Cedars-Sinai Medical Center

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A BI-WEEKLY PUBLICATION FROM THE CEDARS-SINAI CHIEF OF STAFF Sept. 13, 2013 | Archived Issues

Seferian Leads Pediatrics Teaching Mission to Armenia

Edward Seferian, MD, (second from right) led a medical mission to teach healthcare providers in Armenia the latest techniques in pediatric intensive care.

Given just 48 hours, how could doctors from the United States make a lasting impact on the medical care of seriously ill children in Armenia? For a group led by Edward Seferian, MD, a pediatric critical care physician in Cedars-Sinai's Department of Pediatrics, the answer was to do one of the things they do best: Teach.

In a rigorous, two-day seminar in Yerevan, Armenia, in mid-July, Seferian and four colleagues taught some of the latest techniques and advances in pediatric intensive care to that nation's leading pediatricians and nurses. The American team also laid the groundwork for the Armenian participants to become teachers themselves, arming them with knowledge to share with colleagues at their home institutions.

"After the independence of Armenia in 1991 from the Soviet Union, the healthcare system, which had been heavily subsidized, fell apart," Seferian said. "They've been rebuilding over the past 20 years. A large part of the goal of this mission was to educate the doctors and nurses in the most current methods and techniques."

The visit was sponsored by the Fund for Armenian Relief, an organization that oversees both short- and long-term programs for economic growth and social development.

Developed by the Society of Critical Care Medicine, the course the physicians taught included in-depth lectures, simulated situations using mannequins and medical equipment, and intensive review and discussion of case scenarios. Topics included stabilization of patients with organ dysfunction, organ failure, respiratory and heart failure, septic shock, neurological injuries and diseases.

"We didn't really know what to expect when we first began teaching the course," said Seferian, who is also a medical director in the Department of Medical Affairs at Cedars-Sinai. "But the doctors and nurses we worked with were very engaged, very involved, and were grateful for the chance to learn."

When Seferian and his colleagues visited the local hospitals, they got an education themselves about the challenges the Armenian doctors and nurses face in aging facilities where medical equipment is scarce or outdated. One hospital had just acquired a high-frequency oscillatory ventilator, a device used in the United States for 20 years to treat respiratory failure in newborns and children. No one on the hospital staff knew how to operate it. But before the end of the visit, Seferian and his colleagues had taught them how.

Another stark reality in the Armenian hospitals, due to the scarcity of modern equipment, is the lack of home care for chronically ill patients. As a result, many patients end up living in the wards.

"There was a former premature infant with chronic respiratory failure and a tracheostomy who was on a ventilator and had been in the hospital for a year," Seferian said. "In the U.S., you would get a portable ventilator and send the patient home. But for this patient, it just wasn't an option."

All of which is why Seferian, whose grandparents emigrated from Armenia to the Boston area, hopes the trip will be the first in a series of missions to his ancestral homeland.

"There was a pre-course and a post-course exam, and we saw a great improvement in the scores," Seferian said. "We saw how these doctors and nurses do so much with not a lot of equipment, with great dedication and perseverance, and my hope is to expand this program and do more."

Joining Seferian on the mission were Mohan Mysore, MD, professor of pediatrics at the University of Nebraska College of Medicine; Mudit Mathur, MD, assistant professor of pediatrics at Loma Linda University Children's Hospital; Yves Ouellette, MD, assistant professor of pediatrics at the Mayo Clinic Children's Center in Minnesota; and Ndidiamaka Musa, MD, associate professor of pediatrics at the University of Washington School of Medicine and Seattle Children's Hospital.