HOW ONE PAEDIATRIC CARDIOLOGIST IN TRAINING IS BENEFITING FROM A TWIN CENTRES FELLOWSHIP

Barbara Edewele Otaigbe, a paediatrician from the University of Port Harcourt Teaching Hospital in Nigeria was awarded a Twin Centres Fellowship, which gave her the opportunity to complete her training in paediatric cardiology at the Institute of Cardiovascular Diseases of the Madras Medical Mission in Chennai, India. Her main goal is to return to Port Harcourt, where there are no paediatric cardiologists, with the ability to make competent diagnoses with echocardiograms.

Twin Centres Fellowships: increasing the capacity of less advantaged cardiology centres

The purpose of the Twin Centres (TC) Programme is to enhance the quality and capacity of cardiology centres in less advantaged countries or regions. This is achieved using a fellowship programme. The fellowship is the integral part of the Twin Centre arrangement. Fellows are physicians or cardiologists who receive post graduate training in specified area of cardiology. This programme allows young cardiologists and cardiovascular scientists to undergo training in the best centres of the world.

Each fellow receives a grant of 25,000 Swiss francs to help cover 12 months of living expenses. The fellowships/traineeships are granted for a period of one year. Recipients of the awards must agree to return to their country of origin to assist in the development of cardiology in that region.

Dr Barbara Edewele Otaigbe: the first 6 months

Dr Otaigbe, a paediatrician from the University of Port Harcourt Teaching Hospital in Nigeria was twined with the Madras Medical Mission in Chennai, India. She is undergoing her training in the Paediatric Cardiology Department which is a subunit of the Institute of Cardiovascular Disease (ICVD), at the Madras Medical Mission. The Dean of ICVD is Dr Philomena Mariados, while the Head of Department of the Paediatric Cardiology Department is Dr Suresh Kumar. One of Dr Otaigbe’s specific goals is to return to Port Harcourt, where there are no paediatric cardiologists, with the ability to make competent diagnoses with echocardiograms.

She shares her learning’s from the first six months and the skills she hopes to take back to her home country of Nigeria.

The training programme

• Clinical Rotations: 3 months stay in EACH of

• Ward postings
• ECHO room/Outpatient Department posting
• Paediatric Intensive Care Unit (PICU) posting
• Cardiac Catheterisation Laboratory posting

• Didactic Lectures: 08:00-09:00, Monday to Friday (except alternate Wednesdays)
• Seminar Presentations: Alternate Wednesdays, 08:00-09:00
• Journal Club meetings: Saturdays, 08.15-09.15
• Grand meeting with Adult Cardiologists/ECG/CATH/Mortality meeting- 10:00-12:00, every Saturday

My experience so far: the words of a trainee

Ward Posting: I started my 3-month ward posting on Saturday, 1 February 2008 and ended on 30 April 2008. I was involved in the admission of pre-operative paediatric cardiac patients and was responsible for clinical consultative services for both pre-op and post-operative patients as well as for medical admissions and emergencies. I was also on call once a week and during weekends (5 calls per month).

My duties involved ensuring all patients were duly clerked, examined and that the blood samples were collected for investigations. The patients were presented to the consultants at the daily morning and evening rounds with the results of the CXray, ECG, ECHO and blood investigations. Medical management was also instituted by me, if needed. The status of every patient in the ward was reported to the Head of Department at 21:00 every evening by the Fellow on call.

Skills acquired: During this period, I improved my skills in identifying murmurs, interpreting ECG and chest x-rays and making provisional diagnoses before the patient’s final diagnosis was confirmed by ECHO. This is especially important to me as I come from a country were ECHO machines are not readily available. Now I can diagnose with a lot more confidence, and teach medical students on how to make provisional diagnosis in the absence of ECHOs, wherever they are posted and thereafter send to a centre with an ECHO machine. I also can treat medical conditions associated with paediatric heart diseases better.

ECHO/Outpatient clinic: I started this clinic on 1 May 2008 and should end on the 31 July 2008. It is in this clinic that the first contact with the patient is made. The patients are either referred by another physician outside the hospital or occasionally by self referral. As a Fellow, I evaluate all new patients after taking a history through an interpreter (most times, a Physician Assistant), review with the ECG and chest x-rays and then send for an ECHO. From here, clinical-management plans are formulated, either in favour of emergency surgery, elective surgery or interventional surgeries. I started by observing ECHOs for the first two weeks after which I was allowed to perform post-op ECHOs only. Now I have the authority to do ECHOs on new patients, under supervision. In the past 2 months and 3 weeks, I have done 98 ECHOs, a third of which are on new patients.

Taking knowledge back to my home country

“I wish to again thank the World Heart Federation for giving me this lifelong and life-saving opportunity. I promise to go back, buy the cheapest but durable ECHO machine and give the Children of the Niger Delta of Nigeria and Nigeria as a whole (as much as possible), a chance to be properly diagnosed, properly treated medically and referred  appropriately for  cardiac surgery in instances where they can afford it.”