Response to letter on the Cape Town Declaration

Heart Federation]) formed an umbrella body (“Cardiac Surgery Intersociety Alliance” [CSIA]) – with the goal of jointly facilitating access to cardiac surgery in the developing world. It was ratified by all councils and is chaired by Robert Higgins, Chief at Johns Hopkins and President of STS. As called for in the Cape Town Declaration, the main mission of CSIA is to facilitate the establishment of local cardiac surgical capacity rather than fly-in “missions” or sporadic “fly-out” assistance affecting only a few children. As stated in our joint assessment of “Global unmet needs in cardiac surgery”(3) “The question as to whether these fly-in or fly-out missions have benefitted a few while harming the many is a controversial topic of ongoing debates. While one may argue that these missions could be seen as trial-runs for the infrastructure and interdisciplinary skills-harmonisation necessary for commencing local openheart surgery, the long-term verdict is largely less positive. In the long run, ‘missions’ – f inanced by NGOs or their governments and mostly deploying big teams for a handful of predominantly congenital corrections and well publicized ‘fly-out’ missions for a handful of children to private health businesses provided the local governments with fig leaves. Being able to superficially claim that heart surgery was offered to their population, allowed them to camouflage the gap between the population’s needs for life-saving surgery and the actually offered miniscule relief for society.”