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• W2899758437 abstract "Dr Sinclair [1Sinclair M.C. Reflections of a cardiac surgeon turned global health educator.Ann Thorac Surg. 2018; 106: 1271-1273Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar] raises very pragmatic issues on the key considerations and adjustments necessary for an enriching global health experience, but more importantly, he highlights the need for coordinated, sustained engagements between and among stakeholders [1Sinclair M.C. Reflections of a cardiac surgeon turned global health educator.Ann Thorac Surg. 2018; 106: 1271-1273Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar]. Getting the priorities of the host countries and institutions right, and as the saying goes, “…working yourself out of the job by building local capacity for posterity…,” should be major criteria for the assessment of any global health undertaking especially targeted at provision of surgical care. Heart surgery may appear not to be a priority in low and middle income countries where there is lack of skill and high-technology equipment to monitor patients intraoperatively and postoperatively. However, with the increasing double burden of disease as noncommunicable diseases such as diabetes mellitus and its attendant cardiovascular complications are on the increase against the background of health systems already overstretched by infectious disease challenges, heart surgery is fast becoming a priority [2World Health OrganizationNon-communicable disease country profiles.http://www.who.int/nmh/countries/uga_en.pdf?ua=1Date accessed: September 18, 2018Google Scholar, 3Schwartz J.I. Guwatudde D. Nugent R. Kiiza C.M. Looking at non-communicable diseases in Uganda through a local lens: an analysis using locally derived data.Global Health. 2014; 10: 77Crossref PubMed Scopus (55) Google Scholar]. The need for capacity building in terms of training, equipment, and supplies makes the careful review and planning of global health engagements vital. Short-term medical missions have a number of benefits if well organized, namely: specialized surgeries are carried out on patients who cannot afford to travel abroad; hands-on experiences for both the local and visiting residents and faculty (surgeons and nurses); and the boost from carefully selected equipment and supplies donated to the hosting hospitals. The long-term impact would be enhanced through advocacy, participatory identification of local surgical and training needs for the subsequent missions, and formation of long-lasting collaborations including collaborative research projects. Dr Sinclair’s enviable experience with the largest global health undertaking in low and middle income countries—the Rwanda Human Resource for Health Program—and a similar model in Liberia highlights the need for a multiskilled specialist in a health system where referral and the lack of subspecialists to handle different cases pose major challenges [4Binagwaho A. Kyamanywa P. Farmer P.E. et al.The human resources for health program in Rwanda—a new partnership.N Engl J Med. 2013; 369: 2054-2059Crossref PubMed Scopus (188) Google Scholar]. There is also a misconception allayed by the Dr Sinclair in reassuring potential global health scholars and practitioners that life is still fun in most of the low and middle income countries, contrary to the general beliefs of abundant desperate living conditions [1Sinclair M.C. Reflections of a cardiac surgeon turned global health educator.Ann Thorac Surg. 2018; 106: 1271-1273Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar]. Infrastructure and provisions in many of the cities have continued to improve and the rollout of mobile telephone and Internet access have made communication much easier. Reflections of a Cardiac Surgeon Turned Global Health EducatorThe Annals of Thoracic SurgeryVol. 106Issue 5PreviewAfter 35 years of cardiac surgery practice in Allentown, Pennsylvania, I was ready to work full-time in global health (GH). I was not a novice: I had studied tropical medicine in the Panama Canal Zone and worked for 2 years as an epidemiologist at the Centers for Disease Control and Prevention. In addition, before my retirement I had served five overseas missions in roles as cardiac surgeon, epidemiologist, general surgeon, and primary care physician. Full-Text PDF ReplyThe Annals of Thoracic SurgeryVol. 107Issue 4PreviewI concur with Ssebuufu [1] that recognition of the priorities of host countries or host institutions and long-term commitments are essential for success of a global surgery effort. He is correct that visiting surgical teams should do more than provide patients with otherwise unavailable operations by becoming involved in educational programs. Full-Text PDF" @default.
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• W2899758437 title "Double Burden of Disease: A Global Health Challenge" @default.
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• W2899758437 doi "https://doi.org/10.1016/j.athoracsur.2018.09.050" @default.
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