This is part of a series to profile our colleagues from around the world to learn about their role, education and efforts to improve professional practice in EP.

In the land of tribal mystique mixed with growing modernization, South Africa's public healthcare system serves about 80% of the sub-Saharan Africa’s 840 million, while a small but lucrative private sector caters to the mid- to high-income earners and the ever-popular medical tourism industry.

Groote Schuur Hospital in Cape Town is the only public hospital with a full-time EP unit for South Africa’s population of 50 million! The EP labs are staffed by nurses and techs. Typically, nurses set up the procedural case tables and perform patient prep, while advanced trained nurses provide medications and patient care support during the procedures. The cardiac clinical technologists are responsible for equipment/patient setup for EP procedures, assistance with data measurements and operation of mapping/ablation equipment. They also perform pre-implant device programming, threshold testing during device implant cases (pacemaker, CRT, ICD) and device clinic follow-up. The technologists are cross trained from the cath lab; thus, they are responsible for hemodynamic monitoring, intra-aortic balloon pumps when the cardiologists are inserting them, and the ICU follow-up of these cases. Industry-trained allied professionals may be used to help support complex procedures, and in some instances of the private sector, assist physicians with device follow-up.

Technologists undergo the clinical technology course primarily for training cath lab techs. Students learn about basic EP in the second year of training, although much of the learning comes from on-the-job training. What is most needed in South Africa is an accredited curriculum for EP specialization and resources for continuous advance training and updating in new technology. Although the IBHRE certification exams are well recognized in South Africa, the cost is fairly prohibitive for nurses and technologists except for those employed in the industry. The main professional organization in the cardiovascular field is the South African Heart Association (SAHA), with two sub-groups CASSA (Cardiac Arrhythmia Society of Southern Africa) and PACE (Prevent Arrhythmic Cardiac Events). These organizations are working intensely to develop guidelines, educational resources and quality health measures to ensure that South African EP practice meets established criteria and standards.

See the following links to learn more about EP in South Africa:

Editorial commentary by Prof. A. Okreglicki
http://www.saheart.org/journal/index.php?journal=SAHJ&page=article&op=vi...

CASSA website
http://www.cassa.co.za/About_Mission.asp

South African Heart Association
http://www.saheart.org/index.html

Carl Russouw is a Cardiac Clinical Technologist at Groote Schuur Hospital, Cape Town, South Africa.

Christine Chiu is an EP Pacemaker Technologist at The Labatt Family Heart Centre of the Hospital for Sick Children, Toronto, Ontario, Canada.