Paediatric cardiac assistance in developing and transitional countries: the impact of a fourteen year effort

Abstract

Background: Paediatric cardiac services are poorly developed or totally absent in underdeveloped countries. Institutions, foundations and interested individuals in those nations in which sophisticated paediatric cardiac surgery is practised have the ability to alleviate this problem by sponsoring paediatric cardio-surgical missions to provide care, and train local caregivers in developing, transitional, and third world countries. The ultimate benefit of such a programme is to improve the surgical abilities of the host institution. The purpose of this report is to present the impact of our programme over a period of 14 years. Methods: We specifically reviewed our database of patients from our missions, our team lists, surgical results, and the number and type of personnel trained in the institutions that we have assisted. In order for the institution to be entered into the study, the foundation had to provide at least 2 months of training. In addition, the institution had to respond to a simple questionnaire concerning the number and types of surgery performed at their facility before and after intervention by the foundation. Results: We made 140 trips to 27 institutions in 19 countries, with 12 of the visited institutions qualifying for inclusion. Of these, 9 institutions reported an increase in the number and complexity of cases currently being performed in their facility since the team intervened. This goal had not been accomplished in 3 institutions. The reasons for failure included the economic situation of the country, hospital and national politics, personality conflicts, and continued lack of hardware and disposables. Conclusions: Paediatric cardiac service assistance can improve local services. A significant commitment is required by all parties involved.

Congenital heart disease at Laos Children's Hospital: Two year experience

“…Novick et al . showed that a visiting surgical team can significantly improve local care, as indicated by the increased number and complexity of cases in the visited institutions . This indicates that the development of independent and sustainable programs within developing countries should be the ultimate goal of external interventions and that long‐term commitment of both the visiting team and the local recipient institution is important.…”

Ethics in humanitarian efforts: giving due credit to the local team

“…Certainly, there is evidence in the literature that various organisations have helped to establish sustainable programmes using a system of repeated surgical trips with an emphasis on teaching. 8,9 Future work could include interview or focus-group studies of local providers to learn their perceptions of the relationships. It could also be informative to do similar work focussing on other forms of humanitarian assistance, such as the effect on or perception of local providers when patients are either sent out for surgery, or when a permanent local institute is established totally or partly staffed by foreigners.…”

Children’s heart disease in sub-Saharan Africa: Challenging the burden of disease

“…There is a growing consensus about the need to work together to build regional centres which themselves can become a resource to surrounding areas and countries through satellite outreaches. (84,85,86,87) Such regional "surgical hubs" could form training and resource bases for surrounding countries, with international aid coordinated at one centre rather than being diluted through multiple small efforts. is directed toward first-world needs for both pharmaceuticals and technology.…”

“…(87) A degree of education of the local community and recruitment of political leadership is important.…”