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Lin Y, Hoffner-Heinike A, Clair V, Han JJ, Louis C, Bolman R. Global cardiothoracic surgery: A survey of trainees' interests and barriers. JTCVS OPEN 2023; 16:610-618. [PMID: 38204623 PMCID: PMC10775122 DOI: 10.1016/j.xjon.2023.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 07/17/2023] [Accepted: 07/31/2023] [Indexed: 01/12/2024]
Abstract
Background More than 5 billion people lack access to surgical care, disproportionately in low- and middle-income countries. The emerging literature demonstrates high interest in global surgery across specialties; however, participation in global cardiothoracic surgical care remains low. To date, there has been no research quantifying the attitudes of cardiothoracic surgeons about global surgery. Our study aimed to acquire a broader understanding of cardiothoracic surgical trainees' interest in global surgery to address barriers and promote cardiac healthcare worldwide. Methods An online survey was sent to all North American cardiothoracic surgical residents via the Thoracic Surgery Residents Association email listserv. The survey was designed in the REDCap database and administered twice, in 2021 and 2022. Data were analyzed by descriptive and chi-square analysis using Stata. Results Seventy-three cardiothoracic surgical trainees responded to our survey, of whom 95.3% considered increasing cardiothoracic surgical access to be important, and 67.2% identified this as a future career priority. Most respondents (82.8%) would participate in global surgery if opportunities were available through their home institution. Lack of opportunities (70.0%) and finances (66.7%) were the primary barriers to participation. Respondents identified funding (85%) and institutional support (83.3%) as the most significant incentives to increase involvement. Conclusions There is strong interest in global surgery among cardiothoracic trainees; however, involvement remains low. A consensus among the North American cardiothoracic surgical community is needed to address barriers to global volunteerism within surgical residency and improve access to cardiac surgery worldwide.
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Affiliation(s)
- Yihan Lin
- Department of Cardiothoracic Surgery, Stanford University, Palo Alto, Calif
| | | | - Victoria Clair
- Department of Cardiothoracic Surgery, University of Colorado School of Medicine, Aurora, Colo
| | - Jason J. Han
- Division of Cardiothoracic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Clauden Louis
- Brigham and Women's Hospital, Harvard University, Boston, Mass
| | - Ralph Bolman
- Department of Cardiothoracic Surgery, University of Colorado School of Medicine, Aurora, Colo
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Dopke C, Connor J, Zheleva B, Gauvreau K, Bakalcheva B, Bina N, Calvimontes G, Cerovic I, Majani N, Oketcho M, Pechilkov D, Shidhika F, Shiryaev T, Jenkins K. Effects of COVID-19 on paediatric cardiac centres in low-income and middle-income countries: a mixed-methods study. BMJ Open 2022; 12:e065031. [PMID: 36418128 PMCID: PMC9684279 DOI: 10.1136/bmjopen-2022-065031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The aim of this study was to understand the effects of the COVID-19 pandemic on paediatric cardiac services in critical access centres in low-income and middle-income countries. DESIGN A mixed-methods approach was used. SETTING Critical access sites that participate in the International Quality Improvement Collaborative (IQIC) for congenital heart disease (CHD) were identified. PARTICIPANTS Eight IQIC sites in low-income and middle-income countries agreed to participate. OUTCOME MEASURES Differences in volume and casemix before and during the pandemic were identified, and semistructured interviews were conducted with programme representatives and analysed by two individuals using NVivo software. The qualitative component of this study contributed to a better understanding of the centres' experiences and to identify themes that were common across centres. RESULTS In aggregate, among the seven critical access sites that reported data in both 2019 and 2020, there was a 20% reduction in case volume, though the reduction varied among programmes. Qualitative analysis identified a universal impact for all programmes related to Access to Care/Clinical Services, Financial Stability and Professional/Personal Issues for healthcare providers. CONCLUSIONS Our study identified and quantified a significant impact of the COVID-19 pandemic on critical access to CHD surgery in low-income and middle-income countries, as well as a significant adverse impact on both the skilled workforce needed to treat CHD and on the institutions in which care is delivered. These findings suggest that the COVID-19 pandemic has been a major threat to access to care for children with CHD in resource-constrained environments and that this effect may be long-lasting beyond the global emergency. Efforts are needed to preserve vulnerable CHD programmes even during unprecedented pandemic situations.
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Affiliation(s)
- Campbell Dopke
- Prevention and Community Health, George Washington University School of Public Health and Health Services, Washington, District of Columbia, USA
- Human Evolutionary Biology, Harvard University, Cambridge, Massachusetts, USA
| | - Jean Connor
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Najeebullah Bina
- Department of Cardiology, French Medical Institute for Children (FMIC), Kabul, Afghanistan
| | - Gonzalo Calvimontes
- Department of Cardiology, Unidad de Cirugia Cardiovascular de Guatemala, Guatemala City, Guatemala
| | - Ivana Cerovic
- Department of Cardiology, Mother and Child Health Institute of Serbia, Belgrade, Serbia
| | - Naizihijwa Majani
- Department of Paediatric Cardiology, Jakaya Kikwete Cardiac Institute, Dar Es Salaam, Tanzania, United Republic of
| | - Michael Oketcho
- Department of Paediatric Cardiac Surgery, Uganda Heart Institute, Kampala, Uganda
| | - Dimitar Pechilkov
- Department of Paediatric Cardiology, National Heart Hospital, Sofia, Bulgaria
| | - Fenny Shidhika
- Department of Paediatric Cardiology, Windhoek Central Hospital, Windhoek, Namibia
| | - Tengiz Shiryaev
- Congenital Cardiac Surgery Department, JoAnn McGowan Paediatric Cardiac Surgery Center, Tbilisi, Georgia
| | - Kathy Jenkins
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Paediatrics, Harvard Medical School, Boston, Massachusetts, USA
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Hoosen EGM, Cilliers AM, Brown S, Mitchell B. Improving Access to Pediatric Cardiac Care in the Developing World: the South African Perspective. CURRENT TREATMENT OPTIONS IN PEDIATRICS 2022; 8:141-150. [PMID: 37521172 PMCID: PMC9137262 DOI: 10.1007/s40746-022-00247-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 04/21/2022] [Indexed: 12/02/2022]
Abstract
Purpose of Review The paper outlines the current status of health care and pediatric cardiac services in South Africa and the challenges faced in providing pediatric cardiac care in the country. Recent Findings As infant and child mortality rates in South Africa and most of Sub-Saharan Africa continue to decline, establishing and improving the infrastructure to manage congenital heart disease increases in importance. Summary South Africa has well-established pediatric cardiac units in most major centers in the country. These have been able to train sufficient numbers of pediatric cardiologists to double the number in the country in just over a decade as well as train fellows from surrounding countries. A significant proportion of funding for this training comes from non-government sources. The number of pediatric cardiologists is however still far less than required with services spread unevenly throughout the country. Pediatric cardiac surgical services remain severely constrained with an urgent need to train more pediatric cardiac surgeons. Further progress depends not only on focussing resources on cardiac disease but also improvements in the health care systems and socioeconomic conditions in general.
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Affiliation(s)
- Ebrahim G. M. Hoosen
- Paediatric Cardiology, Inkosi Albert Luthuli Central Hospital, Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
| | - Antoinette M. Cilliers
- Paediatric Cardiology, C.H. Baragwanath Academic Hospital, Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa
| | - Stephen Brown
- Division of Paediatric & Congenital Cardiology, University of the Free State, Bloemfontein, South Africa
| | - Belinda Mitchell
- Paediatric Cardiology, Department of Paediatrics and Child Health, University of Pretoria, Pretoria, South Africa
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Su Z, Zou Z, Hay SI, Liu Y, Li S, Chen H, Naghavi M, Zimmerman MS, Martin GR, Wilner LB, Sable CA, Murray CJL, Kassebaum NJ, Patton GC, Zhang H. Global, regional, and national time trends in mortality for congenital heart disease, 1990-2019: An age-period-cohort analysis for the Global Burden of Disease 2019 study. EClinicalMedicine 2022; 43:101249. [PMID: 35059612 PMCID: PMC8760503 DOI: 10.1016/j.eclinm.2021.101249] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/27/2021] [Accepted: 12/07/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Congenital heart disease (CHD) is the leading cause of morbidity and mortality from birth defects worldwide. We report an overview of trends in CHD mortality in 204 countries and territories over the past 30 years and associations with age, period, and birth cohort. METHODS Cause-specific CHD mortality estimates were derived from the Global Burden of Disease 2019 study. We utilised an age-period-cohort model to estimate overall annual percentage changes in mortality (net drifts), annual percentage changes from 0 to 4 to 65-69 years (local drifts), period and cohort relative risks (period/cohort effects) between 1990 and 2019. This approach allows for the examination and differentiation of age, period, and cohort effects in the mortality trends, with the potential to identify disparities and treatment gaps in cardiac care. FINDINGS CHD is the leading cause of deaths from non-communicable diseases (NCDs) in those under 20 years. Global CHD deaths in 2019 were 217,000 (95% uncertainty interval 177,000-262,000). There were 129 countries with at least 50 deaths. India, China, Pakistan, and Nigeria had the highest mortality, accounting for 39.7% of deaths globally. Between 1990 and 2019, the net drift of CHD mortality ranged from -2.41% per year (95% confidence interval [CI] -2.55, -2.67) in high Socio-demographic Index (SDI) countries to -0.62% per year (95% CI: -0.82, -0.42) in low-SDI countries. Globally, there was an emerging transition in the age distribution of deaths from paediatric to adult populations, except for an increasing trend of mortality in those aged 10-34 years in Mexico and Pakistan. During the past 30 years, favourable mortality reductions were generally found in most high-SDI countries like South Korea (net drift = -4.0% [95% CI -4.8 to -3.1] per year) and the United States (-2.3% [-2.5 to -2.0]), and also in many middle-SDI countries like Brazil (-2.7% [-3.1 to 2.4]) and South Africa (-2.5% [-3.2 to -1.8]). However, 52 of 129 countries had either increasing trends (net drifts ≥0.0%) or stagnated reductions (≥-0.5%) in mortality. The relative risk of mortality generally showed improving trends over time and in successively younger birth cohorts amongst high- and high-middle-SDI countries, with the exceptions of Saudi Arabia and Kazakhstan. 14 middle-SDI countries such as Ecuador and Mexico, and 16 low-middle-SDI countries including India and 20 low-SDI countries including Pakistan, had unfavourable or worsening risks for recent periods and birth cohorts. INTERPRETATION CHD mortality is a useful and accessible indicator of trends in the provision of congenital cardiac care both in early childhood and across later life. Improvements in the treatment of CHD should reduce the risk for successively younger cohorts and shift the risk for all age groups over time. Although there were gains in CHD mortality globally over the past three decades, unfavourable period and cohort effects were found in many countries, raising questions about adequacy of their health care for CHD patients across all age groups. These failings carry significant implications for the likelihood of achieving the Sustainable Development Goal targets for under-5 years and NCD mortality. FUNDING Supported by the National Natural Science Foundation of China (81525002, 31971048, 82073573 to ZZ and HZ), Shanghai Outstanding Medical Academic Leader program (2019LJ22 to HZ), and Collaborative Innovation Program of Shanghai Municipal Health Commission (2020CXJQ01 to HZ), the Bill & Melinda Gates Foundation for the Global Burden of Disease Project (to NJK) and NHMRC fellowship administered through the University of Melbourne (to GCP).
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Affiliation(s)
- Zhanhao Su
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Pediatric Cardiac Surgery Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhiyong Zou
- Institute of Child and Adolescent Health, National Health Commission Key Laboratory of Reproductive Health, Peking University School of Public Health, No.38 Xueyuan Rd, Haidian District, Beijing 100191, China
- Corresponding authors.
| | - Simon I. Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, United States
| | - Yiwei Liu
- Heart Center and Shanghai Institute of Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, Room 7016, Heart centre, Shanghai Children's Medical centre, No. 1678, Dongfang Rd, Pudong District, Shanghai, China
| | - Shoujun Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Pediatric Cardiac Surgery Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huiwen Chen
- Heart Center and Shanghai Institute of Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, Room 7016, Heart centre, Shanghai Children's Medical centre, No. 1678, Dongfang Rd, Pudong District, Shanghai, China
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, United States
| | - Meghan S. Zimmerman
- Division of Pediatric Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- Milken Institute School of Public Health, George Washington University, Washington, DC, United States
- Department of Cardiology, Children's National Health System, Washington, DC, United States
| | - Gerard R. Martin
- Department of Cardiology, Children's National Health System, Washington, DC, United States
| | - Lauren B. Wilner
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, United States
| | - Craig A. Sable
- Department of Cardiology, Children's National Health System, Washington, DC, United States
| | - Christopher J L Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, United States
| | - Nicholas J. Kassebaum
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States
- Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, WA, United States
| | - George C. Patton
- Institute of Child and Adolescent Health, National Health Commission Key Laboratory of Reproductive Health, Peking University School of Public Health, No.38 Xueyuan Rd, Haidian District, Beijing 100191, China
- Department of Pediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Centre for Adolescent Health, Royal Children's Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Hao Zhang
- Heart Center and Shanghai Institute of Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, Room 7016, Heart centre, Shanghai Children's Medical centre, No. 1678, Dongfang Rd, Pudong District, Shanghai, China
- Corresponding authors.
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Sanadgol A, Doshmangir L, Majdzadeh R, Gordeev VS. Engagement of non-governmental organisations in moving towards universal health coverage: a scoping review. Global Health 2021; 17:129. [PMID: 34784948 PMCID: PMC8594189 DOI: 10.1186/s12992-021-00778-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 10/14/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Developing essential health services through non-governmental organisations (NGOs) is an important strategy for progressing towards Universal Health Coverage (UHC), especially in low- and middle-income countries. It is crucial to understand NGOs' role in reaching UHC and the best way to engage them. OBJECTIVE This study reviewed the role of NGOs and their engagement strategies in progress toward UHC. METHOD We systematically reviewed studies from five databases (PubMed, Web of Science (ISI), ProQuest, EMBASE and Scopus) that investigated NGOs interventions in public health-related activities. The quality of the selected studies was assessed using the mixed methods appraisal tool. PRISMA reporting guidelines were followed. FINDINGS Seventy-eight studies met the eligibility criteria. NGOs main activities related to service and population coverage and used different strategies to progress towards UHC. To ensure services coverage, NGOs provided adequate and competent human resources, necessary health equipment and facilities, and provided public health and health care services strategies. To achieve population coverage, they provided services to vulnerable groups through community participation. Most studies were conducted in middle-income countries. Overall, the quality of the reported evidence was good. The main funding sources of NGOs were self-financing and grants from the government, international organisations, and donors. CONCLUSION NGOs can play a significant role in the country's progress towards UHC along with the government and other key health players. The government should use strategies and interventions in supporting NGOs, accelerating their movement toward UHC.
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Affiliation(s)
- Arman Sanadgol
- Department of Health Policy & Management, Tabriz Health Services Management Research Center, School of Management&Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leila Doshmangir
- Department of Health Policy & Management, Tabriz Health Services Management Research Center, School of Management&Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.
- Social Determinants of Health Research Center, Tabriz Univerisity of Medical Sciences, Tabriz, Iran.
| | - Reza Majdzadeh
- CenterCommunity Based Participatory Research Center and Knowledge Utilization Research Center, Tehran Univerisity of Medical Sciences, Tehran, Iran
| | - Vladimir Sergeevich Gordeev
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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Stoehr JR, Hamidian Jahromi A, Chu QD, Zibari GB, Gosain AK. Considerations for resuming global surgery outreach programs during and after the coronavirus disease 2019 (COVID-19) pandemic. Surgery 2021; 170:1405-1410. [PMID: 34130811 PMCID: PMC8148426 DOI: 10.1016/j.surg.2021.05.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/16/2021] [Accepted: 05/15/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND The coronavirus disease 2019 pandemic has disrupted the delivery of safe surgical care worldwide. One specific aspect of global surgical care that has been severely limited is the ability for physicians and trainees to participate in global surgical outreach programs in low- and middle-income countries. METHODS A narrative review of the literature regarding global surgical outreach programs during the coronavirus disease 2019 pandemic was performed. Factors that must be considered in the reinstatement of global surgical outreach programs were identified, and suggestions to address them were provided based on the available literature and the experiences of the senior authors. RESULTS As global surgical outreach programs were canceled at the start of the pandemic, many academic surgeons turned to digital solutions to continue to engage with low- and middle-income country partners. With the advent of coronavirus disease 2019 vaccines and improved access to testing and treatment worldwide, the recommencement of global surgical outreach programs may begin to be considered. Important considerations before initiation include vaccine and testing availability for visiting providers, local staff, and patients, local hospital capacity, staff and equipment shortages, and the characteristics of the patient population and visiting providers. Region- and country-specific factors, including local infection rates and concomitant health crises, must also be taken into account. Expansion of digital collaborative efforts may further deepen international connections and promote sustainable models of care. CONCLUSION With careful consideration, global surgical outreach programs may begin to be safely restarted in the near future. The current article evaluates individual factors that must be considered to safely restart global surgical outreach programs as the coronavirus disease 2019 pandemic is better controlled.
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Affiliation(s)
| | | | - Quyen D. Chu
- Division of Surgical Oncology, Department of Surgery, Louisiana State University Health–Shreveport, LA
| | - Gazi B. Zibari
- John C. McDonald Regional Transplant Center, Willis-Knighton Health System, Shreveport, LA
| | - Arun K. Gosain
- Feinberg School of Medicine, Northwestern University, Chicago, IL,Division of Plastic Surgery, Department of Surgery, Ann and Robert Lurie Children’s Hospital, Chicago, IL,Reprint requests: Arun K. Gosain, MD, FACS, Division Head, Plastic Surgery, Ann and Robert H. Lurie Children’s Hospital of Chicago, Professor of Pediatric Surgery, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave, Chicago, IL 60611
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Tretter JT, Jacobs JP. Global leadership in paediatric and congenital cardiac care: "global health advocacy, lift as you rise - an interview with Liesl J. Zühlke, MBChB, MPH, PhD". Cardiol Young 2021; 31:1549-1556. [PMID: 34602114 DOI: 10.1017/s104795112100411x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Professor Liesl Zühlke is the focus of our fifth in a series of interviews in Cardiology in the Young entitled, "Global Leadership in Paediatric and Congenital Cardiac Care". Professor Zühlke (nee Hendricks) was born in Cape Town, South Africa. She would attend medical school in her hometown at University of Cape Town, graduating in 1991. Professor Zühlke then went on to complete a Diploma in Child Health at College of Medicine in Cape Town followed by completion of her Paediatric and Paediatric Cardiology training in 1999 and 2007, respectively. She would subsequently complete her Masters of Public Health (Clinical Research Methods) at the University of Cape Town, completing her dissertation in 2011 on computer-assisted auscultation as a screening tool for cardiovascular disease, under the supervision of Professors Landon Myer and Bongani Mayosi.Professor Zühlke began her clinical position as a paediatric cardiologist in the Department of Paediatrics and Child Health at the Red Cross War Memorial Children's Hospital in Cape Town, South Africa in 2007. In this role, she has been instrumental in developing a transitional clinic at the paediatric hospital, is a team member of the combined cardio-obstetric and grown-up congenital heart disease clinics, each of which are rare in South Africa, with very few similar clinics in Africa. Professor Zühlke would continue her research training, completing her Doctorate at the University of Cape Town in 2015, with her dissertation on the outcomes of asymptomatic and symptomatic rheumatic heart disease under the supervision of Professor Bongani Mayosi and Associate Professor Mark Engel. In 2015, in affiliation with the University of Cape Town and the Department of Paediatrics and the Institute of Child Health, she established The Children's Heart Disease Research Unit, with the goals to conduct, promote and support paediatric cardiac research on the African continent, facilitate Implementation Science and provide postgraduate supervision and training in paediatric cardiac research. In 2018, she would subsequently complete her Master of Science at the London School of Economics in Health Economics, Outcomes and Management of cardiovascular sciences. Professor Zühlke currently serves as the acting Deputy-Dean of Research at the Faculty of Health Sciences, University of Cape Town.Professor Zühlke has achieved the highest leadership positions within cardiology in South Africa, including President of the Paediatric Cardiac Society of South Africa and President of the South African Heart Association. She is internationally regarded as a leader in research related to rheumatic heart disease. Professor Zühlke's work includes patient, family and health advocacy on a global scale, being involved in the development of policies that have been adopted by major global organisations such as the World Health Organization. In addition to her clinical and research efforts, she is highly regarded by students, colleagues and graduates as an effective teacher, mentor and advisor. This article presents our interview with Professor Zühlke, an interview that covers her experience as a thought leader in the field of Paediatric Cardiology, specifically in her work related to rheumatic heart disease, Global Health and paediatric and congenital cardiac care in resource-limited settings.
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Affiliation(s)
- Justin T Tretter
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jeffrey P Jacobs
- Congenital Heart Center, UF Health Shands Children's Hospital, Gainesville, FL, USA
- Division of Cardiovascular Surgery, Departments of Surgery and Pediatrics, University of Florida, Gainesville, FL, USA
- Cardiology in the Young, Cambridge University Press, Cambridge, UK
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8
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Vervoort D, Guetter CR, Munyaneza F, Trager LE, Argaw ST, Abraham PJ, Dayan V. Non-Governmental Organizations Delivering Global Cardiac Surgical Care: A Quantitative Impact Assessment. Semin Thorac Cardiovasc Surg 2021; 34:1160-1165. [PMID: 34407434 DOI: 10.1053/j.semtcvs.2021.08.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 11/11/2022]
Abstract
In low- and middle-income countries (LMICs), 93% of the population lacks safe, timely, and affordable access to cardiac surgical care when needed. As countries slowly build or expand local, independent cardiac centers, non-governmental organizations (NGOs) partially bridge the gap in cardiac surgical care delivery in LMICs. However, little is known about the current scope of cardiac NGOs. Here, we perform an analysis of active NGOs involved with the delivery of cardiac surgical services in LMICs or for patients from LMICs. Cardiac surgery NGOs were identified from medical literature, established NGO databases, and Google Scholar searches. The search was performed between December 2019 and May 2020. NGOs whose websites were not updated or described missions or projects taking place no later than 2015 were considered inactive. Eighty-six NGOs are actively providing cardiac surgery services in LMICs or treating patients from LMICs. Five NGOs performed adult cardiac surgery only, 56 performed pediatric cardiac surgery only, and 25 performed both adult and pediatric cardiac surgery. NGOs originated from 23 different countries and were operational in a total of 111 countries, 96 of them being LMICs. Fifty-three NGOs reported data on annual surgical volume, of which half performed less than 50 operations per year. NGOs effectively address the burden of cardiac surgical disease in LMICs and contribute to local capacity-building. Increased, more detailed, and standardized reporting of the impact and outcomes of NGOs is necessary to better understand annual cardiac surgical volume and to support local centers working towards independent services.
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Affiliation(s)
- Dominique Vervoort
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | - Camila R Guetter
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Faustin Munyaneza
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Lena E Trager
- School of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Salem T Argaw
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Peter J Abraham
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Victor Dayan
- Centro Cardiovascular Universitario, Hospital de Clinicas, Facultad de Medicina, Universidad de la Republica, Montevideo, Uruguay
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Giamberti A, Caldaroni F, Varrica A, Pace Napoleone C, Marianeschi SM, Uricchio N, Vanini V, Santoro F, Luciani GB, Stellin G, Gargiulo G, Murzi B, Filippelli S, Oppido G, Agati S, Galletti L, Frigiola A. Impact of COVID-19 Pandemic on the Italian Humanitarian Congenital Cardiac Surgery Activity: What No One Tells You. Front Cardiovasc Med 2021; 8:705029. [PMID: 34395564 PMCID: PMC8355370 DOI: 10.3389/fcvm.2021.705029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/05/2021] [Indexed: 01/25/2023] Open
Abstract
More than 4 millions of children with congenital heart disease (CHD) are waiting for cardiac surgery around the world. Few of these patients are treated only thanks to the support of many non-governmental organizations (NGOs). Starting in December 2019, the so-called coronavirus disease 2019 (COVID-19) has rapidly become a worldwide pandemic and has dramatically impacted on all the international humanitarian activities for congenital heart disease. We analyzed data from all the Italian congenital cardiac surgery centers with the aim to quantify the impact of the pandemic on their charities. Fifteen Italian centers participated in the study and contributed to data collection. We analyzed and compared data regarding humanitarian activities carried out abroad and on site from two periods: year 2019 (pre-COVID-19) and year 2020 (COVID-19 pandemic). In 2019, 53 international missions were carried out by Italian congenital cardiac surgeons, resulting in the treatment of 471 CHD patients. In the same period 11 Italian cardiac centers operated on 251 foreign patients in Italy. In 2020, the pandemic led to a reduction of this activity by 96% for the surgery performed overseas and 86% for the interventions carried out in Italy. In conclusion our study shows the important quantitative impact of the pandemic on the Italian humanitarian cardiac surgical activity overseas and in Italy. This shocking result highlights the failure of the systems adopted so far to solve the problem of CHD in developing countries.
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Affiliation(s)
- Alessandro Giamberti
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy.,Association "Bambini cardiopatici nel Mondo" Non-Governmental Organization (NGO), Milan, Italy
| | - Federica Caldaroni
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Alessandro Varrica
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | | | - Nicola Uricchio
- Cardiac Surgery, Aziende Socio Sanitarie Territoriali (ASST) Papa Giovanni XXIII, Bergamo, Italy
| | | | - Francesco Santoro
- Missioni Cardio Chirurgiche Internazionali, Gaslini Pediatric Hospital, Genova, Italy
| | - Giovanni Battista Luciani
- Pediatric and Congenital Cardiac Surgery Unit, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, Verona, Italy
| | - Giovanni Stellin
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Gaetano Gargiulo
- Pediatric and Grown-up Congenital Cardiac Surgery, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Bruno Murzi
- Pediatric Cardiac Surgery Unit, Heart Hospital, G. Monasterio Foundation, Massa, Italy
| | - Sergio Filippelli
- Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Guido Oppido
- Congenital Cardiac Surgery Unit, Monaldi Hospital, Naples, Italy
| | - Salvatore Agati
- Centro Cardiologico Pediatrico del Mediterraneo - Bambino Gesù, "San Vincenzo" Hospital, Taormina, Italy
| | - Lorenzo Galletti
- Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Alessandro Frigiola
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy.,Association "Bambini cardiopatici nel Mondo" Non-Governmental Organization (NGO), Milan, Italy
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10
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Jailobaeva K, Falconer J, Loffreda G, Arakelyan S, Witter S, Ager A. An analysis of policy and funding priorities of global actors regarding noncommunicable disease in low- and middle-income countries. Global Health 2021; 17:68. [PMID: 34187499 PMCID: PMC8240078 DOI: 10.1186/s12992-021-00713-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Noncommunicable diseases (NCDs), including mental health, have become a major concern in low- and middle-income countries. Despite increased attention to them over the past decade, progress toward addressing NCDs has been slow. A lack of bold policy commitments has been suggested as one of the contributors to limited progress in NCD prevention and management. However, the policies of key global actors (bilateral, multilateral, and not-for-profit organisations) have been understudied. METHODS This study aimed to map the key global actors investing in action regarding NCDs and review their policies to examine the articulation of priorities regarding NCDs. Narrative synthesis of 70 documents and 31 policy papers was completed, and related to data collated from the Global Health Data Visualisation Tool. RESULTS In 2019 41% of development assistance for health committed to NCDs came from private philanthropies, while that for other global health priorities from this source was just 20%. Through a range of channels, bilateral donors were the other major source of NCD funding (contributing 41% of NCD funding). The UK and the US were the largest bilateral investors in NCDs, each contributing 8%. However, NCDs are still under-prioritised within bilateral portfolios - receiving just 0.48% of US funding and 1.66% of the UK. NGOs were the key channels of funding for NCDs, spending 48% of the funds from donors in 2019. The reviewed literature generally focused on NCD policies of WHO, with policies of multilateral and bilateral donors given limited attention. The analysis of policies indicated a limited prioritisation of NCDs in policy documents. NCDs are framed in the policies as a barrier to economic growth, poverty reduction, and health system sustainability. Bilateral donors prioritise prevention, while multilateral actors offer policy options for NCD prevention and care. Even where stated as a priority, however, funding allocations are not aligned. CONCLUSION The growing threat of NCDs and their drivers are increasingly recognised. However, global actors' policy priorities and funding allocations need to align better to address these NCD threats. Given the level of their investment and engagement, more research is needed into the role of private philanthropies and NGOs in this area.
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Affiliation(s)
- Kanykey Jailobaeva
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, EH21 6UU UK
| | - Jennifer Falconer
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, EH21 6UU UK
| | - Giulia Loffreda
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, EH21 6UU UK
| | - Stella Arakelyan
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, EH21 6UU UK
| | - Sophie Witter
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, EH21 6UU UK
| | - Alastair Ager
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, EH21 6UU UK
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11
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Tchervenkov CI, Herbst C, Jacobs JP, Al-Halees Z, Edwin F, Dearani JA, Finucane K, Sandoval N, Sarris GE, Fragata J, Abdulgani HB, Arboleda M, Bacha EA, Barron DJ, Becker P, Boumzebra D, Cervantes J, Elgamal A, Helvind MH, Iyer KS, Jatene MB, Jun TG, Kirklin JK, Kreutzer C, Lee C, Lotto AA, Manuel V, Maruszewski B, Najm H, Overman D, Rahmat B, Reddy D, Sakamoto K, Samankatiwat P, Sivalingam S, St Louis JD, Stellin G, Stephens EH, Tretter JT, Truong NLT, Tweddell JS, Vida V, Vosloo S, Zhang H, Zheleva B, Jonas RA. Current Status of Training and Certification for Congenital Heart Surgery Around the World: Proceedings of the Meetings of the Global Council on Education for Congenital Heart Surgery of the World Society for Pediatric and Congenital Heart Surgery. World J Pediatr Congenit Heart Surg 2021; 12:394-405. [PMID: 33942697 DOI: 10.1177/21501351211003520] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The optimal training of the highly specialized congenital heart surgeon is a long and complex process, which is a significant challenge in most parts of the world. The World Society for Pediatric and Congenital Heart Surgery (WSPCHS) has established the Global Council on Education for Congenital Heart Surgery as a nonprofit organization with the goal of assessing current training and certification and ultimately establishing standardized criteria for the training, evaluation, and certification of congenital heart surgeons around the world. The Global Council and the WSPCHS have reviewed the present status of training and certification for congenital cardiac surgery around the world. There is currently lack of consensus and standardized criteria for training in congenital heart surgery, with significant disparity between continents and countries. This represents significant obstacles to international job mobility of competent congenital heart surgeons and to the efforts to improve the quality of care for patients with Congenital Heart Disease worldwide. The purpose of this article is to summarize and document the present state of training and certification in congenital heart surgery around the world.
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Affiliation(s)
- Christo I Tchervenkov
- Division of Cardiovascular Surgery, 10040The Montreal Children's Hospital of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Claudia Herbst
- Department of Cardiac Surgery, Pediatric Cardiac Surgery, 27271Medical University of Vienna, Austria
| | - Jeffrey P Jacobs
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, USA
| | - Zohair Al-Halees
- Heart Center, 37852King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Frank Edwin
- National Cardiothoracic Centre, Accra, Ghana.,University of Health and Allied Sciences, Ho, Ghana
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Nestor Sandoval
- Department of Cardiac Surgery, Fundacion Cardioinfantil-Instituto de Cardiologia, Bogota, Colombia
| | | | - Jose Fragata
- Cardiothoracic Surgery, Santa Marta Hospital, NOVA Medical School, Lisbon, Portugal
| | | | - Miguel Arboleda
- Pediatric Cardiovascular Surgery, Instituto Nacional Cardiovascular (INCOR), Lima, Peru
| | - Emile A Bacha
- Department of Surgery, Section of Pediatric and Congenital Heart Surgery, Columbia University New York-Presbyterian/Morgan Stanley Children's Hospital, New York, NY, USA
| | - David J Barron
- Pediatric Cardiac Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Pedro Becker
- Cardiovascular Surgery, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Drissi Boumzebra
- Cardiovascular Surgery Unit, Mohamed VI University Hospital, Marrakech, Morocco
| | - Jorge Cervantes
- Department of Pediatric Cardiac and Congenital Heart Surgery, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico
| | - Adel Elgamal
- Congenital and Pediatric Cardiac Surgery, Mansoura University Children's Hospital, Mansoura, Egypt
| | - Morten H Helvind
- Department of Congenital Heart Surgery, Rigshospitalet, University Hospital of Copenhagen, Denmark
| | - Krishna S Iyer
- Pediatric & Congenital Heart Surgery, Fortis-Escorts Heart Institute, New Delhi, India
| | | | | | - James K Kirklin
- Division of Cardiothoracic Surgery, University of Alabama at Birmingham, AL, USA
| | - Christian Kreutzer
- Division of Pediatric Cardiovascular Surgery, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Cheul Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Attilio A Lotto
- Pediatric Cardiac Surgery, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Valdano Manuel
- Cardiovascular Surgery, Clinica Girassol, Luanda, Angola
| | - Bohdan Maruszewski
- Pediatric Cardiothoracic Surgery Department, Children's Memorial Health Institute, Warsaw, Poland
| | - Hani Najm
- Division of Cardiovascular Surgery, Pediatric and Congenital Heart Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - David Overman
- Division of Cardiovascular Surgery, Children's Minnesota, Minneapolis, MN, USA
| | - Budi Rahmat
- Pediatric and Congenital Heart Surgery Division, National Cardiovascular Center, Harapan Kita, Jakarta, Indonesia
| | - Darshan Reddy
- Lenmed Ethekwini Hospital and Heart Centre, Nelson R. Mandela School of Medicine, Durban, South Africa
| | - Kisaburo Sakamoto
- Department of Cardiovascular Surgery, Mount Fuji Shizuoka Children's Hospital, Shizuoka, Japan
| | - Piya Samankatiwat
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sivakumar Sivalingam
- Department of Cardiothoracic Surgery, National Heart Institute, Kuala Lumpur, Malaysia
| | - James D St Louis
- Departments of Surgery and Pediatrics, Children's Hospital of Georgia, Augusta University, Augusta, GA, USA
| | - Giovanni Stellin
- Pediatric and Congenital Cardiac Surgery Unit, University of Padova, Padova, Italy
| | | | - Justin T Tretter
- Department of Pediatrics, University of Cincinnati College of Medicine, Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Nguyen Ly Thinh Truong
- Department of Cardiovascular Surgery, Children's Heart Center, National Children's Hospital, Hanoi, Vietnam
| | - James S Tweddell
- Cardiothoracic Surgery, Heart Institute, Cincinnati Children's Hospital Medical, Cincinnati, OH, USA
| | - Vladimiro Vida
- Pediatric and Congenital Cardiac Surgery Unit, University of Padova, Padova, Italy
| | - Susan Vosloo
- Christiaan Barnard Memorial Hospital, Cape Town, South Africa
| | - Hao Zhang
- Shanghai Children's Medical Center and National Medical Center, Shanghai, China
| | | | - Richard A Jonas
- Cardiac Surgery, Center for Neuroscience Research, Children's National Hospital, Washington, DC, USA
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12
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Vervoort D, Antunes MJ, Pezzella AT. Rheumatic heart disease: The role of global cardiac surgery. J Card Surg 2021; 36:2857-2864. [PMID: 33938579 DOI: 10.1111/jocs.15597] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/25/2021] [Accepted: 04/15/2021] [Indexed: 11/30/2022]
Abstract
Rheumatic heart disease (RHD) remains a neglected disease of poverty. While nearly eradicated in high-income countries due to timely detection and treatment of acute rheumatic fever, RHD remains highly prevalent in low- and middle-income countries (LMICs) and among indigenous and disenfranchised populations in high-income countries. As a result, over 30 million people in the world have RHD, of which approximately 300,000 die each year despite this being a preventable and treatable disease. In LMICs, such as in Latin America, sub-Saharan Africa, and Southeast Asia, access to cardiac surgical care for RHD remains limited, impacting countries' population health and resulting economic growth. Humanitarian missions play a role in this context but can only make a difference in the long term if they succeed in training and establishing autonomous local surgical teams. This is particularly difficult because these populations are typically young and largely noncompliant to therapy, especially anticoagulation required by mechanical valve prostheses, while bioprostheses have unacceptably high degeneration rates, and valve repair requires considerable experience. Devoted and sustained leadership and local government and public health cooperation and support with the clinical medical and surgical sectors are absolutely essential. In this review, we describe historical developments in the global response to RHD with a focus on regional, international, and political commitments to address the global burden of RHD. We discuss the surgical and clinical considerations to properly manage surgical RHD patients and describe the logistical needs to strengthen cardiac centers caring for RHD patients worldwide.
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Affiliation(s)
- Dominique Vervoort
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Manuel J Antunes
- Clinic of Cardiothoracic Surgery, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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13
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Paratz ED, Mock N, Gutman SJ, Horton A, Creati L, Appelbe A, Eggleton S, Kushwaha V, da Silva Almeida IT, Monteiro A, Bayley N. Taking the pulse of Timor-Leste's cardiac needs: a 10-year descriptive time-trend analysis. Intern Med J 2021; 50:838-845. [PMID: 31237730 DOI: 10.1111/imj.14411] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/13/2019] [Accepted: 06/16/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Timor-Leste is one of the poorest countries in the world. The East Timor Hearts Fund is a charitable organisation involving Australian cardiologists providing outreach screening and access to cardiac interventions. AIMS To assess ten years of clinical volume, demographics and patient outcomes. Our intention was to identify existing limitations to facilitate planning for further capacity building over the next decade. METHODS The East Timor Hearts Fund database was sectioned into 2-year intervals (2009/2010, 2011/2012, 2013/2014, 2015/2016 and 2017/2018). Demographics and clinical outcomes of patients were compared, with subgroup analysis of adult (>18 years old), paediatric and interventional patients. RESULTS Over 10 years, 2050 patient encounters have occurred; 1119 (54.6%) encounters occurred in 2017/2018; 73.6% of patients were assessed in the capital Dili. Rheumatic and congenital cardiac diseases remain very common (39.1% of adult new patients and 74.2% of paediatric new patients), with 1.4% of new patients exhibiting both pathologies. The number of new patients with rheumatic or congenital heart disease tripled in 2017/2018 compared to 2009/2010 (99 vs 34 patients, P < 0.0001). Paediatric case volume increased over 10-fold over 10 years (288 new patients in 2017/2018 vs 24 in 2009/2010, P < 0.0001), with corresponding increase in proportion of paediatric interventions (59.4% in 2017/2018 vs 25.0% in 2009/2010, P = 0.027). For patients undergoing intervention (n = 87), post-procedural complications and mortality are extremely low (3.4% and 1.1%, respectively), with all eligible patients attending at least one post-procedure appointment. CONCLUSION Demand for cardiac services in Timor-Leste is rising exponentially, with inequitable geographic coverage. Rheumatic and congenital cardiac diseases remain priorities for assessment, and paediatric case volume is increasing. Patients undergoing intervention experience good medical outcomes.
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Affiliation(s)
- Elizabeth D Paratz
- East Timor Hearts Fund, Melbourne, Victoria, Australia.,Cardiology Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Cardiology Department, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Nicki Mock
- East Timor Hearts Fund, Melbourne, Victoria, Australia
| | - Sarah J Gutman
- East Timor Hearts Fund, Melbourne, Victoria, Australia.,Cardiology Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Cardiology Department, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Ari Horton
- East Timor Hearts Fund, Melbourne, Victoria, Australia.,Paediatric Cardiology, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Louise Creati
- East Timor Hearts Fund, Melbourne, Victoria, Australia.,Cardiology Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Alan Appelbe
- East Timor Hearts Fund, Melbourne, Victoria, Australia.,Cardiology Department, Geelong Hospital, Geelong, Victoria, Australia
| | - Simon Eggleton
- East Timor Hearts Fund, Melbourne, Victoria, Australia.,Cardiology Department, Eastern Heart Clinic, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Virag Kushwaha
- East Timor Hearts Fund, Melbourne, Victoria, Australia.,Cardiology Department, Eastern Heart Clinic, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Inez T da Silva Almeida
- Internal Medicine, Hospital Nacional Guido Valdares, Dili, Timor-Leste.,Valdares Cardiology, Warrnambool Base Hospital, Warrnambool, Victoria, Australia
| | - Andre Monteiro
- Internal Medicine, Hospital Nacional Guido Valdares, Dili, Timor-Leste.,Valdares Cardiology, Warrnambool Base Hospital, Warrnambool, Victoria, Australia
| | - Noel Bayley
- East Timor Hearts Fund, Melbourne, Victoria, Australia.,Valdares Cardiology, Warrnambool Base Hospital, Warrnambool, Victoria, Australia
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14
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Vervoort D, Swain JD, Pezzella AT, Kpodonu J. Cardiac Surgery in Low- and Middle-Income Countries: A State-of-the-Art Review. Ann Thorac Surg 2021; 111:1394-1400. [DOI: 10.1016/j.athoracsur.2020.05.181] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 05/10/2020] [Accepted: 05/29/2020] [Indexed: 12/17/2022]
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15
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Vervoort D, Zheleva B, Jenkins KJ, Dearani JA. Children at the Heart of Global Cardiac Surgery: An Advocacy Stakeholder Analysis. World J Pediatr Congenit Heart Surg 2021; 12:48-54. [PMID: 33407026 DOI: 10.1177/2150135120955189] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
One in a hundred babies, or 1.3 million per year around the world, are born with congenital heart defects (CHD), of which over 70% will require medical or surgical treatment within their first year of life. In low- and middle-income countries, the majority does not receive the treatment they need or receive suboptimal care. Despite a higher pediatric cardiac surgical disease burden, low-income countries only have 0.07 pediatric cardiac surgeons per million pediatric population, compared to 9.51 per million in high-income countries. Here, we perform a stakeholder analysis of existing advocacy bodies within the field of pediatric global cardiac surgery and identify gaps and opportunities in advocating for cardiac care for children with CHD. We propose a framework to optimize civil society messaging in order to more effectively advocate domestically and internationally to hold national and international policy makers accountable for existing gaps and disparities in CHD care around the world.
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Affiliation(s)
- Dominique Vervoort
- 222464Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Kathy J Jenkins
- Department of Cardiology, 1862Boston Children's Hospital, Boston, MA, USA
| | - Joseph A Dearani
- Department of Cardiac Surgery, 6915Mayo Clinic, Rochester, MN, USA
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16
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Vivian LMH, Hunter C, Tan L, Comitis G, Neveling G, Lawrenson J. Found in translation: navigating uncertainty to save a child's heart. Paediatric cardiac surgery in Cape Town, South Africa. MEDICAL HUMANITIES 2021; 47:112-122. [PMID: 32467300 DOI: 10.1136/medhum-2019-011650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/31/2020] [Indexed: 06/11/2023]
Abstract
This medical humanities paper describes our qualitative research into pathways to care and informed consent for 10 children who had cardiac surgery in the Red Cross War Memorial Children's Hospital, Cape Town, South Africa. Our multidisciplinary team consists of cardiologists, anthropologists, a social scientist and a general practitioner in two sites, South Africa and Australia. This paper builds on our first publication in a specialist cardiology journal on a 'qualitative snapshot' of these children's life stories from 2011 to 2016 but turns to the medical humanities to explore a concept of 'uncertainty'. Data analysis revealed that for the children's parents and doctors, 'uncertainty' underscored procedures. Indeed, the literature review showed that 'uncertainty' is intrinsic to heart surgery and was integral to Barnard's first heart transplant in Cape Town in 1967. We demonstrate that in meeting the challenges inherent in the 'uncertainty dimension', doctors established greater 'medical certainty'about each operation. This happened as they encountered the difficult clinical and biopsychosocial factors that were fundamental to the diagnosis of children's cardiac defects. It was doctors' translation of these decision-making processes that informed parental decisions and described why, despite feelings of uncertainty, parents signed consent. To visually describe heart surgery in this locality we asked the South African photographer, Guy Neveling to record some children undergoing echocardiograms and surgery. These photographs qualitatively demonstrate what medical certainty entails, and parents' trust in doctors and surgeons, whom they knew had 'reasonable certainty' that their child's 'heart is worth saving'.
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Affiliation(s)
- Lauraine Margaret Helen Vivian
- School of Child and Adolescent Health, University of Cape Town Faculty of Health Sciences, Observatory, Western Cape, South Africa
- Global Health Section, Department of Public Health, University of Copenhagen Faculty of Health Sciences, Kobenhavn, Denmark
| | - Cynthia Hunter
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Lawrence Tan
- Department of General Practice, Western Sydney University School of Science and Health, Sydney, New South Wales, Australia
| | - George Comitis
- School of Child and Adolescent Health, University of Cape Town Faculty of Health Sciences, Observatory, Western Cape, South Africa
| | - Guy Neveling
- School of Child and Adolescent Health, University of Cape Town Faculty of Health Sciences, Observatory, Western Cape, South Africa
| | - John Lawrenson
- Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, Western Cape, South Africa
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17
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Zhang XE, Geng Z, Shao J, Yao H, Wang L, Li X, Li Q. The Heartguard: A Humanitarian Pediatric Cardiac Surgery Program in Rural China. Thorac Cardiovasc Surg 2021; 69:723-728. [PMID: 33626572 DOI: 10.1055/s-0041-1723846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Congenital heart disease (CHD) accounts for the most common birth defects in China, pressuring both the physical and mental health in children. The inaccessibility of CHD children in rural China due to financial difficulties is demanding inputs from both the government and society. The Heartguard project is a program developed to improve the delivery of CHD care in rural China. METHODS The Heartguard project partners with county hospitals and performs CHD screening to diagnose patients with CHD in rural China. Diagnosed children with CHD who are unable to afford therapy will subsequently receive treatment sponsored by the financial partners. All patients are followed up by the local partner and visiting surgical team members. RESULTS More than 10,000 children across 9 provinces underwent CHD screening. A total of 240 (accounting for an incidence of 2.4%) was treated by the program, of which 226 patients were managed invasively, the other 14 patients conservatively. Open surgery was performed in 162 patients, while endovascular procedures were applied in another 64. No mortality or significant complications occurred during the transfer. There was no perioperative or late death. CONCLUSION This humanitarian cardiac surgery program is able to promote accessibility of care for CHD children in rural China. The quality of life of these patients can be improved with continuous input from the society.
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Affiliation(s)
- Xun E Zhang
- Cardiovascular Center, The 2nd Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Zhi Geng
- Cardiovascular Center, The 2nd Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jun Shao
- Cardiovascular Center, The 2nd Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Hao Yao
- Cardiovascular Center, The 2nd Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lu Wang
- Cardiovascular Center, The 2nd Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaobo Li
- Cardiovascular Center, The 2nd Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Qingguo Li
- Cardiovascular Center, The 2nd Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.,Department of Cardiovascular Surgery, Yancheng First People's Hospital, Yancheng, Jiangsu, China
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18
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Taylor J, Forgeron P, Vandyk A, Finley A, Lightfoot S. Pediatric Health Outcome Evaluation in Low-and Middle-Income Countries: A Scoping Review of NGO Practice. Glob Pediatr Health 2021; 8:2333794X21991011. [PMID: 33614849 PMCID: PMC7868502 DOI: 10.1177/2333794x21991011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 01/03/2021] [Accepted: 01/09/2021] [Indexed: 11/17/2022] Open
Abstract
Objective. The purpose of this study was to explore the research on the delivery and evaluation of pediatric health services by non-governmental organizations in low-and middle-income countries to better understand how they contribute to positive and sustainable health outcomes. Methods. A scoping review was completed using a 2-step study selection procedure. Results. Of the 5742 studies, 17 met criteria, including quantitative and mixed method designs, representing 10 different non-governmental organizations with programs in 33 low-and middle-income countries. Health outcomes were reported 89 times across the studies. A total of 56 different outcomes were identified in total, of which 24 were positive, 27 were negative, and 5 were unchanged. Conclusions. Widespread variation between non-governmental organizations exist, however, comprehensive pediatric health outcome evaluation is growing. Further emphasis should be given to adolescent specific research and robust measurement of quality of life.
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Affiliation(s)
| | | | | | - Allen Finley
- Dalhousie University & IWK Health Centre, Halifax, NS, Canada
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19
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2019 Presidential Address of The Southern Thoracic Surgical Association: "WHY". Ann Thorac Surg 2021; 111:1420-1434. [PMID: 33545154 DOI: 10.1016/j.athoracsur.2020.11.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/02/2020] [Accepted: 11/08/2020] [Indexed: 11/21/2022]
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20
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Rebolledo MA, Kumar TKS, Tansey JB, Pickens B, Allen J, Hanafin HJ, Boston US, Knott-Craig CJ. Single Institution Experience With International Referrals for Pediatric Cardiac Surgery. World J Pediatr Congenit Heart Surg 2020; 11:727-732. [PMID: 33164680 DOI: 10.1177/2150135120937230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pediatric cardiac surgery in developing countries poses many challenges. The practice of referring patients from abroad via nongovernmental organizations has occurred for many years. We describe our experience with international referrals for pediatric cardiac surgery via Gift of Life Mid-South to the Heart Institute, Le Bonheur Children's Hospital in Memphis, Tennessee. METHODS We performed a retrospective descriptive review of data collected in our Society of Thoracic Surgeons Congenital Heart Surgery Database (STS CHSD) along with data from our electronic medical record from January 1, 2007, to December 31, 2017. Available data included patient demographics, diagnoses, surgical procedure, entire inpatient length of stay (LOS), complications, and operative mortality. Cardiac surgeries were grouped according to the Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery Congenital Heart Surgery Mortality Categories (STAT Mortality Categories). Complications were defined according to the STS CHSD. RESULTS In this retrospective descriptive study, case complexity level varied; however, 38% cardiac surgeries were in STAT Mortality Category 3 or 4. Honduras was the most common referral source with a total of 18 countries represented. Operative mortality remained very low (1 [1.4%] of 71 cardiac surgeries) despite patients being referred beyond infancy. There were an increasing number of complications and longer inpatient LOS (with greater variance) in STAT Mortality Category 4. CONCLUSIONS International patients referred for congenital heart surgery can be successfully treated with an acceptable mortality rate despite late referrals. Inpatient LOS is related to surgical complexity. Follow-up studies are needed to determine the long-term outcomes of these patients.
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Affiliation(s)
- Michael A Rebolledo
- The University of Tennessee Health Science Center and The Heart Institute, 14505Le Bonheur Children's Hospital, Memphis, TN, USA
| | | | - James B Tansey
- College of Medicine, 12325The University of Tennessee Health Science Center, Memphis, TN, USA
| | | | - Jerry Allen
- The University of Tennessee Health Science Center and The Heart Institute, 14505Le Bonheur Children's Hospital, Memphis, TN, USA
| | - H Jane Hanafin
- The University of Tennessee Health Science Center and The Heart Institute, 14505Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Umar S Boston
- The University of Tennessee Health Science Center and The Heart Institute, 14505Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Christopher J Knott-Craig
- The University of Tennessee Health Science Center and The Heart Institute, 14505Le Bonheur Children's Hospital, Memphis, TN, USA
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El Rassi I, Assy J, Arabi M, Majdalani MN, Yunis K, Sharara R, Maroun-Aouad M, Khaddoum R, Siddik-Sayyid S, Foz C, Bulbul Z, Bitar F. Establishing a High-Quality Congenital Cardiac Surgery Program in a Developing Country: Lessons Learned. Front Pediatr 2020; 8:357. [PMID: 32850519 PMCID: PMC7406661 DOI: 10.3389/fped.2020.00357] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/28/2020] [Indexed: 12/14/2022] Open
Abstract
Background: Developing countries are profoundly affected by the burden of congenital heart disease (CHD) because of limited resources, poverty, cost, and inefficient governance. The outcome of pediatric cardiac surgery in developing countries is suboptimal, and the availability of sustainable programs is minimal. Aim: This study describes the establishment of a high quality in-situ pediatric cardiac surgery program in Lebanon, a limited resource country. Methods: We enrolled all patients operated for CHD at the Children's Heart Center at the American University of Beirut between January 2014 and December 2018. Financial information was obtained. We established a partnership between the state, private University hospital, and philanthropic organizations to support the program. Results: In 5 years, 856 consecutive patients underwent 993 surgical procedures. Neonates and infants constituted 22.5 and 22.6% of our cohort, respectively. Most patients (82.6%) underwent one cardiac procedure. Our results were similar to those of the Society of Thoracic Surgeons (STS) harvest and to the expected mortalities in RACHS-1 scores with an overall mortality of 2.8%. The government (Public) covered 43% of the hospital bill, the Philanthropic organizations covered 30%, and the Private hospital provided a 25% discount. The parents' out-of-pocket contribution included another 2%. The average cost per patient, including neonates, was $19,800. Conclusion: High standard pediatric cardiac surgery programs can be achieved in limited-resource countries, with outcome measures comparable to developed countries. We established a viable financial model through a tripartite partnership between Public, Private, and Philanthropy (3P system) to provide high caliber care to children with CHD.
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Affiliation(s)
- Issam El Rassi
- Department of Surgery, The American University of Beirut-Medical Center, Beirut, Lebanon
| | - Jana Assy
- Department of Pediatrics and Adolescent Medicine, The American University of Beirut-Medical Center, Beirut, Lebanon
| | - Mariam Arabi
- Department of Pediatrics and Adolescent Medicine, The American University of Beirut-Medical Center, Beirut, Lebanon
| | - Marianne Nimah Majdalani
- Department of Pediatrics and Adolescent Medicine, The American University of Beirut-Medical Center, Beirut, Lebanon
| | - Khalid Yunis
- Department of Pediatrics and Adolescent Medicine, The American University of Beirut-Medical Center, Beirut, Lebanon
| | - Rana Sharara
- Department of Pediatrics and Adolescent Medicine, The American University of Beirut-Medical Center, Beirut, Lebanon
| | - Marie Maroun-Aouad
- Department of Anesthesiology at the Children's Heart Center, The American University of Beirut-Medical Center, Beirut, Lebanon
| | - Roland Khaddoum
- Department of Anesthesiology at the Children's Heart Center, The American University of Beirut-Medical Center, Beirut, Lebanon
| | - Sahar Siddik-Sayyid
- Department of Anesthesiology at the Children's Heart Center, The American University of Beirut-Medical Center, Beirut, Lebanon
| | - Carine Foz
- Department of Anesthesiology at the Children's Heart Center, The American University of Beirut-Medical Center, Beirut, Lebanon
| | - Ziad Bulbul
- Department of Pediatrics and Adolescent Medicine, The American University of Beirut-Medical Center, Beirut, Lebanon
| | - Fadi Bitar
- Department of Pediatrics and Adolescent Medicine, The American University of Beirut-Medical Center, Beirut, Lebanon
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Adult and Paediatric Cardiac Intervention in Timor-Leste: Disease Burden, Demographics and Clinical Outcomes. Heart Lung Circ 2019; 29:1112-1121. [PMID: 31831263 DOI: 10.1016/j.hlc.2019.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 10/03/2019] [Accepted: 10/09/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND The East Timor Hearts Fund (ETHF) is a charitable organisation of Australian cardiologists providing outreach screening in Timor-Leste. For patients requiring intervention, ETHF arranges logistics, procedures, and postoperative care. The aim of this project is to evaluate outcomes of patients requiring intervention. METHODS The ETHF database of all patients was utilised to identify patients with disease warranting surgical or percutaneous intervention. Both patients who underwent intervention and those who did not proceed to intervention were included in this study. Patients who had intervention arranged by other organisations but have then had follow-up with ETHF were also included. Overall demographics and pre and postoperative factors were assessed, with sub-group analysis of adult and paediatric patients to identify any differences in care. RESULTS Of 221 patients requiring intervention, 101 patients underwent intervention, receiving 22 different operations or procedures. Patients were predominantly young (median age 17.5 years) and female (64.7%), with rheumatic heart disease (63.8%). Twenty-four (24) (33.3%) women aged 15-45 years old with cardiac disease warranting intervention were documented as pregnant or breastfeeding at time of clinic assessment. Of patients who did not proceed to intervention, adults were more likely to be lost to follow-up (42.4% vs 18.5%) while paediatric patients were more likely to experience progression of disease (18.5% vs 7.5%, p=0.005). Median waitlist time was 5 months, with no significant difference between adults and children, correlating with a preoperative mortality rate of 5.4%. For patients who underwent intervention, post-procedure mortality was extremely low (0.9%) and attendance of at least one post-procedure review was excellent (99.0%). Eleven (11) (10.9%) patients have required repeat intervention, with no difference in rates between adult and paediatric patients. Length of follow-up extends up to 20 years for some patients. CONCLUSION The Timor-Leste interventional cohort was predominantly a young female population with rheumatic and congenital cardiac disease. There were also high rates of pregnancy amongst female patients with severe cardiac disease. Delayed access to intervention may result in preoperative adverse events and mortality, and is a key target for improvement. Patients who undergo intervention have very low post-procedural mortality, good adherence to early medical follow-up and good long-term outcomes.
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23
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Vervoort D. The Neglected Component of Cardiovascular Care: Dispelling the
Myths. Glob Heart 2019; 14:281-283. [DOI: 10.1016/j.gheart.2019.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 04/20/2019] [Indexed: 11/30/2022] Open
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24
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Jacobs JP, St Louis JD, Scholl FG. Commentary: Humanitarian outreach-Providing resources and measuring quality. J Thorac Cardiovasc Surg 2019; 159:1000-1001. [PMID: 31256961 DOI: 10.1016/j.jtcvs.2019.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 05/03/2019] [Indexed: 11/17/2022]
Affiliation(s)
| | - James D St Louis
- Department of Surgery, University of Missouri-Kansas City School of Medicine, Kansas City, Mo
| | - Frank G Scholl
- Cardiac Kids Foundation of Florida, Saint Petersburg, Fla; Department of Surgery, Joe DiMaggio Children's Hospital, Hollywood, Fla
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25
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Murala JSK, Karl TR, Pezzella AT. Pediatric Cardiac Surgery in Low-and Middle-Income Countries: Present Status and Need for a Paradigm Shift. Front Pediatr 2019; 7:214. [PMID: 31263686 PMCID: PMC6584790 DOI: 10.3389/fped.2019.00214] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 05/14/2019] [Indexed: 11/13/2022] Open
Abstract
In low and mid-income countries, there has been a 50% global decrease in the incidence of preventable deaths of children since 1990. However, the mortality from non-communicable diseases (NCD) such as congenital heart disease (CHD) has not changed. Of the estimated 1.3 million children born with CHD annually, over 90% do not have access to cardiac care. With the increasing fertility rates in sub-Saharan Africa, the health burden of CHD will increase as well. Over the last 30 years much has been achieved with short term cardiac medical missions. However, much remains to be done to provide long term solutions needed to achieve the sustainable development goal of reducing deaths of children <5 years of age. This review discusses the present status and the need for a paradigm shift to achieve long term sustainability.
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Affiliation(s)
- John S K Murala
- Cardiothoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Tom R Karl
- Professor Emeritus Johns Hopkins University, Baltimore, MD, United States
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26
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Jacobs JP, Tchervenkov CI, Stellin G, Kurosawa H, Mavroudis C, Jatene MB, Al-Halees Z, Cicek SM, Sandoval NF, Backer CL, Cervantes J, Dearani JA, Ebels T, Edwin F, Finucane K, Fragata J, Iyer KS, Kinsley RH, Kirklin JK, Kreutzer C, Liu J, Maruszewski B, St Louis JD, Sarris GE, Jonas RA. History of the World Society for Pediatric and Congenital Heart Surgery: The First Decade. World J Pediatr Congenit Heart Surg 2018; 9:392-406. [PMID: 29945512 DOI: 10.1177/2150135118775962] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The World Society for Pediatric and Congenital Heart Surgery (WSPCHS) is the largest professional organization in the world dedicated to pediatric and congenital heart surgery. The purpose of this article is to document the first decade of the history of WSPCHS from its formation in 2006, to summarize the current status of WSPCHS, and to consider the future of WSPCHS. The WSPCHS was incorporated in Canada on April 7, 2011, with a head office in Montreal, Canada. The vision of the WSPCHS is that every child born anywhere in the world with a congenital heart defect should have access to appropriate medical and surgical care. The mission of the WSPCHS is to promote the highest quality comprehensive cardiac care to all patients with congenital heart disease, from the fetus to the adult, regardless of the patient's economic means, with an emphasis on excellence in teaching, research, and community service.
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Affiliation(s)
- Jeffrey P Jacobs
- 1 Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,2 Division of Cardiovascular Surgery, Department of Surgery, Johns Hopkins All Children's Heart Institute, Johns Hopkins All Children's Hospital and Florida Hospital for Children, St Petersburg, Tampa, and Orlando, FL, USA
| | - Christo I Tchervenkov
- 3 Division of Pediatric Cardiovascular Surgery, The Montreal Children's Hospital of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Giovanni Stellin
- 4 Pediatric and Congenital Cardiac Surgical Unit, University of Padova Medical School, Padova, Italy
| | - Hiromi Kurosawa
- 5 Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan
| | - Constantine Mavroudis
- 1 Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,2 Division of Cardiovascular Surgery, Department of Surgery, Johns Hopkins All Children's Heart Institute, Johns Hopkins All Children's Hospital and Florida Hospital for Children, St Petersburg, Tampa, and Orlando, FL, USA
| | - Marcelo B Jatene
- 6 Department of Pediatric Cardiac Surgery and Pediatric Cardiology, Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | - Zohair Al-Halees
- 7 Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Sertac M Cicek
- 8 Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Nestor F Sandoval
- 9 Instituto de Cardiopatías Congénitas, Fundación Cardioinfantil-IC, Universidad del Rosario, Bogota, Colombia
| | - Carl L Backer
- 10 Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, CA, USA
| | - Jorge Cervantes
- 11 Department of Cardiac Surgery and Congenital Heart Diseases, Instituto Nacional de Cardiologıa "Ignacio Chavez" (National Institute of Cardiology "Ignacio Chavez"), Mexico City, Mexico
| | | | - Tjark Ebels
- 13 Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Frank Edwin
- 14 National Cardiothoracic Center, Korle Bu Teaching Hospital, Accra, Ghana.,15 Department of Surgery, University of Health and Allied Sciences, Ho, Ghana
| | - Kirsten Finucane
- 16 Green Lane Paediatric and Congenital Cardiac Services, Starship Children's Hospital, Auckland, New Zealand
| | - Jose Fragata
- 17 Hospital de Santa Marta, NOVA Medical School, Lisbon, Portugal
| | - Krishna S Iyer
- 18 Fortis Escorts Heart Institute and Research Centre, New Delhi, Delhi, India
| | - Robin H Kinsley
- 19 The Paediatric Cardiac Centre for Africa, Sunninghill Hospital, Johannesburg, South Africa
| | | | - Christian Kreutzer
- 21 Division of Congenital Heart Surgery, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Jinfen Liu
- 22 Department of Pediatric Thoracic and Cardiovascular Surgery, Xinhua Hospital, Shanghai Children's Medical Center, Shanghai Second Medical University, Shanghai, China
| | - Bohdan Maruszewski
- 23 Department of Pediatric and Congenital Heart Surgery, Children's Memorial Health Institute, Warsaw, Poland
| | - James D St Louis
- 24 Department of Surgery, University of Missouri-Kansas City School of Medicine, Kansas City, MI, USA
| | - George E Sarris
- 25 Athens Heart Surgery Institute and Department of Pediatric, Congenital Heart Surgery at IASO Children's Hospital, Athens, Greece
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Perceptions of Orthopaedic Volunteers and Their Local Hosts in Low- and Middle-Income Countries: Are We on the Same Page? J Orthop Trauma 2018; 32 Suppl 7:S29-S34. [PMID: 30247397 DOI: 10.1097/bot.0000000000001297] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Our goal was to compare the perceptions of overseas orthopaedic volunteers and their hosts in low- and middle-income countries (LMICs) regarding the role of international volunteerism. We also sought to determine if differences in perception exist between trainee and fully trained orthoapedic surgeon volunteers. METHODS Surveys with similar multiple-choice and open-ended questions were administered to 163 Health Volunteers Overseas orthopaedic volunteers (response rate 45%) and 53 members of the host orthopaedic staff (response rate 40%). Fifty-four volunteers and 20 hosts also contributed open-ended responses. Quantitative responses were analyzed for significance using Mantel-Haenzel χ tests. Open-ended responses were coded using thematic analysis. RESULTS Both the international volunteers and their LMIC hosts agreed that volunteers learned new skills while volunteering. Both groups believed that international volunteerism had a positive overall impact on the local practice, but hosts viewed these benefits more favorably than volunteers did. LMIC staff believed that, besides altruistic reasons, volunteers were also motivated by professional gains, diverging from volunteer responses. In open-ended responses, hosts desired longer term commitments from volunteers and had some concerns regarding volunteers' qualifications. Between volunteer trainees and fully trained surgeons, trainees were more likely to be motivated by personal benefits. CONCLUSION Efforts must be made to further align the expectations and goals of volunteers and their hosts in LMICs. Certain measures such as predeparture orientations for volunteers and developing a more longitudinal and bidirectional experience may enhance the impact of orthopaedic volunteerism in LMICs. Further studies are needed to explore the impact of international orthopaedic volunteerism on the host population.
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28
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Rheumatic Heart Disease Worldwide. J Am Coll Cardiol 2018; 72:1397-1416. [DOI: 10.1016/j.jacc.2018.06.063] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/13/2018] [Accepted: 06/15/2018] [Indexed: 11/19/2022]
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Abstract
This review will outline the role of visiting cardiac surgical teams in low- and middle-income countries drawing on the collective experience of the authors in a wide range of locations. Requests for assistance can emerge from local programmes at a beginner or advanced stage. However, in all circumstances, careful pre-trip planning is necessary in conjunction with clinical and non-clinical local partners. The clinical evaluation, surgical procedures, and postoperative care all serve as a template for collaboration and education between the visiting and local teams in every aspect of care. Education focusses on both common and patient-specific issues. Case selection must appropriately balance the clinical priorities, safety, and educational objectives within the time constraints of trip duration. Considerable communication and practical challenges will present, and clinicians may need to make significant adjustments to their usual practice in order to function effectively in a resource-limited, unfamiliar, and multilingual environment. The effectiveness of visiting trips should be measured and constantly evaluated. Local and visiting teams should use data-driven evaluations of measurable outcomes and critical qualitative evaluation to repeatedly re-assess their interim goals. Progress invariably takes several years to achieve the final goal: an autonomous self-governing, self-financed, cardiac programme capable of providing care for children with complex CHD. This outcome is consistent with redundancy for the visiting trips model at the site, although fraternal, professional, and academic links will invariably remain for many years.
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30
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Ng-Kamstra JS, Riesel JN, Arya S, Weston B, Kreutzer T, Meara JG, Shrime MG. Surgical Non-governmental Organizations: Global Surgery's Unknown Nonprofit Sector. World J Surg 2017; 40:1823-41. [PMID: 27008646 DOI: 10.1007/s00268-016-3486-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Charitable organizations may play a significant role in the delivery of surgical care in low- and middle-income countries (LMICs). However, in order to quantify their collective contribution, to account for the care they provide in national surgical plans, and to maximize coordination between organizations, a comprehensive database of these groups is required. We aimed to create such a database using web-available data. METHODS We searched for organizations that meet the United Nations Rule of Law definition of non-governmental organizations and provide surgery in LMICs. We termed these surgical non-governmental organizations (s-NGOs). We screened multiple sources including a listing of disaster relief organizations, medical volunteerism databases, charity commissions, and the results of a literature search. We performed a secondary review of each eligible organization's website to verify inclusion criteria and extracted data. RESULTS We found 403 s-NGOs providing surgery in all 139 LMICs, with most (61 %) incorporating surgery into a broader spectrum of health services. Over 80 % of s-NGOs had an office in the USA, the UK, Canada, India, or Australia, and they most commonly provided surgery in India (87 s-NGOs), Haiti (71), Kenya (60), and Ethiopia (55). The most common specialties provided were general surgery (184), obstetrics and gynecology (140), and plastic surgery (116). CONCLUSIONS This new catalog includes the largest number of s-NGOs to date, but this is likely to be incomplete. This list will be made publicly available to promote collaboration between s-NGOs, national health systems, and global health policymakers.
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Affiliation(s)
- Joshua S Ng-Kamstra
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA. .,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA. .,Department of Surgery, University of Toronto, Toronto, ON, Canada.
| | - Johanna N Riesel
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA.,Harvard Plastic Surgery Combined Residency Program, Boston, MA, USA
| | - Sumedha Arya
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Brad Weston
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tino Kreutzer
- Department of Emergency Medicine, Brigham & Women's Hospital, Boston, MA, USA.,Affiliated Staff Harvard Humanitarian Initiative, Cambridge, MA, USA
| | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Mark G Shrime
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA.,Department of Otology and Laryngology and Office of Global Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
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31
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Edwin F, Zühlke L, Farouk H, Mocumbi AO, Entsua-Mensah K, Delsol-Gyan D, Bode-Thomas F, Brooks A, Cupido B, Tettey M, Aniteye E, Tamatey MM, Gyan KB, Tchoumi JCT, Elgamal MA. Status and Challenges of Care in Africa for Adults With Congenital Heart Defects. World J Pediatr Congenit Heart Surg 2017; 8:495-501. [PMID: 28696875 DOI: 10.1177/2150135117706340] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The 54 countries in Africa have an estimated total annual congenital heart defect (CHD) birth prevalence of 300,486 cases. More than half (51.4%) of the continental birth prevalence occurs in only seven countries. Congenital heart disease remains primarily a pediatric health issue in Africa because of the deficient health-care systems: the adults with CHD made up just 10% of patients with CHD in Ghana, and 13.7% of patients with CHD presenting for surgery in Mozambique. With Africa's population projected to double in the next 35 years, the already deficient health systems for CHD care will suffer unbearable strain unless determined and courageous action is undertaken by the African leaders.
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Affiliation(s)
- Frank Edwin
- 1 National Cardiothoracic Center, Korle Bu Teaching Hospital, Accra, Ghana.,2 Department of Surgery, University of Health & Allied Sciences, Ho, Ghana
| | - Liesl Zühlke
- 3 Department of Pediatric Cardiology, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.,4 Cardiac Clinic Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Heba Farouk
- 5 Department of Cardiovascular Medicine, Cairo University Hospitals, Giza, Egypt
| | - Ana Olga Mocumbi
- 6 Division of Non-Communicable Diseases, Faculty of Medicine, Department of Medicine & Instituto Nacional de Saúde, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Kow Entsua-Mensah
- 1 National Cardiothoracic Center, Korle Bu Teaching Hospital, Accra, Ghana
| | - Desrie Delsol-Gyan
- 1 National Cardiothoracic Center, Korle Bu Teaching Hospital, Accra, Ghana.,2 Department of Surgery, University of Health & Allied Sciences, Ho, Ghana
| | | | - Andre Brooks
- 8 Chris Baarnard Division of Cardiothoracic Surgery, University of Cape Town, Cape Town, South Africa
| | - Blanche Cupido
- 4 Cardiac Clinic Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Mark Tettey
- 1 National Cardiothoracic Center, Korle Bu Teaching Hospital, Accra, Ghana.,9 Department of Surgery, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
| | - Ernest Aniteye
- 1 National Cardiothoracic Center, Korle Bu Teaching Hospital, Accra, Ghana.,10 Department of Anesthesia, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
| | - Martin M Tamatey
- 1 National Cardiothoracic Center, Korle Bu Teaching Hospital, Accra, Ghana.,2 Department of Surgery, University of Health & Allied Sciences, Ho, Ghana
| | - Kofi B Gyan
- 1 National Cardiothoracic Center, Korle Bu Teaching Hospital, Accra, Ghana.,2 Department of Surgery, University of Health & Allied Sciences, Ho, Ghana
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Perez MT, Vázquez M, Canarie MF, Toribio J, León-Wyss J. Clinical Progress in the Management of Tetralogy of Fallot in the Dominican Republic: A Case Series. World J Pediatr Congenit Heart Surg 2017; 8:584-589. [PMID: 28901230 DOI: 10.1177/2150135117727257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Definitive surgical interventions for Dominican children with congenital heart disease, like those of other low- and middle-income countries, have been historically limited. METHODS We undertook review of a case series focusing on the surgical correction of complex forms of tetralogy of Fallot at a single center, CEDIMAT Centro Cardiovascular, in the Dominican Republic, over a 30-month period. RESULTS According to our criteria, 43 cases were determined to be complex tetralogy of Fallot repairs from the two-year period. Besides tetralogy of Fallot, the cohort had an additional 55 anatomic anomalies that had to be addressed at the time of surgery. Median age at the time of surgery was notably 30 months, and an average of 42 months elapsed from the time of diagnosis to the time of surgery for this group. Only 33% of the cases reviewed had no hypercyanotic crises before repair. Median time to extubation for this group of patients was one day, with a three-day median length of stay in the intensive care setting. CONCLUSIONS Our study importantly captures the present experience of a surgical congenital heart program that has recently transitioned from a traditional "mission model" to a now self-sustaining local practice. Both the number and the complexity of the lesions corrected in this caseload represent an advance from the level of care previously provided to children in the Dominican Republic.
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Affiliation(s)
- María T Perez
- 1 Department of Pediatrics, Yale New Haven Hospital, New Haven, CT, USA
| | - Marietta Vázquez
- 1 Department of Pediatrics, Yale New Haven Hospital, New Haven, CT, USA.,2 Yale University School of Medicine, New Haven, CT, USA
| | - Michael F Canarie
- 1 Department of Pediatrics, Yale New Haven Hospital, New Haven, CT, USA.,2 Yale University School of Medicine, New Haven, CT, USA
| | - Janet Toribio
- 3 Department of Pediatric Cardiology, CEDIMAT Centro Cardiovascular, Santo Domingo, Republica Dominicana
| | - Juan León-Wyss
- 3 Department of Pediatric Cardiology, CEDIMAT Centro Cardiovascular, Santo Domingo, Republica Dominicana
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Edwin F, Entsua-Mensah K, Sereboe LA, Tettey MM, Aniteye EA, Tamatey MM, Adzamli I, Akyaa-Yao N, Gyan KB, Ofosu-Appiah E, Kotei D. Conotruncal Heart Defect Repair in Sub-Saharan Africa: Remarkable Outcomes Despite Poor Access to Treatment. World J Pediatr Congenit Heart Surg 2017; 7:592-9. [PMID: 27587494 DOI: 10.1177/2150135116648309] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Accepted: 04/07/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND The outcome of children born with conotruncal heart defects may serve as an indication of the status of pediatric cardiac care in sub-Saharan Africa (SSA). This study was undertaken to determine the outcome of children born with conotruncal anomalies in SSA, regarding access to treatment and outcomes of surgical intervention. METHODS From our institution in Ghana, we retrospectively analyzed the outcomes of surgery, in the two-year period from June 2013 to May 2015. The birth prevalence of congenital heart defects (CHDs) in SSA countries was derived by extrapolation using an incidence of 8 per 1,000 live births for CHDs. RESULTS The birth prevalence of CHDs for the 48 countries in SSA using 2013 country data was 258,875; 10% of these are presumed to be conotruncal anomalies. Six countries (Nigeria, Democratic Republic of the Congo, Ethiopia, Tanzania, Uganda, and Kenya) accounted for 53.5% of the birth prevalence. In Ghana, 20 patients (tetralogy of Fallot [TOF], 17; pulmonary atresia, 3) underwent palliation and 50 (TOF, 36; double-outlet right ventricle, 14) underwent repair. Hospital mortality was 0% for palliation and 4% for repair. Only 6 (0.5%) of the expected 1,234 cases of conotruncal defects underwent palliation or repair within two years of birth. CONCLUSION Six countries in SSA account for more than 50% of the CHD burden. Access to treatment within two years of birth is probably <1%. The experience from Ghana demonstrates that remarkable surgical outcomes are achievable in low- to middle-income countries of SSA.
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Affiliation(s)
- Frank Edwin
- Department of Surgery, National Cardiothoracic Center, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Kow Entsua-Mensah
- Department of Surgery, National Cardiothoracic Center, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Lawrence A Sereboe
- Department of Surgery, National Cardiothoracic Center, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Mark M Tettey
- Department of Surgery, National Cardiothoracic Center, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Ernest A Aniteye
- Department of Anesthesia, National Cardiothoracic Center, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Martin M Tamatey
- Department of Surgery, National Cardiothoracic Center, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Innocent Adzamli
- Department of Surgery, National Cardiothoracic Center, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Nana Akyaa-Yao
- Department of Child Health, National Cardiothoracic Center, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Kofi B Gyan
- Department of Surgery, National Cardiothoracic Center, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Ernest Ofosu-Appiah
- Department of Anesthesia, National Cardiothoracic Center, Korle-Bu Teaching Hospital, Accra, Ghana
| | - David Kotei
- Department of Child Health, National Cardiothoracic Center, Korle-Bu Teaching Hospital, Accra, Ghana
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Paediatric cardiac surgery in a peripheral European region: is a joint programme a safe alternative to regionalisation? Cardiol Young 2017; 27:273-283. [PMID: 27086665 DOI: 10.1017/s1047951116000469] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND In 2007, a partnership was initiated between a small-volume paediatric cardiac surgery unit located in Las Palmas de Gran Canaria, Spain, and a large-volume cardiac surgery unit located in Milan, Italy. The main goal of this partnership was to provide surgical treatment to children with CHD in the Canary Islands. METHODS An operative algorithm for performing surgery in elective, urgent, and emergency cases was adopted by the this joint programme. Demographic and in-hospital variables were collected from the medical records of all the patients who had undergone surgical intervention for CHD from January, 2009 to March, 2013. Data were introduced into the congenital database of the European Congenital Heart Surgeons Association Congenital Database and the database was interrogated. RESULTS In total, 65 surgical mission trips were performed during the period of this study. The European Congenital Heart Surgeons Association Congenital Database documented 214 total patients with a mean age at operation of 36.45 months, 316 procedures in total with 198 cardiopulmonary bypass cases, 46 non-cardiopulmonary bypass cases, 26 cardiovascular cases without cardiopulmonary bypass, 22 miscellaneous other types of cases, 16 interventional cardiology cases, six thoracic cases, one non-cardiac, non-thoracic procedure on a cardiac patient with cardiac anaesthesia, and one extracorporeal membrane oxygenation case. The 30-day mortality was 6.07% (13 patients). CONCLUSIONS A joint programme between a small-volume centre and a large-volume centre may represent a valid and reproducible model for safe paediatric cardiac surgery in the context of a peripheral region.
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Mirabel M, Lachaud M, Offredo L, Lachaud C, Zuschmidt B, Ferreira B, Sidi D, Chauvaud S, Sok P, Deloche A, Marijon E, Jouven X. Cardiac surgery in low-income settings: 10 years of experience from two countries. Arch Cardiovasc Dis 2017; 110:82-90. [DOI: 10.1016/j.acvd.2016.05.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 05/12/2016] [Accepted: 05/23/2016] [Indexed: 11/16/2022]
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Graham H, Tokhi M, Duke T. Scoping review: strategies of providing care for children with chronic health conditions in low- and middle-income countries. Trop Med Int Health 2016; 21:1366-1388. [PMID: 27554327 DOI: 10.1111/tmi.12774] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To identify and review strategies of providing care for children living with chronic health conditions in low- and middle-income countries. METHODS We searched MEDLINE and Cochrane EPOC databases for papers evaluating strategies of providing care for children with chronic health conditions in low- or middle-income countries. Data were systematically extracted using a standardised data charting form, and analysed according to Arksey and O'Malley's 'descriptive analytical method' for scoping reviews. RESULTS Our search identified 71 papers addressing eight chronic conditions; two chronic communicable diseases (HIV and TB) accounted for the majority of papers (n = 37, 52%). Nine (13%) papers reported the use of a package of care provision strategies (mostly related to HIV and/or TB in sub-Saharan Africa). Most papers addressed a narrow aspect of clinical care provision, such as patient education (n = 23) or task-shifting (n = 15). Few papers addressed the strategies for providing care at the community (n = 10, 15%) or policy (n = 6, 9%) level. Low-income countries were under-represented (n = 24, 34%), almost exclusively involving HIV interventions in sub-Saharan Africa (n = 21). Strategies and summary findings are described and components of future models of care proposed. CONCLUSIONS Strategies that have been effective in reducing child mortality globally are unlikely to adequately address the needs of children with chronic health conditions in low- and middle-income settings. Current evidence mostly relates to disease-specific, narrow strategies, and more research is required to develop and evaluate the integrated models of care, which may be effective in improving the outcomes for these children.
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Affiliation(s)
- Hamish Graham
- Centre for International Child Health, Royal Children's Hospital, University of Melbourne, MCRI, Melbourne, VIC, Australia.
| | - Mariam Tokhi
- Victorian Aboriginal Health Service, Melbourne, VIC, Australia
| | - Trevor Duke
- Centre for International Child Health, Royal Children's Hospital, University of Melbourne, MCRI, Melbourne, VIC, Australia
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Gutnik L, Yamey G, Riviello R, Meara JG, Dare AJ, Shrime MG. Financial contributions to global surgery: an analysis of 160 international charitable organizations. SPRINGERPLUS 2016; 5:1558. [PMID: 27652131 PMCID: PMC5021658 DOI: 10.1186/s40064-016-3046-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 08/11/2016] [Indexed: 11/23/2022]
Abstract
Background The non-profit and volunteer sector has made notable contributions to delivering surgical services in low-and middle-income countries (LMICs). As an estimated 55 % of surgical care delivered in some LMICs is via charitable organizations; the financial contributions of this sector provides valuable insight into understanding financing priorities in global surgery. Methods Databases of registered charitable organizations in five high-income nations (United States, United Kingdom, Canada, Australia, and New Zealand) were searched to identify organizations committed exclusively to surgery in LMICs and their financial data. For each organization, we categorized the surgical specialty and calculated revenues and expenditures. All foreign currency was converted to U.S. dollars based on historical yearly average conversion rates. All dollars were adjusted for inflation by converting to 2014 U.S. dollars. Results
One hundred sixty organizations representing 15 specialties were identified. Adjusting for inflation, in 2014 U.S. dollars (US$), total aggregated revenue over the years 2008–2013 was $3·4 billion and total aggregated expenses were $3·1 billion. Twenty-eight ophthalmology organizations accounted for 45 % of revenue and 49 % of expenses. Fifteen cleft lip/palate organizations totaled 26 % of both revenue and expenses. The remaining 117 organizations, representing a variety of specialties, accounted for 29 % of revenue and 25 % of expenses. In comparison, from 2008 to 2013, charitable organizations provided nearly $27 billion for global health, meaning an estimated 11.5 % went towards surgery. Conclusion Charitable organizations that exclusively provide surgery in LMICs primarily focus on elective surgeries, which cover many subspecialties, and often fill deep gaps in care. The largest funding flows are directed at ophthalmology, followed by cleft lip and palate surgery. Despite the number of contributing organizations, there is a clear need for improvement and increased transparency in tracking of funds to global surgery via charitable organizations.
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Affiliation(s)
- Lily Gutnik
- Department of Surgery, University of Utah, Salt Lake City, UT USA ; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA USA ; Tidziwe Center, UNC Project Malawi, Privae Bag A-104, Lilongwe, Malawi
| | - Gavin Yamey
- Duke Global Health Institute, Duke University, Durham, NC USA
| | - Robert Riviello
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA USA ; Department of Surgery, Brigham and Women's Hospital, Boston, MA USA
| | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA ; Department of Plastic Surgery, Boston Children's Hospital, Boston, MA USA
| | - Anna J Dare
- King's Centre for Global Health, King's Health Partners, King's College London, London, England, UK
| | - Mark G Shrime
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA ; Harvard University Interfaculty Initiative in Health Policy, Boston, MA USA ; Office of Global Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA USA ; Department of Otology and Laryngology, Harvard Medical School, Boston, MA USA
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Public-non-governmental organisation partnerships for health: an exploratory study with case studies from recent Ghanaian experience. BMC Public Health 2016; 16:963. [PMID: 27618964 PMCID: PMC5020518 DOI: 10.1186/s12889-016-3636-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 09/04/2016] [Indexed: 11/23/2022] Open
Abstract
Background The last few decades have seen a dramatic increase in public-non-governmental organisation (NGO) partnerships in the health sector of many low- and middle- income countries (LMICs) as a means of improving the public’s health. However, little research has focused to date on the nature, facilitators and barriers of these partnerships. Methods In-depth qualitative interviews were conducted with 17 participants from five different NGOs and their collaboration with state partners in the Ghanaian health sector at the national and local levels in four regions of the country (Northern, Upper East, Greater Accra, and Eastern) to explore the drivers and nature of these partnerships and their advantages and disadvantages in the effort to improve the public’s health. Results Major findings reveal that: 1) each collaboration between civil society organisations (CSOs) and the state in the health sector demands different partnerships; 2) partnership types can range from equal, formal contractual, decentralized to advocacy ones; 3) commitment by the state and NGOs to work in collaboration lead to improved service delivery, reduced health inequities and disparities; 4) added value of NGOs lies in their knowledge, expertise, community legitimacy, ability to attract donor funding and implementation capacity to address health needs in geographical areas or communities where the government does not reach and for services, which it does not provide and 5) success factors and challenges to be considered, moving forward to promote such partnerships in other LMICs. Conclusions Recommendations are offered for NGOs, governments, donors, and future research including studying the organisational effectiveness and sustainability of these partnerships to deliver effective and efficient health outcomes to recommend universal best practices in health care. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3636-2) contains supplementary material, which is available to authorized users.
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Dearani JA, Jacobs JP, Bolman RM, Swain JD, Vricella LA, Weinstein S, Farkas EA, Calhoon JH. Humanitarian Outreach in Cardiothoracic Surgery: From Setup to Sustainability. Ann Thorac Surg 2016; 102:1004-1011. [PMID: 27319988 DOI: 10.1016/j.athoracsur.2016.03.062] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 03/16/2016] [Accepted: 03/18/2016] [Indexed: 10/21/2022]
Abstract
Noncommunicable diseases account for 38 million deaths each year, and approximately 75% of these deaths occur in the developing world. The most common causes include cardiovascular diseases, cancer, respiratory diseases, and diabetes mellitus. Many adults with acquired cardiothoracic disease around the world have limited access to health care. In addition, congenital heart disease is present in approximately 1% of live births and is therefore the most common congenital abnormality. More than one million children in the world are born with congenital heart disease each year, and approximately 90% of these children receive suboptimal care or have no access to care. Furthermore, many children affected by noncongenital cardiac conditions also require prevention, diagnosis, and treatment. Medical and surgical volunteerism can help facilitate improvement in cardiothoracic health care in developing countries. As we move into the future, it is essential for physicians and surgeons to be actively involved in political, economic, and social aspects of society to serve health care interests of the underprivileged around the world. Consequently, in developing countries, a critical need exists to establish an increased number of reputable cardiothoracic programs and to enhance many of the programs that already exist. The optimal strategy is usually based on a long-term educational and technical model of support so that as case volumes increase, quality improves and mortality and morbidity decrease. Humanitarian outreach activities should focus on education and sustainability, and surgical tourism should be limited to those countries that will never have the capability to have free-standing cardiothoracic programs.
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Affiliation(s)
- Joseph A Dearani
- Department of Cardiovascular Surgery, The Mayo Clinic, Rochester, Minnesota.
| | - Jeffrey P Jacobs
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Cardiovascular Surgery, Department of Surgery, Johns Hopkins All Children's Heart Institute, All Children's Hospital and Florida Hospital for Children, Saint Petersburg, Tampa, and Orlando, Florida
| | | | | | - Luca A Vricella
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Samuel Weinstein
- Children's Hospital at Montefiore, Montefiore Medical Center, New York, New York
| | - Emily A Farkas
- Department of Surgery, Saint Louis University, St. Louis, Missouri
| | - John H Calhoon
- Department of Cardiothoracic Surgery, University of Texas Health Science Center, San Antonio, Texas
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Flynn-O’Brien KT, Trelles M, Dominguez L, Hassani GH, Akemani C, Naseer A, Ntawukiruwabo IB, Kushner AL, Rothstein DH, Stewart BT. Surgery for children in low-income countries affected by humanitarian emergencies from 2008 to 2014: The Médecins Sans Frontières Operations Centre Brussels experience. J Pediatr Surg 2016; 51:659-69. [PMID: 26454469 PMCID: PMC5860656 DOI: 10.1016/j.jpedsurg.2015.08.063] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 08/16/2015] [Accepted: 08/18/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Pediatric surgical care is deficient in developing countries disrupted by crisis. We aimed to describe pediatric surgical care at Médecins Sans Frontières-Brussels (MSF-OCB) projects to inform resource allocation and define the pediatric-specific skillset necessary for humanitarian surgical teams. METHODS Procedures performed by MSF-OCB from July 2008 to December 2014 were reviewed. Project characteristics, patient demographics and clinical data were described. Multivariable logistic regression was performed to determine predictors of perioperative death. RESULTS Of 109,828 procedures, 26,284 were performed for 24,576 children (22% of all procedures). The most common pediatric operative indication was trauma (13,984; 57%). Nine percent of all surgical indications were due to violence (e.g., land mines, firearms, gender-based violence, etc.). The majority of procedures (19,582; 75%) were general surgical, followed by orthopedic (4350; 17%), and obstetric/gynecologic/urologic (2135; 8%). Perioperative death was low (42; 0.17%); independent predictors of death included age <1year, use of general anesthesia with a definitive airway, and operation during conflict. CONCLUSION Surgical care for children comprised nearly a quarter of all procedures performed by MSF-OCB between 2008 and 2014. Attention to trauma surgery and infant perioperative care is particularly needed. These findings are important when resourcing projects and training surgical staff for humanitarian missions.
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Affiliation(s)
- Katherine T. Flynn-O’Brien
- Department of Surgery, University of Washington, Seattle, WA, USA,Harborview Injury Prevention and Research Center, Seattle, WA, USA,Corresponding author at: University of Washington, Department of Surgery, 1959 NE Pacific St., Suite BB-487, P.O. Box 356410, Seattle, WA 98195-6410. Tel.: +1 206 543 3680. (K.T. Flynn-O’Brien)
| | - Miguel Trelles
- Surgery, Anesthesia, Gynecology, and Emergency Medicine Unit, Médecins Sans Frontières, Brussels, Belgium
| | - Lynette Dominguez
- Surgery, Anesthesia, Gynecology, and Emergency Medicine Unit, Médecins Sans Frontières, Brussels, Belgium
| | - Ghulam Hiadar Hassani
- Médecins sans Frontières-Operational Centre Brussels, Surgical Unit, Brussels, Belgium,Boost General Hospital, Médecins sans Frontières, Lashkar-Gah, Afghanistan
| | - Clemence Akemani
- Médecins sans Frontières-Operational Centre Brussels, Surgical Unit, Brussels, Belgium,General Referral Hospital, Médecins sans Frontières, Lubutu, Democratic Republic of the Congo
| | - Aamer Naseer
- Surgery, Anesthesia, Gynecology, and Emergency Medicine Unit, Médecins Sans Frontières, Brussels, Belgium,Dargai DHQ Hospital, Dargai, Pakistan
| | - Innocent Bagura Ntawukiruwabo
- Médecins sans Frontières-Operational Centre Brussels, Surgical Unit, Brussels, Belgium,General Referral Hospital, Médecins sans Frontières, Masisi, Democratic Republic of the Congo
| | - Adam L. Kushner
- Surgeons OverSeas (SOS), New York, NY, USA,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Department of Surgery, Columbia University, New York, NY, USA
| | - David H. Rothstein
- Department of Surgery, Women & Children's Hospital of Buffalo, NY, USA,Department of Surgery, University at Buffalo, SUNY, Buffalo, NY, USA
| | - Barclay T. Stewart
- Department of Surgery, University of Washington, Seattle, WA, USA,School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana,Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana
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Corno AF. Paediatric and congenital cardiac surgery in emerging economies: surgical 'safari' versus educational programmes. Interact Cardiovasc Thorac Surg 2016; 23:163-7. [PMID: 27001675 DOI: 10.1093/icvts/ivw069] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 02/22/2016] [Indexed: 11/14/2022] Open
Abstract
To attract the interest of all people potentially involved in humanitarian activities in the emerging economies, in particular giving attention to the basic requirements of the organization of paediatric cardiac surgery activities, the requirements for a successful partnership with the local existing organizations and the basic elements of a patient-centred multidisciplinary integrated approach. Unfortunately, for many years, the interventions in the low and middle income countries were largely limited to short-term medical missions, not inappropriately nicknamed 'surgical safari', because of negative general and specific characteristics. The negative aspects and the limits of the short-term medical missions can be overcome only by long-term educational programmes. The most suitable and consistent models of long-term educational programmes have been combined and implemented with the personal experience to offer a proposal for a long-term educational project, with the following steps: (i) site selection; (ii) demographic research; (iii) site assessment; (iv) organization of surgical educational teams; (v) regular frequency of surgical educational missions; (vi) programme evolution and maturation; (vii) educational outreach and interactive support. Potential limits of a long-term educational surgical programme are: (i) financial affordability; (ii) basic legal needs; (iii) legal support; (iv) non-profit indemnification. The success should not be measured by the number of successful operations of any given mission, but by the successful operations that our colleagues perform after we leave. Considering that the children in need outnumber by far the people able to provide care, in this humanitarian medicine there should be plenty of room for cooperation rather than competition. The main goal should be to provide teaching to local staff and implement methods and techniques to support the improvement of the care of the patients in the long run. This review focuses on the organization of paediatric cardiac activities in the emerging economies, but 'the less privileged parts of the world' can be anywhere, not necessarily limited to economic constraints. Lack of diversity because of social, intellectual, educational and professional growth, the last consisting in cultural stagnation, is responsible for the lack of scientific progress and development.
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Nguyen N, Pezzella AT. Pediatric cardiac surgery in low- and middle-income countries or emerging economies: a continuing challenge. World J Pediatr Congenit Heart Surg 2015; 6:274-83. [PMID: 25870347 DOI: 10.1177/2150135115574312] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A number of recent publications, addresses, seminars, and conferences have addressed the global backlog and increasing incidence of both congenital and acquired cardiac diseases in children, with reference to early and delayed recognition, late referral, availability of and access to services, costs, risks, databases, and early and long-term results and follow-up. A variety of proposals, recommendations, and projects have been outlined and documented. The ultimate goal of these endeavors is to increase the quality and quantity of pediatric cardiac care and surgery worldwide and particularly in underserved areas. A contemporary review of past and present initiatives is presented with a subsequent focus on the more challenging areas.
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Affiliation(s)
- Nguyenvu Nguyen
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
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McKavanagh P, Booth K, Blair L, McNeilly G, Varadarajan B, Nzewi O. Addressing discrepancies: personal experience of a cardiac mission programme in Africa. Int J Cardiol 2014; 177:794-9. [PMID: 25449501 DOI: 10.1016/j.ijcard.2014.09.180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 09/27/2014] [Indexed: 10/24/2022]
Abstract
The worldwide incidence of cardiovascular disease (CVD) is increasing, reflecting a combination of ongoing infective diseases and a rapid rise in traditional 'western' risk factors. It is estimated that in the next 20 years that CVD be the leading cause of death in developing nations. There are high incidences of rheumatic heart disease, coronary artery disease, cardiomyopathies, uncorrected congenital heart disease and human immunodeficiency virus (HIV) associated disease in many low-income countries. Such high levels combined with a lack of diagnostic tests and therapeutic options means mortality and morbidity rates are high. A number of charities and organizations have tried to address the discrepancy of cardiac care within developing areas although the needs remain great. However there is no one global cardiac organization that coordinates such humanitarian work. The challenges of missionary work include the need for appropriate facilities, financial constraints of clinical consumables, and lack of education of local healthcare staff, making the move away from the mission model difficult. The strategy for delivery of care in developing countries should be long term educational and technical support, so that local case volumes increase. However it must be realized that there are many different levels of local services within developing nations with different health and educational needs, including some countries with very high facilities and skills levels, yet high case loads. This paper highlights the personal experience of our organization and the types of diseases encountered in developing countries.
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Affiliation(s)
- Peter McKavanagh
- Royal Victoria Hospital, Belfast, United Kingdom; Save a Heart Charity, Belfast, United Kingdom.
| | - Karen Booth
- Royal Victoria Hospital, Belfast, United Kingdom; Save a Heart Charity, Belfast, United Kingdom
| | - Laura Blair
- Save a Heart Charity, Belfast, United Kingdom; 352 Healthcare, Belfast, United Kingdom
| | - Graham McNeilly
- Royal Victoria Hospital, Belfast, United Kingdom; Save a Heart Charity, Belfast, United Kingdom
| | - Bharathi Varadarajan
- Royal Victoria Hospital, Belfast, United Kingdom; Save a Heart Charity, Belfast, United Kingdom
| | - Onyekwelu Nzewi
- Royal Victoria Hospital, Belfast, United Kingdom; Save a Heart Charity, Belfast, United Kingdom
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Wyber R, Zühlke L, Carapetis J. The case for global investment in rheumatic heart-disease control. Bull World Health Organ 2014; 92:768-70. [PMID: 25378731 PMCID: PMC4208481 DOI: 10.2471/blt.13.134486] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 03/21/2014] [Accepted: 03/26/2014] [Indexed: 11/27/2022] Open
Affiliation(s)
- Rosemary Wyber
- Telethon Kids Institute, University of Western Australia, 100 Roberts Road, Subiaco, Western Australia, 6008, Australia
| | - Liesl Zühlke
- Departments of Paediatrics and Medicine, University of Cape Town, Cape Town, South Africa
| | - Jonathan Carapetis
- Telethon Kids Institute, University of Western Australia, 100 Roberts Road, Subiaco, Western Australia, 6008, Australia
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