Africa

Humanitarian activity


From right to left Prof. Omaswa with two Ugandan colleagues, Prof. Lucio Parenzan, Mr. Donald Ross, Dr. Philipp Bonhoeffer.

In 1992 Philipp Bonhoeffer was invited to participate in the World Laboratory project for the development of Cardiology in East Africa under the direction of Prof. Lucio Parenzan.

Over the following years he developed a strong interest in designing strategies to deliver cardiac care in developing countries focusing on sustainability and independence of programmes.

Over the years he collaborated with many humanitarian organisations including Chaine de l’espoir (Paris), Institut du Coeur (Saigon, Vietnam), Chain of Hope (London), Terre des Hommes (Nairobi), Children’s Heart Link (Minneapolis) and the Medtronic foundation (Minneapolis).

In 2002 he became director of the World Laboratory project (http://www.worldlab.ch). In 2004 funding of Medical Projects for World Laboratories ended and therefore he organised a handover of the Kenyan project he was leading to the Chain of Hope (London). He has developed specific affordable technology for cardiac catheterisation in association with the company NuMed (Hopkinton, New York), which is now used in many countries around the world. He has lectured about the development of cardiac programmes in developing countries in many scientific meetings.

Personal engagement in Africa

In 1991 Philipp Bonhoeffer travelled for the first medical mission to Kenya. He worked in the project of World Laboratories “Epidemiological Studies and Training of Staff for the Establishment of Local Units for Prevention and Treatment of Heart Diseases in African Countries”,  under the directorship of Prof Lucio Parenzan.

Philipp Bonhoeffer was asked to develop the diagnostic aspect of the World Laboratory project teaching local physicians to make diagnosis by echo alone in order to be able to select patients for simple cardiac surgical cases to be carried out locally in Kenya. He therefore organised Echo workshops to which local physicians brought their patients. These doctors were guided through the echo examinations and a full diagnosis of the patients was obtained while teaching. Within a relatively short time period a large number of patients with operable disease had been identified. However, this positive experience soon led to important frustrations. The World Laboratory budget was designed for the development of Cardiology and Cardiac Surgery in equatorial Africa. There were no funds for the patient care, in particular if this needed to be carried out abroad. The physicians in Kenya, Prof Lucio Parenzan and Philipp Bonhoeffer had raised hopes for the patients but were unable to provide treatment of the very needy patients.

Through enormous personal engagement of Prof. Lucio Parenzan, Father Antonio Giudici, an Italian missionary and Philipp Bonhoeffer along with the Kenyan doctors, efforts were made to provide surgery for some few cases in Italy. This was evidently to the benefit of the patients but also helped to keep the moral to continue with the Kenyan teaching project.

In 1992 Dr Jowi (one of the kenyan doctors) came to the workshop with a young boy with tetralogy of Fallot who had spent many months as an inpatient in Kenyatta Hospital in Nairobi. The boy was in a miserable clinical state presenting with one life threatening anoxic spell after the other. In the echo performed during the workshop a diagnosis of a regular form of Tetralogy was made. If the boy could reach a cardiac surgical centre alive he would have an excellent prognosis in terms of surviving the operation and the long term quality of life. Dr. Jowi asked Prof Parenzan and Philipp Bonhoeffer to consider to send him to Bergamo for surgery.

Within 1 week the father of the boy, Dr. Jowi and father Antonio were able to organise a passport and the travel documents for the boy. Philipp Bonhoeffer identified a host family in Italy who was also willing to contribute to the traveling costs of the boy and Prof. Parenzan organised the surgery. The boy travelled alone from Nairobi to Milan.

The boy was admitted as an emergency in the department of cardiac surgery in Bergamo the same day of his arrival and was operated the following day by Prof. Lucio Parenzan. As expected the surgery went well and after his hospital stay he spent some days with the host family before flying back to Kenya.

At the next workshop of echocardiography in Nairobi Dr Jowi asked her patient to come again for the post surgical echo assessment. At this occasion the father of the boy wanted to express his gratitude for having saved his child. He brought gifts to Dr. Jowi and Philipp Bonhoeffer but more importantly he made the biggest gesture of thankfulness and respect an African man can make. He stated that he had discussed this with his wife and the son. He said that he had been unable to keep his son alive and that it was through the help of Philipp Bonhoeffer that the son was now well. He therefore had decided to give this, his first born son, to Philipp Bonhoeffer. Philipp Bonhoeffer was taken aback and was very aware of this major honour. He responded that he accepted this enormous honour and now considered the boy as a son but wanted him to stay in the family where he grew up. In order to give a meaning to this event he decided to carry all expenses related to the education of the boy. Shortly after a 6th child was born into this family. The child was named after Philipp Bonhoeffer, he was called “Doctor”. Philipp Bonhoeffer offered a cow to the family for this event. When in Kenya Philipp Bonhoeffer visited this family many times in their rural home and a very close and long lasting friendship developed. Philipp Bonhoeffer then decided to support also the other children of this family for their education.

Philipp Bonhoeffer developed love for Africa and was increasingly engaged in the echo workshops. However everybody in the group felt uncomfortable that more and more patients had been diagnosed but little treatment opportunities existed. The patient selection was a major ethical challenge. Few patients presented like the boy above in serious conditions with a probability of a good outcome. The patients who were severely symptomatic, often with rheumatic heart disease were bad candidates for surgery whereas the ones who were still doing fine would have had a reasonable risk profile. The decision of whom to offer treatment in Italy had to be made after all patients at the workshop had been seen. The day of the decision making a large number of families came to get the bad news from Philipp Bonhoeffer that nothing could be done for them. A small minority was given hope that an engagement would be made to try to organise a trip to Italy. For the families with severely sick children who got the bad news it was unbearable to see that those who did not appear so sick would be at an advantage. In fact most of the severely sick patients were operable, only that the risk profile was unacceptable and the management of an operative mortality in Italy would have been unsurmountable even with the best will of all participants in the project.

For this and many other reasons it became imperative to develop treatment options in Kenya. Philipp Bonhoeffer, then still a very young cardiologist, suggested to start to perform pulmonary dilatation for patients with isolated congenital pulmonary stenosis. When this successful program started it had a major impact and it soon led to the dilatation of mitral valves with the MultiTrack System which Philipp Bonhoeffer developed in order to find a cost-effective way to handle mitral stenosis which is a typical disease of the socially disadvantaged (see Medical innovations, The Multi-Track system). During this time Philipp Bonhoeffer became increasingly active in East Africa, he had started to work also in Uganda and Tanzania. He was offered a professorship at Entebbe University in Uganda and he spent 2 longer periods of time in Kenya of 3 and 4 months respectively.

Philipp Bonhoeffer was seriously considering transferring his professional activity  fully to Africa  when he was unexpectedly invited to join the cardiological team at the prestigious Hopital Necker in Paris which offered interesting clinical and research opportunities. The job in Paris was offered to Philipp Bonhoeffer by Prof Daniel Sidi related to the work Philipp Bonhoeffer had undertaken in Africa. At the time Daniel Sidi was involved in the development of the Heart Institute in Ho Chi Minh Ville in Vietnam under the initiative of Prof Alain Carpentier. Philipp Bonhoeffer later also participated in this project.

In 1994 Philipp Bonhoeffer began to acquire some side income from royalties and consultancies from medical device industry. He was aware that this income arose principally through his innovative work he performed in Kenya. Since he was receiving a salary in Paris he felt it was appropriate that certain monies generated through his activities in Kenya would go back to benefit this country. He therefore set aside funds to help young people with their education. He had started this with the family as described above but later broadened this to more boys and girls. Over time he became more and more aware of how such sponsorship should be performed. He realised that giving money alone made no sense, and that true personal engagement with students was crucial to the success of their education. Furthermore he believed that few students should be chosen, but come what may, they should be supported and followed through, until their education was completed, and ideally they had found a job and could be independent. He was aware that this made financial planning difficult because costs of education increased with the age of the student. He was against the funding of young students in school who would then subsequently not have university funding since this was a typical cause of frustration in young Kenyans, and is known to lead to crime. Therefore, Philipp Bonhoeffer helped students who were struggling with their university funding shortly before the end of their curriculum by sporadic help. He decided to take on only few young students because of his personal commitment towards accompanying them through their entire studies. However over time he committed to provide full funding for 8 students throughout their entire educational development.

The plans for the students for choice of school or faculty at the university were made with the students and their parents with whom Philipp Bonhoeffer also developed a close relationship which continues up to present time. A circle of friendship developed in which Philipp Bonhoeffer spent much of his free time while working in Kenya.