Renzo Cecere, Surgical Director of the Heart Failure and Heart Transplant Program at the MUHC, describes how international work benefits patient care at home. —Report from a presentation at the 2012 conference of the MUHC-ISAI

Dr. Cecere helps develop cardiovascular care models abroad, primarily in the Middle East and Asia Pacific where material resources are plentiful but models are needed to deliver effective care to the population.

We work with colleagues in partner/client institutions abroad to identify gaps in their programs we can help close. We assess their needs very carefully and find areas where capabilities identified within our institution can be useful. Matching their needs with interests and expertise within our institution allows us to select international collaborations that have significant returns at home.

Novel technologies

In choosing partners abroad, we look at their strengths in different areas. In the delivery of high-level cardiac care, which is highly dependent on technology, we tap into various markets where devices, technologies and novel therapies are in high demand and have achieved regulatory approval.

Some forms of therapy for end-stage heart disease include mechanical support devices, mechanical pumps that we attach to the patient’s heart as a substitute to their own heart. Many of these novel devices have not yet gone through the very stringent regulatory processes in the U.S. and Canada. The European regulatory process is different and in some ways a lot more liberal, allowing these devices to receive the CE mark of approval, which hospitals in many other parts of the world, including the Middle East and Asia, rely on to approve implementation.

The MUHC/McGill University has partnered with hospitals where these devices are approved to help them implement optimal ways of using them to improve care. This has been a very successful model for the MUHC and there has been tremendous interest from our colleagues in Asia and the Middle East in using these novel therapies, either as a standard of care or as a research program. These projects allow us to share expertise but also gain experience with technologies we do not yet have in our institutions.

Research populations

Many of the geographic areas where we are engaged have, as part of their genetic makeup, very high incidences of certain diseases, such as diabetes, hypertension and obesity. We have experts who are recognized as global leaders in the study of these disease patterns, but do not always have the high volume of patients necessary to answer a research question in a reasonable amount of time. Researchers greatly appreciate the opportunity to study populations where the disease prevalence and population are much higher, enabling them to generate data much more quickly and find solutions to these very important health issues.

Supports for international collaboration

Dr. Renzo Cecere and his MUHC colleagues,  Ms.  Patricia O’Connor and Dr. Tarek Razek, were asked how their organizations could help them develop international collaborations and implement the innovations they bring back. Here are their main prescriptions:

• No high-level institution in North America has the redundancy to deliver high-level care halfway around the world on a consistent basis. Partnerships across faculties within the university, across hospitals within a city, and across universities within North America become essential.
• To bring innovation back into the home institution, initiatives need to align with other agreed-upon corporate priorities.
• Global collaboration needs to be very highly respected by the hospital and university. Recognition of the bipartisan benefits achieved through partnership would give physicians and nurses greater “permission” to undertake these activities.
• Support from the executive team is essential for new ideas to be implemented. That requires focus over a considerable period of time. It cannot just be the “flavour of the month.”
• The vision of the academic health centres must expand to include global collaboration and be shared by all levels of management, right up to the Ministry of Health. This is essential to ensure the level of human resources required to conduct these activities while never threatening the core mission of caring for patients at home.
• Incubators and think tanks should be promoted within the institution to enable like-minded people to come together to generate innovative ideas for the international community.