Teamwork and program organization in developing countries.

Establishment of congenital heart surgery programs in developing countries is often impeded by competition among providers for scarce resources and opportunities. To avoid this problem, the authors have sought to focus program development on a domestic medical team that includes a visiting North American surgeon. A leadership group was formed consisting of a domestic cardiologist and surgeon, the visiting surgeon, and leading local benefactors. Surgery was initiated beginning with closed cases, and the volume and complexity were gradually increased. The team was mentored by the visiting surgeon, and full medical brigades visited periodically. All members of the leadership group interacted with local health care providers, missionary groups, and visiting medical teams from international organizations, aiming to develop a single congenital heart surgery center. Over a period of 3 years, 185 children have been operated on and the team has progressed to do more complex open and closed cases. Overall mortality is 6.5%. Actively working with the program are 3 of the 5 local pediatric cardiologists, 2 of 4 pediatric intensivists, the only pediatric perfusionist, and the only active pediatric heart surgeon. Three additional international organizations currently participate in program development. Fundraising by the domestic nonprofit organization has increased approximately 20-fold in 5 years, and the program has been evaluated and approved by the government-based health insurance program. Focusing program development around a domestic leadership team allows coordination of patient referrals and resources, which contributes to excellent patient care and program sustainability.