A stepwise model for delivering medical humanitarian aid requiring complex interventions J. Nilas Young, MD, Josie Everett, BA, Janet M. Simsic, MD,

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Presentation transcript:

A stepwise model for delivering medical humanitarian aid requiring complex interventions J. Nilas Young, MD, Josie Everett, BA, Janet M. Simsic, MD, Nathaniel W. Taggart, MD, Sonny Bert Litwin, MD, Natalia Lusin, PhD, Lizbeth Hasse, Esq, JD, Evgeny V. Krivoshchekov, MD, James P. Marcin, MD, MPH, Gary W. Raff, MD, Frank Cetta, MD The Journal of Thoracic and Cardiovascular Surgery Volume 148, Issue 6, Pages 2480-2489.e1 (December 2014) DOI: 10.1016/j.jtcvs.2014.07.067 Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Heart to Heart self-sustaining and developing sites. The Russian Federation is made up of 8 geopolitical districts. Note: Heart to Heart's work does not extend to the Central District (home to Moscow and advanced cardiac programs) or the North Caucasian District (politically unstable). The Journal of Thoracic and Cardiovascular Surgery 2014 148, 2480-2489.e1DOI: (10.1016/j.jtcvs.2014.07.067) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Pediatric cardiac case volumes at all of Heart to Heart's collaborative sites in Russia. Figure indicates projected volumes to 2019. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 2480-2489.e1DOI: (10.1016/j.jtcvs.2014.07.067) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Coordinated travel routes of Heart to Heart specialists for missions to Tomsk, Siberia, 2006-2012. Medical volunteers represent the following institutions: Berlin Heart Inc, Spring Tex; Children's Healthcare of Atlanta/Emory University Hospital, Atlanta, Ga; Children's Hospital of Philadelphia, Philadelphia, Pa; Children's Hospital of Wisconsin, Milwaukee, Wis; Children's Medical Center of Dallas, Dallas, Tex; The Hospital for Sick Children, London, UK; Loyola University Medical Center, Maywood, Ill; Mayo Clinic, Rochester, Minn; Nationwide Children's Hospital, Columbus, Ohio; UC Davis Medical Center, Sacramento, Calif; UC San Francisco Children's Hospital, San Francisco, Calif. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 2480-2489.e1DOI: (10.1016/j.jtcvs.2014.07.067) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Pediatric cardiac surgical case volumes by year and age group at Heart to Heart's Tomsk site 2006-2012. Note progressive increase in younger patients, including newborns. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 2480-2489.e1DOI: (10.1016/j.jtcvs.2014.07.067) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Pediatric cardiac cases (classifiable by Risk Adjustment for Congenital Heart Surgery 1 scores) by year and procedure complexity at Heart to Heart's Tomsk site 2006-2012. Note volume increase in procedures performed at every level of complexity. RACHS, Risk Adjustment for Congenital Heart Surgery. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 2480-2489.e1DOI: (10.1016/j.jtcvs.2014.07.067) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 6 Mortality for pediatric cardiac surgical procedures: Tomsk, 2006-2012. Note marked decrease in operative mortality over time in conjunction with a progressively higher level of case complexity (Figure 5). The Journal of Thoracic and Cardiovascular Surgery 2014 148, 2480-2489.e1DOI: (10.1016/j.jtcvs.2014.07.067) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 7 Russian medical colleagues from various cities observed Heart to Heart's surgical-educational mission in Tomsk, Siberia, 2011. Arrows depict travel routes from cardiac programs throughout Russia sending medical personnel. In this instance, a total of 35 specialists traveled to Tomsk, Siberia, to observe our educational collaboration. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 2480-2489.e1DOI: (10.1016/j.jtcvs.2014.07.067) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 8 Heart to Heart's program value. The chart shows the actual total expenses needed to implement Heart to Heart's program model in Tomsk, Siberia, 2006-2012. Total program value is the sum of nonmedical in-kind donations, in-kind medical services (pro bono work of medical volunteers), and actual expenses (travel, lodging, visas, and amortized Heart to Heart staff time and services) in US dollars. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 2480-2489.e1DOI: (10.1016/j.jtcvs.2014.07.067) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 9 Heart to Heart site development algorithm. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 2480-2489.e1DOI: (10.1016/j.jtcvs.2014.07.067) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions