Download Team Heart Rwanda - Brigham and Women`s Hospital

Team Heart —
· TeamHeart ·
A Collaborative Project for Creating an Independent Cardiac Surgery Program in
Rwanda
P Shekar, MD, L Nascimben*, MD, V Formanek*, MD, L Sabatino, RN, BSN, S Breakey, RN, PhD, C Patton Bolman, RN, MSN, J Connell, MD, MPH, RM Bolman III, MD
Divisions of Cardiac Surgery and *Cardiac Anesthesia, Brigham and Women’s Hospital, Boston MA
BACKGROUND…
LONG TERM GOALS…
OUTCOMES…
The Problem:
In collaboration with Partners-In-Health and the Rwandan Ministry of Health:
 10 males, 1 female
 17-39 years
 11 surgeries performed on Cardiopulmonary Bypass:
Rheumatic Fever (RF) and Rheumatic Heart Disease (RHD)
1. To establish a sustainable independent cardiac surgery program in Rwanda.
 Caused by untreated Group A Streptococcal infections
 Consequences result in valvular dysfunction and heart failure
 Disproportionately affect children and young adults in developing countries:
2. To improve the identification and treatment of RF/RHD in Rwanda.
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15.6 million world-wide (incidence in industrialized countries <1/100,000)
282,000 new cases, 233,000 deaths yearly
2.4 million children between 5 and 15
1 million of whom live in sub-Saharan Africa
3. To establish a heart disease registry to identify and follow patients who have had complex
cardiac procedures.
valve replacements
mitral valve repairs
ASD repair
double valve surgery
100% survival
The Treatment:
 Effective primary and secondary prevention strategies
including antibiotic therapy to treat and prevent recurrence
 Surgical intervention to repair damaged valves
7
2
1
1
for
RF/RHD
FIRST SURGICAL MISSION (APRIL 2008) GOALS…
EDUCATION…
1. To perform surgery on young adults with advanced rheumatic heart disease and
congenital heart disease.
 Patient/Family Education:
2. To begin a collaborative relationship with King Faisal Hospital to build a sustainable
cardiac surgery program over a 7 to 10 year period.
Barriers to Treatment in Developing Countries
 Health Care Determinants:
Lack of access to primary health clinics
Scarcity of health providers
Lack of awareness among health workers, patients, and families
Lack of availability of cardiology and cardiac surgery resources
Lack of Cardiovascular Centers in Africa (18/900 million)
 Social Determinants that impact health:
Inadequate housing/shelter
Lack of access to education
Other effects of poverty (e.g. poor nutrition, access to clean water)
3. To begin education with KFH staff, patients, and families focused on RF/RHD awareness,
cardiac surgical care, and post-discharge care to increase awareness of the effects of
RHD and to optimize surgical outcomes.
Continuous patient/family teaching pre-and post-operatively
Booklets in Kinyarwanda that focus on RHD and its effect on the
heart, on post-operative care, on discharge and on warfarin.
 Providers Education:
Assessment of their current knowledge and skills and education
through preceptoring/partnering and direct involvement with care
POST MISSION EVALUATION…
METHODS…
Team Selection
Funding
37 volunteers:
surgeons, anesthesiologists, intensivists, cardiologists,
perfusionists, OR, ICU, stepdown unit RNs, RN Educator,
respiratory therapists
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Annual Team Heart Fundraiser
Corporate Grants
Local fundraisers events and initiatives
Individual donations
Examples of purchases made with funds:
Shipping, pharmaceutical supplies,
specialized cardiac surgery equipment,
cautery machine
Conclusions
 Cardiac surgery with adequate follow-up is
possible in Rwanda.
 Collaboration with both PIH and the Rwandan
Government is essential for success.
 Collaborative and respectful relationships were
established between Team Heart and KFH staff
that can serve as the foundation for
sustainability.
Equipment Procurement
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Generous vendors
BWH, MGH Biomedical Departments
Private individual and anonymous sponsors
Examples of donations: cardiopulmonary
bypass machine, infusion pumps, invasive
hemodynamic monitors, specialized cardiac
surgical packs, cell-saver machine
Areas for Improvement/Goals for 2009
 Increase number of post-operative local nurses
 Procure new radiographic technology
 Coordinate methods to guarantee adequate longterm patient follow-up
 Continue and expand fund raising and equipment
procurement. Involve other Medical Institutions
 Expand methods for education of KFH staff, for
patients and their families
Patient Selection
RWANDA: HEALTH PROVIDERS
MDs:
401
RWANDA:
Population:
Nurses:
Gross National Income:
1,270
Life expectancy at birth (M/F):
51/53
Midwives:
Pharmacists:
Dentists:
Community Health Workers:
Lab Techs:
3953
54
278
Expenditure on health per capita ($):
21
12,000
39
9,464,000
136
(US: 6350)
Expenditure on health (% GDP):
7.2
(US:15.2)
 Pre-screening done prior to arrival by PIH cardiologist
 Daily team meetings to finalize cases for next day
 Decisions required critical evaluation of physiologic
factors (surgical complexity, co-morbidities, nutritional
status) and resources (ICU beds, ventilators, equipment,
supplies)
 Explore opportunities for screening, prevention,
and early intervention of RF/RHD in Rwanda
It was awesome medically, as it always is, when the pericardium is opened; it was
awesome personally, as someone who has fought alongside many others to make
sure that quality medical care be made available to the poorest; and it was
awesome spiritually to see, on the exact anniversary of the 1994 genocide, that the
power to heal continues to trump the power to maim, sicken, or kill.
—Paul Farmer, MD, PhD
Http://teamheart.blogspot.com