During its first year, the Global HOPE initiative made tremendous progress at creating an innovative pediatric hematology-oncology treatment network in sub-Saharan Africa. Learn more by visiting our 2018 virtual Annual Report.
A delegation of Texas Children’s physician leadership, executives and experts were recently invited to attend the 6th annual U.S. News & World Report Healthcare of Tomorrow summit in Washington, D.C. There, they met with top hospital leaders, policymakers, insurers, consumer advocates and other industry professionals from across the country to discuss some of the most important topics in health care today.
Texas Children’s had a major presence throughout the event. Not only did we sponsor key discussion sessions, but every attendee had their event credentials on a Texas Children’s-branded lanyard, Additionally, a raffle of four sets of Rudolph’s Pediatrics, the landmark pediatric health care reference, of which Physician-in-Chief Dr. Mark W. Kline is editor-in-chief, was extremely well received at our conference booth.
Kline and Surgeon-in-Chief Dr. Larry Hollier also represented Texas Children’s as featured event speakers.
Taking compassionate care into the global community
In his keynote address, “Global Child Health at the Tipping Point: Lessons from the Field,” Kline stressed that though significant progress has been made to improve child health and mortality rates worldwide, challenges still remain, especially in resource-limited countries. He also said that through increased awareness, partnership and active engagement, those challenges can become opportunities for health care providers to improve the lives of the world’s poorest and least fortunate.
To illustrate this point, Kline highlighted the successes and lessons learned of the Baylor International Pediatric AIDS Initiative (BIPAI) at Texas Children’s Hospital in helping stem the tide of the AIDS pandemic, particularly in sub-Saharan Africa. The network, which Kline founded in 1996, has grown from a single pilot HIV clinic in Romania into a comprehensive global health network – the largest HIV/AIDS network in the world – that includes 16 centers and clinics in 14 countries, providing care for hundreds of thousands of children and families, education for nearly 90,000 health care professionals, and research into pediatric health.
Kline also explained how leveraging the BIPAI network’s infrastructure has enabled Texas Children’s to extend its global reach and to offer care for many other diseases and disorders, including pediatric cancer, sickle cell anemia, OB/GYN care, tuberculosis, malaria, malnutrition and other conditions.
“For too long, children have been on the outside looking in, and it’s particularly true for the poor children of the world, who’ve not had the same access to life-saving therapies as American and European children,” Kline said. “The HIV/AIDS pandemic certainly challenged the world’s commitment, and our compassion, for these children. But our success in the fight against HIV/AIDS has opened the door to treatments for a host of other serious diseases that have threatened the health and well-being of children and families for generations.”
Using partnership to drive patient experience
At a discussion session entitled “The New Patient Experience Era: Focusing on the Consumer of Tomorrow,” Hollier and other panel members addressed how enhancing the patient experience can lead to improvements in quality and safety and to increased consumer and caregiver satisfaction.
Hollier discussed the crucial role that partnerships have played in improving patient experience at Texas Children’s.
“We believe strongly that partnerships – with our providers and employees, with our families, and with experts inside and outside of health care – are a critical component of driving an exceptional experience,” Hollier said. “As families’ expectations evolve, we continue to explore more innovative solutions to help us meet them where they are in their care journey, and to ensure they feel supported at every step along the way.”
One such solution was an initiative to improve communication and interaction between providers and patients and families. Partnering with experts at Press Ganey and Academy of Communication, and drawing information from provider and patient/family surveys, we developed a communication training curriculum for caregivers that elevates the level of engagement for families. Providers now feel empowered to manage interactions between both patient and parent, and are better equipped to communicate important information in a way that families will understand.
Texas Children’s also relied on partnership with families during the development of Lester and Sue Smith Legacy Tower. A 20-member Family Advisory Board worked for three years, from initial planning to the go-live date, to ensure that families’ needs were kept at the center of important decisions. Their input was essential for room and facility layouts, in simulation exercises, and for the development of family support resources during the move into the new building.
For Texas Children’s Department of Surgery, partnerships have been integral in enhancing tech processes, which has led to several improvements across the Texas Children’s system, including streamlined and transparent data sharing, consolidation and standardization of our and our providers’ online presence, and more frequent updates and scheduling information for families during surgery through the EASE app.
Hollier also highlighted Texas Children’s recent partnership with Disney, a $100 million initiative that has the potential to transform the patient experience in children’s hospitals across the globe. Initial concepts for development include allowing children to customize their hospital visit with their favorite Disney stories and characters, reimagining spaces through augmented and virtual reality experiences, and creating themed treatment and patient rooms with interactive elements.
A team of Texas Children’s surgeons, anesthesiologists and perioperative staff recently traveled to Malawi and Uganda to provide surgical care for children with cancer and congenital anomalies as part of Texas Children’s Cancer and Hematology Centers’ Global HOPE program. This was one of the first coordinated trips under the new Division of Global Surgery.
Dr. Jed Nuchtern, chief of Global Surgery, Dr. Bindi Naik-Mathuria, pediatric surgeon and Trauma medical director, Dr. Titi Aina, pediatric anesthesiologist, and operating room nurse Anita Hadley worked alongside local surgical teams to provide much-needed surgical care for area children, many of whom had been waiting months for experienced doctors and nurses who could treat their conditions. The team helped complete more than 30 operations, including 10 nephrectomies for Wilm’s tumor, the most common form of pediatric kidney cancer, effectively providing a cure for these children.
“I am so proud to be able to share the talents of our surgical teams by going abroad,” said Nuchtern. “Not only are we able to treat these children who are in great need of surgery, but we are also able to educate the doctors and surgical teams from these countries. The collaborative efforts of Surgery, Anesthesia and the Cancer Center continue, as future trips have already been planned, and we will add to our traveling surgical teams as the Division of Global Surgery grows.”
The Division of Global Surgery, created this past August, expands Texas Children’s ability to help children and women across the globe in low-resource countries and offers pediatric surgery education by providing hands-on instruction and necessary supplies. To build capacity, preliminary Global Surgery efforts are focused on surgical care for pediatric cancer patients and leverage resources, infrastructure and successful global medical programs already in place in sub-Saharan. These include Baylor International Pediatric AIDS Initiative (BIPAI) Network, Global HOPE and existing efforts by Texas Children’s Department of Ob/Gyn. Long-term goals for the division include a surgical facility for women and children in Lilongwe, Malawi; expansion of care capacity in Central America; and, ultimately, recognition for Texas Children’s as a leader in global surgical outreach.
“I must begin by giving a very direct word of appreciation and thanks to Texas Children’s and Bristol-Myers Squibb, for you might not fully comprehend what you did for a whole nation state and civilization,” President Masisi said during his opening remarks at the luncheon held in Peterkin Board Room. “The government and people of Botswana will remain forever grateful for your generous response to our urgent appeal during literally our darkest and most perilous hour at the height of the HIV/AIDS pandemic. When we thought all else was lost, your generosity, your humanity, your assistance among others brought smiles to many of our families, and the nation at large.”
With the generous support of Bristol-Myers Squibb, Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children’s Hospital (BIPAI) began working in Botswana in 2001. They started out small, training doctors and nurses, and testing and treating children with HIV. They then went big in 2003, building the Botswana-Baylor Children’s Clinical Centre of Excellence, a Centre of Excellence where state-of-the-art HIV/AIDs care is administered to children.
“It’s been a blessing to be in partnership with the Ministry of Health, and with the government of Botswana in absolutely everything we’ve done,” said Dr. Mark W. Kline, president and founder of BIPAI, physician-in-chief of Texas Children’s Hospital and chair of the Department of Pediatrics at Baylor College of Medicine. “It really has changed the world for hundreds of thousands of children across the African continent and around the world.”
The goal of Bristol-Myers Squibb, Texas Children’s, BIPAI and the Ministries of Health, Kline explained, is to implement the same principles that have been applied to HIV/AIDS to the treatment of cancer among African children, who for decades have not received the life-saving therapy they need and deserve.
In the United States, where there are 15,000 cases of pediatric cancer a year, 80 percent of children survive and most have a very good quality of life, statistics show. In Sub-Saharan Africa, of the more than 100,000 children who develop pediatric cancer each year, 90 percent die.
View photos below from His Excellency Mokgweetsi E.K. Masisi, president of Botswana’s visit.
Dr. David Poplack, director of Global HOPE (Hematology-Oncology Pediatric Excellence) and associate director of Texas Children’s Cancer and Hematology Centers, said the discrepancy and inequity these statistics represent are intolerable, and are why the Global HOPE cancer program – a partnership between Texas Children’s Hospital, BIPAI and Bristol-Myers Squibb Foundation, along with the Ministries of Health in six sub-Saharan African countries, including Botswana – are working to correct it.
“Africa is now poised to make major advances in the diagnosis and treatment of cancer,” Poplack said. “Based on our experience in the United States, we know what is possible, and we know what it takes to achieve success. We believe Botswana now has a similar opportunity to dramatically improve childhood cancer treatment and care; not only in Botswana, but across the continent.”
To help accomplish this, Global HOPE is working with the Ministry of Health to establish a Center of Excellence in pediatric care in Botswana as well as a pediatric hematology/oncology fellowship training program that will make Botswana a hub for training across Southern Africa. Centers of Excellence also are being established in Malawi and Uganda as part of the Global HOPE program.
Global HOPE was created in February 2017 as a $100 million initiative to create an innovative pediatric hematology-oncology treatment network in sub-Saharan Africa. The program already is making great strides, treating more than 1,000 patients, training 369 health care professionals, and graduating the first class of physician fellows enrolled in the first Pediatric Hematology Oncology Fellowship Program in East Africa.
“Our relationship with Botswana has spanned 15 years, a long time, and was the inception point of Texas Children’s global work in Africa,” said President and CEO Mark Wallace. “We look forward to continuing our extraordinary partnership for many, many years to come and know that your focus on innovation and continuing to create a higher standard of excellence for health care for your country will impact the quality of life for the people of Botswana for generations to come.”
Discussions about these efforts continued throughout the evening at an event at the St. Regis Hotel where leaders from Houston, throughout the United States and Botswana gathered to celebrate the incredible work underway.
Click here for more information on Global HOPE.
The East Africa Pediatric Hematology and Oncology Fellowship Training Program is the result of cooperation and commitment between some of the most eminent institutions in Africa and on the world-stage in cancer care, medical education, health policy, and pediatric hematology and oncology. As part of the comprehensive Global HOPE (Hematology-Oncology Pediatric Excellence) initiative, which launched in February 2017, the two-year fellowship program is building a critical mass of pediatric hematology-oncology specialists to independently provide effective, evidence-based pediatric cancer and hematology care in the African setting.
In the United States, 80 percent of children with cancer survive. In sub-Saharan Africa, the overwhelming majority of pediatric patients do not. The mortality rate is estimated to be as high as 90 percent, meaning that thousands of children die from cancer across Africa each year, with the most common types of childhood cancers being blood cancers, including leukemia and lymphoma.
Most childhood cancers are treatable. However, up until this point, the main reason for the staggering death rate across Africa has been due to an inadequate health care infrastructure and a significant lack of expert physicians and other health care workers trained to treat children with cancer and blood disorders. With the ambitious efforts of Global HOPE to build medical capacity to diagnose and treat pediatric blood disorders and cancer in Africa, the impact is already evident in the higher numbers of children receiving care in Uganda, Botswana and Malawi.
“Traditionally, physicians in Africa have gone abroad to obtain higher specialist clinical training, and often do not return,” said Dr. David Poplack, director of Global HOPE and associate director of Texas Children’s Cancer and Hematology Centers. “By training physicians through the fellowship program, we are increasing the number of pediatric hematology-oncology specialists who will be practicing in East Africa. This will improve the overall survival for children with cancer and blood diseases in the region.”
At the graduation ceremony, Poplack was awarded an Honorary Doctor of Science from Makerere University for his academic contribution in the field of science. Under his leadership for the last 25 years, Texas Children’s Cancer and Hematology Centers established itself as an internationally-recognized leader in the treatment and research of pediatric cancer and blood disorders. With a desire to expand care to areas of the world with limited resources, Poplack and his team have worked over the past decade to provide care to children in sub-Saharan Africa. With the inception of Global HOPE, access to care will only continue to increase with this training of pediatric hematology-oncology physicians through the fellowship program.
“This first class of graduates of the fellowship program represents an exponential increase in the number of pediatric oncologists in east Africa – and by extension – a huge increase in the number of children diagnosed with cancer who may now receive high quality treatment and the chance of recovery,” said John Damonti, president of the Bristol-Myers Squibb Foundation. “We congratulate the graduating physicians and are proud to support the creation of a sustainable, highly qualified team of oncology and hematology healthcare providers in southern and east Africa, to help change the health outcomes for children.”
Partners involved in the Global HOPE initiative include: The Ministry of Health of the Republic of Uganda, Makerere University College of Health Sciences, East African Community, Uganda Cancer Institute, Baylor College of Medicine Children’s Foundation- Uganda, Mulago National Referral Hospital and the Bristol-Myers Squibb Foundation.
“This is a wonderful new opportunity for Texas Children’s Hospital, the Department of Surgery and Dr. Nuchtern, said Surgeon-in-Chief Dr. Larry Hollier. “Providing surgical expertise in underserved areas has been a great passion for Dr. Nuchtern, and he has traveled extensively bringing surgical care to children around the world. I would like to thank him for his continued commitment to patient care and surgical excellence.”
Through Global Health programs, Texas Children’s collaborates with international governments and health organizations to share its expertise and best practices, with a strong focus on sustainability. This collaboration includes providing surgical training and direct care and treatment in many underserved nations, such as Argentina, Haiti, Malawi, Mexico, Pakistan, Tanzania and Uganda. Due to lack of resources, facilities, education and support, surgical interventions thought of as routine here in the United States, such as repairing a broken bone or simply suturing a wound, are difficult to perform and thus much less common in these countries. A more complicated procedure like a C-section becomes altogether life-threatening.
The creation of the new Division of Global Surgery will help Texas Children’s forge new partnerships, offer providers opportunities for exposure, and facilitate care and capacity building to improve the lives of children and women across the globe, beginning in sub-Saharan Africa.
Leveraging resources, infrastructure and successful global medical programs already in place in the region – including Baylor International Pediatric AIDS Initiative (BIPAI) Network, Texas Children’s Cancer and Hematology Centers’ Global HOPE (Hematology Oncology Pediatric Excellence), and existing efforts by the Department of OB/GYN – Nuchtern and his team will first focus on surgical care for pediatric cancer patients, 50 percent of which require some form of surgical intervention, to increase surgical capacity. Ultimately, the approach will have the combined effect of improving care of children with cancer as well as those suffering from other pediatric surgical diseases.
“While the initial focus is on cancer surgery, our approach is to help build capacity in children’s surgery overall,” Nuchtern said. “Our goal is to marshal all of the talent and energy of Texas Children’s department of surgery toward the goal of serving children throughout the world.”
Preliminary objectives include identifying individuals interested in participating, working with partners to develop the infrastructure necessary to provide quality care, and organizing a special group tasked with developing training opportunities, a central focus of this initiative. Building on successes and lessons learned, and through continued collaboration with Global HOPE, the long-term vision includes a surgical facility for women and children in Lilongwe, Malawi, expansion of care capacity in Central America, and, ultimately, recognition for Texas Children’s as a leader in global surgical outreach.
“We’re one family, and this is a team effort that requires substantial perioperative support from nursing, anesthesia, pediatrics, radiology and pathology,” Hollier said. “Dr. Nuchtern and the new Division of Global Surgery will coordinate with all hospital services to ensure that Texas Children’s is well-represented when going abroad and that these children and women receive the best possible care.”
Nuchtern will retain his duties as chief of Pediatric Surgery until a successor is found. A national search is currently underway. Pediatric Surgery at Texas Children’s has grown to include outstanding programs in surgical oncology, surgical critical care, colorectal and pelvic health, and basic science research. The GI Surgery program has consistently been recognized as one of the top five children’s hospital programs for GI & GI Surgery in U.S. News & World Report. Under Nuchtern’s leadership, the division also has received national and international acclaim for the separation of conjoined twins’ cases and many cutting-edge fetal surgeries. Additionally, the Trauma program was re-designated as a Level I trauma center and has expanded educational offerings to the state and region.
Called Global HOPE (Hematology-Oncology Pediatric Excellence), the aim of the initiative is to build long-term capacity to treat and dramatically improve the prognosis of children with cancer and blood disorders in sub-Saharan Africa where the overwhelming majority of pediatric cancer and hematology patients do not survive. The mortality rate is estimated to be as high as 90 percent, in large part due to an inadequate health care infrastructure and a significant lack of expert physicians and other health care workers trained to treat children with cancer.
Global HOPE already is making great strides to change these outcomes and the reasons behind them. Since its creation in February 2017, more than 1,000 patients have been treated, 369 health care professionals have been trained, eight physician fellows have enrolled in the first Pediatric Hematology Oncology Fellowship Program in East Africa and seven cancer awareness and survivor events in Botswana, Uganda and Malawi have been organized.
“We’re very excited by the progress in a relatively short amount of time,” said Dr. David Poplack, director of Texas Children’s Cancer and Hematology Centers. “Capacity building takes time. This may mean we exceed our original expectations.”
Initially, Global HOPE leaders envisioned treating 5,000 patients in the first five years, but the expectation assumed the numbers would ramp up as the program did. A similar situation occurred in 2003 after the largest pediatric HIV treatment network in the world was created by the Bristol-Myers Squibb Foundation, Baylor College of Medicine International Pediatric AIDS Initiative and the Governments of Botswana, Uganda and Malawi. The network has leveraged existing experience, infrastructure, and public/private partnerships to train 52,000 health care professionals and provide care for nearly 300,000 children with HIV and their families in sub-Saharan Africa, lowering the mortality rate for these children to 1.2 percent.
“The success we’ve had in radically changing the course of pediatric HIV/AIDS in sub-Saharan Africa is due in large part to the tremendous support provided by the country governments, health care providers on the ground and donors who have made our work possible,” said Dr. Mark W. Kline, president and founder of BIPAI, physician-in-chief of Texas Children’s Hospital and chair of the Department of Pediatrics at Baylor College of Medicine. “We are very pleased by the progress Global HOPE already has made in building a self-sustaining infrastructure that changes the tide of these childhood diseases in sub-Saharan Africa.”
Global HOPE is building on the work Texas Children’s Cancer and Hematology Centers and its partners have been providing children with cancer and blood disorders in Africa for a decade. Through the partnership, Global HOPE is active in three countries and has 51 faculty and staff working in Texas Children’s global sites.
These sites, called Centers of Excellence, are being expanded in Botswana, Malawi and Uganda, and aim to serve as regional hubs for pediatric hematology/oncology programs. Progress also is being made on implementing standard treatment protocols and clinical practice guidelines to ensure quality pediatric hematology/oncology care and services are provided across the cancer care continuum, and positively impact overall pediatric health services.
To develop local leaders in Africa in the pediatric hematology/oncology field, Global HOPE has established the first Hematology/Oncology Fellowship in East Africa in Uganda. This two-year fellowship is accredited by the Uganda Medical and Dental Practitioners Council and incorporates online training, live lectures, rotations from sub-specialists to provide training on-site, and professional development opportunities, including attending scientific conferences and participating in leadership seminars.
“This fellowship is one of the most important things we are doing in Africa,” Poplack said. “It is the formal educational program that enables us to build medical capacity to diagnose and treat pediatric blood disorders and cancer.”
The Bristol-Myers Squibb Foundation is committing $50 million over five years to fund the training of health care providers as well as clinical infrastructure and operations. Global HOPE will raise an additional $50 million for the initiative.
Read these blogs to learn more about Global HOPE: