Friday, January 28, 2011

The lull BEFORE the storm


We are busy on many fronts, Dr. Pat and Marilyn, our pre-screening team, currently, sitting in DC waiting to take off via Addis for Kigali. Pat received a list of some 40 names last evening from Joseph (our colleague liaison, one of the only 4 cardiologist in Rwanda) of the candidates she will begin to evaluate on her arrival. Pat, in consultation with the Team Heart cardiac surgeons, Prem and Chip, discussed the priority of evaluation and selecting those candidates to begin our theater schedule (that is OR to those of us in US). Both surgeons feel so totally comfortable with Pat making this decision--after all; this is how their practice works here. She is a terrific referral cardiologist, her work-ups are thorough and with sonographer Marilyn at her side, the studies will be as complete as we are used to having here. Taufiek, our surgical resident assigned to help with pre-op screening will arrive just in time to complete the surgical paper work required, double check all the labs, make sure blood bank is ready and begin to do the pre-op teaching preparation. Each person meeting the patients after selection contributes to patient education. Having the patient understand the procedure they are going to have done and how they can participate in their recovery is incredibly important. Suellen will address this aspect later, right Suellen?

As the final packing is playing out, many of you heard about the flight cancellations of 7 of our nurses and 2 physicians. Only a momentary panic--well... about 1 hour, and today our agent is in the final process today of reissuing their tickets. Everyone was cooperative and 4 different institutions helpful as every nurse and physician had to find someone to cover a shift so they could leave a day earlier.

We wait on several supplies to arrive here and surf the net to find Omni infusion pump disposables--our supplier no longer provides. How we fit every single item in is going to be a problem of logistics. It has to happen though--no choice, but it always does. I might have to ask for mercy at check in--our baggage might have to exceed more than 3/person for those traveling with Leslie and I.

Surgical instruments are packed. Yesterday, I watched the 3 theater nurses, Katie and Carmen BWH and Maddie, MGH, sitting on the floor checking and double checking; every clamp, needle holder and retractor was examined and cleared. Again, thank you to Brigham and Women's for the loan of the instruments. Katie even had a valve caliper on loan which had been special ordered after the surgeons became so fond of it in Rwanda year 1--another indication our practice there, improves the care here.

The remaining supplies to arrive to us today, to be tucked in, personal packing begins, (oh that!!) stopping paper , having the house sitter arrive, pick up malaria prevention medications, etc.

But it is the looking over the list of potential patients which will help me focus the need for this "program development" to become clear. There is a young man with aortic regurgitation-wide open, AI , which Dr. Harthorne (MGH) saw year 2. Not as common as a result of rheumatic heart disease, only 14 years old, the size of a child younger, he walked 6 hours to have Jen, MGH sonography (TH-2009-present), do an echo year 3. His family is very frightened, hesitant for him to have surgery. He will die without it. Maybe not this year, but his heart will only get worse and maybe too bad to actually do in country. He is handsome and bright and the future of his country will only benefit from seeing him healthy, back in school and able to take care of himself returning to be a productive member of his family and community society. Will he make the list and if so, will his parents feel comfortable enough to allow him to undergo the surgery?

A young mother of 22....a young man 17, a father 26.....a young girl 7 to evaluate for referral to a Pediatric group....the list of 40 becomes the reason we do this.

1 comment:

  1. Thanks for this update! I was wondering what happened to the travel plans of Dr. Pat and my good buddy, Marilyn, and now I know that Mother Nature can't keep them down for long. Best wishes for a smooth trip to Kigali and congratulations to the whole TEAM on the amazing work that you do!
    Lesley

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