Global Cardiac Surgery

This page is dedicated to global surgery and public health, as it pertains to our cardiothoracic surgery specialty. It is managed by Yihan Lin of the TSRA executive committee. Please let us know if you have any suggestions for our page!

An Introduction to Global Cardiac Surgery

The Burden of Cardiovascular Disease – Cardiovascular diseases are the leading cause of death worldwide. The majority of these, nearly 15 million, are in low- and middle-income countries (LMICs).1 93% of the LMIC population lacks access to safe, timely, and affordable cardiac surgical care.2 Of the over 4,000 centers worldwide able to perform cardiac surgery, there is a significant maldistribution – 1 cardiac center per 120,000 in North America as compared to 1 per 33 million in sub-Saharan Africa and 1 per 16 million in Southeast Asia.3 Similarly, while high-income countries have 7.15 cardiac surgeons per million population, low-income countries have only 0.04 per million.4

Cardiac surgery in global health – Conventionally, cardiac surgery’s role within global health was confined to short-term, fly-in fly-out mission trips. However, there is a growing recognition of sustainable, locally-driven interventions with a focus on wider health systems. Various academic groups and non-governmental organizations have embedded such a focus within their existing international partnerships to meet the local needs and support local partners in their path towards the establishment and expansion of cardiac centers.

A Call to Action – In 2018, the leading cardiothoracic surgical societies and the World Heart Federation developed the Cape Town Declaration and established the Cardiac Surgery Intersociety Alliance to respond to the large global burden of rheumatic heart disease.5 However, efforts are nascent and remain focused on center-specific initiatives and may be expanded to larger-scale efforts addressing systemic gaps, lack of training programs, and the persistent scarcity of up-to-date information.

How you can get involved – Momentum is building for the global cardiac surgery movement, but increasing recognition by societies and programs is necessary to better support trainees in getting involved clinically and/or academically. The TSRA is interested in developing more resources to create opportunities for all cardiothoracic surgical residents interested in global cardiac surgery. Contact us if you are interested in learning more and getting closer involved.

References:

  1. Roth GA, Johnson C, Abajobir A, et al. Global, Regional, and National Burden of Cardiovascular Diseases for 10 Causes, 1990 to 2015. J Am Coll Cardiol. 2017;70(1):1-25.
  2. Vervoort D, Swain JD, Pezzella AT, Kpodonu J. Cardiac Surgery in Low- and Middle-Income Countries: A State-of-the-Art Review. Ann Thorac Surg. In Press.
  3. Cox JL. Presidential address: changing boundaries. J Thorac Cardiovasc Surg. 2001;122(3):413-418.
  4. Vervoort D, Meuris B, Meyns B, Verbrugghe P. Global cardiac surgery: Access to cardiac surgical care around the world. J Thorac Cardiovasc Surg. 2020;159(3):987-996.e6.

How fellows, residents, and medical students can engage in Global Cardiac Surgery

Engaging in Global Cardiac Surgery can seem daunting, but there are opportunities at every stage of your career (students, residents, fellows, attendings). These opportunities can last anywhere from a week to a lifelong commitment. Here are some ways you can start getting involved.

Service

NGOs

There almost 100 NGOs focused on providing cardiothoracic surgery to underserved populations worldwide. Here, we name a few that we have had direct experience with. These NGOs continue to mentor volunteers that are in medical school, residency, and cardiothoracic fellowship. 

Team Heart – Team Heart has partnered with the Rwandan Ministry of Health and Rwanda Heart Foundation to provide cardiac care since 2007. 

Novick Cardiac Alliance – The William Novick Global Cardiac Alliance has treated children with heart disease in more than 32 countries since 1993.

CardioStart – Founded in 1987, CardioStart International Inc educates and assists local teams in providing cardiac care to adults and children.

There are many more NGOs in this field. The following list is by no means extensive, but hopefully will give you some other opportunities to consider:Chain of Hope, Children’s HeartLink, Magdi Yacoub Global Heart Foundation, EMERGENCY, Gift of Life International, Healing Little Hearts, Heart to Heart, International Children’s Heart Foundation

TSRA

The Thoracic Surgery Residents Association (TSRA) and Society of Thoracic Surgeons (STS) offers an annual Global Outreach Fellowship. This fellowship allows cardiothoracic residents and fellows to participate in an established cardiac surgery outreach trip while being paired with a known global surgery mentor in the field. 

Research

Global Surgery Fellowships

If you are a resident interested in a long term (1-2 year) dedicated global surgery fellowship, many institutions are now offering opportunities within their own residency programs. If you are a medical student or resident looking for opportunities outside your home institution, here are just a few to consider:

Harvard Program in Global Surgery and Social Change – Paul Farmer Global Surgery Fellowship

University of Utah – Global Surgery Research Fellowship

Rutgers – Global Surgery Fellowship In Social Equity and ResponsibilityUCSF – Global Surgery and Public Health Pathways

Research scholarship awards

If you require funding for your research, here are some options to consider:

Association for Academic Surgery (AAS) – offers a global surgery research fellowship award, which provides salary support for a resident interested in global surgical research.Fogarty Fellowship – The Fogarty Global Health Program for Fellows and Scholars provides US-based trainees with mentored global health research training opportunities on the ground.

Leadership

Centers for Global Surgery

Multiple institutions are realizing the importance of surgery and global health, and have now created dedicated institutes and centers for global surgery. These present excellent opportunities to find mentors and engage in global surgery leadership.USA: UCSF, Harvard, Univ. of Utah, Univ. of Michigan, Univ. of Minnesota, Rutgers, Northwestern, Univ. of Tennessee, Baylor, and others
Canada: McGill, Univ. of Toronto, UBC Branch for International Surgery
UK: King’s College London, Univ.of Edinburgh, Univ. of Birmingham, Oxford
Sweden: Lund University
South Korea: JW Lee Center at Seoul National University
South Africa: Wits University, Univ. of Stellenbosch, Univ. of Cape Town

GSSA and InciSioN

The Global Surgery Student Alliance (GSSA) is the US’ national student-run global surgery working group, affiliated with InciSioN (the International Student Surgical Network). The GSSA serves to provide early exposure to the field by education, collaboration and mentorship to help students build their surgical careers with global surgery in mind. InciSioN spans a membership of over 80 countries, including over 50 dedicated National Working Groups.

For our colleagues and partners outside of the US

Traveling Fellowships

The Thoracic Surgery Foundation (TSF) offers a variety of traveling fellowships, including the TSF Latin America CT Surgery Conference Travel Scholarship and the TSF Saha scholarship.

The AATS offers the Evarts A. Graham Memorial Traveling Fellowship, a 1 year fellowship for an academic cardiothoracic surgeon from outside the region to study within North America. Visit aats.org for more information. The American College of Surgeons also provides ACS travel scholarships.

This list is non-exhaustive, and will be updated periodically. If you have an opportunity that you want to share with our colleagues, or if you want to find out more about an opportunity listed above please reach out: yihan.lin@mail.harvard.edu.