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!

OCTOBER 7, 2013

It's Monday and the last three days have seen 3 groups of team members arrive in Kigali. Boxes have been unpacked, telephones programed and passed out to all team members. The ICU, pharmacy and OR are arranged, equipment working, organized and set up. Yesterday, our film crew of Sandy Konyu and Dawn Worrall went to one of the patient's house to begin filming for our future documentary. Everyone is excited that the patient, Clementine allowed them to go to her home, ask probing questions and continue to film her through surgery and follow-up. All parties involved are excited about this opportunity The OR has 2 surgeries planned for today. The first one was completed by 11:30 am and had gone well. The ICU nurses were anxiously awaiting their first patient. The second surgery will be Clementine. The medical team is happy to be here and ready to put their dedication of helping others to work. Here are some of the pictures of the first few days, including one of sunset over the North Pole, taken from the airplane.

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.

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.

CICU and TELEMETRY NURSE ORIENTATION

Part of working on a Medical Mission of this magnitude is knowing what we are doing and how to impart that information to our own Healing Hearts Northwest (HHNW) Nursing staff and then to the King Faisal Hospital (KFH) Nursing staff.



To this end, HHNW CICU and PICU nurses have had 2 hours of ventilator training and the CICU, PICU and Telemetry nurses have had 3 hours of Pediatric Congenital Open Heart Training and also a 2 hour Orientation Course on what to expect and how to function at KFH in Kigali, Rwanda. That is a lot of unpaid classroom hours, which gives a whole new meaning to volunteers.

Add on top of this, the 5 HHNW staff that plan on presenting during our full day Cardiac Education Day for the KFH nurses and staff. They will be teaching Ethics, Blood Product Administration, Pediatric Congenital Heart Surgery, ECG Rhythm Interpretation and Coumadin Pharmacology. I am telling you, we have some amazing staff volunteers.

As mentors, we plan to implement a more formalized documentation system of whom and how we have mentored the KFH nurses. Hopefully, this will assist us in future Medical Missions, deciphering who has been trained and is capable of recovering Open Hearts on their own and who still needs full training or just a little refresher.

This is no easy task for any of us, on either end. Traveling clear across the globe, to a foreign country in a foreign city and still having our wits about us to teach appropriately. And, on their end, coming to work one day, seeing all of us Muzungus (white people) and being paired up with one of us to learn as much as possible through a language barrier.

The most fascinating aspect of the above is that it actually works! It is amazing how universal sickness, hospitals, nursing and charades actually is. Unbelievably, we all seem to communicate in the same way about the same subjects or ideas. Although we may struggle to find words or props to show what we mean, somehow each party gets their point across.

And it works because we have such amazing nurses volunteering their own funds to pay for their trip, volunteering their own vacation time and volunteering all of their years of expertise. Sometimes we do not realize what a plethora of useful information we hold within ourselves. My hope is for each HHNW and KFH nurse to find and share and rejoice in each other's knowledge, for this is true collaboration.












So wish us all godspeed in our success, for this will bring King Faisal Hospital one step closer to performing their own Open Heart Surgeries with their own Open Heart Program with wonderfully capable nurses and staff.

PERFORMING SURGERY OUTSIDE THE BOX

Operation Open Heart from Australia allowed me to shadow their each and every move so our Healing Hearts Northwest team knows what to expect.