J Thorac Cardiovasc Surg 2002;123:1016-1017
© 2002 The American Association for Thoracic Surgery
Reply to the Editor:
James L. Cox, MD
President, The World Heart Foundation, 1828 L St, NW, Suite 1100, Washington, DC 20036
I was particularly pleased to learn from the Editor, Dr Wechsler, that he had received the preceding letter to the Editor from Dr Tom Pezzella regarding my presidential address. There is probably no surgeon in the world who is more interested or more knowledgeable on this subject than Dr Pezzella.
I appreciate Dr Pezzella's comments and I agree with him that the regional center concept is not applicable to all areas of the world. Through our activities at the World Heart Foundation during the past few years, it has become apparent that the needs vary widely from one region to another and from one country to another. That is the reason that I tried to outline a variety of approaches to the overall problem of the maldistribution of cardiac surgical care. Dr Pezzella is correct when he says that what we are really attempting to do is to transfer our knowledge and ideas to another people. I would add our skills to that list. The money, equipment, and supplies are simply some of the tools that we will need to effect that transfer. However, a lack of these tangibles is not always the problem.
It is clear that building a regional center de novo is not generally feasible, although Professor Alain Carpentier did precisely that 10 years ago in Vietnam with spectacularly successful results. On the other hand, our colleague in Germany, Dr Hans Borst, has just completed an exhaustive assessment of the situation in Central Europe and finds no need whatsoever for building new centers. On the contrary, we plan to work through several existing institutions in that region to upgrade the availability of cardiac surgery, starting with the pediatric age group. As I mentioned in my address, Dr Aldo Castaneda has already established a center in Central America, and his major problems are ancillary salary support and education. Dr Pezzella is correct in stating that numerous organizations have been actively involved in this area for years, such as Children's Heartlink, Dr Nilas Young's group in the San Francisco area, The World Children's Heart Foundation, and The Madras Medical Mission. The plans for approaching the various problems in disparate regions of the world depend heavily on tapping into the experience of such groups who have preceded us.
One of the most gratifying experiences of my life has been the outpouring of support that hundreds of cardiothoracic surgeons from all over the world have offered since the address in May and the follow-up publication in September. I mentioned in the address that I was fearful that we might have forgotten why we became surgeons in the first place. My fears could not have been more misplaced. At the very top of the list of individuals who have been active in the past and who wish to do more in the future is Dr Tom Pezzella. We at the World Heart Foundation hope to take advantage of this type of devotion, enthusiasm, experience, and ideas in the future as we tackle a problem that is common to us all as humanitarians.
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