Last patient is discharged!

Hello all!!

To add to the picture show, I've attached a picture of Genevieve OUR LAST PATIENT as she will be discharged TODAY!!!!! She looks great and is walking and smiling.

Thanks everyone for all your hard work... the patients (the results) speak for themselves. It will be amazing to see how they look next year when you visit again....

Special thanks to the KFH staff, doctors, nurses, residents, pharmacists, everyone. They've been very gracious and have done a great job taking care of our patients.

It's been so fun to be a part of this miracle and to end with Genevieve is really poignant.

Thanks again all! Be well and hope to see you soon,

Smitha

Genevieve is with Dr. Smitha Phillips, Cardiology Fellow from Georgetown, and Dr. Maurice Musoni, medical officer hoping to train in cardiac surgery

Book donation

Suellen Breakey in the Connell School News:

http://www.bc.edu/schools/son/AnnounceNewsEvents/news/rwanda_books_web.html

Message from Warren Harthorne, M.D.

The trip was extraordinary and life changing. It is hard to put into words: the depth of poverty in the countryside is alarming; the average income is $220 per annum. Children are in rags and bare feet in the countryside with considerable illnesses including rampant active and chronic rheumatic fever and tuberculosis. Our echo technician, Jennifer and I visited five community hospital for diagnosis of children as young as 9 years with advanced active rheumatic heart disease on the threshold of death from congestive heart failure. It was heart breaking to see these attractive kids for whom there is no treatment within the country. I am now approaching 50 years of involvement at the Massachusetts General Hospital in Cardiology. My training mentor was Paul Dudley White who emphasized clinical cardiac evaluation and definitive treatment. I had not seen a case of acute rheumatic fever for the past forty years yet saw multiple cases during this two week visit to Rwanda. I was not totally inexperienced in "Triage" medicine, having spent a year with a MASH Hospital in Korea (I am not Hawkeye) though this was the same MASH hospital from which that program evolved. To witness patients with diseases that no longer exist in our own country such as acute rheumatic fever and its consequences was, for me, as a trainee of Paul White, (who is responsible for describing the diagnosis and treatment of this disease) especially remarkable. In an African nation that has an average income of little over $200 per annum; it was evident that the children have little opportunity to avert the ravages of streptococcal infections. While it was a privilege to participate with Team Heart in this venture, it was, at the same time, depressing to leave behind young children with life threatening valvular heart disease that would be "duck soup" to treat in our own country. My tears of frustration and inability to help these beautiful children were suppressed with difficulty and I had many occasions to find myself in a quiet corner in which to regain my composure.

We saw a 20 year old woman in her third trimester of pregnancy with acute cardiac failure caused by ruptured chordae of the mitral valve from prior bacterial endocarditis. The woman will be sustained to 34 weeks of pregnancy to ensure a successful birth and the baby (a boy) will be delivered by Caeserean section, yet the mother, in the absence of reparative cardiac surgery will surely die leaving the infant as an orphan. This scenario was the subject of one of the first papers that I published nearly forty years ago and left me feeling impotent in saving this young woman. A young, 12 year old girl in the pediatric ward of the Central Hospital of Butare (CHUB) whom we visited was in acute cardiac decompensation with triple valve, rheumatic heart disease. Her mother, distraught at the bedside, was unable to pay for the drugs to bring this young girl out of incipient death from acute CHF. My visit to the pharmacy to purchase the appropriate drugs (Spironolactone, Metolazone) was a simple temporizing solution to her near death experience yet eventual death lurks in the near future without corrective surgery. Such experiences left this participant depressed and feeling helpless in applying half a century of easy solutions to a cardiac crisis. Is there not a way in which such children in advanced heart failure can be accorded the necessary valvular replacement surgery to return them to useful lives?? Do we not have a global obligation in following such human beings to intervene at all costs to ensure that they, as we, are eligible for reparative surgical interventions? Too often, the proverbial observation of "not what you know but who you know" applies to those fortunate enough to be sent for corrective surgery.

This respondent has felt enormous gratitude for being included in this humanitarian enterprise and has great respect for the leaders of this venture yet is left with a great sense of guilt both because the western world (us) did not respond when the genocide was ongoing, leaving hundreds of thousands to die horrible deaths by machete and now in the presence of a virtually absent interventional health care program leaves it citizens to the whims of chance and non treatment. The program of Partners In Health strives to reverse this trend and all of us should be willing participants. We should all look, not only toward the immediate problem of the individual whom we have saved but toward the larger population at risk in the community in whom an early death from correctable cardiac disease is their ultimate expectation. The Rwandan people are friendly and seemingly happy though one wonders why. Those women who were raped during the genocide and acquired HIV/AIDS are given jobs sweeping the streets; the country is lush, remarkably clean, and reminiscent of the State of Vermont.

Warren Harthorne

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.