ROP IN ROMANIA:
A LETTER FROM DR. ANTONIO CAPONE, JR.
For more than 15 years my partners Michael Trese, MD, Kimberly Drenser, MD, PhD and I have been traveling to Italy several times each year to tend to children from Europe and the Middle East with pediatric retinal disorders. [Over that time, more and more Romanian infants and children have appeared in our clinic.] Virtually all have [complications of] retinopathy of prematurity (ROP)– a potentially blinding disease which occurs as scar tissue grows on the surface of the retina of prematurely born infants, and results in retinal detachment.
The increase in the number of Romanian infants in our clinics is typical of a country evolving through the process of improving neonatal care – which in turn increases premature infant survival.
We recognized that it required refining the delivery of neonatal care beyond infant survival, and widespread implementation of a screening program, so that infants requiring treatment for ROP could be identified and treated promptly and properly. This was a national public health issue too big for us to get our arms around on our own, so we have worked to do what we can over the years, tending to one child at a time.
Carmen Maria was the last infant I was seeing in a long and challenging day of exams in March of 2015 – many of the children we see when in Europe are highly complex, profoundly impaired, and the parents are at their wits’ end. Dan Rosca (who came as Nobody’s Children’s Romanian representative) entered the exam room after a long wait, accompanying baby Carmen Maria and her mother Emilia. Carmen Maria’s story was fairly typical – premature birth, ROP, prior surgery without success. I examined Carmen Maria, and discussed the findings and surgical options available in the US with her mother Emilia with Dan Rosca’s help.
The trio of Carmen Maria, her mother and Dan made it to Royal Oak in June. In the interim I’d been contacted by Elaine MacEwen, executive director of Nobody’s Children, about the prospect of having a Romanian physician come to observe how we managed ROP – from screening to surgery – at our center. So along with Carmen Maria also came Dr. Cristina Nitulescu, an ophthalmologist from Bucharest. We often have international scholars interested in pediatric retinal diseases who visit us in Michigan. So even this was not yet so unusual.
But I had no idea that my center’s relationship with the infants, families and physicians from Romania was about to change forever. In short, we’d stumbled upon the hope for meaningful public health change in the care of premature Romanian infants at-risk for ROP. Or rather, the solution - a chance to impact a nation - had found us.
What I’ve learned since that clinic day in Rome just a few months ago is that Elaine MacEwen is a force of nature with a singular mission of improving the level of medical care available to Romanian infants and children. I’ve learned that Dr. Nitulescu, thoughtful and gracious, shares Ms. MacEwen’s iron will and has been a leader in the mission to improve ROP care in Romania for years - championing the development and implementation of ROP screening and treatment standards. They are a formidable duo.
Wisely, Ms. MacEwen understood that meaningful change in Romania would require training more than a single ophthalmologist interested in pediatric retinal disease. Momentum for change would require a team. And such change would be most [successful if it included] an educational opportunity for Romanian neonatologists as well. Dr. Cynthia Pryce, a neonatology colleague at William Beaumont Hospital, and her team have graciously agreed to host visiting Romanian specialists in the Neonatal Intensive Care Unit (NICU) as well. The next “wave” of Romanian physicians brought by Nobody’s Children was comprised of Dr. Mihaela Boboc, a dedicated ophthalmologist from Iasi, who arrived along with Dr. Irinia Franciuc, a neonatologist from Constanta. Most recently, we have hosted young Dr. Corina Taranu and Dr. Pryce and colleagues have hosted Dr. Cristina Chiriac. The genuine interest in and dedication to the well-being of prematurely born Romanian infants evidenced by this group of physicians is striking.
Romania sits at an important point of inflection between the European Union and other regional nations more similar to Romania in the state of their economies and medical care systems. Solutions to the challenges faced by premature Romanian infants are likely to impact not only Romanian infants, but provide a template for addressing similar public health challenges in a number of other countries. Viewed this way, the responsibility may seem even more daunting. From what I’ve seen of this team of Nobody’s Children’s-sponsored Romanians, they are very much up to the task. We are grateful and honored to participate in this extraordinary initiative, and look forward to watching it bloom in full.
-A. Capone, Jr., MD
Dr. Capone is an internationally recognized leader in the areas of advanced retinal surgery, pediatric retinal disease, and macular surgery. He has authored several ophthalmology texts and more than 200 book chapters, original reports, electronic publications, and abstracts. He holds several academic appointments and practices in Royal Oak, Michigan