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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!