Article Text

  1. T. D. Gerschman1,
  2. A. Tamir2,
  3. A. J. Macnab1
  1. 1University of British Columbia, Vancouver, BC
  2. 2Wolfson Medical Centre, Holon, Israel.


Background Congenital heart disease is estimated to affect 2 to 3 children per 1,000 live births. Rheumatic heart disease accounts for even more heart and vascular disease. Many of these malformations can be treated with single-stage surgery. Long-lasting improvements in morbidity and mortality are seen with children from developed countries who reach adulthood, often with excellent quality of life. Access to surgical and medical therapy in developing countries is often unavailable, leading to deaths that could otherwise be prevented. The Save a Child's Heart (SACH) organization dedicates itself to (1) provide care for children in developing countries with congenital and rheumatic heart disease and (2) enable partner countries to develop their infrastructure and access to pediatric cardiac therapy.

Methods SACH consists of a dedicated team of medical professionals, including pediatricians, cardiologists, cardiac surgeons, critical care specialists, and nurses. Partnerships are sought in developing countries to directly provide surgery and to develop local medical expertise. Children are evaluated in their countries of origin for the cardiac surgery and, once selected, travel to Israel to undergo a process of evaluation, surgical treatment, and postoperative recovery. Follow-up is continued in the country of origin.

Results Since 1995, approximately 100 to 200 children per year have been treated with surgery and/or catheterizations at approximately $10,000 per child. Success rates, of up to 96%, are comparable to other modern medical centers. Children from infancy to adolescence, from over 20 countries, have been treated through the SACH program. Long-standing partnerships have been established in Ethiopia, Zanzibar, Vietnam, Palestinian Territories, and China. Follow-up, mostly conducted through local organizations in the partner countries, is estimated above 90% over 5 years.

Conclusions Medical professionals in developed countries have the ability to have a major impact on children in the developing world. Complex, single-stage cardiac surgery can be performed where sufficient infrastructure is in place, regardless of where the patient is originally from. Combined with outreach initiatives designed to improve infrastructure, an atmosphere for future self-reliance in countries in the developing world is created.

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