The two hospitals that our cardiology team of 9 are working at are in western Kenya along the Rift Valley. One is a 1000 bed public teaching hospital for resource limited people and the next facility we head out to in a couple days is a 60 bed mission hospital in a rural area where most of the population makes 3-4 dollars per day. The photo below shows are area which is along the northern limits of the famous Rift Valley. The farms are the level below us with the migration route of all the classic East African animals on the dry valley floor with a scattering of water holes running north and south. The East rim of the Rift Valley is in the distance.
Our team includes 5 Kenyan staff cardiologists, 4 Kenyan cardiology fellows, and most importantly the Kenyan cardiac nurses, ultrasound techs, OR circulators, and nurse anesthetists. Our US team includes 6 cardiologists, 2 echo techs, and one PA. You will note in the photo below only about 12 people in the OR but we will frequently have 20 there learning various roles with these sickest of the sick patients.
The next picture is Mary, a follow-up from her procedure 6 months ago. She was so advanced with her valvular heart disease that I warned the OR team that she was the highest risk patient and that she may be our first OR mortality (out of the 200 cases that we have done with this procedure). She, follow-up, now at age 23 is small and thin but she has gained 25 pounds in the last 6 months, has a more than a perfect result on our current echocardiogram (In fact, I can hardly believe that her heart has remodeled back to near normal---I get surprised on these overseas trips and both Colleen and I who have decades in cardiac medicine experience truly believe that there is a spiritual umbrella over these trips and the patients we care for. Statistically we should have about 10 mortalities with these 200 procedures but currently at 0% mortality!!). Mary is health enough to work breaking rocks into gravel and makes about $3 per day. Colleen and I just had a phone conversation and will add in a layer of education and training for these patients who have been delayed educationally with there heart disease. She did not have the $1.70 in bus fare to come in but the cardiology nurses got funds for her through the cell phone system. Mary received a few months salary from Colleen even though absent but a long term training plan for these kids for self sufficiency makes the most sense.
Below is the start of a case this visit on a tall, skinny (because of her valve disease) 28 yo woman. She would live <10 years without the procedure. The staff at this public hospital does not want to start the case until we pray for the patient which is not the normal MO at this public hospital. A number of the OR staff both Kenyan and our team will gladly pray and we do this with permission before they are intubated and we note a great calming reaction in these patients. I note a stabilization in pulse, blood pressure, and O2 saturation as these patients realize that the cardiac group sees them as individuals and not a heart valve case
The last patient photographed below is a 15 year old coming in on our last day at this hospital with hemoptysis (coughing blood up for the lungs). He is top 10% in his class partially aided by the fact he has not been able to play football (soccer) after school over the past 5 years. This was one of these "coincident" cases where we had a final slot that day to fix his heart (critical severe pulmonary stenosis), two of us who have each repaired this rare valve once previously, the correct balloon catheters and wires for this unusual case found, and most importantly, him being diagnose for the first time the day before our departure. A stressful case with post procedure instability but this Saturday AM he is stable with a great result. He would have died within 6 months without the procedure but now will have a full life. Almost all of these patients realize in a spiritual sense that they have beat tremendous odds just getting to a procedure and that they need to move forward making a difference in lives of others in the name of their creator. We used an introducer about as big as your little finger going down the internal jugular vein to access the heart. Sutures being removed this AM.
