Saturday, December 22, 2012

December Planning Trip to Rwanda.

In mid-December BWH Team Heart volunteers Steve Senat and Leslie Sabatino traveled to Kigali with one mission in mind; Determining the barriers to order supplies direct and ship direct. A first time visitor to the country, it was clear Steve immediately loved the countryside and the people he met. He approached the task at hand systematically and immediately understood the challenges the local team faced.  Together he and Leslie identified where they could work together to meet those challenges and look for a positive resolution. It was amazing to see their heads bent close together hour after hour over a computer, as Leslie, A BWH CISU Nurse,  who knows inventory needed inside and out, and Steve, BWH operating room procurement team,  who knows where to find inventory,  excitedly met with outside vendors and hospital staff alike. This is the unseen side of a trip and one of the largest efforts to build a sustainable program. If you do not have supplies consistently managed, you will never have a cardiac surgical program….

Day 2 brought a trip to Butare. A beautiful drive down with Jean Paul, our favorite transportation expert....and a patient from 2008, we made a stop in Gitarama to meet the nurse who forms the backbone of Coumadin delivery and INR testing for about 7 of our post-operative cardiac surgical patients. It is wonderful to finally place the name and face and see the area where  she works.  Her photo is here with the Team Heart visiting group, Libertha does not get nearly the recognition she deserves for this critical need!

Gitarama Visit 12/11/12-Nurse Libertha from Coumadin and testing clinic with BWH Nurse Leslie Sabatino, BWH Operating Room Procurement Team, Steven Senat Team Heart Volunteer and Coordinator, Ceeya Patton Bolman, and BWH resident in Global Surgery and Health Equity Jabaris Swain, MD

Butare visit to CHUB brought the introduction to the visiting team members to Dr. Ganza, recently returning from training in Brussels following a cardiology fellowship.  First hand, we were able to see the challenges Dr. Ganza and his local team face, as they do not even have the basic echo machine for diagnosis available.  However, with little resources Dr. Ganza was able to present an amazing group of patients, all requiring urgent cardiac surgery. Two  beautiful and frightened  young ladies in early 20's were pregnant and with severe mitral stenosis. They will undergo elective C-sections by a competent OB team in the next few weeks before labor can begin.  They then will recover, nurse their infants and wait for our team to arrive to undergo cardiac surgery when babies are just a bare month old.  They were frightened and overwhelmed by the attention and crowds we attract, but we had two successful patients with us who could speak with them to reassure them there was a future ahead and they might live to take care of their children.  One young lady's eyes opened wider as she looked at the healthy individual showing her a well headed chest incision. She seemed to calm in front of us she talked with the volunteer about how she too became ill when pregnant and found her cardiac disease was rheumatic heart disease. Often rheumatic heart disease is silent until pregnancy increases the demands of the workload of the heart. Until then she had no ideal how ill she was!

Following the pre-op evaluation where each patient was presented efficiently with appropriate  lab results reported.   The  attempt to accurately diagnose using an abdominal echo probe for cardiac diagnosis was a challenge. It is apparent how much this wonderful physician can do with so little resources.  We also watched as he worked closely with the local team with  much respect for the work nurse Marie Claire,  who runs CHUB Coumadin and testing center provides for post operative patients.  Ww watched in amazement as they worked with a machine using the most basic of echo machine with a probe not designed for cardiac echo.  We hope to meet this need in January with a generous donation from Philips of a CX-50 machine to share between two wonderful cardiologists. 

The local team hosted tea for several post operative patients and our visiting Team Heart members and it was only after Dr. Ganza began speaking that we realized the patients had been carefully selected to illustrate the profound change in their life following  critical cardiac surgery. Each postoperative patient in the room would have died without surgery… many within 30 days of the time we initially saw them. It was a profound moment to look around the room and see the healthy individuals.  Choking back emotions, those of us visiting,  were moved to be able to se the result of our work. Several, from the more recent surgical visit still struggle to return to the work force, but others from earlier surgery could relate what had worked well for them,  providing both hope and encouragement. The other amazing moment was to realize that each was part of the intricate post operative care system! works!

Putting clearly into perspective, this is what we do...every aspect. Supply and demand of inventory, surgical expertise, postoperative follow-up, screening and prevention and economic stimulation to return patients to education or the work force.   It distills down to people--People here on US ground and people there on Rwanda soil.

This holiday season, we appreciate your donations and gifts which continue to make this program possible.  Warm season greetings and Happy New Year to you and yours.

Butare Visit 12/11. Team Heart members with patients from previous surgical development trips with Cardiologist, Dr. Jean M.V. Ganza. Leslie and Steven in back with joyeuse and Jean H. Sammy, Marcelline with Deborah, our local administrator for Team Heart in front !