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Bringing heart surgery to the Developing World

by: , Nurse Kathy Blanco, of Chicago, Ill., conducts a heart Outreach Clinic for CardioStart in the remote high mountain village in the Colca Canyon, Peru, one of the deepest canyons on earth.

You can take an EMT and move his practice to the developing world. But to take a cardiologist is a bit more involved. For that reason, Aubyn Marath has had it in his mind to do just that ever since medical school.

'I was very disappointed with the lack of motivation with my colleagues to do international work,' he said. 'It's a complicated profession to export. It was a formidable task but it seemed appealing to me.'

Marath, who moved to Lake Oswego a year ago, took steps to form CardioStart in 1990 while he worked at Providence St. Vincent's Medical Center in Portland. He moved to Florida, though in 1992, where he officially registered as a nonprofit. Now he works at OHSU and much of his work uses local connections.

Marath came to the U.S. from England in 1989 and found that a large amount of equipment was thrown away. He had also worked in Canada, where he saw hospitals sterilize and reuse more equipment. Because of that, he has chosen to recycle used cardio equipment for use in setting up new clinics in other countries.

'Not only is it very satisfying to take, but we capture one of these legitimately and honorably and leave it in working in operation,' he said. Though it costs $7,000 to $8,000 to send a container, CardioStart has never purchased one piece of equipment.

Last October, Marath visited Arequipa, Peru, for two weeks with a team of 25, five of whom work at OHSU. The trip was Marath's eighth trip to Peru in the last 12 years. It is also latest in a series of 42 trips to 18 countries since CardioStart began.

'There are 10 cardiac programs that are still operational thanks to us,' said Marath.

Before CardioStart moves in, officials scout an area to determine that they will be introducing cardio surgery to an area that is in demand for that type of procedure. Recently, the organization began looking at moving into Africa. CardioStart sent a small team to Ghana, where they will 'prepare the scene' for a medical team to come later.

In each country they look for local medical professionals who could use training in cardiac procedures so that they can leave a functioning cardiac clinic.

'I don't even speak Spanish, but I've done surgery with people using sign language and goodwill gestures,' said Marath.

They will provide educational lectures as well as bedside teaching.

'The transition to autonomy varies enormously in some countries,' said Marath. 'It depends on the dynamics of administration or support from the government.'

CardioStart works in some countries where small portions of the population are quite wealthy, said Marath. 'But for most people there's not a chance in heaven of getting a heart operation.'

Marath uses the lottery analogy, saying that good healthcare seems like a matter of luck.

'I think that's the most reprehensible thing in our healthcare system,' he said.

More than a quarter of a billion people are related to someone affected by congenital heart disease worldwide, according to the World Society of Pediatric and Congenital Heart Surgery. The real numbers of how many individuals suffer from congenital heart disease are unknown because many of them live in developing countries and die before they can receive treatment.

In some countries, said Marath, children are abandoned at orphanages when their parents can no longer afford their medical care.

CardioStart is participating in an anthropological study to contrast the costs of providing cardiac care for children in developing countries to the costs of caring for American children with the same health problems.

Marath feels strongly that CardioStart should provide the same quality of care that would be provided at home.

CardioStart always has more children requesting surgery than it can serve during its members' two-week trips. Usually teams do between 12 and 15 surgeries per trip.

'It breaks your heart. You want to give everyone everything,' said Marath. 'It's like if you had 10 toys and 25 orphans. We have to decide who to do and who to reject.'

CardioStart will do all types of surgery except a hypoplast - a procedure for children who have an incompletely formed heart. 'It is a procedure that requires labor intensive round-the-clock care and could take away from other kids,' said Marath.

The organization is also almost entirely volunteer. Marath employs only one administrative employee. CardioStart first deploys medical volunteers, but once a mission has been established the program welcome non-medical volunteers from all walks of life.

For more information on CardioStart, see www.cardiostart.org .