As the New Year approaches, we have reason to be optimistic and celebrate our work in Rwanda. This month, Rwanda approved a young potential surgeon a scholarship to travel to South Africa for general and cardiac surgery training. In April, we hope to see another young talented general surgeon travel to India for cardiac surgery training in Chennai --he would return in 2015 as a fully trained cardiac surgeon. A perfusionist returned few months ago and will work with us in February. Rwanda sent an anesthesiologist to Brussels and he will be back to work with us and has already joined Team Heart anesthesia in discussion and planning. In September, the best echo team ever, screened over 2800 at risk school age children. In November, Team Heart provided a scholarship and the clinical experience for a Rwandan born sonographer to finish a 6 month US training program--he returns home to Kigali in January. Egidia spent two months in Rwanda as the first ever Team Heart BWH Global Nurse Scholar working toward completing a follow-up of the patients having valve surgery in the past 4 years to evaluate outcomes with our Rwanda Colleagues.

And most importantly, we have done it for the right reasons--because we care about the people and the country we have grown to love. We see our patients doing well and although some struggling to make a living, those thriving are supporting the others, some emotionally, some financially. All of this would have never have happened without the support of volunteers working in partnership with the Rwandan team....and it would not happen without the generous financial support of you! We appreciate you end of year donations....

Ewa-Framingham Heart Study

Ewa was educated as a physician in her native country of Poland and added sonography to her resume when she and her husband emigrated to Canada. When he moved to Boston to take a job, Ewa found the perfect place with the well-known Framingham Heart Study. So it is no surprise she was a leader in understanding that exercise, rest, and family and balance in life is important on these trips-a message many of us need to hear--and often!

Although the Sonosite was a new machine to her, she quickly adapted to obtain the best images possible. For an outsider (me a non-sonograher) I had no ideal the importance of size of the chest (Rwandan school children are almost all very, very thin) and the size of the transducer and how machines might over-read---and the challenge this presents. So by the end of the first few days, I could tell what the deep sighs were meaning from the team. For a while I thought every child in Rwanda hadtricuspid regurgitation.....

Consistent through-out this team (and why they were selected), each took great pride in every single study. No corners cut--ever. Ewa certainly fit this mold. It is also no surprise that she immediately offered to help moving forward with education with physicians and potential sonographers in the future.

As always, Josh Goldberg, snapped these photos and more found on Facebook with permission from the students.

Laurel, from Tufts, is originally from Minnesota. She is a quiet presence ready to do what she can to set up her station and keep running smoothly. Quick to volunteer to work in either the boys room or girls, she does whatever is needed. Calm, she does not appear anxious or concerned about new surroundings or challenges--a trait I recognize in sonographers meant to do this type of challenging fieldwork. She keeps the others company during extra activities, whether a run in the neighborhood, or to explore an offbeat restaurant near by. She shows leadership in set-up, and then looks around for who needs help. Quick to convert her space if needed, she has a sense of peace around her which the children immediately recognize. It was so hard to capture the looks she exchanged with each child--although Josh tried....one that gave each child all they needed to know to feel--as Hey this is Ok...

I asked Laurel what attracted her to our program...."I have never been on a medical mission trip. Chances to volunteer doing ultrasound rarely come along. I know that many Rwandans lack basic health care, and my services could help improve the lives of children. How could I resist really? I also love to travel and experience other cultures."

Lisa Bruno, Lahey Clinic

Lisa has been a sonographer at Lahey Clinic for two years after a number of management positions in non-medical fields. She loves solving problems systematically, which is why she is a good sonographer. Lisa’s home institution is supportive of global health initiatives and many co-workers appeared interested and followed her participation. Lisa used every opportunity that came up to spread the word of what Team Heart was about and unselfishly conveyed the role of the organization, embracing the very spirit of our organization. Observant, but not judgmental she was a quiet participant in every aspect of the packed week. I have no doubt if we receive any press from this trip, it will be Lisa’s passionate description when she met the reporter in the airport! It was fortunate for a silent child who watched as she scanned that she found a child who could undergo surgical repair in November by a Belgium partner and extend their life. And that is what it is all about!

Fiercely protective of the young girls privacy during scanning, we coined gender sensitive care to a multitude of tactics!! Lisa helped engineer curtains on the windows and took responsibility for seeing they arrived each day in her blue roller bag. Curiosity won out as various children would try to peek. Amid much giggling they would be chased away again and again...Clearly the girls appreciated the curtains, as did all the sonographers as it reduced the glare on screens!!

Meet David Adams, Duke University Medical Center

David Adams, From Duke University Medical Center, is so unpretentious and down to earth that it was hard to balance the persona you find when you Google him with the very sincere person just doing his job. He brings over 30 years of experience and education to cardiac sonography. David is one of the most recognized names of sonography is the US and is known for his expertise in teaching.

He has received numerous awards, but a recent one recognizes a cardiac sonographer who has played a luminary role in the field of echocardiography. The first Sonographer Lifetime Achievement Award was presented during ASE's Annual Scientific Sessions, June 11-14, in Montreal, Quebec, Canada.

For us he was just a great guy, pushing the bus out of the deep ruts when stuck, quietly supporting the other sonographers, teasing his friends out of a slow start in the morning. The father of grown children, he is the comfort that children seek when they place their tiny hand in his as they walk toward a couple of desks pushed together to make a cot. For him, that child and echo takes the role of the most important thing on the moment as his concentration never wavered as he watched the screen for anything abnormal in a long day, For us, it was an honor and a pleasure to have him part of this team.

Marc Couturier-The Miriam Hospital Rhode Island

Marc Couturier is the calm presence with the “big “machine--everyone else on the team had machine envy! When Mark heard there had been a problem with the number of machines requested, he made contact with the vendors supplying his region. Thanks to Dave Allard and Phillips, we had one more machine to work with—critical since that would have been close to 300 scans that would NOT have happened.

Marc works at the Miriam Hospital, Rhode Island . Although this was his first global experience, he settled in as if it had been his 100^th. When he applied to travel as part of the team he said, “I've always wanted to participate in a medical mission where I can help people using my echocardiography skills”.

Efficient and quiet, he calms any frightened children and makes them feel safe while undergoing a process totally foreign to any of them. Few will have had an exam of any type—much less taking off your shirt and lying down with a wet, cold goo spread on your chest—The kids watch Marc’s face closely for any changes in his expression. The master of control… they are not going to see anything on HIS face that might make them concerned. A shy smile is exchanged as they realize they can trust him.

One of the best memories of the last week was the kids crowding Marc as he read aloud Tyrone—multiple times! Josh Goldberg captured these photos.

Dr. Puneeta Arya, Mass General and Team Heart

Photographs by Josh Goldberg. 1.With Duke Sonographer David Adams. 2. Puneeta and Emmanuel watching Jen coaxing the perfect image out of her machine.

On Tuesday, September 20, day 7 of screening we are the guest at Cyuga School, in Jali Sector, still in Gasabo District, but also high in the hills. The terrain is different but the road a challenge. We traveled in all wheel drive Jeeps since the road is very narrow, as well as steep. The children were more apprehensive since a busload of pale faces is not the every day routine., but totally cooperative. There were over 320 scans done and we saw a number of serious medical conditions which need follow up—all will be referred through the medical system. It is another great advantage to travel with three Pediatrician Cardiologists, since they are right there to assist when we identify a positive finding or any medical condition. Two of the physicians are from Rwanda, Dr. Emmanuel from CHUK and Dr. Joseph Mucumbitisi from King Faisal and have led this project from the beginning.

The Team Heart Pediatric Cardiologist, Dr. Puneeta Arya is from Boston’s Massachusetts General Hospital, and traveled to Rwanda from India during a visit to her home country. Puneeta joined Team Heart recently and we are delighted to have her as part of our Team. Soft spoken and a total team player she worked as a colleague-often the first to grab a bin to unload and right in the midst for set up. She completed her training at Boston Children’s recently and will be soon at MGH working with Dr. Michael Picard and the Pediatric group .

We always asked permission from the children before taking any photographs.

Meet Stephen Preiss, The Miriam Hospital, Providence Rhode Island

Ready to embrace every single experience, Stephen Preiss became a go to person from day one. A sonographer at The Miriam Hospital in Providence Rhode Island: this is his first global sonography experience.

He loved the kids from the first and interacted with them earlier than others. He made them smile with his games and toys. At one particular difficult rural site, the bus was incredibly late picking us up as darkness descended. Stephen was calm and even returning to site to look for another team members’ missing and perhaps dropped camera endearing himself to the team forever. Looking forward to each day, he was always the first to interact with the children in large groups. He could be found on the soccer field the moment we are finished to engage groups in soccer or whiffle ball in between long sessions of scanning hearts. Very tender and compassionate with the younger kids, they are fascinated by his beard as they peer intently at his face since he had more hair on his face than most of the children have seen before on a head. Always calm—we never saw Stephen loose his cool and is always the first to soothe ruffled feathers of the team with a no-non-sense comment with just the right tone. Definitely a team player, we are happy to have him on our team.