The Bambino Gesù Paediatric Hospital's international humanitarian programme

INTERNATIONAL PROGRAM

The Bambino Gesu PaediatricHospital’s internationalhumanitarian programmeGiuseppe De Simone

Gian Franco Bottazzo

AbstractThe Bambino Gesu Hospital (Ospedale Pediatrico Bambino Gesu, OPBG)

is engaged in humanitarian activities conceived to provide healthcare

as well as medical and nursing training to developing countries. The

humanitarian programme involves many activities: health care and

consulting activity in developing countries; referral to the OPBG of

patients in need of highly complex surgical interventions; training at

the OPBG and in the field for medical, nursing and technical staff; the

provision of medical and laboratory equipment; as well as contributions

to the development of healthcare facilities. The programme currently

involves 16 countries in four continents, providing care for over 900

patients and training physicians, nurses and technicians. The OPBG

intends to pursue this humanitarian cooperation programme with great

intensity, with the intention of providing direct care and primarily of

promoting sustainable development in the countries involved.

Keywords care; developing countries; humanitarian activities;

international mission; sustainable development; training

The Paediatric Hospital Bambino Gesu (Ospedale Pediatrico

Bambino Gesu, OPBG) recognises as a fundamental part of its

institutional mission the support and care of children living in

countries with precarious socio-economic and health conditions

whose life is endangered. The humanitarian mission programme

involves several kinds of intervention:

� missions by OPBG healthcare staff in foreign healthcare

structures to provide direct care and consultancy activity;

� the transfer to the OPBG of children with very complex

diseases, mostly cardiological, to receive highly specialised

surgical care that cannot be performed in their country of

origin;

� the training of healthcare, medical, nursing and technical

personnel either on site or in-house at the OPBG;

� the supply of laboratory and medical equipment.

Giuseppe De Simone MD PC is a senior cardiologist in the International

Missions and Cooperation Program, Ospedale Pediatrico Bambino Gesu

e Scientific Institute for Research, Hospitalization and Health Care

(IRCCS), Rome, Italy.

Gian Franco Bottazzo MD FRCP FRCPath is a Scientific Director of the

Ospedale Pediatrico Bambino Gesu e Scientific Institute for Research,

Hospitalization and Health Care (IRCCS), Rome, Italy.

PAEDIATRICS AND CHILD HEALTH 19:S1 S6

Countries in which the OPBG has carried out international

mission activity

Algeria

The OPBG has organised an in-house scholarship programme to

train Algerian medical and paramedical staff.

Bangladesh

The missions related to plastic surgery began in 1991 and lasted

until 2006. They took place at the Santa Maria Sick Assistance

Centre in Khulna and involved several OPBG surgical teams:

plastic surgeons, orthopaedic surgeons, urologists and general

surgeons.

Ethiopia

The cooperation project saw several missions by OPBG’s plastic

surgery teams at St Luke’s Hospital in Wolisso to treat children

affected by cleft lip/palate or with severe burns. One undertaking

carried out in October 2006 allowed surgical correction for 19

patients.

Haiti

In 2002, a cooperation agreement with the Haitian Ministry of

Health developed a training programme for one paediatric

surgeon for a period of 1 year, one intensive care physician for 2

months and two intensive care nurses for 3 months. Further-

more, updating courses on human immunodeficiency virus (HIV)

and on mother-to-child transmission have been carried out.

Ivory Coast

The 2004 cooperation agreement between the OPBG and the

Ivory Coast Ministry of Health involving the Alepe Children’s

Hospital has witnessed:

� upgrading of the paediatric ward and of the laboratory of

immuno-infectious diseases;

� clinical experimentation with a paediatric vaccine capable of

blocking the mother-to-child transmission of HIV virus during

breastfeeding;

� the joining of OPBG researchers and physicians in the pro-

gramme Families First Africa;

� surgical assistance to children with oesophageal stenosis due

to caustic materials carried out by a team from the OPBG Unit

of Surgical and Digestive Endoscopy.

Libya

During 1999, in response to a request from the Libyan Govern-

ment (through the Ministry of Foreign Affairs), the existing

assistance in favour of children affected by HIV/acquired

immune deficiency syndrome (AIDS) was increased on a yearly

basis, and a group of children affected by HIV were included in

a follow-up programme. The OPBG became, for the year 2000,

a referral centre for patients and their families presenting with,

besides the known pathologies, a wide range of care needs,

including complex surgery. Within this programme, intense field

training has been carried out with Libyan physicians, achieving

significant results in terms of the transfer of technical and

scientific skills.

The aim of this cooperation, which is part of the EU’s Action

Plan 2005, is aimed at providing clinical and laboratory assis-

tance for the 405 Libyan children with nosocomial HIV infection.

� 2009 Published by Elsevier Ltd.

Figure 1 A Libyan child with severe dystrophy in AIDS-related wasting

syndrome before and after a period of treatment in Italy.Figure 3 The Casa Doru, a new pavilion at the Bucharest Victor Babes

Hospital that has been refurnished by the OPBG.


Since 1999, these children have been regularly referred to the

OPBG for treatment and follow-up (Figure 1). In addition, OPBG

doctors and technicians regularly visit Benghasi to train local

doctors and technicians in clinical and laboratory work related to

HIV infection.

Madagascar

Cooperation between the OPBG and the Clinique St-Damien in

Ambanja started in 2002 (Figure 2). Three cardiology missions

have performed about 900 visits, and children have received the

appropriate medical treatments. Two patients with congenital

heart malformations have been transferred to the OPBG and

successfully operated on.

Peru

A cooperative treaty between the OPBG and Lima’s Children’s

Hospital was set up in 2001 and consisted of the bilateral orga-

nisation of meetings and seminars on paediatric cardiology and

cardiosurgery, training stages at the OPBG for Peruvian medical

and nursing staff, and transferral to the OPBG of patients with

congenital heart disease who were in need of highly specialised

surgery.

Figure 2 The Clinique St-Damien in Ambanja, Madagascar.


Romania

Romania is the European Country with the highest number of

children affected by HIV. In 1997, a wide cooperation project

began with the Romanian Ministry of Health in a paediatric ward

of the hospital in Bucharest (Figure 3). Here, young AIDS patients

(Figure 4) have been treated by physicians: one immunologist,

one dermatologist and two plastic surgeons.

Between 1997 and 2001, humanitarian activity developed to

involve many Romanian healthcare centres: Bac�au, Bucharest,

Constanta, Cernavod�a, Craiova, Galati, Giurgiu, Postcura, Targu

Muresx and Vidra. In 2006, thanks to a protocol of agreement

between the OPBG and the Romanian Ministry of Health and the

Romanian Family, the professional training of local healthcare

staff in the field of paediatric infectious diseases and dermatology

was made possible.

Santo Domingo

Following the 2001 cooperation agreement with the Italian Latin

American Institute (IILA) for an exchange programme of

professional skills for medical and paramedical staff in the Latin

American countries selected by the IILA, professional upgrading

courses for physicians and nurses were run at the Hospital

General de la Plaza de la Salud, with a regular exchange of

medical and paramedical staff between the two institutions.

Furthermore, there have been haemodynamics sessions as

well as three cardiosurgery missions to Santo Domingo with 15

surgical operations for the correction of complex congenital heart

Figure 4 A severe case of multiple molluscum contagiosum of the eyelids

of a Romanian child before and after surgery.



disease, while five patients affected by complex heart diseases

have been operated on at the OPBG. A study has also started on

the prevention of mother-to-child transmission of HIV infection.

Additionally, several international courses on HIV infection and

AIDS have been organised, with participants from El Salvador,

Haiti, Nicaragua, Honduras, Costa Rica and Panama. The last

course was held in October 2006.

Countries in which the OPBG is still active

Albania

Figure 6 A child with a cleft lip before and after surgery.

A cooperation agreement was signed at the end of December

2007 with the Albanian Ministry of Health. The cooperation

programmes include: healthcare at the OPBG for children

requiring highly specialised care; the training of medical and

nursing staff; missions in Albania with OPBG specialists; and

a telemedicine service.

Cambodia

Cooperation between the OPBG and the Ministry of Health of

Cambodia began in 2002 at Dankeo Children’s Hospital in Takeo.

In 2008, the OPBG has contributed to the development of a clin-

icalesurgical centre (Figure 5), with 27 beds for ordinary hos-

pitalisation, eight intensive care beds, a fully equipped operating

theatre, a sterilisation facility, a medication room, a physicians’

room, a conference room and a playroom for the children,

a laundry and a study centre.

A OPBG plastic surgeon always on site, and OPBG physicians

are available on rotation for all specialties. In particular, surgical

care is provided in the areas of: reconstruction (malformation of

the face, hands and genital area); burns and scars; orthopaedics

(hands, clubfoot, pseudo-arthrosis, bone malformations and

general surgery: hernias, hydroceles, varicoceles, thyroid gland

and genitalia); cardiology and cardiac surgery (consultations and

the transfer of serious cases to Italy, nine patients having been

transferred); and otorhinolaryngology (chronic perforations,

mastoiditis and cholesteatoma; Figure 6).

Clinical care is provided in gastroenteric diseases, infectious

diseases such as Dengue malarial fever, encephalitis, meningitis,

typhus and nephrotoxic syndrome. Since January 2008, a service

for treatment of serious malnutrition has been activated, as has

Figure 5 The Dankeo Children’s Hospital in Takeo, Cambodia.


training for the medical and nursing staff of the Takeo Centre; the

latter has included computer and English courses as well as

a 3-month training stint at the OPBG.

Ecuador

Cooperation programmes with Ecuador are active still today on

the basis of the agreement signed in 2003 between the OPBG and

the Ecuador National Institute of the Child and Family, including

in the programme the institution of specific scholarships. Medical

activities are carried out at Baca Ortiz Hospital in Quito.

The cooperation foresees: the hospitalisation of young

patients affected by serious and complex pathologies: enhance-

ment of the professional training of Ecuadorian physicians,

nurses and health assistants; charitable interventions in favour of

the children’s hospital Baca Ortiz in Quito; specialised paediatric

treatments for young patients coming from this South American

country; a training programme with international scientific

seminars; a specific training programme in cardiosurgery; and

a scholarship programme, started in February 2007, to support

the training of Ecuadorian medical and surgical staff at the OPBG.

Georgia

In 2003, a humanitarian cooperation project started between the

OPBG Unit of Neurology and Caritas Georgia focused on the

Tblisi Children Hospital. Regular donations of hospital equip-

ment, such as an electroencephalograph, were made, while the

Figure 7 The Village of Hope in Dodoma, Tanzania.


Figure 8 The laboratory facility at the Village of Hope, Dodoma, Tanzania.

Figure 10 The National Children’s Hospital in Hanoi, Vietnam.


OPBG neurologists regularly travel to Tblisi for consultations.

The OPBG also supports a scholarship programme in paediatric

neurology to train Georgian medical and technical staff at the

OPBG.

Tanzania

Distribution of countries involved in the OPBGhumanitarian programme

Continent Country

Asia Cambodia

Bangladesh

Georgia

The OPBG cooperation with Tanzania began in 2003, contrib-

uting to the building of the Village of Hope for orphans

(Figure 7). The village is located in Dodoma, the country’s new

capital, and is run by the Suore Missionarie Adoratrici del Sangue

di Gesu and by the Padri Missionari del Preziosissimo Sangue. It

provides live-in care for 130 seropositive children, orphans

whose parents have both been killed by AIDS.

During the first semester of 2005, a team of OPBG physicians

and laboratory and microbiology technicians travelled to

Tanzania to test electromedical equipment donated by the OPBG.

They performed diagnostic tests, beginning with viral load and

lymphocyte count, essential for the application of new and

particularly effective antiretroviral therapies. Then, in the second

semester of 2005, OPBG physicians and laboratory technicians

guaranteed continuity of the diagnostic service and took care of

local personnel training in order to make the village completely

self-sufficient in diagnostic and therapeutic activities (Figure 8).

In January 2005, a cooperation project started between the

OPBG and the St Gaspar Hospital in Itigi, Singida region, located

between a major arterial road and a railway line (Figure 9). Its

Figure 9 The St Gaspar Hospital at Itigi, Tanzania.


position means it is easily accessible from the surrounding

regions and villages and makes it a referral centre for an

increasing number of patients. In this region, there is no elec-

tricity, and the nearly 14 000 inhabitants live in huts made of

mud. They do not receive drinkable water, water being collected

from puddles in the rainy season, often several kilometres away

from the village.

The cooperation between the hospital and the OPBG foresees

the donation of equipment, training for local staff and the

provision of care related to a respiratory monitoring unit,

congenital heart disease facilities, with cardiosurgery being per-

formed at the OPBG, the constant presence of one paediatrician

on a 3-monthly rotation, and plastic surgery for the treatment of

burns.

Haiti

Vietnam

Africa Algeria

Ethiopia

Ivory Coast

Libya

Madagascar

Tanzania

South America Peru

Santo Domingo

Ecuador

Europe Albania

Romania

Table 1



Vietnam

Since 2005, cooperation with the National Children’s Hospital in

Hanoi has been active in the fields of cardiosurgery, molecular

biology, virology and genetics. The OPBG has helped with

refurnishment of the hospital and has provided new medical

apparatus (Figure 10).

The cooperation foresees the exchange of specialised skills for

invasive and non-invasive diagnostic cardiology and for more

complex cardiosurgical interventions. In 2007, the OPBG sent

a medicalenursing team composed of three experts to train the

local medical and nursing staff in paediatrics and urology.

Furthermore, the programme includes staff training in genetics

and in the molecular biology laboratory with specialised

personnel who spend long period of activity at the Hanoi

Hospital, as well as scholarships for Vietnamese physicians and

nurses to train at the OPBG.

Conclusion

The OPBG humanitarian cooperation programme has proven

successful and now involves 16 countries in four continents,

providing care for over 1000 patients and training physicians,

nurses and technicians (Table 1). The improvement in healthcare

facilities associated with training healthcare staff (physicians,

nurses and technicians) has allowed a significant improvement

in the healthcare provided in the institutions involved in the

cooperation programme.

The model chosen for this programme has intended not only

to transfer technical and scientific resources while giving an


example of solidarity, but also to respect the local realities and

traditions, as well as promoting self-development and autonomy,

and regaining for doctors and nurses a feel for the healthcare in

their local setting. The loss of newly trained local staff seeking

employment in more developed and central national institutions,

an occurrence expected in this kind of programme, has been

infrequent and has not influenced the positive outcome.

The OPBG intends to pursue this humanitarian cooperation

programme with great dedication, with the intention of providing

direct care but primarily promoting sustainable development in

the countries involved.

Conflict of interest

None of the authors of this paper has a financial or personal

relationship with other people or organisations that could inap-

propriately influence or bias the content of the paper. A

Acknowledgements

We wish to thank all our OPBG colleagues who have, over the

years, taken part in the humanitarian programme. It is only by

their expertise and loving care that the development of such

a programme has been possible.


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The Bambino Gesù Paediatric Hospital's international humanitarian programme