14 Days to Go! Screening Team prepares to travel!

In two weeks, the screening team begins their work! Nurse Practitioner Julie Carragher, from Braintree MA has coordinated screening now in her 5th year. Working closely with RBC (Rwanda Biomedical Center--the care delivery arm for the Ministry of Health, Julie has arranged for the first screening to be in Musanze, which is always one of our largest screening sites. We have been there multiple times, know the staff under leadership of CEO, Dr. Pascal and always look forward to this part of the trip.

The drive out of Kigali will begin to climb immediately, and as the team leaves in the yet dark morning, the road becomes alive with farmers going to market early. This drive is one of the most beautiful in Rwanda. But is 2.5-3 hours and as we drive, patients are lining up.  The patients will have left home hours before to walk, take a mini-bus or a moto-to see the team.  Many do not feel comfortable to speak English and our Rwanda team will be there to translate. Cardiologists, Dr. Jeanne De Cara, Evanston, IL and Dr. Patricia Come, Boston are both well-recognized heart failure cardiologists in the US. Both have traveled for more than 7 years with our team--and there is NOTHING they will not have seen before. Fierce advocates for their patients, they would like to see help for all we see (more about the Cardiac Center Rwanda needs in future posts) ....The team has other key members--our sonographers need a post of their own; meet them here next week!

More than 400 beds, Ruhengeri Hospital serves more than 350,000 in the catchment area. Now with an ophthalmology clinic since 2015 and transitioning to a referral center, it is always busy. Musanze is a district and is home to the famed volcanoes; five of the eight Virunga Volcano Chain lie with its boundaries. Ruhengeri, now most often called Musanze is the principal city and the hospital lies on the main road near the police Academy. The area is fertile and always green and is center of agriculture and tourism. Because the surrounding mountains which are beautiful beyond belief, they are high and damp. It is a perfect environment for strep throat in overcrowded homes with small children. Without easy access to health care centers, strep throat might be undiagnosed and untreated and progress to rheumatic disease and to rheumatic heart disease. This area is where many of our patients come from.

 Meanwhile, our Rwanda counterparts are busy as well. Most of these patients will have been ill for years, even though the average age is 18, and range from 12-32 years. They will have worked their way through the health care system to see a cardiologist and that could take months. Each patient has been followed and selected by 1 of the 2.5  cardiologists in the public sector which serve the 12 million population.  The RBC will be making certain dental clearance, screening for infectious diseases and required paperwork has been done.  The cardiologists will have discussed surgery and asked for their commitment to following advice of medical care post-operatively. It is the one chance they will have. We cannot do it without your help.

Vermont Welcome to 2017 Team Heart-Karen Lucas

A warm thank you to Bruce and Anne Leavitt for opening their home on Tuesday 1/31 for a great kick-off dinner for Team Heart's 2017 trip to Rwanda. It was a wonderful evening filled with many stories of past trips to Kigali for this life-saving mission and much advice to those of us who have not been yet.

I am ecstatic to be going and to be a part of this amazing group of dedicated medical professionals! As someone who got into the medical field later in life, this opportunity to help others is a dream come true and to be going with Team Heart is even more amazing.  I had heard about the trip for a few years and knew now was the time to go for it. After connecting with Ceeya last spring, the pieces started to fall into place.  I have heard the phrase "life changing" so many times in association with Team Heart and Rwanda and I don't doubt for a minute that it will be true for me as well!

Thank you again to the Leavitt's for hosting a lovely event and to everyone who is making this trip a reality for so many patients and their families. A special thanks as well to Judy Sgantas for the great picture!

Karen Lucas, UVM

Team Heart Stepdown, 2017

Visits from patients of past years! So they begin...

There have been many special moments, but one in recent days admittedly without compare: a joyful reunion with a former patient. As word spreads that we are back at King Faisal, there comes a steady stream of healthy, smiling Rwandans - former patients - returning for follow-up but bringing with them so much more. 

To see these patients, once so thin and compromised, now so vital, ready with robust hugs and grateful greetings - what a gift. And what they are making with their lives - a teacher here, a medical student there, and another student, this one in procurement   - they carry with them the inspiration of their new lease on life. 

On Thursday a quiet young lady arrived. Donatha from 2015! Our last patient on the last day. We would have liked to have her scheduled in the beginning, because of her extreme wasting due to the rheumatic heart disease, but an error in pre-admission lab testing disqualified her initially. The screening team worked to get her retested and she was accepted to be our last procedure of the trip. She never would have survived to travel to India or until another team arrived.  She required hospitalization for 9 weeks, but now is healthy and back in school to make up lost ground. We are all so happy....the stories such as this are incredible. #wecanonlydo16. #shemadeourday

First patient to Step-down on Wednesday

It's great being back at King Faisal Hospital for the 9th year, preparing for a great trip with Team Heart and sixteen life-saving surgeries. As we prepare the step-down unit for opening, we reflect on the previous patients that have followed this path and are doing so well. It's exciting to see a group of enthusiastic and passionate professionals come together for such a worthy cause.

Today we had our first step down ICU patient! Although we had some speed bumps on our road to recovery, she triumphed and pushed through. With her strength and support from Team Heart, she was able to be disconnected from her IV drips, chest tubes were removed, and she was eating full meals!  She was applauded by the King Faisal and Team Heart Staff as she exited the ICU. She has such a strong spirit, that she walked about 22 feet to her bed--AMAZING!

She continues to inspire us as she ambulates (or walks)  multiple times and wows us with her beauty and her smile. She was very ill before surgery and this photo makes her appear like she is almost well! It is very misleading to the patients as they have a hard time convincing family they must take it easy during recovery for 8 weeks before returning to farm. She is the mother of twins, a boy and a girl now almost 2 1/2. She,  like so many young women with RHD was diagnosed in pregnancy.  She is the patient we love to do. A strong will to live and to return to her family. 

She has given her permission to use her photograph. 

NP Julie in action...

I traveled to visit Redempta's family in her village near Kamonyi, located to the south of Kigali.  Our Team Heart patient and registered nurse Theo and his Uncle  accompanied me.  It was an incredibly beautiful drive.  The mountains and valleys so green.  We arrived and were immediately greeted by Demi's youngest brother Cosi and her Mama.  Her Mama looked wonderful, she was dressed in a traditional Rwandan dress with a matching head scarf.  

We  entered Demi's home and were met by her Papa, who was wearing a purple Braintree Youth soccer shirt (either my son Nolan's or Andrew's from a past year, sisters Laetitia, Rebecca and brother David.  All looked very well, smiling and happy!  We had a wonderful visit.  Papa asked to speak and with Theo as an interpreter, welcomed us to their home and went on to say how happy they were to see me and how appreciative that I was caring for Demi.  Papa continued by saying it was tradition to give me something to express their joy.  Pap went outside and came back into the room with a chicken!  The chicken was placed in my lap and my arms placed around him to hold him in my lap.  If only someone from Team Heart could have seen me!!  I was trying to hold on so tight, his legs were moving, his body was rested up against my left cheek.  I don't know how I managed to keep a hold of him...there are plenty of photos to share that I am certain will make you chuckle.  However it was not a laughing matter for Papa.  This was serious, almost ceremonial feel.  I explained that I was unable to keep the chicken, despite my pure happiness and gratitude, as I was staying in the hotel and working long hours at the hospitals.  I asked that he keep and take care of for me.  He was happy to do so.   Certainly a first for me!  Julie Carragher

You cannot help but be amazed by these volunteers…their expertise, love of teaching and true compassion brings one to quick tears. It is always so emotional when you arrive, have jet lag and are reminded why you are here. The screening teams advocacy for the vulnerable population, those patients so ill they would not survive a trip to India if they could pay for it, propels the team into action…it is this point they can advocate for the majority and not the reality of having to select a number to fit into 16 slots for the operating room. Come a week from Sunday,  in a classroom with Bobby, Chip, Danny and Martin and Rwanda colleagues joining them to select—reality sets in…16 slots.

I joined the screening team at Rwanda Military Hospital for a few hours to watch them in action. We were  pleased to have our advocate Dr. Evariste Nganda, from RBC there, because it helps the RBC to see the faces we see, the disease that is there. Dr. Evariste is a quick study and spritely moves through the room to sidestep being roped into a cardiology tutorial 101 as teaching is everywhere.  If he is not careful Dr. Come will be including him in her teaching session  all about venous filling and how to interpret in the face of RHD. 

Being in the same room with her energy is infectious, as everyone loves cardiology in her hands. Rwanda Military Hospital is one of the the best-organized hospitals we screen in  which  cares for public sector in the country.  Although it is designated a military hospital, it is viewed as a key public hospital for the civilian population.  It seem like a good place to work for civilians as well and I am sure having more of what you need when you need it is a big part of that, and there is job security for good performance.  We work with Dr. Jean Vianney Ganza, a cardiologist out of University of Rwanda Medical School who trained in Cardiology in Belgium.  His team is very welcoming and provides great space for our screening. Dr. Ganza has been our closest ally here and we see how the referral population is changing for him. There are few patients referred by him that do not meet the strict screening criteria that Julie C., NP and her screening team set forth. 

We enjoy and admire all the cardiologist. There are 4!! Yes 4 for this country of 12.5 million and maybe 2-3 in training in South Africa or Brussels. They each bring their expertise and are fierce advocates for their patients…

Just today we saw the impact of this advocacy. Dr. Emmanuel our Pediatric Public sector cardiologist,  who is much loved and admired by all of our Team brought a scrawny young man for consideration in Screening 2014. The young 14 year-old lived with his two older brothers who took wonderful care of him, but felt hopeless for his future. He had been turned down by other teams and Dr. Emmanuel felt if he just had a chance…one chance, he might have a future. He was the last patient selected at the selection meeting and for those of us there,  the discussions were intense.  He was sick very sick, malnourished due to the heart disease beyond imagination and he had this wonderful smile and was so trusting.

His rheumatic heart disease had ravaged his body and the best efforts to provide nutrition by his bothers was not evident as his body wasted.  I am sure the call to the brothers was a happy  one for Dr. Emmanuel to say he had been selected for a chance to have surgery. Dr. Emmanuel stopped by every few days to check on him..a second visit to the OR for tamponade gave the ICU team and surgeon Chip a scare but was handled so competently we could have been in any major cardiac center—we did have the best nurses, surgical, anesthesia and ICU teams.  

Young Mr. Gratien visited us today and just could not understand the tears as cardiologist, sonographers looked at him with so much pride. He looks so normal! Now in primary 4 he is making up for lost time. His brother was pleased at his school performance and his attention to his health maintenance.  I predict good things for this bright young man…..

He is photographed here he is with Dr. Jeanne who screened him in 2014.  We normally get Cardiologist Jeanie Decara for 2 weeks, but this year she must leave before surgery begins.  Full of compassion and expertise, she certainly can feel good about giving back when she sees the outcome of this young man. He would have not survived 6 more months. 

The Starfish Theory From Louise King, MD

Dr. Louise King and her husband, Dr. Caleb are Missionaries in Ruhengeri....they post a weekly blog which we have followed for a few years... Louise  has diagnosed and followed many of our patients.    A Starfish by thekingfamilyinRwanda

My father likes to tell the story of a 2 men on the beach, where there were thousands upon thousands of washed up starfish on the sand. One man was throwing starfish back, one by one. The other man, seeing the multitude of starfish still out of the water, said “Why are you doing that? It doesn’t make any difference?” to which the man who was throwing the starfish replied, as he threw another back in the ocean, “It made a difference to that one.”

Here’s my latest starfish: Angelique.

Angelique is 18 years old with very bad heart failure from leaky valves, from rheumatic heart disease that she probably contracted as a child. She herself has a small baby and until last week, she was unable to walk across the room without getting short of breath, and she desperately needed a valve replacement. She was evaluated 2 weeks ago by Team Heart, an awesome group of nurses, echo techs, cardiologists, and cardiac surgeons from Boston, who come every year to operate on people like Angelique. I had the gut sense that this time next year, Angelique wouldn’t be around for a second chance; this was it, so I was really praying for her. The cardiology teams have a tough time choosing patients-there are so many sick heart patients. The patients have to be sick enough to need surgery but not too sick that they won’t survive the operation. There was initially some concern that Angelique had an underlying infection, but it cleared up and she was operated on and received not one, but two, artificial valves. I was thankful that God gave me the wisdom to have her come in a couple of days early to get “tuned up” before the cardiology team came. And I am very thankful for Team Heart

And we are thankful to Dr. King. Angelique has returned home and we feel better knowing she will be watched carefully over the next few critical months of recovery. !