"If you think in terms of a year, plant a seed; if in terms of 10 years, plant trees; if in terms of 100 years, teach the people." This insight from Confucius is embodied by Daniel James Penny, MD, PhD, FACC, who organized a collaboration that included a comprehensive teaching program that eventually led to the creation of an international-caliber heart institute in Hué, Vietnam. The College recently recognized Penny for his work and presented him with the International Service Award at ACC.16.

The world-renowned pediatric cardiologist was “compelled to see if there was anything I could contribute,” after a Saturday morning clinic visit where some 60 children with congenital heart disease (CHD) were being treated in a setting with very rudimentary technology and facilities. Rather than being cured by a single operation, as they would be at his hospital in Australia, they were destined to a shorter life that would be spent in a hospital.

In contrast to his lectures on technical and modern concepts of mechanical support or ventilation for children after surgery for CHD, what he saw in the clinic in Vietnam in 2002 was “eye opening.” This put a face on the more than one million babies born with CHD worldwide, 90 percent of whom do not have access to care in places like Australia and the U.S.

Penny knew that the scope and scale of the need required more than sending surgeons to perform a few surgeries each year in Vietnam or training a few Vietnamese physicians in Australia or elsewhere; he decided that a more permanent solution was needed. At the time, Penny was the chief of cardiology at the Royal Children’s Hospital in Melbourne, where there was an international group led by Garry Warne, MD, committed to improving health care resources in their region and willing to support a program in Vietnam.

This matched the commitment of the local champion who Penny credits for the success of this effort. Professor Bui Duc Phu, a cardiac surgeon, is now the medical director of the institute created by this collaboration. “His inspiration allowed us to achieve our goals,” says Penny.

Penny would then learn about their specific needs and cross-cultural negotiation during his 25 trips over eight years to Hué. He also worked with the team to secure funding for the center. “We wanted a hospital that in all aspects would suit the culture and environment in Vietnam,” he explains.

Together the partners created a multipronged, customized education program that has trained more than 100 local physicians, nurses and other health care workers. Some of this training was provided in Vietnam, by visiting physicians or nurses and some in Australia, where nurses from Vietnam took the same training courses as Australian nurses and senior cardiologists or cardiac surgeons completed during fellowships. Training was also provided for all services and functions needed within the center, such as the blood bank, laboratories and infection control, as well as financial expertise. In addition, English teachers worked full-time in the hospital for years.

The Hué Central Hospital Heart Institute is now a self-sustaining, seven-story center that performed about 800 cardiac surgeries, mostly in children, in 2011. All procedures are performed by local staff. In comparison, Texas Children’s Hospital in Houston, TX, where Penny is now the chief of pediatric cardiology, performs about 1,000 cardiac surgeries annually.

“Every day I was in Vietnam reminded me of why I became a doctor,” says Penny. In 2011, Phu presented Penny with the “For People’s Health Award,” on behalf of the government of Vietnam.

His international service does not end there. Since rheumatic heart disease remains a major killer in children in low- and middle-income countries, Penny’s group at Baylor College of Medicine, where he is section head of pediatric cardiology, is working to establish programs to address rheumatic heart disease in sub-Saharan Africa. He believes that primordial prevention in children is required, as it is unlikely these emerging countries will have sufficient resources to address the manifestations of ischemic heart disease in adults.

When he looks back on all that he accomplished in Vietnam, Penny believes it is one of his greatest satisfactions. "What's amazing to me now is the way in which the local leadership in Hué is developing programs to improve the care of patients with heart disease in other areas in Southeast Asia," says Penny. More trees are being planted.

Keywords: Cardiology Magazine, ACC Publications, Heart Defects, Congenital