Andersons pediatric cardiology 2265
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TheIQICforCongenitalHeartSurgeryinDevelopingWorldCountrieswas
launchedin2008byBostonChildren'sHospitalrepresentatives,Children's
HeartLink,andotherNGOs,includingHumanitarianAssociationCoeurspour
Tous,theKMCherianFoundation,andtheNovickCardiacAlliance.75This
collectiveendeavorspecificallyseekstoaddresssignificantgapsthatexistwith
careofchildrenwithCHDinLMICswhencomparedwithadvancedeconomies.
TheIQICseekstoprovidebenchmarkingdataforhealthcareprofessionalsand
guidesQIeffortsatmorethan50sitesin22LMICs.Theimpressivedecreasein
morbidityandmortalityratesatparticipatingsiteshasbeensteadyand
significant.53
ContinuingMedicalEducationandTraining
Initiatives
InmanyLMICsettings,pediatriccardiacprofessionalscomefromvaried
trainingbackgroundsandoftenperforminrolesthattheyhavenotbeen
specificallytrainedin.Vitalsupportstaffthatincludeperfusion,respiratory
therapy,andintensivecarenursesareespeciallyinneedofconstanttraining.
Limitedopportunitiesexistforaccesstocontinuingmedicaleducationprograms
andtrainingworkshopsamongnursingandresidentdoctorstaff.Fundsfortravel
toconferencesandworkshopsareinshortsupply.
TheInternethashelpedtoovercomemanyoftheselimitations,androbustelearningplatformshavebeenestablishedforallpediatriccardiacprofessionals.
TheIQICconductsregularwebinarsfornursesonkeydriversofQI,andits
websiteservesasanexcellentresource(Astructured
e-learninginitiativehasbeenestablishedtofacilitateteachingofpediatric
cardiologyfellowsthroughe-classesconductedtwiceeveryweek.Thisis
integratedintothecoursecurriculumoffellowsintraining.76TheCHIP
Network,theCongenitalHeartProfessionalsNetwork(isdesignedtoprovideasinglegloballistofallCHD-interested
professionals.77ThisinitiativeseekstoconnectpediatricandadultCHDinterestedprofessionalstoevents,conferences,andincreaseeducationand
providerawarenessofnewdevelopmentsinthefield.
Animportantmissionthatpediatriccardiacprofessionalshavetoundertakein
LMICenvironmentsisineducatingprimarycaregivers(mostlygeneral
pediatricians).21Criticalareasthatpediatriciansneedtobeeducatedinclude
identificationofheartdiseaseininfantsandnewborns,stabilizationofasick
childwithcriticalheartdiseasepriortoreferral,theneedforpostsurgicalholistic
care,andtheimprovedoutlookforchildrenwithheartdiseaseincurrenttimes.It
isvitaltoliaisewithprofessionalbodiesforgeneralpediatriciansand
neonatologiststoenablecontinuedinteractionandconstantfeedback.
Conclusions
Thedemographicshiftofpediatricdiseasesbroughtaboutbyimprovinghuman
developmenthasunmaskedamassiveburdenofCHDinLMICs.RHDremains
unconquered,andtheabsoluteburdenofotheracquiredheartdiseasesishigh
simplybecauseofthelargenumberofaffectedchildren.Asaresult,the
magnitudeofpediatricheartdiseaseisimmense.Althoughseveralnewpediatric
cardiacprogramsarebeingestablishedinmanyemergingeconomiesinAsiaand
SouthAmerica,thevastmajorityoftheworld'schildrenstilldonothaveany
accesstocomprehensivepediatriccardiaccareandmuchneedstobedoneto
addressthisfundamentalchallenge.Fromaglobalperspective,wecanclaimto
haveprogressedonlywheneverychildbornintheworldwithheartdiseasehas
accesstocomprehensivepediatriccardiaccare.
ForthosechildrenwhoreachpediatriccardiacprogramsinLMICs,important
challengesareposedbylatepresentation,comorbiditiessuchasundernutrition,
infections,andlimitationsinhumanandmaterialresources.Thechallenges
necessitateimportantadaptationsandinnovationsinclinicalpractice.
ItisalsonecessaryforpediatriccardiacprofessionalsinLMICstofind
answerstotheuniqueclinicalproblemsthattheyfacethroughsystematic
researchandcollectiveeffortssuchasmulticenterstudiesandregistries.
Summary
Muchofthischapterspeakstotheneedforadvocacyandactivismforandon
behalfoftheneglected90%ofchildrenwithheartdisease.Parentsandpatientbasedsupportgroupshaveacrucialroletoplayinputtingheartdiseasein
childrenfirmlyontheglobalhealthagenda.However,physiciansandsurgeons
haveaheavyburdenofresponsibilityandthereforeneedtoshowleadershipin
thesecampaigns.Partnershipisimportant,andthemostimportantglobal
institutionsneedtobeusedtogoodadvantage.
TheSustainableDevelopmentGoals(SDGs)areacollectionof17global
goalssetbytheUnitedNationsGeneralAssemblyin2015.TheSDGsarepart
ofResolution70/1oftheUnitedNationsGeneralAssembly:“Transformingour
World:the2030AgendaforSustainableDevelopment.”80IntheSGGsThe
UnitedNationssetglobaltargetsfor“goodhealthandwell-being.”Included
hereunderSDG3isthetargetto“reducebyone-thirdthemortalityfrom
noncommunicablediseasesby2030throughpreventionandtreatment”andby
2030,“toendpreventabledeathsofnewbornsandchildrenunder5yearsofage
withallcountriesaimingtodecreaseneonatalmortalitytoatleastaslowas12
per1000livebirthsandunder-5mortalitytoatleastaslowas25per1000per
1000livebirths.”Wehaveshowninthischapterthatthesegoalswillneverbe
reachedwithoutsustainedglobalactionwithinvestmenttoincreaseaccessto
affordableandeffectivesurgeryandtreatmentforchildrenwithheartdisease.
Furthermore,thecallintheSDG's“toachieveuniversalhealthcoverageand
accesstoqualityessentialhealthcareservicesandaccesstosafe,effective,
qualityandaffordableessentialmedicinesforall”isconsistentwithwhatis
requiredtoprovideprimarypreventionforchildrenatriskofrheumaticfever,
secondarypreventionforchildrenwithRHDandtreatmentforallformsof
children'sheartdisease.Forthefirsttimetheglobalpediatriccardiaccare
coalitionandthepublichealthconstituency,moved,motivatedanddrivenbythe
UnitedNationsandtheWorldHealthOrganization,shareasetofobjectives
whicharenecessarytoreachtheSDG'sandgetcardiaccaretotheneglected
90%.
