Uganda

Our Hearts Are In El Salvador:Conference, October 22nd to the 24th in San Salvador, El Salvador

Gift of Life International hosted an International Conference in El Salvador from October 22nd to the 24th. Here are the findings of that conference and the strategic plan that has been developed in order to create a sustainable pediatric cardiac surgery program in El Salvador.

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Conference Overview

Gift of Life International (GOLI) convened an international conference with the intent of developing a strategic plan which would lay the framework for the ultimate creation of a sustainable National Pediatric Cardiac Surgery Center in El Salvador. During the 3‐day conference, more than 100 attendees participated in discussions centered upon the current state of pediatric cardiology in El Salvador and the possibilities that present themselves for the development of a sustainable program. Amongst the participants at this conference were: Ambassadors from 5 countries (The United States, Peru, Colombia, The Dominican Republic and Israel), representatives from many sectors of the Salvadoran Government (the Ministry of Health, Ministry of Foreign Affairs, Inclusione Sociale), the administrator of Benjamin Bloom Hospital (the only children's hospital in El Salvador), surgeons from El Salvador and abroad, nurses from El Salvador and abroad, Rotarians from 10 Gift of Life (GOL) programs around the world, Rotarians from El Salvador and abroad, the Board of Directors of GOLI, representatives of prospective medical training mission teams, representatives from GOL El Salvador, numerous interested parties from the public and private sectors, and, notably, the Pioneer of Pediatric Cardiac surgery, Dr. Aldo Castaneda.

Conference Findings

The following salient and important issues need to be addressed.

  1. Development of a culture of pediatric cardiac care in El Salvador
  2. Address the salaries and compensation of health care professionals
  3. Develop an International network of healthcare professionals and NGOs to assist in addressing the issues
  4. Past missions to Bloom Hospital were clinically orientated and succeeded in helping many children, but their size, scope and focus did not foster an environment for training and continued education and thus did not advance the local program
  5. The lack of Government support in the past is a significant reason for the lack of progress
  6. Space is a major obstacle at Bloom Hospital
  7. There has been a lack of coordination between past mission teams
  8. There is a need to coordinate the efforts of multiple individuals and groups involved in the development of a program at Bloom Hospital
  9. Interest must be developed within the health care community of El Salvador as it relates to future employment in the field of pediatric cardiac care
  10. Create a focus for research and academics at Bloom Hospital
  11. A transition must take place from the employment of part‐time surgeons to full‐time surgeons
  12. The cost per surgery needs be determined by hospital administration
  13. Dedicated ICU beds are needed if this program is to be a success. A minimum of two ICU beds now and more with the growth of the program and during educational missions
  14. Training and education of a group of ICU nurses in post op cardiac care is essential, along with subsequent maintenance of their skills
  15. Introduction and implementation of a comprehensive pediatric cardiac nursing curriculum and program at Bloom Hospital
  16. Adequate and dedicated OR time in an appropriately equipped operating theatre
  17. Government funds alone are not enough and must be subsidized by private sources (Corporations/Foundations/Charities)
  18. Commitments must be made by the Government, Hospital Administration and Non‐Governmental Organizations. Such commitments will be embodied in a Memorandum of Understanding
  19. Salvadorans must drive this process
  20. The focus of visiting medical missions will be primarily training and education.
  21. A Quality Assessment program is imperative for the success of this program and to help guide its evolution
  22. Develop family support programs focused on preparation for surgery and aftercare considerations for families
  23. A Medical Advisory Board will be established to set protocols and provide guidance for incoming missions. Protocols and program will evolve with time and experience
  24. Complete assessment needs to be made of current equipment and supplies (inventory must be taken)
  25. A Salvadoran Doctor will lead this effort full‐time
  26. Honest appraisals of all challenges must be paramount during discussions
  27. A team approach is necessary at all levels. (Training/Planning/Negotiation)
  28. Assess the possibility of a joint pediatric/adult Center with potential sharing of equipment
  29. Need a line item in National Budget for the Pediatric Cardiac Surgery Program
  30. A new generation of young, well trained cardiologists, pediatric cardiac surgeons, and other healthcare professionals will have to be identified and given the opportunity to lead this effort into the future.
  31. THE ULTIMATE GOAL IS A SINGLE, FULLY‐FUNCTIONAL NATIONAL PEDIATRIC CARDIAC SURGERY CENTER

Moving Forward

The conference attendees agreed to focus on a strategy which calls for a short-term approach to the development of a single National Pediatric Cardiac Surgery Center. This strategy is based upon the following agreements:

I. FUNDING, STAFFING AND INFRASTRUCTURE

  1. A leadership team will be formed that represents the current Salvadoran pediatric cardiac health care community. This team will be made up of the following members:
    • Dr. Mauricio Velado, Pediatric Cardiologist, Bloom Hospital
    • Dr. Francisco Gamero, Pediatric Surgeon, Bloom Hospital
    • Digna Emerita Hernandez de Rosas, Head of Nursing, Bloom Hospital
  2. Dr. Julio Robles will represent the Minister of Health in the development of this short‐term approach
  3. Dr. Alvaro Hugo Salgado will represent Bloom Hospital in this short‐term approach
  4. Important issues and goals for discussion:
    • Medical Supplies: Current status and future needs
    • Surgeon hours: part‐time vs. full‐time surgeons
    • ICU Space: need for dedicated beds
    • Dedicated nurses
    • Two dedicated perfusionists
    • Two dedicated anesthesiologists
    • Dedicated operating room
    • Equipment: current status and future needs
  5. A scoping meeting will be held at the offices of the Minister of Health on November 17, 2010. The above representatives will be present along with the Minister of Health and the Executive Directors of Gift of Life International and Gift of Life International – El Salvador
  6. All parties acknowledge the urgency at hand given that pediatric cardiac surgeries are currently being postponed at Bloom Hospital on a regular basis
  7. THE ULTIMATE OUTCOME OF THESE MEETINGS WILL BE THE SIGNING OF A MEMORANDUM OF UNDERSTANDING BY THE SALVADORANGOVERNMENT, BLOOM HOSPITAL ADMINISTRATION AND GIFT OF LIFE INTERNATIONAL BY DECEMBER 31, 2010

II. TRAINING/EDUCATION

  1. A Medical Advisory Board will be formed. The Co‐Chairs of this Board will be Dr. Joseph Gaffney and Dr. Mauricio Velado. Membersof this board will be identified by Drs. Velado and Gaffney. The criteria for selection will be based upon the candidate's ability to represent a specific discipline (for example, Nursing, social work, surgery, cardiology). Both Salvadorans and non‐Salvadorans will be enlisted for membership on this Board. The goal of this Board will be to form the medical decision‐making body of our training program. This Board will approve all incoming missions and develop a protocol which will be followed by the visiting teams.

    2. The following areas will be addressed in this protocol:

    • Ensure training is the priority of each mission
    • Coordinate the training programs employed by all visiting teams
    • Implement Nurse Training Program
    • Establish guidelines for the size and make‐up of visiting teams
    • Determine the length of missions and number of patients operated on during each mission
    • Establish plan for types of surgeries and caths to be performed on missions. This will be an evolving process, coordinated with the training, education and progression of the program; to start with simpler surgical cases with advancement to more complicated patients as the program improves
    • Cath cases may be determined by available devices, visiting expertise, and local clinical and educational needs
    • Salvadoran team to choose patients for intervention with guidance and advice from visiting teams
    • Ongoing, remote advice and consultation will be available to Salvadoran team from contributing medical teams via phone and the internet
    • Salvadoran surgeons to be scrubbed and primarily involved and responsible for all surgical patients with guidance and assistance from visiting surgical team
    • Develop a Salvadoran way of treating children with Congenital Heart Defects
    • Prioritize the training of the post‐op team with regard to family support and medical care issues
    • As program evolves, begin to focus specific missions on specific pathologies, to be determined by local team in consultation with visiting missions along with educational and training needs of the program
    • Focus all efforts on team approaches
    • Ensure that all cases are jointly reviewed by the local team and visiting team prior to all surgeries
    • Establish guidelines for supplies provided by incoming teams and those provided by local team

Conference Conclusions

After three days of discussions, the conference attendees concluded the following:

  1. A National Pediatric Cardiac Surgery Center can be a reality in El Salvador. There is a need for both a short and long term approach and plan with the current emphasis on the short term
  2. Cooperation between the Salvadoran Government, the Administration of Hospital Bloom and the Non‐Governmental Organizations isparamount
  3. A Memorandum of Understanding between the aforementioned three entities needs to be agreed upon by the end of 2010
  4. Training missions of the future will follow a specific protocol to be developed by the Medical Advisory Board
  5. Redirect the primary focus of future missions toward training and education. This will of necessity require smaller visiting teams working closely with the Salvadoran team
  6. The Team Approach must be followed in all aspects of this program, including planning, training and negotiation of the Memorandum of Understanding
  7. THERE NEEDS TO BE AN URGENCY TO OUR EFFORTS BECAUSE SURGERIES FOR CHILDREN ARE POSTPONED ON A REGULAR BASIS AT BLOOM HOSPITAL

Click here to view Conference Photos