Thank you from Chip and Ceeya

Ceeya writes:

Today, Egidia returns home and Team Heart will be home in full. I want to take this opportunity to thank each and every one for the incredible job. Always rising to the challenge and characteristically with an offer to help before being asked.

From the moment we landed and the volunteers helped unpack and set up, thank you Andy, Katherine and Natalie, Paige and Sofia to the patient work up with Gene, Les, Warren and smiling Jen and Meera (hey hey).....From the moment patients reached theater into the competent hands of Daljit, Luigi, and Nelson with Dr. Bonaventure we were on track, even with some very fragile patients to induce. Thanks to Chip and Prem for doing what they do best with a very competent support team Katie, Laureen and Terry. Barry always steady, always competent and calm shoring up where it needed to be and never complaining....Even getting Leslie M and Judah into OR...What a wonderful addition the MGH and Minnesota team makes to Team Heart!

Thanks to Amy and Mike--the dynamic duo. Cannot imagine a better perfusion team anywhere for this type of work. ICU was led by ever competent Jim and Zara and of course the ever present John Connell who received the ultimate compliment...the ONLY person the Rwandan team wants to make certain returns....(a reflection of John's willingness to always help out and not judge or treat people with anything less than full respect!). ICU nursing is a group of the most competent people Ahsley, Barbara, Bridget, Kevin, Leslie, Lindsey, Lisa, and Sue and thank goodness for Brenda and Jane.....what would we have done without them--they never complained of all the hours they worked.

Stepdown was busy and packed for several days, but still time for teaching and in Kinyarwandan...no less.With Egidia, Carol, Denise, Kristin, Marie, Monica, Sara, Terry-- and Sofia when needed....Thank you Liv, you were great--next year we want you to stay longer....

I am so glad George was with us...no fair sneaking off in the middle of the night.....no one was able to say good-bye.

We cannot forget to include thank yous to the Rwanda based team, Drs. Betty, Mugisa and Mucumbitsi and Juliet--with leadership of Maureen.....thank you to the warm welcome and preparations of Rosemary--thank you to Campbell for making things fit together and Clare, John McCally and Dr. Innocent for listening.

Last thanks to the volunteers in Boston, there at the beginning counting meds and planning and there at the end....Bonnie, Pharmacy, Anne and Julie and of course Ms. Leslie, who procured and packed what I had forgotten and listened to my panic stricken midnight emails and calls...

Smitha--many thanks for being there and helping to take care of the patients in hospital now...I knew you were an answer to a prayer when I first heard from you.....between you and Drs. Betty, Alex and Maurice and Dr. Narish, I know the patients are in good and competent hands.

And Hal we learned much from you because of the questions you asked--we will stay in touch (as soon as my voice returns)

Katherine will be scheduling a debriefing, so stay in touch. If there is information that did not get placed in the green reminder book, let me, Katherine or your team leader know..... Jim has volunteered to find a central photo sharing spot....more on that later....

KFH team is doing a really really good job. Anastasie is off dopamine, might have left ICU today, Genevie is getting better, Claudine has had some syncopal epidsodes and getting a neuro work up to rule out seizures, Jean la dieu is having fevers and will be in hospital for a time--there are others diruresing but progressing. We are lucky to have you all---


Chip writes:

Please allow me to add my heartfelt and sincere thanks and appreciation for all the hard work and dedication once again displayed by every member of the team. Ceeya speaks for both of us in expressing our deep pride in being associated with such an outstanding group of human beings. You are an inspiration to both of us. What we have accomplished, all of us together, is a wonderful start toward an eventual self-sustained heart surgery program in Rwanda. You should all be justifiably proud of your contributions. It could not have been done without you. Thank you, and I am already having Rwanda withdrawal, and looking forward to next year.

Team Heart 2009

Message from Jennifer Neary

My apologies for the delay in writing. Sadly I am now back in the states and away from the patients and members of Team Heart.

I departed Kigali on Tuesday evening, sad to be leaving, and was back to work in Boston Thursday morning. 
The last few weeks have been full of emotions, eye opening experiences and encounters and a few surprises...but I guess that's to be expected when you fly with a dedicated team of 46 to do heart surgery in sub-Saharan Africa.

Rwanda is a beautiful country full of beautiful people. The land of a thousand hills. It’s very green and lush with red dirt like Hawaii. The streets are bustling with people all hours of the day and night. Rwandans are friendly and polite…a pleasant change coming from Boston.

In my time in Rwanda I visited four other Hospitals, one in the city center and three others in the country. King Faisal certainly is at a higher level as far as available resources, cleanliness and patient care. During these visits I traveled with Dr Harthorne a cardiologist from MGH and saw things on echo that I have never seen before. He felt and heard things on physical exam that he hadn’t in 50 years. It was difficult for both of us assessing these patients. The Rwandan physicians have all been wonderful and are eager to develop their skills but they don’t have the resources to do so. They don’t have the experience or equipment to treat many of their patients and look to us for help. They make a diagnosis with a physical exam and prescribe the right medication but without cardiac surgeons in Rwanda, treatment stops there. The operative list is long and many of the patients needed help months ago. In our trips to the University and Community hospitals we were essentially just confirming and documenting the severity of their disease. Walking away was difficult, knowing that the next surgical team isn’t set to arrive until November. Many of the patients will either not survive that longer be too far into the disease process that surgery will no longer be of use. The most difficult part is that the patients see us "muzungu” with an ultrasound machine or a stethoscope and they appear a bit more hopeful and seem to think that we're there to help and we're going to save them. The reality is that we're there to assess them, and pass their info on to the two doctors who have the daunting task of creating the list. There are 20 patients to be selected to undergo surgery in Sudan and less than that for the Australians and Team Heart 2010.

I would like to give thanks and Kudos to all the dedicated individuals involved in this project: Ceeya who organized this whole endeavor, the surgical, anesthesia and perfusion teams who worked tirelessly through complex cases in an environment with limited resources and daily power outages (and a backup generator that takes a few seconds to kick on). The ICU team of doctors, nurses and respiratory therapists who stayed up all night watching over and tending to the patients in their most critical hours.  The step-down nurses and PA’s who also worked hard day and night caring for these patients. They were all rock stars, as Sue G would say, and there are 13 patients whose lives have been forever changed as a result of their dedication and humanity.  Thanks to Sarah Fostello and Jim McCarthy from GE for providing me with the Vivid I.  And a special thanks to Dr Warren Harthorne, without him I would not have had the opportunity to be involved in this wonderful project.

Chip said it …this truly is the best thing we do in our lives. 
It was a true privilege to be a part of this team.

Jennifer Neary

From Lindsey Couture

I am sitting in the hospital as the ICU is starting to close down and reflecting on the past two weeks here in Rwanda. I joined team heart at the last minute, two weeks before they departed so I was unsure of what to expect. In many ways this is something that is hard to describe. The nursing was very difficult at times due to equipment malfunctions, lack of supplies and limited varieties of medications. The patients were very sick and many times we came very close to reaching the limits of what we could provide. It has been amazing to see the patients transition through this process and the excitement on their faces as they are walking and doing things they haven't been able to do in so long. The smiles and hugs just make you melt. Every single person on this team has worked so hard and given hours upon hours of dedication and time to make this possible. I just want to thank everyone for this amazing opportunity. I am very blessed.

From Prem Shekar, M.D.

We have arrived in Boston. It is 7pm EST. It has been a long 32-hour but fairly uneventful journey back to the US. Most of us are quite worn out. The only highlights of the return trip were the interactions with Newark Customs (needed to be bailed out by a fellow missionary Customs Officer) and a 6-hour layover in Newark.

We have completed our second trip to King Faisal Hospital, Kigali, Rwanda. Once again, it has been a rewarding and humbling experience. We have successfully operated on 13 patients this time. We raised the bar and were able to perform more valve repairs on more complex patients with Rheumatic Valvular Heart Disease. We have learnt from our past experience that durable valve repairs are ideal in Rwandan patients for their long-term after care. We have had one complication with a cerebrovascular accident but we are hopeful that she will recover adequate neurological function in the long-term.

The most memorable event of this trip was seeing all the patients that we operated on last time. They are all healthy and most of them, had successfully returned back to school/work and other activities.

Once again, the dedicated team that I have traveled with came through. It has been a great experience working alongside these colleagues of mine, some of them for the second time. I would like to commend and thank all members of the team - Cardiac Surgery Fellows, Residents, PA's, Cardiac Anesthesiologists, Cardiac perfusion technologists, OR, ICU and floor nurses, Cardiologists, Intensivists, Echocardiographers, Respiratory Therapists and Volunteers.

I would like to specifically thank Chip Bolman - I have greatly enjoyed working with him on both trips.This trip has been a great learning experience for me and an example of collaborative work.

Needless to say, this trip would not be feasible without the dedication, commitment and drive of Ceeya Bolman. She has already asked me to keep time aside for the next trip. Her dedication is truly amazing.

Kigali continues to be a fascinating city. It is very safe and scenic. We able to discover more of it this time even with the limited spare time that we had. Our visit to Rwinkwavu was, once again, memorable.

"He who saves a single life saves the world entire" - Quote from the Genocide Museum, Kigali.

Prem Shekar MD - April 22, 2009.

From Smitha Philip, M.D.

Today is the first day after our last day of operations. What a week it has been! Drs. Bolman and Shekar have done what they do best and as it were done it both gracefully and cheerfully. Now, we're in the ICU doing our best to make sure these patients do as well as they possibly can post-operatively. So far, so good.

As an outsider to the team, I've had the great pleasure and privilege to watch this group give generously and be amazed at how well they do it. It's not just enough to say that they do their jobs extremely well or with the greatest care for their patients. That's to be expected. It is another thing to be able to say that they have done it with abundant generosity and overflowing spirit even in the generally dicey situation of working in a foreign country of limited resources. It has been truly humbling for me and a welcome reminder of the true meaning of caring for people. It has trickled down from the top leadership through all the branches of this operation ultimately touching each patient's life in an awesome way. I am in awe and speechless at times in thinking of how much of a miraculous endeavor it has been and how it was realized.

Sincere thanks and appreciation to all the people I have had the honor of working with and getting to know as colleagues this past week. I hope we will do it again soon!

Sincerely,
Smitha Philip, MD
Pediatric Cardiology Fellow
Children's National Medical Center

Message from Dr. Bolman

Today is our last day in the OR on our second year mission to Rwanda. The people have been most warm and welcome, and we all immediately felt right at home at King Faisal.   The patients have been much sicker and more challenging this year.  For example, to quote our friend, the estimable Erneste Simpunga, we have done 11 double valve operations, and one triple valve operation out of a total of 13 surgeries. That is compared to only one double valve operation last year out of 11 surgeries. As one might expect, the longer times on the heart-lung machine have been associated with more bleeding in several patients. We have definitely pushed the envelope of what is possible here, in this environment. I was reminded of this one night about 1 a.m., when a young girl I had operated upon was very unstable with low blood pressure and a very erratic heart rhythm. We came very close to losing her, and I thought to myself that, if she had to return to the operating theater, or have her incision reopened in the ICU, then what was I going to do? There is no OR facility here at night. All our surgical team had left, and, even if I had needed them, it is doubtful that they could have responded quickly enough to make a difference.  Fortunately, she settled down and has improved slowly but surely over the next days. That is very sobering, and a reminder of all we take for granted at home.  My next to last patient, Criserie, motioned me to her bedside this afternoon. She took my hands in hers, and said "Merci Beaucoup". Needless to say, she knows the way straight to my heart. 

I have to leave early morning for Japan to speak at a conference- not my best ever move, as there is almost no way to get there from here. I will close by saying that this is the best thing we do in our lives. I think I speak for almost the entire team when I say that.  It is an awesome privilege to take care of people who don't even share our language, and yet are brave enough to trust us with their lives, in exchange for a chance at a better, longer life. As a healer, one can ask for no greater gift than that, that we might be able to make a difference for people in such desperate need.

I thank everyone who has helped make this such a wonderful experience- my fellow BWH mates, the MGH contingent- Warren, Terri and Jen, Leslie Macho and Sofia Ormaza  from the U of M, Andy Willett, who was a super volunteer, George Shortis from Operation Open Heart, Australia, my daughter Paige, Jim and Zara and the ICU team, my friend and colleague, Les Miller, Katie and Laureen in the OR, and everyone else. I have to mention Meera Kotagal, who was basically the surgical intern, doing all the patient workups and generally being a positive force.  John Connell has done a great job, and is a tireless worker. Barry has been the Ironman in the OR. Thank you, and thank everyone. Thank you to Gene Bukhman, cardiologist for PIH, who did case selection. Mostly, thank you, Ceeya, for organizing this whole enterprise. You have been the one constant this past year- picking the team, fundraising, procuring the equipment, labeling, boxing and shipping over three tons of equipment, not to mention the trunks we brought along on the flight here. It has been a labor of love, the work of at least 3-4 people, and you have never complained of faltered. You are truly amazing, and Team Heart and the people of Rwanda are lucky, indeed, to have you. As am I, for that matter.

That's all until next year in Kigali.

Chip Bolman

From Sara Stankiewicz, RN

Greetings from the Team Heart Stepdown Unit! Today is the last day of surgery. We have successfully operated on 14 Rwandans, and there are currently 8 patients in the Step Down unit, which is keeping Marie, Kristen, Carol, Terry, Monica, Egidia, Denise and I very busy.  There are many challenges to providing nursing and medical care here at King Faisal--losing power mid surgery with a 15 second delay on the back up generator, running low on supplies, language barriers and a difficult paper documentation system are just some of the biggest ones we face each day.  The entire Team Heart group has become very resourceful in the face of all these challenges...and I know all of the nurses on Team Heart will think twice before complaining about eMar at BWH! Our days at work are very tiring. All of the Team Heart members are putting in extremely long hours, but our patients are so appreciative, it makes our exhaustion all worth it.  We are managing to appreciate the beautiful city of Kigali and the Rwandan landscape on our days off. Many of us have been fortunate enough to travel to Akagera Park for safari and also to Volcanos National park to see the mountain gorillas-both were unbelievable!

The first group of Team Heart members left yesterday, and are already missed terribly.  We will say goodbye to the OR team on Tuesday and then the Step Down unit and rest of the ICU staff and physicians will leave this Saturday.

Thanks to everyone back at home for your kind words and continued support.   See you all next week!

Sara

From Brenda and Jane

Brigham and Women's respiratory therapist have done a wonderful job in a sometime challenging setting. Although always with grace and a smile on their face. It is Brenda Graham's second trip to Rwanda and Jane Bartholomew's first.

As we are about to admit the 12th case into the ICU, we can certainly recognize how much we take for granted. Coming from a major medical center and having everything at your fingertips...Let's just say we've learned to be creative. This years patients are finding a great deal of comfort from last year's patients as they visit, giving them support & hope for the future. We are anticipating our 1st discharge tomorrow, (exactly 1 wk. from Easter). The rwandan staff have been so helpful and eager to learn. We are grateful that they tolerate us varying from their customs. A big Thank-you to Ceeya & all the "behind the scenes people" for helping to pull it all together. Well Wishes to the angels in the step-down unit who will stay extra to get all the patients well on the road to recovery. We are proud to work alongside this entire team... You are truly an amazing group. Thank-you for allowing us the opportunity to "pay it forward". or as the rwandan's say.. "Mwakoze cyane"

From Meera Kotagal

Nearly a year ago, I left Rwanda after 10 months working in the Eastern Province for Partners In Health (PIH), with no idea of when I might make it back to this remarkable country.  But through Team Heart I was fortunate enough to make it back this April to work as part of the cardiac surgery team.  And I can't even begin to explain how wonderful it is to be back.  Rwanda is a country of incredible beauty and generosity, but also a country with great need.  There is no cardiac surgeon in the country, but there are many patients who are in need of surgical interventions.  It is a privilege to be here as a member of a team that is working so hard to change the lives of 14 Rwandans this year.  The work has been hard over the past week -- long days, lots of patients to see, and challenging operations and post-operative care.  But everyone has really responded with incredible enthusiasm and worked exceptionally hard.  My role within the team has been a little bit like that of an intern -- I have been helping to get patients ready for surgery, writing up histories and physicals on each of our patients, and making sure the preoperative evaluation is complete for each patient.  And I've gotten to spend a little bit of time in the operating room.  As a soon to be general surgery resident with a strong interest in global health, it has been a great opportunity to learn about surgical evaluation and interventions in resource-poor settings.  And it has been a great chance to come back to a place that feels a lot like home -- to reconnect with old friends and colleagues from last year, to practice my French and Kinyarwanda, and to think more about how Rwanda can continue to figure into my life and career as I go forward.  

One of the most striking features of this trip has been seeing the patients from last year and witnessing how dramatically different there lives are as a result of the surgery they underwent.  It definitely leaves me excited for each of the patients we have operated on this year.  Above all, I am extremely grateful for the chance to have been part of Team Heart this year, and look forward to seeing how our patients do as they recover from their surgeries...  

-- 
"Yes we can to justice and equality.  Yes we can to opportunity and prosperity.  Yes we can heal this nation.  Yes we can repair this world.  Yes. We. Can." 
-- Barack Obama

From Zara Cooper, M.D.

April 18, 2009

Greetings from the equator! Today is my last day here. The first group of us are heading home tonight and I for one am ambivalent about it. This has been an incredible experience and I am so grateful for the opportunity to come and serve in such a remarkable place.

Rwanda is a beautiful country, and it is difficult to fathom what has taken place here in the recent past. The beginning of our stay was during Genocide Remembrance Week. During our first night in the ICU two young Rwandan nurses were singing to each other at 3 in the morning. The sound was so sweet and so haunting. When we asked them what they were singing, they explained that they were praying for the genocide. They explained that even though they go on, and appear happy, they are still grieving. There is always sadness. It just brings tears to my eyes. My impression is that this country is deeply committed to reconciliation and a bright future. The streets are clean, I feel as safe here as I do in my native New York City, and the people are incredibly proud and hard working. It would be hard to imagine that so many of these people spend their nights on mud floors with only candles to light their homes. There seems to be no self-pity.

As I understand it we are operating on patients who are quite a bit sicker than last year. Some of these patients would have been challenging at BWH - double valves, on multiple pressors, after multiple bypass runs. Not a small feat when it takes almost 24 hours to get STAT blood! Everyone has risen to the occasion and kept their spirits high. Despite long hours, and unfamiliar territory we continue to work as a team, and are doing the best we can for our patients. Many of us are working 18 hour days but the patients inspire us. They are all small, many are pediatric, and some are quite malnourished from poverty and prolonged heart failure. But they are all so thankful and quick to show us a smile. It is difficult to imagine that timely treatment with penicillin could have averted  much of this suffering. 

This is my first year in Rwanda but, I hope not my last. I have been touched by the journey and I think I will continue to learn from it. Finally, I want to thank all of my incredibly thoughtful co workers who gave me and my fiancee a beautiful hand carving to congratulate us on our upcoming wedding. The group here has become and extended family.

See you stateside!

Zara

Pics

Paige Bolman writes:

Following a long day yesterday with no shortage of successfully met challenges, today has run pretty smoothly. Last night's case lasted until the wee hours of the night and so we decided to take on just one surgery today to give some people a bit of a rest. Our newest arrival seemed really uncomfortable throughout the morning in the ICU, but upon grabbing the services of a helpful interpreter, we learned that she just really, really, really wanted an orange Fanta! We were obviously happy to oblige her with such a simple request (but only a little!).

A few Team Heart members went on a safari yesterday in Akagera and this morning some others trekked out to see the gorillas in the Virungas. We're so lucky that we have enough team members so that everyone has been able to get out and see some of this beautiful country.

This afternoon brought another pleasant surprise: Celestin came to visit! Celestin was the very first patient of last years inaugural visit and being such a nice guy, he was also the handsome subject of many a photo. He looks so healthy and all of us were so excited to see him! He is currently finishing up his last year of school for accounting. He showed up with a dashing smile and lots of news. With a roomful of hopeful patients that are still very early in the recovery stages, Celestin was extremely generous with stories of his positive experience. He undoubtedly put numerous fears to rest. Todays patient should be arriving from the OR any time now. He is an extremely happy guy who reportedly had a smile on his face until the very moment he went under. We are looking forward to his arrival in the ICU.

We'll post more as it happens and we find the time! Until then, we leave you with a picture of the sunset. Coincidence? I think not.

OR Day 5

Nelson and Jane, nurse manager of the OR theater

Nelson Thaemert joined Team Heart this year as part of the anesthesia team. A native of Northern Virginia, he did all his medical education in the Boston area. He has been a member of the Anesthesiology staff at the Brigham for 2 1/2 years, which has a strong focus on global mission work. "Doing mission work is a way to give back for all that we have"

Nelson Thaemert, M.D. writes:

Greetings from Rwanda!

It’s taken several days for me to get a chance to come up for air, so to everyone who has been following things on the blog, please accept my apologies.


We’re on OR day number 5, and have been working from early morning until late at night, so finding time to send greetings and updates has been challenging.

We are currently doing our 8th case, and the team tells me that the patients are sicker and more fragile this year than last. In fact, 7 of these 8 cases have been double valve repairs or replacements. Most have pulmonary hypertension, some are malnourished. All have markedly abnormal hearts. Many are teens that have been too short of breath or undernourished to grow.

The patients all have amazing stories. Our youngest patient is a 14 year old boy, our oldest to date is 37. Our smallest patient has been a 29kg 16 year old, who is roughly the size of skinny 8 year old in the US (we weren’t planning on doing kids, so some of this has been on the fly!) All have sequelae of rheumatic heart disease, and all have been living with this for enough time to develop advanced symptoms of heart failure. Most speak Kinyarwandan, although a few speak some French and a little English.

We’ve operated on a mother of three (6, 3 and 5 months) who is a school teacher for 11 year olds and too fatigued to continue breast feeding her infant. Another is a university student whose father was killed in the genocide and is currently studying biology and chemistry, but the school wants him to drop out because they think he’s going to die of his heart disease. Each story is differently tragic, but strangely similar.

Most of the patients that we have cared for live in poverty that is difficult to comprehend, and digesting their stories becomes very emotional. I hear from Dr. Gene Bukhman, our cardiologist at Parnters in Health, that there are two types of poor people here – dry poor, and wet poor. If you can afford to live in mud hut with a dirt floor and a tin roof, you are likely the former. If you live in mud hut with a dirt floor and a banana thatch roof, you are likely the latter.

All of our patients have done well, and some are beaming during their recovery. Our most challenging case of the trip was last night, when an exhausted OR team left off a critically ill postop patient that we weren’t sure was going to survive the night. Amazingly this morning, she has made dramatic improvements, mostly thanks to our friend Dr. Zara Cooper who was running the ICU overnight.

From a surgical standpoint, we've done significantly more valve repairs than replacements, which is good news for the patients because tissue replacements wear out in 15 years, and mechanical valves require anticoagulation. I do hope we have enough rings! We weren't planning on doing this many double valves, and certainly not this many repairs, so keep your fingers crossed. If anyone is counting, we've done one mitral commissuroplasty, one mitral bioprosthesis with tricuspid ring, one mitral mechanical prosthesis with tricuspid ring, four mitral repairs/rings with a tricuspid ring, and one mechanical aortic & mitral replacement. I continue to be impressed with our surgical collagues' abililty to do a repair to a rheumatic valve, which is notoriously difficult and problematic. From an anesthetic standpoint, bringing our own portable transesophageal echo has been instrumental. Thanks to the folks at Phillips for the loaner, and the screeners in the airport for being understanding! [Quote: WHAT is that?? as I put the echo probe in its carrying case through the scanner]

The hospital is quite advanced by African standards, but there are still the blips that one would imagine. We lost power a number of times in the OR, but the emergency generator kicked in within a few seconds and we never had to hand-crank the bypass pump. Oxygen pressure falls on occasions, so we’ve encountered anesthesia machine alarms that we never hear in the US. One day the air conditioner in the OR mounted high on the wall let out flood of water for unexplained reasons, but luckily nothing got contaminated. We have been doing our best to ration the supplies that were previously shipped or packed in our luggage – it takes an incredible amount of “stuff” to care for 14-15 patients having heart surgery, so stretching it to make it last has become an art form!

After three 15 hour OR days in a row, we slept in and had a late start today. Our original goal was to do 15 cases in 8 days, but between a full ICU and a fatigued OR team, we are only doing one case today and our overall schedule will decompress to only fit in 14. Those who don’t get operated on this year will hopefully survive until the Australian team arrives in the fall, or can be sent to Khartoum, Sudan where an Italian organization has set up a hospital for African cardiac surgery.

Kigali is a clean and vibrant city. The topography looks like a mix between Tuscany and coastal California, with homes built all over a series of lush, green rolling hills. There is a vibrant middle class in the city, most roads are paved, streets are regularly swept (by hand, by the way), food is restaurants is generally good, albeit slow, and the locals are friendly and fairly well dressed. I have yet to have time to venture out as much as some of our non-operating room colleagues, but we stop operating on Sunday evening, so I’ll have a day and half to get out and explore.

I’ll get pictures posted to Facebook when I can, but in the mean time I want everyone to know that we're doing well and thinking of everyone back home. Thanks for all of your kind words of encouragement!

Best regards,
Nelson

Busy days

Paige Bolman writes:

It has been a busy few days here in Kigali! The first patient is doing great and has already been transferred to step-down. Her husband Vincent has been quite a delight to have around with his positive attitude and his handy trilingual skills. I think everyone has thoroughly enjoyed his presence.

Two more patients were successfully operated on yesterday, one more this morning and yet another is in surgery as I write. Everything is running relatively smoothly though we have had our share of minor challenges, if you will. The power at the hospital has a tendency to flicker and/or go out for short periods of time in the evening. Although concerning, the expected electrical flickers are well managed by an extremely well prepared staff of perfusionists, surgeons and anesthesiologists. The hospital generator and back up generator work very smoothly. All in a day's work...

Although the two-a-day surgery schedule is tiring for all involved, everyone seems to be in high spirits, and those were undoubtedly bolstered by a lovely afternoon surprise. In between surgeries, some of the patients from last year's trip stopped in to say hello. Just a few hours after liver for lunch (not my cup of tea), Erneste strutted down the hall trailed by a handsome Jean Paul, Vedaste, Samuson, and an at least 3-inch taller Djuma. To any passerby, they looked like a group of regular, healthy guys and each beamed with smiles from ear to ear. Even for those of us that were not here on the first trip, it was an incredibly emotional reunion. In contrast to the physical state of the current patients, to see these men looking so healthy was easily enough to make me cry like a baby. The reality of what Team Heart is giving to each patient became as palpable as the incoming storm in the air as we snapped pictures with Kigali's hillsides in the background.

The second surgery should be getting done in the next few hours and the ICU will be bon-a-fide busy with patients instead of with just paperwork and trying to keep the machines working... As if that doesn't provide the nurses with enough to do! Pizza, which has come to be a common staple here in Rwanda, should be arriving in the ICU in the next hour, courtesy of Andy and Natalie. The rest of us are off to find something to eat and attempt to rest before another busy day tomorrow. Send good wishes for the two patients going under the knife if you have a spare moment, and thanks for reading.

Ceeya's Postscript: My daughter, Paige, said it beautifully. I would only add that there are moments in one's life where one realizes that an experience is likely to be as rewarding as an experience can be. When such moments occur, it is important to recognize and savor them. Today, for me, and for the members of Team Heart, was such an experience. Having just completed a challenging operation on an incredibly sick 15 y.o. girl, and then seeing several of our patients from last April, all looking healthy and having returned to productive and happy lives, was highly emotional and gratifying. I only hope for my daughters that they, too, are able to experience such a feeling in their lives.

Message from Dr. Bolman

We have operated on our first three patients. The first had a mitral commissurotomy, and is doing well. Yesterday, we did two double valves- a mitral and tricuspid repair, and a mitral replacement-tricuspid repair. All are doing well.

The stepdown team has arrived and is setting up today to receive their first patient. Today, are doing a double valve in a 16 yo 65 # girl. The team is a bit concerned regarding her size, but she is very sick and we are going ahead. This afternoon, we are actually doing a familiar case- an aortic valve replacement in a middle-aged woman with calcific aortic stenosis. Everyone is working very hard.

Yesterday, the events in the OR included a brief loss of electrical power, which is expected and was extremely well handled. Fortunately, it was very brief, as we were sewing in a tricuspid ring at the time. At Mike's behest, however, we did proceed to finish expeditiously. Seems the oxygen system is fixed, but the electrical system is a bit spotty. Oh, well. No place is perfect.

All-in-all, the experience has been very positive. Everyone is much more comfortable, and it just feels smoother, as everyone has some sense of what we can and cannot do. The patients are quite a bit sicker than last year- many more double valves, etc. It is such a privilege for all of us, and it is still pretty overwhelming to be doing this. Everyone feels that this is the best thing that we get to do in our lives. That's about all you can ask. Hope everything is good at home. More to follow.

Suellen writes:

It's 10:40 pm Kigali time. Another long, yet rewarding day. Two cases today--the first case of the day is doing well. The second had not come from the OR when I left the hospital at 7:30. It feels as though the team is coming together and getting into a comfortable rhythm. The step down unit nurses will join us tomorrow after returning this evening from their adventure in gorilla country and patients will begin the next phase of their recovery out on the ward. Our Rwandan/KFH team members -- nurses, doctors, and other staff--have been extremely helpful, supportive, and collaborative. It's been great to reunite with familiar friends and meet new colleagues here at the hospital.

For the most part--at least so far-the patients this year seem to be younger and perhaps sicker than last year. But this perception could be a case of selected memory. On this second trip with Team Heart, I find the personal reward of providing this life saving surgery to a few is tempered by the realization that so many others here are afflicted with this preventable disease and that factors such as hunger and poverty only complicate an already complicated issue.

But the fruits of this mission have not gone unrealized. Of course there's Erneste. Looking healthy and thriving. It's so good to see him and his big smile and spend time with him again. A few days ago, a group of us were reminded of why this mission is important. As we were leaving a coffee shop in the center of Kigali, we happened to run into Jean Paul, a patient who received an aortic valve replacement last year on April 8. He is working as a driver, financially supporting his wife, and looking and feeling great!

That's it for now. Time to rest up for another day.

Ceeya writes:

Today we successfully operated on our first patient. The second team arrived yesterday in Kigali at 6:45pm and after all was said and done with shipping and checked bags only one box didn't make it! Immediately upon their arrival, the newest team met up with the 'old hands' on the veranda at Sole Luna for a lovely dinner of delicious pizza.

The first case was meant to begin at noon and virtually the entire team came in early today to make sure everything was in its place and ready to go. Pulling into the OR around one, the OR team expertly finished the first patient at 4pm. all in all, it was a short case and it went as well as could be desired. The nurses, and a few of us others, eagerly awaited the arrival of our first patient in the ICU. We decided with the ratio of 16:1 medical personnel to patient, we may be providing the most thorough post-op care in the world!

Thanks to all the well-wishers and good vibe-senders; you are each appreciated!