In 2005, the World Pediatric Project assembled a consortium of cardiac surgeons to travel to the Dominican Republic to train local surgeons on life-saving surgeries as part of its capacity-building initiative. The goal of capacity-building is to create self-sustaining programs in developing nations by teaching local surgeons the skills necessary to be able to perform the surgeries themselves. What resulted from this initiative was not only the creation of the Dominican Republic’s first and only pediatric cardiac surgery program, but a much larger and further-reaching legacy.
The program, known as the Dominican Hearts Cardiac Consortium, was officially launched in 2005 in order to streamline and coordinate pediatric cardiac mission teams. Hosted by Cedimat Hospital in Santo Domingo, Dominican Republic, the program’s long-term goal was to help build and develop an independent, sustainable pediatric cardiac surgery unit there.
Consider the following global statistics regarding pediatric cardiovascular disease:
- In developing nations, 90% of babies with congenital heart disease (CHD) are denied treatment or receive suboptimal care;
- Up to 80% of CHD cases are not even diagnosed until they have reached irreversible stages of heart failure;
- Without treatment, 1 in 3 babies will die within their first month; the remaining face multiple health complications.
In the eight years following the program’s start, Cedimat Hospital grew the number of open heart surgeries it performed from 1 to 73 surgeries annually.1 The burgeoning cardiac surgery team also expanded the number and complexity of conditions they had the expertise to treat. Building and sustaining an independent program in a lower-resource setting requires committed leadership and passionate persistence from skilled clinical leaders and hospital administrators alike. With this support in place, the addition of strong local partners in the Dominican Republic, such as the David Ortiz Children’s Fund, were instrumental in carrying this program forward to become what it is today.
Given these impressive results, the strong framework for success and the self-sufficiency of the local team, the WPP-led consortium teams were able to gradually transition out of hands-on training and move into a supporting, consultative role.
However, the story doesn’t end there. In March of 2022, leaders from Cedimat’s pediatric heart surgery program published a peer-reviewed article in the International Journal of Cardiology Congenital Heart Disease which further validated the efficacy of capacity-building.
According to “Ten Years of Pediatric Congenital Heart Disease Surgery in a
Caribbean Nation”, Cedimat’s program grew the number of surgeries performed annually from a mean of 278 from 2009-2013 to 1,066 from 2014-2018. For the same time periods, the age of the patients decreased, signifying that heart conditions were being identified and treated earlier. Finally, the mortality rate decreased to a level comparable to that of developed nations.
The authors summarized their findings by stating, “…high standard pediatric cardiac surgery programs can be successful in limited-resource countries with outcome measures comparable to developed nations. Furthermore, by supporting a self-sustaining program…we were able to increase the number of operations performed with no significant impact on early mortality despite an increase in case complexity and number of infants intervened.”
A seed is planted with the hope that it will take root and grow. However with the right vision, skill and hard work that seed can yield an entire crop. A seed was planted in 2005 by a consortium of US and Dominican-based doctors and volunteers who collaborated to create the Dominican Republic’s first pediatric cardiac surgery program. Nearly two decades later, both physicians and patients alike continue to reap the benefits of this collaborative process, thereby reinforcing the effectiveness of capacity-building.
“It has been a joy to work with the World Pediatric Project staff. Through these important [capacity-building] programs, we have been able to teach our in-country colleagues ‘to fish’ on their own. This type of independence is the true measure of a resounding World Pediatric Project success. Thank you to everyone who supports WPP and all the important projects.”
Scott Gullquist, M.D., Pediatric Cardiologist, Children’s Hospital of Richmond at VCU and member of the Dominican Hearts Consortium.
1. Dominican Hearts Cardiac Consortium Cumulative Activity Report, 2005-2013