Global Heart Network Forums: A case study in Myanmar

Let me start this week’s blog with a bit of background:

Every year 1% of the world’s children are born with heart disease, of which only one-third are ever diagnosed, even fewer receive life-saving cardiac interventions. Approximately 75% of the world’s population does not have access to advanced cardiovascular (CVD) interventions. This is often a result of Lower and Middle Income Countries (LMIC’s) political, social and economic status. Initiatives designed to address these issues often fail to learn from each other’s mistakes as they work in isolation rarely looking at the whole problem faced by LMICs.

Founded in 2011 Global Heart Network has developed a web-based platform, www.globalheartnetwork.net  for organizational and program efficiency of organizations providing open heart cardiac surgery in low and middle income countries.  Our platform has 3 principal features:

  1. Global Heart Network is a matching service: a non-profit brokerage facilitating matching needs to resources in cardiac care for clinical services, education and training, and medical equipment and supplies.
  2. Global Heart Network is a place for dialogue: our community forum platform known as the Community Action Panel (CAP) allows members at the forefront of care delivery to share knowledge, insight and learning’s to work towards the single goal of increasing access to cardiac care in LMICs. A designated volunteer expert known as the Project Leader, runs the CAP Forum with the help of 2 Chief Consultants.
  3. Global Heart Network is a source of information: we are starting to build a database that will map activities of organizations and hospitals providing services for cardiac care in LMICs.

Enough of the background, I think you get it…Now onto a short report of our very first CAP Forum focused cardiac care in Myanmar.

Map of Myanmar

In August 2013,  Global Heart Network members, Ms. Sameera Chilakapati (East Meets West Foundation, Oakland, California), Dr. Ravi Agarwal (Frontier Lifeline, Chennai India) and Dr. Nguyenvu Nguyen (Ann & Robert H. Lurie Children’s Hospital of Chicago), invited members to openly share their specific experiences supporting cardiac programs in Myanmar. The objective of the forum was clearly expressed: to discover joint efforts by government, NGOs, and health care practitioners around the world who are conducting work in Myanmar.  The forum aimed at taking inputs from those who have visited or worked in Myanmar regarding the existing pediatric cardiology and cardiac surgery facilities to possibly find the gaps in delivery of cardiac care and to address these areas by combined efforts.

Why Myanmar?

Recent political and economic changes in Myanmar, driven by the reformist, civilian-led government that took office in March 2011, have been encouraging, showing signs of greater cooperation in Myanmar’s health sector.  Myanmar’s economic growth is predicted to grow at an estimated 6.8 % in 2014, placing it among Southeast Asia’s fastest growing economies. Myanmar is keen to be seen to increase access to all aspects of healthcare, and as such access to Cardiac Care is an important topic. This is currently being managed by a range of global stakeholders all aiming to improve cardiovascular capacity and services.  However, there seems to be little collaborations amongst those trying to make a difference working together with the local Burmese doctors who work tirelessly day and night in harsh conditions.

Overall Theme of Forum

Greater Collaboration is the overall theme of the CAP discussion threads. The recent rise in humanitarian cardiovascular support from the international community responding to Myanmar’s recent open door policies has further highlighted the need for greater collaboration. The challenge is that many of the organizations working in this field act independently of one another, often missing out on the opportunity to gain from the critical mass operating in Myanmar . One of our CAP contributors Dr. Htut K Win’s profiled a paper “Expatriate Myanmar Physicians and their way back home” highlighting the vision for a more collaborative approach to capacity building in cardiac care, one which places emphasis on sustainability through close working relationships with the Ministry of Health, and local medical/ nursing staff.  Some contributors to the CAP discussion include:

Professor Daniel Loisance – Paris

Professor Loisance is an adult and pediatric cardiac surgeon based in Paris, leading a team of 6 surgeons from and is now actively involved in training the local team at the Mandalay General Hospital.  Professor Loisance has brought tremendous support to Myanmar by travelling more than 40 times to Yangon and Mandalay. He is engaged in transfer of knowledge, that is, in assisting surgery to young Myanmar surgeons to make them self-standing.  Professor Loisance believes that coordination of the various teams who have arrived recently in Myanmar, with the other teams and with the local surgeons is a necessity to optimize the scare resources. Professor Loisance shares others’ concerns about the many projects in Myanmar that lack a coordinated response.

Christopher Waite and Russell Lee – Sydney

Russell Lee and Christopher Waite 
ICU /CCU Manager 
from the Sydney Adventist Hospital representing Open Heart International
have been building capacity in Myanmar over many years with twice yearly visits since 2004.  Their organization, Open Heart has fostered and maintained a strong working relationship with the Military and Civilian Hospitals and the Health Ministry.  Open Heart International is currently supporting programs in six hospitals in major regions of Myanmar: Yangon General Hospital, Yangon Children’s Hospital, Yankin Children’s Hospital, Defense Services General Hospital No 1 Yangon, Mandalay General Hospital, and Myanmar Defense Services General Hospital

Dr. Htut K Win –  Texas

Dr. Win is a native of Myanmar.  He currently practices interventional adult cardiology in Houston, Texas. Dr. Win is passionate about helping to build sustainable cardiac care in Myanmar.  Since 2012, Dr. Win has been to Myanmar on many occasions to teach and perform cardiac interventions. Dr. Win shared understanding of the complex interactions between politics, society, and healthcare in Myanmar.

Summary

Although we would like to identify opportunities for improvement, and develop recommendations on practical next steps that can be taken over the short term, we believe this warrants another discussion, as we do not have enough input from all the players at this stage. Members in the discussion were individuals from organizations who work in Myanmar.  It is to be noted that there is a distinct imbalance in discussions from the local community.  Without local input in such a forum, we could be misinformed of the true nature of the issues in the specific country; secondary information alone is not possible to develop and implement solutions. This forum would merit a follow up inviting local partners to join in the discussions, to explore the gaps in delivery of cardiac care and to work together to address these areas by our combined efforts.

Suffice it is to say taking a phrase from Dr Win’s observation that: “Myanmar is a very complex state to navigate” and now that the state is opening up for trade and collaboration, the international and national agencies and humanitarian organizations need to work in harmony to avoid duplication of effort and to ensure that the entire spectrum of infrastructure and human resources are made available through a local partner. The local partner is an important aspect due to the social and political background of the country.  It would not be prudent or advisable for any international and national agencies and humanitarian organizations, individual donors, cardiac specialists or individuals to do anything on their own without coordination with other efforts.

It is our hope that the forum will bring the interested parties together so that they can chart out the road map for future collaboration. We would love to hear from the Burmese doctors who incessant efforts at the local level should be honored in this document and we have an equal balance of local versus international organizations in this dialogue.  Please let us know if you have any further comments or suggestions for next steps by writing to gabriel@globalheartnetwork.net.

Moving Forward

Please visit www.globalheartnetwork.net to learn about our work and propose  a CAP Forum.  Through sharing your experiences and ideas, we can work together to exchange information, elevate learning and take concerted action on shared priorities.

Next week we start a series on our blog of stories of how our matching features have started to create an impact.  Little by little we will be able to increase program efficiency and effectiveness…together.

With thanks to our Project Leader and Consultants without whom this Forum would not have been possible:

Sameera Chilakapati, Program Development Officer, East Meets West

About East Meets West:  an NGO with over 25 years of experience in the health, education, and WASH sectors, is piloting the use of the GHN platform to learn about efforts to build sustainable pediatric cardiac care in Myanmar. East Meets West is the first organization on the GHN platform to create a Community Action Panel (CAP

 

About Dr. Ravi Agarwal: Senior Consultant Cardiac Surgeon and Chief of Pediatric Cardiac Surgery at Frontier Lifeline Pvt. Ltd. In Chennai, India is the primary Chief Consultant on the CAP.

About Dr. Nguyenvu Nguyen: Assistant Professor in Pediatrics Cardiology at Ann & Robert H. Lurie Children’s Hospital of Chicago is the secondary Chief Consultant on the CAP. Sameera Chilakapati, Program Development Officer at East Meets West, is the project leader and will be leading East Meets West’s efforts on the CAP.

This document represents a summary of the views discussed on the GHN platform by GHN members and as such is not a reflection of the views and opinions held by the GHN management

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