Reflections on 22 years at the Association of Black Cardiologists, Inc.

After 22 years at the helm of the Association of Black Cardiologists, Inc (ABC), Dr Waine Kong will be stepping down as chief executive officer effective July 25, 2008. Dr Kong was hired on November 10, 1986, in Dallas—the same city, coincidentally, where the organization was founded 12 years earlier. Starting with a membership of 50 and an annual budget of less than $50,000 per year, the ABC has grown to a membership of more than 500 and an annual budget reaching $6 million.

Over the last 20 years, the organization has become known worldwide as a pioneer and promoter of programs that empower patients and lay volunteers to take responsibility for the health of their communities by organizing churches, barbershops, and beauty salons as health promotion centers as well as training, certifying, and motivating community leaders to act as "Community Health Advocates."

Since 1995, the ABC has been a leader in the cardiology field and is an accredited provider of continuing medical education courses. In 2000, the ABC purchased 127 acres of land in South Fulton County and opened their 40,000 square foot International Library, Research and Conference Center 6 years later at a cost of $10 million. According to Dr Malcolm Taylor, past president of the Association of Black Cardiologists "Dr Kong has done great work. Great was his faithfulness to the ABC." We sat down with Dr Kong to discuss the ABC, his legacy, and his plans for the future.

Cardiology Review (CR): What is ABC's reason for being?

Waine Kong (BWK): Every single day, more than 250 African Americans die from cardiovascular disease. This is unacceptable. If a plane fell out of the sky killing that many people per day, there would be a great hue and cry and demand that we do something about it. I am appalled that this problem is ignored in our community. Cardiovascular disease—including heart disease, stroke, kidney failure, and diabetes—kill more African Americans than all other diseases combined. Granted, cardiovascular disease affects mostly people who are over 50 years old but it cuts us down in our prime earning years. You see, if you are sick, you are spending money, not making it. Health and wealth go hand in hand.

The ABC is a primary line of defense against this thief that is stealing so many of our grandparents. If we are ever going to solve our social problems (juvenile delinquency, underachievement, and unwanted pregnancy), we need more grandparents in our community. But, due to cardiovascular disease, they are leaving us too soon. By the time a black child graduates from high school, he or she usually only have one grandparent left—almost always a grandmother.

If one patient has a disease, treat the patient. If most of the community has the same disease, treat the community. The adage "cleanliness is next to godliness" probably did more good for public health than any medical breakthrough. With our current obesity epidemic, we need to find some way to treat the community, whether by eliminating trans fats in our foods, promoting exercise, or taking soda machines out of the schools.

CR: In the years I have known you, you have been preaching prevention as the strategy for reducing the high rate of heart disease and stroke. Is this realistic?

BWK:I am absolutely convinced that prevention is the way to go. Clearly, we have to treat people with disease but it's even more important to prevent disease.

Right now, less than 5% of our health care expenditures are spent on prevention. But look at the record. We eliminated smallpox, typhoid fever, tuberculosis, and shingles, which caused the deaths of more than 1 billion people in the last century. We have almost also rid this nation of tooth decay. Fifty years ago, everyone expected to get false teeth by age 50 and dentists made a nice living pulling teeth. That has changed.

I am convinced that we can have similar success with cardiovascular disease. Heart disease and stroke has very little to do with genes. It is a lifestyle problem. Just by changing the way we live will prevent or significantly reduce our exposure to cardiovascular disease. If we focus on prevention, heart disease and stroke will be a thing of the past.

CR: Dr Kong, in looking back over 21 years, what do you consider your greatest accomplishments?

BWK: I am a humble man who merely tried to make a difference, but I can point to 2 things of which I am particularly proud. First, I believe that the mission statement I wrote and that was adopted by the board of directors in 1988 is one of the most compelling among professional organizations. It states that the members of the ABC believe that "Good health is the cornerstone of progress. We are firm in our resolve to make exemplary health care accessible and affordable to all in need, dedicated to the lowering of the high rate of cardiovascular disease in minority populations, and committed to advocacy and diversity. We are guided by high ethics in all transactions and strive for excellence in our training and skills."

In 1997, the mission statement became the basis for the campaign known as "Children should know their grandparents so they well become GREAT grandparents." With this, I was trying to address the issue of African-American parents and grandparent's penchant for sacrificing themselves for their loved ones. Every day, people make decisions based on their priorities. Do I visit my doctor and buy prescription medicines or buy new school clothes for the children and grandchildren? My sense was that African-American grandparents usually put themselves last and would prefer to buy the clothes. And then I was sitting on an airplane and heard the flight attendant saying, "In case of emergency, put the oxygen mask on yourself first." Eureka! I realized that if you want to continue taking care of the ones you love, you have to take care of yourself first. You cannot help anyone if you are not alive and well. So, I advise everyone to take care of themselves first—particularly if it involves your health.

CR: You said there were two, what's the second?

BWK: I take some credit for changing how we manage high blood pressure. In 1978, only physicians and nurses were allowed to take blood pressure. It was viewed as a medical procedure. Working at that time with a founding member of the ABC, Dr Elijah Saunders, I wrote a proposal to the National Heart, Lung, and Blood Institute (NHLBI) that ended up in the hands of Dr Donald Ware, who was intrigued with the idea of lay volunteers setting up clinics in their churches. But he confessed to me that he would be run out of the NIH if he approved something so radical. So, he advised that if I could get a letter of support from the American Heart Association (AHA), he would support it. In my first meeting with the AHA Hypertension Committee, they turned down my request. I was going home frustrated when the answer just flashed before me. I have always thought that when you pray, you are talking to God and when you get a flash, a catharsis, or a moment of clarity, God is talking to you.

When they agreed to meet with me again, I told them that I intended to use "Church Nurses." As all the members of the committee were white, they thought I meant nurses who were members of churches. So they approved the project and we received the $250,000 3-year grant to organize churches as "High Blood Pressure Control Centers." We trained 500 blood pressure measurement specialists and organized 100 churches in the state of Maryland starting in 1979 and the project has continued since then with the same staff and funding from the state of Maryland Department of Health.

In 1982, we discovered that only 30% of the people we were reaching were men, so we turned to another pillar of the community, barbershops and beauty salons. When men sit in a barber chair, they are all set up to get their blood pressure taken by trained and certified barbers. I have lobbied without success since then to make blood pressure measurement a requirement for licensing barbers and beauticians.

CR: What advice do you have for the members of the ABC?

BWK: One finger is not much of a force but fingers forming a fist can be a formidable weapon. I would love for every black cardiologist to recognize what an important and highly respected resource the ABC has become. It is going to take a very concerted effort to assure its survival and take the ABC to another level.

CR:What do you plan to do after July 25, 2008?

BWK: First and foremost, I want to do whatever I can to assure the ABC continues to do well. But, I also have several other goals. I am very committed to promoting prevention in developing countries such as Jamaica, and for facilitating access for citizens of these countries to the same sophisticated cardiovascular care available in the United States. I grew up in the Woodlands District of Jamaica, a community where the average income is less than $500 per year. I hope to be instrumental in improving the quality of life for the people from that community as well. I am not retiring from life, just pursuing other interests.

CR: How would you characterize your work with the ABC?

BWK: The ABC has been my life's work and hopefully, I have done it well. But it is time to do something else. It is time for someone else to bring new ideas and a new energy that can take the ABC to another level and to be the force that will go a long way to eliminate cardiovascular disease in our community.

As I leave the ABC, my heart is full of good memories, good relationships, and hope for the future. I don't believe God created us to just make a living, pay bills, and die. Maya Angelou put it very nicely when she said, "Most people don't grow up. Most people age. They find parking places, honor their credit cards, get married, have children, and call that maturity." That is not me. I believe each of us is here for a purpose and I found my calling. I want to complete my destiny and leave a legacy before I bid the world good bye.

CR: Thank you and congratulations, Dr Kong.