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The Four P approach to patch up the broken-hearted

Trained as a cardiologist, Professor Bongani Mayosi is currently chief specialist physician at Groote Schuur Hospital and heads up the departments of medicine at both the University of Cape Town (UCT) and the hospital.

Mayosi works by creating a multimodal framework that moves research through to capacity and programme development to influencing policy. He calls it the Four Ps: people, policy, programmes and progress.

"People come first. You need to capacitate them to deal with the problems," says Mayosi. "Academics need to participate in the policy process by providing evidence-based research so that knowledge has effect." It doesn't stop at the first two because it is essential that people­ are trained and that policy is implemented. Mayosi says it is the first three Ps that create the conditions for progress.

Mayosi's research focus came about while he was studying medicine­ at the University of KwaZulu-Natal. He was confounded that so little was known about cardio­myopathy (heart muscle disease)­, especially as it is the second­ highest cause of heart ­disease in Africa after high blood pressure.

Heart disease, as a group, and stroke are two of the main causes of South African mortality after HIV/Aids and tuberculosis (TB).

Popular myth
His academic work looks at heart diseases of the poor – cardiomyopathy, tuberculosis pericarditis and rheumatic fever – affecting around two-thirds of sub-Saharan heart patients. Mayosi says there is a popular­ myth that heart diseases are for the wealthy but the truth is poverty can also break your heart.

Most researchers specialise in one methodology, but Mayosi employs a wide range of investigative approaches to improve the understanding and control of these health problems. The molecular approach (in a laboratory) is used for cardiomyopathy research, clinical trials are held for research on pericardial TB and epidemiology (population research) is used for rheumatic fever.

His work in capacity development involves building up a research group of 25 postgraduates that look at various aspects of heart diseases. Following on his Four P framework, he is involved in several programmes to ensure that research moves forward.

These include creating a combined­ degree at UCT so that students­ can obtain a bachelor of medicine and a PhD concurrently. There are currently three students in the programme, with six more in the pipeline. This is part of the UCT clinical scholars programme that focuses on creating courses and degrees for doctors who want to become researchers.

Knowing and doing
The recently created national health scholars programme, founded by the department of health, aims to have 1 000 PhDs in the health sciences over the next 10 years. Mayosi is integral to this as chair of the national health research committee, a body that advises the minister of health on matters relating­ to health research policy, co-ordination and funding.

Public and professional education is a large part of his work. "While we might know enough to prevent a disease, the problem remains because there is a gap between knowing and doing. This means it's necessary to take the work a step further and educate policymakers, clinicians and the public," says Mayosi.

Known as knowledge translation, it has become a major part of medicine­ and a science in itself. The language has to be adapted to suit the target audience, using a format that talks to the audience's needs. An example, says Mayosi, is conveying information to policymakers: "They need interventions that address real-world problems so you need to measure the size of the problem and you need to show that you are helping the largest number of people at the least cost."

Mayosi's work continues to be far-reaching and forward-thinking in its approach. As a mark of his ­success, in 2009 the Order of Mapungubwe in Silver was ­presented to him by President Jacob Zuma for excellent contributions to medical science.

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