Thank you, Rwanda, and Good bye

Last night we were treated to a party hosted by King Faisal hospital. We were each given some Rwandan coffee and treated to a show of traditional Rwandan dancers. Tonight HHNW staff has been invited to the US ambassador's home for a reception. Then the first wave of staff begin the trek home (or on other adventures) tonight at 8:00 pm. Another group leaves Saturday and the last on group on Tuesday. We have attempted to relay with pictures and words the incredible experience we have had here in Rwanda this April. Because of time constraints, technological delays and failures, we will be adding more pictures and postings when we return. We thank King Faisal Hospital, our patients, the Rwandan people, all our donors for helping us realize this mission and you, readers, for following our work and adventures.

Jean Paul: Past Patient, Present Patient Educator

Jean Paul Iyamulemye is a 34 year old Rwandan who was operated in April 2008 by the Boston team. In 2006, shortly after he married, he became ill and surgery has given him his life back. When HHNW was here last February, Michelle our lead in CCU took a cab ride and Jean Paul was her driver. They spoke about why she was in Kigali and Jean Paul told his story. What a coincidence! Jean Paul now visits the hospital to help interpret to the Rwandan patients and explain what the surgery is about and what to expect. He is an incredible resource to them and us as the patients can hear what he went through and see how he looks and feels now.
He dreams of improving his English and continuing to help people no matter where they are from. He beams with happiness when he speaks of helping the patients understand surgery and recovery. He has immense gratitude for the new life that he has been given through heart surgery.
Jean Paul and his wife take care of 2 orphan boys ages 16 and 18.
He is a taxi driver in Kigali and we are grateful for that service for ourselves sand his help with our patients!

Medical / doc's perspective

Yesterday marked the last surgical day. It was marked by 2 unexpected events: first the 16 year old female, whose mitral valve was replaced yesterday, developed seizures, evolving into status epilepticus. It was determined that she had a heretofore unknown seizure disorder, quiescent for 3 years and on no meds. She finally responded to the addition of midazolam drip, after failure of diazepam and midazolam boluses to control seizures, to the dilantin drip (after a one gram loading dose.) We were able to text message with Dr Jimmy Nguyen, epileptologist at SHMC, who graciously advised us at midnight, PST. We were able to find valproic acid, but only in oral form. Therefore we loaded her via nasogastric tube and will wean the benzodiazepine. She is stable but still on ventilator and sedated at this time.

Secondly, during placement of a permanent pacemaker in a 22 year old male with complete heart block, asystole ensued prior to placement of the ventricular lead. He was intubated, underwent CPR for about 30 minutes, and developed mild pulmonary edema and hypoxemia. As a result, his body temperature was lowered, beginning while still in theater. We used ice bags in axillae and groins and achieved about 34 degrees celcius in 3-4 hours. He remained chilled for 18 hours, then warmed, and is now awake, alert, extubated and mentating well. To the best of our knowledge, we dare say he is the first cardiac arrest patient in Rwanda to undergo hypothermia protocol, albeit with "primitive" means of cooling.

Our final case tally is as follows:
males: 7 (39%)
females: 11 (61%)
age range: 11 - 54
average age: 20.6 years
median age: 17 years


Cases:
Atrial septal defect repair: 2
mechanical valves: 7
bioprosthetic valves: 5
pacemaker placement: 2
Tetralogy of Fallot repair: 3
Right heart cath: 2 (one for undexplained severe TR in patient who received a mitral valve replacement last year, and another for pulmonary hypertension with VSD, w/ finding of a previously undiagnosed PDA)


One case required re-exploration for bleeding, with repair of a small pericardial bleeder and was extrubated several hours later: she is now out of bed, on room air, and is doing well. There were the usual post-op fevers and ateletasis, but less prevalent to that seen in the US, probably due to the absence of comorbidities in these patients. There have already been multiple discharges to home from hospital.

We are now preparing for departure, packing and doing inventory on a huge volume of equipment. Much will be left in secure storage for the next visit. After-action meetings and reports will be done in order to improve our already successful missions.

Brooke, Lead of Telemetry

Brooke Hendriksen is our lead in the telemetry unit which is the step down unit from the CCU. She has had a varied career before becoming a nurse only 6.5 years ago. She is from North Idaho and has lived in Hawaii, St. Louis, and Alaska working in logging camps, saw mills, and as a vet assistant. She settled on nursing because of her love of math and science.
She loves cardiac nursing because of the complexities of the heart. She finds the electrophysiology of the heart a fascinating puzzle. She is the daughter of a military family who moved every 2 years. The HHNW mission is a perfect fit for her. It allows her to travel (in place of actually moving) and do the cardiac nursing she loves. She has always wanted to volunteer and after offering to go to New Orleans after Katrina and Indonesia post tsunami and not being called, she became committed to HHNW. We are fortunate she did!
Brooke's other pastimes are horses (she has 2) and fish (130 gallons of water in 4 tanks!). Fun fact: as well as enjoying exotic fish, she raises tiger shrimp and supplies the only store in Spokane that sells them!
Brooke is married to Brad and she has 3 stepchildren and 1 grandchild.

Brooke is pictured above with Dative, a patient we operated on last year and had to be re-operated on this year.

Jim Dixon, Technician Extraordinaire

Jim is a vital cog in the wheel that turns HHNW. Trained as a biomedical technician he has had a full career of 40 years in the field. Shortly after he retiring in Jan. 2009, he got a call from Sandi Kessler asking him to work with HHNW. He felt he could use his talents and honed skills to help others. He enjoys the challenge of problem solving with all the different variables he finds here in Rwanda. For those who don't know what his work entails, Jim keeps all our machines running. When things don't work as they should, Jim fixes, jerry-rigs, splices or manufactures the solution, often under intense time pressure. No appliance, motor, or crisis is beyond his capabiliies! He endeared himself to the nurses when he went out and bought and installed a toilet seat in the ladies room (previous one was missing)!
Jim has traveled to European countries but never to Africa or a third world country. He really enjoys the Rwandan culture and people. It is the Rwandan people and the close interaction between himself and our doctors, nurses and patients that has brought him back for HHNW's second mission.
When not working for HHNW, Jim volunteers his time to P.E.T., a program based in Mead, Wa. P.E.T. Stands for personal energy transport and they manufacture and assemble a mode of transport similar to a bicycle for persons in third world countries who are missing a lower limb. Jim describes himself as a reserved but when engaged in conversation, he readily shares his wealth of knowledge and experiences.
Jim has been married to Bonnie for 47 years and has 3 children and 7 grandchildren, 2 of whom live with him.