title: A stepwise model for delivering medical humanitarian aid requiring complex interventions.
abstract: OBJECTIVE
  Cardiothoracic surgeons and practitioners of cardiovascular medicine have a long history of humanitarian aid. Although this is worthwhile at multiple levels and occasionally described in some detail, few efforts have a proven algorithm with demonstrable outcomes that suggest effective educational methodology or clinical results approaching accepted standards in developed countries.
  
  
  METHODS
  Our report provides a stepwise approach to developing highly successful self-sustainable, replicable, and scalable humanitarian congenital cardiac surgical programs, and provides data to allow insight into the efficacy of our model.
  
  
  RESULTS
  This program model has evolved over 25 years, during which it has been replicated several times and scaled throughout a vast and populous country. Since 1989, Russia has undergone considerable social, political, and economic changes. Our program model proved successful throughout this time despite dynamic social, political, and medical landscapes.
  
  
  CONCLUSIONS
  The positive results of our program model indicate that these methodologies may be helpful to others attempting to address the worldwide shortage of cardiovascular care and particularly the complex interventions required in the management of congenital cardiovascular disease.
authors.affiliation: Division of Cardiothoracic Surgery, University of California, Davis Medical Center, Sacramento, Calif. Electronic address: nilas.young@ucdmc.ucdavis.edu.
authors.forename: J Nilas
authors.initials: JN
authors.lastname: Young
authors.affiliation: Medical Advisory Council, Heart to Heart International Children's Medical Alliance, Oakland, Calif.
authors.forename: Josie
authors.initials: J
authors.lastname: Everett
authors.affiliation: Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Janet M
authors.initials: JM
authors.lastname: Simsic
authors.affiliation: Divisions of Pediatric Cardiology and Cardiovascular Diseases, Mayo Clinic, Rochester, Minn.
authors.forename: Nathaniel W
authors.initials: NW
authors.lastname: Taggart
authors.affiliation: Herma Heart Center and Division of Cardiothoracic Surgery, Children's Hospital of Wisconsin, Milwaukee, Wis.
authors.forename: Sonny Bert
authors.initials: SB
authors.lastname: Litwin
authors.affiliation: Medical Advisory Council, Heart to Heart International Children's Medical Alliance, Oakland, Calif.
authors.forename: Natalia
authors.initials: N
authors.lastname: Lusin
authors.affiliation: Creative Industry Law, LLP, San Francisco, Calif.
authors.forename: Lizbeth
authors.initials: L
authors.lastname: Hasse
authors.affiliation: Department of Cardiovascular Surgery, Research Institute of Cardiology, Tomsk Scientific Centre, Siberian Branch of the Russian Academy of Medical Sciences, Tomsk, Russia.
authors.forename: Evgeny V
authors.initials: EV
authors.lastname: Krivoshchekov
authors.affiliation: Pediatrics Division, Critical Care, University of California, Davis Medical Center, Sacramento, Calif.
authors.forename: James P
authors.initials: JP
authors.lastname: Marcin
authors.affiliation: University of California, Davis Medical Center, Sacramento, Calif.
authors.forename: Gary W
authors.initials: GW
authors.lastname: Raff
authors.affiliation: Divisions of Pediatric Cardiology and Cardiovascular Diseases, Mayo Clinic, Rochester, Minn.
authors.forename: Frank
authors.initials: F
authors.lastname: Cetta
mesh_terms: D000533:Altruism; D002309:Cardiology / Q000193:education / Q000458:organization & administration*; D003299:Cooperative Behavior; D003695:Delivery of Health Care / Q000458:organization & administration*; D004501:Education, Medical; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007391:International Cooperation; D007857:Leadership; D008493:Medical Missions / Q000458:organization & administration*; D017146:Models, Organizational; D016730:Program Development; D015397:Program Evaluation; D011787:Quality of Health Care / Q000458:organization & administration; D012426:Russia; D013903:Thoracic Surgery / Q000193:education / Q000458:organization & administration*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014838:Volunteers