Operation open heart, another blessing at King Faisal Hospital

Operation Open Heart is a volunteer Cardiac Surgical Programme that has been operating since 1986. The team will be visiting the country in a near future. It is co-hosted by the Sydney Adventist Hospital and ADRA (Adventist Development & Relief Agency), in cooperation with the government of Rwanda through the ministry of health and King Faisal hospital-Kigali. According to the director King Faisal hospital, Dr. John Stephen, the team of forty experts are expected to arrive at King Faisal Hospital late this month. The team will comprise a coordinator, Cardiologists, Surgeons, Anaesthetists, Intensivists, Perfusionists, operating theatre nurses, anaesthetic nurse and intensive care nurses. Others to be included will are ward purses, Radiographer, Pathology technician, Physiotherapist, biomedical Engineer and other health professionals. The in charge of quality assurance at the hospital, Dr. Clare Karibika said, arrangements are being made by the King Faisal hospital authorities in collaboration with Rwanda Air, QANTAS an Australian airliner and the ministry of health. Under the programme, the ministry of health is expected to cover the team’s accommodation and additional patient hospitalisation costs. The cost of the project which will include all required equipment and medications stands at a sum of over $ 300.000 (equivalent to over Frw17, 000, 000). This sum of money will be used for the surgical operations/care while the transport costs from Sydney, Australia to Kigali, via South Africa are to be fully catered for by Rwandair and QANTAS. The programme, which is expected to last for seven days, targets about 30 to 35 people suffering from congenital and rheumatic heart diseases with a prospect of complete repair or long term palliation. Dr. Karibika noted that the screening of the beneficiaries was done from district hospitals especially in Ruhengeri, Rubavu and Gisenyi. “Doctors at King Faisal hospital identified cases that required urgent operation from the many that are referred to the hospital,” she says. Enhancing skills of local medical staff The chairperson of the programme and the in-charge clinical practice at King Faisal, Dr. Joseph Mucumbitsi, says that the key objectives of the programme include collaborating with local doctors in the diagnosis and treatment of patients with heart problems, providing urgently needed surgical procedures for heart problems and providing in-service training aimed at enhancing the skills of local medical, nursing and allied health professionals (staff) and to stimulate interest in improving levels of patient care among others. “As King Faisal Hospital endeavours to achieve its mission of providing specialised medical care, ultimately reducing the number of referrals abroad, this programme and other similar projects aim at enhancing the skills of the local team by sharing highly specialised experience with their international colleagues,” the doctor noted. King Faisal Hospital strives to become a centre of excellenceIn Rwanda, as in many other developing countries, heart diseases among children are a common problem. The children may be born with the heart problem or develop it through an infection, often caused by untreated dental or throat infections. Many children require open heart surgery to correct the problems. These are expensive and complicated operations which usually need to be referred abroad at great cost that the Rwandan society cannot afford. According to the organisers, patients will be categorized according to the complexity and severity of their disease, for example those whose repair is completely possible, those to whom a palliative procedure can be undertaken with the prospect of good, long term palliation. Operation Open Heart project is a group of volunteers who normally contribute their time and expertise as well as meeting their own travel costs to go around the world during their holidays to provide cost effective specialized medical services. The group began providing specialist cardiac surgical services to the Pacific region back in 1986 and the first country visited was Tonga. The team has since visited Vanuatu, Fiji Islands, Nepal, Nepal, Papua New Guinea, China, Solomon Islands, Mongolia, Vietnam, Myanmar, Cambodia and Rwanda. The pending visit to Rwanda will be the second; the first having been part of Hope Rwanda program, where the global communities united in a bid to bring healing and hope to Rwanda in 2006. The program then, coincided with the twelfth commemoration of the 1994 Rwandan Genocide. The specialists brought medical supplies and equipment to enable successful and efficient services. At that time, 19 patients benefited from the heart operation, of these ten patients underwent closed heart surgeries and nine had open heart surgery. Open heart surgery is where the chest is opened and surgery performed on the heart. The term “open” refers to the chest, not the heart itself (which may or may not be opened, depending on the type of surgery). Open heart surgery includes surgery on the heart muscle, valves, Arteries, or other structures. The definition becomes confusing in light of new procedures being performed on the heart through smaller incisions. Minimally, invasive surgery and robotic-assisted heart surgery are still referred to as open heart surgery. An open heart surgery in progress at King Faisal hospital, photo taken during first Open Heart surgery in Rwanda in 2006. A heart-lung machine (also called cardiopulmonary bypass), is usually used to help provide oxygen-rich blood to the brain and other vital organs. It pumps, supplies oxygen to, and removes carbon dioxide from the blood and also provides anesthesia to keep the patient asleep during the operation. Cost of surgery abroad The required funds to transfer heart patients to overseas facilities is so high, the usual cost of such an operation to one patient in India is about $10 000 and $50 000 elsewhere in the world. It is therefore clear that the program will help the country save about $ 350 000 to $1, 750 000 that would otherwise be used to treat the thirty five patients abroad with the same medical care. Meanwhile another voluntary team working with “Chaîne de l’Espoir,” from Belgium will perform at least 12-15 cases of therapeutic cardiac catheterisations to treat some congenital defects, which is also a complicated procedure but one which King Faisal Hospital plans to develop further in its future plans to improve its services. The Belgium team will also provide cardiac devices such as a pace maker. These devices are put to patient with heart diseases who can not benefit from operation alone. A pacemaker is a surgically-implanted electronic device that regulates a slow or erratic heartbeat. Pacemakers are implanted to regulate irregular contractions of the heart called arrhythmias. They are most frequently prescribed to speed the heartbeat of patients who have a heart rate under 60 beats per minute (severe symptomatic bradycardia), normal heartbeat ranges from 60 to 90 beats per minute, however pacer maker devices are also used in some cases where the heart has abnormal fast heart rate called tachycardia to slow down the speed to nearly normal range of speed. Irregular heartbeats A doctor will take a complete medical history and perform a full physical work-up to rule out all non cardiac causes of slow or high speed heartbeats. A temporary pacing system is sometimes recommended for patients who are experiencing irregular heartbeats as a result of a recent heart attack or other acute medical condition. The implantation procedure for the pacemaker leads done in such a way that the actual pacemaker unit housing the pulse generator remains outside the patient’s body. Patients being considered for pacemaker implantation will undergo a full succession of cardiac tests, including an electrocardiogram (ECG) or an electrophysiological study or both to fully evaluate the slow or high speed heart. The King Faisal hospital has been ensuring an environment for more specialized surgeries, for example in July 2005, the hospital was able to accommodate a team of specialists from Kenya and India who performed “Corneal Transplant” for the first time in the country, restoring sight to more than fourteen patients. Since then there were a number of ongoing programmes to accommodate more specialized surgical services. The writer is an anaesthetist at King Faisal Hospital, Kigali.