According to the World Heart Federation, rheumatic heart disease (RHD) causes around 233,000 deaths annually — mostly children and young adults in under-developed countries. It is estimated that more than 15.6 million people have this ailment and a significant number will require repeated hospitalization and heart surgery in the next five to 20 years.
The regions most impacted are sub-Saharan Africa, south-central Asia, the Pacific, Australia and New Zealand. Additionally, one out of every 100 children in the world is born with congenital heart defects, and a third of these children need medical care to survive. This is not readily available in developing countries.
The Save a Child’s Heart (SACH) program at the government-owned Wolfson Medical Center in Holon, near Tel Aviv, is working towards fulfilling this need. Founded in 1995 by cardiac surgeon Amran (Ami) Cohen, who died in 2001, its aim is to help developing countries improve the quality of pediatric cardiac care and create centers of competence in these countries.
SACH has a medical team of more than 100 doctors, nurses, physiotherapists and technicians and about 90% of the pediatric cardiac care at Wolfson comprises SACH patients.
Notes Tamar Shapira, director of international relations: “SACH is an Israel-based international humanitarian foundation with a mission to improve the quality of pediatric cardiac care in developing countries and Israel” by bringing children from developing countries to Wolfson Medical Center for lifesaving treatment. “It also trains medical teams from these countries.”
Adds Sion Houri, head of the pediatric cardiac unit at Wolfson: “In many cases, the children who come for medical treatment have been neglected. As a result, their condition is much worse than it should have been with timely treatment. This results in a great challenge for the medical team.”
SACH’s executive director, Simon Fisher, says that many of the group’s physicians at Wolfson have returned from fellowships overseas and are using their know-how to teach others doctors trained by SACH. “One of the surgeons has recently returned after training at the Children’s Hospital in Toronto. A few months ago, we had a pediatric cardiologist return from Berlin after two years of fellowship in invasive cardiology at one of the top centers in the world. This is increasing our capacity to treat more children.”
“We manage to pack in not only the medical costs but all other expenses for $15,000.” — Simon Fisher
The children come from all over the world, including Iraq, Syria, China, Moldova, Russia and Tanzania. Fifty percent are from Gaza, the West Bank, and surrounding Arab countries. Once they return to their home countries, follow-up treatment is done either by local doctors trained under SACH or by a visiting SACH team. The number of patients being treated has increased steadily from around 50 per year initially to around 250 per year at present.
Wolfson provides the treatment to SACH patients at a sharply discounted rate, says Fisher. “The actual rate of such surgeries in Israel would be around $20,000, and with other medical costs could go as high as $40,000 to $50,000. In the U.S., open-heart surgery could be as high as $100,000. We manage to pack in not only the medical costs but all other expenses for $15,000.”
The funds are raised from various public, private and government organizations in Israel and abroad. In addition, the European Union Partnership for Peace, USAID and the Israeli ministry for regional cooperation jointly have been sponsoring the treatment of Palestinian children, training Palestinian physicians, holding joint medical conferences and doing community work under a special SACH project called Heart of the Matter. “It involves not only the treatment of the children and training of physicians, but serves as a bridge between people in the current conflict. There is a support group for Palestinian and Israeli parents to work with hospitalized children. In addition, Palestinian and Israeli doctors are sent together to international conferences,” says Fisher.
On the Expansion Track
SACH is now starting to build a state-of-the-art children’s hospital and international pediatric cardiac center at Wolfson. This new facility will have the infrastructure to perform 300 to 400 pediatric heart surgeries per year (versus 250 at present) and provide all relevant pre- and post-operative care. The idea behind this new project is twofold – to treat SACH patients and enable the less privileged in Israel to enjoy the same type of access to health care enjoyed by the wealthy.
The new facility is expected to cost $35 million. Of this, $17.5 million has been raised so far. According to Fisher, the ministry of health will be responsible for the running expenses.
Even as it is looking to upgrade its facilities at Wolfson, SACH is going strong on another of its key goals: to create local centers of competence around the world. These include projects in Tanzania, Ethiopia, Romania and Ramallah on the West Bank. Notes Fisher: “Depending on the needs in their own country, we bring doctors and nurses to Wolfson for lengthy periods of time to gain hands-on experience. Once they gain the necessary experience, they return to independently treat the local population.”
A recent example is that of Dr. Godwin Godfrey, who returned to Tanzania after six years of training at Wolfson and is now the only pediatric cardiac surgeon in his area. The training of Dr. Godwin and his team in Israel was possible thanks to the support pf the Australian Pratt Foundation. Dr. Godwin is now working at the Jakaya Kikwete Cardiac Institute (JKCI) in Dar es Salaam, under the leadership of the hospital director, Prof. Mohamed Janabi. Currently, a surgeon from Ethiopia is being trained at Wolfson and, on completion of the course, will be Ethiopia’s first and only pediatric cardiac surgeon.
According to Fisher, until now more than 100 doctors and nurses from outside Israel have been trained under the SACH program. The training is free, and for doctors it varies from six months to six years depending on their level of expertise and what they want to do on their return to their home countries. At present, 250 children are being treated under SACH annually and, since inception, the lives of 4,000 children from 50 developing countries have been saved. Of these, around 10% have received treatment in SACH centers in other countries.
“Israel [has a] mindset that combines innovative thinking with the desire to be a global force for good.” — Guy David
During its missions abroad, the SACH teams are often joined by partner organizations such as Gift of Life International, which also helps children with heart diseases. Rob Raylman, executive director of Gift of Life International, says: “The need in emerging countries is great to provide care for children suffering from heart disease. Save A Child’s Heart has provided Gift of Life International with a strong partner in the effort to allow for children who suffer from heart disease in emerging countries to access treatment. They have successfully treated many children we have referred to them from Uganda, El Salvador and elsewhere.”
Another such partner organization is Burbank, Calif.-based Mending Kids, which provides surgical care to children worldwide. “We have referred pediatric cardiac patients from Ethiopia and other countries to SACH because we consider it a center for excellence in the field of open heart surgery,” says Isabelle Fox, mission coordinator at Mending Kids.
Fox’s interaction with SACH started when she was contacted by Fisher and Russel Lee of Open Heart International soon after she had completed a cardiac site visit in Tanzania. Fisher and Lee suggested that they could pool resources and the idea appealed to Fox. “Pooling resources and working together makes perfect sense when resources are limited and raising funds is a challenge. If we can make a concerted effort to each send a cardiac surgeon to Tanzania to help Dr. Godwin Godfrey (trained by SACH) then we can [achieve] self-sustainment really quickly,” she says.
Building International Goodwill
Guy David, professor of health care management at Wharton and a senior fellow at the Leonard Davis Institute of Health Economics, views Israel as a small economy that wants to appeal to a broader market. This makes Israel “attuned to global needs with a mindset that combines innovative thinking with the desire to be a global force for good.”
Pointing out that Israel has 3.7 physicians per 1,000 people compared with countries like Ghana (0.1), Angola (0.2) or Indonesia (0.3), and even the U.S. (2.4) or the U.K. (2.7), David adds: “By partnering with a medical center, like Wolfson, SACH helps close gaps in access to care in many countries while providing physicians with valuable experience in performing corrective heart surgery. Beyond the obvious importance to the patients and their families, the hospital and its physicians enjoy tremendous professional growth that ultimately benefits Israeli patients and enhances the hospital’s reputation and standing in the community.”
Orit Even-Shoshan, associate director, Center for Outcomes Research at The Children’s Hospital of Philadelphia and a senior fellow at The Leonard Davis Institute of Health Economics, notes that “research shows that high-risk, complex pediatric patients achieve better outcomes at highly specialized regional centers, and increasingly the care delivery system recognizes the benefits of referring such patients to medical centers better suited to meet their needs.”
“Replicating this Save a Child’s Heart model in a developing country is a target of our organization.” — Simon Fisher
Shoshan adds that “there is no reason to not consider highly specialized cardiac centers in Israel as potential regional medical centers providing care to children from outside Israel. “In addition to the benefits to the children in SACH, to the Israeli physicians and future Israeli patients, we should not minimize the importance of the international goodwill that this initiative will generate.”
But the SACH project also has its share of challenges, notably fundraising (it tries to raise upwards of $3.5 million every year), setting up the infrastructure and identifying suitable candidates for training. The most difficult task, Fisher says, is to get the various governments to support SACH initiatives in different countries on an ongoing basis. “To partly overcome some of the challenges, we work with other organizations. We bring them on board to complement the efforts of our medical teams and try to sustain the new centers of competence in the first few years with outside support until they are fully established. This can send a message to the governments that things can be done locally and hopefully they will start investing in the program in terms of equipment, manpower, etc.”
But can the SACH model be replicated successfully in other countries? Fisher is not sure. He points out that there are several unique factors that come into play at Wolfson. For instance, it is a hospital-based program and the medical team works for SACH without additional pay in addition to the hospital charging lower rates.
Says Fisher: “The fact that we are based at the Wolfson Medical Center and supported by the government to a certain extent, enables us to do things that ordinarily would be extremely difficult to replicate in another country. But replicating this model in a developing country is a very much the target of our organization.”