CRAJ Fall 2016

Fall 2016 (Volume 26, Number 3)

Best Training in the World…Only in Canada?

By Deborah Levy MD, MS, FRCPC, Chair, Pediatric Committee of the CRA

While pediatric rheumatology remains a nascent specialty in many countries, Canada is one of the most popular places for training, owing to our internationally recognized excellence. We have welcomed more than 60 trainees from over 20 countries into the three training programs at McGill University, University of Toronto (UofT) and University of British Columbia (UBC) through the years; see related article by Dr. Mercedes Chan on p.14. Although many of these trainees arrive with expertise and years of experience working as pediatric rheumatologists, they always leave Canada with expanded knowledge and experience, memorable travel experiences and many new and lifelong friends. For this issue of the CRAJ, I solicited comments from trainees who returned to their home countries to show the impact that our community has had around the world. I received many enthusiastic replies, and most have been abbreviated since the request for 50 words frequently produced a 300- or even 500-word email!

From Asia, Dr. Gun Phongsamart writes “I completed my pediatric rheumatology training at B.C. Children’s Hospital and returned to work in my home country at Queen Sirikit National Institute of Child Health in Bangkok, Thailand. I was one of the pioneers in pediatric rheumatology in my country as well as a pioneer member of the pediatric rheumatology workforce in Southeast Asia, where up to 670,000 children suffer from rheumatologic diseases. It would be nice if we could create international collaborations to establish international standard pediatric rheumatology training to serve these children. The healthcare system in Thailand is quite complicated, which results in differences in access to necessary drugs. Therefore, I founded a juvenile arthritis and autoimmune diseases fund at the Children Hospital Foundation (www.thaichf.org) and we run charity concerts, musical plays, auctions, and other campaigns each year. I learned about patient advocacy from Dr. Ross Petty, and I recently started a patient self-advocacy group. I wish I could reproduce the excellent transition program that Dr. Tucker and Dr. Cabral run, but our healthcare system is not amenable to this. I enjoyed my training in Canada, and it was definitely one of the most important phases of my life.”

Also from Thailand, Dr. Tassalapa Daengsuwan writes “I am currently the Head of the Pediatric Allergy, Immunology, and Rheumatology Division at the Referral Centre of Thailand. Because of the shortage of pediatric rheumatologists in Southeast Asia, the training I had from the Centre for Innovation & Excellence in Child and Family-Centred Care at the Hospital for Sick Children in Toronto, Canada, allowed me to have the great opportunity to help a lot of children who suffer from serious autoimmune diseases in Thailand, as well as our neighbouring countries.”

In India, Dr. Rachana Hasija writes with a different perspective from Mumbai: “Pediatric rheumatology is still very much in its beginnings here, but challenges are welcome because the scope to grow begins with them. My training at SickKids will remain with me for my entire lifetime. Every patient I encountered, every presentation, every colleague, all my respected teachers... I have carried you all back with me to Mumbai. Every patient is my teacher here. I hope my wealth will be my patients, presentations and articles. Hoping to continue a synergistic relationship with SickKids.”

Our Canadian ties with Australia extend beyond our mutual love of good food, wine and the outdoors. Dr. Roger Allen writes from Melbourne: “Australia currently has 17 pediatric rheumatologists —five locally-trained, one American-trained, four British-trained and the other seven all Canadian-trained. After the MD and FRACP, our next most important academic qualification is the ‘BTCACB’ (i.e., Been To Canada And Came Back). I led the charge back in 1982 when I went to Vancouver with the intention of doing 12 months of “something a bit different” before heading towards being a rural general pediatrician. I fell under the spell of the amazing Ross Petty and finished up staying on to train in rheumatology, and 35 years later, I am still at it. Despite our obvious geographic differences, there is something very special between our two countries which is hard to quantify —sense of humour? Or, a common sense approach to things? My family look on Vancouver as their second home even though we only get there every couple of years usually en route to the snow. Some years ago, my then 12-year-old twins directed a taxi driver as to the best way to miss the traffic to get from the airport to David Cabral/Lori Tucker’s home —I guess that says it all!

From Western Australia, Dr. Senq Lee writes: “I am a consultant pediatric rheumatologist at Princess Margaret Hospital in Perth. As with most Australians, part of my advanced training/fellowship involved training in Toronto (2010-12) in Rheumatology at SickKids. I hold my time in Canada as the most enjoyable in my life. The supervision and training was of the highest-degree worldwide. I am primarily a clinical physician. The caring staff at SickKids provided a framework for fantastic clinical care which I’ve incorporated into my daily practice, for which I am forever grateful.”

And Dr. Jonathan Akikusa has a different perspective of Canada. “I am currently a pediatric rheumatologist and consultant pediatrician at the Royal Children’s Hospital in Melbourne, Australia. My time at SickKids was valuable not only for the incredible learning opportunities it provided but also for the opportunity to meet people who have become lifelong mentors and friends. My ties with Canada remain very strong, not only professionally but —having married a Canadian— personally as well!”

From Israel, Dr. Joseph Press writes “I had the distinct privilege of undertaking advanced studies in pediatric rheumatology at the Hospital for Sick Children in 1993-94. The two-year fellowship was indeed life-changing as upon my return to Israel, I was appointed head of Pediatric Emergency at Soroka Hospital in Beer Sheba and later headed the Pediatrics Division. In January 2008, I was appointed CEO of Schneider Children's Medical Center of Israel, the only tertiary care hospital of its kind in the country.

Many of my colleagues are alumni of SickKids, rightfully acknowledged as one of the key leaders in global Pediatric Medicine. It is for this reason that we actively encourage advanced training at SickKids where possible. Over and above my professional positions, I have continued throughout the years to serve in the Rheumatology Clinic at Soroka Hospital in Beer Sheba, alongside the publication of many research papers which concern rheumatology alone. I will forever be indebted to SickKids for having granted me this unique opportunity.”

From Saudi Arabia, Dr. Abdullatif Alenazi writes, “I am a pediatric rheumatologist in Riyadh at King Fahad Medical City, a tertiary care centre providing services and receiving consultations from all over the country. It was a great opportunity for me to do a pediatric rheumatology fellowship in Vancouver, where the first Canadian pediatric rheumatology training was established and I was able to work with the father of Canadian pediatric rheumatology, Dr. Ross Petty. All I learned I have utilized upon returning home to help kids with rheumatic diseases. I have excellent relations with my colleagues and teachers in Canada and I can seek opinions for my most challenging cases.”

In the United States (although originally from Germany), Dr. Hermine Brunner is currently the endowed chair and director, Division of Rheumatology at Cincinnati Children’s Hospital Medical Centre. She is also the scientific director of the Pediatric Rheumatology Collaborative Study Group. She writes: “The Masters in Clinical Epidemiology Training at UofT was critical for my career in clinical trial designs and outcome measure development. I also cherished the great clinical training with a constant emphasis on how to become better in treating pediatric rheumatic diseases – to mind come specialty clinics, fellow rounds and standard treatment protocols before anybody else was using them. I continue to have ties with Canadian sites for research and to exchange ideas.”

From South America, Dr. Ricardo Russo writes: “I am currently the Head of Pediatric Immunology and Rheumatology at the largest pediatric center in Argentina, the Garrahan Hospital in Buenos Aires. My training in Canada not only provided me with a wide background (which I still carry) but also set the standards by which I have been practicing since I finished my fellowship and started my own program, 23 years ago. The fashion in which I deliver inpatient care, teaching, and research is the very one I was taught during my training period. I keep ties with close friends currently working in Toronto and other cities across Canada.”

And from Europe, Dr. Boris Hugle writes: “I was a fellow in Toronto from 2008 to 2010. I had already completed pediatric and rheumatology training in Germany, but felt that it had not been sufficiently rigorous. Training at SickKids gave me a whole new perspective on pediatric rheumatology. I now work as a staff rheumatologist at the German Centre for Pediatric and Adolescent Rheumatology in Garmisch-Partenkirchen, the largest facility in Europe dedicated to treating pediatric rheumatologic diseases. Apart from the clinical work, my area is to build a research program and to establish quality-controlled teaching. For that kind of work, I can put my training in SickKids to use virtually every day!”

In the Netherlands, Dr. Sylvia Kamphuis, from the Sophia Children’s Hospital at Erasmus University MC in Rotterdam writes: “I came as an experienced pediatric rheumatologist to specifically train in lupus with Earl Silverman (now my mentor) and his great team. Just focusing on lupus for two years has given me unique knowledge and experience and a broad network of ‘lupologists’ internationally. Additionally, I greatly enjoyed being part of the pediatric rheumatology team and especially appreciated the academic half-days. These two years were fundamental for where I am now: (i) part of the childhood systemic lupus erythematosus (cSLE) team in a European project for developing standards of care for children with autoimmune diseases; (ii) having a Ph.D. student studying long-term outcomes of cSLE; and (iii) starting a national cSLE registry in the Netherlands.

Back here in Canada, in addition to the wonderful colleagues and friends that we have all made, we have also expanded our knowledge of food and other customs distinct to different cultures, while realizing opportunities for combining work with foreign travel to maintain our ties.

Deborah Levy, MD, MS, FRCPC
Associate Professor of Pediatrics,
University of Toronto
Rheumatologist,
Hospital for Sick Children
Toronto, Ontario