Cardiology

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Thursday, May 29, 1997

When Opening a Heart Saves a Life

(May 26) Parents in Moldova, Ethiopia, Gaza and Hebron send their children - weak, lethargic, their skin sometimes tinged blue from lack of oxygen - to a Holon Hospital. Three weeks later, returned to their parents, the youngsters are able to kick around a soccer ball.

Since early last year, the open-heart surgery and rehabilitation have been offered completely free of charge by an altruistic team of volunteers at Wolfson Hospital's pediatric cardiology department.

Led by department head Dr. Amram Cohen, the Save a Child program is unique in the world - repairing more foreign young hearts free than any other hospital in the world.

The idea originated in 1988, when Harriet Hodges, founder of a voluntary organization called Save the Hearts, asked Dr. Cohen - then serving in the US military in Seoul, Korea - if he would operate on some of the children in her program. Hodges was committed to sending 300 poor South Korean children to Western countries for treatment; since her budget was limited, she sent the children to the medical centers with the most reasonable price. Cohen, who was chief of pediatric surgery at the prestigious Walter Reed Medical Center in Washington, D.C., and on a tour of duty in Korea, agreed and performed 35 such operations in Seoul. Bitten by the bug of helping the helpless, Cohen decided to launch his own program when he came on aliya in 1992 and was hired to head the Wolfson pediatric cardiac surgery unit.

Last year, 46 youngsters (including 15 from the Palestinian Authority) had life-saving open-heart surgery at Wolfson, and 150 - 30 Ethiopians, 30 Moldovans, 22 Gazans, 20 Hebronites, 18 Eritreans and 30 Kazakhs - are due to be treated this year. In 1998, Save a Child hopes to reach its maximum possible capacity, at least for the time being, of 250 patients.

Cohen, a big, mustachioed man who was born in the US capital, lived in Israel as a child in the Sixties and returned with his family to Silver Spring, Maryland, to attend high school, Johns Hopkins University and the University of Virginia Medical School. He studied the specialty of surgery at Walter Reed and at Brooke Army Medical Center in San Antonio, and of pediatric cardiac surgery at the Hospital for Sick Children in Toronto.

Now a dual US-Israeli citizen, he continues to serve in the US army as a lieutenant-colonel in the reserves. "I go back for three weeks a year of reserve duty," Cohen explains. "Some US hospitals do three or four pro bono heart operations on needy foreign children a year. There are many volunteer groups that deal with cardiology, but few offer free heart surgery to correct congenital defects in children."

Cohen managed to persuade the management of Wolfson - a government hospital headed by Dr. Moshe Mashiah - to agree to the project; since the operations are performed by doctors and nurses in the late afternoons and evenings on their own time, the program doesn't come at the expense of Wolfson's regular patients. The other volunteer personnel include Dr. Lior Sasson (a surgeon who will soon be sent to California for a year for formal studies in pediatric cardiac surgery - the volume of cases there is large enough to provide expertise in all the various types of operations); pediatric cardiologist Dr. Akiva Tamir, pediatric intensive-care unit director Dr. Sion Houri, intensive-care staff physician Dr. Yoram Ben-Yehuda, pediatric anesthesiologist Dr. Deeb Zabeeda and a dozen or so Wolfson nurses. Sally Esakov, a hospital staffer, donates her time to serve as administrative coordinator of the program, which involves complicated logistics and organization.

In order to choose candidates for surgery, Cohen and some of his colleagues travel to the country where the children live once or twice a year. They and local doctors examine them and the most suitable ones are chosen to come to Israel. Groups of youngsters are arranged so that older children are matched with younger ones during the flight. Met at the airport by Save a Child personnel who speak their language, they are taken to a residence not far from the Holon hospital and supervised by adults as they adjust to Israeli time. After the surgery, they are cared for in intensive care until they are well enough to be moved to the regular pediatric department and from there to the residence to complete their recovery. Three weeks later, they fly home, better than new, and are met with local doctors who ensure proper follow-up.

The cost for all this is $10,000 per child, including flights and accommodations - a very low figure due to all the work by volunteers.

Funds to cover expenses are raised by Cohen and his family and the Wolfson Cardiac Foundation in Rockville, Maryland, with support from the Joint Distribution Committee and the blessings of the Foreign Ministry's Department for International Cooperation (Mashhav). The Herzliya Medical Center has donated its catheterization lab for free diagnostic examinations of the children.

The more money that is raised, the greater the number of operations that could be performed, says Cohen. The hospital's facilities currently limit the annual number to 250, but if that maximum is reached, he will seek local and foreign volunteers from other hospitals, and may even "farm out" some patients to other Israeli medical centers.

There are, at present, seven pediatric cardiac surgeons in Israel, together performing some 400 open-heart operations (to repair or replace defective valves and other congenital defects). "There used to be about 800 annually in the country, but many of them are now never born, as serious defects can be detected during pregnancy and are aborted as fetuses. It isn't yet technically possible to repair such fetal defects in the womb."

While some parents - mostly haredim and Arabs - decide to continue the pregnancy, the risks are relatively high, and 10% of the babies die soon after birth. "There is no queue for such heart surgery here; none of us are overworked," Cohen says. There is no reason to send a baby with a congenital heart defect abroad today, a situation that existed as late as the Eighties, he continues, as he and his colleagues have been well trained here and abroad.

Although the young foreign patients are the main beneficiaries of the program, Cohen says that he and his team gain as well. "We deal with cases that we wouldn't ordinarily confront in Israel, where babies are diagnosed and treated quickly. Children from abroad tend to come older, sometimes at an age beyond the limit of surgery here. And because we can't count on the same type of follow-up and drug treatment there that we give here, we often repair faulty heart valves instead of replacing them completely."

Word about the success of the project has gotten out, and requests for inclusion in the program have been informally made by Nigeria, Kenya and China. "We will do our best. In some countries, there are 400 or 500 children waiting in their local hospital's queue for heart surgery but only a handful are accepted, or local facilities may be unable to offer such treatment at all."

For more information and donations, Save a Child can be contacted at (03) 502-8723 or (09) 955-9528; by e-mail at uniqtour@netvision.net.il or at the Wolfson Cardiac Foundation, c/o Kamerow, Weintraub and Swain, Suite 800, 11400 Rockville Pike, Rockville, MD 20852-3004.

Thursday, February 20, 1997

Company Offers TV-Phone Contact
Between Doctor and Patient

JERUSALEM (February 17) - The Shahal emergency medicine company has unveiled the country's first home application of the integrated services digital network (ISDN) - a TV phone that lets subscribers and Shahal center doctors see each other and speed diagnosis, overcoming heart patients' reluctance to seek help for every little pain.

The TV phone, manufactured by British Telecom, links up with Bezeq's ISDN lines to provide what is apparently the first such medical application in the world.

Images on the 12.7-centimeter color screen are very crisp and lifelike, but the service is not cheap: NIS 5,400 for the device (which is the size of three stacked Tel Aviv phonebooks) plus NIS 480 (a special introductory offer) for the ISDN phone line.

Shahal, which has 40,000 subscribers around the country for its other services, does not intend to rent out the phones at present, but only to sell them.

The innovation, which yesterday elicited much interest, was kept carefully under wraps: Shahal staffers themselves were shown the device only on Friday.

Prof. Arye Roth, a medical adviser for Shahal, noted that heart patients are typically reluctant to seek help when suffering symptoms, believing they will go away. This makes the average time between suffering heart attack symptoms and going to the hospital about three hours.

The delay significantly increases the risk of death, as medications to dissolve blood clots in a coronary artery are most effective when administered shortly after the attack. Shahal, which has until now offered a service transmitting electrocardiograms over a phone line, has reduced the delay time to an average of only 44 minutes among its subscribers.

The TV phone is expected to shrink this period even more. Patients with the device feel that medical staff are with them in their home rather than far away, and reduces anxiety about getting ill, Shahal officials said.

Other Shahal innovations are Teledelet, a device that automatically opens the front door of subscribers who are incapacitated inside; Telepress, which automatically takes blood pressure readings and transmits them over the phone; and P-100, a system for sending respiratory data over the line. The company also sells franchises to provide such services abroad.

Wednesday, October 16, 1996

J'lem Researchers Develop Chip
To Aid Surgeons

JERUSALEM (October 16) -- A team of Jerusalem researchers has successfully developed an electronic chip capable of creating an image from an object's thermal radiation.

The chip's many applications include the identification - during open-heart surgery - of blocked blood-vessels. It will replace bulky and much more expensive electronic and mechanical devices.

The chip was built by a team at the Jerusalem College of Technology (JCT). It functions in a thermal-sensing camera in a way similar to that of a retina in the human eye, and contains 16,000 tiny thermal-radiation detectors.

The development, by Dr. Shmuel Borenstein, was conducted in cooperation with Opgal Industries of Karmiel and with the center for sub-micron technology at the Weizmann Institute in Rehovot.

In heart surgery, the chip can be used by surgeons to verify proper blood-flow in vessels grafted as coronary bypasses, before the patient is sewn up. Blocked blood-vessels radiate a lower heat-level than healthy ones, making the detection of problems possible with the use of the new thermal sensor.

Until now, the use of such a medical system for open-heart surgery was prohibitively expensive. The JCT sensor will allow for widespread use of thermal imaging for commercial applications.

The research team already has begun its second phase of development on a much denser detector array, with more than 82,000 detectors on a one-centimeter-square chip. JCT's business arm has formed a new company, Sagi Nahor Ltd., to realize the device's business potential and is negotiating with prospective investors.