Wednesday, March 15, 2017

Rheumatic Heart Disease and Cardiac Surgery in Rwanda

Matthew Swisher
Resident in Anesthesiology at BWH

Our home for two weeks, King Faisal Hospital in Kigali
Team Heart and I just finished our two-week surgical mission to King Faisal Hospital in Kigali, Rwanda.  Rwanda is a rapidly growing country, however it lacks access to cardiac care for its people.  The country itself has only four cardiologists for a population of 12 million people and no cardiac surgeons.  Without access to proper screening and care, rheumatic heart disease is frequently a fatal disease for many Rwandans.  Team Heart’s mission for the past 10 years has been to help build a sustainable cardiac program for Rwandans.
Selection meeting with all of Team Heart and Rwandan cardiologists/staff

The mission started with a “selection” meeting in which a long list of potential patients were presented after having been screened in the community weeks before by Team Heart members and local cardiologists.  The surgeons, cardiologists, anesthesiologists, and other team members weighed in on each particular patient and their echocardiographic findings. 

A pre-repair heart with a massively dilated right atrium from severe tricuspid regurgitation
Over the course of the past next 8 days, we performed 16 open heart surgeries (15 valve replacements/repairs and 1 ASD repair) on young Rwandans in addition to 3 pacemakers.  The care itself took a village of over a hundred Team Heart volunteers and native Rwandans working in concert for these complex patients.  Our cardiac anesthesia team consisted of three BWH attendings, two BWH residents, and two Rwandan residents.
Team of anesthesiologists preparing a patient for surgery in the operating room

The Rwandans embraced our team, and we quickly learned about their culture and practice of medicine.  In contrast to ours, a large emphasis is placed on camaraderie in the OR.  The OR itself will be briefly paused for everyone to enjoy morning tea/cake and afternoon lunch together.  While there are many systematic differences (i.e. blood product availability), the basic practice of anesthesia remains quite similar allowing for us to teach and mentor the Rwandans about cardiac anesthesia. 

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