Borderless CICU

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Until very recently, the exchange of experiences and knowledge between Cardiac Intensive Care Units (CICU) has been limited. While this has improved for many in wealthy countries, this type of collaboration remains uncommon in low- and middle-income countries, limited mainly to conferences and some publications with international collaboration. To interact with the editors of the textbooks, or the authors of that amazing publication? Very far from reality!

I was born and raised in Brazil and all my training was done in my home country. In my former CICU, the multidisciplinary team had no international experience, and most of the attendings were alumni of the same institution. Same training, same exposure, same mentors, same style. We were comfortable; it’s human nature to feel more comfortable with the similar and the known. In other words, we like to be in our comfort zone, keeping everything the way we are used to, including our way of thinking.  We were a skilled and experienced team that worked very well together. While having the same background was good for consistency in care, the lack of exposure to diverse perspectives in patient care was somewhat limiting.  Cognitive dissonance favors keeping the status quo. It is also human nature that, while we want progress, we are resistant to change.

I always had the wish to see more, to learn more, and to experience different approaches to care. I did a few observerships in the US and Canada and always came back full of new knowledge and enthusiasm to apply as much as possible of what I learned to my local reality.

Three years ago, the CICU’s borders began to open for me, when I decided to step out of my comfort zone and accept a job in the Middle East. At Sidra Medicine, in Qatar, there are healthcare providers from over 80 countries. It’s amazing to see how the hospital, and specifically the pediatric CICU, can function so well when people with such different training, beliefs, and culture are working together. It is a continuous exercise of learning, sharing, and most importantly, being open-minded.  In addition, a culture of safety, tolerance, and mutual respect is critical.  Despite the challenges, I am really enjoying this experience and I believe I have grown, both professionally and personally.

During the COVID-19 pandemic, attending scientific meetings in person became impossible due to travel restrictions and social distancing concerns.  Fortunately, the internet became the instrument for educational opportunities with virtual conferences and webinars. In the first month of the lockdown, in April of 2020, Drs. Gil Wernovsky and Salvatore (“Sasha”) Agati created something unique: The Congenital Heart Academy (CHA). The CHA is a web based educational platform dedicated to worldwide healthcare providers caring for patients with congenital heart disease, aiming to share high-quality scientific knowledge and experience, in a spirit of collaboration and unity, all around the world, during such a difficult moment in history.

As a member of the international pediatric cardiac community, I found it to be an amazing initiative and I volunteered to help. I was soon rewarded with more responsibilities as the Co-Chair, and in the past couple of years, together we have organized over 100 webinars. With a phone call or email, experts around the world made themselves available immediately, without exception! Sessions covered not only pediatric cardiac intensive care, but anesthesia, surgery, neurodevelopment, and all aspects of pediatric cardiology. Sessions were recorded and posted on YouTube (https://www.youtube.com/c/CongenitalHeartAcademy) which as of July 2023, has nearly 10,000 subscribers, and over 200,000 individual views of the webinars!

What started as a temporary replacement of face-to-face conferences, revealed itself as an amazing tool for health education that I hadn’t ever realized before. Virtual events have an unbelievable reach, are virtually borderless, and reach practitioners of all incomes and social structures.  While evaluating the feedback surveys and personal communication with friends and colleagues, I could understand that this type of event had the ability to reach health care providers who had never had the privilege of attending international conferences, or interacting with those outstanding speakers and panelists, whether for economic, geographic or staff availability reasons. For example, I’ve received an email from a colleague grateful for the opportunity, as he could never attend an international conference because he was the only cardiovascular surgeon within a 300km radius.

While nothing can truly replace face-to-face interaction, the informal and friendly atmosphere of the webinars actually allows greater audience participation for questions and comments. At most large meetings, it is rare to see a trainee approach the microphone to pose a question, but they feel much more comfortable typing it in the Q&A chat box.

I feel fortunate to be part of such an initiative, working hard in my free time to deliver education to Sudan, Argentina, Canada, Singapore, Sri Lanka, Iran… you name it. More than 100 countries have been reached. I feel very touched when a cardiac sonographer stops me in the corridor to comment on the last echo webinar, and so happy to know that the recordings available without cost on YouTube are a legacy from pioneers of our field.  Above all, I feel blessed to be able to help improve the care of children with heart disease, regardless of where they live. Borderless!

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Grace van Leeuwen, MD, FSCAI

Asst. Professor of Clinical Pediatrics at Weill Cornell Medicine – Qatar
Senior Attending – PCICU – Sidra Medicine
Co-Chair of Congenital Heart Academy
Co-chair of Marketing and Communication Committee of the 8th World Congress of Pediatric Cardiology and Cardiac Surgery 2023