WILLIAM NOVICK GLOBAL CARDIAC ALLIANCE INC
This organization has already been registered
Someone in your organization has already registered and setup an account. would you like to join their team?Profile owner : b*********k@c**************e.o*g
Mission Statement
No child should be denied cardiac care because of where they are born. We provide pediatric heart care and education in low and middle-income countries to children and local healthcare professionals regardless of race, ethnicity, gender, religion, or political affiliations.
About This Cause
Mission Statement and Objectives The William Novick Global Cardiac Alliance (Global Cardiac Alliance) is a 501 (c) (3) nonprofit organization committed to providing sustainable healthcare solutions to children with cardiac disease in Low- and Middle-Income (LMIC) countries. We are dedicated to improving the skills, knowledge, technology, and experience of local healthcare providers in regions of the world without access to quality Pediatric Cardiac Care. We aim to provide comprehensive care to all children with congenital or acquired heart disease regardless of gender, ethnicity, religion, political ideology, genetic factors, or economic means. Our vision is that in the future all children with heart disease, no matter where they are born, will be able to receive the medical and surgical care they require to live a long and healthy life. Our administrative staff is small with only 2 full-time staff (Logistics Director, Inventory Specialist). However, 2 of our staff clinicians serve dual roles as clinicians with administrative responsibilities, this allows us to maximize donations to project service rather than overhead expenses (94% vs 6%). History What began thirty years ago (1994) as the International Children’s Heart Foundation [1] transitioned to Novick Cardiac Alliance (NCA) in November 2014. Over the last thirty years, our combined efforts resulted in over 10,000 children receiving operations on over 550 trips to 36 countries. We work in those countries where pediatric cardiac care is deficient or absent. Our overarching goal is to build independently functioning pediatric cardiac programs that are sustainable [2]. Toward this goal, several sites have graduated from our program and are independently operating in Belarus, China, Colombia, Croatia, Ecuador, Egypt, Ethiopia, Honduras, India, Iran, Iraq, Kazakhstan, Libya, Nicaragua, Northern Macedonia [3], Pakistan, Peru, Russia, Serbia, Sudan, Ukraine [4]. We continue to develop programs in the Democratic Republic of Congo, Ecuador, Lebanon, Libya, Rwanda, Ukraine, and Uzbekistan. Several countries require more than one program, and we have developed as many as three to four programs in a single country, such as China, Iran, Iraq, and Ukraine. Request for Assistance We receive multiple requests yearly. The sources of the requests may be parents, physicians, hospital directors, local or international foundations, or Ministers of Health. We have received requests from all. We have a detailed site assessment questionnaire that is sent to the individual making the request. Once the form is returned with answers and photos, we decide if an in-person visit for a site review is indicated. When a site review is conducted, we take a detailed tour of the site, covering infrastructure, support services, blood bank capabilities, equipment, and human resources. Discussions are held with all stakeholders to determine their motivation and commitment to starting a multi-year program. If all agree, a Memorandum of Understanding (MOU) will be drawn up by the hospital director or the Minister of Health. The MOU outlines the responsibilities of each party. Trip Preparation Once the MOU is signed it takes 10-12 weeks to complete all preparations. We may need to ship equipment, supplies, and, depending on whether the route is air or sea this timeframe is adequate. Our team is unique; we have full-time clinical staff who form the core of the team. The NCA core team is present on every trip, thus providing the opportunity to develop continuity of care protocols and giving time to develop professional relationships. Volunteers are needed to complete the team, and recruitment starts as soon as a schedule is determined. Most of our volunteers come from major pediatric cardiac programs in the US, Canada, the UK, Australia, and the EU. Team documents, including professional licenses, Curriculum Vitae, specialization certificates, and passports, are forwarded to the Ministry of Health for approval of temporary licensure. Our Logistics Director handles all airline reservations and arranges transit hotel accommodations as needed. Implementation Our model is to develop long-term relationships with institutions in LMIC where pediatric cardiac care is deficient. We do this by sending teams of pediatric cardiac care specialists to sites for periods of 2-4 weeks 3-6 times per year for 3-7 years. Before the arrival of the NCA team, the local team sends a list of potential patients with diagnoses, demographics, and pertinent laboratory results to Memphis for review. A patient management conference is held the day following arrival. A surgical schedule is made for the week and the NCA surgeon and local surgeon discuss the plan with each patient’s parent(s) and consent is obtained. We provide direct mentorship to our local colleagues, working side-by-side with them to provide training, education, and experience. Initially, our specialists provide all primary care. As the local team's capabilities increase, we gradually reverse roles with the local team providing more direct care. We are cognizant of the need to build confidence in the local team and do not place them in positions that exceed their level of expertise [5]. Our team provides 24-hour coverage in the Intensive Care Unit, and the surgical team is on call every night should the need arise for a return to the operating room. We schedule a nonsurgical day to provide didactic lectures, and every patient provides the opportunity for impromptu teaching moments. Monitoring and Quality Improvement All patients are entered into our detailed database, which covers preoperative demographics and clinical status, anesthetic details, perfusion parameters, preoperative and intraoperative diagnoses, operative procedure, intensive care details, as well as complications in the operating room and intensive care unit. Hard copy sheets are returned to Memphis. Encrypted cloud storage is uploaded daily while we are onsite. We encourage every site to develop an electronic database with a hard copy backup. Additionally, we encourage all sites to enroll in the International Quality Improvement Collaborative in Congenital Heart Disease in Low and Middle-Income Countries (IQIC) [6]. The IQIC is a database and registry that has participating programs in over 50 countries and is based at Boston Children's Hospital. All participating sites input data into the RedCap system and twice-yearly reports are distributed to participants. Each site receives a report of its results compared to anonymized participants. This allows the site to understand deficiencies they might have. We hold a review of the trip on the day before the departure of the team. The conference covers systemic issues and obstacles, morbidity, and mortality, and is given by the local team with input from our team. Upon conclusion, a summary of the issues to work on is produced, for both teams. Between visits, our team is available for consultation via Zoom or WhatsApp for difficult decisions, diagnoses, or planned surgical interventions. We review the site's results quarterly to gauge progress. Our metrics are patient weight, complexity of operations performed, complication rate, failure to rescue from complications, and mortality. Innovations and Research Children in LMIC frequently have a delay in diagnosis or treatment. The result is that they suffer from the consequences of chronic congenital heart disease or rheumatic valve disease. A common problem we encounter is severe pulmonary hypertension in children with untreated ventricular septal defects (a hole in the wall separating the pumping chambers). The expense of valves needed to replace a pulmonary valve is extremely expensive. We have developed innovative operations for both these problems that mitigate or eliminate costly purchases [7,8]. We encourage sites to develop their clinical research interests to evaluate their program's progress. Summary A consistent approach to building or improving a pediatric team is imperative. All stakeholders need to commit to a significant time to achieve the goals requested. Local healthcare professionals, the hospital administration, and the Regional/National Ministries of Health must all be philosophically and, in some cases, financially supportive of the project for success and sustainability at program completion. References 1. Novick WM, Stidham GL, Karl TR, Guillory KL, et.al. Are we improving after 10 years of humanitarian paediatric cardiac assistance? Cardiol Young 2005; 15: 379–384. 2. Novick WM, Molloy F, Bowtell K, Forsberg B, et.al. Pediatric Cardiac Service Development Programs for Low- and Middle-Income Countries in Need of Improving or Initiating Local Services. Front. Pediatr. 2019 7:359. doi: 10.3389/fped.2019.00359 3. Cardarelli M, Chadikovski V, Novick W. Cost-Effectiveness Analysis: Small Country Pediatric Cardiac Surgery Program Development. Journal of Humanitarian Cardiovascular Medicine, 2022 1(1). https://doi.org/10.12681/jhcvm.30093 4. Polivenok IV, Molloy FJ, Gilbert CL,… Novick WM. Results of international assistance for a paediatric heart surgery programme in a single Ukrainian centre. Cardiol Young. 2019 Mar;29(3):363-368. doi: 10.1017/S1047951118002457 5. Fenton KN, Molloy FJ, Novick WM. Ethics in humanitarian efforts: giving due credit to the local team. Cardiol Young 2019 Feb;29(2):195-199. doi: 10.1017/S1047951118002081. 6. Sandoval N, Carreno M, Novick WM, Agarwal R, et.al. Tetralogy of Fallot Repair in Developing Countries: International Quality Improvement Collaborative. Ann Thorac Surg 2018;106:1446–51 7. Novick WM, Sandoval N, Lazorhyshynets VV, Castillo V, et.al. Flap Valve Double Patch Closure of Ventricular Septal Defects in Children With Increased Pulmonary Vascular Resistance. Ann Thorac Surg 2005;79:21–8 8. Golovenko O, Lazorhyshynets V, Prokopovych L, Truba Y DiSessa T, Novick W. Early and long-term results of ventricular septal defect repair in children with severe pulmonary hypertension and elevated pulmonary vascular resistance by the double or traditional patch technique. Europ Jour of Cardio-Thorac Surg 2023