizations with similar interests.
Since, it would be a continental society; it was felt that PASCAR membership should comprise national or regional cardiac societies in Africa. But the society's formation was taking place at the height of the struggle against the apartheid system in South Africa and none of the participants wanted to be seen as undermining this struggle by admitting a country under apartheid rule. On the other hand, we realized that our colleagues in Europe and America would consider non-inclusion of South Africa discriminatory and unacceptable. We therefore, tried to avoid a conflict between us and the ISFC by admitting only cardiac societies located in countries, which were members of the Organisation of African Unity (OAU). South Africa had been expelled from that body many years back and any cardiac society in that country was therefore not eligible for PASCAR membership.
Individuals from non-OAU countries who had contributed significantly to the practice of cardiology in Africa and had been judged worthy of membership by the Governing Council of PASCAR were to be admitted as associate members.
Furthermore, individuals who were engaged in the practice of cardiology in OAU countries with no established cardiac societies would also be considered as members of the society. At that time there were many African countries with no cardiac societies and it was necessary to insert that clause to ensure that cardiologists from such countries were not excluded. Happily, the establishment of PASCAR spurred some of these countries to form their national cardiac societies. Examples were Zambia and the then Zaire.
Composition of the governing council
In choosing the officers of the new society, the committee kept in mind the geopolitical realities of Africa. South Africa, which ought to have played a major role in the continental society, was unfortunately under apartheid rule and could not be considered for positions. There was also the usual rivalry between the Francophone and Anglophone African countries to contend with. Moreover, the orientation of the Arab countries in North Africa was more toward Europe and the United States of America and less towards Africa although they were geographically located in the continent. Finally, there was the question of the Portuguese speaking countries (Angola and Mozambique) to take into consideration. These countries however had serious internal conflicts at that time and could not play a substantial role in the new society. Sudan also had internal conflicts and was not represented at the meeting.
All these factors were taken into consideration during the election of the first officers of the society. We divided the continent into four regions - North, South, East and West Africa. Each of these was to be headed by a Vice-President and an Assistant Secretary-General. Thus, each of the four regions was represented in the Governing Council of the Society.
We also recommended that the President should be elected on a rotating basis among the regions. The immediate problem however was : w0 hich region should produce the first President? West Africa was the natural choice since this zone midwifed the congress and PASCAR. And within the West African zone Professor Falase was the obvious candidate in view of the leading role he played in the organization of the congress and formation of the society. However, in a magnanimous gesture aimed at smoothening political feelings and galvanizing every member nation, Nigeria conceded the Presidency to a Francophone country although retaining its strong bid for the position of Secretary General so that Professor Jaiyesimi, who also played a crucial role in the organization of the congress, would be first Secretary-General of the society. All the congress participants appreciated this gesture. Subsequently, Professor Papa Koate of Senegal was unanimously elected the first President of PASCAR and Professor Femi Jaiyesimi, the first Secretary-General.
Other positions, which were included in the Governing Council, were shared among the other zones of the continent. These positions included the treasurer and the Editor of the Society's Journal. The immediate past President of the Society, whenever we reached that stage, was also made a member of the Governing Council of the Society to allow for continuity. The ex-President is however to function as an ex officio member of the Council.
The tenure of office for each member was fixed at 4 years except for that of the editor whose tenure shall be determined by the Congress on the advice of the Governing Council.
Formal launch of PASCAR
As stated earlier, PASCAR was formally launched at a general meeting held toward the end of the first Pan-African Conference of Cardiology. This followed a motion proposed by Professor Falase, chair of the congress and the then President of the Nigerian Cardiac Society [Figure 3]. The motion was seconded by Professor Metras, a cardiac surgeon from Ivory Coast. Precisely at 5.15 p.m. on Wednesday 6 th April 1981, PASCAR was inaugurated.
Second Pan African Conference of Cardiology
At the congressional general meeting referred to above Kenya offered to host an international conference the following year (1982) for the main purpose of ratifying the clean copy of PASCAR constitution and taking other crucial decisions. Ratification of the draft constitution of PASCAR was indeed effected at the Kenya meeting. Other decisions taken at the Kenyan 1982 related to the:
The following scientific committees of PASCAR were also set up:
- Opening of PASCAR bank account in Geneva (to be facilitated by the ISFC).
- Establishment of Scientific Committees of PASCAR to deal with specific areas of its objectives.
- Formation of an African Heart Foundation.
Research, with subcommittees on:
- Information and training
- Public education and prevention,
These committees were to initiate, promote and coordinate activities aimed at achieving the broad objectives of PASCAR.
- rheumatic heart disease;
- hypertension, and
- ischemic heart disease.
The Kenyan meeting also agreed to hold the third Pan-African Congress of Cardiology in Cairo, Egypt; to be hosted by the Egyptian Cardiac Society. Finally, the meeting agreed that ISFC be formally notified of the formation of PASCAR.
Some initial problems
Funding of the new society was as expected, difficult. The OAU was willing to include the society in its annual budget, but there were obvious concerns about this as OAU was a political organization. Where the bank account of PASCAR would be located was also a problem. Those were the days when transfer of funds within Africa was difficult. Such movement of funds had to go via European banks and there were stringent regulations in many African countries on foreign exchange transactions. A decision on this was therefore deferred until the second meeting of the Society when it was decided to open an account in a European country. Geneva was chosen because that was where the ISFC was based. Even then, most of the members failed to pay their subscriptions, thereby almost crippling the new society.
In this regard, it needs to be noted that PASCAR predated the advent of mobile phone technology, internet, and E-mails. Phone calls among African countries were virtually impossible as they had to be routed via Europe (United Kingdom for Anglophone countries and France for Francophone countries). For instance, to call the Benin Republic from Nigeria, its next door neighbor was extremely difficult as the call had to go through London and Paris before being routed to Cotonou. This again made the work of the Governing Council and scientific committees of the society very difficult.
Relationship with the ISFC
As stated earlier, the ISFC was notified about the coming into existence of the new society. While the ISFC welcomed PASCAR, it however, insisted on the admission of South Africa before PASCAR could be admitted as the fourth continental member of the ISFC. That created a stalemate.
The political situation in Africa has improved considerably compared with what obtained in the early eighties. The introduction of modern communication technology such as the mobile telephone and the internet, and easier international money transfers among African countries should make the administration of PASCAR less difficult nowadays. Its presence should therefore be felt in all the African countries. Although we in Africa must continue to keep track of advances in cardiovascular medicine in the rest of the world, PASCAR should also be strengthened hence that it would be the vehicle through, which Africa could effectively respond to the cardiovascular needs of the diverse people of the continent.
It should be kept in mind that these needs are constantly changing because most of the African countries are currently experiencing reasonable degrees of economic growth and a greater percentage of Africans now belong to the middle and upper classes. Such people expect a high standard of care, similar to what is obtainable in the rest of the world.
At the time, PASCAR was formed, the major cardiovascular problems were diseases caused by ignorance and poverty; and these are still dominant in some of the countries on the continent. However, at the same time diseases caused by affluence are increasing and we must urgently institute effective preventive measures against their further rise. PASCAR must therefore continue to monitor and review the trend of cardiovascular diseases in Africa through its councils and committees (the internet should make this easier) and advice member countries appropriately, just like the World Bank and the IMF do on economic issues. This will make PASCAR more relevant and visible.
PASCAR congresses should be held regularly every 2 years and regional congresses (North, South, East and West) held yearly and rotated between countries to coincide with their national society meetings. The African Heart Foundation should also become more functional as it is crucial to the operations of PASCAR. Collaborative research in Africa must be encouraged as a deliberate policy.
PASCAR must also continue to encourage the formation of national cardiac societies in those countries where these are currently non-existent. Furthermore, PASCAR must react to the problem of Human immunodeficiency virus/Acquired immune deficiency syndrome (HIV/AIDS by setting up a separate PASCAR Council/Committee on the disease. PASCAR is no doubt growing; and that growth must continue at a commendable pace.
| Conclusion|| |
In conclusion, we thank the Nigerian Cardiac Society for the leadership role it played in the formation of PASCAR. We also thank our numerous colleagues, including Professors Mayosi and Silwa of South Africa and Mensah of Ghana for breathing new life into the society. We acknowledge the contributions of Professor Adebo, current PASCAR President, and his executive committee members. We urge all cardiologists in Africa, particularly the younger ones, to be actively involved in the activities of PASCAR and to ensure that it becomes a more virile society, able to fulfill its mission in Africa and the world.
[Figure 1], [Figure 2], [Figure 3]