Indian-American urologist and colleagues address unmet burden of children’s surgical disease in India

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Dr. Aseem Shukla, Children’s Hospital of Philadelphia. (Photo: LinkedIn)

Dr. Aseem R. Shukla, a pediatric urologist at Children’s Hospital of Philadelphia (CHOP), along with several of his colleagues from around the world, have created an innovative program to help address urological needs in India. Their study was published in the prestigious Journal of the American Medical Association (JAMA), March 7, entitled, “The International Bladder Exstrophy Consortium: A Model for Sustained Collaboration to Address the Unmet Global Burden of Surgical Disease.”

“The manuscript details the first ever global health project that is focused on complex reconstructive surgery with a 10 year experience,” Dr. Shukla told News India Times.  “Our project demonstrates that a sustainable partnership in India to build a Center of Excellence for complex reconstruction at a free, public hospital in India can deliver surgical results on par with developed countries, and that a surgical mission, with the right local partner, can offer patient followup rates that approach 80% (the average for global surgical missions is 25%),” he added.  The collaboration, Dr. Shukla  said in an email, “offers a model for Indo-U.S. collaboration that is unique in that it is long-term, sustainable, and delivering academically rigorous results enough to be published in the country’s most important medical journals.”  He also noted that the Hindu American Foundation, of which he is a co-founder, also provided financial support for this project.

In the project, the team specifically addressed bladder exstrophy (BE), a complex, rare disorder that occurs during fetal development when the bladder does not form completely and drains onto the surface of the abdomen. If untreated, the disease raises the risk of serious infections and cancer, along with psychosocial complications.

With a population of 1.2 billion, India accounts for 21 percent of the global burden of disease. Approximately 500 babies are born there with BE each year, and the highly-specialized surgical knowledge required to treat BE is limited to a few major medical centers, a press release from the university said. The consequent lack of access is what prompted Dr. Shukla, along with Dr. Douglas Canning, chief of the Division of Urology at CHOP, and several of their colleagues from around the world, to create a multi-institutional collaborative that leverages capabilities to alleviate the global burden of this surgically treatable disease.

Team that worked together on the Exstorphy project: Front row (seated), from left, Dr. Pramod Reddy (Cincinnati Children’s Hospital), Dr. Paul Merguerian (Seattle Children’s Hospital), Dr. Pippi-Salle (Sidra Health), Aseem Shukla (Children’s Hospital of Philadelphia) and Anjana Kundu (Dayton Children’s Hospital). Standing, center back, Dr. Rakesh Joshi, head of Pediatric Surgery at Civil Hospital, Ahmedabad. (Photo: courtesy Dr. Shukla)

The article describes their project at Civil Hospital, a public hospital in Ahmedabad, India, between January 2009 and 2015. In addition to surgeons at Civil Hospital and CHOP, it joined together experts in urology from various other institutions, including Seattle Children’s Hospital, Cincinnati Children’s Hospital, and Sidra Medical and Research Center, in U.A.E.

“The international collaboration that we forged has transformed the care of children born with bladder exstrophy here in India and together, we are delivering care and surgical outcomes on par with the best hospitals in the world,” Dr. Rakesh Joshi, director of pediatric surgery at the Civil Hospital, and a lead author of the study, is quoted saying in the press release from CHOP.  “We have seen our own surgical experience and follow-up care improve not only in the management of exstrophy, but for all complex anomalies as a result of the collaboration.  This study confirms that ours is a model to emulate in reducing the surgical burden in this part of the world.”

The goals of this program included transmitting  knowledge to provide long-term patient care for the future. The team accomplished this by partnering with Civil Hospital, which served as a location to train and perform surgeries. Surgeons local to India learned and participated in the procedures so that, with time, they are able to perform them on their own.

A contributor to this collaboration’s success was rigorous patient follow-up, which resulted in improved patient outcomes and an accelerated surgical learning curve for participating surgeons, according to the team. The results were impressive, the collaboration revealed. Seventy six percent of patients who underwent complete primary repair of BE during the study interval returned for annual follow up in 2016. The same team that performed the surgeries was present for follow up, which helped to ensure cohesive care. Additionally, the team shared resources and infrastructure of academic research centers from higher income countries.

“This was not simply mission work, it was an opportunity to provide long-term sustainability to our mission and deliver the highest levels of treatment,” said Dr. Shukla.

Shukla said he first traveled to India in 2002, and was “awed” by the volume and diversity of pathology, and the “massive burden” of surgical disease in children. “With Dr. Joshi, we resolved to help change the staggering statistics.”

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