Response to Letter Regarding Article, “Improvement in Congenital Heart Surgery in a Developing Country: The Guatemalan Experience”
We agree with the public health issues raised by Dr Soliman in response to our article.1 When public health systems and policymakers in the developing world have to decide where to allocate limited resources, there is no doubt that congenital heart disease would not be a priority for a country where widespread malnutrition and communicable diseases such as malaria, tuberculosis, and HIV-AIDS are highly prevalent. In 2000, for example, HIV-positive patients occupied more than 50% of all beds in urban hospitals in Zimbabwe.2
Nevertheless, children with both congenital heart disease and who acquire rheumatic heart disease also use resources, but they can often be essentially cured with definitive surgical treatment. Surveillance and other healthcare systems that identify and provide complex treatments for these children help build important infrastructures and bring hope to many families. Agencies and individuals who invest money in these areas need data to determine the impact of funds provided. Demonstrating substantial improvement in outcomes may stimulate interest and appropriation of additional funds from external sources, as well as help internal public health agencies in making these important determinations.