Table 1.

Challenges in developing cardiac centers abroad.

Medical personnel/training	• Lack of expertise in diagnosis and treatment and the country's healthcare system as a whole (2,4,18)
	• Training local surgeons on unfamiliar heart diseases restricted to a particular geographic region (2,4)
	• Local surgical team members lacked incentive and work ethic due to low salaries (18)
	• Poor retention of highly trained medical personnel (10)
	• Noncompliance with aseptic technique among the native healthcare team members (18)
Equipment	• Lack of reliable medical records system (18)
	• Low quality equipment and maintenance (2,18)
Hospital infrastructure	• Lack of hospital infrastructure and capacity (2,18)
	• Lack of research facilities (2,18)
Communication	• Language barriers between the international and local team (11)
	• Lack of cooperation between domestic and international donors (4)
Patients	• Poor health and literacy of patients resulting in them not abiding by a physician's instructions or understanding operative risks (18)
	• Poor patient follow-up (2,9,19)
Miscellaneous	• Poor local governance and lack of commitment to cardiac care from politicians (2,18)
	• Problems with growth and expansion of the program due to the region's isolated location (18)
	• Poor financial sustainability (2,4,18)
	• Late surgical interventions with poor prognosis due to late diagnosis (2,9,19)
	• Time delay between diagnosis and surgery (2,9,19)