CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
106
AFRICA
1014: STATE OF THE ART HUMANITARIAN PAEDIAT-
RIC CARDIAC MISSIONS: A DESIGN FOR SUSTAINABLE
DELIVERY OF ASSISTANCE
William Novick
1,2
, Frank Molly
2
, Christian Gilbert
2
, Martina Pavanic
2
,
Stacey Marr
2
, Caroline Lonsdale
2
, Kathleen Fenton
2
1
University of Tennessee Health Sciences Center, USA
2
International Children’s Heart Foundation, Memphis, TN, USA
Background:
Paediatric cardiac development assistance is widely
but sporadically practiced. The delivery of more than one assistance
mission per year is beyond the ability of many centres. We describe an
organisational structure enabling the sustained delivery of assistance
through an NGO-based multi-national, multi-institutional team-
member approach. Our results over the last 20 years are presented.
Methods:
The database of the NGO was reviewed since inception
in 1993. Totals were harvested for trips made, sites of assistance,
number of team members, country and institution of origin of team
members, and number of operations. Data were analysed by five-year
periods (eras) for differences. A
p
-value of
<
0.05 was considered
significant
Results:
Total number of years of assistance was 20. Total team
members were 3 578 on 289 trips. Team members came from 106
institutions in 43 countries. The average number of trips and team
members/year increased between all eras (
p
<
0.001) from 3.6/48 in
era 1 to 29.0/401 in era 4. The maximum number of trips in one year
was 36, requiring 509 team members. The number of institutions
and countries of origin of the team members increased over time and
the average was significantly different between eras (
p
<
0.01). The
single largest number of institutions and countries represented on a
trip was 13 and 11. Previous recipients of assistance became team
members in 2000. A total of 26 countries have received assistance,
with the greatest number of trips and operations provided in Central
America and Asia, at 61/1 132 and 58/1 128, respectively.
Conclusions:
Paediatric cardiac education and service can be
provided to multiple sites simultaneously utilising this model. We are
not aware of a single hospital, institution or charitable entity that can
provide a similar level of assistance
1024: NECESSITY OF BIO-MEDICAL ENGINEERING
SUPPORT ON HUMANITARIAN MEDICAL MISSIONS
David Weiduwilt
1
, Roy Morris
1
, David Coquat
1
, William Novick
1,2
1
International Children’s Heart Foundation, Memphis, TN, USA
2
University of Tennessee Health, USA
Background:
Due to less complex technology for medical equip-
ment in the past, there was little emphasis placed on the impor-
tance of biomedical engineering support for humanitarian medical
missions. However, as the evolution of technology for medical equip-
ment has progressed at a rapid pace, and the complexity of proce-
dures has increased, it is evident the role of biomedical engineering
has expanded. An education in this field is not enough. A discipline
in computer engineering, anatomy and physiology, and knowledge
of equipment that is procedure specific must be incorporated. In
under-developed countries, it is quite common for these disciplines
to simply not exist.
Methods:
Data were analysed from ICHF’s (International Children’s
Heart Foundation) database over the past five years. During this
period, a total of 677 pieces of medical equipment was sent to 23
locations in 16 different countries. Some specific types of medical
equipment included patient monitors, anaesthesia machines, cardio-
pulmonary bypass machines, ventilators, defibrillators, electro-surgi-
cal units, syringe pumps, hypo/hyperthermia units, and cardiac echo
ultrasound units. Additionally, the ICHF biomedical engineering
staff/volunteers have made 49 trips to provide biomedical engineer-
ing support and emergency repairs.
Results:
The analysis provides a common link between the various
types of equipment needed across all developing countries where
humanitarian medical programmes have been started.
Conclusions:
The
ICHF has created a paradigm shift and raised
the bar of expectation on the level of education and expertise for
biomedical engineering support. This support is defined as install-
ing, servicing, repairing and providing staff training on biomedical
equipment. The end result has allowed ICHF medical programmes
in developing countries to grow at an accelerated pace, by ensuring
better patient safety and improving surgical results
1116: RHEUMATIC HEART DISEASE HEALTH WORKER
TRAINING AND SYSTEM STRENGTHENING IN FOUR
PACIFIC ISLAND NATIONS
Liz Kennedy
1
, Samantha Colquhoun
1,2
, Alani Tangitau
3
, Maliesi
Latasi
4
, Geoffrey Kenilorea
5
, Kautu Bakatu
6
, Bo Remenyi
1
, Jonathan
Carapetis
1,7
1
Menzies School of Health Research, Darwin, Australia
2
Centre for International Child Health, University of Melbourne,
Melbourne, Australia
3
Ministry of Health, Republic of Nauru, Pacific Islands
4
Ministry of Health, Republic of Tuvalu, Pacific Islands
5
Ministry of Health, Republic of the Solomon Islands, Pacific Islands
6
Ministry of Health, Republic of Kiribati, Pacific Island
7
Telethon Institute for Child Health Research, Centre for Child
Health Research, Subiaco, Australia
Background:
The Pacific region has the highest documented rheu-
matic heart disease (RHD) prevalence globally. Since 2005 the World
Heart Federation and Menzies School of Health Research have been
working to strengthen rheumatic heart disease prevention and control
with Pacific Island nations. Additional funding was secured in 2011
to assist four additional Pacific countries, Nauru, Tuvalu, Kiribati and
the Solomon Islands.
Methods:
The programme is based on WHO international recom-
mendations for register-based prevention and control. An Australian-
based team assists local staff from the Ministries of Health to expand
capacity and strengthen existing activities.
Results:
Health professionals from the four Pacific countries have
received RHD training. Each country has been supported to develop
clinical information materials, patient injection cards and national
protocols for the diagnosis and prevention of ARF. A regional RHD
trainer’s manual has been developed to support local staff to extend
RHD training to health workers on the outer islands and provinces.
National registers have been developed for each country. In Nauru,
2011 baseline data showed that 46% of patients were receiving 50%
or more of their injections. Echocardiography screening to define
baseline burden of disease has been conducted, showing a preva-
lence of 15.1/1 000 in Nauru and 35.1/1 000 in Tuvalu. Screening
will be conducted in the Solomon Islands and Kiribati in 2012–13.
A community and patient-education campaign plan has been devel-
oped, which includes: patient–peer support groups and multi-media
campaigns to raise awareness of ARF and RHD.
Conclusion:
The Pacific RHD programme has seen an increase
in disease notification and awareness among health staff and the
community. It is anticipated that system and capacity strengthening
will contribute to a more sustainable programme, including a more
efficient and user-friendly service for patients and an increase in the
delivery of secondary prophylaxis in patients, and improve primary
healthcare for RHD patients.
1162: DONOR EXPECTATIONS IN PAEDIATRIC CARDIAC
SURGERY: ARE THE SELECTION CRITERIA JUSTIFIED?
Lynda Bleazard
Former CEO of Walter Sisulu Paediatric Cardiac Foundation, South
Africa
Background
The purpose of this research was to determine the best
practice in case selection to ensure that the use of donor funds is
effective for sustainable and maximum impact. Bearing in mind that
the objective of donors is to save as many children per donated rand
as possible, it is therefore incumbent on the Foundation’s selection
