Mission Report: Nepal 2018

CardioStart International’s 8th Mission to Kathmandu, Nepal & 2^nd Screening Outreach Mission to Nepal Providing Screening and Education Outreach

November – December 2018

In Nepal, Rheumatic Fever remains one of the leading causes of significant valvular disease.  All previous CardioStart missions in Nepal have included a satellite team to perform needs assessments and conduct outreach clinics in the remote valleys and mountainous terrain areas where access to local medical care is rare or impossible. The prior mission marked a new initiative to enroll selected nurses in an ongoing CardioStart-sponsored “Echo School” where they will be trained in the capacity of an Echo Technician. These echo technicians are almost fully trained and on the December mission, increased access to evaluation & care with echo screenings & diagnostic studies in remote satellite clinical locations.                                                                          

Between November 27^th and December 3^rd, 2018, CardioStart conducted awareness, education, and screening outreach in multiple regions of Central Nepal.

November 27^th and 28^th – Edwards Lifescience (EW) visited CardioStart in Nepal to review their “Every Heartbeat Matters” Campaign, which supports education, screening, and treatment of 1+ M underserved patients worldwide. EW spent the day with CardioStart in the Bhaktapur Transplant Hospital filming echocardiography follow-up and interviews of three CardioStart patients treated on the April mission. Two out of three of the patients operated on in April appeared for echo’s and are doing very well.

In the afternoon, CardioStart conducted a school health program for 500 children and parents that included oral hygiene, hand-washing techniques, and RHD education where EW debuted their new RH video developed by Stanford Biodesign, India and translated into Nepalese. 500+ toothbrushes and paste were distributed.

The EW team was very encouraged by the work that CardioStart is doing in low resource settings and found great value to our efforts.

November 30^th – The team travelled to Lumbini, Nepal and with logistic partnership from the Central Lumbini Rotary Club, held a screening clinic where 87 villagers were screened for signs and symptoms of heart disease, the same 87 villagers were educated 1:1 for causes, prevention, and treatment for rheumatic fever and its relationship to rheumatic heart valve disease. 19 patients displayed some level of signs or symptoms for heart disease and were referred to on-site echo performed by a US sonographer volunteer and two Nepalese echo-trainees. 9 patients were diagnoses with heart valve disease, either congenital or rheumatic in origin.

Screened	Educated	Echo Performed	Pathology Dx
87	87	19	9

December 1^st – The team travelled to Danda, Nepal and with logistic partnership from the Danda Rotary Club, held a screening clinic where 303 villagers were screened for signs and symptoms of heart disease, the same 303 villagers were educated 1:1 for proper oral care and for causes, prevention, and treatment for rheumatic fever and its relationship to rheumatic heart valve disease. 53 patients displayed some level of signs or symptoms for heart disease and were referred to on-site echo performed by a US sonographer volunteer and two Nepalese echo-trainees. 30 patients were diagnoses with heart valve disease, either congenital or rheumatic in origin.

Screened	Educated	Echo Performed	Pathology Dx
303	303	53	30

December 2^nd –The team travelled to Madi, Nepal and with logistic partnership from the Red Cross Society of Nepal, held a screening clinic where 343 villagers were screened for signs and symptoms of heart disease, the same 343 villagers were educated in groups of 10 for causes, prevention, and treatment for rheumatic fever and its relationship to rheumatic heart valve disease. 30 patients displayed some level of signs or symptoms for heart disease and were referred to on-site echo performed by a US sonographer volunteer and two Nepalese echo-trainees. 28 patients were diagnoses with heart valve disease, either congenital or rheumatic in origin.

Screened	Educated	Echo Performed	Pathology Dx
343	343	30	28

  

This successful CardioStart mission included 733 screening physician visits, 102 echocardiograms, and 67 patients diagnosed with cardiac pathology. In keeping with CardioStart’s emphasis on heart health, patients diagnosed with pathology will be referred to local surgeons for cardiac surgery, and services will be offered for free for patients without financial resources.

Outreach Demographics

AGE	TOTAL
< 25	51
25-49	271
50 +	411
TOTAL	733

Services Provided

Service	Number of Patients
Follow-up on prior surgical patients
Prior surgical patients	3
Education
Student (RHD, oral care, hygiene)	450-500 students and parents
Outreach, RHD-specific	733
Outreach, on oral care	303
Outreach Screening
Primary Care Physician Consultations	733
Cardiology Consultations	102+
Echocardiograms	102
Pathology identified (CHD, RHD)	67

Nepal Outreach 2018 Team Members

Physicians

• Sampurna Tuladhar, MD Nepal
• Mohan Prajapati, MD Nepal
• Kishan Kushwaha, MD Nepal
• Prayash Panthi, MD Nepal
• Michael Noce, MD USA
• Sabair Lee, MD USA

Cardiac Sonographer

• Jeanne Jeaneau, RDCS USA
• Binu Kakshapati Nepal
• Osha Nepal

Nurses

• Rachael Noce, RN USA

Medical Outreach Volunteers

• Brinda Prajapati Nepal
• Jackie Scholtz USA
• Mike Hanson USA
• PeiHan Chua, EMT, perfusion Singapore

Mission Director

• Ali Curtis USA

Acknowledgements

CardioStart International is very grateful for the following who made this trip successful:

• Edward Lifesciences Foundation for grant support through the “Every Heartbeat Matters” initiative 2017 fund
• Donna Doxsey McGrew, NP for her support, supplies and preparation of the outreach medical care
• Alex Devito, Territory Manager for Proctor & Gamble for procurement of toothbrushes and paste to supply the villages.
• AmeriCares Medical Outreach Program for equipment, medications, and medical disposables through the “Safe Surgery Initiative” program
• Janine Henson, Charlotte Kozlin & Margaret Child for CardioStart office administration and logistics
• Matt Plourde for jumping on a plane in the last minute and guiding the initial days of the mission.
• MAP International for discounted OTC pharmaceuticals to distribute in the village clinics.
• Suzy Dix, Realtor of Windermere Real Estate for all her support in preparation of the outreach work.  We missed you on the mission and hope you can join us in the future!