Children'Heart 2019 - LIFE-SAVING CARDIAC SURGERY

by Mission Bambini
Children'Heart 2019 - LIFE-SAVING CARDIAC SURGERY
Children'Heart 2019 - LIFE-SAVING CARDIAC SURGERY
Children'Heart 2019 - LIFE-SAVING CARDIAC SURGERY
Children'Heart 2019 - LIFE-SAVING CARDIAC SURGERY
Children'Heart 2019 - LIFE-SAVING CARDIAC SURGERY
Children'Heart 2019 - LIFE-SAVING CARDIAC SURGERY
Children'Heart 2019 - LIFE-SAVING CARDIAC SURGERY
Children'Heart 2019 - LIFE-SAVING CARDIAC SURGERY

The surgery mission has taken place during a week at the end of april at the 

Nepal – Manmohan Cardiothoracic Vascular and Transplant Center (MCVTC) – Kathmandu. 

o   It was established 13 years ago as a part of the Institute of Medicine, Tribhuvan University. Since its inception, it has been considered a centre of excellence for training undergraduate and post-graduate doctors. It focuses on Cardiology, Cardiothoracic and Vascular Surgery. It is one of the 42 departments of the TUTH but the director of the MCVTC is different from the director of the Tribhuvan Hospital, which is a teaching hospital, and they are not in a hierarchy. The Teaching Hospital is backed by the University (MoE) but the MoH helps in buying instruments.

o   It is one of the most important governmental hospitals in Nepal and one of the 2 dealing with heart diseases, together with Shahid Gangalal National Heart Centre (so they are 2 for 30 million inhabitants while the recommendation would be to have 1 every 1 million inhabitants). The main difference between the two hospitals is that Gangalal National Heart Centre could only provide services connected with heart surgeries. MCVTC is scheduled to provide cardiac, thoracic and vascular services with the added benefit to establish connections with different centres/areas of Tribhuvan Hospital, by being one of the pillars of the Institute of Medicine: therefore any medical complications can be treated within the hospital while the Gangalal has to refer them to the Tribhuvan Hospital. At Gangalal approximately 1700 cardiac procedures are performed every year, out of which approximately 800 children

o   It is structured in 3 Departments: the Department of Cardiothoracic & Vascular Surgery; the Department of Cardiothoracic & Vascular Anesthesiology; the Department of Cardiology

o   Dr Anil reported that about 200/300 children are operated on at MCVTC every year (out of whom 40 supported by FMB, coming not only from our medical camp but also from others, 20 by Cuore Fratello and a varying number by the Heart of Children of Dr Vanini, while the others are referred by other hospitals[1]). He is responsible for cardiac surgeries at MCVTC. The OTs are used for cardiac 3 times a week (Tuesday, Thursday and Sunday) and 3 times a week for vascular and thoracic (Friday is off). For cardiac, 5-7 patients (adults or children) are operated every day. They also operated RHD. They are also starting to see the first TOF patients who need to replace the first valves they had installed as they grew up (after 10-15 years). He does not do hemodynamic procedures even if he is also a cardiologist.

No. of children screened: 2 children (1 screening and 1 clinical record analysis)

-        1. Siwani B.K., 3 years old, 2 secondum ASD 0.9 cm & 0.3 cm both L-R shunt, mild TR, dilated RA, RV & PA. (from Free Screening Health Camp in Beni Bazar, April 22)

-        2. Harsit R. M, 16 months/M, Large subaortic VSD 1.4 cm, bidirectional shunt, sev. Valvular, TOF (from Free Screening Health Camp in Beni Bazar, April 22)

1st screening performed by Dr. S. S. (Cardiologist)

2nd screening (as clinical record analysis) performed by Dr. Stefano Marianeschi (Heart surgeon)

 

No. of follow-ups: 2 children (from Free Screening Health Camp in Palpa, Nov 21)

-        1. Rajina R., 11 years old, F, ASD 16 mm

-        2. Arina C., 3 years old, F, VSD

Follow up performed by Doc. Stefano Marianeschi and Doc. Anil B.

 

Teaching results achieved:

  • Teaching lecture made by Dr Stefano Marianeschi in the Seminar Hall of Manmohan Cardiothoracic Vascular and Transplant Center (old building). 25 health professionals involved, including Prof. Dr Uttam (Executive Director), Prof. Dr. B. Koirala (Head of the Department of Cardiothoracic and Vascular Surgery)
  • Master’s lecture made by Dr Stefano Marianeschi. Congress promoted by Cardiac Society of Nepal. 40 participants (mainly doctors and resident doctors of Shahid Gangalal National Heart Centre)
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After more than a year since Mission Bambini brought a child with heart disease to Italy for surgery - due to the Covid-19 pandemic - on 6 February, a little 4-year-old Albanian boy with heart disease arrived in Milan with his mother to undergo heart surgery on 21 February at Niguarda Hospital in Milan.

Diagnostic tests on the little boy began in 2018, and in 2019 a specialist visit during a screening mission involving Dr Marianeschi - scientific head of the Cuore di Bimbi programme - revealed the need for the child to undergo cardiac surgery, 2 years after the visit, to close an inter-atrial defect.

Background
Albania is a country characterised by widespread socio-economic hardship among the population. According to the Human Development Index, the country ranks 69th out of 189 countries considered. Twenty percent of the population is under 14 years of age and the infant mortality rate under five years of age is about 8.8 children per thousand live births (Italy, 3).
At the moment in Albania there is no possibility for congenital (born with a heart defect) or acquired (born healthy but suffering from rheumatic diseases) heart patients to be operated on in their own country. The cost of operations and drugs, as well as the high level of corruption in the country, leads families with children with heart disease to seek help from NGOs and international associations to have their loved ones operated on abroad. The poorest families find themselves unable to afford the costs of having their children operated on abroad or in a private centre.
The project
With the Fondazione Mission Bambini project "Healthcare for children with heart disease paid for by the Lombardy Region", Mission Bambini is committed to offering an operating opportunity to children with heart disease on the waiting list for an operation, through the regional funds made available by the Lombardy Region. While the Lombardy Region Health Fund guarantees coverage of the cost of the hospital operation, Mission Bambini covers all out-of-hospital expenses (travel, food, accommodation, and - in this historical period - also expenses related to the pandemic situation e.g. swabs).
The project is also made possible thanks to the long-standing partnership between Mission Bambini and the "Madonnina del Grappa" Outpatient Clinic for Cardiopediatrics in Shkodër (Albania), a centre that diagnoses congenital heart disease and then performs corrective cardiac surgery in Italy. Mission Bambini is in constant collaboration with Dr. Arketa Pllumi, cardiologist at the clinic, and Sister Enza, internist with whom we are in constant contact to meet the needs of families whose children, suffering from heart disease, cannot be operated on in the country.

Reception
Little D. arrived in Milan with his mother on 6 February, welcomed by a volunteer from the Mission Bambini Foundation who took care of the shopping. Daors will be the 25th child to be operated on since 2015 thanks to Mission Bambini under the Regione Lombardia Health Fund.

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To save children with serious heart defects, born in developing Countries and to enablelocal hospitals to be autonomous, through capacity building and training by volunteer doctors who work alongside local doctors: this is the ambituous goal of our Children Heart programm.

And this is particular challenging in this period completely focused on the treatment and takle of Coivd 19 pandemic. 

Congenital Heart Defects (CHD) is the most common cause of major congenital anomalies, representing a major global health problem.

An estimated 1 million children is born every year affected by heart diseases .

In developed countries, congenital heart disease is easily diagnosed (even prenatally) and successfully treated, with pediatric cardiac surgery if necessary.

In developing countries are oftenlacking prepared medical staff and adequate health facilities. Years can go by just to obtain a correct diagnosis.

Significant Data

  • 50% of children born with severe heart conditions are at a greater risk of death if not treated in the first years of their life; others face serious development problems.
  • The differences in mortality rate between the industrialized countries and developing countries are striking, from 3-7% to 20% respectively.
  • Strong differences in the availability of congenital heart surgeons across the world: 1 for 3,500,000 individuals in North America and Europe, 1:25,000,000 in Asia and 1:38,000,000 in Africa.
  • The «Children’s Heart» Program aimsatreducing the mortality rate in developing countries of children affected by congenital or rheumatic heart diseases, with particular attention to the lessprivileged population. 

    in Myanmar, cardiac surgery was supported at the Yankin Children Hospital for 30 children with congenital heart defect;

     

    in Nepal, Mission Bambini financed the travel cost to Kathmandu for 20 children awaiting surgery, as well as room and board for the caregiver, for the entire duration of the hospital stay.

    We also supported a medical camp of cardiological screening.

     

    in Zimbabwe, we have supported the follow-up for about 70 children operated on in the past years, to constantly monitor drug therapy.

     

    in Uganda, Mission Bambini supported the consumables cost for the heart surgery of 10 young patients.

    ü

    üin Italy, we supported the reception of 2 children from Albania, to be surgically treated at the Niguarda Hospital in Milan.

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Due the covid restrictions which strictly reduce the traveling possibilities aroun the world  we have to remodulate the programm: we have moved pur investements to the local hospital to give them the opportunity to proceed with surgical interventations. 

We have the responsibility to mantain our engagemet with the communities to guarantee the right to health service access, so we have enforced the training programm through a specific platform for doctors and health operators. 

The mail goal of Children'Hearth Programm is  to save children with serious heart defects, born in developing Countries and to enablelocal hospitals to be autonomous, through capacity building and training by volunteer doctors who work alongside local doctors and we want to make local hospitals  self-sufficient in treating heart diseases in children (diagnosis, surgical treatment and follow up). 

Mission Bambini

  • identifies and assesses the Countries and hospitals with whomdevelop a multi-year partnership, involvingGovernmental Institutions;
    verifies the feasibility of paediatriccardiac surgery camps;
    • ensuresmonitoring and evaluation phases;
    • realizesfundraising e communication activities;
    • plans, organizes and manages the campslogistics.

The Foundation covers the costrelated to:

  • travel, accommodation and stay abroad of the volunteer medical team;
  • medicalequipmentifneeded;
  • travel and reception in Italyfor the child and his/hercarer;
  • treatment for the children of lessprivileged families, reported by local hospitals;
  • Improvement of facilities or equipmentpurchasingfor the local hospitals.

The long termaim of the partnership with local hospitals is to reach the autonomy in treatingheartdiseases in children, raising the level and quality of the whole local sanitarysystem. 

The Multidisciplinary Specialist Training Program in CHD designed and implemented by MB in collaboration with the local Univerities of Medicine aims to enhance theoretical and technical competences of local healthcare staff, training future professionals to treatheartdiseases in children.

A team of volunteerinternationallecturerstake part to periodical training camps, in accordance with the local Hospitals and Universities.

The team of volunteerinternationallecturers follow the students during the academic year through a digital platform.

The Multidisciplinary Specialist Training Program included in the local university curricula, is formalized by the issue of an academic certificate

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On March 11th, 2020, the WHO declares the COVID-19 pandemic. Initially, the highest prevalence of Covid19 cases is detected in Europe and the US, and the MB volunteer health professionals are called upon to deal with the emergency in their own countries

To cope with the pandemic situation, Mission Bambini had to implement strategic changes, such as the reallocation and rationalization of resources, to pursue the expected results as much as possible, especially in terms of treated children, for example by increasing support to local partner hospitals. 

In the emergency phase, Mission Bambini took action also at a national level to support the Niguarda Hospital in Milan by providing:

  • 16.000 FFP2 filter masks to medical and nursing health personnel involved in the management of patients affected by Covid19;
  • 200 protective face shields intended for pediatric healthcare professionals.

in Myanmar, cardiac surgery was supported at the Yankin Children Hospital for 30 children with congenital heart defect

in Nepal, Mission Bambini financed the travel cost to Kathmandu for 20 children awaiting surgery, as well as room and board for the caregiver, for the entire duration of the hospital stay.

We also supported a medical camp of cardiological screening.

in Zimbabwe, we have supported the follow-up for about 70 children operated on in the past years, to constantly monitor drug therapy.

in Uganda, Mission Bambini supported the consumables cost for the heart surgery of 10 young patients.

A significantaspect of the “Children’sHeart” Program isthe training of localdoctors and healthpersonnnel.

The long termaim of the partnership with local hospitals is to reach the autonomy in treatingheartdiseases in children, raising the level and quality of the wholelocalsanitarysystem.

During surgery campsabroad, the selected local healthcare staff work alongside with the MB volunteerdoctors for the transfer of skills and

know-how.

To ensurecontinuity of the training activities, with the local hospitals the partnership is long-term and the surgerycamps are carried out twice a year.

The Multidisciplinary Specialist Training Program in CHD designed and implemented by MB in collaboration with the local Univerities of Medicine aims to enhance theoretical and technical competences of local healthcare staff, training future professionals to treatheartdiseases in children.

A team of volunteerinternationallecturerstake part to periodical training camps, in accordance with the local Hospitals and Universities.

The team of volunteerinternationallecturers follow the students during the academic year through a digital platform.

The Multidisciplinary Specialist Training Program included in the local university curricula, is formalized by the issue of an academic certificate.

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Mission Bambini

Location: Milano - Italy
Website:
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Twitter: @aiutareibambini
Project Leader:
Alberto Barenghi
Milano, Italy
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