Humanitarian Missions

Humanitarian Mission: Pediatric Cardiac Surgery

Helping a Well-Developed Chinese Program Take the Next Steps

Back row (l-r): Cardiac catheterization specialist Dr. Alejandro Torres, pediatric intensivist Dr. H. Michael Ushay (from Montefiore Medical Center), pediatric cardiac surgeon Dr. Jonathan Chen, pediatric cardiac anesthesiologist Dr. Ralph Slepian (from NYP-Cornell), pediatric catheterization nurse Erin Driscoll.
Front row (l-r): pediatric cardiac anesthesiologist Dr. Johanna Schwarzenberger, pediatric perfusionist Thomas Beaulieu (From St. Michael's - New Jersey), pediatric ICU nurse Jillian Kirkpatrick, pediatric echocardiology specialist Dr. Patrick Flynn (from NYP-Cornell)


Dr. Chen with one of Jilin Heart's young cardiac surgery patients.


l-r: Dr. Huo and Dr. Chen performing repair of Ebstein's anomaly.

For the each of past three years, Jonathan M. Chen, MD, has led teams of doctors, nurses and perfusionists—predominantly from New York-Presbyterian Hospital/Columbia—on missions to perform heart surgery on children with congenital heart disease. In May 2008, the team traveled to China 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.

Jilin's clinical capabilities were nonetheless more advanced than that encountered by the team during previous trips. 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.

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 who 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.

This year's mission 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 mission is complete. Chen's group and others from NewYork-Presbyterian may follow up the May mission 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.

In coming years Dr. Chen thinks his team may return to Cambodia (where they traveled in March of 2006) or Senegal (the focus of their 2007 mission). 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." He 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.

Read about the 2007 trip to Senegal.
Read about the 2006 trip to Cambodia.