At Boston Children’s Hospital, we believe that all children deserve the same opportunity to live a healthy life, no matter where they are born. Boston Children’s Global Health Program helps solve pediatric global health care challenges by transferring our expertise through long-term partnerships with scalable impact.
Here are just a few examples of the ongoing work our cardiac clinicians are involved in to care for children around the world.
IQIC: Training clinicians to provide quality care
The IQIC works with low- and middle-income countries to create a culture of safety and quality for care of congenital heart disease to reduce mortality and major complications for these conditions.
The program got its start in 2007, when Kathy Jenkins, MD, MPH, was invited to a meeting of the Global Forum for Humanitarian Medicine in Cardiology and Cardiac Surgery. Jenkins had developed one of the top risk adjustment models, risk adjustment for congenital heart surgery (RACHS), and was asked to give a talk about how to measure outcomes.
At the meeting, Jenkins discovered a common theme: there was no data to work from. “At the time, I was working on multi-center databases and had started to run quality and safety programs for the hospital, so I knew it was possible to collect data,” she says.
Over the next year, Jenkins worked with some of the top non-governmental organizations (NGOs) from the forum to put together a steering committee and start a database that would work in low-resource settings. Five pilot sites were chosen and a database was created.
This year, the group has enrolled 64 sites from 25 different countries, including its new foray into Africa, with three sites enrolled there. There are now more than 81,000 surgical cases entered into the database. To date, about 50 clinicians from Boston Children’s have given their time to the program.
The group collaborates with sites through monthly webinars that may be watched live or downloaded later, as well as through learning sessions that bring all the teams together. A core team from Boston Children’s and Children’s Heart Link, a partnering NGO, also travel to each of the sites once a year to audit data.
“At each site visit, we audit a 10 percent sample of the most important variables, and any group that passes the audit gets put into the aggregate database,” says Jenkins.
The data shows that the program is meeting its goals. Since IQIC’s inception, the risk-adjusted mortality for enrolled sites has improved, as have infection rates.
“It’s not a perfect comparison because centers have joined along the way, but we published a study in Pediatrics based only the sites that have been involved since the beginning that showed the same trend,” says Jenkins.
Hearts and Minds of Ghana: Bringing cardiac care to children in need
This past October marked Hearts and Minds of Ghana’s tenth trip to the Komfo Ankoye Teaching Hospital (KATH) at the University of Ghana Kumasi. The mission project is the vision of Francis Fynn-Thompson, MD, a Boston Children’s surgeon who originally hails from Ghana. The goal is to help fill the region’s much-needed void in pediatric cardiac care.
“We serve a very large catchment area of at least 5 to 10 million people,” says Michael Goldsmith, MD, a senior fellow in cardiovascular critical care who joined the team for the first time in 2017.
Within a few hours of their arrival, the team sets up a cardiac operating room complete with a cardiopulmonary bypass machine, a four-bed cardiac intensive care unit with two ventilators and bedside monitoring, and a four- to eight-bed step-down unit, as well as a complete pharmacy.
During their most recent trip, the team evaluated more than 100 children and performed 17 surgeries on 16 children, all over the course of 10 days.
Nurses lead by example in Ghana
This past April, as part of the Hearts and Minds of Ghana program, nurses and clinicians from Boston Children’s traveled to Kumasi to lead the second Boston Children’s Hospital & Komfo Anokye Teaching Hospital Collaborative Symposium.
Led by Beverly Small, RN, CCRN, the team covered a wide range of topics in Cardiovascular Critical Care Nursing and Oncology Nursing over the course of the two-day conference.
“My dream was to have 30 people attend,” says Small. “Within an hour of the conference’s start, we had 144 KATH clinicians show up, ready to participate.” Small and her team immediately jumped to action to accommodate the larger group, renting more chairs, ordering more food for lunch and moving breakout sessions to other rooms as needed.
Specific sessions included ventilation using bubble CPAP, ICU pharmacology, intubation and a technique for communicating effectively with doctors, called SBAR (Situation, Background, Assessment, Recommendation). In addition, Karen Horn, RN, BSN, CCRN, and her team of three managed to certify 89 clinicians in CPR over just two days. Meanwhile, the oncology team offered eight training modules, with two additional modules available on OPENPediatrics.
“Our respiratory therapist, Duncan Geddes, taught them bubble CPAP two years ago, and now they’ve opened a new mother/baby unit and eight of their sickest kids were on it,” says Small. “They also taught us how they have modified his technique to better fit their needs.”