RAMA Mission to Kemerovo, New Project Developments
Yakov Elgudin, MD, PhD, FACS
Past President of RAMA
RAMA missions are a part of the ongoing RAMA Siberian Heart Project that began in 2007 and organized in close collaboration with the International Children’s Heart Foundation. The first of two pediatric cardiac missions to Kemerovo took place on April 16th through 30th of this year. The second took place on June 17th through 26th. This mission has been very productive and successful. It further improved skills of the local team of pediatric cardiologists and cardiac surgeons and expanded the expertise of other team members taking care of children with congenital heart disease. The 3rd RAMA-ICHF pediatric cardiac surgery this year mission to Kemerovo took place in September of 2011.
Over the last four years, both, pediatric and adult components of the RAMA’s Siberian Heart Project have been occurring simultaneously at every mission we undertake. Given the great difficulty in having simultaneous highly intensive operating schedules on both children and adults during such missions, this year we decided to separate them and dedicated one week in June to performing only new, advanced, and complex surgeries on adult patients in the Kemerovo Center of Cardiology and Cardiac Surgery. During this mission we had a number of meetings and conversations with hospital administrators and physicians interested in opening and developing similar RAMA projects in their hospitals/regions.
Meetings and new developments.
1. On June 18th, immediately after my arrival in Moscow, I met with a group of doctors and businessmen from Yaroslavl (a regional center about 4 hours north of Moscow): Anna Bogacheva, MD - a Chief Pediatric Cardiologist of Yaroslavl Region - and her colleagues who are interested in starting a congenital heart surgery program in Yaroslavl similar to the one RAMA-ICHF has run in Kemerovo since 2007. During our two-hour meeting, we discussed many issues and questions concerning this project. We formulated a plan for the immediate future, particularly to have one of the doctors, and possibly one of the hospital administrators from Yaroslavl, go to Kemerovo in September during our next mission to meet with the group. We will use this to see how the mission’s work is arranged, how patients are treated etc. Meanwhile, further important steps in Yaroslavl will have to be made in order to create a coherent plan and identify a specific group of individuals, and a specific hospital that would serve as a clinical base for the mission.
2. On June 19th I spoke to Prof. Alexey Maschan – Deputy Director of the Republican Center of Hematology, Oncology, and Immunology in Moscow, Russia. This center is working in close alliance with Chulpan Chamatova’s fund, providing financial support for the most critical and urgent needs of the center in pediatric hematology and oncology. During an hour-long conversation we discussed several topics that were of particular interest to him and his institution. First, professor Maschan expressed great interest in cooperating with RAMA in nursing education and training for the new hospital that will start accepting patients in October of 2011. Some potential ways for RAMA to help them with nursing education and training will include sending nursing educators to Moscow for periods of 2-3 weeks at a time on a continuous basis. Such educators will provide didactics as well as bedside training and supervision for nurses at the ICU, training on chemotherapy and bone marrow transplant units, guidance on general medical procedures, and so forth. There is a nursing school on the clinical base of the hospital that can help formalize such nursing education project.
Another topic of great interest for professor Maschan and his center: pediatric hematological and oncological surgery, and, in particular, neurosurgery. There is a serious potential for cooperation with RAMA in this field as well.
In summary, these two main programs of RAMA cooperation with the Moscow Center of Hematology, Oncology, and Immunology are now under development.
3. In Leninsk-Kuznetzky – a town of about 250,000 people located about 90 miles south of Kemerovo - there is a large multispecialty hospital mainly built and designed to provide care for coalminers and industrial workers with work-related traumas and injuries. Over the years, this institution has become a premier regional tertiary care center for trauma, orthopedics, and neurological surgery as well as critical care and other related specialties such as general surgery and ob-gyn. Director of this Center – Professor Vagram Agadganyan invited me to visit the center on June 25th. Professor Agadganyan and his colleagues gave me a tour of the hospital after which we discussed ways of RAMA cooperation with their institution. Out of many potential areas of interest, the trauma/orthopedics and neurosurgery were chosen as pilot specialties for a new RAMA project. Currently, we are communicating with the Leninsk-Kuznetzky’s hospital, working on the mission specifics and developing a plan.
Siberian Heart Project clinical work
During the week of June 20, we performed six operations in the Kemerovo Center of Cardiology and Cardiac Surgery. Two of them were performed for the first time in the Russian Federation. These cases introduced coronary bypass grafting performed through a small skin incision on the left side of the chest. This operative approach dramatically improves the rehabilitative potential for patients and shortens their recovery time. We were able to perform such operations in part because of excellent support provided by Medtronic, Inc. and Medtronic Foundation. Medtronic manufactures specific equipment and supplies that made this surgical procedure possible. In an outstanding supporting effort by Medtronic, the company representatives delivered several critical disposable and reusable supplies to Kemerovo in addition to those we brought with us from the US. As a result of such support we were able to successfully perform two of these minimally invasive coronary bypass surgeries during our mission and had local surgeons learn the technique of the procedure. All patients did well and are either discharged or finishing their recovery at the hospital. Over the course of our mission we also saw and consulted 14 patients with complex heart disease for which the diagnostic and treatment plans were established. There were three meetings with the hospital administration related to our further research cooperation with Kemerovo Center of Cardiology and Cardiac Surgery as well as the potential for Siberian doctors coming to the US for observership training programs.
In summary, the June’s 2011 RAMA Mission to Kemerovo was a rather intense and productive experience from clinical and developmental points of view. In fact, in one of our conversations Professor Leonid Barbarash – the head of the Kemerovo Center - said that this was extremely important and in many ways a “breakthrough” mission that opened up several new areas of cardiac surgery for development at the Kemerovo Center. Professor Barbarash who had also conceived of and supported RAMA Siberian Pediatric Heart Project, emphasized that the result of our mission ultimately yielded success and advancement of the pediatric and congenital heart surgery program at his institution, and that it exceeded his most optimistic expectations. We appreciate such recognition and will continue to expand our mission and do the best we can to help patients in different parts of the world.