News from the American College of Chest Physicians (CHEST) : ChestSoundings
Volume 16, Issue 1 (January 2002), International News, Page 12
Aroonwan Preutthipan, MD, FCCP
พญ. อรุณวรรณ พฤทธิพันธุ์
Sending the Children Home — Donated Ventilators Provide Home Care Support
The program to support home mechanical ventilation for children in Thailand first started by our group at the Division of Pediatric Pulmonology, Ramathibodi Hospital, in 1992. The financial constraints have been and are presently the biggest problem of our program. There is no federal government or insurance coverage for home ventilation. The cost is borne entirely by the family. Conventional home mechanical ventilators with essential features for home use are available but hardly affordable. We have to adapt ventilators for home use that were manufactured for other purposes, such as using BiPAP and CPAP machines. These ventilators have inadequate alarm systems, and the caregivers are responsible for intensively observing patients’ respiration. Given no internal batteries, the caregivers must ventilate the patient manually during the time when the electrical supply is turned off. Most patients have to wait in the hospital for an extended period until financial resources can be identified. In 1998, I had the fortunate opportunity to attend a lecture by then ACCP President, Allen Goldberg, MD, FCCP, on recent advances in home mechanical ventilation. Thereafter, at the 29th World Conference of the International Union against Tuberculosis and Lung Diseases, Global Congress on Lung Health in Bangkok, Thailand, I heard Dr. Goldberg speak again about the work he had done for his patients. I wished I could do the same for my poor patients. After the Congress, Dr. Goldberg came to visit Professor Subharee Suwanjutha, MD, FCCP, my superior, at Ramathibodi Hospital. We showed him how the team of pediatric pulmonologists, respiratory nurses, ambulatory nurses, and a secretary successfully worked on pediatric respiratory home care under limited conditions.
A 15-year-old girl with bronchiectasis and chronic respiratory failure received a home ventilator from Mr. Tim Buckley, Walgreens Company, USA. She lived happily in one of the slum areas in Bangkok.
In 1999 in Chicago, I participated in the panel discussion, “International Experience with High Technology Home Care,” at the CHEST meeting. It was my honor to be among the famous panel speakers from the USA, France, and Japan. I was the only one from a developing country. I spoke on how we helped ventilator-dependent children go home. I had to confess that most home ventilators were obtained through charitable agencies and donations. The caregivers were almost always the family members who were nonmedical professionals. Some had no education at all but had wholehearted dedication to their child. We were proud showing that the children were happy being home with family.
The ACCP has recently launched NetWorks to provide all members a chance to meet in person or electronically, share common experiences, disseminate useful knowledge, and develop new ideas and working relationships. I have known and worked with Tim Buckley and Kathy Keating for years, developing with them home mechanical ventilation programs in Chicago. Although I only had recently met Aroonwan, I immediately recognized her as a compassionate, competent physician who was dedicated to her patients. I encouraged all three to join the College and the Home Care NetWork, promising them that the ACCP gives members opportunities unlike any other organization I know. This story demonstrates that NetWorks work and that, working together, you can make a difference!
Allen I. Goldberg, MD, FCCP
Home Care NetWork
From left to right, Allen I. Goldberg, Tim Buckley, Aroonwan Preutthipan