It is 7am, outside King Faisal Hospital theatre. I’m here to unravel the intricacies in open heart surgery, something that is often left to only the medical staff with access to the theatre to know.  

A group of American surgeons, under the banner, Team Hearts, are in the country to carry out the delicate operations. The US-based charity has been offering free heart surgery services in Rwanda over the years. 

Ceeya Patton-Bolman, the Team Heart’s programme coordinator, takes me through the briefing of some of the requirements observed before the surgery. Among others, she says a patient has to be at the hospital a day or two before surgery to evaluate whether they are fit.

"A patient has  to under go HIV, TB, Hepatits B and C screening, urinalysis, chest X-ray, dental and full blood screen,” Patton-Bolman says.

 Patton-Bolman says a patient found to be HIV-positive or has Hepatisis B or C cannot be operated on currently  since there are no specialised equipment to handle them.

"This operation is too draining, so carrying out surgery on people with such ailments exposes them to too much risk,” she says.

Entrance into the theatre

Before entering, I am given green gowns, head gear and facial masks as protective gear.

The theatre is neat and smells of disinfectant, and in the centre, are two figures clad in similar garb (anaethologists) bent over a table with a patient covered in a blue sheet with a rectangular opening around the chest area–wait, the opening is on the sheet, not body, at least for now.

The medics are administering injections, I later learn its sedation to numb the patient, one of the many aspects of anaesthesia.

It’s not every day that you get to attend an open heart surgery and this opportunity is exciting enough. Whats more, the medical team are feisty and I am allowed to venture close enough, instructed on what to touch and what not. 

This particular patient is a victim of rheumatic heart disease, a disease that makes a patient extremely weak with difficulty in breathing. The surgery is done to enable the replacement of the mitral valve with an artificial one that better aids the functions of the heart.

"Anaestheologist, perfusionists (a specialist who pumps a liquid into an organ or tissue, especially by way of blood vessels), cardiologists, and cardiac surgeons should agree that the patient is ready before any surgery starts,” says Alex Mucyo Katabarwa, the national nurse coordinator for cardiac care 

The chest is cleaned before the surgeons get to work, incising with precision. When it comes to the chest bone (sternum), an electric scalpel (a small and extremely sharp bladed instrument) is employed to cut through.

The chest is open and one can spot the heart now, it’s a fatty ball with a blend of white and yellow that expands and compresses rapidly.

Perfusionists move to stop the heart, by planting tubes into it from the heart–lung machine (this machine temporarily takes over the heart’s role) so the sick valve (mitral valve) can easily be  located and worked on.

When the  heart stops, its not long before surgeons spot the mitral valve as it had earlier on been located through an eco-cardiography. You will occasionally spot a surgeon  whispering or gesturing to a nurse to extend a particular tool.

The sick valve is quickly cut out, its hard to make out its exact appearance since the surgeon quickly shoves it away in his gloved, bloody hand. 

Occasionally, blood spills from organs  around the heart as the surgeons go about cutting. You have to be a hard specimen to endure all the sight of blood. 

In my mind, assumptions are running. What would happen if this sharp knife  accidentally dropped on the heart? What if there was some mistake in the cutting? But these guys are up to the job. The dexterity in their hands is like for a pugilist. 

They replace the valve with an artificial one; a small, round metallic object sealed in the centre with a cross-like sign. A white sponge-like coating is used on the valve’s seal.

Its planted in the spot using absorbable stitches, and the heart is restarted to see if it functions normally with new tube. It’s monitored for a while before the team agrees that it works. The stitching starts, with the chest born is repaired, muscles and skin stitched back.  

The chest is stitched and bandaged  and the patient removed from the anaesthesia machine though consciousness does not return immediately. The patient is wheeled to the intensive care unit (ICU) with many tubes hanging to the mouth, nose, chest and genital area. 

Katabarwa says the patient usually spends two to three days in the ICU for monitoring before they are transferred to the general ward for recovery. 

"It takes six to eight weeks for a patient to achieve full recovery, but follow-up continues almost for their life time,” he says.

Currently, Rwanda is the only country in Africa that Team Hearts have extended their charitable works to.

 "When we got here,  it was a bit sad to learn that for a nation of 11 million people, there is no cardiac surgery hospital. Yet back in the US for every less than a million people there was one. Besides the people here  are too hospitable, they encourage us to keep coming back,” Patton-Bolman says.      

She added that they have conducted 102 surgerries since 2008, with a success rate of 98 per cent.   

The team is made of about  250 doctors in total, but only 44  were in the country for their seventh visit.

"These specialists  do not only donate  their vacation time,  but also pay their own air fare just to come and volunteer in this service,” Patton-Bolman says.

Currently, Team Heart has no plans of ending their operations in  the country "until a speciliased cardiac hospital is established.”

The group fundraises about $250,000 (about Rwf170 million) on average annually and more than $300,000 (about Rwf202 million) worth of equipment around the US to support the project in Rwanda. 

At last month’s annual three-week visit, 16 patients operated on.

However, Patton-Bolman  says it has not been a smooth ride altogether.

 "During the first year  of operation, we had to bring every equipment, ranging  from the heart lung machine to all other surgery impliments,” she says.

Experts say because of limited facilities in the country, patients with heart complications are discovered late, making treatment sometimes expensive since cases are usually  advanced. The other challenge is follow-up on patiests, Patton-Bolman adds.

"Since most of us immediately depart after the exercise, it’s difficult to follow-up all the patients we have worked on,”  she says.

Rwanda has only four cardiologists but for their number, the work output is tremendous, officials say. 

 Rheumatic heart complication, which is the commonest in the country, usually affects  people  aged 15 to 25 years. 

Julie Carragher, the Team Heart screening coodinator who was on her  second trip to the country, expressed pleasure over her participation.

" When I was asked to be a part of the team last year, I was eager to come  and fulfill my dream of participating in mission work. What I experienced while  here  from a cardiology perspective was immeasurable, but I also enjoyed the  hospitality of ordinary Rwandans,” Carragher says.