**3.6 Intermittent cardiac surgery missions**

It has been argued that transporting children to other countries for treatment coupled with intermittent "missions" to existing non-specialist hospitals to carry out cardiac surgery can act as "enabling projects" that help bring the problem into focus while the creation of a sustainable unit is being planned (Yacoub, 2007). Some have however criticized this treatment alternative because only a limited number of patients can be assisted and the results are not consistently satisfactory - since the local hospital conditions are often far from ideal and the team may not be on ground long enough to observe and manage some of the post-operative complications (Stolf, 2007). It is nevertheless a better option than no surgery at all and offers the possibility of training local surgeons and hospital personnel, which should be a major focus (Stolf, 2007; Yacoub, 2007).

#### **3.7 Establishing treatment centres in developing countries**

The ideal option remains the development or establishment of treatment centres in the developing countries themselves. This is the most challenging option because of the huge investments required – in terms of technology, infrastructure and the training of personnel (cardiologists, surgeons, intensive care personnel and other cardiovascular specialists) . Some of the success stories notably in India and Brazil have been as a result of home-grown efforts coupled in some cases with the efforts of returning citizens trained in developed countries. Others have been spearheaded by humanitarian efforts of individuals and groups from developed countries – notably in China, Vietnam, Mozambique and Guatemala (Pezella, 2010; Yacoub, 2007). It is a daunting task that requires great commitment in view of the tremendous social and economic challenges often encountered. The biggest challenge here is that of sustainability. The presence of home-grown technology (as in India, Brazil), cost-saving measures such as re-sterilizing and re-using consumables, long-term commitment and support from donor organizations in developed countries and incorporating research into the programme appear to be factors that favour sustainability (Rao 2007, Yacoub 2007).
