Tuesday, March 7, 2017

Collaboration :)

Team Heart is as much about saving lives as it is teaching our Rwandan counterparts how to care for a post op heart surgery patient. In our 10 years of surgical missions we have been fortunate enough to collaborate and work with some of the best Rwandan nurses and physicians. Looking forward to many more year of teamwork and seeing our goal of establishing the first cardiac care center in Rwanda! Team Heart is made up of medical and nursing volunteers from 12 U.S. states and 5 countries, representing over 15 different hospitals.

Our Team Heart Pharmacy

Visits from Former Team Heart Patients

One of the best things about returning to Kigali, Rwanda year after year, is to see our former patients. After they have had surgery, it is remarkable how strong and healthy these young adults become. They are not only physically bigger and healthier, but they have been able to return to school and to work for the first time in years!
Here are some pictures of our some of former patients....ranging from 1 to 6 years post op!

16 Surgeries Completed!

Greetings Friends! 

Long time no update. Apologies for the hiatus. Things have been moving along here in Kigali, with the 15th and 16th surgeries being performed today. We are halfway through the day and the 15th case just came out of the OR. 

This patient is different from all our other patients because he was an atrial septal defect repair - meaning there was a hole in his heart between the left and right atrium - where the blood goes first before it is pumped into the ventricles. The atrium collects the blood and pass it to the ventricles, the ventricles are the chambers that pump the blood out to the lungs and the rest of the body. 

Atrial septal defects or ASD's are usually congenital and are the third most common type of congenital heart defects. When there is a defect in the atrial septum several problems can occur. When the defect is large, the problems can be life threatening. 

Our patient had a very large ASD and the concern is that normally blood does not cross between the atrium - so that it must pass through the lungs before entering the left side of the heart and being delivered to the body. In a patient with an ASD - some blood from the left atrium passes through the hole back into the right atrium and as a result there is more blood in the right side of the heart than there should be. Over time, the right side of the heart and the arteries in the lungs have to work harder to accommodate this extra blood. The muscles that make up the walls of arteries in the lungs bulk up from all this working out and because they are stronger, there is more resistance to the blood flow causing what is called pulmonary hypertension. Because of this increased resistance, the blood chooses the path of least resistance and starts flowing directly through the hole in the atrial septum and into the left side of the heart without going through the lungs first. This means blood that has not been oxygenated by the lungs is now circulating through the entire body. This causes the obvious challenge of not having enough oxygen. 

There are a few other problems caused by an ASD and that is why we needed to fix this one today. Dr. Bolman and Dr. Swain (up and coming fellow at UPENN in cardiothoracic surgery) repaired our patient's ASD today. They used bovine (yep, from a cow) pericardium in the shape of an elliptical about 4x5cm. 

This case was special not just because it was the only ASD repaired or because it was the last day of surgery, but also because Dr. Bolman and his daughter got to scrub in together and her husband got to wear scrubs and watch with me from the anesthesia pod. Pictures of all involved are below as well as some pictures of the bovine pericardium and the incision made in the atrium. We tried to capture the ASD, but didn't get it on camera - it was pretty amazing though, just so you know! 

Well, that is all folks. I will try to do at least one more update tomorrow. I am working night shift tonight so I am sure I will have at least one good story to report. 

Until then… Urabaho!

~Bridget C. and all of us here with Team Heart

Thursday, March 2, 2017

Updates from the Step-down Ward

Good evening! 

It's been a beautiful day in Kigali. Our patients were perking up like flowers in the sunlight after yesterday's rainy weather. Three of our six post-op patients have transitioned from the Intensive Care Unit to the Step Down unit with pacing wires and chest tubes being taken out. They are returning not just back to baseline, but doing even better than they were before surgery now that they have their new valves.

So what does all this mean? Intensive Care Unit (ICU) and Step Down? Well, that is one of the things as a medical student and up and coming resident I am learning. Determining how far along a patient is in their recovery and if they are ready for less invasive monitoring is one of the most important aspects of post-operative care. I have had the opportunity to discuss care in the ICU with the intensivists as well as surgical residents and learn about ventilator settings, the type of medications, and monitoring patients are on while in the ICU. And today I had the opportunity to talk to Sue Ellen, the nurse in charge of the Step Down unit to discuss the difference between ICU and Step Down and the different goals for transition out of each.  

The goal of the ICU is  immediate recovery after surgery. This includes recovery from the effects of anesthesia, intensive monitoring for life threatening complications of surgery such as bleeding or stroke, and removal of lines and wires that are placed on them for surgery. Once we have monitored their vital signs, blood pressure, breathing, heart rhythm on an EKG, and made sure there is no bleeding in their chest, monitored by output from a tube that is placed in their chest at the end of surgery, and the patient appears to be doing well, they are transferred to the Step Down Unit.

The goals of the step down unit are to optimize the patient's condition and prepare them to go home. A challenge unique to the work we do in Rwanda is that they do not have the accessibility of visiting nurses and medical care that we have in the United States. Therefore, before patients leave we must make sure they have the education and resources to get the medications and follow-up care that is needed after surgery.

While the patient is in the step down unit, we make sure they are getting up and moving around, doing deep breathing to prevent complications in their lungs, their pain is well-controlled, and that any fluid built up around their heart as a result of their damaged valves is starting to come off. We can tell the fluid is decreasing with chest x-rays, listening to their lungs, and tracking their body weight.

Once the patients start to feel better the goal is to educate them on what they need to know for post-surgical care, about the Warfarin medication they will be on, and making sure they are connected to a local physician who will be able to monitor and manage them. To educate the patients we have local nurses who translate and work with the patients and we have videos in Kinyarwanda - the language of Rwanda.

When a patient does not do well after surgery it is not usually a direct effect of the surgery, it is a result of lack of follow-up care. We must make sure they will have access to the medications we discharge them home on, that they are available in the country and that they are inexpensive enough the patients can afford them.

Educating the patients is essential for them to be able to advocate for themselves once our team has left. For the same reason, it is important to educate the patients' families as well as the local nursing staff - together they can all advocate for the patient to ensure strong follow-up care.  

Our first patient Emmanuel is doing extremely well. Today, one of our nurses in training, Sam, began speaking with Emmanuel about possible barriers to his follow-up care so we can figure out ways around potential obstacles that may arise in terms of patient education, finances, transportation, etc. Sam and Emmanuel are pictured below having this discussion. Emmanuel gave a big smile when Sam asked him  if he would mind me taking his picture for the blog post today. I am so happy to see him smiling and feeling well again. 

I will post more as the week goes on and we see our patients in the step down unit walking around, talking, watching videos, sitting outside and starting to feel even better than they did before their surgery. 

Have a great day everyone! Until the next post…

~Bridget C.

Patient Emmanuel receiving post op teaching

Dr. Bruce Leavitt with one of our patients and his father

Volunteer Judy Sgantas with one of our patients and her family

Wednesday, March 1, 2017


Is there anything better after a busy night shift than seeing the sunrise.....YES...Actually being able to be outside for that sunrise!!!! King Faisal Hospital, the hospital we work at in Kigali is designed so that all of the hallways are outside. It is amazing to be able to get a little fresh air during your shift....but can get interesting (and slippery) during those afternoon thunderstorms.
Here are some pictures of the hospital, our (now very busy and full) ICU, as well as that sunrise view from the hallway in between the ICU and Step-down ward.
Sunrise, Thursday, March 2nd, 2017

Sunrise, Thursday, March 2nd, 2017

King Faisal Hospital

Amazing collaboration

First Patients out of ICU and Scenes from the Countryside

Emmanuel, our first patient, WALKING into the Step-down Ward
Today is Wednesday and our first patient, Emmanuel transferred out of ICU. He is a 37yo farmer. Our second patient, Israel transferred over later in the day as well.  He is only 11yo. Both patients, had single valve replacement surgery on Monday and are doing fantastic, transferring out of ICU on post of day 2!
Several Team Heart nurses took a trip out of the city today with Abraham. Abraham is a local shop owner and jewelry designer who has been a friend of Team Heart since 2009. Abraham brought the nurses to a co-op where many of the traditional Rwandan baskets are made by local women. It was quite the experience, to see the grass drying and the women weaving it into the beautiful baskets we all take home as gifts. The areas outside of downtown Kigali, are lush and stunning. It is always nice to enjoy the beauty of Rwanda on days off from the hospital. With four patients in ICU and now two in the Step-down Ward, we are just getting started...keep following along for more updates and pictures :)

Rwanda: the land of a thousand hills

Hitching a ride uphill :)

Women taking a break from basketweaving
Stepdown Ward ready for patients
Our first Step-down Ward Patient

First Day of Surgery 2017!!

The First Day of Surgery!!

Greetings Friends and Family of Team Heart!

My name is Bridget Colgan, I am a fourth year medical student from University of Vermont, and have been blessed with this amazing opportunity to volunteer with Team Heart for their 10th medical mission trip to Kigali, Rwanda.

Briefly about myself, I will be graduating from medical school May 21 and starting my general surgery residency at Tripler Army Medical Center in Honolulu, Hawaii on June 1.

How did I wind up in Kigali, Rwanda? Well, that story goes back a long time… when I was born… Just kidding. I will start when I met Dr. Bolman, Ceeya, and Dr. Leavitt during my third year of medical school. I have had a strong interest in cardiothoracic surgery and medical mission work for many years and during my third year of medical school when I first heard about Team Heart, I instantly knew I wanted to be a part of it. I will be forever grateful to Dr. Leavitt for telling me to talk to Dr. Bolman and Dr. Bolman for telling me to talk to Ceeya, and Ceeya for accepting me along as a volunteer for the trip.

Ceeya emphasized the value of being actively involved in the team to maximize my experience and I know without a doubt how right she was. I was able to help with inventory prior to the trip, receiving all the emails of supplies for perfusion, pharmacy, the supplies that were still in Kigali from last year and those that needed to be shipped - and I did my best to input them into FileMaker, the software we used to keep the inventory records. It was not until last Sunday, February 19, that I was able to actually put a visual to the weeks and months of emails regarding the inventory. To see all the supplies stacked up filling the closet of the Team Heart house wall to wall was very exciting - the trip was here! The 16 life-saving surgeries that required all these supplies would soon be happening!

The past week I have had the amazing opportunity to be a part of the screening team. We travelled to multiple sites in Kigali. The day before I got here, February 18, the team took a trip a couple hours away to visit Ruhengeri Hospital. While I was here from Monday, February 20 through Thursday, February 23 we went to three other sites: Kanombe, which is the Military Hospital, and Chuk, which serves as the city hospital of Kigali  also called Shiaska, as well as King Faisal, which is where we are currently doing the operations. Screening week was surreal. We saw so many patients, not just with rheumatic heart disease, but congenital heart defects, including corrected transposition of the great vessels and an ostium primum atrial septal defect, cardiac tumors, and many other diseases and pathologies. It was extremely challenging to not be able to help all the patients we saw, but the team did our best to collect the data we could on each patient and advise the local cardiologists on recommendations for further treatment, even for those we are not able to operate on and treat during this trip.

The screening meeting took place yesterday afternoon, February 26, at 1pm at King Faisal Hospital in the outpatient building. You can see pictures of the meeting below. We selected 16 patients and 5 alternates for surgeries. The selection was not without the challenge of wanting to be able to help everyone but being limited by time, resources, and disease burden. If the patients are too sick to tolerate surgery, it is a difficult but necessary decision to recognize our limitations as surgeons and medical professionals.

After finalizing the OR schedule for the week, we went out as a Team to Heaven, a local restaurant and favorite place of Team Heart where we were able to talk and reflect on the many life experiences that brought us together to serve in this amazing way. I had the privilege of sitting next to Dr. Bolman and Ceeya and hearing not only the story of how they met, but also the story of how Team Heart came into being. I am so amazed by their heart for service, their vision, and their ability to realize their vision in such an amazing way. They dream with their feet - putting their visions and hopes into action. They have inspired me not only as a future surgeon, but in the type of person I hope to become.

Dr. Bolman was going to read a quote last night at dinner from A Thousand Hills to Heaven by Josh Ruxin the owner of Heaven restaurant. He wound up not reading it, but he shared it with me and I wanted to share it with all of you because I think it sums up beautifully why we are all here on this trip:

"You cannot leave Africa and then expect to be satisfied by ordinary living. You will have to continue doing extraordinary things, because you know what can be done in the world, and you know what you are capable of doing, and you know that, wherever you go, many lives will depend on your willingness to exercise your privileges and skills on their behalf."

Today was the first day of surgeries - we had two single valve cases, one aortic valve and one mitral valve. Both cases went well and the patients are in the ICU now recovering. It was an exciting day for the patients and the team as everyone moved into their professional roles and worked together to make the day a successful one.

We all had breakfast in the morning and headed over to the hospital to get started. Zander, the UVM resident who is here with us, and I ran to the lab to make sure blood was available for the first patient - started the day off right with a yes! And the first surgery stayed on schedule. After checking into the OR to see how things were getting started, someone had brought in a coloring book, markers, a Dr. Seuss book, and play-dough for our second patient and I had a bunch of stickers to give each of our patients. I felt this sounded like a medical student task, so I brought it all up to our second patient and found him getting a lecture for eating a banana by the anesthesiologist because he was not allowed to eat before surgery. The nurse and the patient's sister were bargaining with the anesthesiologist to be able to give him some apple juice. I was happy to be able to distract our patient from wanting to eat with some coloring. It was color by number and he loved it - did an amazing job. While we were sitting there, the team walked in on morning rounds and he, being a little ham, soaked up the attention from his audience. His sister loves when we take pictures of him and she adopted my phone for a few minutes today to take some pictures herself and I taught her how to take a selfie - she was so enthused. It was overall a great morning and the day continued to go well.

We got the OR schedule finalized with a few changes and distributed to everyone. We got the patients for tomorrow all set up. And then I got the chance to scrub into the second case, which I was so grateful for the unexpected opportunity to be in a case on the first day. It was really awesome to be able to see a mechanical mitral valve replacement. I was able to actually see the old valve, how damaged it was, its removal and the process of the new mechanical valve being put in. Dr. Bolman had a camera attached to his headlamp so all the people in the room had the opportunity to see the operation on a small monitor in the OR. The cardiology fellows also had the opportunity to watch along with the anesthesiologists. It was a great case for everyone.

Tomorrow will be another full day and I know we are all looking forward to it as we are in the swing of things now. Dr. Oakes will be doing a mitral valve replacement in the morning, followed by Dr. Bolman doing a double mitral valve replacement and tricuspid valve annuloplastly in the afternoon. I will write more soon!

We are so grateful for all your support in this endeavor, we couldn't do it without you.


From Bridget and the rest of Team Heart

The second case: an 11yo boy, single valve replacement

Saturday, February 4, 2017

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.

Thursday, February 2, 2017

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