Mission to Macapá, Brazil

7/30/2017 to 8/11/2017

Hospital São Camilo

On July 30, the CardioStart team began its second mission at the Hospital São Camilo of Macapá, Brazil, which provides free cardiac care to impoverished patients in the region of Amapá State, located in the Brazilian Amazon area. This region is very underserved with medical care and patients have to travel sometimes hundreds of miles to get even basic care. The volunteers were welcomed by an enthusiastic local team who wanted the best care for their patients and were eager to learn more how to provide a more advanced cardiac care and to produce high-quality outcomes for both pediatric patients with congenital and adults with acquired heart diseases.

Patient Surgery: As part of CardioStart’s ongoing education program, a total of 7 adult patients and 10 pediatric patients received surgical care during the two-week mission with CardioStart consultant support. Cases varied from congenital repairs to valve replacements. Patient ages ranged from 2 months to 42 years.

OPERATIONS ACCOMPLISHED :

*NAME Names on file but withheld from published report (HIPAA)**	AGE /sex	PROCEDURE	OUTCOME
M.V.M.D.S., 35 KG	13 yrs F	ASD Closure	Satisfactory
I.L.D.S., 7 KG	18 mo F	MV Repair	Satisfactory
D.P.M., , 7KG	6yrs F	VSD Closure (Severe PAH)	Died on POD Pneumonia +Neuro Dysfunction)
J.I.D.O.C., 4.7 KG	3 mo M	PDA Ligation	Satisfactory
R.F.S.D.S.	42 yrs	VSD Closure	Satisfactory
A.S.G.R., 8.1 KG	11 mo F	ASD Closure	Satisfactory
M.C.A., 65 KG	15 yrs M	Coarctation Repair	Satisfactory
C.M.S.	20 yrs F	TAPVC Repair (Intracardiac Type)	Satisfactory
M.B.D.B.B.	30yrs M	MV Repair	Satisfactory
B.N.D.A.	67 M	AVR	Satisfactory
M.C.D.S.P.	12 mths F	PDA ligation	Satisfactory
A.S.D.S.B.	6yrs F	ASD Closure	Satisfactory
N.W.	2 mo F	Pulmonary Artery Banding (Multiple VSD + Malaria)	Died on POD 14 (HF + Liver dysfunction)
E.G.D.S.V.	37 2yrs F	Double Valve Replacement (AVR+MVR)	Satisfactory
E.S.D.S.	30 yrs M	MVR (Redo)	Satisfactory
T.R.R., 8.3KG	9 mo F	PDA ligation	Satisfactory
A.G.P.P.	24 yrs M	AVR	Satisfactory

Rheumatic Heart Disease Screening

Our team also conducted Echocardiogram screening for RHD in children and young adults. A total of 144 Echocardiograms were performed in two towns (45 in Santana and 99 in Cidade Nova).

Education

Through daily lectures, hands-on demonstrations and protocol provisions, the CardioStart team was able to assist program development towards international benchmark standards and 545 students and professionals received formal education.

A second area of attention was that of post-operative recovery with our team demonstrating and teaching evidence based best practice for improved outcomes. This included earlier mobilization, aggressive pulmonary care, increased pain control and suggestions on use of vasoactive medications and adjunct therapies.

Pre-op and discharge teaching was also stressed. Classroom presentations, ward discussions and bedside demonstrations were well attended by nurses, physicians and allied health care providers with most suggestions eagerly accepted by the local professionals. CardioStart presented several recommendations and procedures/protocols for ongoing program development sustainability.

Data collection

As part of CardioStart’s continued mission, extensive data is collected about each patient including demographics, socio-economic details, medical history and surgical care and this is shared with other agencies. Obtaining this information is a critical part of our work and required almost full time attention by two of our volunteers.

Outreach:
The CardioStart outreach team traveled to the village of Mazagão, located in the riverside area of the Vila Nova River one of the tributaries of Amazon River in the state of Amapá where an abbreviated outreach program during the first week of the mission from August 3^rd through the 5^th was carried out. Medical students from the Medical School, Federal University of Amapá, provided assistance and translation support. During those three days, in a makeshift clinic at the home of one of the community leaders, more than 14 patients were evaluated; most had gastrointestinal issues, including gastritis and worms many of which were either poorly controlled or undiagnosed. The lack of available doctors in the area with an impoverished population of more than 200 families was observed to be a

major cause of this problem. Their local clinic is not operational because it is not equipped; a pier was never built and there is no water ambulance to reach it. Some medications are also expensive for the local community to obtain. Anemia was another health issue the team encountered related to worm infestation.

Public health education was provided to the local population to recognize the importance of oral hygiene as a mean to prevent diseases. Public Health education for prevention of RHD took place including 50 Echocardiograms screenings were also conducted by our team.

The Mission Team:

Leadership: Dr.Vinicius Nina (Mission Director) & Ms Suzana Maluf (Team Coordinator).

Pediatric Cardiologist / Intensivist: Dr. Rachel Nina.

Cardiostart Surgeons: Dr. Vinicius Nina & Dr. Emily Farkas

Pediatric Cardiologists / Echocardiographers: Dr. Renata Cassar & Dr.Renata Rossi

ICU Nursing: Ms. Diana Gonzales, Ms. Nicole Burnham, Ms.Karlie De Angelis, Ms. Nikki Perry Scrub Nursing: Francis Younger. Respiratory Therapy: Ms. Erica Sady

Echocardiography Tech: Ms. Heather Evers

Outreach: Dr. Richard Harper (Director), Ms. Yvonne Keep, Ms. Jessica Choi,

Database: Mr.Gali Kolt, Ms. Jessica Choi

Acknowledgements:

A number of individuals and corporations made generous in-kind and financial donations. CardioStart gratefully acknowledges the specified support of the following:

Amy Lauth Foundation – support for logistics , and transport of donations.
Edwards Life Sciences Inc., Grant Support “Every Heartbeat Matters”.
Kaká Barbosa, President of the House of Parliament of the State of Amapá, Brazil – assistance with team accommodations.
Mr Gastão Valente Calandrini de Azevedo, Secretary of Health of the State of Amapá – support and coordination with the local team.
Alcedir Rigelli, CEO of São Camilo Hospital, Macapá, Brasil – Mission Support.
João da Silva Costa “Professor Dudão” for team support and accommodation at the Outreach
Doctors Antonio Furlan and Artur Soutello, Cardiac Surgeons for team welcome, support and
CardioStart Administrative Team – coordination of mission and preparation.
Donna Doxsey-McGrew, RN, FNP- International Mission Committee Outreach Director.