CardioStart Volunteers Teach Advanced Cardiac Surgery & Critical Care

Twelve patients were recipients of cardiac surgery and 27 patients received pacemaker implementation. This accomplishment and collaborative effort included a mini-symposium, and is on record as by far the largest free implant gift provided to patients in one sitting throughout Vietnam.

“These Vietnamese surgeons are already very skilled, doing the simpler procedures and managing them well,” said Janine Henson, Mission Director, and Vice-President of CardioStart. “They asked us to assist in their progression by providing mentoring and teaching new skills to advance their ability to manage more complex cases.” CardioStart’s anaesthesia and perfusion specialist observed, guided and suggested options to maintain a safe transition throughout the case and into the intensive care unit.
Education in Basic Life Support and Advanced Cardiac Life Support were also provided to all staff including physicians. Code Blue demonstration and return demonstrations were completed.

Peripheral Clinic and compassionate Outreach programs conducted several projects in a tight schedule through the two weeks (see under Outreach activity below.)

CardioStart team members embarked on its third mission to Vietnam and the first to a new province in the southwest, the central hospital of Rach Gia in the Kien Giang province, a border province with Cambodia. The population of 1.7 million people, whose main occupations are agriculture, fishing and commerce, exist in great poverty. Kien Giang Hospital has about 1,500 inpatients and over 2,000 outpatients per day. The hospital itself is 10 years old although parts of the building reflect the previous French occupation. There staff of 1780, including 300 Doctors, care for patients in 42 departments. Within the last two years, Cho Ray Hospital in Saigon has adopted this hospital and set the beginnings of an adult and paediatric cardiac surgical program. The heart program has grown since its inception to the current phase-3 in which surgeons are doing simple cases independently. The local surgeon asked CardioStart to assist in this progression, providing mentoring and teaching new skills to advance their ability to manage more complex cases.

CARDIAC SURGERY DATABASE

Throughout the two-week mission, patients were interviewed for data collection using the CardioStart database form. This will be the third time Vietnamese children and adults are being tracked as part of the ongoing international follow-up analysis being conducted by CardioStart. The form is a composite which includes all the elements of the STS adult and congenital forms, and also specific examination of developmental, neuro-cognitive and economic issues needing evaluation on patients living under severely deprived or remote/rural conditions.

EDUCATIONAL DEVELOPMENT

Educational materials, protocols, specialized equipment and guidelines were provided in each related subspecialty in addition to the formal lectures. Education in Basic Life Support and Advanced Cardiac Life Support were provided to all staff including physicians. Code Blue demonstration and return demonstrations completed. Translators were key to all projects prior to and during the mission.

Learning tools, including a library of educational CD’s translated into Vietnamese was donated for ongoing education development. Future recommendations in each department were provided after careful analysis of their local systems and processes. Bedside teaching was the core of preparing the local team for more complicated patients in the future. Gold standard practices were encouraged for best outcomes.

PACEMAKER SYMPOSIUM

Vietnamese cardiologists from nine provinces South Vietnam attended a two-day symposium featuring diagnosis of potential patients (ECG abnormalities), insertion, Pacemaker systems, care of the patient and follow-up. Education was presented by CardioStart specialists and representatives from Zoll, Medtronic, St. Jude, Biotronik and Boston Scientific.

ADULT AND PEDIATRIC HEART SURGERY PROGRAM:

CardioStart brought three surgeons, specializing in adult and paediatric heart surgery, including adult acquired rheumatic conditions, and congenital heart disease repairs. The surgeons worked as mentors through the two weeks, guiding the local team in perfecting their techniques and incorporating safety initiatives to prepare for more complex cases in the future. Anaesthesia and perfusion specialist observed, guided and suggested options to maintain a safe transition throughout the case and into the intensive care unit. All cases were successful and rewarding experiences for the collaborating services.

CardioStart cardiologists screened patients for the current surgical procedures and future needs. A few cases were found to be too complex for the current local program and were referred to Saigon Cho Ray Hospital.

The intensive care unit received a new V-Scan bedside ultrasound device and expert advice and training by a CardioStart Intensivist. Daily bedside teaching was done by expert CardioStart critical care nurses and physicians with a tremendously positive response by the local professionals. Vital medications, including milrinone, not yet easily available, were provided with training.

OUTREACH PROGRAM

The first project involved a government facility which had a clinic, elder care facility and orphanage. CardioStart located and funded a play yard/swing set for the children to provide physical development and entertainment. Hopscotch and other games were painted on the foundation for aesthetics and play. The clinic was equipped with medications and over-the-counter medical supplies. A CardioStart family nurse practitioner did wellness visits and screenings. The clinical team received education in Basic Life Support and the correct management of choking. Large physical therapy balls were donated and instruction in their use provided. The many cerebral palsy affected children were immensely helped by the attention they received and squealed with delight on getting an opportunity to play with the Outreach team. Music therapy was provided by Kin Vu, a Doctoral candidate from the University of Minnesota who, as an infant, was saved by “Operation Babylift” in the 1970’s. He came to reconnect with his heritage and give back to those who saved his life many years ago.

The second outreach location was the Catalyst non-profit foundation from Minneapolis MN. Its mission is to improve the lives of at-risk populations in Viet Nam through child trafficking prevention and community capacity building. The International Labor Organization estimates that over 1.3 million persons have been trafficked into forced labor in Asia, representing over 55% of the worlds trafficking industry. For many years, Viet Nam has been identified as a “source country” for child trafficking. To combat this, Catalyst provides housing, education, vocational training and medical care for adults and children who had been subsisting in a garbage dump. Our team assisted the campus with a new thatch roof over a play area, electrical and plumbing repairs. CardioStart clinical teams did health screenings of adults and children, identifying needs which were referred to available service agencies. Medications, medical equipment and supplies were donated to the facility to care for the many recipients who are treated on a daily basis by a physician’s assistant.