Nicholas Ossei-Gerning: Interventional Cardiology and Pudendology Specialist at Euracare Ghana

Interview with Professor Nicholas Ossei-Gerning, Medical Director and Interventional Cardiologist at Euracare Ghana

What do you do?

I am a consultant, cardiologist specifically, in interventional cardiology. I’ve worked in the University College Hospital in Cardiff for the last 16 years and then, last year, I was appointed Medical Director of Euracare. In 2015, I was appointed Professor of Cardiology in the University of Cape Coast and because of my work in erectile dysfunction, I was also appointed Professor of Pudendology, which has to do with sexual dysfunction in men. And then in 2016, I was appointed Professor of Practice, Working Cardiology and Vasculogenic Erectile Dysfunction in the University of Wales. So, I do wear those hats, but my two major areas of interest are cardiology, specifically interventional cardiology, and also what we call vasculogenic erectile dysfunction. Many years ago, I also got my certificate as a general physician in the UK when I qualified as a consultant.

You have international experience and you are an expert in your field. What do you think you can bring here to Accra in terms of expertise?

My biggest contribution in Ghana is how to not only treat, but also help train and expose the public to the fact that when you have a heart attack, it is not a death sentence, which in many parts of the world it is.

The biggest thing and perhaps what would make most impact has to do with the area of heart attacks. Sub-Saharan Africa has been thought of as an area where infectious diseases, maternal deaths, AIDS and so on, are the biggest killers. What people do not realize is that cardiovascular disease over the last decade or so has been rising exponentially. And if you look at the figures now, heart attacks and strokes are number one according to the data. That is increasing exponentially and it has to do with a dramatic increase particularly in diabetes, obesity, and hypertension. Anybody who’s been practicing cardiovascular medicine in Africa will have seen the absolutely dramatic rise in hypertension. And those two have conflated and indeed exponentially increased the risk of heart attack and stroke. If you were unlucky enough to have a heart attack in Ghana, most of the time, you would be put in some quiet corner and have to die quietly. That is putting it rather mildly. If you happen to be in Accra, then there is one center where there is a cath lab which doesn’t even run 24 hours. So, the biggest thing for me, the big game changer with Euracare, was to provide a 24-hour heart attack center where anybody could be brought in at any time of the day and night to manage their heart attacks. If you have a heart attack and the three major arteries are completely blocked so there is no blood supply to an area of heart muscle, what you need is not tablets, even though tablets can help, what you need is to mechanically open up that artery. For that, you need a catheter, you need a functioning cath lab, you need the expertise of somebody who knows what they are doing to open up the heart, and of course, you need equipment. Euracare provides all of that. I have been practicing heart attack medicine for the last 26 years and it is an area that I have been in for a very long time and I have been working around the world honing my skills for dealing with heart attacks. My biggest contribution in Ghana is how to not only treat, but also help train and expose the public to the fact that when you have a heart attack, it is not a death sentence, which in many parts of the world it is. We can actually get you to our cath lab and open up your artery. If you were to have a heart attack now, you have a chance because we have a cath lab. If you are in Takoradi, you might as well sign your death sentence.

Ghana is one of the more developed countries in Africa. How do you explain this situation?

At Korle-Bu, which is another cath lab, most of the time, the cath lab is not working and there have been times where people have called them and there is nobody there to do anything because they are just not organized enough. Heart attack treatment in Ghana is a complete disaster. Most of the time, they give aspirin. If you are lucky, the doctor will give you Clopidogrel and you may or may not get a bit of nitrate. And that is it, you’ll just be put in a corner. When in fact, your heart muscle is infarcting, you need to unclog the artery.

Is the cost of equipment too expensive? What is causing this problem?

The problem, as with most things in life, is multifactorial. There is obviously the lack of equipment, but that is not the only thing. There are big, expensive hospitals that have been built in Ghana that are still not functional. So, it is clearly not just equipment, it is lack of expertise. I have trained for cardiology in general for the last 26 years, and for interventional cardiology for the better part of two and a half decades. You need to go out there and you need to train for a very long time to be able to operate on people’s hearts. Unfortunately, we just do not have the expertise and that needs to change. People need to train. Currently, there is no training program at all in Ghana to train new interventional cardiologists. So, it is lack of expertise and lack of hospitals that have cath labs and other experts as well.

Your other specialty is erectile dysfunction. Can you explain what your expertise is in that area?

People have often wondered why a cardiologist should be interested in erectile dysfunction and I would first and foremost direct them to a major publication that has been published in Heart BMJ on the 5th of September which is entitled, “What the Cardioligst Should Know About Erectile Dysfunction.” It is one that I am proud of because it is my work and it is in a major publication. It sets forth the background as to why anybody involved in cardiovascular medicine should know a bit about erectile dysfunction. There are two major reasons. Two thirds of all cardiac patients have erectile dysfunction. If you look at diabetes alone, up to ¾ or 75% of diabetic patients will have some form of erectile dysfunction. The best exposer of this was the Massachusetts Male Ageing Study which studied men between the ages of 40 to 70. It was quite a large study. They discovered that 52%, that is ½ of men in Massachusetts between the ages of 40 to 70 had some degree of erectile dysfunction. 36% of those had severe erectile dysfunction. So, it is a major problem and it is a very common problem which nobody talks about. And the reason why I got involved is that a lot of my patients would see me for their heart attacks or whatever cardiac problem it was and as they were going out they would come back and say by the way, doctor, I have a problem. And that led me to do a study in my hospital in Cardiff, where we found that 60%, so nearly 2 out of every 3 patients who were getting out of my cardiac ward for heart attack were going out there with problems of erectile dysfunction, which I thought was completely unacceptable. So, the first thing was what kind of patients have ED? In the UK, I run the biggest vasculogenic erectile dysfunction clinic in the country, so a lot of my patients have had vascular problems, heart attacks, strokes, or some other vascular disease. What became fascinating for me was that these patients who were coming to me with erectile dysfunction were cardiovascular patients. If you ask them when they had their erectile dysfunction, nearly 100% of them (only one of those patients did not match) would tell me that they had their erectile dysfunction before their cardiac event. Alarm bells started ringing. When you then went back to the studies, and there have been several studies done since over the last two or three decades, that demonstrates very clearly that you get erectile dysfunction that was a harbinger, two to five years later, you have your cardiac event. The reason for this is because what blocks off the arteries to the male organ, that process is the same thing that is happening in the heart and brain. In the heart it causes a heart attack, in the brain it causes a stroke. But, these arteries to the male organ are much smaller and for the same amount of what we call plaque disease you are blocking off these arteries much more quickly than you would block the heart or the brain. We call it the arterial size hypothesis, which basically means if you have a smaller artery for the same amount of plaque that you lay down, you are going to block off the artery that much quicker. So, erectile dysfunction is a major risk marker of a future event. If a patient comes to you with a problem with their male organ, immediately, alarm bells start ringing. You tell them you can help them with their erectile dysfunction, but more importantly, that they may have a heart attack. And I am happy and proud to say that I have managed to save quite a few people from having future heart attacks by picking them up before they fall in the ditch, so to speak. So, it is two things: if you have erectile dysfunction, you are at major risk of a heart attack and if you have a heart attack, you can bet your last dollar that these patients have erectile dysfunction. There are two major types of erectile dysfunction: the organic type and the psychogenic type. If you go back historically, everybody thought erectile dysfunction was a psychological problem. We now know that 80% is organic, you have a proper problem, whereas only 20% is purely psychogenic. And of that 80%, 80% of those are cardiovascular, they have some endocrine causes, renal causes, neurological causes, etc. So, in fact, 66%, 2/3 of all erectile dysfunction is cardiovascular, 2 out of 3. And that is why a heart cardiovascular doctor is interested in erectile dysfunction.

Is there anything you want to add about the hospital?

At Euracare, we have hand-picked our doctors. So we have an interventional radiologist who has been trained in Singapore and in the States, and has an international status. One of our specialists was a consultant in London before coming here. We have hand-picked our specialists to make sure that they have international training. So, when you come here, you are getting properly trained doctors who know what they are doing. It is sad to say, but we have been around for nearly 18 months practicing here. There are practices that are not very good and are rather subpar on the international stage. So, expertise for me is very, very important. You can have a nice building, you can have nice equipment, but you need expertise, which is what we offer. At the moment, across the range of medical expertise, Euracare is a major player in Ghana. If I were to have a medical problem, I would certainly think of coming to a place where I know that we have a nice facility, modern equipment, combined with expertise. I have practiced in the UK all my life, I did my interventional training, at least part of it, at a fellowship in Canada, I have worked throughout the world at the Washington Heart Center, in South Africa, and around Europe, of course. The center that we have here is as good as anywhere with regard to equipment and expertise.

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