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ISTH e-Newsletter: RTW-Molnar
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Five Years Later – Q&A with a Past Reach-the-World Fellow

The ISTH launched our Reach-the-World program to give healthcare professionals from developing countries access to thrombosis and haemostasis related knowledge and education. The program has promoted this access for many years. For this issue of the ISTH e-newsletter, we check-in with a former recipient from 2009, Dr. Soledad Molnar of Clinica Universitaria Reina Fabiola in Cordoba, Argentina, to see the continuing impact of her Reach-the-World fellowship.

What led you to choose hemostasis/thrombosis as your career focus?

When I started doing my residency in hematology, I had not initially thought about doing hemostasis, but it happened that the doctor in charge of hemostasis in my hospital relied heavily on me. Each time he was absent for a congress or other reasons, I covered his office. This allowed me to study and be in contact with patients with thrombotic and bleeding diseases. While seeing patients, I discovered how interesting this specialty is, and I chose to continue down that path.

What inspired you to seek out the ISTH Fellowship program?

I was always interested in improving my skills, and get more experience to treat patients with thrombosis. I wanted to spend more time in a hospital where the focus is thrombosis, to be more in touch with experts in the field, and to interact with other doctors to exchange experiences and answer questions from my daily practice. While looking for scholarship programs, I found the ISTH Reach-the-World Fellowship program, which was an excellent option, so I decided to apply.

How has the Fellowship experience impacted your own practice?

I chose McMaster University in Ontario, Canada for my fellowship experience. I had met Dr. Sam Schulman while reporting patients to the International Registry of Recurrent Thrombosis in patients with cancer, and Dr. Schulman agreed to be my tutor.

The experience allowed me to recognize our work as doctors in Argentina, as the management of patients is very similar. In my practice as a hematologist, in Argentina I see patients with hemostasis and general hematology problems. During the fellowship I was dedicated for three months to the area of hemostasis in different fields: cardiology, trauma, cancer, pregnancy and prophylaxis. This allowed me to learn the management of complications and how to make decisions in critical situation. The large volume of patients being treated at McMaster allowed me a broader vision and gave me confidence in my daily work with patients I see in my office.

Examples of what I learned:

  • I reviewed for bridging protocols that were used in McMaster. I used these protocols as examples to write protocols for my hospital, based on the drugs we have available in Argentina.
  • I returned with even more desire to teach and gain scientific knowledge. In conjunction with the Society of Hematology of Cordoba, we developed our first International Meeting in Hemostasis and Thrombosis in Cordoba. At my hospital we wrote our guidelines for management of Pulmonary Embolism and Thromboprophylaxis and I am working on our own Registries, too.
  • I have been in contact via email with some experts in thrombosis from McMaster with whom I can discuss difficult clinical cases. Is good to have this possibility because there are situations where hemostasis expert opinion is helpful.

Which disorder(s) of hemostasis/thrombosis deserve more attention in your country?

Many disorders in the field of hemostasis deserve attention in my country. In Cordoba, Argentina, which is where I live, the area of hemostasis is not well developed. It is a subspecialty of hematology, but most of hematologists develop greater interest in Oncohematology, and there are few references in the field of hemostasis. So I think hemostasis in general deserves more attention and not a disorder in particular.

What trends (for better or worse) have you noticed during your career in hemostasis/thrombosis?

With respect to the trends that I notice in my country:

Regarding trends for worse:

  • Indiscriminate thrombophilia testing in pregnant patients with obstetric complications
  • Indiscriminate use of low molecular weight heparin in pregnancies and thrombophilia
  • Indiscriminate use of new anticoagulants by professionals who do not know about the mechanisms and risks of these drugs, and cannot advise the patients about an appropriate treatment

Trends for the better:

  • Many young hematologists interested in the area of hemostasis, with the idea of ​​updating and meeting criteria
  • Progress in the development and availability of new drugs such as both anticoagulants and products to control bleeding
  • Registries to know how to treat patients in special or unusual situations
  • Development of new laboratory tests that allow us to find etiology of thrombotic diseases

What advances in the field would you like to see in your home institution?

In my institution, we have been growing in the area of hemostasis. It is a teaching hospital, so the transmission of knowledge plays a major role. I think we should continue to grow in interdisciplinary work, finish writing our own guidelines to study and manage patients with thrombosis and bleeding disorders, and record our casuistry. I would also like us to have access to international research trials in the area of hemostasis.

What is your advice to young physicians or scientists considering a career in thrombosis/hemostasis?

Hemostasis is an exciting field, where there is a lot to study and there is much research. It is important to persevere and be constantly updated. I believe that participation in local or international societies is very useful. To be member of the ISTH is affordable for doctors who live in developing countries and will allow you to access the Journal of Thrombosis and Hemostasis.  And, if they can, I recommend that young professionals take part in an exchange experience in universities where thrombosis and bleeding disorders are the focus. The ISTH Fellowship program is an open door.

What are your favorite hobbies or pursuits outside medicine/science?

I really enjoy nature, and I like to spend my free time outside and trekking in the country outside and the mountains. We have beautiful mountains and rivers in Cordoba. I like reading, too.

What is your favorite book and why?

My favorite book is "Ensayo sobre la ceguera" by Jose Saramago ("Blindness"). I like this book because it shows how a critical situation brings out the best or the worst of each one.  It invites reflection, and I definitely recommend it.

Dr. Molnar and Dr. Schulman

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