To the Editor: Humanitarian Cardiac Surgery Care for Developing Countries: Role in Achieving Sustainable Global Health

Cardiovascular disease (CVD) in children and adults in least developed countries is on the rise in both urban and rural communities. In the case of sub-Saharan Africa, CVD is now a leading cause of premature deaths, with poor health infrastructure and shortage of skilled cardiac healthcare professionals. There is much discussion among members of the cardiac surgical specialty as to how best to address the latter in such countries. Previously, we have proposed that several actions aimed at implementing humanitarian programs to support nonaffording patients in health systems around the world, would be a forward way. However, the European Association of Cardiothoracic Surgery and its International Committee, on the other hand, does not believe that the best solution is achieved by sending teams to the developing world. Their point of justification is that teamwork is particularly important in cardiac surgery, where the weakest link can determine the ultimate outcomes of surgery. Using this as our starting point, we explored ways of implementing training in local centers partly funded through charitable donations and a public private partnership model. The CardiacEye International Foundation (CEIF; www.cardiaceye.com) team made an exploratory visit to the coastal city of Mombasa in Kenya, to explore contacts with government representatives and health ministers and local hospital doctors and administrators. During this visit, CEIF assessed and examined the levels of local experience and knowledge and the available equipment. A project proposal was put forward aiming to expand scope for provision of cardiac surgery services locally to nonaffording patients through collaborative training of specialists depending on the needs. A cardiovascular surgical team was put together made up of a cardiologist, a surgeon, an anesthetist, a perfusionist, a scrub nurse, an intensive care nurse, a respiratory therapist (or both), and a ward nurse where necessary.