The schedule of the world famous Swiss heart surgeon Paul R. Vogt is very busy. His life consists of a succession of clinics and operating rooms, as well as planes and trains which carry him to the most remote corners of the world to do the work of the EurAsia Heart Foundation. The interview is scheduled for early Saturday morning. I am met by an extraordinarily agile person with the movements of a dancer. «You are very similar to Mikhail Baryshnikov. Have you been told this before?» The words come of their own volition. «No,» the professor answers in a detached manner. I seem to distract him with this absurd question, to pull him out from the depths of his inner world, where he is focused on more important problems.
He gives the impression of an extremely restrained and closed person, but behind this is a person fanatically dedicated to saving lives, a self- sacrificing enthusiast to whom thousands of people «trust» their own hearts.
– Professor Vogt, you are one of the leading heart surgeons in the world, with both recognition and status. You could enjoy them, limiting yourself to working in the comfortable conditions of a Swiss clinic. Nevertheless, you devote the lion’s share of your time to charity: you operate on patients throughout the world, you train local experts and you run the EurAsia Heart Foundation. How did it all start?
– The history of the Foundation began in 2000, when I went to China as a part of our first mission.
I performed some relatively simple surgery that was filmed and then shown to other doctors. this video was very popular among Chinese universities. Asian colleagues asked if the «doctors from the European Union» (as they called us) could come more often to them to train their specialists in their clinics and on their own patients.
Then there was a trip to Vietnam, where I appeared in a children’s clinic which was critically overcrowded with patients. I was told that there were 8,500 children on the waiting list for surgery. they were lying around everywhere: on the floor, in the beds, several people to each one. At the same time, it was possible to conduct only two surgeries per week. this hospital, overcrowded with children and their parents, and the impossibility of providing timely assistance to all of them, made a strong impression on me. I realized that I had to do something. ^en the idea of an organization which would involve itself systematically in the professional development of doctors on site to increase the number of experts capable of carrying out complex surgeries came to me.
– How big is the need in other countries for such assistance?
– In Vietnam, where 82 million people live, 10,0children with heart problems are born every year and another three thousand are diagnosed with various cardiac diseases. But only 6,000 heart surgeries are performed! By comparison, in Germany, with 80 million inhabitants, this figure is 60-90 thousand surgeries every year (starting sometime in the 1970s). At the same time, in the hospital in Myanmar, there is only one pediatric heart surgeon, who has 5,000 children in the queue for surgery! Can you imagine? And this list is growing and every day more than one child dies!
In China, 100,000 babies are born every year who are then diagnosed with heart diseases. They all need qualified medical assistance. At the same time, in the whole region, young specialists facing difficult cases understand that they are not properly qualified, because in these countries there are no traditions or continuity in cardiovascular surgery as there are, for example, in Switzerland. And all the rapid developments in cardiology, cardiac surgery and related disciplines like resuscitation and anesthesia, which have been going on for the past 30-50 years, pass them by.
– It turns out that today it is more important to help not with money, but with training, right? It is more than a matter of expensive equipment – it is that there are just not enough hands, isn’t it?
– Wherever we go, whatever city, country or clinic we get to, everywhere they tell us about new buildings and expensive equipment. Millions and billions are invested in equipment and construction, but, in my opinion, too little is invested in the education of doctors and staff. It is possible to help 90% of patients by means of locally available equipment, but the person is treated not by an instrument but by the doctor using it.
therefore, we teach doctors and staff to work more effectively with the equipment that is available. Imagine if we took all the equipment with us and then took it back. It wouldn’t yield any results! Another example. Suppose a Vietnamese, Chinese or Russian doctor comes to Switzerland to study here in the department of heart surgery. But for two years he will be able to work only as an assistant unless he is allowed to conduct the simplest surgery, even just once. And in his country, on the other hand, we assist him during surgery, demonstrating how to best use the means available. In my opinion, this is the best possible kind of education and professional development.
– You receive thousands of inquiries every year. How do you decide in favor of a particular clinic?
– The request comes not from the hospital, but from the Ministry of Health of the country in question. I cannot, at the request of a colleague whom I meet, for example, at a congress, come to his clinic and start training. An official request is required.
We see what is needed for a specific department of heart surgery, whether there is a solid team of specialists ready to study and work together, because our goal is to leave behind a team of doctors who can work perfectly without us, having gained new knowledge and experience. Then a larger number of patients will receive good medical care. If we face problems, then we ask the local management to join us and make certain changes. If nobody wants changes, then we stop working.
– How long does such local professional development take?
As a rule, our cooperation with clinics is designed for a period of four to eight years. During this period, it is possible to achieve the desired result. We do not work by the principle of «here today, gone tomorrow». I call this surgical tourism.
– And what examples of successful cooperations with clinics are you proud of?
– First of all, the Department of Heart Surgery at the University of Yangon (Myanmar) comes to mind. In 2009, when I first arrived, there were about 100 surgeries a year. ^e mortality rate was extremely high. Today, with a lot of missions behind us, we can say that this university has a reliable team of doctors. they have two operating rooms, fully technically equipped. Experts can operate on a wide range of diseases in adult patients, and the mortality rate is the same as in our clinic in Switzerland. they cope with the most difficult cases and focused on children’s cardiac surgery themselves.
In addition, until the end of April 2014, I worked in Donetsk, in the department of cardiac surgery of adult patients. I have not been there for three years, but I still have good contacts with the doctors and I know that they will continue what they have started.
– How many people are there in your team?
– About 120 people work with the Foundation. Of them, 50 are doctors of various specializations. There are physicians from Switzerland, other European countries, Japan, Australia, America… We create international teams for each mission.
It is clear that most doctors cooperate with us on a part-time basis, since they have their basic practice. When we are going to a new clinic, first we analyze what will be required from us: training in the fields of cardiology, anesthesia, intensive-care medicine, surgery or artificial ventilation of lungs. It is also important not to squander funds. Based on this, a group of training specialists is formed. It can happen that only one surgeon or cardiologist will go, or a surgeon with a resuscitator or a cardiology equipment specialist. We never travel as a big team. The main principle is working hand in hand with the experts on site: our anaesthetist with their anaesthetist, our surgeon with their surgeon, our resuscitator with their resuscitator. The most valuable thing is for us to stand next to the local doctor during the surgery and assist him.
– How many surgical operations have you conducted?
– Over 3,100 plus 9,000 consultations. Over 12,0patients have passed through our hands. I would like to point out that diagnostics is also a large part of the work. It sometimes happens that the patient is told that he needs complex surgery, whereas it is enough for him to take medication and be monitored regularly by a specialist. So, preventing unnecessary interventions has the same value as the surgeries themselves.
– How is the Foundation financed?
– Of course, like all charity foundations, we exist through donations. the life of one child costs 1,000 dollars. We do not take money for our activities and conduct all surgery and training free of charge, but there are local running expenses that have to be covered by the Foundation’s budget. Today, the need for such assistance is estimated in hundreds of millions of children’s lives.
– Tell us about a case that you remember when, in practice, the work of the Foundation helped to save a young patient?
– There are a lot of such cases and we often remember these children. For example, David from Ingushetia, who was diagnosed with arachnodactylia, an insufficiency of connective tissue membrane. His mother left her job to take care of her son, since he had to come 22 times to Moscow for additional examinations. In Russia, nobody took up his case. In the German clinic, they were ready to operate for 85 thousand euros, but this sum of money was too much for David’s parents. the boy grew weaker and weaker; he could not live a normal life. We met him while carrying out joint consultations with doctors in the North Caucasus. We performed an ultrasound examination and told him, «Of course, it is complex surgery, but we can carry it out and it should be in St. Petersburg». It cost about 3 thousand euros, which the parents paid to the St. Petersburg Pediatric Medical University, where we regularly and successfully conduct our missions. The surgery lasted almost 12 hours and was successful. Now David goes to school, and last year he wrote me an SMS that he felt well. He does sports and lives as he wants to live. He is an absolutely normal young man with a healthy heart and he is developing well.
– How difficult is it to deal with small patients? After all, an adult understands when he has complex surgery and makes every effort to survive and he can explain in detail his state of health and feelings.
– With children it is the same, but on a different level. Surgeons often have to deal with unexplained phenomena. Once I performed very complex surgery on a four-month-old girl in Russia, whom all other surgeons refused because they did not know how to help her. She was, in fact, doomed. But we took up the surgery. It may sound unusual, but we worked together with the child. Her body responded to every movement, every manipulation of mine. This unconscious desire for life and for victory over death is sometimes more powerful than any verbal communication. When the surgery was over and the baby emerged, the first thing she did was smile at me and mischievously show her tongue.
– People travel to rest. You travel to work again. How do you relax?
– When I am at home, I like to read. I am fond of international politics, I go in for sports. And you know, during my trips I get to know the country much better than if I went there 10 or 20 times as a tourist. I discover the countries through people, through my patients.
Paul R. Vogt
Doctor of Medicine, Professor of Cardiovascular Surgery, President of the EurAsia Heart Foundation. In 1983, he graduated from the Medical Faculty of the University of Zurich. He worked as an assistant physician in the field of heart surgery and vascular surgery at the University Hospital of Zurich under the guidance of Professor Marco Turin. In 1992, he defended his thesis. In 1997, he headed the Department of Heart Surgery and Vascular Surgery at the University Hospital of Zurich. He has been invited to clinics and universities in Germany, China, and Myanmar. He is an Honorary Doctor of the Pavlov First Saint Petersburg State Medical University and Professor of the Department of Neonatal Surgery and Cardiac Pathologies of Newborn and Premature Children of the State Medical Pediatric University,
St. Petersburg, Russia.