In 2025, we will commemorate 77 years since the death of one of America’s most influential presidents, Theodore Roosevelt. He was the 26th and youngest president of the United States, succeeding William McKinley. Roosevelt was a pioneer of peace, winning the Nobel Peace Prize in 1906 after successfully mediating the end of the war between Japan and Russia. He accomplished many great things for the people of America and the world.
Reflecting on his life, the greatest obstacle he faced was his health. He experienced serious chronic, oral, and systemic health problems. Despite these significant health challenges, he cultivated a lifetime of joy, laughter, and humor. Theodore Roosevelt was known as “the first president that smiled,” and he was often photographed and illustrated grinning from ear to ear. His flashing white teeth, wide smile, and engaging openness became symbols of national and international acceptance. At a very young age, he was diagnosed with debilitating asthma, for which doctors at the time had no cure. Like many others in the world today, Theodore Roosevelt died in his home in his sleep after suffering a pulmonary embolism.
Today, the global burden of pulmonary embolism (PE) is on the rise compared to two decades ago, most notably in high-income countries (HICs). The increased incidence of venous thromboembolism (VTE) may be attributed in part to improved survival rates among high-risk populations, such as cancer, chronic obstructive pulmonary disease (COPD), and autoimmune disease patients. Additionally, enhanced diagnostic capabilities, heightened clinical suspicion, and the routine use of CT pulmonary angiography have contributed to this trend.
In contrast, PE-related in-hospital death rates and age-standardized mortality from PE have plateaued in recent years. This trend may be due to the greater proportion of innocuous cases being diagnosed and improvements in management practices. It parallels the overall improvements in global health, as measured by age-standardized disability-adjusted life-years in the latest systematic analysis of the Global Burden of Disease Study. Despite these reassuring trends, PE associated with hemodynamic instability continues to carry high rates of in-hospital and early mortality.
According to Danwang et al., at least one-quarter of patients at risk for VTE in Africa do not receive prophylaxis. A quantitative cross-sectional study conducted in tertiary regional and district hospitals, polyclinics, and private hospitals in the Kumasi Metropolis of the Ashanti Region of Ghana classified thromboembolic disease (TED) as a medium risk in most areas of clinical practice, with cases predominantly reported in inpatient settings. Deep vein thrombosis and ischemic stroke were the most commonly reported conditions, with pain as the most frequent symptom. Thromboprophylaxis was practiced at an average rate across clinical settings. Pharmacological management of TED was preferred, with low-molecular-weight heparins and warfarin being the most widely used therapeutic options. Cost was the greatest barrier to therapy and choice of medication, while bleeding was the most common side effect observed. Although therapies for TED management and prophylaxis are available and effective, the condition remains a burden in Ghana due to the high cost of treatment.
A study conducted by Fitsum Kifle found that Ethiopia faces a critical shortage of intensive care unit (ICU) beds and resources. The distribution of ICU beds is uneven, and there is a widespread deficiency in both basic life support equipment, such as oxygen and monitoring devices, and advanced life support technologies, including organ support systems and invasive monitoring. These limitations significantly hinder the provision of optimal critical care services, including the diagnosis, management, prevention, and treatment of pulmonary embolism and deep vein thrombosis.
The global health burden of PE has had a major impact on African and sub-Saharan countries. Many African lives are lost to PE due to delayed recognition or a lack of appropriate infrastructure. Another contributing factor is medical negligence. Regarding the care and treatment of a patient with PE in Africa, the availability of expertise must be considered. Unfortunately, the number of specialists equipped to diagnose and treat PE is very low. For more than a decade, Ghana trained only two pulmonologists, who were significantly overburdened by the number of patients requiring care.
Many African experts believe the current burden of the disease is far greater than what disease burden models suggest. The limited number of trained specialists and the lack of diagnostic tools further hinder the proper management of PE-related complications.
Interventional pulmonology societies in HICs can significantly enhance training, infrastructure, and quality of care in countries like Ghana through a multifaceted approach. Establishing fellowship programs and exchange initiatives can provide Ghanaian doctors with hands-on experience, while online courses and webinars can offer continuous education. Equipment donations, telemedicine programs, and mobile clinics can help address infrastructure needs, ensuring that essential diagnostic tools are available even in remote areas. Collaborating with local health authorities to develop standardized guidelines and offering continuous professional development opportunities can improve the quality of care. Additionally, partnerships with NGOs, universities, and medical device manufacturers can facilitate research, policy advocacy, and public awareness campaigns, ultimately leading to better health care outcomes. By implementing these strategies, interventional pulmonology societies can make a substantial impact on the health care landscape in Ghana and other resource-limited settings.
Pulmonary embolism remains a significant global health challenge, and its impact is even more pronounced in resource-limited settings. Addressing this issue requires a concerted effort to improve diagnostic capabilities, enhance clinical training, and ensure equitable access to effective treatments. Only through such initiatives can we hope to reduce the burden of this potentially deadly condition and improve outcomes for patients worldwide.
Princess Benson is a medical student in Ghana.
