Eldoret and Mombasa Hospitals in Kenya Nov.-Dec. 2024

On this teaching trip we were honored and blessed to have Dr. Ross Goodfellow, Dr Owais Abdul-Kafi, and Dr Micaila Iantorno, all skilled interventional/structural cardiologists with us. The team also included skilled cardiac ultrasound sonographers Eileen Nemec and Nancy Martin. There skill allowing us to follow our wires and catheters passing through the heart with skilled ultrasound is key to a safe procedure,

Tenwek Hospital 2016

First of all, everyone and  especially I (Ron) missed Colleen's organization on site and appreciated her 100 + hours of work to pre-organize this teaching trip at two large hospitals in Kenya (1000 bed and 800 bed public hospitals) for resource limited people.  Above is a pic of Colleen on a prior trip scrubbing in on her first permanent pacemaker because no OR nurses were available.

We have done this route before so I didn't bother the flight crew with questions about why we were deviating over the Red Sea toward Saudi Arabia.  We are dodging Sudan and Somalia (on the flight tracking below)  Both countries have surface to air missiles with capability to 80,000 feet and are less "predictable" than the other over flight counties.

The pictures above and below show the Cardiology team that we are training.  First at the procedural table and second imaging with an ultrasound catheter that goes down the esophagus (showing the wall between the right and left atrium that we need to puncture safely.)

Below is a sample of 5 of the 20 patients, the youngest 12 years old.  Without the procedure they would have only lived 2-10 years but now will have normal lives.  None of the families would have had the financial resources needed.

As Colleen  emphasizes and trains, the post-op care is essential.  Below is the great CCU team that makes sure these young people recover along with 4 from our team.

Our volunteers  each trip of 5-8 cardiologists, nurses, and technicians are vital in passing off the  skill sets to our overseas colleagues..  Below is Eileen Nemec, likely the top pediatric cardiac ultrasound person in Minnesota.  She is comforting and praying for a 17 yo Turkana girl pre-op.  She is from an extremely poor family (2-3 dollars per day and they live in the chronic drought ridden NW. )  The patient was our highest risk (complex pulmonary valve dilation) but had a perfect result. Second pic is her balloon through the valve.

Eileen Nemec sonographer with patient

Both hospitals are so aware what a high risk this procedure is in these very sick hearts that they initiate prayer before the procedure, sometimes in both Arabic and English.  We sometimes think that the highest level coordinating power is Colleen but it is still higher!

Cameroon January 2024 Letter from Ron

It was mid-evening in the quiet darkness around the hospital when I walked to the 24 bed women's ward to meet with the worried internal medicine residents on call.  There was a surreal looking tint to the moonlight through the dusty air from the dry season and  sand aloft from the Sahara gave a sepia appearance to the mountains around us and the dry highland foliage along my path..  This time of night in the low lit ward, the very quiet background of muted conversations despite the number of patients, many with children sharing the hospital beds, gave a warm homey feeling in the long room with beds on both sides.

There was tension, however,  at the 27 year old mothers bedside with two nurses and two residents in attendance.    She was admitted to the hospital in the early evening holding her 5 month old baby and having extreme difficulty breathing even at rest.  She had very low oxygen levels and her blood pressure was barely detectable.   We had been teaching the residents to use their hand held ultrasound device to evaluate the heart. Together we worked to sort out how each of the valves and chambers and cardiac walls were working.    She had a classic peripartum cardiomyopathy. (Severe failure of pump function on both sides of the heart that develops a month before delivery or within 5 months postpartum).  This zone of Africa is one of the epicenters of the disease.  So many young women throughout Africa and especially in this region do not survive this event but if we can get them through the dangerous period, 1/3 have complete recovery and 1/3 have moderate recovery.

Throughout the two training weeks I was at Mbingo Hospital we had three severe peripartum cardiomyopathy patients and all the residents learned how to make accurate diagnosis with the ultrasound device and most importantly the subtleties of when to use certain cardiac medications and the order to start them, usually ending up with the patients on 5 medications carefully balanced.   We have all the proper medication here (generics) with the newer versions used in highly developed countries slightly more effective but very expensive.  My input and training for these 3 women made a difference and the trip would be worthwhile for these cases alone but most importantly, the residents are now expert in this disease presentation and the multiplying effect as they additionally care for patients and share their new expertise is what we strive for.  Below is a picture of this mother and child (with permission for teaching).   The other two women did well and were also up walking around the wards before I left.  This  case represents one of many different cardiac diseases with diagnostic and management teaching opportunities that the residents will use lifelong.

Leprosy village on the hospital grounds from the old days of multiyear treatment, now cured in 6 months of Rx.  Housing is mainly used now by hospital workers but we see many people around with leprosy damage.

I was asked  "Don't just send pictures on patient's, send some pictures of you guys".     This is the guest hostel.  I am smiling because I am done lecturing (frequently 2 lectures a day) and done with ward and consult teaching.   No Colleen in this picture----this hospital was in a US Embassy no travel zone and no help available for American citizens, so we decided to only have one parent/grandparent on this trip.  I started to write up the security events that happened and planned to share the email after I was back, but changed to I'll let you know in person if requested.  I have great concern for the Cameroonian  hospital leadership l left behind.   I was able to debrief and counsel a number of people that were traumatized during those two weeks. 

Included below is one of the many houses Colleen has contributed to building for very special nationals with decades of selfless service and no place to stay without rent ( 1/3 of their $80/month pay) or for a pre-retirement home as in this case.    The lady in the picture who we have known for 14 years will live here with her daughter and grandson.   The small amount that I brought with me will allow her to put ceilings in the house and bring gravity flow water to the kitchen and bathroom and then they will move in.

The three of them have spent the last 20 years in a 12 ft X 14 foot space on the hospital site despite her being the onsite hostel caretaker, cook, and mamma to the visiting nurses, technicians and docs and doing her role with such love and skill.    We help many  at the places we work overseas in small ways who are special in their roles but not recognized by the hospital for their special and competent roles but only a small group of unique people get partial support to build a house of their own.  

The market across from the hospital.  Everything you need (except shampoo, diet coke, and potato chips much to my distress!!)

There is enough fresh food and basic items that one could live at Mbingo Hospital and never need to shop in the big city one hours drive to our south.

Lots of stories to share with you, and looking forward to catching up on your lives.   I'll be home in a few days.   I am in the capital of Cameroon, Yaounde, and out of the embassy no travel zone and very safe.

Much love and appreciation to all,  Dad/Ron/Grandpa

Looking Back, Looking Forward

As we approach the end of 2023 we look back to see where we have been and look ahead to where we to go from here. We made it through the Covid years with it’s closed borders and difficult travel restrictions. We did have to reduce the number of trips that we made but were able to do some traveling each year.

Moi Teaching and Referral Hospital Theater (OR)

Since starting the Mitral valve balloon valvuloplasty program in 2014 in Kenya, we have taught the procedure at 3 locations. Tenwek Hospital in Bomet Kenya is doing a hybrid surgical/catheter approach. The Addis Ababa program at Saint Peters Hospital in Ethiopia is now fully independent. They have done over 200 cases since their training was completed. The program in Eldoret at Moi Teaching and Referral Hospital in Kenya (were we are currently) will soon start to do the procedure independently.

Moi Teaching and Referral Hospital staff with visiting team

We have trained Rheumatic Heart Disease screeners in Cameroon, Kenya, Tanzania, Ethiopia and Republic of Congo. Our most successful team is at Soddo Christian Hospital in Ethiopia. Since starting in 2017 they have screened over 15000 school aged children and have found 3.5 % of the children positive for early signs of rheumatic heart disease. The children that were found positive are now on penicillin to prevent the progression of their disease.

Soddo Christian Hospital screeners

Soddo Christian Hospital Screeners with visiting team

Our newest screening team at Kapsowar Mission Hospital in Kenya has made steady progress despite many difficulties. Since they started in 2021 they have screened over 3000 school aged children and have over 100 on prevention. They are dedicated to reach out to help as many children as they can. The hospital administration has been very supportive.

Kapsowar Mission Hospital

Lucy, team leader for kapsowar Mission Hospital screeners

The numbers are reassuring but they are not only numbers. If you have read our blog you will be familiar with the faces behind some of those numbers. Names like Aziza, Able, Moses Joy , Perpetua and Mary. They are just examples of the lives saved through the dedicated work of the screeners and Cath lab staff that we have the privilege to work with.

As you think about your end of year giving please consider those children yet to be reached with these life saving interventions. Even a small donation can make a large difference. And thank you for participating in the mission to reach these children physically, emotionally and spiritually.