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Send to a FriendTraining in the U.S. Army at Walter Reed Army Medical Center in the early 1980's, I was fortunate to go through that period with a group of residents that all turned out to be outstanding cardiac surgeons. A common denominator in that group was that all had what we considered the 'day-after vision'.
As students or young residents in training, we each had visions of what would happen when we were 'real' cardiothoracic surgeons. These visions sustained us through long, insufferable rotations and came in many forms, depending on our varied personalities. One vision was simply 'to control the 7-0 prolene'. Another, 'to see the heart pink up after a switch'. A third, 'to present the perfect paper at the STS'. For those of us who really understood what we were getting into, the vision became, 'to do cardiac surgery and still control my personal life,' and 'to look into a mother's face and tell her that her ill baby was going to be fine'.
Over the years, DRG's, managed care, our aging patient population, job competition, angioplasty and the major fiscal and political restraints of modern day medicine whittled away at my visions. In 1988, while doing a tour of duty in Korea, I found myself with the skills I so desperately wanted 10 years before but realized I had lost the motivation that drove me to acquire them in the first place.
Fortunately, I was introduced to a young woman of 70 by the name of Harriet Hodges who helped indigent children in Korea with heart problems. She enlisted me into her program and for a full year, we held clinics, sent pro-bono cases to U.S. hospitals, and operated on 35 children with PDA's at the 121st EVAC Hospital in Seoul. The week I left Korea, I was presented with a $5 plaque of gratitude from these children and their parents. To this day, this plaque hangs in my office as one of my prized possessions.
My experience in Seoul introduced me to a small but very strong and dedicated network of surgeons who were attempting to help with the problem of children with heart disease in developing countries. Surgeons like Joseph C. Kiser of Children's HeartLink of Minnesota, and former army surgeon Tom Pezzella started making contacts and inroads in organizing help for the millions of untreated children with surgically correctable heart disease.
Inspired by this network, in 1995 at the Wolfson Medical Center of Tel Aviv University, a pediatric cardiac division was established that is dedicated to researching and helping the problem of children with heart disease in developing countries. Funded by the Save a Child's Heart foundation, the program is dedicated to establishing partners in developing countries and creating centers in these countries for the diagnosis and treatment of pediatric heart disease. The program interacts with its partners by running annual clinics and teaching programs in each partner site, operating in partner sites when possible, training doctors and nurses from partner sites at Tel Aviv University, and operating on the most complex cases in Israel. To date, the program has 9 partner sites, has made 16 teaching and 4 teaching and operating trips, and operated on 565 children in Israel from the nine partner localities.
The program has caught the imagination of the hospital staff and over 75 medical professionals donate their time to the program. Both the hospital administration, headed by Dr. Mashiah, and the Ministries of Health and Foreign Affairs have nurtured us through our difficult beginnings. Because of the great need, there is no competition in this program and a wonderful cooperative spirit permeates throughout the project.
Our partners have benefited greatly from our cooperative efforts, but personally I feel I have received the better part of the deal. I am working with wonderful people at our partner sites, doctors such as Belay Abegaz at the Children's Heart Fund of Ethiopia, Sam Omokhodian of Save a Child's Heart Nigeria, Prof. Gui of Hebei Children's Hospital and Prof. Ciubotaru of the Republican Hospital in Moldova. All of these dedicated professionals are laboring under what most of us would consider unbearable conditions, all motivated by their own 'day-after vision', the vision of one day having the capability to provide their patients with all the care they need. Being able to be a partner in accomplishing this goal is a real privilege.
We have witnessed great moments in this project. We have trained cardiothoracic surgeons who are now back in Ethiopia and Nigeria. We have trained the first cardiologist on the Island of Zanzibar. We were partners in the initiation of cardiac surgery in Ethiopia and continuously treat children from the Palestinian Authority. Recently I was in Nigeria where we brought from Israel a new Hewlett Packard Echo-Doppler to replace a 20-year-old machine. The first child examined was a 2-year-old with Tetralogy of Fallot. When our cardiologist demonstrated the coronary arteries, our Nigerian colleagues could not contain their amazement.
Two other tetralogies come to mind. One was a 7-year-old from Gaza, one of the first children of the program. The case was routine technically. When I took the mother to see the child, the look on her face was one of pure joy. If ever I had truly lost what had induced me to pursue cardiothoracic surgery, it flooded back at that moment.
The second child I operated on today. I am writing this on November 23rd, Thanksgiving in the U.S. In Israel, violence is escalating. A bus was blown up by terrorists in Hadera, Northern Israel, and Israeli helicopter gunships retaliated by attacking Gaza. The child I operated on is a 3-month-old from Gaza with severe right ventricular outflow tract obstruction and an arterial oxygen saturation of 45%. Somehow a missionary managed to bring the child and father through the fighting to the Save a Child's Heart project. The baby had an emergency complete repair today and is doing well. Sitting with the father outside the recovery room, I am sure saving this child was a sane act in the midst of an insane region.
I am convinced that for the vast majority of people who chose cardiothoracic surgery as a profession, idealism was initially a strong factor. For those of you who are reading this and just starting out, hold fast to your 'day after-vision' because, if it fades, despite all the skills acquired, there will be something missing. For those who are searching, join us and together let us make the network to help children with heart disease globally big enough to be equal to the task. There is work for everybody. There are no dollars and cents in it, but it is worth a fortune.
Finally, to Harriet Hodges who is now 83 and continues to help whenever she can .… thank you, Harriet, from the bottom of my soul.
For cardiothoracic surgeons and other health professionals wishing to join this network, CTSNet provides a list of member humanitarian organizations at a>http://www.ctsnet.org/organizations