Sunday, February 19, 2012
It was a great trip this year full of lots of team work and I can't wait for next year! Also can't wait for my bed and shower tonight!
Friday, February 17, 2012
|Suellen ( ward RN leader) and Dr Joseph Mucumbitsi taking to Theopista|
|our Rwandan collegues getting report and taking over Team Heart pt|
|Our hardworking Gita signing off|
|Ceeya teaching valve types to pt Jean Diodonne|
|Susan Gabriel and Jean De Dieu ( operated in 2009) visiting|
|Team Heart founder, Leslie Sabatino packing up|
|Chip and Paige Bolman|
|our first patient of 2012 Jean De dieu|
|Ceeya and Chip taking a break after a long day|
|Susan and Connie ( resource nurses) passing on report in the ICU|
|our triple valve patient Diodonne ( a strong boy)|
|Dr Dimitrios hard at work|
|Dr Maurice ( Rwanda cardiac surgery canidate)|
|Dr Maurice, Jabaris, Joseph, Gita, and Dimitrios|
|Pat and Jolie|
|Erneste, Kevin and Alexis|
|our important words|
|jolie and husband walking to the ward|
|Rich our pt from the class of 2011 with a gift and his caretakers|
|Pat Come, Diodonne and Connie|
|pals celestine and Jean de dieu|
|Team Heart 2012|
Today we left our patients in the good care of our Rwandan collegues and said good bye. This is always a sad and difficult process. It was buffered by a visit from our former patients who look and feel wonderful. This is one of the first times all if of our patients were together at the end. This was truely a wonderful mission.
Tuesday, February 14, 2012
Yesterday was a long day with the last two patients rolling out of theater, one returning for exploratory for bleeding, but now doing well. This week has been heroic effort by the theater (nursing, perfusion anesthesia, surgery) and ICU team, working long-long hours, but as a finely tuned machine. It is hard to leave the others also desperate for surgery here......but we are happy the Spokane team will be here in two months.
Monday, February 13, 2012
Sunday, February 12, 2012
One of our OR nurses is from Spokane and has been a hilarious addition to the OR! Terra is extremely hard working and even late at night after a hard day has us all cracking up!
Time for the second case of the day to go on cardiopulmonary bypass!
We have had the great pleasure this week to help Alexis, a wonderful 16 year old boy who lives in an orphanage with very devoted caregivers, one or more of whom have visited him every day he has been at King Faisel. His mother is alive, but was too poor to raise him. Alexis had been unable to play with his peers, as he had had significant shortness of breath with exertion. He had kept up with his studies, however, despite his disability. On his screening echo, he had what appeared to be isolated severe tricuspid valve regurgitation (leaking of a right-sided heart valve). However, his labs came back with an hematocrit of 79 (nl is about 40-45) and the oxygen saturation in his arterial blood was very low at 77% (nl 98-100%). We had to search further, for a communication between the right and left heart, which would allow blood returning from the body and, therefore depleted of oxygen, to bypass the lungs and get into his left heart and then to his head and body. To evaluate for this communication, we injected agitated saline into an arm vein and we saw the saline contrast enter the right atrium and, then almost immediately, enter the left heart. We had found the communication between both atria (upper chambers of the right and left parts of the heart). To compensate for the low oxygen saturation in his arterial blood, his body had produced almost 2 x the amount of red blood cells to try and oxygenate his body. We then had to make sure that he did not have what we call Eisenmenger physiology where a hole in the heart initially causes excess flow to the lungs, followed by the development of high and irreversible pressure in the lungs. That high pressure would make the shunt reverse direction, sending unoxygenated blood to the body. Our echo, with a small pulmonary artery, equal to the size of the aorta, and only low velocity leakiness of his pulmonic valve (the valve separating the pumping chamber to the lungs and the main vessel to the lungs) did not support irreversible pulmonary hypertension. However, to make sure, our anesthesia team did the first ever right heart catheterization, passing a catheter from a vein in the neck into the right heart and pulmonary artery. We found a normal pulmonary artery systolic pressure of 20 mmHg. We then extensively consulted among our entire team and, via e-mail, cardiopulmonary experts at a combined adult-congenital heart disease program at Children's and the Brigham and the head of cardiac anesthesia at Children's Hospital. Our anesthesia team, led by Drs. Danny Muehlschlegal and Nelson Thaemert, and our perfusion team (they run the heart-lung bypass machine) came up with a surgical game-plan. This involved taking off units of blood and replacing it with fresh frozen plasma to correct his coagulopathy and lower his hematocrit before putting him on the heart lung bypass machine. There was concern that his baseline high hematocrit would cause him to clot in crucial areas of the heart and brain and also that his coagulopathy would cause him to bleed in other areas. On the pre-op night, Alexis developed a supraventricular tachycardia, rate 166/min on 2 occasions, but we were able to restore normal rhythm with medications. He had no chance without surgery. What a brave soul he is. He made friends with all of the other boys we have done and watched them have surgery and begin to recover, while he patiently waited while we determined his operability, tolerating a tranesophageal echo (where he has to swallow a probe a bit smaller than the size of a quarter, to better visualize his communication between the atria), a right heart cath to determine the pulmonary artery pressure (if elevated, he would not be able to be helped), and multiple visits by our entire team to determine if we could do him. I saw occasional tears from the corners of his eyes, as he looked at his fellow operated-on patients and said "I wish that were me. "We were pretty convinced of what was wrong with him, but we lacked the full heart catheterization, CT angiogram and MRI imaging that would have been available to us in the US. We knew there was a small chance that he could have additional pathology which we had not been able to detect. However, we also knew that our team offered him his only chance to grow up—we had been told that he would not be a candidate to go the the Sudan or India for surgery. Fortunately his heart had the pathology we had predicted and, with the excellent skills of our 2 anesthesiologists, our perfusionists and our two very experienced senior surgeons, Dr. Chip Bolman and Dr. Chuck Edwards, he successfully had his huge atrial septal defect closed and his tricuspid valve replaced with a mechanical valve. His blood immediately turned from blue to red. His breathing tube is now out, he is sitting up and enjoying the fact that he is alive and will feel much better. No one in our group had ever cared for this type of problem before. The orphanage has previously been his salvation and the wonderful staff there have promised to bring him back very frequently for INR checks and medical appointments.
We feel lucky to have them be our partners in restoring Alexis to a full life.
Pat Come, MD, cardiologist
Permission granted for disclosure of information from Alexis, 12.Feb.2012
This year more than any i feel this " Veteran leadership". I sat in on the patient selection process, have worked closely with Connie ( our ICU resource nurse) in the ICU and been able to teach Rwandan staff ( and newly graduated nurse Paige) in recovering some of our sickest patients. It has been exhausting yet exhilarating at the same time.
Coming back to King Faisal Hospital is almost like returning to summer camp. I see many old friends whom i share a common bond. The ease in which we renew our friendship is a testament to strength of our bond from previous years. I think the most dramatic change is watching someone like former patient Erneste Simpunga, who i met in 2008, help recover from surgery in Boston that year and watch grow into a strong, bright young man. He recently graduated from high school and would like to be a heart surgeon someday. He always comes back to encourage our patients and recently i was drawn to both tears and laughter watching him teach and comfort our 16yo orphan patient. He was giving Alexi and his caretakers some preoperative advice and i was in awe watching him. He was so confident telling this frighten, young boy he must concentrate on 3 things before surgery to achieve success.
1. He must have confidence the surgery will go well.
2. He must pray to God to keep him safe and guide his caretakers
3. He must do everything the medical staff tells him to do and he will recover strong like him.
I think this is sound advice to every person undergoing surgery!
During the past week we have had great nursing support from the King Faisal ICU.Both Connie, nurse manager HDU where we are located, and Judith, nurse manager of ICU have been here for whatever we need--negotiating with customs and bureau of standards inspection, as well helping provide care. We know three of the nurses from the past, always favorites, (Clementine, Idi, and Placide), and now joining, a new addition to the ICU, Felicity. It has been a pleasure to work with all. Felicity has been incredibly helpful during her day shifts. She is a dynamo of action, and always anticipating needs of both the patients and the team. Taking full patient assignments, today she is assigned our triple valve patient who has been in unit for a couple of days, doing well, but needing the expert care she provides. She has wonderful credentials and has a vast knowledge base from previous positions of working throughout cardiac surgery programs. What a pleasure it is to be on the same team!
Saturday, February 11, 2012
A few of us here feel like something should be said about the Healing Heart members from Spokane, WA. Though Jim and Terra make up a small fraction of this year's team, their presence here is imperative. Terra signed on to come with us at the last minute when one of the OR nurses had to back out because of a car accident. She arrived ready, no-nonsense, and raring to go. She's been an integral part of the OR team that's been working through the daylight hours since Monday morning.
It's hard to believe that we're already more than halfway done with our cases! As anesthesia residents with Team Heart for the first time, this has been an incredible educational opportunity for us. We are learning a lot about how to take care of complicated patients that we don't generally get a lot of exposure to back home. Also, practicing medicine in an environment that we are less familiar with has pushed us to be creative problem-solvers! Every day is so different and a new challenge arises every morning, but that's what keeps things interesting!
In addition to working closely with Danny & Nelson, we've gotten to know the surgical team, cardiologists, nurses and procurement engineers better these past few days and it's so great to be working with a group of energetic, dedicated and fun-loving people! We feel lucky that we were invited to join such a great crew! Days in the OR can be pretty busy and intense, but its always so refreshing to walk down the hall and see our patients in the ICU and step-down doing so well. We look forward to another few days here in Kigali with Team Heart!
-Trusha & Joyce
Today is Saturday in Kigali. It is like a holiday for us, we have had many visitors, and all tell wonderful stories about their lives. We love seeing Deborah, Richard and Jean Damascene (2011). Yesterday Suzan and Delphine visited. Marilyn has been keeping busy doing follow up studies and we even did an INR or two. They all are so happy to see the Team and miss those of you not here with us. It keeps us busy and focused as while we for our first patient of the day to roll out. Sighs of relief and a smile or two since word coming out things going very well. We are all so amazed and touched by the incredible teamwork. It is that stage of the trip where we are so very, very busy. For Chuck, and Alysia, here today in the unit with us, I think they have enjoyed seeing those who have captivated our hearts....And for those of us who saw how very sick they were last year, it seems nothing short of a miracle.....and now 5 minutes until the next patient rolls through the door!
One of the most amazing aspects of watching Team Heart is how, from the moment they hit the ground, the individual members of the group, all from different hospitals, different programs, different parts of the country, immediately transform into an integrated, cooperative, well-oiled machine. I've been watching Julia Jones with awe. On our first day, we all walked into two large, empty rooms of the King Faisal Hospital with huge trunks and pallets lining the walls. Twenty four hours later, I returned and found Julia scrubbed in a fully equiped heart room, accompanied by a heart ICU, and across the hall from a cardiac step-down unit. Magically, Julia and the team transformed the place into a beautiful heart unit. And immediately went to work.
The fourth case of the week was particularly difficult. Julia was scrubbed from about 8 in the morning, until close to midnight. But I got a call around 11:45 p.m. - "Let's go shopping tomorrow - I don't have to scrub until the afternoon! See you at 7:30 a.m. I don't want to waste a whole lot of time in case I'm needed again!" Wow! I had selected a nearby and relatively "tame" market to take Julia to - we had no time to waste, after all. As the cab driver started off, I explained my choice to avoid the "traditional market" to make things easy. Well, Julia's eyes widened and she said "No! Let's turn the cab around and go to the REAL market!" And so we went where few tourists dare to tread. And we had a blast! Hopping out among rows of plantains, bags of rice and beans, crowds of women with pineapples on their heads - Julia was in heaven! We wound our ways through the stalls, bought yards of fabric and negotiated with a seamstress to make and deliver skirts, bags later that day to the hotel. We ogled jewelry, baskets, carvings. Women were amused by the sight of a Muzonga (white girl!) outside the tourists' usual haunts. But Julia's easy going style of adventure suited everyone! How did the morning end? We were laden with wares, had an appointment to see our newest friend that evening, and the phone rang to call Julia back to the OR. I don't know how she does it - and most of all, I don't know how she makes it so much darn fun!
Friday, February 10, 2012
Goodnight for now!
Thursday, February 9, 2012
Wednesday, February 8, 2012
The one downside of Rwanda is there are no speedy restaurants so we get creative and send a few people ahead to place our orders while we clean up in the OR. Great teamwork! :-)
Things are exciting from a Perfusion perspective this year as we have a Rwandan Perfusionist working with us. He was trained in India and is eager to continue his education in perfusion and is doing great pumping cases. I'm excited to see the progress he will make as we continue in the OR!