Paediatric and congenital cardiac surgery in emerging economies: surgical ‘safari’ versus educational programmes

Abstract

To attract the interest of all people potentially involved in humanitarian activities in the emerging economies, in particular giving attention to the basic requirements of the organization of paediatric cardiac surgery activities, the requirements for a successful partnership with the local existing organizations and the basic elements of a patient-centred multidisciplinary integrated approach. Unfortunately, for many years, the interventions in the low and middle income countries were largely limited to short-term medical missions, not inappropriately nicknamed 'surgical safari', because of negative general and specific characteristics. The negative aspects and the limits of the short-term medical missions can be overcome only by long-term educational programmes. The most suitable and consistent models of long-term educational programmes have been combined and implemented with the personal experience to offer a proposal for a long-term educational project, with the following steps: (i) site selection; (ii) demographic research; (iii) site assessment; (iv) organization of surgical educational teams; (v) regular frequency of surgical educational missions; (vi) programme evolution and maturation; (vii) educational outreach and interactive support. Potential limits of a long-term educational surgical programme are: (i) financial affordability; (ii) basic legal needs; (iii) legal support; (iv) non-profit indemnification. The success should not be measured by the number of successful operations of any given mission, but by the successful operations that our colleagues perform after we leave. Considering that the children in need outnumber by far the people able to provide care, in this humanitarian medicine there should be plenty of room for cooperation rather than competition. The main goal should be to provide teaching to local staff and implement methods and techniques to support the improvement of the care of the patients in the long run. This review focuses on the organization of paediatric cardiac activities in the emerging economies, but 'the less privileged parts of the world' can be anywhere, not necessarily limited to economic constraints. Lack of diversity because of social, intellectual, educational and professional growth, the last consisting in cultural stagnation, is responsible for the lack of scientific progress and development.

Establishing a sustainable open heart surgery programme in Nigeria, a low-income country: which is the best model?

“…Ultimately, success should not be measured by the number of successful operations of any given mission but by the successful operations that the local team performs after the visiting leave. 11,12,13 In a similar study by Velebit et al, a team of fully trained specialists did a cardiac mission in Tbilis Georgia for a period of 5 years where the frequency was monthly of 1 week duration with an average of 10 times in a year, After 5 years, the local team was able to become independent and has performed 111 cases within the first 7 months in 2008 out of 204, while the remainder was done by foreign team during irregular support visits in relationship to difficult cases. 14 In Nigeria, the mission programme can be described as surgical Safari type rather than educational.…”

Challenges in Pediatric Cardiac Anesthesia in Developing Countries

“…Various non-governmental humanitarian organizations (NGOs) have been providing pediatric cardiac surgeries in developing countries for many years. Majority of them were short-term missions called “surgical safaris” ( 7 ). The World Society for Pediatric and Congenital Heart Surgery established in 2006 shifted the focus from providing individual pediatric cardiac care to developing global standards for the practice of pediatric cardiac surgery and professional education of the local teams ( 5 ).…”

Guidelines and checklists for short‐term missions in global pediatric surgery

“…While many cadres are involved in care provision, this work will focus primarily on pediatric surgeons, anesthesia providers, and nurses. Many surgical specialties have developed their own guidelines for successful short‐term missions, with recommendations from high‐income country and low‐ and middle‐income country perspectives and groups within children's and adult surgery . However, no consensus recommendations currently exist for pediatric general surgery and associated perioperative care.…”