This is the first in a series of posts featuring Children’s HeartLink Centers of Excellence. These hospitals became regional training centers after enhancing their own pediatric cardiac programs with the help of our medical volunteers. Our five Centers of Excellence in India, Malaysia and China commit to training pediatric cardiac specialists from low-resource regions. This is the heart of our train-the-trainer model. This is how we treat the most children the fastest.
Our featured partner is Amrita Institute of Medical Sciences (AIMS) in Kochi, India. When pediatric cardiologist, Dr. Krishna Kumar, started the cardiac program in Kochi in 1998, there were 150 patients already waiting to see him before the hospital had officially opened its doors. It was the first hospital of its kind in southern India. Over the course of the next 15 years, the team grew and so did the program’s impact in the state of Kerala and elsewhere. They built a strong pediatric cardiology training program and developed strong connections with community providers through years of outreach and awareness building. This, coupled with their steadfast commitment to excellence and quality, has helped them grown into one of the most advanced pediatric cardiac centers in the country today. The hospital has received many accolades and recognition for its standards of care. And as a Children’s HeartLink Center of Excellence since 2014, the team has also begun to support cardiac professionals from India and other countries. Dr. Kumar, whose leadership helped AIMS become the program it is today, answers our questions about the accomplishments of AIMS as a training center.
Dr. Krishna Kumar with a young patient and his parents
Could you tell us more about AIMS’ training programs?
The following training programs are offered at the pediatric cardiac program at AIMS:
DM (Doctor of Medicine) Program. AIMS has a well-established structured training program in pediatric cardiology, DM Pediatric Cardiology, since 2011. This was the first post-doctoral DM pediatric cardiology in the country to be recognized by the Medical Council of India. Currently, we are one of three centers in India offering this course. This is a 3-year comprehensive structured training in pediatric cardiology, much like the fellowship programs in the USA. The current annual intake is two candidates. The comprehensive curriculum is designed to train and nurture highly-skilled, dedicated pediatric cardiologists for India. The training also mandates a research project. Thus far, all candidates have passed in their first attempt and have published their work in leading international and national journals. A similar program exists in cardiac anesthesiology and intensive care. Two candidates are trained each year in advanced cardiac anesthesiology. AIMS also offers an opportunity to train pediatric cardiovascular surgeons in their formative years. Six leading pediatric heart surgeons in India have been trained here, and overseas programs in Japan, China and Portugal have sent their surgeons for advanced training at AIMS.
Children’s HeartLink fellowship. Recognizing the deeply felt need to train pediatric cardiac specialists in low and middle-income nations, Children’s HeartLink has initiated a fellowship in pediatric cardiac sciences in its two Centers of Excellence: here, at AIMS, and at Institut Jantung Negara in Malaysia. The Children’s HeartLink’s fellowship includes trainees in each of the three disciplines: cardiology, intensive care and cardiac surgery.
Short-term training. A number of trainees from other low- and middle-income countries have been trained at AIMS in pediatric cardiology, intensive care, and pediatric cardiac surgery. These professionals came from Sri Lanka, Vietnam, Bangladesh, Nepal, Uganda and Ethiopia.
Rotations. Short rotations in pediatric cardiology are routinely offered to postgraduate students in cardiology and pediatrics from other institutions in the state of Kerala. These rotations serve to orient the students in the scope of modern pediatric care.
How many clinicians were trained since AIMS became a regional trainer? What regions of India/countries are your trainees from?
In the last 10 years, AIMS has trained 21 specialists in pediatric cardiology in-person from all over India and several low- and middle-income countries in Asia and Africa. Particularly, our trainees came from hospitals located in such densely populated cities as Mumbai, Bangalore, Hyderabad, Ahmedabad and Chennai, and from smaller cities in the southeastern states of Andhra Pradesh and Tamil Nadu. We trained several professionals from Bangladesh, two from Uganda, and one from each country I mentioned earlier.
What’s the outcome of this training? Do you have any examples that illustrate the benefits of this training? How did your cardiac team benefit from this experience?
Our trainees have either established new programs in their own or neighboring countries or have improved the quality of care within previously established programs. A good example is illustrated by the training that we offered to two pediatric cardiologists from Uganda, Dr. Sulaiman Lubega and Dr. Twalib Aliku. Our training helped them establish and independently operate a pediatric interventional program, a cardiac catheterization laboratory at the Uganda Heart Institute. This country’s single cardiac cath lab serves a population of approximately 42 million children and adults. This unique experience of starting and operating a cardiac cath lab in a low-resource setting was described in this recent publication.
Our center has benefited immensely from visiting trainees who have contributed to our research initiatives. We maintain a life-long relationship with our trainees. A recent example is one of our trainees from Sri Lanka, Dr. Chamith Gunasekara, who has contributed vitally to our study evaluating the association between low birth weight and outcomes of neonatal cardiac surgery in low- and middle-income countries.
What challenges has AIMS faced as a regional trainer, before the pandemic and currently with remote training?
Before the pandemic, there were not many challenges. We have had a regular and free influx of trainees. The pandemic has made it very difficult for trainees from other countries to travel. There are significant visa and entry restrictions related to COVID-19.
A number of virtual sessions are now being held to enable the wide dissemination of lessons. The sessions are carefully designed to simulate real-life challenges. A good example is the Children’s HeartLink Center of Excellence webinars on challenges in pediatric heart surgery in low-resource environments, conducted by AIMS and Institut Jantung Negara. Each session focuses on a review of a specific congenital heart defect and a multidisciplinary case presentation. It also includes a review of relevant literature and commentary from invited experts. For now, around 1,000 clinicians—physicians and nursing staff from pediatric heart programs—have attended our lecture series.
What is most satisfying to you when you train and support your peers?
The contribution that we make to the cause of improving care for children with heart disease beyond the geographical confines of our region. The core philosophy at AIMS is affordable, patient-centered care that is provided without any compromise in quality, with a view to ensuring the best possible outcomes. This is imbibed very well by all our trainees who then go on to teach others. The centers that our fellows have joined have started to deliver similar results.
Children’s HeartLink saves children’s lives by transforming pediatric heart care in underserved parts of the world. Founded in 1969, we currently support 18 partner hospitals in Brazil, China, India, Malaysia and Vietnam. Last year alone, the medical providers we trained served 177,000 children with heart disease, more than ever before.