Friday, February 22, 2013

Team Heart mentioned in Entertainment Weekly!

The film, Open Heart,  up for an Oscar is also 
about Rwanda....and children suffering from 
rheumatic heart disease. 

Thank you Keif and Cori for bringing this wonderful story to the international community. Many of you know, since 2008 Team Heart, Inc., (501 c 3 27-1435443) is one of four teams, (In order of appearance, Operation Open Heart Australia, Team Heart, Chain of Hope, Belgium and Healing Hearts of Northwest, Spokane WA) operating on children and young adults with rheumatic heart disease IN Rwanda.  Our Team just completed their sixth trip providing surgical intervention on 16 individuals who had no other chance of survival. Patients are doing well but the work earnestly continues to coordinate post-operative care in a resource poor setting.

Team Heart alone has provided care to nearly 100 individuals bewteen ages 14-44 years and at this time, currently supplies Coumadin for all those who receive mechanical valves—including the children operated in Sudan or India. Although there are four Rwanda cardiologists for a country of ten million people to  provide the follow-up care for our patients, one of the biggest challenges has been a consistent supply of Coumadin not readily available in country and the increased need  to see patients in follow-up and evaluate post-operatively how they are doing.

Team Heart provides not only life saving surgical care; we are actively led a screening of 3000 school-aged children to detect early disease for intervention, to prevent further progression of heart disease. In collaboration with the Rwanda Heart Foundation, an Awareness and Prevention program was developed. We initiated a c collaborative with the schools of nursing to change the curriculum to include an emphasis on heart health including rheumatic heart disease.  In 2009 we identified a young surgeon and assisted in finding a training program, now  he is currently nearly halfway through a five year program. In regards to education, we have developed a curriculum for internal medicine physicians to increase their knowledge base for cardiology to better provide care and diagnose of cardiac disease.  We support a patient network of over 160 patients in the country who need follow up information and support to maintain good health. Returning to school and work is an important part of the effort to return to normal life. 

From the beginning Team Heart’s goal was to help build a sustainable comprehensive program in cardiac surgery in Rwanda to address this significant burden of disease. Rwanda is a landlocked country that borders include over 10, million people, 80% are within the poverty range.  Burundi and Congo and eastern Tanzania have no cardiac program, so the potential population of people to be served is well over 40 million.

Challenges in all programs like this are immense. In order for progress to be made in one area means a power shift from another. Competing for the same funds in the global world is difficult in a world where surgery is deemed too expensive, unless of course it might be your child who needs the surgery. 

Rheumatic heart disease  (RHD) is a disease of poverty and children.  Neither category has a voice in decisions about care in most settings around the world.  RHD is caused by, repeated bouts of untreated strep throat where inflammation destroys the heart valves or kidneys over a period of years. Eradicated in the US and most of the western world it is a disease process that is silent over time until congestive heart failure is recognized. Unfortunately, at this advanced stage, only surgery is the answer to return the patient to good health; ONLY IF follow up and medication is available and provided.

Let this movie be a CRY OUT to encourage those in health care to make the changes necessary and to put jealously aside to provide the care needed.  Demand that sustainable cardiac surgery be possible to those who need it while forging forcibly ahead with an educational, prevention and early intervention. Sudan is one wonderful  place where care can be provided, but it is not enough for the anticpated 15,000 individuals in Rwanda who need our help. Top surgeons and committed efforts from the US, Australia and Eurpope  are helping Rwanda to develop a program now.  Top leaders in Rwanda recognize the need and have pledged their help.   Help us to help Rwanda achieve the program needed.

Monday, February 18, 2013

Shout out to the Team Members

Suellen and Ellen with their patients

Every year for the past 6 years we have come to Kilgali Rwanda to do Heart Surgery on 16 choosen patients who would die without it.   We have become comfortable with our core team of so many who have worked for years to make this mission better.   I must say, there are a few who came and worked without a day off and i want to give a big thanks to these folks.   Cardiologist Pat and her echo stenographer  Marilyn provided evaluations for the selection process and were available until the last few days to do post op evaluations on our surgical patients.  Marilyn's fine work prove to be life saving for one of our patients who needed additional surgery to heal.   The extraordinary surgical team of perfusionists, Anesthesia, OR nurses and surgeons worked from morning until late night during the eight days we did  surgery.   Connie,  ICU resource nurse worked 11 straight 12 hour days...exhaustion is not the word....and Pam, our night charge nurse 8  12hr shifts out of 10 days...MGH you are lucky to have such fine nurses.

I think the two people who tirelessly worked everyday was Suellen and Ceeya.   Suellen is our step down/ ward team leader.  She has come on every trip with Team Heart.   Her role is vast as she is the one person who the patients see from beginning to end..   She was part of the selection process, pre op visit, and teaching, orienting staff and opening the Ward. She is available to the staff everyday and continues with the patients in their discharge teaching.  She helps tie up loose ends and believe me there are lots of them.   She also closes the ward and makes sure the closing goes as smooth as possible.   I admire her and her work.   She quietly loves all of the patients and they love her too.    Ceeya does so much both with the actual mission and behind the scenes that i am not sure how she does it.    The social issues of our patients are vast and she has always tried to make the transiton from hospital to living life as smooth and as promising a possible.   She deserves a assistant and my hope is that she can someday afford to have a counterpart in Rwanda to follow through on all the needs of our patients.  She is a true leader.

Ceeya so hard at work
We all worked so hard and now i am starting to feel the fatigue of working 9 12hr days...but my passion for this work has not diminished.   God willing i will return in 2014.

Sunday, February 17, 2013

Stepdown is HUMMING!!! 2.17.2013

Stepdown is busy...very busy and very happy. Jean Leonard, Thamar and Letitia will be going home.  We have become very fond of this entire group of patients but this is the first "large" group to depart. Gukunde left yesterday and has called to say he is well. We are very pleased with their progress, but it is sad to see them go in one way...delighted in another.

Yesterday was patient photo day. It began with seeing all the patients out in the sunshine and how healthy and vibrant they were looking. With permission we began to snap photos and they really became an active part as they realized Sue Gabriel had brought a printer and our souvenir to them was a group photo copy to take home!  It seemed like the entire hospital wandered over to watch and smile as they began to realize this was the open heart team patients. The festive feeling followed though dinner and no one wanted to settle down for the night. Sheryl Sanders from Lincoln, NE and Nadia Aires, Boston  had a hard time convinicing them sleep was good thing and part of recovery.

This is always much work , so much anxiety in the preparation, yet so much joy. The hand over to the local team  is in progress and the voices of Sue Gabriel and Sara Stankiewicz, and Egidia Rugwizangoga carry across the courtyard to pharmacist Bonnie as they give instructions (again). The church below is singing hymns and occasionally the patients join in.

 I have had so much fun watching these dedicated nurses these past two days and Bonnie with JaBaris Swain complete  the handover. They are like mother hens reinforcing teaching and medication guidelines. It was not planned but it is a Brigham and Women's Hospital team today and they rival a flight crew for coordination.

Saturday, February 16, 2013

Hearts of Courage

February 11, 2013 World Premiere! Hearts of Courage, a film by Michael Fasciano

In 2012, Michael Fasciano returned to Rwanda to follow Team Heart  for his second Rwanda based film, showing the team delivering care to young teens and adults with critical rheumatic heart disease. Following patients and medical team, he captures the emotion of the team as they struggle with patient selection, (to ensure fairness and an ethical solution for the critically ill who have no other chance).  The film shows the patients as they recover rapidly and rejoin life and their community moving from critically ill to hope for the future. 

Many of the patients included will capture your heart, but Michael follows  one of the handful of past patients who serve as  team volunteers. They serve  as  interpreters for the team by communicating to the patients and families when needed and coordinate transportation.  

Following the team as they visit the rural village former patient, Erneste Simpunga calls his home to meet his parents and relatives. Erneste is followed  through the process of applying and being accepted to  to medical school in Rwanda which helps to illustrate the benefit of good surgical outcomes and good health post-operatively.  The return to a normal life, to be able to help support family and self  with the dream to someday give back himself to help others is a theme through out. 

It is clear the wish for good health and return to normal life for their patients is one  motive for this medical team  as the patients one by one rejoin life in good health.

 It takes a very special team to travel around the world and donate vacation time, several for the 5th consecutive year to provide the best care possible in  this setting. 

Open your heart!

Thursday, February 14, 2013

ICU-Docs! The best!

Meet our behind the scenes team caring for patients after surgery. The intensivist is a physician coordinating and providing care for patients in the ICU following surgery. They can be boarded certified in critical care but also have back ground in anesthesia, Internal medicine, pulmonary medicine, surgery or Pediatrics. Working closely with the nursing team and the surgical team they are the glue who keeps us together and focused during the most critical time.  These two, shown here with Chip have been exceptional to work with and provide care for our patients.

Dr. David Morrison is returning for his third Team Heart trip. An anesthesiologist from the Gundersen Clinic, in LaCrosse WI. He traveled with CARDIOSTART on a cardiac surgical  trip before we met.

Dr. Norm Yunis is a pulmonary medicine intensivist and works at North Memorial in Minneapolis, MN. This is first Team Heart trip.

They received the highest complements from the ICU nurses this year--which given the incredible nurses we have,  great praise!

Monday, February 11, 2013

A few thoughts from the Stepdown Ward...

In 2009, I came to Rwanda for the first time. I had previously done mission work as a nursing student in Kenya, but cardiac surgery and Rwanda were new to me. I was excited to learn about this beautiful country and to work with Team Heart as we changed the lives of several very sick Rwandans suffering from Rheumatic Heart Disease. Flash forward to 2013, and my 5th trip to Rwanda. I continue to be in awe of this country, it's landscape but more importantly the people. In the last five years, I have been fortunate to have provided nursing care to nearly 60 Rwandans ranging from 15 to 45 years old.  Their stories of struggle and illness preoperatively are profound and their recoveries after life saving cardiac surgery (specifically heart valve replacement/repair) is miraculous. Last Saturday, about 40 of our former patients travelled to Kigali for a reunion. Some travelled by bus for 8hours! Seeing these patients healthy and happy is overwhelming. I can remember how sick they were before surgery, and their daily progress in the Ward after surgery. Now, if not for the chest scar peeking out of the top of their shirts, you would not know how near death they all were at one time. They have returned to school, gone back to work, gotten married and some have even had babies. It is remarkable to see them all together, hugging and catching up. It is such a privilege to be here doing this work. This year I was fortunate enough to have my husband Justin join me for the first two weeks of our mission. He worked hard with the preoperative team, screening potential patients and helping prepare them for surgery. At the end of his two weeks, he was finally able to understand why I return to Rwanda year after year. Pictures don't do this experience justice. It is the best thing we as medical professionals and people can do. The 40 or so Team Heart volunteers are all such special people, donating their vacation time, money and time away from their families to be here for almost 3 weeks. Today is our last day of surgery, the step down ward is booming with 11 patients and 5 more expected to move over in the next two days. They are all amazing individuals, aging 16 to 45, from all different parts of the country, but now all bonded by this shared experience of heart surgery. I am already looking forward to seeing them all next year, a year post op with stories of renewed hopes and dreams.  Thanks for supporting Team Heart and following our story...

Sunday, February 10, 2013


First batch of pictures! Saturday morning, 2/9, in the OR at King Faisal. Check out the slideshow through the link here:

More to follow!


Getting to Know You: Part I

As one of the only non-medical members of Team Heart here in Rwanda this year, I can’t say I know much about the details of heart surgery.  I’m grateful that we have a whole group of really smart, thoughtful people who ARE experts on the subject and are anxious to share their stories—I promise to leave that part of Team Heart ‘s day-to-day in their expert hands. 

Before arriving in Rwanda, I wondered how I might find a way to really connect with Team Heart—and how our supporters, followers, friends, families, donors, and general Boston fans might do the same without the benefit of a medical background. It became clear pretty quickly that these patients are something special, and they all have a story. To me, that’s the hook.  These patients have names, faces, families, dreams, some amazing curiosity, and now, bright futures.  What does it look like when they start to feel safe again after the surgery? When they realize they’re not going to die, and they allow themselves to feel hopeful? When do they lower their guards? These patients have been given back their lives…what will those lives entail going forward? 

Over the last week, I have watched some of these stories unfold.  Some stories are in their infancy; some are second hand; some started with Team Heart at the beginning and are incredible to see today.  There is one gentleman who is currently in the step down unit at King Faisal. He was the first surgery of the 2013 trip, and he is just amazing.  This patient is older than most of the people we see, but at 39, he has a beautiful wife, a new baby, and a good job at the Ministry of Defense in Rwanda.  This past Monday, he had a successful single valve replacement operation, and just 2 or 3 days later, he was like a new person.  I first met him in the ICU recovery room after his surgery, and soon after that, I found myself looking forward to seeing him each day.  Many of the patients speak a minimal amount of English, and when they are weak and tired in the days after surgery, it’s hardly a surprise that they don’t feel like saying much in a secondary language.  This man, so soft-spoken and warm and smart, surprised me with his mastery of the language and seemed to go out of his way to engage us every day.  “Good Morning, Mackenzie” was the simple greeting that I looked forward to.

I could gush forever about his sweet personality, but it was one particular conversation with this man that will stay with me.  As I sat next to his bed chatting and sharing pictures one afternoon, he politely asked if he might ask me a “complex question.” He explained that, to him, Team Heart seemed like a military operation. He wanted to know how the whole thing worked, and I was struck by his thoughtful questions:  Team Heart is so organized, how did that happen? (The answer to that one was easy: Ceeya!). How do we pay for all the medical supplies? How do we get them here? Do we leave our families behind in the United States to come to Rwanda? Is that hard for us? How do we pay for the trip? How do we get so much done in so few days? How do we take time away from work for the trip? Are we working together with the government in Rwanda?  How will the program go on once we return home? Maybe I shouldn’t have been surprised by his questions, but I was.  These patients come to us in need of help, feeling quite vulnerable, and Team Heart heals them. That’s enough for anyone to try to process. But he had thought so much about the program beyond what he was seeing first hand, and I realized that he truly cared beyond the scope of his own experience.  It was a meaningful reminder that these surgeries change the lives of the patients, but they also change the doctors and nurses and team members who become part of that story; in the big picture, this project forges deeply strong bonds and connections among people—and even though we are the caregivers, the patients care for us too.

- Mackenzie 

Patient Reunion 2/9/2014

Patient Reunion -Each year we plan a reunion for our patients and attempt to do follow up of as many as possible. We keep Marilyn and David  Of the 60 patients we have done in previous years, over 40 returned!
It was emotional for both patients and team. Recalling those we thought would never survive and seeing them vibrant and healthy was wonderful. We celebrate a wedding for Delphne and meet her husband, we see Anastasie pregnant and proud. in turn, the patients love meeting Justin Pitman, husband of Sara.

Several are in University and several are in high school. It is a tough economy to be entering the work force, but they encouraged each other and celebrated the Rwanda way with community and sharing. The patients performed a wonderful song in our honor and LOVED "Hearts of Courage" a film, by Michael Fasciano, premiered in Rwanda a few nights before.

Suellen and Laetitiia

Sara and Suzan

Sara and Sufa

Emmanuel, Shabani, Erneste
Patient Reunion 2013

Thank you to Jean Paul I, President of the Rwanda Heart Foundation who notified each patient. Thank you to Deborah Rekundo, Team Heart Rwanda Administrator who made all the arrangements, selected the food and did a fantastic job.
Ashley Kleinkauf, RN from  Ft. Lauderdale, Fl and Boston  area is returning for her second year. Here she is with John, 15 years of age in ICU before transfer. This year she brought co-workers with her, Hanna Isenstein,  photographed below and Patty Weist featured in a later entry. Ashley Hanna and Patty all work at Holy Cross,  and their hospital is one of THREE  of the 16 hospitals that support the commitment of the employees to donate their vacation time and travel with this team. 
Diane Gay, MGH, Boston,  Bonnie Greenwood, BWH Boston, Ashley, Hanna. Connie Fail, MGH and Dr. Norm Yunis, North Memorial, Minneapolis, MN

A note from Chip, February 10, 2013

February, 10, 2013, Team Heart surgical trip number six. 

As always, the team has exceeded all expectations. This is not easy, as expectations have become quite high during our past trips. The coming together of this disparate group of individuals, from 8 or 9 different states and 18 hospitals, united by a desire to help those less fortunate, manifests itself in ways expected and totally unexpected. Everyone works incredibly hard and without complaint. A 17 yo patient had some problems in the middle of the night, and, when I threw on some clothes and ran out, there was the Top Tower bus full with OR nurses, anesthesiologists, surgeons, at 3 a.m., all not just ready, but eager to help. All ended well, fortunately.

We hope to do sixteen heart operations, and one pacemaker insertion in our eight days of surgery. All has gone well up til now.

In reflecting on our now six years of experience with having the privilege of doing this work, I think I can sum it up by saying: "If not this, what? If not now, when? If not us, who?
Thank you to all who are here with us, and to all who are supporting us back home. Our success is your success, and it has been the highest honor of my life to do this with all of you.

Chip, Cardiologist Patricia Come, Jeanne DeCara at the Premier showing, Courage of Hearts, a film by Michael Fasciano

Surgical Team Bobby Oakes, Chip Bolman and Terra Lawson, work with theater nurses from King Faisal Hospital in Rwanda. 


Friday, February 8, 2013

Inside the OR

Many thanks to Dr. Bruce Leavitt for a look inside the Team Heart operating room:

(1) The Team Heart anesthesia team evaluates the pre-operative echocardiogram.

 (2) Terra concentrating hard on her job!

 (3) Dr. Chip Bolman and team begin the surgical procedure on one of our patients. 

 (4-5) Chip and Bruce operating together after several years of planning for this event.

Bonnie Greenwood, Pharmacy from Brigham and Women's Hospital, Boston USA returned for her 4th year to Rwanda with Team Heart. But this is not just the 3 week trip as it is for some, as she continues the work year round. She is involved in meetings with the other teams to coordinate a central medication list to share and is an integral part of the Coumadin delivery program. For the past year, while Rwanda improves the supply and demand aspect, Bonnie has helped coordinate the supply side. Earlier this year joined Team Heart in a request to place Warfarin/Coumadin on the essential drug list. A great first step! 

Below, Bonnie and Ceeya are delighted to see the IV fluid arrive...and in "pouches"!, (IV bags to us in US and standard use).  For our six years we have wanted to have the bags purchased in Rwanda to decrease the weight and the clearance and this year it was successful.  We wish Steve Senat,  BWH  OR procurement was here to celebrate....Thank you to Steve and Vedaste!

 Bonnie at station in between mixing medications.

February 8-We miss Julie already!

Our first team member headed home yesterday and we already feel the emptiness in the space she leaves behind! Julie Carragher, a nurse practitioner from Harvard Vanguard in Boston. It was Julie's first visit to Rwanda and she too has fallen in love with the experience. Julie joined the screening team of veteran cardiologists, Patricia Come, MD (photographed with Julie), Jeanne DeCara, MD and  veteran sonographers Marilyn Riley and David Adams. A team of incredible experience! Julie jumped in looking fresh as a daisy every moment and with a smile on her face the entire time.  Her willingness to track lab values, tick off needed procedures and advocate for the patients for rapid process through the system. She quickly found Alphonsine in admissions to help  speed up the front office process, and made friends with dental for rapid clearance.  Julie was so inclusive  and immediately became found Cardiology house officer Vincent, who helped to facilitate the care needed.

Julie left Kigali yesterday with beautiful sunshine and moderate temperatures in low 80's. She returns home to a snow storm.

Thursday, February 7, 2013

As i worked in the ICU last night i watched our first female patient brighten and come to life as her tubes were removed and she was told she would move to the ward today.   She smiled and i understood from the many years i have worked with Team Heart that this means " she has made it".   She will survive.   As much as we try to provide privacy for our patients in the icu it is a open area and lots of the drama surrounding recovering a sick patient.   Today she will go to the ward and the magic will start...she will eat well and walk,  play soccer.   She will grow strong and now have the chance to live a long life.   I was told this evening she may want to be a nurse...kind of cool to think her experience will make her more empathetic and kind to other sick patients.   I will remember this one....

Wednesday, February 6, 2013

Meeting the Patients

Yesterday, as day one of surgery got underway at King Faisal Hospital, we had the opportunity to meet with two young women who were scheduled to undergo valve replacements this week. The first patient was scheduled for yesterday afternoon, and the second –though originally slotted for this morning—has been pushed back due to a bad cough.

The first things I notice about Patient 2 are her arms. They are so incredibly thin from wrist to shoulder that it’s hard to imagine even a bone fitting in there.  They are no more than 2” in diameter, and as a nurse takes her bicep to check the patient’s blood pressure, her fingers overlap. The nurses tell me that she is weighing in at 36.5 kilograms. That’s just 80 pounds.

Like many of the patients we see, this young woman does not speak English; she also doesn’t smile. It seems clear that she’s frightened, as most of the patients are, but her eyes are wide open and inquisitive. She’s just stunning.  I ask if I can take her photograph, and the nurse from King Faisal Hospital translates. “No problem”, she responds, but still no smile. I’ve been told that the Rwandese like to see the pictures taken of them, so as I snap the camera, I share the photos with the patient. I wonder if she’ll like them and find myself hoping that she does.  She is hugely captivating.  Her gaze is so frank, not the least bit self-conscious, and she stares at the camera with a depth that feels very personal.  I am hoping that she likes seeing herself on screen; I really love taking her picture.  It’s not surprising that she doesn’t offer much of a reaction—but she keeps looking.  I’m curious to see if she’ll open up once the surgery is behind her.

On the other side of the room, Patient #2 is a few years older and far more animated.  When I first enter the room with my camera, she can’t keep her eyes off of it. I have to leave so that she can concentrate on the important conversation one of the team members is trying to have with her about the surgery scheduled for that afternoon.

This patient is just 21-years old, and with the mechanical valve that the doctors want to implant, she will be on a blood thinning medication for life. Patient 2 must make a decision: the valve will save her life, but leave her unable to bear children. For a Rwandese woman, that is an incredibly difficult decision—this is a culture that places an immeasurable importance on a woman’s fertility and childbearing capacity. To give that up for the durability of a mechanical valve will negate her worth in the eyes of her culture. How does any 21-year old woman make a decision like that, and how does a Rwandese woman choose to give up something that will define her within her culture? She must decide, is choosing life worth what she will be giving up? Happily, this patient thought so. It’s a hard decision to both witness and understand, but, of course, a much harder decision to have to make.  It is a major factor to consider for many of Team Heart’s prospective patients.

When I met Patient 2 for the first time, the intricacies of the surgery—and the childbearing repercussions—have just been explained to her. We wonder if she really understands. She is fascinated by my camera, and even though I want to catch her in candid moments, she can’t stop looking directly into the lens. She wants to see the pictures I’ve taken and expects Polaroids. I try to explain that the pictures are digital and show her the mechanics of the camera (why I thought that might clarify the situation is hard to say). We don’t share a common language, so I pull out the memory card to try to explain. I think she understands, but is more concerned with having her picture taken than how the whole thing works.  I don’t think it’s vanity…I think she is self-conscious about being sick, and vulnerable.

She, too, is beautiful. The Rwandese that I have met so far have amazing deeply dark skin, big eyes, and gorgeous bone structure.  Even these patients, sick and scared and uncomfortable, have a natural beauty that is striking.   It’s a photographer’s dream! This young woman is embarrassed when she sees her own picture, but keeps posing—so I know she likes it. She, too, loves to just gaze at the camera, but loosens up as the day goes on. Jean Paul, a former patient and ambassador to Team Heart, shows her his own scar, listens to her questions, reassures her, and most importantly, makes her laugh.  It’s a beautiful thing to witness.  Her caregiver—maybe her mother? —is sitting by the bedside and looks on the whole scene without a word. I wonder if she’s nervous, or disapproving.

Patient 2 got out of surgery late last night, and thankfully, all is well. When I saw her this morning, clutching tightly to her Team Heart pillow (a gift that all the patients receive after surgery), she looked tired but relieved. One of the team members stops by her bed and explains to me that this was her first ever patient. The young woman smiles through her oxygen tubes, and it’s a special moment to witness between the two of them. The patient is forever changed, but so is that doctor.

Patient #1 is still awaiting surgery, but I saw her again this afternoon and hardly recognized her—she was grinning!

                                         Patient #1

-Mackenzie Craig

Tuesday, February 5, 2013

Update from Bruce Leavitt, MD February 5, 2013

February 5,

Today is my third full day in beautiful Rwanda.  Here is a little background as to what has transpired since arrival.  After two long flights from North America, I landed in Rwanda on Saturday evening.  I never really saw the light of day on Saturday, and Sunday passed mostly in a  haze of jet lag. Team Heart met in the early afternoon to review all of the cases that had been seen by the awesome pre-visit evaluation team.  We prioritized the patients for the week which was a difficult job.  Monday the fourth of February was our first operative day.  The first case was a 39-year old man who received a new mechanical aortic valve by Drs. Oakes and Bolman.  The second was a 21-year old female who received a mechanical mitral valve for her rheumatic mitral stenosis by Drs. Matthew and Bolman.  Both cases went very well, especially considering that it was the first operative day; the kinks were small and worked out very smoothly.  

I am truly amazed at the teamwork, dedication, knowledge and skill of everyone on Team Heart.  I guess I now know why "Team" is the leading word for our organization.  Today (Tuesday, February 5th) we started with my first cardiac surgery case in Africa.  Our patient was a 19-year old young man with severe mitral insufficiency and tricuspid insufficiency, again from rheumatic disease.  His case was difficult because of the greatly enlarged size of his heart.  He received a mechanical mitral valve and a tricuspid valve repair with a ring.  He did have one of the largest hearts I have ever operated on, especially for such a young man.  After today we will have finished 4 cases with 12 to go.  More to come.

Bruce Leavitt, MD

Mackenzie arrived.....February 4, 2013

This morning began bright and early at King Faisal Hospital in Kigali for many members of team. Today, surgery begins! The patients have been screened, evaluated, and carefully selected.  Though there are still decisions to be made and some factors to consider for individual patients, the team has set the surgery schedule for the week and patients have begun to filter into the hospital. It’s a day of hazy sunshine with a perfect breeze, the kind that feels like the first day of summer back home, and everyone is smiling.   Jetlagged, exhausted, but smiling—there is a palpable current of pride and purpose in the room where Team Heart has taken over.
The hospital itself is surrounded by some incredible views of Rwanda. There is an open air walkway all along the outside of each floor of the hospital; hazy mountains seem hundreds of miles away, and local men and women farm the land, for potato crops we think, just beyond the hospital property. In between, there is a fascinating mix of sights.  Modest homes with corrugated metal roofs, a sweeping golf course, government buildings, a palatial private residence, and a lake are just a handful of things that fill the countryside. 
Inside the ICU where the team has set up shop, there is a stillness and real sense of anticipation as we await the first patient.  The first surgery of the trip has just finished, and at any moment our first patient will be wheeled in for post op care.  The surgeons come in first, and we’re told that the surgery went well.  Everyone seems relieved, but anxious to begin work! A calm before the storm, they know. This will be the first  patient of 16 over the next week or two, and this ICU room will become increasingly more hectic.
The first patient is wheeled through the door, and Team Heart is all smiles.  The room is quite suddenly bustling and one of the talented surgeons says “First one down…It means everything is working. More or less!” We all get a kick out of the “more or less”.
The mobility here is amazing.  The volunteers have set up what is essentially a portable post op unit, and the team tells me that much of what I see in that ICU room has been brought and donated by Team Heart over the years.  Suitcases and backpacks are stuffed under every surface in the room, a pharmacy is set up on two folding tables set in an “L” shape, and about 20 people have converged around the patient to get him connected to all the machines and monitored. 
The patient is stable, and the anesthesiologist reports on what happened in the operating room.  What we’re seeing is part of a program called ‘PAUSE’, and it is intended to ensure that everyone involved with the patient care is on the same page.  It’s meant to encourage open dialogue between team members and ensure that no detail is overlooked; there’s a real sense of unity and a common goal of success as everyone gathers around to discuss this surgery and the plan of care going forward.
One down, 15 to go!  I met 2 more patients on Team heart’s list today—stay tuned!