Dispatches from the Field: Performing Heart Surgery in Rwanda
This past fall, I was offered the opportunity to volunteer as a cardiac surgeon with Team Heart by my good friend, Dr. Chip Bolman. Seven years ago, Chip, who is chief of cardiac surgery at Brigham and Women’s Hospital in Boston, founded the Team Heart with his wife, Ceeya Bolman. The organization’s mission is to provide heart surgeries to Rwandans on an annual mission trip that takes place every February. (Two other teams do a yearly mission trip similar to that of Team Heart).
Rwanda is a country of 11 million people; it is also a country without a standing heart surgery program. From when I arrived on to when I left, we performed surgeries on 16 patients – in eight consecutive days.
Team Heart consists of more than 40 volunteers, from across the country (from Vermont and Massachusetts to Florida, Nebraska, and Washington). The team includes: 4 heart surgeons; 3 surgical residents; 4 anesthesiologists; 2 perfusionists; 3 scrub nurses; 2 critical care physicians; one pharmacist; 2 cardiologists; several cardiac ICU and step-down nurses; one medical technician; and several other members of Team Heart.
Our job was to operate on 16 patients in eight consecutive days at the King Faisal Hospital in Kigali, the capital of Rwanda. A team of cardiac sonographers and cardiologists arrived in Kigali beforehand to evaluate and screen patients. On February 3, Team Heart met to review each patient case and to determine upon whom we would operate.
All of our patients had untreated and severe valvular heart disease, secondary to rheumatic fever. The patients were experiencing severe heart failure caused by heart valves that were damaged by untreated rheumatic fever. Most patients were either teenagers, or in their early 20’s. They ranged in age from youngest (14 years old) to eldest (33 years old). Several patients weighed less than 85 pounds.
My first case was Felicien, a 19-year old man with severe mitral insufficiency (a disorder in which the mitral valve does not close properly when the heart pumps out blood resulting in abnormal leaking of blood from the left ventricle, through the mitral valve, and into the left atrium, when the left ventricle contracts) and tricuspid insufficiency (a disorder in which the heart’s tricuspid valve does not close properly, causing blood to leak into the right upper heart chamber when the right lower heart chamber contracts). Both are caused by rheumatic disease.
Felicien’s case was difficult because of the greatly enlarged size of his heart. He had one of the largest hearts I have ever operated on, especially for such a young man.
He received a mechanical mitral valve and a tricuspid valve repair with a ring. He did very well with surgery as you can see by my photo with Felicien the day I left Kigali.
I participated as surgeon or co-surgeon in nine cases during the eight days. We used one operating room and performed two surgeries per day. The surgeries were very difficult because of the low body weights of the patients, who had extremely large hearts from leaky heart valves.
The King Faisal Hospital was constructed for a tropical climate: the hallways were outside the wards, ICU, and operating room. When we transported patients from the OR to the ICU, we were outside. I was told that Rwanda is the thunderstorm capital of the world. One night, we transported my patient during a rainstorm and used umbrellas to shield the patient from the rain. When it wasn’t raining, it was very unusual and refreshing to walk out of the OR with your patient into a tropical atmosphere for a 2-minute transfer to the ICU.
The eight operative days went very fast. The teamwork practiced by the members of Team Heart was amazing! It became very clear why the word “Team” was the lead word of our organization. I am already looking forward to going with Team Heart next year for their eighth mission.
Bruce J. Leavitt, MD, is a cardiothoracic surgeon at Fletcher Allen Health Care, where he has served for nearly 25 years. Throughout his tenure at Fletcher Allen, he has participated in surgical missions in China, Panama, and Russia before becoming a member of Doctors Without Borders (Medicins Sans Frontieres), with whom he traveled to Sri Lanka in 2009 and Nigeria in 2010.