Our Center of Excellence in Malaysia Helps Improve Cardiac Programs in Several Countries

This is the third 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 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 our work helps the most children the fastest.

Nurses in training at Institut Jantung Negara, 2018

Institut Jantung Negara (IJN) is located in the national capital of Malaysia, Kuala Lumpur. It’s widely recognized as a regional leader in pediatric cardiac care. With Children’s HeartLink support, IJN offers one of the largest and most comprehensive pediatric cardiac fellowship programs in the region to medical professionals from low- and middle-income countries. So far, IJN has prepared 75 fellows from overseas for clinical practice in pediatric cardiology and intensive care as well as provided training experience in cardiothoracic surgery for 21 fellows. With borders closed, IJN had to pause its in-house fellowship programs for foreign trainees and switch to online training, in collaboration with our other Center of Excellence, Amrita Institute of Medical Sciences in India

Foreign trainees

“IJN has been involved in cardiovascular disease training programs for over a couple of decades,” says Dr. Sivakumar Sivalingam (Dr. Siva), Deputy Head of Cardiothoracic Department at IJN. “One group of fellows is focused on targeted training to get more exposure to the surgical and catheter-based intervention. The fellows from the other group, mostly from Southeast Asia, Middle East and North Africa, come to IJN for more structured training as these countries lack a structured training program. Since the partnership with Children’s HeartLink, we have received many surgical fellows in the training program over the last 15 years,” adds Dr. Siva. 

Institut Jantung Negara announced as Children’s HeartLink Center of Excellence, 2016

“In low-income countries, we access knowledge mainly from books, newspapers, and hands-on skills from senior surgeons. The fellowship training program organized by IJN and Children’s HeartLink has given me a huge opportunity. I look forward to continuing to have learning opportunities to improve the treatment results for congenital heart patients,” says Dr. Mai Dinh Duyen from National Children’s Hospital Hanoi, Vietnam, who had completed her first year of fellowship at IJN just before the pandemic started. 

IJN has provided cardiology fellowship positions for trainees from Indonesia, Vietnam, Sudan, Nepal, Egypt, Libya, Pakistan and Saudi Arabia. The Pediatric and Congenital Heart Center at IJN has offered them a fellowship program for a duration of one year, which could be extended to two years. 

Besides, IJN has been involved in the training of all the pediatric cardiologists and cardiac surgeons from Malaysia. It includes trainees referred by Malaysia’s Ministry of Health and local universities.

Dr. Siva admits that there are some challenges to train fellows from other countries: “Each trainee comes with a varying level of experience, and it is very difficult to identify these issues prior to commencement of training at IJN. Many trainees come from regions where their basic medical degree may not be recognized by the Malaysian Medical Council. There are no certifying examinations to qualify these candidates to get registration for getting involved in clinical practice.” 

Online training  

During the pandemic, two of Children’s HeartLink’s Centers of Excellence—Amrita Institute of Medical Sciences (Kochi, India) and IJN—have started conducting online webinars on challenges in pediatric heart surgery in low-resource environments. Currently, over 1,200 physicians and nursing staff from pediatric heart programs have attended this lecture series.

“The Children’s HeartLink Center of Excellence webinar series has been well organized to promote education over the last year. This has come in a timely manner wherein it is difficult to organize educational programs on-site due to travel restrictions as the world is ravaged by the COVID pandemic. The online webinars are extremely useful as we are still able to continue our training with the regional audiences. We are able to extend our educational activities with our partnering centers in Vietnam, Indonesia and Myanmar. Our IJN team too has benefitted from the webinar lecture series and also the other online educational series,” says Dr. Siva.

To make online training more effective, IJN incorporated new technologies into its curriculum for surgical trainees. 

“Virtual training is a good alternative training tool for training. However, virtual training is efficient for providing didactic lectures to trainees. It is difficult to conduct virtual training when it comes to practical aspects such as training in surgical techniques or catheter intervention. We have managed to conduct some dry lab and web lab simulations on a virtual platform. This is, indeed, a work in evolution, and we hope to fine-tune the processes to make it effective,” explains Dr. Siva. 

Outcomes

A number of centers had sent their teams of surgeons, cardiologists, and intensive care specialists to IJN for training. This has helped IJN maintain strong relationships to continue its training programs to help more clinicians who will come for training in the future. 

“Over the years, we had successfully helped improve the pediatric cardiac programs in Sudan (Ahmed Gasim Hospital, Khartoum); Indonesia (Dr. Cipto Mangkunkusumo Hospital, Jakarta);  Vietnam (University Medical Centre of HCMC, Ho Chi Minh City); Pakistan (National Institute of Cardiovascular Diseases, Karachi); and Myanmar (Yankin Children’s Hospital, Yangon). As a trainer, it is the most satisfying to see our trainees from different regions start new cardiac programs or help improve already established programs in their home countries. This itself is an impetus for the institute to continue the mission of providing training and education in cardiovascular care within the country and region,” says Dr. Siva.

Read about our Center of Excellence in India: Our trainees establish cardiac programs

Read about our Center of Excellence in China: West China Hospital uses 3D heart models in training