Besos (kisses) from the Zumba Instructors Convention in Orlando Florida where Kat, I and 7,000 plus global fitness instructors, our brothers and sisters, are dancing, sweating, engaging, and expanding our professional skills in the company of our global Zumba Tribe. Huge THANKS to the three Albertos who created and continue to evolve and empower the international Zumba community (180 countries, 15 million people, 200,000 locations). Zumba is committed to creating health, fitness, peace and love and for that we are joyously grateful.

Within the world of Healthcare communities, countries, and continents collide, connect, intersect, and merge to develop and transform individuals, resources, systems, processes, and medical solutions.   A perspective in healthcare that attempts to be isolationist is not only myopic, it is not viable. Let’s travel with curiosity and open minds; keeping our eyes, ears and hearts open……

Cardiac Conditions and Preterm Birth – Close to our Hearts

Come walk with us through a bit of the history of pediatric cardiac surgery…. and celebrate the Global personality of healing, health and medicine.

Living and working in Guatemala resides a brilliant pioneer in pediatric cardiac surgery, Dr. Aldo Casteneda. Born July 17, 1930 in in Nervi, Italy to a Nicaraguan mother and a Guatemalan father, Aldo entered elementary school in Munich, Germany. When World War II began in 1939, his family, Guatemalan citizens, became “enemy aliens” and they were not allowed to leave Germany.  Eventually, Dr. Castañeda received his MD training at the University of Guatemala and completed his training as a surgeon through the University of Minnesota. At 86 years of age, Dr. Casteneda continues to provide cardiac surgeries to the neediest children in Guatemala, Honduras, El Salvador, Nicaragua, Belize, Haiti and the Dominican Republic.

We initially discovered Dr. Casteneda in a short video provided by Hearts for Life Across the World-World Society for Pediatric and Congenital Heart Surgery (Every child born anywhere in the world with a congenital heart defect should have access to appropriate medical and surgical care) at:  http://www.wspchs.org/index.php/interviews/78-interview-with-dr-aldo-castaneda-intro).

Walking around Greenlake in Seattle WA. one beautiful evening last week we located and listened to (one ear bud per person, nerdy-we know!) a more recent YouTube interview with Dr. Casteneda. The intro to the YouTube (below) itself presents a story of global and national medical significance. Please enjoy this short read:

Published on Dec 9, 2015

“Aldo R. Castañeda is a pioneer in pediatric cardiac surgery. He has been a vigorous supporter of early correction of complex cardiac malformations in infants and newborns. These efforts culminated in the successful repair of transposition in neonates, giving rise to the modern era of neonatal cardiac surgery. Under his mentorship William Norwood developed the Norwood operation for hypoplastic left heart syndrome.”

Dr. Castañeda received his training at the University of Guatemala and the University of Minnesota. Upon completion, he remained at Minnesota as a faculty member. In 1972 he accepted an appointment as Cardiac Surgeon-in-Chief at The Children’s Hospital in Boston and Professor of Surgery at Harvard Medical School. From 1981 to 1994 he served as Surgeon-in-Chief at The Children’s Hospital. Dr. Castañeda’s many contributions to pediatric cardiac surgery are remarkable and well documented in his more than 400 scientific articles and two books.

Dr. Castañeda’s work has spanned the globe. Upon retirement he returned to Guatemala and developed one of the most successful programs for pediatric cardiac surgery in Central America. More than forty of Dr. Castañeda’s trainees have served as chiefs of Pediatric Cardiac Units at institutions across the globe. In 2006 he was appointed to the Pediatric Cardiology Hall of Fame”.

Now, for the SHOW: Please enjoy Dr. Casteneda’s answers the questions posed. His unique personality really shines!

WSPF – “History of Medicine Series: Cardiac Surgery” with Dr. Aldo Castaneda, for OPENPediatrics”-

Funding for the medical treatment the communities Dr. Casteneda serves is provided through the US Based Non-Profit Organization “Friends of Aldo Casteneda” at http://saveachildshearttoday.org/Friends_of_the_Aldo_Castaneda_Foundation/Home_page.html

Home Sweet Home:

U.S. News & World Report has ranked Boston’s Children’s Hospital Heart Center # 1 in the Nation – Cardiology and Heart Surgery – 2016/17.  Frank Pigula, MD, Director of the Neonatal Cardiac Surgery Service at Boston Children’s Hospital, discusses how the Heart Center team cares for the most complicated prenatal congenital cardiac diagnoses. This video provides a personalized look into the world of neonatal cardiac surgery. 

Local Flavor –Shout Out ……and forever thank you’s to Kat’s Cardiac Surgeon, Margaret Allen M.D. – A National Library of Medicine Local Legend. Kat would not have survived her preterm birth if not for the skill, courage, and genius of her cardiac surgeon, Margaret Allen MD and her surgical and after care team.  A pioneer in cardiac and transplant surgery, Dr. Allen’s legend continues to unfold through her research (tissue engineering, stem cells, and autologous cardiomyocytes for repair and regeneration of cardiac muscle).  Dr. Allen’s inspiring biography can be found at: https://www.nlm.nih.gov/locallegends/Biographies/Allen_Margaret.html

WARRIORS:

Medical research exploring cardiac issues that challenge preterm birth survivors is relatively new. While preterm birth infant survival rates in the USA have dramatically improved over the past few decades, developing research reports that preterm birth has been identified as an emerging risk factor for arterial hypertension, diabetes mellitus, cardiovascular disease, and stroke in later life.

The following article in Forbes Magazine AUG 12, 2013 is interesting and provides us with an opportunity to explore related ongoing medical research.

Preterm Birth Linked To Adult Heart Problems – Robert Glatter, MD

“Based on results of new research, babies born prematurely may be at risk for structural heart abnormalities which can lead to additional cardiac risk factors such as high blood pressure as they age.  This may ultimately impact individuals who are at risk for coronary artery disease, making early screening for high blood pressure particularly important for those who were born prematurely (< 37 weeks)”.

The article cited research in which investigators studied 102 premature infants from birth into their mid 20’s.  The article stated “They compared their findings to 132 individuals who were full term, and found that progressing into adulthood, the right lower chamber of the heart (the right ventricle) was smaller in size, but had walls which were significantly thicker with a pumping mechanism which was less efficient compared to those born full term.  They also found that the more premature the birth, the greater overall decrease in size as well as function of the right ventricle”.

Dr. Paul Lesson, the lead investigator from Oxford University’s Clinical Cardiovascular Research Facility in England stated “Up to 10 percent of today’s adults were born prematurely, and some have an altered higher cardiovascular risk profile in adult life”.

Dr. Adam Lewandowski, the Lead study author, agreed, explaining,  “We are trying to dig deeper into what’s different about the hearts of those born preterm”.   He added, “The potential scientific reasons why their hearts are different are fascinating and our study adds to the growing understanding of how premature birth shapes future heart health”.

http://www.forbes.com/sites/robertglatter/2013/08/12/premature-birth-linked-to-adult-heart-problems/#7d414f6b3c58

Preterm Birth and the Shape of the Heart – Mikael Norman-Circulation – January 15, 2013: Preterm Birth and the Shape of the Heart: http://circ.ahajournals.org/content/127/2/160

The article begins with the following summary “Preterm birth, that is, delivery >3 weeks before term, affects an estimated 13 000 000 newborn infants annually, and rates are increasing. In only the United States, ≈500 000 infants are born preterm each year, and of these, 80 000 are delivered very preterm (>8 weeks before the expected date). Without effective care, the number of deaths among very preterm infants would equal that of major causes of death in adults such as Alzheimer disease or essential hypertension. Although mortality after preterm birth was high until a few decades ago, advances in perinatal medicine have resulted in almost universal survival, so the concept of prematurity nowadays is shifting from a pregnancy complication to a common developmental basis for a whole new generation of young adults. Although this progress is very welcome for women delivering preterm, their infants, and their families, there is an increasing concern because preterm birth has been identified as an emerging risk factor for arterial hypertension, diabetes mellitus, cardiovascular disease, and stroke in later life”. The article shares the following suggestion  “The most obvious clinical implication of this new knowledge is that young people born very preterm need continued and tailored follow-up, taking the total cardiovascular risk factor burden into account”.

If these articles spike a bit of interest, you may also want to review this December 10, 2012 thought provoking article in Medscape Multispecialty “Premature Birth ‘Should Be New Risk Factor’ for Cardiovascular Disease” which offers interesting research/findings.- http://www.medscape.com/viewarticle/775950

The developing research into preterm birth and cardiovascular disease is new, exciting, and perhaps, for some, concerning. Further research may allow our preterm birth family to understand and promote our own health and well-being as we experience adulthood. Access to emerging medical research may inspire us to discuss questions and concerns with our personal health care providers as we responsibly choose to empower our own well-being.  Aloha Warriors!

 

“Lighting the way, building community, empowering the NICU/Preterm Birth traveler”

What’s happening locally……………………

CHEERS! WEST COAST WE ARE RIPPING!!

NIFTY CUP!

Designed in Seattle, this $1 cup could save millions of babies….

The Seattle Times – Originally published May 23, 2016 at 1:54 pm Updated June 15, 2016

Inventors from PATH, the University of Washington and Seattle Children’s designed a feeding cup that could help prevent starvation in premature and high-risk babies in developing countries who have trouble breast-feeding. It will soon be widely distributed in Africa.-SOURCE- http://www.seattletimes.com/seattle-news/health/designed-in-seattle-this-1-tool-could-save-millions-of-babies/

IN-PROCESS:

Seattle Children’s Research Institute Secures $3 million for Seattle-PAP Infant Breathing Support Invention

“April 30, 2014 – Seattle – Today,　Seattle Children’s Research Institute　announced the receipt of a three year, $3 million dollar grant from the Bill Melinda Gates Foundation　to conduct two clinical trials of Seattle-PAP, an affordable device intended to provide breathing support to premature infants. The trials will begin later this spring in the neonatal intensive care unit (NICU) at Texas Children’s Hospital, the largest NICU in the U.S., and will confirm whether Seattle-PAP fosters similar or better outcomes than other infant breathing devices, as preclinical research suggests. If results are favorable, Seattle-PAP, which was developed in-house at Seattle Children’s Research Institute, is expected to be commercially available to healthcare providers around the world by 2017.

Developed by a team co-led by Seattle Children’s CEO　Tom Hansen, MD and Charles (Skip) Smith, PhD, Seattle-PAP is significantly cheaper to produce, operate, maintain, and repair than ventilators and other respiratory support devices typically used in U.S. healthcare facilities. These features make Seattle-PAP ideal for use in areas where access to healthcare resources may be limited. To operate the device, only relatively simple supplies are needed, including water, a continuous air supply, a breathing circuit tube, and a tube for the nose.”

“Worldwide, almost 1 million infants die each year from respiratory distress. Most of these deaths occur in resource-limited countries due to a lack of access to respiratory support devices commonly used in the developed world,” said Thomas Hansen, MD, CEO at Seattle Children’s. “Seattle-PAP may be a solution to this problem by making effective respiratory support accessible to newborns anywhere in the world.”

Please see the full article: http://www.texaschildrens.org/about-us/news/releases/seattle-childrens-research-institute-secures-3-million-seattle-pap-infant

Warriors!

We will be exploring TRAUMA as we view our Neonatal Womb Community at home and abroad….

What is Trauma?

1. A deeply distressing or disturbing experience:
   • emotional shock following a stressful event or a physical injury, which may be associated with physical shock and sometimes leads to long-term neurosis.
2. Physical injury.

KAT-Currently I am working at Harborview Medical Center in Seattle, WA. as an office assistant in the Surgical Residency Department. Seeking a long-term career in surgery it is my pleasure to work alongside and learn from the amazing community members at Harborview Medical Center. At the trauma center of Harborview the sounds of sirens, helicopters, alarms, and codes are a familiar never-ending tune to an even greater symphony of staff and community members that orchestrate themselves on a daily basis to provide care to those whose lives change within an instant.

To me, trauma begins in an instant, often without warning as it deconstructs our reality and shakes us into a new world.

If you have been in the Neonatal ICU or received emergency preterm birth care trauma may be a part of your life story.

As a Neonatal ICU patient the majority of my care was focused on the trauma my tiny body endured each day as I fought, like many of my fellow preemie brothers and sisters, to live. I recognize my unanticipated birth and the loss of my twin brother Cruz was a horrific emotional shock to my family. In a past blog I shared that I received open heart surgery with no anesthia as a neonate. Though my body experienced harsh physical trauma I feel that the surgery may have been equally distressing to my surgeon, surgical and neonatal teams, and my family.

As members of the Neonatal Womb Family we have all have a relationship with trauma. We know what it means to will ourselves forward. I believe it is important for us as a community to acknowledge the trauma we have ALL encountered. Let us extend our deepest empathy and love to the families currently finding themselves in the traumatic experience of having a premature infant and the health-care providers that work within the environment of preterm birth associated trauma each day.

To my fellow NICU Grads/Premature Birth Survivors we have an important voice and role! We are valuable resources to our community! WE ARE SYMBOLS OF HOPE!

“Lighting the way, building community, empowering the NICU/Preterm Birth traveler”-The Neonatal Womb Foundation

_{Salsa, rumba and mambo… Gloria Estefan… plantains …white-sand beaches, rolling mountains …cigars and rum…}

Recently, we shared the March of Dimes preterm birth report card for the USA, and Global Preterm Birth standings per WHO. We queried what can we learn from other nations that would move the USA from a C grade to an A grade? Globally, resources to empower positive changes domestically and abroad are present, accessible and evolving! As our doors open to Cuba; we open our eyes to the wealth of wisdom, experience, and medical resources Cuba presents to the Neonatal Womb Community globally and locally.

Low Birth Weight Outcomes: Why Better in Cuba Than Alabama?

Yasmin Neggers, DrPH, RD and Kristi Crowe, PhD, RD, LD – Journal of the American Board of Family Medicine – March-April 2013       http://www.jabfm.org/content/26/2/187.full

Doctors  Neggers and Crowe report that low birth weight (LBW; <2500 g) is the single most important factor affecting neonatal mortality and a significant determinant of post neonatal mortality. They indicate that LBW babies are at an increased risk for serious health problems, ranging from neurodevelopmental disabilities such as cerebral palsy and mental retardation to respiratory disorders. They note that in the United States, 65% of all infant deaths result from LBW and preterm birth. The authors report numerous factors associated with LBW including maternal age, race, weight before pregnancy, weight gain during pregnancy, prenatal care, and use of tobacco and alcohol products. In addition, socioeconomic conditions, nutrition during pregnancy, and anemia are key factors that have been proven to influence the prevalence of LBW. The article states “The percentage of LBW in Cuba is not only much lower than its neighboring developing countries such as Jamaica, Haiti, and the Dominican Republic, but is also lower than far more affluent countries such as England and the United States. Despite a per capita gross domestic product that places Cuba in the fourth quintile of nations, Cuba’s infant mortality rate rivals that of Canada and is lower than the average infant mortality rate in the United States and, in particular, the state of Alabama”. According to World Bank data, 100% of pregnant Cuban women receive prenatal care, defined as medical and nursing care recommended for women before and during pregnancy. In Cuba, implementation of universal health care with a strong focus on community-based services for prenatal care has significantly reduced the prevalence of LBW over the past 20 years. The article outlines several examples for implementing community-based prenatal care in the United States that were considered for adaptation on pilot scales in Alabama and North Carolina (USA).

* Most, but not all, LBW infants are born preterm. We encourage you to read the full informative and detailed article! –Source: Cuba’s Health Care System: a Model for the World – The Huffington Post 08/08/2014 http://www.huffingtonpost.com/salim-lamrani/cubas-health-care-system-_b_5649968.html

According to the UN’s World Health Organization, Cuba’s health care system is an example for all countries of the world.

“The Cuban health system is recognized worldwide for its excellence and its efficiency. Despite extremely limited resources and the dramatic impact caused by the economic sanctions imposed by the United States for more than half a century, Cuba has managed to guarantee access to care for all segments of the population and obtain results similar to those of the most developed nations. During her recent visit to Havana in July of 2014, Margaret Chan, Director-General of the World Health Organization (WHO), impressed by the country’s achievements in this field, praised the Cuban health care system: ““Cuba is the only country that has a health care system closely linked to research and development. This is the way to go, because human health can only improve through innovation.”” She also praised ““the efforts of the country’s leadership for having made health an essential pillar of development””. Cuba’s health care system is based on preventive medicine and the results achieved are outstanding. According to Margaret Chan, the world should follow the example of the island in this arena and replace the curative model, inefficient and more expensive, with a prevention-based system. ““We sincerely hope that all of the world’s inhabitants will have access to quality medical services, as they do in Cuba,” she said””.

The article concludes with the following statement: “In praising Cuba, the World Health Organization stresses that it is possible for Third-world countries with limited resources to implement an efficient health care system and provide all segments of the population with social protection worthy of the name. This is possible if the political will exists to put human beings at the center of the project”.

In our “Healers” blog we touched upon the fact (WHO November, 2013) that globally there was a deficit of 7.2 million skilled health professionals, and the deficit is increasing…And the Largest Medical School in the World is in?

 CUBA

Havana, Cuba: Latin American Medical School (ELAM) -“Supporting the world’s largest medical school in the education of socially committed physicians.”

“I know of no other medical school with an admissions policy that gives first priority to candidates who come from poor communities and know, first-hand, what it means to live without access to essential medical care. For once, if you are poor, female, or from an indigenous population, you have a distinct advantage”.   ~WHO Director-General Dr. Margaret Chan, visiting ELAM. Dr. Chan states “Cuba has the lowest infant mortality rate in the hemisphere: a child born in the eastern mountains of Cuba has a better chance of survival than a newborn in Washington DC. ” –Source-http://medicc.org/ns/?page_id=63

The Cuban success in decreasing LB weight infants is worthy of our attention. As we investigated Cuba’s health care system we stumbled upon this comprehensive experience based and awakening Ted Talk by journalist Gail Reed: Where to train the world’s doctors?

Journalist Reed discusses how the world’s largest medical school (Havana Latin American Medical School/ELAM) provides:

• – community based learning
• – teaches students to treat the whole patient
• – promotes the concept that a good patient interview and a thorough clinical exam provide most of the clues  for diagnoses saving costly technology for confirmation, importance of prevention
• – a team approach to teaching, learning, working to support their mission In order to train physicians “for people that need them the most; the over 1 Billion who have never seen a doctor”.
  

WARRIORS!

Did you know that surfing in Cuba was illegal for many years? This nostalgic and dynamic YouTube adventure takes us on a short and beautiful journey into Cuba!

The narrator tells us “I believe surfing makes me a better person, challenges me and makes me feel connected to my body and to the ocean in ways that transcend simply being in the water and riding waves.”

 

-Published on Jun 11, 2013 Ola Libre – A Waterlust film about surfing in Cuba. A film by Mike Gibbons & Patrick Rynne aimed at exploring and supporting the emerging surf culture of Cuba.

How do you choose to be challenged, and what connects you to your body, to nature and our oneness on this life journey?

   MAHALO