Medical missions for the provision of paediatric cardiac surgery in low- and middle-income countries.

Frank J Molloy,Emma Scanlan,Marisa Mize,Nguyenvu Nguyen,William M Novick,Gavin Wright,Cecilia St George-Hyslop,Maura O’Callaghan

doi:10.1017/s104795111700261x

Abstract

This review will outline the role of visiting cardiac surgical teams in low- and middle-income countries drawing on the collective experience of the authors in a wide range of locations. Requests for assistance can emerge from local programmes at a beginner or advanced stage. However, in all circumstances, careful pre-trip planning is necessary in conjunction with clinical and non-clinical local partners. The clinical evaluation, surgical procedures, and postoperative care all serve as a template for collaboration and education between the visiting and local teams in every aspect of care. Education focusses on both common and patient-specific issues. Case selection must appropriately balance the clinical priorities, safety, and educational objectives within the time constraints of trip duration. Considerable communication and practical challenges will present, and clinicians may need to make significant adjustments to their usual practice in order to function effectively in a resource-limited, unfamiliar, and multilingual environment. The effectiveness of visiting trips should be measured and constantly evaluated. Local and visiting teams should use data-driven evaluations of measurable outcomes and critical qualitative evaluation to repeatedly re-assess their interim goals. Progress invariably takes several years to achieve the final goal: an autonomous self-governing, self-financed, cardiac programme capable of providing care for children with complex CHD. This outcome is consistent with redundancy for the visiting trips model at the site, although fraternal, professional, and academic links will invariably remain for many years.

Highlights

POOR ACCESS TO PAEDIATRIC CARDIAC SURGICAL interventions in low- and middle-income countries represents a large unaddressed disease burden, with around 90% of those one million born annually with CHD having no access to affordable
Requests for assistance vary by host centre characteristics, ranging from new sites with minimal cardiac surgical experience to established sites seeking to improve on results in high-risk, lowweight critical defects.[14,17]
For sites where cardiac surgery is already being performed, direct evaluation may not be necessary, later biomedical engineering support is frequently useful for local training, identifying unmet needs, and optimising equipment usage

Summary

Introduction

POOR ACCESS TO PAEDIATRIC CARDIAC SURGICAL interventions in low- and middle-income countries represents a large unaddressed disease burden, with around 90% of those one million born annually with CHD having no access to affordable. Visiting teams generally comprise between five and 20 professionals per trip, including clinicians from anaesthesia, cardiac surgery, perfusion, cardiology, nursing, and ICU staff. Infrastructure, drugs, and equipment should be sent in advance, and a visit by a core team including a biomedical engineer along with one to two other clinicians is critical when establishing a new site.

Results

Conclusion