Update 10.10.2012

v  Approval to work in Rwanda is now required for all NGO's. In response, the application for official INGO status in Rwanda has been prepared and submitted.  A comprehensive 104-page document prepared under the leadership of Team Heart project manager, Noella Bigirimana details the work we do, the partners in country we work with and the source  and amount of our funding. We anxiously await approval, indicating the country values the contributions TH makes to both education and care delivery in cardiac disease and acknowledges TH's careful attention to following  guidelines for providing care. An advantage of the process includes the opportunity to align Team Heart and Rwanda's goals and to determine the best measurement of outcomes. 

 Noella, a pre-med graduate of Cornell University in Ithaca,NY, is a  native of Rwanda and taking a gap year while working with Team Heart. Noella will travel with the surgical team to Rwanda in February and currently is coordinating a meeting of international surgical partners working in Rwanda, scheduled June 2013 in Geneva, among other strategic planning.

v  A successful Team Heart Golf Tournament raised funds for team travel for the 2013 surgical trip to deliver life-saving surgery for young adults and adolescents. Held October 1 on a gorgeous day in Nashua, NH, the tournament was chaired by three-time traveler and step down-ICU nurse, Michelle LaChance. The course at Sky Meadow Country Club is already booked for the third annual tournament in September, 2013, as planning began as soon as we wrapped up play. Thanks to an amazing organizing committee who, incidentally, all work full time at leading hospitals!

v  A comprehensive curriculum has been developed and copyrighted under the leadership of Dr. Patricia C. Come, a 5-year traveler for Team Heart pre-op evaluation team. Submitted for approval to the Senate of the Medical School of the National University of Rwanda, we anticipate and hope applications will be entertained for January admission. The curriculum is a diploma program designed to increase the cardiology knowledge of selected internal medicine physicians working in regional centers to improve post-operative care and increase the identification and early intervention of those with rheumatic heart disease and other heart disease. The selected physicians, after completing the program, will work closely in regional clinics with nurses to provide care. The regional  Rwandan nurse led clinics, forms the backbone of the health care system.  

v        JaBaris Swain, MD, 3-year traveler with Team Heart begins his two-year Cabot Fellowship in Global Health Equity Residency in General Surgery, designed to train academic surgeons in the science and practice of surgical care delivery in austere settings, as well as develop research and policy leaders in this nascent field. Housed in the BWH Center for Surgery and Public Health, the program is one of the few global surgery residencies in the U.S. His work will be designing a proposal to investigate the cost benefit analysis of cardiac surgery in resource poor settings to submit to the Ministry of Health for consideration to work with local caregivers and investigators. Team Heart is proud to support a portion of this fellowship.

In October, under Team Heart sponsorship, JaBaris will travel as an invited guest to the NIH as an observer in global health. In December he will travel to COSECA, (College of Surgeons, East Central and South Africa) in Addis Abba, Ethiopia and will return with the team in February to provide direct care.

Team Heart and Dr. Swain was featured in the recent RHD News Newsletter for the World Heart Federation! Thank you JaBaris for your acknowledgement of Team Heart and the work we do in Rwanda!

v  December travel to Rwanda will include BWH procurement expert Steve Senat and Leslie Sabatino.  Steve and Leslie identified a short list of critical items to order and procure with direct delivery to Kigali working with local team leaders, led by Vedaste Ndayisaba, King Faisal hospital and the newly restructured CAMERWA. Team Heart is the first expatriate cardiac team to take this critical step to sustainability.  This step to transfer expertise for cardiac surgical procurement must happen if surgery is possible independently.

v  Rwanda welcomes back home Dr. Jean Marie Vianney Gapira Ganza from completing his interventional cardiology fellowship, Université Catholique de Louvain Brussels. Originally located in Butare where his family lives he had previously worked in the NUR Medical School UTHB. Team Heart has worked with him since our first year in Rwanda, and he is both loved by his patients and respected by his colleagues. His graduate thesis was regarding rheumatic heart disease, the leading cause of heart disease in Rwanda at this time.  We look forward to working closely with him in the future.

v        Dr. Maurice Musoni has begun his first year of general surgery and cardiac surgery in Johannesburg, South Africa. We have very little information about how his work is going, he is on trauma service now and is working very hard. He traveled with the support of the Ministry of Health.Team Heart is very proud to have arranged the position and to ensure he is able to take advantage of the comprehensive learning experiences.

v  Strategic planning for Team Heart. Do we expand, do we focus, do we build? Do we answer the multiple requests to fill urgent needs in other countries?  If you would like to join a meeting or sit on a committee, or receive minutes contact: teamheartinfo@gmail.com

v  Screening-What happened to the screening program of school-age children from September 2010? Data analysis is in process at this moment. Thanks to Boston cardiologist, Bernard Bulwer, and Studycast, all echocardiograms have been read. Echo findings must be graded for input into computer and Dr. Mucumbitisi is compiling  gradings in Rwanda. Early indications could predict a large number of unknown individuals with RHD in the country who will one day need surgery if not identified and placed on prophylaxis. Even then, some will progress to require cardiac surgical intervention. Thank you to The Medtronic Foundation, the J. Warren Harthorne, MD Fund for Screening, Studycast, and Cathy and Mannie Jackson Gift for funding this project and making it possible.

v  Support Team Heart! Consider a Capital ONE Credit Card! A percentage of your charges will be donated back to Team Heart each month to support these projects. To apply for the card, visit:

https://www.cardlabconnect.com/AffinityPortal/visitorAction.do?affinityName=TeamHeart,Inc.

Father's Day Tribute Card....

This father's day, show your support of Team Heart by purchasing one of our Fathers Day Tribute Cards. All proceeds will go to improving our post-operative patient care in Rwanda. With the new Rwanda requirement of  10% co-pay for all patients, accessing the health care system is a challenge for some. Many of our patients have been ill for years, on the brink of death,  waiting for the chance to have life-saving surgical intervention. Most are young and may never have entered the work force without our help. Though survival rates and post-operative health are improving, our patients still need jobs to pay for medical care. Though Rwanda offers universal coverage, or "mutuelle," the care providers  who are knowledgeable about rheumatic heart disease and post-operative care are located in just a few hospitals throughout the country--and because many people do not have access to public transportation, they do not know about the options available to them.

It's hard to believe that $15 tax deductible donation of the $20 sales price could have much of an effect on our patients. But it could save a life.  

For more information? information@teamheart.org.

The second annual Team Heart Golf Tournament will be October 1, 2012 at Sky Meadow Country Club in Nashua, NH.  The tournament is a scramble start with teams of four.  There are many prize opportunities including airfare and two nights accommodations for two to Las Vegas.  This prize includes a round of golf at the exclusive Spanish Trail Country Club.  There will be a dinner and awards ceremony to follow.  Fundraising is crucial to completing Team Heart's overall goals and mission and is the main funding source for all of our traveling volunteers.  Please join us for a great day of golf and support a good cause to eradicate Rheumatic Heart Disease in Africa. 

For more information on both participation and sponsorship of this event please contact...  Michelle at mlteamheart@gmail.com, or teamheartinfo@gmail.com

To Register: http://www.golfdigestplanner.com/20888- teamheartgolf

Strengthening Rwandan Surgery: Surgical Residents’ Perspective

Guest bloggers Gita Mody (Team Heart 2012), Robin Petroze & Edmond Ntaganda discuss efforts to strengthen surgical care in Rwanda.

In March 2011, the Rwanda Surgical Society hosted a workshop in Kigali on the theme “Strengthening Rwanda Surgery.” Rwanda has been extremely successful in combating morbidity and mortality due to communicable diseases and is now actively tackling treatment of non-communicable diseases, many of which require surgery. However, there are very few surgeons in Rwanda, and over the past several years, there has been growing interest amongst local, regional and international partners to promote Emergency and Essential Surgical Care as well as specialty surgical care in Rwanda. Therefore, the purpose of the workshop was for stakeholders in Rwandan surgery to meet one another, form the basis of lasting partnerships, and strategize on cooperatively expanding surgical services. The attendees were forty-five surgeons, anesthesiologists, industry representatives, residents, students, and others from five countries. There were some long-term and some brand new participants in Rwanda surgery, but all were eager to form a collaborative with a shared vision of a Rwandan-owned, sustainable surgical training and delivery program.

For the full article: http://blogs.plos.org/ speakingofmedicine/2012/03/20/strengthening-rwanda-surgery-surgical-residents’-perspective/

Blogging From Brigham and Womens Hospital 3/19/2012

In advanced countries like the United States, it is rare for strep throat, a common and highly treatable infection, to lead to rheumatic heart disease, a life-threatening condition. In underdeveloped nations like Rwanda, however, rheumatic heart disease claims the lives of many children and young adults because medications, like antibiotics, and interventions are simply not available.Last month, a team from Brigham and Women’s Hospital (BWH), Massachusetts General Hospital, and other hospitals from across the United States, returned from an annual trip to King Faisal Hospital in Kigali, the capital city of Rwanda, to perform heart valve replacements and repairs for Rwandan residents who would otherwise die without them. Led by Dr. R. Morton Bolman, Chief of Cardiac Surgery at BWH, Team Heart was formed in 2007 as a ten-year mission to provide cardiac surgical care for Rwandans with rheumatic heart disease, as well as medical and surgical training for physicians and nurses at King Faisal Hospital.“This nation of more than 11 million people has less than one quarter of the number of physicians and nurses in our hospital in Boston,” said Dr. Bolman. “Team Heart’s ultimate goal is for Rwanda to have a sustainable cardiac surgery program at the end of our ten-year mission.”For each of the annual mission trips, Team Heart travels with a group of 35-40 individuals, comprising surgeons, anesthesiologists, nurses, perfusionists, residents in surgery and anesthesia, pharmacists, and volunteer support staff. An “at home” support team at BWH also helps in many ways, from loaning surgical instruments and enabling the purchase of supplies at cost, to packing, shipping, grant writing, and fundraising. The highly-specialized cardiovascular team at BWH also provides remote support during each mission.

READ MORE »

http://healthhub.brighamandwomens.org/

Alexis.....

Greetings to all of our followers and thank you for the wonderful support illustrated during our trip. It was amazing in many, many ways. The team was wonderful absolutely no drama, just pure teamwork. Our Rwandan colleagues were gracious hosts and valued team members. But we left feeling a great sense of pride. 16 patients, received valves between the ages of 14 and 36. Most patients selected were in the early second decade of life—and all but one with rheumatic heart disease.

The patients were all discharged in a reasonable time frame rivaling our LOS here in US. Several, have had a more challenging time of managing the INR and two have been readmitted for further management of Coumadin. We send messages through our local patient support group wishing for a speedy recovery and receive updates of how everyone is doing.

Many of you might be aware that one of our patients died soon after our return. I mention Alexis because this patient illustrates our reason for being in Rwanda. Reaching our goal to ultimately having a full time cardiac surgical program would have brought this young adolescent to surgery earlier. A cardiac catheterization lab would have provided early accurate diagnosis.

Alexis, a young 14 year old, won our hearts by being his own best advocate. Not that he had to be his advocate alone, Dr. Pat Come, Dr. Danny Muehlschlegel, Dr. Chuck Edwards and Dr. Gita Mody and the entire step-down nursing team also felt he should have this chance and served as the most devoted advocate team ever. Definitely not straightforward, every possibility of surgical intervention was debated. After 4 years of saying we would not place a PA line in Rwanda, we placed a PA line to rule out pulmonary hypertension as part of the work up! The strong support for this young man had each person on the team cheering for him, as well as all the other patients joining in. He did well very initially and was among the first to be discharged. But he awoke during the night, a few days after discharge, felt anxious and died en route to the nearest hospital.

Of all of our patients this trip, he had one of the most secure home situations to be discharged to. An orphan, he was doted on and well cared for and lived in a very secure and clean environment. Much love shown to him and the orphanage provided wonderful care. Everything material needed was provided as well as emotional support and guidance. He was a very happy teenager....

For us, it was not expected. But we have long learned from looking at our successes, that you cannot predict the outcome in some and life is often fragile. We grieve for his youth, the loss of the young man we had already had a vision to have a wonderful future and give back to his country.

In his name and for others, we will establish a patient resource fund to provide education, support and follow-up for all patients having received Team Heart care. We think Alexis would like this—

Sara, a 4 year Team Heart RN in the step-down took the photo of the three young men who won our hearts, Alexis is in the middle in the green hat, Celestine in the red, Jean de Dieu in the navy. Here they are celebrating post op, the day before the step-down nurses departed....