CardioStart International’s 6th Mission to Nepal providing 

Adult Cardiothoracic Surgery
Shahid Dharma Bhakta National Transplant Centre Human Organ Transplant Centre (HOTC)
Bhaktapur, Nepal


Adult & Pediatric Cardiovascular Outreach
Pokhara, Nepal
Baglung, Nepal
Bandipur, Nepal

April 2018

In April 2018, CardioStart International returned for a sixth time to the country of Nepal and for a third time to the Human Organ Transplant Center (HOTC) in the historical city of Bhaktapur. CardioStart volunteers were organized into 2 teams: a surgery team that stayed in Bhaktapur to perform cardiovascular surgeries and a medical outreach team that ventured out into underserved rural areas to provide heart screenings with a focus on rheumatic heart disease (RHD) education.

CardioStart’s first mission to Nepal was to initiate a cardiac surgery program in Dhulikhel in May 2015. However, this scheduled mission overlapped with the devastating earthquake that claimed more than 9,000 lives, so volunteers instead partnered with local hospitals to provide much-needed care for earthquake victims. CardioStart wasn’t able to perform surgery until its second visit a few months later in November 2016, and has returned several times since then to continue developing this important cardiovascular surgery program.

The April 2018 mission coincided with a nine day long Nepali New Year celebration in Bhaktapur called Bisket Jatra, which made for a great cultural experience for our volunteers. As the local Nepalese were celebrating the beginning of the year 2075, our team was hard at work in the Human Organ Transplant Center.


Cardiac Surgery Program Development

CardioStart volunteers provided all aspects of cardiac surgery in partnership with the HOTC team, including preoperative assessment and perioperative management. A high priority was given to providing education and skill transfer to the developing cardiovascular team at HOTC. In total, the CardioStart surgery team provided 6 diagnostic cardiac catheterizations, 1 aortogram, 2 atrial septal defect (ASD) repairs, and 1 double-valve replacement surgery.

Ongoing Echo Tech Training Program

This mission comes at the beginning of CardioStart’s yearlong training program of bringing experienced echocardiographers (or “echo techs”) from the United States to train Nepalese medical technicians how to perform and read echocardiograms. By the program’s end, Nepali echo techs should be able to perform heart scans entirely on their own and be able to train future echo techs in other hospitals. Nepali echo techs were trained throughout CardioStart’s surgical and outreach mission. 86 echocardiograms were performed during the surgery mission and 75 were performed during outreach by both Nepali trainees and CardioStart volunteers.

Medical Education

CardioStart International has been engaged in continuing education courses and advanced trainings for Nepalese healthcare providers since 2014 at Dhulikhel Hospital and since 2016 at HOTC. However, the April 2018 mission marked the inaugural educational program for the Intensive Care Unit nursing staff for three different learning groups: Bhaktapur Cancer Hospital, Bhaktapur Hospital, and our surgery host hospital HOTC. Over 182 hours of courses were taught over the course of 8 days (April 6 – 13, 2018):

Didactic and Hands-On Learning (14 hours):

  • Basic Life Support Adult/Infant/Child
  • Head to Toe Assessment and Breakout Sessions
  • VAP, CAUTI, CLABSI Infection Prevention
  • Mobility and Transferring Techniques
  • Hemodynamic Management
  • Heart Failure Management and Case Study
  • EKG Rhythm Interpretation and Management
  • Ventilation Management and ABG Interpretation

Bedside Education Precepting (168+ hours):

  • Epicardial Pacing
  • Rhythm Interpretation and Management of Arrhythmias
  • Identification of Pericarditis
  • PA Catheter Placement and Hemodynamic Management
  • Post Operative Care and Hemodynamic Resuscitation
  • Fluid Balance Management
  • Signs, Symptoms and Management of a Pericardial Effusion
  • IV infiltration Management
  • CAUTI, CLABSI prevention
  • Ventilator Weaning and Extubation Techniques
  • Aline and Pressure Bag Transducer Management
  • Chest Tube Management
  • Drip Titration of Inotropic & Vasoactive Medications
  • Electrolyte Replacement
  • Medication Administration & Monitoring of Cardiac Surgery Specific Medications

Cardiology Outreach

CardioStart’s Nepal Outreach Team saw a total of 400 patients during cardiac outreach clinics in three different locations: Pokhara, Baglung, & Bandipur. The team traveled to remote locations in order to provide cardiac services like echocardiograms to areas that don’t have them. These outreach clinics had CardioStart volunteers working alongside and discussing cases with Nepalese physicians and nurses. Although heart health and Rheumatic Heard Disease screening was at the center of these free clinics, general healthcare was also provided.

# PATIENTS 40 300 60 400
EKGS 10 200 40 250
ECHOS 5 50 20 75


Cardiothoracic Surgeons

  • Emily Farkas, MD USA
  • Fernando Riveron, MD USA


  • Martin Cheung, MD USA


  • Thomas Hilton, MD USA
  • Khalid Sheikh, MD USA
  • David McLaughlin, MD USA


  • Ariyo Idowu, CCP NIGERIA

Echo Tech

  • Laura Ladwig, RDCS USA

Surgery Tech

  • Fran Younger, CST USA

Biomedical Engineer

  • Amos Dantene GHANA

Cath Lab

  • Kevin Kunce, RT USA

Charge Nurse/Coordinator

  • Matthew Plourde, RN USA


  • Margaret Hudson, RN USA
  • Jessica Thatcher, RN USA
  • Stephanie Pretty, RN USA

Physicians Assistant

  • Brendan Riordan, PA USA

Database Researcher

  • Kelsey Zuckerman, BS USA

Outreach Internal Medicine  

  • Cleland Child, MD, MPH USA

Outreach RN

  • Abbey Roepke, RN, MPH USA

Outreach Assistant

  • DJ Sheikh, ESQ USA

Outreach Coordinator

  • Margaret Child, MPH USA


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

  • Edwards LifeSciences Foundation / Thoracic Surgery Foundation / Society of Thoracic Surgeons for grant support through the “Every Heartbeat Matters” initiative
  • Edwards LifeSciences Inc. for equipment and medical disposables donations
  • Medtronic / ATS for donation of heart valves and cardiothoracic disposables
  • Maquet Medical Systems USA for cardiovascular device and disposables donations
  • Scanlan Inc. for surgical instruments
  • AmeriCares Medical Outreach Program for equipment, medications, and medical disposables through the “Safe Surgery Initiative” program
  • ThedaCare Appleton Medical Center for medication, surgical supplies, and disposable materials donation
  • John Tylee Wilson and the J. Tylee Wilson Family Foundation
  • Joe and Brenda Adeeb
  • Ashley and Will Slagle
  • Bahram Hashemi and Accuware Consultants for logistical assistance and facilitation of medical donations
  • Shari Maguire and colleagues from CardioStart ReSale Thrift Foundation, Oregon, for their donation for database and general fund support
  • Janine Henson, Charlotte Kozlin & Margaret Child for CardioStart office administration and logistics
  • Lexi Parliament and Darlene Crook for managing all the equipment & supplies at the CardioStart warehouse
  • Manatee Memorial Hospital in Bradenton, Florida and Johns Hopkins All Children’s Hospital in St Petersburg, Florida for recurring medical donations
  • Warming The World for the donation of handmade baby blankets and hats
  • United Methodist Church, (Marilyn Zeigler & colleagues) Lake Oswego, Oregon for the heart pillows given to our surgery patients to splint for pain.
  • Abbey Roepke, Lexi Parliament & the Parliament Family for donating outreach supplies
  • Dan Carella & his student volunteers from Lecanto High School in Lecanto, Florida for donating outreach supplies
  • Maxine Rodgers for donating post-op patient kits
  • All of the generous donors and volunteers who have supported our programs in Nepal and worldwide throughout our 31 years of service