MONEY CHANGERS

One of the jobs for the volunteers is changing money for members of the team so that they can spend a little and add to the local economy for gifts, restaurants etc. This is the way it works. Rwanda is a cash society. Very few places take credit cards. We bring our dollars in the form of CLEAN, UNMARKED, NON-FOLDED $100 bills. Designated volunteers take these pristine $100, each in its own legal sized envelope to the money exchange (these are not banks but have the best exchange rate!). Then we exchange $1500=$2000 at a time (a lot of envelopes!) for dirty, folded Rwanda francs. One dollar buys 6.5-6.78 R francs. So each $100 bill comes out of the envelope, handed to the cashier and we receive a wad (678,000)dirty, Rwanda francs!

PAST SUCCESSES

Not only was our first surgery of 2012 a success, our first surgery of 2011 was a success ... just look at him!  We were graced by a visit from Evariste today - our very first patient last year came to visit us right after our first surgery arrived for 2012. What fate. It looks like both gentlemen are very happy with the result.

Have you ever seen such a handsome bunch of men? All fixed by Team Heart and HHNW.  Ernest, Jean Paul and Evariste. Ernest has graduated and will start University next year, Jean Paul has a successful taxi business and he interprets and educates our patients pre-operatively each year and Evariste is studying finance and banking. Not bad eh?

FIRST SUCCESS OF 2012

Our first day of surgery and post op recovery was a huge success in the CICU. This is Tanya, Bryan (KFH RN), Ashley and Dr. Atul tucking in our first patient - Angelique. I will use her as an excellent example of the difficulties that arise from choosing patients for HHNW surgery and then choosing valve types for each patient.

Our Screening Team (Cardiologist and Echo Tech) travels to Rwanda in February/March to perform Echocardiograms on 100's of patients. Then they narrow this list down to 40-60 patients. Dr. Hal Goldberg, our HHNW Medical Director, has set down excellent ground rules for patient selection, but our surgical team must narrow down this 40-60 patient list to 18 candidates and 5 alternates. You can imagine the difficulties they face - how sick is the patient?, would they tolerate the surgery?, do they have access to follow-up care?, etc.

Then, based on the Echos, the surgical team decides which valves need repair or replacement. Repairs happen with rings and replacements happen with either tissue or mechanical valves. (By the way, a big "shout out" to Edwards Life Sciences, Medtronic and St. Jude who donate all these rings and valves.) If a patient has a tissue valve they do not need to take Warfarin (Coumadin) post operatively, but they may need another valve surgery in the future. If a patient has a mechanical valve they will need to take Warfarin post-op to make sure their blood is thin enough not to form clots around the valve. Warfarin leads to several other decisions - will they be able to obtain Warfarin?, do they have a clinic nearby to perform their INR lab draws to determine Warfarin levels?, are females done with childbearing?

Which brings us full circle to Angelique. She lives in a Congolese Refugee Camp and has 3 young children. Angelique stated she was finished with childbearing - but was this because she felt so awful because of her mitral valve disease or was this her true heart's desire? What happens after we fix her Mitral Valve and starts to feel better?, will she want more children?, will she be able to obtain Warfarin?, will she have a clinic available to her in a Refugee Camp?

In the end we try and educate patients as much as possible so they can make an informed decision. This begins weeks before we arrive, thanks to the groundwork of the 3 Kigali cardiologists who manage our patients before and after surgery. Angelique chose a Mechanical Mitral Valve and is Post-Op Day 2 here, we will give her the first dose of Warfarin, per her decision. Then she will move from the CICU over to Telemetry. We wish her all the best, our first patient of 2012.

WELCOME BACK

It began and ended with a toast, of course, to us and you and our families for allowing us to leave the country, finally!

And the long flights were just that. Thankfully they had great movie selections, so if you missed the Oscar Nominees, now is your time to catch up.

And, even those of us (Jamie and Ashley) who are plagued with lost luggage, were not so this time. All of the luggage and trunks arrived safe and soundly. This morning we are ready to greet our Berg Shipment and the Customs Officials at King Faisal Hospital (KFH) and justify all of our supplies. Wish us luck!

TET-A-TET

Both of our TET kiddos from yesterday did fabulous, thanks to the great care by the 2 pediatric nurses we brought from Providence Sacred Heart Medical Center's Women and Children's Hospital. Yvette and Nicole tag-teamed our youngest 12 and 15 year olds, settling and caring for them with swift hands and kind hearts. I have never seen someone so exquisitely tuck in a patient so expediently as Yvette. She truly is a master of her profession. Then our adult cardiac nurses took over for night shift (Katie and Sarah S.) Fortunately, in preparation for our Mission, they had an intensive 2 hour Congenital Pediatric Care Course provided by Barb and Beth, our pediatric education specialists from SHMC. And we could not have done it all without the support of "Dr. Dan," as Rwandans say. Brutacao to us. He recently arrived from the grueling Boston Marathon finish line. The long flights cross country stoved him up a bit but he gimped into the groove like he'd never left. Thanks Peds team for taking the responsibility for our little ones!

FIRST DAY OF WORK

Except for the trunks that keep filtering in with each wave of staff flights, we are all unpacked and prepared to begin our first OH surgeries. This is the recently paved street down to KFH with a lovely cobblestone sidewalk and fresh grass sidelines.




After many years of preparation, they have just received their Accreditation from "The Council of Health Services Accreditation of Southern Africa (COHSASA)." This is the equivalent of our JCAHO and so they were frantically pulling their hair out just like us when the surveyors arrive on site. King Faisal is beautiful and clean and we love working with the staff who have been more than accomodating.

DEPARTURES AND ARRIVALS

It's always good to begin and end a journey with some consistency, for us this was the universality of beer. Heffy in the States and Primus in Africa. Especially when the country welcomes you with open arms into it.













Our first group of travelers made it here safely, including all of our personal luggage. Our trunks are having a sleep over in Customs. Sandy, Hal and Dr. Mucumbitsi plan to retrieve them on the morrow.

The rest of us will also be up and at 'em on our way to King Faisal Hospital to unload all of our beautiful shipping boxes. And it will be like Christmas going through all of our belongings we left here last year.

Good luck to the three remaining waves of travelers, we will see you all soon. And you will be just as happy as Brooke to take off your support stockings!!

MAKING RESPIRATORY THERAPISTS OUT OF NURSES?

Well, hosting a whole surgical group in Kigali is very expensive for the Ministry of Health of Rwanda. To defray these costs, we have reduced our group size by not taking Respiratory Therapists this year. Thank gosh we took them last year though. Otherwise, Sally Lutz would not have the first hand quirky experience to teach us about the Avea Viasys ventilators we use at King Faisal Hospital. Sally and her colleague Scott have been gracious enough to teach all of the CICU nurses the ins and outs of the ventilators we plan to use in Kigali, Rwanda. We thank both of them for giving up their personal time to instruct us so thoroughly!

WE HAVE ARRIVED!

Dr. Hal Goldbert, Sandy Goldberg and Jim Dixon relieved to finally be on the plane.

Andrea Daugherty, Katie Bland and Morgan Lonsford entertain themselves while waiting in the San Francisco Airport.

Jane Vantassel at the "Yotel, Motel, Holiday Inn..." at Heathrow's Airport in London.

The first team arrived at noon yesterday. We cleared Customs at Kigali International Airport with no problems and we were greeted by our wonderful colleagues from King Faisal Hospital, there to make sure our Customs experience went smoothly.

It was great to see all of our pallets of supplies unloaded in the CICU and ready for us to unpack tomorrow. We are all looking forward to a quick dinner and a long rest as we plan to start this organizational process.