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Ann Thorac Surg 2001;71:407-408
© 2001 The Society of Thoracic Surgeons
a Cardiothoracic Surgery, Rapid City Regional Hospital, Rapid City, South Dakota, USA
Address reprint requests to Dr Pezzella, Cardiothoracic Surgery, Rapid City Regional Hospital, 2880 Fifth St, Rapid City, SD 57701
e-mail: tpezzella{at}rcrh.org
Safely returned from distant lands a man with joy is welcomed by his friends and kin. So too, a good man who has left this world, by his good deeds is welcomed in the next. The Dhammapada
One of the results of the big bang theory was the solar system and the creation of the planet Earth, now more than 4.5 billion years old [1]. Man appeared around 2.5 million years ago. As we enter the 21st century, 6 billion people occupy this planet. Yet less than 20% of the population consumes more than 80% of the world’s resources. Certainly, no one individual group, country, or organization of countries, eg, the United Nations, can change or reverse that trend. However, just as that one heroic Chinese citizen halted a parade of advancing tanks in Tiannemen Square, so too, bold individual initiatives can make an immediate and lasting impact.
The performance of cardiac surgical procedures with cardiopulmonary bypass was a significant medical advance benefiting millions of people during the last half of the 20th century. Currently, 1 to 1.5 million open-heart operations are done annually in more than 2,500 centers by more than 5000 cardiac surgeons worldwide. However, the majority of these operations are performed in the economically advanced countries whose population base is 500 million people. The rate of growth for the remaining 5.5 billion people in underdeveloped or politically and economically hampered countries has been slow to nonexistent.
In recent years, increased activity has occurred to reverse that trend. Doctors Robert Replogle, Thomas Ferguson, and Peter Greene pioneered in creating the CTSNet (www.ctsnet.org) [2, 3]. Doctor Gerald Rainer helped organize The Society of Thoracic Surgeons Ad Hoc Committee on International Relations. The international page of the CTSNet highlights a variety of activities and programs. The Society of Thoracic Surgeons National Database is available for review and participation. Wyse and Taylor [4, 5] have promoted extension of the European Cardiac Surgical Registry database worldwide. The expansion of the Internet has clearly broadened communication throughout the world. Baudet [6] pointed out the potential growth of the Internet to virtual meetings but stressed the importance of necessary direct relationships.
The organization and the growth of activity at the society level, particularly on the part of The Society of Thoracic Surgeons and the European Association for Cardio-Thoracic Surgery, are fostered by the gratifying and stimulating efforts of a number of individuals, groups, and organizations to get more involved internationally at the humanitarian, academic, and venture capital levels. Examples of these activities are readily available on the CTSNet and in the literature [7–9]. The recent report by Borst [10] is noteworthy. He has organized a very effective teaching strategy for Eastern Europe and Russia. The humanitarian effort of Dr Alain Carpentier to establish an open heart surgery center in Ho Chi Minh City, Vietnam, is a monumental example of an achievable goal. The program, now locally funded and staffed, performs more than 1,000 such operations per year. In addition, at least 20–30 cardiac surgical teams from the United States are involved in organized, continuing programs worldwide.
The statistical report for 1998 of the documents World Health Organization a worldwide annual mortality of more than 54 million people [11]. Ischemic heart disease accounts for greater than 7 million deaths and valvular heart disease, for more than 380,000 deaths. Congenital heart disease is included in the miscellaneous causes of death (>3 million), and its incidence ranges from 2 to 3 per 1,000 live births in developed countries to 10 to 15 per 1,000 live births in underdeveloped countries [12]. Given the decreasing costs, morbidity, and mortality associated with cardiac surgical procedures, a planned approach to extend worldwide the benefits of such operations is worthwhile and achievable. Clearly, the growth of cardiac surgery favors those in underdeveloped countries.
Dr Cohen and his staff are to be congratulated on their gratifying and successful project. In this issue of The Annals, they have presented a creative as well as practical approach to advance cardiac surgery in developing countries. The report, though quasi-scientific in terms of a retrospective in-depth study of a group of patients, gives a very thorough analysis of a bold strategy to accomplish this. Careful examination of their presentation yields three important factors necessary to ensure the success of their project: a dedicated host program, be it individuals, institutions, or government; a partner group or country seeking help and cooperation; and a financial base and source of sustained revenues. The cooperative partner must have the support of the government, the academic community, and committed groups of individuals in health care and other fields. The financial source consists of both money and donated equipment and supplies. The usual contributors include government, nongovernmental organizations, private voluntary organizations, and corporate and individual support. For example, many airline companies have traditionally waived their fees. The partner and sponsor must have continued government backing to facilitate key areas such as acquisition of visas and control of customs. A hampered, uncooperative bureaucracy can be a very real roadblock if the effort is not organized and coordinated.
Those who favor international cooperation in and expansion of cardiac surgery cite many advantages. These include extension of surgical procedures and care and broadening of the teaching and research base. Whether the motives are religious, humanitarian, political, or economic, the result is that more patients receive care. On the other hand, some very fundamental questions must be addressed: Who will pay for all this? (An Italian proverb says: Without money, the saints do not perform miracles.). How can we solve our own problems if we are trying to handle those of the rest of the world? Are the truly indigent being mixed with the politically and economically favored groups? Certainly, an open discussion and debate would benefit all concerned with these activities. Political, economic, and humanitarian goals must strike a responsible compromise. As cardiac surgeons, our humanitarian idealistic background has been weathered by realism in the everyday battlefield of health care. As we grow, a balanced idealistic reality emerges, fostered by maturity, experience, judgment, a sense of finality, and a desire to leave something behind—reputation, family security, a sense of accomplishment.
There is one psychological peculiarity in the human being that always strikes one: to shun even the slightest signs of trouble on the outer edge of your existence at times of well-being ... to try not to know about the sufferings of others and your own or one’s own future sufferings, to yield in many situations, even important spiritual and central ones—as long as it prolongs one’s well-being.
Alexander Solzhenitsyn
Suffering
References
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