Gino Strada


Surgeon; Founder of Emergency (an Italian NGO)

Khartoum, Sudan

Building on the success of your Salam Center for Cardiac Surgery in Sudan, you plan to open 10 free hospitals throughout Africa. Funding will come from Emergency, the NGO you founded in 1994. Can you talk about your approach?
If I look at the health indicators in Africa, I see something that is very, very similar to what the situation was in Europe 200 years ago. In other words, medicine has not developed. Millions of people are suffering and dying, and so we have to ask, How do we reverse this trend?

How will you do things differently?
Most health facilities in Africa are completely filthy. There's no hygiene whatsoever. The staff doesn't go to work; patients are attended by family. Nothing's free of charge; nothing's available.

If you start with a completely different approach to building medicine from top to bottom by establishing high-standard facilities, there is a possibility you can start training qualified personnel and helping other centers not at the same level.

The Salam Center treats patients whose hearts have been damaged by rheumatic fever. Can you talk about the epidemiology of that illness in Africa?
Rheumatic fever is becoming the leading cause of death in Africa. The link to poverty is quite clear. The World Health Organization estimates that around 20 million people have rheumatic fever in Africa. They require two million hospitalizations every year. One million need heart surgery because of that. Two thirds of those affected are children, and there are 300,000 deaths every year. Would there be more of a public health benefit if you spent this money on vaccines and antibiotics instead of on more sophisticated care?

If you're comparing the cost of treatment of patients with heart disease with treatment of patients with malaria, tuberculosis or hepatitis, the cost of cardiac treatment is much higher for sure. But this way of thinking makes sense if we've established that the main factor determining what we do for health is money. The problem is not to put one against the other: malaria versus rheumatic fever. The problem is to understand we have to solve both problems.

How will you get started with the 10 centers of excellence you are building?
We're hoping to construct a center of excellence in pediatric surgery in Uganda. In most cases, it will correct congenital defects. Care will be free of charge, and it won't matter where the patients come from. Uganda will pay 20 percent of the overall cost of the program. If we get the resources, we will start in a very few months. The hospital has already been designed by one of the greatest architects in the world, Renzo Piano, who is a friend of Emergency.