global health initiatives 

Changchun, China, 2009

Jilin Heart Center

A short year after the group had visited the Jilin Heart Center in northwest China (see below for 2008's summary), they returned in 2009 on a follow-up visit. In addition to Dr. Chen, the team included Dr. Alejandro Torres, a pediatric cardiac catheterization specialist; Dr. Patrick Flynn, a pediatric echocardiography specialist; Thomas Beaulieu, a pediatric perfusionist; Dr. Johanna Schwarzenberger, a pediatric cardiac anesthesiologist; Dr. Ralph Slepian, a pediatric cardiac anesthesiologist; Jillian Kirkpatrick, a pediatric ICU nurse; Dr. H. Michael Ushay, a pediatric intensivist; and Erin Driscoll, a pediatric catheterization nurse.

Rewardingly, in the interim time, the Jilin Heart Center had made great progress in their ability to perform many of the more straightforward operations that the group from NYP had demonstrated in 2008. In addition, directed quality initiatives in the pediatric ICU and inpatient ward had been implemented to reduce infection and optimize communication. Accordingly, the procedures performed collaboratively this time involved far more complex operations and catheter-based procedures. The NYP group also helped in the planning of the new Jilin Heart Hospital, which opened in 2011. The 2009 trip, like that in 2008, was overseen by Children’s Heartlink with partial support from the Clinton Global Initiative and The Bracco Group. As always, teaching and team-building were essential parts of the endeavor, and the exchange of ideas and techniques were reciprocal.

The group hopes to visit the new Jilin Heart Center. Said Dr. Chen, "The new space will undoubtedly not only provide a spectacular place for the children undergoing these heart procedures, but also will be a great draw for Jilin’s recruitment efforts toward enlarging their staff and faculty. We really look forward to a return visit."

Changchun, China, 2008

In May 2008, just one week after a major earthquake shook Southwest China, Dr. Jonathan Chen and a team of doctors, nurses, and perfusionists, predominantly from NewYork-Presbyterian, traveled to the former Manchuria to perform surgery and train local surgeons at the Jilin Heart Hospital in the city of Chang Chun. The team's goal was to transmit knowledge of newer procedures to surgeons at Jilin who, though they were performing three hundred cardiac cases per year, did not have access to training for state-of-the-art procedures. The trip was supported by the Children's Heartlink Foundation.

In addition to Dr. Chen, the team included Dr. Alejandro Torres, a pediatric cardiac catheterization specialist; Dr. Patrick Flynn, a pediatric echocardiography specialist; Thomas Beaulieu, a pediatric perfusionist; Dr. Johanna Schwarzenberger, a pediatric cardiac anesthesiologist; Dr. Ralph Slepian, a pediatric cardiac anesthesiologist; Jillian Kirkpatrick, a pediatric ICU nurse; Dr. H. Michael Ushay, a pediatric intensivist; and Erin Driscoll, a pediatric catheterization nurse.

Jilin's clinical capabilities were more advanced than those encountered by the team during previous trips to Cambodia and Senegal. The clinical staff at Jilin included anesthesiologists, nurses and perfusionists in addition to surgeons, and teams had their own systems in place and were performing modern catheterization procedures with techniques and devices engineered China. "It's a very different thing to go to a place that's fully functioning all the time," says Dr. Chen.

Teaching – and learning

Working with Jilin's well-developed program had both advantages and disadvantages. At Jilin the team participated in approximately nine cases, and as in previous trips, their goal was to train clinical staff that could, in turn, train other staff. "The number of cases we perform," says Dr. Chen, "is never as important as the transfer of knowledge. The operations we completed together at Jilin involved mostly me watching or assisting, and only occasionally stepping in to perform the operation." The American team's lack of familiarity with Chinese catheterization technology proved to be a challenge for knowledge transfer efforts. But Dr. Chen says it was nonetheless refreshing to be able to instruct surgeons with established protocols and skills. "There were several young surgeons whom we could teach newer techniques and thereby potentially impact the future sophistication of the hospital's congenital heart program."

The cases performed by the team were all relatively similar, with all patients over two years old. "In the developing world, children with severe defects die at a very young age," he says. The exception came at the end of the week, when Dr. Chen and his team performed a complex surgery on a teenager with Ebstein's anomaly. In Ebstein's, the opening of the tricuspid valve is faulty, leading to backflow of blood to the right atrium. Symptoms can include peripheral edema, exercise intolerance and congestive heart failure.

More work to be done

This year's trip was sponsored by Children's HeartLink, a Minneapolis-based nonprofit that sends pediatric cardiac care teams all over the world, and is part of the Clinton Global Initiative. The connection with Children's HeartLink and the Jilin Heart Hospital is not over even though the trip is complete. Chen's group and others from NewYork-Presbyterian may follow up with some long-distance consulting to assist Jilin with planning and layout for a new hospital. The team is also currently conducting long-distance follow-up on specific cases.

All of the members of Dr. Chen's team donate their time and use vacation days to pursue these trips. In coming years Dr. Chen thinks his team may return to Cambodia (where they traveled in 2005 and 2006) or Senegal (the focus of their 2007 trip). The funder for those trips, Surgeons of Hope, is also considering treating children in Central America. Dr. Chen says that though his group is open to new locations, he feels strongly about the importance of repeat visits. "It's best for us to go repeatedly in order to help the teams cement what we teach them."

Overall, Dr. Chen says he pleased with this year's trip, citing especially the sophistication of the Jilin program, "It's nice to go to a place with a full and developed clinical staff. You can't build a program around one person." Dr. Chen believes that Jilin is ready to make the step to treating smaller children and to increase its volume. "The clinical capability is there. It's just a matter of government buy-in, facilities enhancement and financial support," he says.

(Written in conjunction with the Office of External Affairs, Columbia University Department of Surgery.)

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