International cooperation in healthcare: model of irccs policlinico San Donato and Bambini Cardiopatici
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International cooperation in healthcare: model of IRCCS Policlinico San Donato and Bambini Cardiopatici nel Mondo Association for congenital heart diseases Alessandro Frigiola 1,2,3,4,5 * , Nadia Moussaidi 1,2,3,4,5 , Alessandro Giamberti 1,2,3,4,5 , Giuseppe Pome ´ 1,2,3,4,5 , Giuseppe Isgro ` 1,2,3,4,5 , Tammam Youssef 1,2,3,4,5 , Matteo Reali 1,2,3,4,5 , Alessandro Varrica 1,2,3,4,5 , Halkawt A. Nuri 1,2,3,4,5 , Silvia Cirri 1,2,3,4,5 , Mario Carminati 1,2,3,4,5 , Lorenzo Menicanti 1,2,3,4,5 , Roberto Ferrari 1,2,3,4,5 , and Marco Ranucci 1,2,3,4,5 1 Department of Cardiac Surgery, IRCCS Policlinico San Donato, Piazza E. Malan 1, 20097 San Donato Milanese, Milan, Italy 2 Department of Pediatric Cardiology, IRCCS Policlinico San Donato, Milan, Italy 3 International Cooperation Unit, IRCCS Policlinico San Donato, Milan, Italy 4 Department of Anesthesiology and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy 5 Department of Cardiology and LTTA Centre, University Hospital of Ferrara and Maria Cecilia Hospital, GVM Care and Research, Ettore Sansavini Health Science Foundation, Cotignola, Italy Cooperation activity in training programmes promoted by IRCCS Policlinico San Donato and Bambini Cardiopatici nel Mondo Association is a model of cooperation between people as an alternative intervention in promoting the right to healthcare, especially offering programmes of training and medical care on cardiovascular and congenital heart disease. This new strategy, implemented in several developing countries, has ab- solutely contributed to the improvement of the medical services concerning the diagnos- tic and surgical approach in the treatment of paediatric and adult cardiovascular disease. To strengthen this kind of activity, both IRCCS Policlinico San Donato and Bambini Cardi- opatici nel Mondo have introduced a global perspective aiming at the realization of sur- gical missions ‘in situ’, building new cardiac surgery units in collaboration with the local partners, which are mainly university hospitals. They, furthermore, support financially the scholarship and accommodation in favour of medical and paramedical staff. KEYWORDS
International cooperation; Development of cardiac surgery in developing countries; Training programmes; Right to healthcare access Introduction A brief approach on cooperation in healthcare within the Italian and the international context The concept of cooperation requires the involvement of multiple agents or persons working in synergy to realize a common goal. ‘Working together’ means optimize the resources of the shared project so as to harmonize all the parts differences while seeking the involvement of as many collaborating people as possible. 1 Federico Bonaglia and Vincenzo de Luca, 2 authors of the book ‘La coopera- zione internazionale allo sviluppo’ (international cooper- ation for development), identify the word ‘cooperation’ as a set of policies implemented by a government, or by a multilateral institution, which aims at creating the neces- sary conditions for economic and social development in a sustainable way within the developing countries. 3 Cooper-
ation can be of various types, but, usually, the term is asso- ciated with the international sphere; therefore, in foreign policy the term ‘international cooperation’ is used to mean * Corresponding author. Tel: +39 02 52 774392/4519, Fax: +39 02 52774783, Email: alessandro.frigiola@grupposandonato.it Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2016. For permissions please email: journals.permissions@oup.com European Heart Journal Supplements (2016) 18 (Supplement E), E72–E78 The Heart of the Matter doi:10.1093/eurheartj/suw023 that the actors are sovereign states cooperating in the im- plementation of projects in favour of other countries. According to the traditionalist view, the international co- operation activities are carried out through financial support allocated by the developed countries in favour of the ‘developing countries’. There are other methods of intervention that can be summarized as follows (www. regione.lombardia.it): (i) transferring know-how through training courses ‘in situ’ on medicine, food, agriculture, economy etc.; (ii) giving aid loans; (iii) donate equipment; (iv) providing services and public infrastructures; and (v) promoting the safeguarding of the right to health making health services accessible to as many people as possible. To strengthen this kind of activity, all of the international actors, such as the UN agencies, 4 the European Union, and non-governmental organizations (NGOs), are mainly involved to extend the healthcare facilities, the protection of the right to health, 5 and nutrition and education through programmes aimed at improving the standard of living of the inhabitants of the most disadvantaged countries. 6 The programmes of action are proposed by the UN headed by the World Health Organization (WHO) (www. who.org/health), according to the guidelines of the Inter- national Conference on Primary Health Care, held in Alma Ata in 1978 (https://en.wikisource.org/wiki/Declaration_ of_Alma-Ata). However, to implement those programmes, George Rosen says that it is not enough to offer ideas and public policies to ensure their acceptance and accomplish- ment, but, apart from the governments consensus, it is es- sential that the local actors/authorities and beneficiaries accept.
7 Referring to the Italian context, international cooper- ation in healthcare, thanks to the law n. 49 of 1987 (www.regione.lombardia.it), becomes a significant com- ponent of foreign policy, because it sets out the basic needs and safeguards of human life. The humanitarian ac- tivity implemented by the Italian government and some Italian NGOs such as Bambini Cardiopatici nel Mondo, whose activity will be shown in detail later on, is a model of cooperation between people as an alternative interven- tion in promoting the right to health 8 care, especially offer- ing programmes of training and medical care on congenital heart disease (CHD). 9 Cooperation activity in training programmes promoted by IRCCS Policlinico San Donato and Bambini Cardiopatici nel Mondo Association In the early 1990s, a large number of NGOs, working on health sector, introduced a new way of helping developing countries to extend the healthcare facilities. The Associ- ation Bambini Cardiopatici nel Mondo, established in Milan on 1992 by Prof. Alessandro Frigiola and Prof. Silvia Cirri, implemented a humanitarian programme to meet the urgent need of congenital heart disease treatment mainly in Northern Africa, Middle East, Eastern Europe, and Latin America. 10 According to the WHO statistics (2008), there are about 1.5 million newborns per year affected by CHD and about 4 million children waiting for cardiac surgery interventions in developing countries. Fur- thermore, more than 220 000 babies die per year within 1 year of age. Table 1 summarizes the incidence and preva- lence rate of CHD among the most frequent cause of death (www.who.org/health-statitics). Indeed, cardiovas- cular diseases are the first cause of death worldwide al- though, in the last decade, medicine has obtained a large progress in this field. However, there is still an enormous gap between medical performance and healthcare services within developed vs. emerging countries. 11 According to a worldwide survey published in 1999, in Northern America, with regard to cardiac surgery at an international level, there is an unequal distribution and access to healthcare facilities, 12 as per the statistics each centre is able to provide medical care to about 120 000 people. In Australia and Europe, each centre can provide 1 000 000 people with cardiac surgery. In Asia, the number of people treated per centre increases up to 16 000 000, whereas in Africa the number of people who could benefit from centre facilities is nearly almost double than that in Asia, so the figure is 33 000 000 patients. 13 IRCCS Policlinico San Donato and Bambini Cardiopatici nel Mondo goals can be summarized into six points: 14 (i) offering scholarships for foreign doctors for training, professional development, and exchange of scientific and organizational protocols at the IRCCS Policlinico San Donato; (ii) training of medical and paramedical staff during the medical and surgical missions carried out ‘in situ’; (iii) building new paediatric cardiac surgery centres or units and providing hospitals with medical equipment; (iv) sponsorship and organization of medical and surgical missions abroad; and (v) treatment of patients affected by complex congenital heart disease to IRCCS San Donato Hospital within the agreement in force with several developing countries partners or with the help of humanitarian activities. Table
2 presents that, from 1992 to 2014, 302 doctors and nurses have received scholarships to study for a period of training (varying from 6 to 24 months) in the cardiovascular field focusing on paediatric cardiology and cardiac sur- gery. The main purpose of the educational programme for Table 1 WHO 2010 statistics—deaths selected by cause in WHO Cause of death Figures Ischemic heart disease 7 029 000 Rheumatic heart disease 345 000 Congenital heart abnormalities 223 600 Tuberculosis 1 196 000 Trachea, bronchus, lung cancers 1 527 000 Road traffic accidents 1 328 500 Oesophageal cancer 395 000 International cooperation in healthcare E73 medical and paramedical staff coming from different coun- tries is to provide them with the opportunity to acquire specialized knowledge and advanced practices in the field of CHD.
Results Cardiac Center Cameroon Since its inauguration held in November 2009, the St Eliza- beth Catholic Hospital—Cardiac Center Shisong—Kumbo, Cameroon (Figures 1 and 2 )—has become a reference cardiac surgery centre not only for the whole country, but also for Western Africa. The medical and paramedical ac- tivity is carried out by the local physicians, nurses, and technicians, who have been trained at the IRCCS Policlinico San Donato during the period of construction (http://www. bambinicardiopatici.it/progetto/camerun). Medical and surgical mission are scheduled regularly three times per year. Each mission involves the presence of a medical team made of 10/12 operators (physicians, nurses, and technicians) and has a typical duration of 8 days. During this period, about 200 children are examined and out of 25 children, about 20 undergo interventional cardiology or heart surgery proce- dures. To support and make the centre more autonomous, the educational programme to provide scholarships (in Italy or in Europe) for training periods. Thanks to this Center, thou- sands of patients have been given a chance of survival and have access to high-quality healthcare facilities as well as a permanent follow-up. From 2009 to 2015, 26 scholarships have been granted to the Cameroonian staff, 42 medical and surgical missions have been carried out, and 851 children have been treated. The activities are summarized in Table 3 . Cardiac Center Damascus, Syria The centre was inaugurated in July 2011 (Figures 3 and
4 ) since
then several physicians, nurses, and technicians have been trained in Milan during the building phase in order to prepare the local staff to run the paediatric surgical activity; 23 Syrian physicians, nurses, and technicians have been offered a scholarship (http://www.bambinicardiopatici.it/progetto/ siria). The surgical and medical activity is run by Prof. Tammam Youssef in collaboration with the Italian team. The realization of this project has definitely contributed to the im- provement of the cardiac surgery facilities in Syria. The new centre performs about 200 interventions per year and up-to-date 700 patients have been treated from 2011 to 2015. Romania Pediatric Cardiac Project In 2013, a medical programme for the paediatric cardiac surgery and cardiology was set up with the Romanian Table 2 International activity of IRCCS Policlinico San Donato and Bambini Cardiopatici nel Mondo 1992–2014 Country Scholarships Surgical missions Patients treated Cameroon 26 42 851 Romania
40 27 192 Egitto 66 53 386 Northern Iraq (Kurdistan) 10 13
Tunisia 59 48 283 Syria
23 21 74 Canary Islands (Spain) 17 69 333 China
28 4 16 Peru 8 29 427 Ethiopia
2 3 19 Other countries* 23 27 199 Total
302 336
2993 *http://www.bambinicardiopatici.it/progetti. Figure 1 First operation at the New Cardiac Center Saint Elizabeth Shisong Cameroon, 19 November 2009. Figure 2
Panoramic view of the New Cardiac Center Saint Elizabeth. A. Frigiola et al. E74
Ministry of Health, IRCCS Policlinico San Donato, and Bambini Cardiopatici nel Mondo. This project aims at supporting the improvement of the healthcare facilities and educational, training, and scientific programme of the local staff (http:// www.bambinicardiopatici.it/progetto/romania). Forty scho- larships have been granted to medical and paramedical per- sonnel of the Marie Curie Hospital in Bucharest, 13 surgical missions have been carried out, and more than 192 patients have been treated (Figures 5 and 6 ). Kurdistan (Northern Iraq) Project In 2007, the Kurdish national programme for the treatment of CHD was entrusted to the IRCCS Policlinico San Donato in Table 3 Results of St Elizabeth Catholic Hospital—Cardiac Center Shisong Cameroon St Elizabeth Catholic Hospital—Cardiac Centre Principal Results 2009–14 Activities 2009/2010 2011 2012
2013 2014
Progress since 2009 Consultation 5.956 5.420
5.268 5.246
5.976 27.866
Echo diagnosis 2.423
2.470 2.357
2.520 2.705
12.475 ECG diagnosis 2.464 2.263
2.132 2.307
2.476 11.642
Pacemaker implantation 4 17 17 27 22 87 Catherizations 58 61
55 57 309 Surgeries 104
103 87 101 60 455
Holter ECG 0 60 62 56 77 255 Mobile consultations 0 420
892 1.354
3.672 6.339
Figure 3 First operation at the New Cardiac Center in Damascus, Syria, on 24 July 2011. Figure 4
Panoramic view of the New Cardiac Center Damascus, Syria, opened on 24 July 2011. Figure 5 First operation at Marie Curie Hospital in Bucharest, September 2013. (Right) Prof. A. Frigiola and (left) Prof. T. Youssef. Figure 6
Marie Curie Hospital, Bucharest, Romania. International cooperation in healthcare E75
collaboration with Bambini Cariopatici nel Mondo Associ- ation. The project, undertaken in collaboration with the General Directorate of Health of Iraq Duhok (Northern Iraq) and Heevie Nazdar for Children Organization (Iraq), aims at creating a network of paediatric cardiology in major cities of Kurdistan (Kirkuk, Erbil, Sulaimania, Duhok) for the management of the new paediatric cardiac surgery centre, opened in 2012 and already operating at the Azadi Heart Center in Duhok (Figures 7 and 8 ), in a training pro- gramme lasting 5 years with a full team of cardiac surgery (surgeons, cardiologists, anaesthesiologists, intensivists, perfusionists, and nurses), as well as the organization of con- ferences and missions operating scientific update on site. Up-to-date 10 scholarships have been granted to Kurdish staff, 13 surgical missions have been successfully carried out, and 213 children have been saved. The congenital Cardiac Unit at the Azadi Heart Center is now run by Dr Halkawt A. Nuri, one of the trainees who was granted an 8-year scholarship. During this period, he has attended the Faculty of Medicine at the University of Milan, the School of Specialty on Cardiac Surgery (University of Milan), and the cardiac surgery department under the supervision of his mentor Prof. Alessandro Frigiola (http:// www.bambinicardiopatici.it/progetto/kurdistan). Present challenge Children’s Heart for Africa Project In sustainable perspective, Bambini Cardiopatici nel Mondo and IRCCS Policlinico San Donato are seeking to realize an ambitious project starting from the heart of Africa and are willing to introduce a new strategy of learning and know-how exchanges with African colleagues without trav- elling abroad. In this way, there will be a huge financial saving regarding the doctors’ expensive flights and accom- modation fees; furthermore, the local doctors will also skip the very long and complicated visa issuing processing for entering European Countries. The ‘Children’s Heart for Africa’ project was inspired by the need to offer the possibility to develop a paediatric cardiology and cardiac surgery programme in Africa. The continent of Africa has a population greater than 1 billion, 100 million inhabitants and has a significant insufficient number of cardiovascular and cardiothoracic centres dedi- cated to CHD. Hence, there two main necessities: (i) building centres dedicated to the treatment of patients with congenital heart diseases and (ii) establishing a training programme for doctors, nurses, and technicians. Since Europe is facing an increasing difficulty in training non-EU doctors, it is essential to focus on an ‘African solu- tion’ which would allow African centres to become referral training and research centres. To achieve this goal, it is necessary to provide the existing centres with dedicated training and research facilities, which should remain within the same premises (therefore adjacent to the clinical areas). This project is based on six main principles: (i) Identification of the referral centres; (ii) Completion of the building works in the identified centres;
(iii) Trainees selection; (iv) Revision and tutoring of the training programme by designated centres regularly accredited to keep learning standards at good levels; (v) Building satellite video conferencing facilities at the selected training centres to ease learning and infor- mation exchange platform between the European Society of Cardiology associated centres and the train- ing centres; and (vi) Building and strengthening research and teaching facilities at the selected centres. Identification of the referral centres The identified centres will have to fulfil fundamental requirements, which include the followings: (i) the adequate number of medical staff able to lead the clinical work but also the training programme and (ii) a minimum number of surgical (100–150 cases per year) and interventional cardiology procedures (50– 100 procedures per year). Figure 7
Azadi Heart Center Duhok (Iraq). Figure 8
Italian Team during a surgical mission in Duhok (Iraq). A. Frigiola et al. E76
Completion of the building works of the identified centres
The selected cardiovascular centres will have specific areas dedicated to teaching, research, and residency near the clinical area. The centres will also need to be pro- vided with a conference centre of at least 100 seats, a library and accommodation for the trainees (Figure 9 ). Trainees selection The project’s headquarter, Milano, will shortlist the candi- dates accordingly to criteria established by the organizing committee. The candidates will then be notified to the sci- entific committees of the participant countries. Six to eight candidates will be assigned to each centre and will be divided accordingly to the different specialties. Preparation of the training programme The organizing committee will establish a specific training programme for the different specialties, which will be adopted by all participant centres, but will also be modified accordingly to the duration of the training. From a practical point of view, there are aspects that need to be dealt with simultaneously. Preparation of the architectural design The architectural design should be the same for all partici- pant centres. We estimate a total cost of ca. 700 000 Euros for one academic or research and educational centre, which will include a conference room, two seminar rooms, a room dedicated to telemedicine, a library, and a maxi- mum of 10 rooms used as doctors’ accommodation. Definition of candidates’ selection criteria This is a difficult task since the potential candidates for car- diology and cardiac surgery of the participating countries are not subscribed with a professional body. In other words, a list of professionals does not exist. We consider it appropriate to have a direct link with the Pan African Society of Cardiology and contacting the Scientific Soci- eties of the Countries involved in the programme. In this way, there will be a reference institution able to help in selecting the adequate candidates. The Ministry of Health or the medical schools also can be potential further refer- ence points for the candidate selection. The number of doctors that can be trained ranges between 6 and 8. Training programme The organizing committee should already be working on a training programme for the various specialties that will be applied to all participating centres. Estimated costs of the project Academic or research and education- al centre 700 000 Euros Scholarship (inclusive of board and room)
10 000 Euros each/ year
Management costs 150 000 Euros/year Cooperation Children’s Heart for Africa is an initiative proposed and promoted by Prof. Alessandro Frigiola, President of Bambini Cardiopatici nel Mondo in collaboration with IRCCS Policlinico San Donato as to widen their training programme to as much as possible in African Countries aiming at the improvement of the local medical and para- medical staff practice in paediatric cardiology, cardiac surgery, and postoperative intensive care management. As regarding the first step of the project implementation, we are working to set up partnerships with the Pan African Society of Pediatric Cardiology (Chairman Prof. Samuel I. Omokhodion), European Heart for Children—Global Forum (President Prof. Roberto Ferrari), Chaine de l’Espoir France (President Dr Eric Cheysson), RobinAid (President Dr Matthias Angre ´s), and Bambini Cardiopatici nel Mondo Foundation Switzerland (President Dr Max Spiess). In 2011, Bambini Cardiopatici nel Mondo joined European Heart for Children (EHC) Global Forum, another humanitar- ian foundation established by Claudia Florio and Roberto Ferrari, when he was a President of the European Society of Cardiology. EHC shares forces to conduct missions, proper training, and build medical units for the treatment of congenital heart disease in developing countries that have a very high incidence and prevalence of serious cardiac diseases that can be treated. 15 The forum operates with rigorous, transparent, solid, and impartial principles. Once an area or a country in need has been identified, we try to establish contacts with the local institutions (public hospitals, national cardiac societies, politicians, etc.) and professionals with the aim to start medical missions (to prove that ‘it can be done’) and to facilitate a training programme for doctors, nurses, technicians, etc. Thereafter, we explore the possi- bility of developing an ultimate sustainable centre. The Figure 9 Rendering residence for the trainees. International cooperation in healthcare E77
infrastructure required often includes buildings, equip- ment, and human resources. The latter is probably the most lengthy and difficult process that requires a coordi- nated
effort. Continuous educational programmes (through missions and scholarships) are an integral part of the Global Forum programme. Once all of this has been achieved, sustainability becomes of utmost importance as does staff retention. Sustainability requires sufficient funds from the local government, insur- ance companies, members of the community, and of course generous benefactors, regardless of how small these contri- butions might be. Acknowledgements All the international activity here described is continuously carried out by the collaborators of the International Cooperation Office of IRCCS Policlinico San Donato and Bambini Cardiopatici nel Mondo association, thanks to: Dr Nadia Moussaidi, Mrs Elena Romero, Mrs Saida Sassi, Mrs Brigida Sorrentino, Mrs Yulia Sukhneva, Mrs Gina Nabil, Dr Sara Biffi, Dr Silvia Castoldi, Dr Riccardo Giani, and Mrs Elisabetta Vanzaghi. Conflict of interest: none declared. References 1. Rizzi F. Educazione e cooperazione internazionale. Brescia: La Scuola; 2007. p. 9–12. 2. Bonaglia F, de Luca V. La cooperazione internazionale allo sviluppo. Bologna: Il Mulino; 2006. p. 36–37. 3. CeSPI (Centro Studi di Politica Internazionale). Osservatorio Interna- zionale Cooperazione e Sviluppo. p. 7. 4. UN General Assembly 1948 Declaration of Universal Human Rights. http://www.un.org/en/documents/udhr/. 5. Italian Constitution, Article nr 32. 6. Forum Solint Solidarieta ` e cooperazione internazionale. The challenge of the complex crises in the International cooperation: the role of the NGOs and the partnership between institutions and civil society [La sfida delle crisi complesse nella cooperazione internazionale: il ruolo delle ONG e la partnership tra istituzioni e societa ` civile]. Roma: 2000. p. 189–201. 7. Rosen G. A History of Public Health. Baltimore and London: The John Hopkins University Press; 1993. p 80–85. 8. Charter of Fundamental Rights of the European Union, 2010/C 83/02 Title I, art. 3. 9. Law nr 49 of February 1987, New politics on the Italian Cooperation with Developing Countries. 10. Giamberti A, Mele M, Di Terlizzi M, Abella R, Carminati M, Cirri S, Frigiola A. Association of Children with Heart Disease in the World: 10-year experience. Pediatr Cardiol 2004;25:492–494. 11. Pezzella AT. Global expansion of cardiac surgery in the New Millennium. Asian Cardiovasc Thorac Ann 2001;9:253–256.. 12. Neirotti RA. Access to Cardiac Surgery in the Developing World: Social, Political and Economic Considerations. http://www.fac.org.ar/qcvc/ llave/c010i/neirotti.php (September 2007). 13. Pezzella AT. Global aspects of cardiothoracic surgery with focus on developing countries. Asian Cardiovasc Thorac Ann 2010;18:299–310.. 14. Butera G, Abella R. Associazione Bambini Cardiopatici nel Mondo. Cir- culation 2007;115:f29–f30. 15. Ferrari R. European Heart for Children: a story of humanity and success. Eur Heart J 2015;36:1789–1790. A. Frigiola et al. E78 Download 104.83 Kb. Do'stlaringiz bilan baham: 
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