**Abstract**

Global health initiatives have expanded over the last 25 years and are no longer based solely on improving public health issues like clean water and childhood vaccination programs. Global healthcare assistance has grown into programs that provide specialty services and education today. Cardiovascular diseases are causing more deaths today in low and middle-income countries today as infectious diseases cease to be the number one cause of mortality in many of these countries. Growth in cardiovascular assistance has been substantial during the last 25 years and especially in the area of pediatric cardiac care. We discuss the ethical issues that can be found when visitors assist countries with different cultural values. The success of program development depends on navigating the ethical issues such that all stakeholders are satisfied with the project and the end result. The foundation of program development should be based upon medical ethics that are sensitive to cultural differences so that a capable sustainable program is developed upon completion.

**Keywords:** Ethics, short term global surgery programs, cardiac surgery, humanitarian assistance

#### **1. Introduction**

Global health programs have substantially increased in number and sophistication over the last 25 years. No longer do we see only primary care programs from upper-income countries (UIC) visiting lower and middle-income countries (LMIC). Today we have specialty global health care initiatives that include pediatrics, pediatric general and cardiac surgery, orthopedic and neurological surgery. Internal medicine programs specifically for endocrine and oncology, as well as singular issues with women's health. The increase in global health initiatives has sparked a discussion in the overall purpose and ethics of these efforts. The altruistic nature of these efforts cannot be overstated, but with the health care deficits in LMIC it is vitally important to consider building capacity at the local level and not fostering a dependency on the visiting team for a higher level of healthcare that is intermittent at best. Cardiovascular diseases are the number one cause of mortality world-wide [1]. However, there are deficiencies in cardiac care in almost 90% of the world, almost all in LMIC [2]. The result is that patients in these areas are poorly served and a significant healthcare in-equality continues to exist. The need to expand cardiac care to these parts of the world must be balanced with a beneficent approach to this problem since there are several ethical issues in providing medical

education, training, experience and optimal patient care which can be violated without adequate thought, preparation, and execution. Moreover, legal issues with the importation of medicines, supplies, equipment, and licensure must be considered on a country-by-country basis. Critics of surgical development assistance in general and cardiac specifically abound, some with relevant points. It is incumbent of those assisting to do so within the scope of ethical standards both from the visiting team's country and the country receiving assistance if success is to be assured.
