Children's Heart- LIFE-SAVING CARDIAC SURGERY

A long fruitful collaboration between Mission Bambini Foundation and

Mulango Hospital Uganda teams

Since 2013 a fruitful collaboration has been established between Mission
Bambini Foundation and Mulago Hospital teams’ thanks firstly to Dr Arioli and
Dr Ammirati and recently to Dr Marianeschi. All volunteers are cardiologist
and or cardiothoracic surgeon of which they are mostly from Niguarda
hospital located in Milan.

Mulago hospital, located in Kampala, is the largest hospital in the country and
has been funded by Sir Arthur Ruskin Cook and English missionary doctor in
1917.

The Pediatric heart surgery project has started in the 70s, and today, after
more than 50 years, this hospital can offer very good quality of health care
services to both adults and children.
The collaboration with Mission Bambini Foundation can support the Ugandan
health care team way through training, screening and surgical operations for
children patient having complicated hearth surgery.
During the last mission in May 2023, Mission Bambini volunteers flew to
Kampala to support the local medical team in ten pediatric heart surgeries.
These surgical interventions are also known as save file intervention, in fact if
the intervention was not performed, the child could have sooner or later died
All health care fees are free of charge and additional costs as care givers’
accommodation and or local transportation are covered by Mission Bambini
Foundation.
One week after the surgical intervention, all children are in very good health
conditions.
Among the beneficiaries, A., a child operated on twice by our volunteer
doctors, first in Uganda and then in Italy, came to visit Mission Bambini’s
volunteers at the Mulago National Referral Hospital Complex - Uganda Heart
Institute.
A. and his father travelled a whole day almost 18 hours and covered
500 km, just to say goodbye and thank to all members’ team, for the
unconditional support and they brought a cake with the words "Thank u
Bambini Mission".

Mission Bambini Foundation, as part of the Children’s Heart Program, has been engaged in the treatment of childhood heart diseases around the world since 2005. In order to save children with severe heart conditions, born in the poorest countries, one of the ways of intervention is to provide medical assistance on site.

Medical missions can have two different goals: supporting and training the local èquipe in difficult surgeries or supporting the medical team in screening patients, sharing knowledge and best practices to apply when visiting a potentially cardiopathic child.

During the last expedition, Mission Bambini’s team flew to Nepal to support the local medical èquipe in screening around 12,000 children, intercepted by involving 18 primary and secondary schools. 14 of them will need a surgical operation in the next months.

Among The screened children we met P., a 4 years old child with a sever heart condition.

P. was accompanied by her grandmother aa both her parents cannot take care of her.

Her father had developed an addiction to alcohol, which soon turned into a problematic behavior and led him to lose his job and divorce from P.’s mother.

On her own and with a child to feed and take care of, the mum needed to find a job quickly: she was hired as a construction yard worker in Dubai.

P.’s mum can come back to Nepal only once every two weeks for just 7 days, after which she has to fly back to work.

The situation, already enough hard on itself, left no other choice to P. and her mother but to ask the child’s grandmother to be the main caregiver.

Despite these difficulties, a bright future nevertheless lies ahead for little P. In fact, she has been placed on the list of children waiting for a heart operation at Mission Bambini, which will be able to guarantee her a better life expectancy and quality of life. The operation, scheduled for the next mission in March 2023 if more serious cases are not identified, will allow her heart to function better.

The Mission Bambini  Foundation, as part of the Children's Heart Program, has been engaged in the treatment of childhood heart disease around the world since 2005.
In order to save children with severe heart disease who are born in the poorest countries, one of the ways of intervention is to provide arrangements and assistance to travel to Italy for children who can not have surgery in their own country, due to lack of hospital facilities and/or sufficiently specialized personnel.
G. Sier
Little Sier was born in Tirana in 2019 with congenital heart disease, which was diagnosed at the age of 2 months and since then she has been regularly followed up with outpatient visits while waiting for surgery. She lives with her mom and dad in Tirana and recently had a baby sister born.
Sier has always demonstrated herself to be a strong child, and this has allowed her to have a fairly regular growth path. Unfortunately, due to the Covid-19 pandemic and border closures, she had to wait longer than expected and developed bacterial endocarditis.
Finally, at the end of July 2022 came the confirmation of his hospitalization in Italy, at Niguarda Hospital in Milan.
Sier and his dad were followed by Mission Bambini regarding all travel arrangements, in terms of airline tickets, visas, and reception.
Thanks to the Foundation's volunteers, the dad and his little girl were followed every step of the way in such a delicate situation as heart surgery in a foreign country.
Fortunately, the surgery went well according to expectations and today little Sier is doing great and can fully enjoy her childhood. Since the surgery was conclusive, she will not need surgery in the future. She will be visited regularly by the Albanian cardiologist to monitor her gro

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)

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

2^nd 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)

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.