Heart2Heart

PROJECT PROFILE 2018-2019 www.rcofeltahrir.webs.com

Background HEART 2 HEART - PROJECT OVERVIEWStrategic Egypt has roughly 17’00 CHD cases per year Alliance • That’s around 33% of neonates born with congenital heart disease • H2H uses minimal invasive procedures for treatments RC of El Tahrir intends Heart2Heart as one of its sustainable development projects spanning from 2017-2020 •In the Rotary year 2017-2018 RC of El Tahrir completed 28 cases •In the first quarter of Rotary year 2018-2019 RC of El Tahrir completed 22 cases with the aim to complete another 50 by the end of Rotary year 2019 •RC of El Tahrir’s target for 2019-2020 is to complete an additional 50 cases. Procuring specialized early detection equipment for the PICU at Aboul Reesh Children’s Hospital. Aboul Reesh Children’s Hospital Assiut University Hospital Sohag University HospitalCompliance GOE Medical • the Health • Cardiology initiative issued • Ophthalmology, by the GOE to • Oncology, diminish waiting • tumors lists for critical • kidney and liver surgeries issued on July 18, 2018 transplant8/25/2018 Heart2Heart; an RC of El Tahrir Project; 2 Member of D2451 Rotary Egypt

HEART 2 HEART - PROJECT OVERVIEWDemography Sources: World Congenital Heart Result of Lack of Bank; UNICEF Defect in Egypt Access to Medical •Egypt demographic •CHD is 1% of Care data a one person newborns at a birth gain every 17 rate of 3.1 •an estimate of seconds •Confounding factors 35’000 newborns such as cousin with CHD yearly. marriages & chronic disease prevalence •50% of those will need intervention before age 5 •one third of the intervention is catheter interventionHealth Care Due to their high costs, because of their consumables, the GOE health services do not cover Need catheter interventions. The current health care system, only covers surgeries. However, because of the staggering waiting lists, the MOE can not cope, with the piling waiting lists for surgical cases; despite of the fact that catheters are significantly less invasive. Cardiac catheter interventions in children is pointedly more expensive because of the consumables needed (please review the budget section of this project profile) Children in upper Egypt are less fortunate because they have locally equipped hospitals; both Government and private, but they lack access to the consumables required, and qualified staff. Children and their families have to travel 500 kilometers or more, to Cairo to receive the badly needed treatment that they require but cannot afford. Heart2Heart will cover that need.Heart2Heart •Local junior doctors Extend Health Care to Children in Remote •Local hospitals do not •Children with heart Targets Areas have the consumables defects are listed at local •Nurses needed we need to hospitals and are Medical Capacity Building on the Ground •Technicians Build Community Awareness provide inventory for the prepared by doctors there hospital to be able to do •Specialized Pediatric the catheter interventions •Lists are made available Intensive Care Unit Staff for NGOs, charities to •However, these local sponsor treatment hospitals have the infrastructure equipment •As H2H qualified trained like: doctors from Cairo University will screen the •Monitors, patients ourselves and repeat echo imaging when •Echo machines. needed and this will be training to local junior •ECG machines, doctors •Catheter suites 3 •H2H will build their capacity to extend service in their area8/25/2018 Heart2Heart; an RC of El Tahrir Project; Member of D2451 Rotary Egypt

HEART 2 HEART - BUDGET OVERVIEW – RY 2018 - 2019 Category Description Cost in Cost in EGP USD1 High Nurse To train an average of 15 22,500.00 1,184.21 nurses for the PICU 25,000.00 1,315.792 ICU Doctor – After procedural care 1,100,000.00 57,894.74 Night Shift 10,526.32 200,000.00 31,578.953 Supplies 1 Devices for closure of the 600,000.00 heart holes4 Supplies 2 Consumables Package (Operating5 Hospital Theater & One Night plus doctors) Accountant, Banners,6 Misc. Expenses Travel to Remote Areas in 12’200.00 642.11 Egypt, Accomodations & Admin Expensesetc. Total H2H budget 2018-2019: 1’959’700.00 103’142.11 EGP USD HEART 2 HEART - SUSTAINABILITY• USD 103’140 operating cost for Training • Neonates Current •GOE Health Care does not 2018-2019 • Infants Status cover catheters • Capacity building by Cairo • Families• Budget subject to price University Staff increase for the following year Livelihoods in accordance to market • Will save whole families parameters and international prices. 2 Year •Coverage is expected Plan within the law due to be Budget Requirements issued by 2020 2018-208/25/2018 Heart2Heart; an RC of El Tahrir Project; 4 Member of D2451 Rotary Egypt

Heart2Heart PremiseAccording to Index Mundi the crude birth rate in Egypt is at 29.6births/1,000 population (2017 est.). Furthermore, according to a studypublished by the Alexandria Journal of Pediatrics, Congenital; authored byDr. Amal El Sisi (et al.) heart disease (CHD) is the commonest single groupof congenital abnormalities, accounting for about 30% of the total. Also GITanomalies and abdominal wall defects represent a considerable proportionof the congenital anomalies. Many studies proved a significant associationbetween cardiac anomalies and somatic anomalies.1,2 Associated cardiacanomalies with other types of congenital anomalies, especially GITanomalies can vary from simple lesions as ventricular septal defect (VSD)patent ductus arteriosus (PDA) and tetralogy of Fallot (TOF) to rareassociations as intracardiac epithelial cysts. Down syndrome is commonlyassociated with cardiac anomalies as well as intestinal anomalies.The incidence of congenitalheart disease (CHD) in thewestern industrialized worldhas varied from a low valueof about 3 to 5 per 1000 livebirths to about 12 per 1000live births. Most of the lowerincidence figures wereobtained before there weresufficiently well trainedpediatric cardiologists.8/25/2018 Heart2Heart; an RC of El Tahrir Project; 5 Member of D2451 Rotary Egypt

Early Diagnosis in NeonatesThe advent of echocardiography with Doppler color flowmeasurements has made it possible to diagnose lesions that areasymptomatic, minor, and even without murmurs.6-8 The incidencein Egyptian children has been estimated to be 5-6/1000 live births.9In our studied neonates with congenital malformations, the incidenceof significant cardiac malformation was found to be 37%, indicating atrue association. Khalil (et al) reported associated somatic anomaliesin 28% of their studied infants with congenital heart disease.However, Dr. El Sisi (et al) reported significant cardiac anomalies in33% of neonates with GIT anomalies.An incidence close to that wasreported by Tulloh (et al), in Cardiac Anomalies in Neonatestheir study, which was carriedout on 166 neonates withselected congenitalgastrointestinal malformations(anorectal anomaly, tracheo-esophageal fistula, duodenalatresia, exomphalos, andgastroschisis).CHD was diagnosed in 38 (23%)neonates: 22/57 (39%) with atracheo-esophageal fistula,10/67 (15%) with an anorectalanomaly, 4/20 (20%) withexomphalos, 6/20 (30%) withduodenal atresia, and 1/7 with Total Population Neonates with CHDgastroschisis). They concluded 6that early diagnosis of CHDallowed a unified approach to bepresented to the family.8/25/2018 Heart2Heart; an RC of El Tahrir Project; Member of D2451 Rotary Egypt

Heart2Heart Objectives – Medical Treatment & PreventionObjective 1 – Pediatric CHD Treatment through Minimal Invasive Procedures1. Pediatric Cardiac Catheterization 2. Balloon AngioplastyCardiac catheterization is a specialized Balloon angioplasty, also known as balloonprocedure in which a long, flexible tube dilation, is used to expand narrowed blood(catheter) is inserted into a blood vessel vessels. Read more about angioplasty.(usually in the leg) and guided into theheart, allowing a close look at thestructures inside. Cardiac catheterizationmay be recommended for diagnosticpurposes, with the intent of obtaininginformation only. It can also betherapeutic, with the intent of providingtreatment or intervention for anabnormality, such as a congenital(present at birth) heart problem.It may be performed for the following Fig 1reasons: Fig 2• To obtain diagnostic information, such as pressures and oxygen levels in various parts of the heart• To further define heart anatomy in the setting of congenital heart problems• To obtain cardiac tissue samples for biopsy• To open the atrial septum in congenital heart problems that cause a child to become cyanotic (blue color of the skin, lips, and nail beds due to an insufficient supply of oxygen in the blood)8/25/2018 Heart2Heart; an RC of El Tahrir Project; 7 Member of D2451 Rotary Egypt

Heart2Heart Objectives – Vocational Training & Capacity BuildingObjective 2 – Vocational Training & The Creation of Specialized Medical Staff Pediatric critical care is an important component of reducing morbidity and mortality globally. Currently in Egypt, pediatric critical care remains in its infancy in most hospitals. While most major teaching hospitals have highly specialized pediatric intensive care unity, the majority of local hospitals are still in need of specialized medical staff and nursing or lack designated intensive care units, healthcare staff trained to care for critically ill children, adequate numbers of staff, and rapid access to necessary medications, supplies and equipment. In addition, most hospitals in the southern governorates of Egypt lack pediatric critical care training programs for healthcare providers or certification procedures to accredit healthcare providers working in their pediatric intensive care units and high dependency areas. Therefore, our primary objective is to build pediatric specialized medical care capacity in an overall vocational training.8/25/2018 Heart2Heart; an RC of El Tahrir Project; 8 Member of D2451 Rotary Egypt

Heart2Heart Objectives – Vocational Training & Capacity BuildingObjective 2 – Vocational Training & The Creation of Specialized Medical StaffThe use of quality improvement Pediatric critical care is anmethods and safety principles can important component ofimprove child health outcomes and reducing morbidity andreduce harm. Multi-institution mortality globally.collaboratives have achieved improvedresults by identifying and implementingbest practices and by using rigorousimprovement methodology. Children’shospitals and their partner academicinstitutions have redesigned not onlyspecific aspects of patient treatmentbut also the fundamental processesthat determine how care is given andhow the work within hospitals is carriedout and communicated. Although thisprogress is to be commended, moreneeds to be done. Significant variationsin care and outcomes, and gaps in thecapability of physicians to engage inand lead QI, continue to exist. Thesedeficiencies could be remedied byincreasing the availability ofimprovement curricula, trainingopportunities, and skilled faculty. Anintegrated approach to buildingcapacity for quality and safety wouldconnect children’s hospitals and theiracademic partners, addressingalignment of quality priorities andresources across organizations,education and training for physicians inthe science of improvement, andrecognition of the legitimacy of QIactivities for professional developmentand career progression.8/25/2018 Heart2Heart; an RC of El Tahrir Project; 9 Member of D2451 Rotary Egypt

Heart2Heart GeographyEstablish a Qualified Reach in Areas Where the Need is Most Prevalent Eighty-five cities are even smaller, but still have respectable populations that have surpassed 100,000. Of course, there are other smaller cities and towns that round out the country's total population. Heart2Heart Projected Reach City Population Cairo 7,734,614Egypt is the 30th largest country in the Giza 2,443,203world by area, and a country this size Beni Sueif 189,624also has a population to match. With a 420,585population exceeding 100 million, Egypt Asyut 209,419has the world's 16th largest population. SohagIts population is so large in part because 10of its major cities. The largest city inEgypt is Cairo, which boasts a populationof over 7 million. The next largest city,Alexandria, has about half of thatnumber, with 3.8 million inhabitants.One other city, Al Giza, has a populationof 2.4 million, for a total of threeEgyptian cities with populationsexceeding 1,000,000. Thirty-four cities inthe country have populations that are abit smaller but still contributesignificantly to the high populationdensity. These cities have populationsthat exceed 100,000, including Port saidwhich has over 500,000 and severalcities that are approaching the half-million inhabitant milestone.8/25/2018 Heart2Heart; an RC of El Tahrir Project; Member of D2451 Rotary Egypt

Heart2Heart Affiliations With Organization on the Ground Treatment & Medical Staff Capacity Building Heart2Heart Institutions City University/Faculty of Medicine Cairo & Giza Aboul Reesh Children’s Hospital Beni Sueif Beni Sueif University Hospital; Al Shamla Asyut Asyut University, Faculty of Medicine Sohag Al Orman Pediatric Cardiology Hospital Sohag University, Faculty of Medicine8/25/2018 Heart2Heart; an RC of El Tahrir Project; 11 Member of D2451 Rotary Egypt

Heart2Heart - Treatment & Medical Staff Capacity Building Abu El-Reesh El-Mounira Pediatric Hospital Established in 1928 as the first of Cairo's Abu El-Reesh pediatric hospitals, El- Mounira offers a full range of pediatric in- patient and out-patient care through its specialized departments, treating more than 250,000 patients per year. Assiut University Hospital Assiut University was established in October 1957; and its Faculty of Medicine started during the academic year 1960/61; as the first university in Upper Egypt to prepare highly qualified graduates with the basic specialized academic knowledge and training expertise on the various necessary skills. Besides, the university offers an abundance of programs complying with the contemporary world changes.Sohag University is a regional universitywhich has a general strategic aim which isto prepare a generation of distinguishedscientists. The history of Sohag Universityextends from the history of theconstruction of the first of its faculties, backin 1971. The faculty of medicine followedsuit, as a subordinate to Assuit Universityand later to South Valley University.8/25/2018 Heart2Heart; an RC of El Tahrir Project; 12 Member of D2451 Rotary Egypt

Heart2Heart – RC of El Tahrir – Project Leader Amal El SisiRotary ID #5923437 General Paediatrics and Neonatology: El Sisi has practiced general pediatrics in Abou El Reesh Children’s Hospital (Cairo UniversityH2H Project LEADER Pediatric Hospital). This is the biggest teaching children hospital in Egypt with a total bed capacity of 750 beds including five PICUs. It isEmail: [email protected] prepared with high technology equipment and serves as a tertiaryPersonal: [email protected] referral hospital for all of Egypt. Amal El Sisi has completed extensiveMobile: +20 1001145556 training starting as a resident and gained enormous experience from the heavy workload at Aboul Reesh. She has also completed general Is a member of the RC of El Tahrir pediatrics as pediatric registrar at Alder Hey Children’s Hospital which since 2016; she’s led several medical is the biggest and oldest teaching children hospital in Europe. It is a projects in the club including tertiary referral hospital for all of the north west of England. She has vocational training and capacity completed the first on call for acute admissions as well as the second building in Assiut, Sohag and Beni on call for inpatients. The job also included squads to transfer sick Sueif. She’s currently the Chair Person children from regional hospitals to the ICU in which she learnt how to at the Catheterization Division in stabilize critically ill children and transport medicine. She has had Aboul Reesh. Under her leadership, rotating registrar post in Respiratory, endocrinology, gastroenterology RC of El Tahrir has initiated the Heart and oncology. El Sisi is also trained in neonatology in SCBU attached to 2 Heart project, and has helped the maternity ward at Cairo University Hospital, which receives 6000 families through their trauma. Her deliveries per year. It had, during her training time, 25 incubators with most recent endeavor, has helped ventilatory facilities. She has completed SHO in neonates in Gravesend over 20 cases in Sohag, and for more Hospital which is a peripheral hospital with 1500 deliveries per annum. on our Heart2Heart please visit our Furthermore, she has completed all neonatal procedures as neonatal website and our Facebook page. lines, umbilical catheters, intercostal tubes and basic cranial sonography. Cairo University Pediatric Cardiology department is a tertiary referral unit for Currently, El Sisi heads the neonatal cardiology unit; and is head of the most of Egypt. The out patient clinics for neonatal cardiology unit at Cairo University Children’s Hospital with 6 all pediatric cardiology subspecialties. neonatal ICU beds. As far as her Pediatric Cardiology Career goes, she There are routine echo clinics daily with has around 22 years of pediatric cardiology training. Both her MSc and four up to date echocardiography MD thesis are in cardiology. Throughout her training, she has worked machines. There is also echocardiography for 6 years in pediatric cardiology at 3 different centers in England: service to all ICUs, cath lab and cardiac Freeman Hospital, Royal Manchester Children’s Hospital (Pendlebury) theaters. There are 3 biplane catheter labs and finally at Royal Liverpool Children’s Hospital (Alder Hey). She spent with around 600 cases yearly both most of the time in Alder Hey as SHO and then Specialist Registrar. The diagnostic and interventional catheters cardiology ward there has 24 beds, cardiac ICU was joint with the are done. general ICU and had 12 cardiac beds. There were 400 pediatric cardiac surgeries per annum both open and closed and around 450 catheters per year mostly interventional. All activities are displayed on the hospital web site www.alderhey/cardiac.com .8/25/2018 Heart2Heart; an RC of El Tahrir Project; 13 Member of D2451 Rotary Egypt

Heart2Heart – RC of El Tahrir – Project Team Nesrine Rifaat Indjie Hafez Is a founding member of the RC of Is a member of the RC of El Tahrir El Tahrir since 1998; she’s held since 2012; she’s held several several leadership posts to date leadership posts to date and is and is currently the Club President. currently the President Elect & Rifaat comes from a banking Honorary Secretary of the club. Hafez background, where she held the comes from a strategic position of VP Operations, and administration background and has Advisor to the Chairman. She has worked in development in FMCGs, worked on client relation Advertising & PR, Education, MegaRotary ID #5923455 enhancement and has staff training Rotary ID #8381568 Projects both nationally and as well as branding and regionally as well as Management &H2H Project communications & planning. In H2H ProjectManagement addition to establishing the RC of El Tahrir, Rifaat has also created the Management Training. She holds a doctorateEmail: RAC Club of El Tahrir [email protected] continues to be a leader in its age Email: degree from UCSC in InstitutionalPersonal:[email protected] [email protected] Management – focus education. Personal: [email protected]: +20 1001714860 group. Mobile: +20 1223222999 Nagwa Zaki Bassem Gaber Is the Immediate Past President Is a member of the RC of El Tahrir of RC of El Tahrir; this was Zaki’s second term serving as Club since 2014; Gaber has held several President. She is member of the RC of El Tahrir since 2007; she’s leadership posts to date at both held several leadership posts to date and is currently the Club RAC & RC of El Tahrir. In 2016 Gaber Advisor. Zaki comes from an administrative background, she was appointed as D2451 Treasurer has created the Interact Club of AIS of El Tahrir during her first and the year proceeding his term in office. appointment he served as El Tahrir President. Bassem was one of theRotary ID #5923457 Rotary ID #9152983 youngest Rotarians to ever serve atH2H Project H2H Project the Presidential level. He isAdvisor - Planning currently the Club Treasurer and TRF Chair 2018-2020 Chairman of the TRF Committee.Email:[email protected] Email: Gaber comes from a background inPersonal:[email protected] [email protected] finance, and holder of a CPAMobile: +20 1223448820 Personal: credential. He is currently working [email protected] Mobile: +20 1224996555 on his Masters Degree. Nevine Abdelkhalek Is a member of the RC of El Tahrir since 2010; Abdelkhalek has held several leadership posts to date at the D2451 level and enjoys an excellent international standing in Rotary. Abdelkhalek assumed different posts in her career and is currently the Vice President of ECG Engineering Consultants Group in Egypt. Among her achievements is the design and development of the Professional Academy for Teachers and the initiation of two main sustainable projects: one in Upper Egypt in the field of Illiteracy “Eliminating the Sources of Illiteracy” and also University To Work (UTW) and School To Work (STW) Initiatives. She has also supported the initiation of UNICEF and Rotary District 2451 - Egypt - \"Water for Life\" Project that is being implemented in Upper Egypt since 2013. Abdelkhalek was the organizing committee chair of the 1st Water Summit with the Rotary & UNICEF that was Under the Auspices of The Prime Minister H E. Eng. Ibrahim Mehleb in June 2014Rotary ID #5939131 entitled Water is Life. Among her achievements include the organization of the round table of Investment in UpperH2H Project Advisor Egypt in Summer of 2015 focusing on Assiut and Sohag with the Egyptian Businessmen Association (EBA) as well as “Made in Egypt” Forum & Exhibition for Sohag Ethnic products.Email: [email protected] Personal : [email protected] Mobile: +20 012231277068/25/2018 Heart2Heart; an RC of El Tahrir Project; 14 Member of D2451 Rotary Egypt

PROJECT PROFILE Save a Heart Save a Family www.rcofeltahrir.webs.comhttps://www.facebook.com/RotaryClubofElTahrir/ [email protected] For Donations: MIDB Account # 033457-003 2018-2019Serving Egypt with Pride & Love Since 1998