It's a Small World

Readers with children will perhaps be familiar with a notorious production called “It's a small world (after all)” on display in various Disney Parks. In this musical boat ride visitors embark small vessels and are carried along more than 300 animated dolls representing children around the world by costume and language, all singing the rather monotonous and therefore the catchy title song. This “happiest cruise that ever sailed around the world” (Disney slogan) intends to communicate a spirit of international unity and peace through innocent representatives. Our world may be relatively small indeed, which you realize when you run into your neighbor from home in downtown Kigali, but it is nevertheless very diverse, as proven yet again by the first two articles in this issue.[1] [2]

The 2013 statistics covering cardiovascular surgery in Germany[1] were promised in January 2014,[3] and here they are. Please take some time and compare them to their predecessor.[4] I think it is fair to say that surgical cardiac care in this country has reached a very satisfactory level, both in terms of quantity and (far more important) in quality. Of course, there are developments which require close scrutiny and may prove to be erroneous, but generating alerts when required is a major purpose of this regular enquiry. One should once more emphasize the fact that participation of the German institutions performing heart surgery is 100% complete—relatively unique for a comprehensive and work-intensive annual survey, which is voluntary (after all).

A few hours flight time away things are totally different. The overview of what is going on in Africa by comparison[2] is the merit of Charles Yankah who is tirelessly collecting all the data that he can get hold of, as difficult as this may be. It seems that a very small minority of states is able to provide their people with a basic standard care. Others rely heavily on occasional visits by the charitable organizations, and the vast majority largely ignores their populations' potential need for cardiac surgery. As it becomes evident from these data, congenital and valvular heart disease dominate in Africa. This, in turn, directly implies a certain complexity: highly sophisticated surgery and costly implants. But even consequent care after a primarily successful operation appears to be far from routine. Africa remains a troubled continent in many respects. Nigeria, for instance, apparently invested considerable means trying to establish rudimentary cardiac care for its 168 million inhabitants in the past. At present, however, the threat of extremist terror groups seems far more real than that of heart disease—which is perfectly understandable. The huge and “dark” continent will continue to hope for the benevolence of its more affluent partners.

To return to Disneyland:

It's a world of laughter, a world of tears.

It's a world of hopes and a world of fears.

There's so much that we share

that it's time we're aware:

It's a small world after all.[5]

Though sentimental and obvious, this simple rhyme does contain a lot of truth, as simplifications generally do. This one, however, is well worth to be occasionally remembered.

• References

• 1 Funkat A, Beckmann A, Lewandowski J , et al. Cardiac surgery in Germany during 2013: a report on behalf of the German Society for Thoracic and Cardiovascular Surgery. Thorac Cardiovasc Surg 2014; 62: 380-392
• 2 Yankah C, Fynn-Thompson F, Antunes M , et al. Cardiac surgery capacity in Sub-Saharan Africa: Quo Vadis?. Thorac Cardiovasc Surg 2014; 393-401
• 3 Heinemann MK. Buy one - get one free!. Thorac Cardiovasc Surg 2014; 62 (1) 1-2
• 4 Beckmann A, Funkat AK, Lewandowski J , et al. Cardiac surgery in Germany during 2012: a report on behalf of the German Society for Thoracic and Cardiovascular Surgery. Thorac Cardiovasc Surg 2014; 62 (1) 5-17
• 5 Sherman RM, Sherman RB. It's a Small World (after All). Burbank, CA: Wonderland Music Company; 1963