Mission to Macapa, Brazil

Program development in pediatric and adult cardiology and surgery

July 30 – August 11, 2017

Mission location

Macapá is the capital city of Amapá, a north Brazilian State. Because of the isolated location, in the middle of the rain forest, the only way to reach the capital is by plane or boat.

This region is well known for its access to the Amazon forest. The state of Amapá has the biggest area of intact rain forest in Brazil; it is crossed by the Equator line and bathed by the Amazon River to the East.

This area was discovered in the 16th century by the Europeans, and the region subsequently suffered disputes between French and Portuguese invaders. The Portuguese claimed regional control and began colonization, introducing Christianity (Catholicism) and robust fortifications. The economy of the state is based on agriculture, and many mineral sources.

Current Status of Cardiology and Cardiac Surgery

The birth rate is high, and many children are born with complex congenital cardiovascular diseases. There is no pediatric cardiovascular support for them; almost all are currently referred to other centers in South of Brazil.

The cardiovascular team in Macapá is composed of: two cardiovascular surgeons.  Dr. Furlan, CV surgeon is in charge of the Cardiac Surgery Program.  As part of the mission, the CardioStart team will be working with the local team for advanced training technique development in pediatric cardiology (interventional), cardiac surgery for more complex adult and pediatric case presentations, and their intensive care management.

They have one anesthesiologist, a physician assistant, a perfusionist, a respiratory therapist and three scrub nurses. They can currently manage routine adult cardiovascular diseases and a few adult congenital cardiac defects.  This team has served the local population for ten years within the state.

All cardiac operations and pacemaker implantations are performed at the Hospital São Camilo, a philanthropic institution; which belongs to a catholic foundation named “Sociedade Beneficente São Camilo”. This foundation has a chain of hospitals in different locations of Brazil.

Currently, at Macapa, their annual caseload is: 180 adults (49% valves, 46 % CABG, 5% Aorta) and 60 pacemakers. They are very early in the development of their pediatric heart program and wish for CardioStart to assist them. During the CardioStart mission, all pediatric cases will be 100% public, now and thereafter to assist parents who are very poor and unable to pay for an operation or to afford insurance.  The language is Portuguese, with 10% speaking English in the hospital.  A number of medical students and other colleagues will assist with translation throughout the working day.



1-Pediatric Anesthesiologist    (Pediatric TEE Experience needed by either anesthesia or cardiology)

1 Adult Cardiac Surgeon

1 Pediatric Cardiac Surgeon

1 – 2 Pediatric Cardiologist/ Intensivist

1 – 2 Perfusionist (with pediatric experience)

5 Cardiovascular ICU nurses (three must have pediatric ICU experience)

1 Respiratory Therapist

1 Education Coordinator

1 OR Nurse/Tech/Scrub

1 Database research assistant

1 Outreach Physician and 2 Nurses (1 week)

1 Echo tech


CardioStart’s role will be to develop pediatric cardiac surgery and pediatric cardiac intervention as well as to strengthen the current program of adult cardiac surgery.   Our mission will support and extend their work reducing the large volume of cases needing to be done. Particular attention will be given to late-presenting congenital heart disease and valve repair techniques, where possible.  On this occasion, the CardioStart team will also attempt to accomplish the following:

1]. Establishing a permanent pediatric cardiac surgery center at the hospital and help set the necessary benchmarks for the hospital to develop its role as a regional cardiac surgical referral center;

2]. Help set up the necessary benchmarks, protocols and algorithms for the hospital to develop their role further, as a regional cardiac surgical referral center;

3]. Provide ongoing physician and nurse cardiology/surgical medical education;

4). Outreach clinic combined with rural cardiology screening, public health education and primary clinical care in the community of Ariramba.  This is an Amazonian riverside town of 200 families.  The trip to the site will be a 3-hour boat trip.  Outreach will occur from Aug. 3-8 in a local church.



Travel & Airfare:

A grant has been received from Edward Lifesciences, which will assist in some flights being paid.   Flights should be arranged to travel to Macapa, [Alberto Alcolumbre International Airport, code: MCP). Popular flight corridors are through Miami, JFK or Lisbon, and can be direct to Belem, Sao Paulo or Brasilia.  TAM, LAN, GOL and Varig are commonly used carriers; if traveling from Europe or Middle East, Etihad, Varig, TAP, BA, Air France, Iberia and TAM are favored.

DO NOT PURCHASE A TICKET UNTIL YOU ARE ACCEPTED ON THE TEAM BY WRITTEN CONFIRMATION.  This will follow meeting all the required paperwork submission by CardioStart and the Brazilian hospital.

Lodging:  This will be provided freely at Hotel do Forte by our hosts.  Volunteers should expect that they will be asked to agree to same-gender room sharing in order to help reduce the costs to our hosts.  CardioStart will assure minimum standards to ensure volunteer safety and comfort.

Meals:  During the day, meals will be available and provided for by the hospital.   Evening meals/snacks, etc. are available in the hotel or local restaurants, at volunteers’ own expense. They are generally of a high standard and inexpensive.


Please complete the Volunteer Interest Form and upload your CV/resume. Upon being accepted on the team, you will receive additional correspondence from CardioStart via email with information on how to proceed in submitting necessary paperwork and documentation.

MISSION DIRECTOR: Prof. Vinicius Nina, MD, Ph.D., Sao Luis, Maranhao, Brazil.  rvnina@terra.com.br

If you have vital pre-mission clinical questions or wish to collect medical donations to send for the mission, please e-mail us at info@cardiostart.org.

All applicants will be confirmed after the Mission Director has assembled the team, (selected on a first-come first-served arrangement). If we are not able to place you on this next mission, your name will be placed as a first call priority for a future location.

Personal Health:

Malaria, Zika, Leprosy, Dengue, TB, & H1-N1 are important diseases in Brazil. Hepatitis A & tetanus boosters should be obtained; Diphtheria; Hepatitis B; Rabies; Typhoid; Yellow Fever, and Schistosomiasis are potential threats to your health particularly, at the end of the mission when you may travel inland.  You no longer need a Yellow Fever certificate before travel. We suggest you follow CDC advisories before planning the mission.  All volunteer activity will be carried out following routine clinical universal precautionary measures. It is strongly advisable to have a routine check-up before travel of your HIV and Hepatitis a/b/c status prior to travel. Vaccinations should be reviewed and documented by your local travel clinic.  Those with serious medical conditions should obtain consultation and approval from their doctor prior to the mission.  You will also be required to either purchase travel medical insurance or proof of medical coverage out of your home country.


CardioStart mission leaders cannot directly help you make internal tourist travel arrangements but you can usually obtain travel packages during the week you arrive. Any tours must be conducted AFTER the mission; CardioStart assumes no responsibility for volunteer activity after August 12, 2017.

The ecotourism of the area has been only recently explored. When the Amazon River meets the Atlantic Ocean, there is a phenomenon called Pororoca: waves 3 to 4 meters tall in the direction of the river. Some people risk these waves for surfing.

There are some beautiful waterfalls and many river beaches in the countryside. Another attraction is the São José de Macapá Fortress, which is the largest in Brazil, built by the Portuguese on the colonial period (18th century).

The world-famous waterfalls of the Iguassu region are breathtakingly beautiful, but note – they will require a short flight and overnight stay.


                                       Do join us on this historic mission to North Brazil!