Five-year-old Salamata Compaore in Burkina Faso suffers from a malformation of the heart that leads to shortness of breath, stunted growth and sometimes heart failure. Last month, she appeared on national TV in an appeal for help with an operation overseas.

“Without surgery, she will die,” said Professor Patrice Zamsoré, head of the cardiology department at the Yalgado hospital, the largest in Burkina Faso.

An expensive trip abroad is the only hope for people like Compaore, in Burkina Faso and other countries in the region where medical specialists and equipment to treat many conditions are unavailable.

Some of the most common health problems in Burkina – cardiovascular disease and cervical and breast cancer – cannot be treated inside the country. Advanced surgery, radiotherapy and chemotherapy materials are not available.

“We do not have surgeons as such in Burkina,” said Zamsoré, one of 10 cardiologists in the country of some 13 million people. “No human resources and no available equipment.” He said some Burkinabé are trained as surgeons, but they work outside the country where salaries are higher.

In what the UN considers the fourth-poorest country in the world, the struggling healthcare system must compete with other priorities, including education and access to clean water.

“For a long time, with different economic reforms, we were made to believe that you had to develop the economy before the healthcare system,” said Jean Gabriel Wango, secretary general and top official of the health ministry. “But without health, people can’t prosper.”

The waiting list

The Burkina government helps people travel abroad for treatment to the extent it can – last year sending nearly 60 patients, most suffering from cancer and heart disease. But the government does not have the means to help everyone who needs a transfer, officials say.

Cardiology experts say only one of 10 heart patients who need overseas treatment is sent abroad. “I have patients who have been waiting to be evacuated for three years. Every year, I update and update and the queue is getting longer,” cardiologist Zamsoré said.

As it is the government spends nearly 1 billion CFA francs (US$2.2 million) every year for medical evacuations, surpassing the 800 million CFA francs (US$1.7 million) parliament allots for such transfers.

“When you have 10 to 15 people who will die unless they are transferred, we cannot wait until we find ways to make health care accessible at home,” the health ministry’s Wango said.

The minimum cost of one type of breast cancer surgery in Europe is around 1 million CFA francs (US$2,162) with 10 days of admission in a private clinic; medicines for the first six months amount to 800,000 CFA francs (US$1,730). Fees for heart surgery in Europe range from 10 million to 20 million CFA francs (up to US$43,242).

Poor hospitals, poor people

Burkina is working to build up its own health infrastructure in order to better serve the people, officials said.

The government spends 10 percent of its budget on healthcare. Burkina receives funds to boost health services from various partners including the Islamic Development Bank, the African Development Bank and the government of Taiwan, which is building a hospital in Ouagadougou.

In 2003, the government installed the country’s first X-ray scanner at the main hospital in the capital. A second machine is planned for Bobo-Dioulasso, Burkina’s second largest city, next year. Wango told IRIN people from neighbouring countries, including Togo and Niger, have come to Burkina for the X-ray scanner.

But even when high-tech equipment becomes available, the cost of treatment will prevent many from accessing health services.

“The problem that we face is how to use the technology within a poor community,” Wango said.

In Burkina Faso 72 percent of the population lives on under $2 day.

Cardiologist Zamsoré pointed out that hospitals in Burkina are expected to be largely self-sufficient. “I am wondering if we can get the money back from patients who are among the poorest,” he said.

The dialysis department at the main Yalgado hospital, for example, has a debt of nearly 400 million CFA francs (US$868,000) due to patients who could not pay their bills.

Reducing costs

In the absence of the necessary health infrastructure in the country, the government is exploring ways to bring in medical experts or help patients find affordable care elsewhere.

One option has been to send people to Morocco where advanced technology exists and costs are far lower than in Europe. “We have tested the equipment there and now have patients returning who have recovered from their illnesses,” the health ministry’s Wango said.

Beginning this year, a French team of surgeons will visit Burkina annually to operate on children with heart malfunction – a move that will help save hundreds of lives, officials told IRIN.

In recent years, European teams have been providing free surgery for orthopaedic and trauma patients.

Non-governmental organisations have also been trying to relieve the burden on government by funding the transfer of some cases abroad. For example, the Swiss organisation Sentinelles sends victims of the gangrenous noma disease to France for facial surgery. Still, the transfer depends on the availability of the only surgeon who offers the humanitarian services in Switzerland.

Little Salamata Compaore is now out of danger. Concerned TV viewers came up with the 400,000 CFA francs (US$868) her parents needed to send her to hospital in France where aid organisations secured free treatment.