CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
102
AFRICA
acquired heart disease. Each year a nursing conference is conducted
in collaboration with the nursing department at Shastin Medical
Centre in Mongolia. Mongolian ICU nurses then partner with a
visiting nurse to care for the children after surgery. The goal for the
Mongolian nurses is to be fully responsible for the care provided by
the end of the week.
Results:
Since 2005, over 350 nurses have attended the conference
and 840 hours of clinical mentoring have been provided. In addi-
tion, nursing rounds have been conducted each year to encourage
the Mongolian nurses in their roles. The team has provided over 200
stethoscopes and provided assessment training and practice. The
nurses, who had never used stethoscopes before our team’s arrival,
have used their new assessment skills with the postoperative patients.
Discussion
: This abstract describes one mission team’s efforts to
improve the postoperative nursing care of children in Mongolia. The
nurses in Mongolia have been eager to learn and have taken seriously
their role in the success of a paediatric cardiac surgery programme
for their country. In order to meet the mission of the WSPCHS,
education and training of nurses must be included whenever cardiac
surgery teams are working in developing countries.
191: MEDICAL MISSION OR OUTREACH CLINIC? OPER-
ATIONALISING PAEDIATRIC CARDIOLOGY SERVICES
WITH A PORTABLE ELECTRONIC MEDICAL RECORD
(EMR) AND MEDICAL SCRIBE IN THE FEDERATED
STATES OF MICRONESIA
Gira Morchi, Michael Rebolledo, Anthony Chang, Melville Singer,
Jimmy Luu
Paediatric Subspecialty Faculty, Cardiology Division, Children’s
Hospital of Orange County, USA
Background:
We operationalised our paediatric cardiology services
in the Federated States of Micronesia (FSM). Located in the Western
Pacific Ocean just north of equator, FSM comprises 600 islands
spread over an area of 1 000 000 square miles and is a medi-
cally underserved area. Previous outreach trips took five weeks and
consisted of a visit with a brief handwritten entry in the patient’s
medical record. Our team consisted of a paediatric cardiologist, an
echocardiography technician with a portable Philips CX-50 echo-
cardiography machine, and a medical scribe for data entry. Using a
portable EMR we hypothesised that we could improve the efficiency
of our outreach. In addition, we sought to characterise the spectrum
of congenital and rheumatic heart disease (CHD and RHD) in the
region.
Methods:
We created a customised mini-EMR using a Microsoft
Excel
©
spread sheet. Drop-down lists with common diagnoses,
surgeries, physical examinations, echo findings, and medications
were used to fill in the spread sheet. Additional data were free-texted
as needed. Data entry for each patient took under two minutes by the
medical scribe and a consultation note was generated using the Mail
Merge feature in Microsoft Excel
©
.
Results:
We evaluated 328 patients on four different islands over
a period of three weeks (compared to five weeks previously). The
portable EMR generated comprehensive individualised notes with
complete treatment plans for local providers. Perimembranous and/or
supracristal VSDs are the most common forms of CHD in this popu-
lation. The clinical spectrum of RHD is similar to previous studies of
Asian/Pacific islanders.
Conclusions:
We improved the efficiency of our paediatric cardiolo-
gy outreach services to FSM using a customised portable EMR along
with a medical scribe for data entry. In addition, we documented the
clinical spectrum of CHD and RHD in this region.
229: INNOVATIVE ORGANISATIONAL STRATEGY FOR
CRITICAL CONGENITAL HEART DISEASE
Oleh Fedevych, Ganna Vorobiova, Kyrylo Chasovskyi, Volodymyr
Zhovnir, Nadiia Rudenko, Andrii Kurkevych, Illya Yemets
Ukrainian Children’s Cardiac Centre, Ukraine
Objective:
We described an innovative organisational strategy for
neonates who have prenatal diagnoses of critical congenital heart
disease (cCHD) with a focus on the earliest surgical repair, using
autologous umbilical cord blood (AUCB). The programme, First
Hours of Life Cardiac Surgery, was innovated and applied at the
Ukrainian Children’s Cardiac Centre.
Methods:
From September 2009 to May 2012, 350 neonates with
cCHD were operated on at our institution. For patients with prena-
tal diagnoses, new management was proposed. This included: (1)
re-examination by Echo at the 36th week of gestation to confirm
the diagnosis; (2) checking the pregnant woman for blood infection
and referring to the maternity department; (3) planning labour for an
early morning on a working day by induction or caesarian section
due to the obstetric indications; (4) harvesting of AUCB in utero and
testing it at the blood transfusion service in accordance with stand-
ards for blood products; (5) immediate transfer of the newborn to the
cardiac department; (6) complete primary surgical repair of cCHD
in the first hours of life after specification of the anatomy; (7) using
AUCB for peri-operative blood management.
Results:
During this period, 47 neonates underwent the new strategy.
In 27 cases (57%) labour was induced, and 20 patients (43%) were
delivered through caesarian section. Mean volume of harvested cord
blood was 85
±
24 ml (50–140). Neonates were admitted to the
cardiac department within an hour of birth. Mean age at operation
was 3.9
±
1.1 hours (2–6). No patients required ICU admission, inter-
ventional procedures, mechanical ventilation or medications before
surgery, which resulted in significant positive economic effects,
compared with the conventional approach. Thirty-seven neonates
(78%) underwent open cardiac surgery without homologous blood
transfusion.
Conclusion:
The proposed innovative organisational strategy for
cCHD allows avoidance of pre-operative ICU stay, balloon atriosep-
tostomy and reduction in homologous blood transfusions, and shows
significant positive economic effect.
255: ATTENDING TO THE UNATTENDED: THE ESTAB-
LISHMENT OF THE FIRST PAEDIATRIC CARDIOLOGY
OUTREACH CLINIC IN UGANDA
Nicolas Madsen
1
, Debbie Lester
2
, Rory Wilson
3
, Peter Lwabi
4
,
Lubega Sulaiman
4
1
Cincinnati Children’s Hospital, University of Cincinnati School of
Medicine
2
ISIS Foundation
3
Kiwoko Hospital, Uganda
4
Uganda Heart Institute, Mulago Hospital, Uganda
Background:
The burden of paediatric cardiac disease in the devel-
oping world is substantial and under-resourced. Several million chil-
dren in sub-Saharan Africa suffer with acquired conditions such as
rheumatic heart disease (RHD) and endomyocardial fibrosis (EMF).
More than 90% of these children live in areas of inadequate or absent
care. Our aim was to create an outreach clinic in an under-served
community in Uganda to address this care deficit.
Methods:
A paediatric cardiology outreach clinic was started in
2011 in the Luwero region of Uganda. This clinic was a coordinated
effort between Kiwoko Hospital (clinic site) and the Uganda Heart
Institute. Funding for the clinic was established by the Uganda Heart
Institute and the ISIS Foundation (a non-governmental organisa-
tion). Kiwoko Hospital supplied a portable echocardiogram machine
(Acuson Cypress Portable Ultrasound) and laboratory support.
Prescriptions were supported by the National Medical Stores. The
Uganda Heart Institute provided skilled clinic personnel.
Results:
A total of four outreach clinics took place in 2011. The
mean number of patients seen was 11 (range 7–15). The cost of a
single clinic day was 650 000 Uganda shillings ($263 US dollars),
covering allowance for two outreach doctors, two outreach nurses,
a single driver, and 40 l of fuel. Several conditions were identified,
including EMF, RHD, non-pathologic murmurs, and patent ductus
arteriosus. All of the patients cared for in the clinic did not have the
