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J Thorac Cardiovasc Surg 2002;123:1016
© 2002 The American Association for Thoracic Surgery

Letters to the Editor

Worldwide maldistribution of access to cardiac surgery

Good Samaritan Regional Health Center, Mt Vernon, IL 01655

To the Editor:

I read with interest and enthusiasm the recent presidential address to The American Association for Thoracic Surgery by Dr James Cox. ¹ The content contained subjective and objective data worthy of comment. Subjectively, he struck an emotional chord with all cardiothoracic surgeons to rally and address the maldistribution of cardiac surgery worldwide. Objectively, he outlined a strategy that includes extensive educational modalities with the Internet as the primary vehicle of transfer of knowledge and information.

Having been involved with international cardiothoracic surgery development for the past 23 years, his address was timely and appropriate. At present at least 20, and certainly no more than 40 groups, based in North America, are involved with structured international projects on a recurring basis. The era of bringing patients to the United States for free cardiac surgery is over. There are still a few programs involved in this endeavor, for example, the Gift of Life Program in the metropolitan New York area. The focus with the majority of donor programs is to develop an on-going relationship with a host program. From this relationship, clinical, teaching, research, and administrative/logistic strategies evolve. Ultimately the host program becomes autonomous, with the donor program playing a subsequent mentoring or consultant role. It must be stressed that, as with any program development, trust and respect must be earned and cherished. The subsequent earned relationship pays dividends well beyond the anticipated goals.

There are inherent problems with the "regional centers" concept. As a base or center for teaching and regional organization, this is effective and practical. However, for logical, illogical, and emotional reasons, each country wants its own program and is reluctant to send patients to another country. Despite their poverty and lack of access, patients and families still want personalized attention and resist the notion of being channeled into a socialized and structured system.

Clearly this is a challenging area, and Dr Cox should be congratulated for presenting an outline for all of us to study, discuss, and debate. Ultimately, it all comes down to the challenges of transfer—the transfer of knowledge, ideas, or information; the transfer of people; and the transfer of things, that is, money, equipment, and supplies. That is what we are really attempting to do. The transfer of knowledge, ideas, or information is via communication, such as personal contact, meetings, conferences, telephone, fax, E-mail, or telecommunication. The transfer of people involves training of medical and nonmedical professionals, either in the donor country or in the host country itself. The transfer of money and things, that is, equipment and supplies, is probably the most difficult. Unfortunately, money and financial support will ultimately be the greatest challenge. Sources of income include government, quasi-government (eg, the United Nations), corporate, nongovernment organizations, and private entities. Corollary issues like politics, attitudes, and cooperation are the challenge of leadership—those who have it, those who aspire to it, and those who should aspire to it. As a final thought, immediate attention by The American Association for Thoracic Surgery to the development of an ad hoc committee for international relations, similar to that of the Society of Thoracic Surgeons, may accelerate the process and develop a worthwhile agenda along the guidelines Dr Cox has proposed. Those of us presently involved eagerly await an organized coalition to work with and share our collective experiences.

12/8/123129

doi:10.1067/mtc.2002.123129

Reference

1. Cox JL. Presidential Address: Changing boundaries. J Thorac Cardiovasc Surg. 2001;122:413-8.[Free Full Text]
   

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): A. Thomas Pezzella Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Pezzella, A. T. Search for Related Content PubMed PubMed Citation Articles by Pezzella, A. T.