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