In 1986 the Hospital formalised their outreach work in third world countries amongst disadvantaged sick men, women and children by launching the HealthCare Outreach (HCO) Program with the Operation Open Heart inaugural trip to Tonga. Since then almost 100 HCO trips to 13 countries have been made with over 2,850 surgeries performed. In 2007 the 21st anniversary of the first trip was celebrated. Surgeries have now been expanded to cover cleft palate defect repair, orthopaedic surgery, burns scar contracture repair, and uterine prolapse.