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The World Loses Another Giant in Pediatric Heart Surgery

Dr. Francis Fontan

When receiving the news that Dr. Francis Fontan passed away earlier this week, Dr. Novick’s initial response was “Another giant in pediatric heart surgery passed from our midst.” Dr. Fontan is the individual who pioneered the development of the “Fontan” operation. The Fontan operation made it possible for those children born with one ventricle to have a chance to separate the “red” from the “blue” blood and lead nearly normal lives for many years. Dr Fontan’s contribution to the field of pediatric heart surgery cannot be over-emphasized as it is the final operation which nearly all children born with one ventricle receive thus providing them with a future free of the debilitating effects of chronic cyanosis.

Fontan Procedure

 

Dr. Novick reminisced about meeting Dr. Fontan.

“As a resident in cardio-thoracic surgery at the University of Alabama from 1987-1991 I was fortunate to meet Dr. Fontan on more than one occasion because of his professional and personal relationships with Dr. John W. Kirklin and Albert D. Pacifico. I will never forget my first encounter with Dr. Fontan. He was visiting Birmingham to work on the finishing touches of his sentinel paper with Dr. Kirklin, “The Perfect Fontan”. On the day I had the honor of meeting him I was assigned by Dr. Pacifico to start the second case of the day. As would have it, by design I am sure, it was a child who needed a completion “Fontan.”

As usual this required a redo-sternotomy, which we performed without difficulty. When I sent word to Dr. Pacifico that the sternum was open, I received an unusual response, “Proceed”, which meant he wanted me to lyse the adhesions and place the cannulation sutures to enable the patient to be placed on bypass. I knew that Dr. Fontan was in the hospital and might be visiting the operating rooms, so I was a bit nervous. Nonetheless we proceeded without incident. When I sent word again to Dr. Pacifico that we were ready for him to cannulate and place the patient on bypass, I was again greeted with “Proceed.” This response was totally unexpected as I had never placed a “Fontan” completion patient on bypass, and I was early in my residency. So, as I was placing the arterial cannula, Dr Fontan suddenly appears above the anesthesia screen and says ‘Good morning Dr. Novick!’ Well as fate would have it, I muffed the cannulation and could not get the arterial cannula in. I stopped and responded ‘Good morning Dr. Fontan, sorry I muffed the cannulation, could you please ask Dr. Pacifico to come now.’ Francis laughed and apologized for spooking me at exactly the time I had tried to place the aortic cannula. Remembering this encounter with Dr. Fontan reminds me of the importance of having a sense of humor even while performing challenging heart surgery.”

Francis Fontan, creator of the Fontan operation, actually considered his greatest accomplishment the formation of the European Association of Cardio-thoracic Surgery. He is truly an innovative leader in pediatric cardiac surgery and one of the main individuals responsible for the progress of cardiac surgery in Europe. The world will miss Francis, but we can never forget his tremendous contributions to the field of cardiac surgery, specifically pediatric cardiac surgery. His legacy to this world can be found in the thousands of adults living with Fontan circulation today. We imagine that he and Dr. John Kirklin are together now, perhaps discussing “The Perfect Fontan.”

Novick Cardiac Alliance Featured on ShareAmerica

Cardiac Alliance has been featured on ShareAmerica, a platform produced by the US Department of State. Our story has been shared to all the US Embassies worldwide. This particular story can be translated into seven different languages. Read the article on ShareAmerica to learn more about our life-saving work in war-torn areas.

Witnessing Sustainability in Libya

Two brothers, Four heart defects.

In 2012, we met Abdul, a Libyan boy who was born with four heart defects, called Tetralogy of Fallot. Dr Kathleen Fenton operated on Abdul alongside Libyan pediatric cardiac surgeon Dr Wejdan Abou Amer. Because his heart defects were diagnosed late, Abdul was very sick following his surgery and remained in the ICU for many days. Our team was scheduled to leave the country, but Dr Fenton changed her flight to stay and help the Libyan team care for Abdul. 

Abdul, 2012

In June, our team returned to Benghazi and met Abdul’s little brother Mohammed. Mohammed has also been diagnosed with Tetralogy of Fallot. His parents were devastated to learn their second son also had a life threatening heart defect. It is “life threatening” because he lives in war-torn Libya with limited basic health care available, let alone pediatric heart surgery. 

Mohammed, 2017

Since our team has been visiting Libya and educating the local Libyan medical professionals for several years, we are witnessing the magic our work accomplishes. Mohammed needs a type of surgical procedure that the local Libyan surgeon Dr Wejdan can now perform on her own! Dr Fenton collaborated with the Libyan team and determined that Mohammed’s surgery can be performed by Dr Wejdan after our team leaves the country. From our continued teaching, she has developed the skills to do this, and the ICU team has the skills necessary to care for a patient like Mohammed. 

Dr Wejdan and Dr Fenton operating in Libya.

Without our continued perseverance to travel to Libya, children like Mohammed and his brother Abdul would not survive. There would be no miraculous story to tell. 

And by the way, Abdul is now 6 years old and attending school! 

4 Reasons We Provide Heart Surgeries in a War Zone

4 Reasons We Provide Heart Surgeries in a War Zone

Libya is a country in turmoil, with a health care infrastructure that is falling apart. We get criticized sometimes for continuing to go to Libya to perform lifesaving heart surgeries in the midst of the violence and chaos.

‘They need aid’ is what we hear in America, when the topic of Libya comes up.

Here are four reasons why we provide heart surgery in a war zone like Libya:

  1. Libyans know what they need—and they asked us to come.

Libyans are savvy. They care for their own people. They want to provide what their people need. It isn’t helpful to come from the outside, without intimately knowing the situation on the ground, and assuming to know better.

  1. By teaching best ICU care practices, preservation of sterilization in the operating room, and echocardiogram diagnosis techniques—as well as surgical techniques—we raise the level of care across the board.

Local medical staff who master best practices in care of young heart surgery patients are able to apply those skills in every other hospital department.

  1. When we teach the skills required to perform pediatric heart surgeries, local medical staff can then handle whatever gets thrown at them.

When doctors and nurses become skilled healing the smallest, most vulnerable patients, with incredibly challenging heart defects, they have the skills needed to handle trauma, and any other condition they might be presented with.

  1. It’s within our hands to do.

We aren’t the UN. We aren’t the World Food Programme. Thankfully, those groups already exist to provide broad relief aid.

We are focussed on the immediate needs of Libyan children who need heart surgeries to live, as well as a medical system which requires more trained medical personnel to care for their own citizens.

We are focussed on what is needed right now. But at the same time, we are able to help bring positive systemic change. We all have the ability to contribute to the stabilization of Libya—this is how we do it.

For Libyans, Is a Tiny Boat In A Huge Ocean the Only Way To Get Care?

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“Unable to get specialist care for his six year-old daughter in Libya or a visa for treatment

abroad, Abdulhakim Shaybi bought a motor boat and set off with her last month across the Mediterranean. Two and a half hours into their journey from Sabratha in western Libya, they reached a European ship deployed to rescue migrants.

‘I raised a white flag to the ship in a sign of peace,’ Shaybi told Reuters by phone this

week from the Italian city of Genoa, where his daughter Sajida, who has the rare blood cell disease aplastic anemia, is now undergoing tests. ‘My friend told them that we have a sick little girl.’

‘We are only conducting emergency operations now,’ General Manager Mukhtar al Habbas told Reuters [from Tripoli]. ‘We have no anesthetic, sterilizing materials, or medical gauze, so how we can work?’

It is a similar tale across Libya. About half of the country’s 159 hospitals are either closed or barely delivering services, said Haroon Rashid, a World Health Organization official.”

The current health care situation in Libya is so precarious that the father of a sick young girl risked an ocean crossing to get her the treatment she desperately needs. Nearly 3,000 refugees died this year alone, making this same crossing.

This is why we continue to work in Libya. This is why we partner with Libyan surgeons, cardiologists, and nurses—so desperate fathers don’t have to make these kinds of choices.

How do we celebrate World Down’s Syndrome Day?

How do we celebrate World Down’s Syndrome Day?

Today (March 21st) has been dedicated as World Down’s Syndrome day by the United Nations. Nearly half of all children born with Down’s Syndrome will have a heart defect as well. The Novick Cardiac Alliance is committed to bringing sustainable health care solutions to all children with cardiac disease in the developing world.Alex being silly on ward copy

 

“Persons with disabilities, including those with Down syndrome, are more than persons in need of assistance; they are agents of change who can drive progress across society – and their voices must be heard as we strive to reach the Sustainable Development Goals.”
Ban Ki-moon Secretary-General of the United Nations

2015.02.09.Tobruk.Libya.Fuji._71 (1)Cardiac Alliance operate on children with Down’s Syndrome in 11 countries around the world this is about 12% of all the children that we operate on every year. This is not enough! We need to reach more children and we need your help to do it. Children with Down’s Syndrome are more than a collection of symptoms or a disease and like the rest of the population they learn at school, have interests, hobbies, talents, friends and relationships. Down’s Syndrome occurs in all races, religions and economic situations but when a child with Down’s Syndrome cannot get the Cardiac care they need their world becomes smaller and restricted- they cannot play or go to school or make friends – they are also much more likely to die in childhood. We are celebrating Down’s Syndrome day by renewing our commitment to meeting the needs of this unique and valuable group of children. Join us in our celebration  Donate financially today or volunteer with us and help us reach more children like these!.

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Lamar after surgery 2

Sajad and grandmother

You Are Essential For Every Surgery!

You Are Essential For Every Surgery!

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From the moment a trip begins, precise preparations for every operation begin: instruments are sterilized, equipment is checked, hands are washed, surgical gowns and masks are secured, lights are adjusted—each in a very particular way.

When the patient is ready, surgeons open the chest, assess the exact nature of every heart defect, make each delicate stitch to repair the heart, all the while being aware of any subtle changes in the patient’s condition, and finally closing up the chest to cover a repaired heart. Two surgeons scrub in for each surgery—it takes more than one set of hands to perform a successful operation.

It’s easy to think of heart surgeries as solo shows—a single surgeon the only player onstage.

In reality, heart surgeries are complicated choreographies, and everyone involved is essential.

Before any surgery takes place, the cardiologist sees the patient, diagnoses any heart defects, and recommends candidates for surgery.

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Inside the operating room, the scrub nurse prepares patients, manages instruments, and maintain a scrupulously sterile environment for surgery. Anesthesiologists administer the fluids which keep patients asleep for just the right amount of time and keeps a close eye on levels. Perfusionists manage the heart-lung machine, and keep blood oxygenated during surgery. The blood bank manager ensures there is enough life-giving supplies at hand. And a biomedical engineer is always at the ready, keeping complicated machinery running smoothly.

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In the Intensive Care Unit, critical-care doctors and nurses treat healing patients, continuously measuring heart rates and fluids. The respiratory therapist keeps lungs functioning well and helps to prevent complications like pneumonia. X-ray and lab technicians provide the evidence needed to fully manage care.

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In the Step-down Unit, the last phase of in-hospital treatment, further monitoring takes place to manage patient wellness, and parents are trained how to best care for their children so they can go home as quickly as possible.

Behind the scenes, there are further layers, including those who clean the hospital, sterilize instruments, wash sheets, and more.

Skilled surgeons are essential to every operation, of course! Dr. Novick and our surgical staff brings tens of thousands of hours of training and experience to every operation. There is no surgery without surgeons!

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But it’s also true that without cleaners, there is no surgery. Without sterilized instruments, there is no surgery. Without bagged blood and plane tickets and filled syringe pumps, there is no surgery.

In this complicated choreography, everyone is essential—including you! Without your generous donations, there is no surgery. You help to make all of this happen! Give today.

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We Are Making A Real Difference In Libya—Join Us!

We Are Making A Real Difference In Libya—Join Us!

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It was a small news article, easy to miss. Turkish hospitals and hotels are refusing to receive any new patients from Libya. The debt has grown too high, as Turkish hospitals treated more than 8,000 Libyans sent to them for care, and the bills have not been paid.

Why are so many Libyans sent out of country for care? After too many years of civil war and instability, and the growing presence of ISIS, the health care system in Libya is unable to cope.

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Syria and Iraq get the bulk of media attention, but life in Libya is difficult for many. Half of the population has been directly affected by war. Two million residents are in need of health services, and there are nearly three quarters of a million refugees and displaced people in Libya.

Large organizations like the World Health Organization are focused on delivering basic care to large swaths of the population—providing childhood vaccines and preventing communicable diseases.

But with limited hospitals functioning in Libya, a shortage of health care workers, and limited funding, children with acute health needs like those born with heart defects can’t get care.

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That’s where we come in.

We aren’t afraid of the challenges in Libya. In fact, this is a country where we can make a real difference!

We provide surgeries for children with the most complicated heart defects—saving lives. We perform surgeries in-country, which is not only cheaper than sending patients out for treatment, but keeps precious dollars and resources in Libya where it’s so needed.

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We provide local doctors and nurses with the expert training they need. They are able to learn global best practices, from some of the world’s best practitioners, within their own communities. This hands-on learning is put to work immediately, saving the lives of Libyan children.

We provide continuity, returning throughout the year to care for more children and to further the education of local health care professionals. In a place so unstable, our continued presence provides needed stability!

In the face of civil war, instability, ISIS, and massive systemic needs, we aren’t running away.

In fact we’re investing further. Join us in making a real difference by donating today.

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