Dr. Joel Lim and team build Intestinal Rehabilitation center at Children's Mercy

For the last six years, Joel Lim, MD, and a multidisciplinary team have built Children’s Mercy Intestinal Rehabilitation into one of the premier programs in the U.S; now Dr. Lim is sharing his expertise to help establish what he hopes will become a prime referral center in his native Philippines.

“I came to Children’s Mercy in 2010 to lead the Intestinal Rehabilitation Program, and I would say we have developed one of the top programs in the country,” said Dr. Lim. “I work with a multidisciplinary team that includes nurses, dietitians, psychologists, pharmacists, a pediatric surgeon and a social worker, and we are one of the more comprehensive programs in the country.”

Dr. Joel Lim (center) with Reynaldo Sinamban, MD, Director of the Nutrition Support Program at St. Luke's Medical Center in Manila, the Philippines, and Grace Paguia, MD, pediatric nutrition support physician at the hospital. St. Luke's, one of the largest hospitals in the Philippines, launched the country's first pediatric nutrition support program in August. Dr. Lim has been a mentor to the program, which was modeled after the program Dr. Lim established and leads at Children's Mercy.

The main causes of bowel dysfunction are congenital or acquired early in life. When necrotizing enterocolitis develops, primarily in premature infants, portions of the bowel undergo tissue death. When this tissue is removed, the bowel is too short to allow adequate nutrient absorption and growth.“The goal for intestinal rehab patients is to allow them to get food through their GI tract again,” said Dr. Lim.

The Intestinal Rehabilitation Program currently treats about 100 patients who need parenteral (intravenous) nutrition because their bowels do not work properly. Some patients’ conditions are so severe that they require Total Parenteral Nutrition (TPN). When Dr. Lim arrived at Children's Mercy, the hospital treated about five TPN patients; the center now treats about 25.

“These kids are really sick and medically complex,” Dr. Lim said. “Imagine yourself not being able to eat and being fed with a central line in the veins. There’s always the risk of infection, and their acuity is high. But we’re able to save more and more of these chronic kids. Before this program was established, some of these patients were too complex to send them home, but now they can get their TPN at home. Even if they’re three or four hours away, we can still help them.”

In addition to his duties as Director of the Intestinal Rehabilitation Center, Dr. Lim also is Director of the Nutrition Support Program. “The kids we treat in the center need specialized nutrition, so the two roles go hand-in-hand,” he said.

Development of the Children's Mercy center enables patients from this region who formerly had to travel to places like Omaha, Cincinnati or Boston for treatment to come here. Children's Mercy’s growing reputation and collaboration with other centers allow referrals and co-management of patients. Team members are invited to give lectures at national and international conferences, and Dr. Lim serves on the scientific committee of the Intestinal Rehabilitation and Transplantation Association.

Two years ago at an international conference, Dr. Lim talked with a members of a contingent from the Philippines who were astounded at the U.S. survival rates of patients with severe intestinal failure.

“Children born with this condition in the U.S. have a 90 percent chance of survival,” Dr. Lim said. “There, the chance of survival is close to zero. It’s a death sentence.”

The conversations led to Dr. Lim engaging with staff members at St. Luke’s Medical Center in Manila (not affiliated with the St. Luke’s system in Kansas City), one of the biggest hospitals in the Philippines, which also has a medical school.

“Basically, they wanted to pick my brain and use the program we’ve developed as a road map to build a program there,” Dr. Lim said. “I’ve been in communication since then, advising them, donating books, and generally serving as a mentor.”

Dr. Lim has traveled to Manila at his own expense several times to lecture and consult with staff members at St. Luke’s. He recently returned from an eight-day visit during which he delivered a lecture at the launch of the first pediatric nutrition support program in the Philippines, which he helped build. Their next step will be to establish an intestinal rehabilitation program.

“They have the expertise and the building blocks to make it happen, they just need our know-how on how to pull it all together,” Dr. Lim said.

To that end, he hopes to have staff members from Manila visit and observe at Children's Mercy and other leading institutions in the U.S., and to enlist the help of colleagues from the U.S. who have expressed a desire to provide assistance.

“I’m thinking big,” Dr. Lim said. “I believe this could become a referral center for all of Southeast Asia. They have the ability to save these patients, and there are people passionate about making it work.

“For me,” he added, “It’s my way of trying to give back. I grew up and attended medical school there, then came to the U.S. because of my interest in cutting-edge intestinal rehabilitation. Now that I’ve achieved knowledge, experience, and earned a strong reputation in this field, I want to help them get their program running. In the United States, we’re saving these kids. We should be doing the same thing there.”

Podcast Listen to Dr. Lim’s podcast titled, “Intestinal Rehabilitation: Multidisciplinary Approach to Care,” which is part of “Transformational Pediatrics,” a free podcast for health care professionals featuring the specialists from Children’s Mercy covering topics that are changing in pediatric medicine.https://radiomd.com/childrens-mercy/item/32484-intestinal-rehabilitation-multidisciplinary-approach-to-care