In any country, the development of open heart surgery programme parallels stable political climate, economic growth, good leadership, and prudent fiscal management. This is lacking in a country like Nigeria without a functional cardiac hospital.

To review and compare the various models being adopted towards establishing a sustainable open heart surgery programme in Nigeria.

For ethnic and cultural reasons, Nigeria is divided into six geopolitical regions. Each region has one or more Federal Teaching Hospitals including medical centres. The hospitals have trained cardiothoracic surgeons and cardiologists as well as other auxiliary staff. After attainment of democratic rule in 1999, individual hospitals have devised various models to establish sustainable open heart surgery programme. The number of hospitals in each region, the models devised, and the limitations including the outcome were studied and analysed.

Each geopolitical zone has about three to four centres, either public or private, trying to establish the programme. There are six different models. Each centre has been trying the different models since the year 2000. The oldest of the model is cardiac mission and the newest is employment of highly skilled retired expatriate consultant cardiac surgeon to help develop the local team. Inadequate funds, lack of governmental support, and brain drain syndrome have largely affected the programme.

On 28 November 2002, three suicide bombers crashed their car into a hotel in Mombassa, Kenya; 12 people were killed, including three Israelis, and 80 were wounded (22 of whom were Israeli). The Israeli Defense Force Airborne Medical Evacuation Flight Teams participated in a repatriation mission to bring the wounded home.

The objectives of this study are to outline the distinctive aspects of this mission, as well as to share the experiences and lessons learned.

Israeli Army debriefing reports were used to study the composition of the crew, medical equipment taken, injury distribution, mode of operation, and mission schedule.

A total of six fixed-wing aircraft were used—two Boeing 707s and four Hercules C-130s—with a total of 54 medical team members on board. A total of 260 Israelis were repatriated, 22 of whom were wounded, and three were dead. Of the casualties, 14 were conveyed sitting, and eight supine. The time from the first landing in Kenya to the evacuation of the last supine patient was 5.5 hours. Nurses, as well as social workers, played a central role in the mission. A forward team, including five doctors, was used for the initial organization and for gathering information on the medical status of the casualties.

There was redundancy in the medical crew and medical equipment sent. The need for improved infrastructure on the medical aircraft was stressed. Based on this experience, a new mode for operation for similar missions in the future was formulated.