Mission to develop adult and adult congenital heart surgery in Dar es Salaam, Tanzania. 5th – 19th January, 2019
We have pleasure in announcing the first historic mission to JKCI (The Jakaya Kikwete Cardiac Institute), Dar es Salaam. Volunteers will be enlisted from previous waiting-list files, and on a first come, first served basis. You are encouraged to apply; if there is insufficient room on one particular mission, your name will be held forward for the next available mission.
The Republic of Tanzania was formed as a sovereign state in 1964 through the union of the separate states of Tanganyika and Zanzibar. Mainland Tanganyika covers more than 99 percent of the combined territories’ total area. It is bound by 7 countries through its borders and is South of the Equator. Dodoma, since 1974 the designated official capital of Tanzania, is centrally located on the mainland. Dar es Salaam, (in Arabic, meaning ‘Haven of Peace’) remains the seat of most government administration, as well as being the largest city and port in the country. It has Africa’s highest mountain, Kilimanjaro (19,340 feet), and the world’s second deepest lake, Lake Tanganyika (4,710 feet deep). The majority of Tanzanians are of Bantu descent. A third of the population are Christians and slightly more are Muslim. The two principal languages are Swahili and English. The economy is largely agrarian.
It varies: it is equatorial, so there is no strict separation into Winter or Summer, but in January, it can still be hot and humid.
Cardiac Surgery Status in Dar es-Salam
JKCI is the only cardiac institute in the country; it also attracts patients from some surrounding countries. It is affiliated with the University, has junior doctors rotating through the specialties there, and strongly emphasizes teaching.
The hospital has 128 beds, including 15 ICU beds (combined pediatric and adult), 3 OR theaters (at the time of visiting, only two were in use) a pediatric and adult cardiac ward for pre and post-operative patients (a new pediatric ward with 50 beds is in development). There is a busy cardiac catheter laboratory and an outpatient clinic (open 6 days a week). The institute is funded publicly.
The need for cardiac surgery development is dire. Complex cases are generally sent to India. As with other countries in Africa, there are very few centers doing cardiac surgery and even then, many are functioning at the minimal volume level.
A: ADULT CARDIAC SURGERY & OLDER COMPLEX ADULT CONGENITAL CASES
B: FURTHER DEVELOPMENT OF PACING, INTERVENTIONAL CARDIOLOGICAL PROCEDURES
CardioStart’s role will be to help develop a comprehensive adult cardiac surgery program in January, 2019.
The team will work with the local team to:
- further establish the essential features required for routine cardiac surgery, including some advanced adult operative techniques;
- help set the necessary benchmarks for the Hospital to retain its position as a regional tertiary referral center;
- assist development of a rhythm of regular operating,
and provide bed-side teaching of vital principles of nursing management in caring for the per-operative patients.
CardioStart will not be sending a container to this location.
The angio-catheter suite is functioning well and has accomplished several hundred procedures with the visiting US charity team (led by Dr. Peter O’Brien, Virginia, USA). Although JKCI does do some surgical coronary revascularization they want more training in advanced techniques. Their personal experience with valve surgery is limited due to their difficulty in obtaining valves locally.
Before surgery begins, a full review of patients and a “Dry Run” rehearsal will be carried out, testing equipment and staff educational in-servicing. The educational program will focus on anesthesia, nursing, biomedical, perfusion, ICU equipment preparation and teaching. The choice of heart cases will be made at the discretion of the heart surgeons, and will likely be adult acquired, older congenital cardiac presentations and various valvular pathology, subject to local cardiology review and recommendation.
Visiting cardiac surgery team recommended:
- 1-2 adult cardiac surgeons
- 1-2 adult anesthesiologists
- 1 intensivist
- 1 Laboratory medicine physician/hematologist
- 2 Cardiologists (One, interventional trained)
- 1-2 perfusionists
- 4 adult cardiac ICU nurses
- 2 pediatric cardiac ICU nurses
- 1 biomed engineer
- 1 respiratory therapist
- 1 educational instructor
- 2 OR Nurses/Techs (1 circulating, 1 scrub)
- 2 Database collators
Airfare costs will be self-funded by each volunteer. Popular flight corridors are Delta or United from Dulles to Zurich or Amsterdam. Then to Nairobi or Kilimanjaro and on to Dar es Salaam. Others have taken routes through London. In selecting your airfare, first select the most convenient international embarkation point from your home state, as domestic travel from the point of origin can be negotiated separately and sometimes, much cheaper.
This is in discussion and may be at the Southern Sun Hotel which is 3km from the hospital. Volunteers should expect that they may be asked to agree to same-sex room sharing in order to help reduce the costs incurred. CardioStart will assure minimum standards to ensure volunteer safety and comfort, but we will try to be sensitive to the financial burden borne by the local officials.
Breakfast is at the hotel. 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 volunteer’s own expense. They are generally of a high standard and inexpensive.
Tanzania is listed as Level 2 (exercise increased caution) on the website Travel.State.Gov as being a level advisory: Random crime, terrorism (1998), and targeting of LGBTI westerners has occurred. The hospital and surrounding areas are safe according to mission teams that have already visited. Further advisories will be given to those who apply to join this mission.
(Full details will be sent to those volunteers joining this mission). All volunteer activity will be carried out with full HIV precautionary measures. You should have a routine check before travel of your HIV and Hepatitis a/b/c status. Vaccinations must include a current Yellow Fever if you are traveling from a previously known yellow fever location, and tetanus protection (within 10 years) with certification. Volunteers will be advised to take malaria prophylaxis just before the mission and those with serious medical conditions should obtain consultation and approval from their doctor prior to the mission. Please see the CDC website for international travel guidelines.
Applying to join the team:
Simply contact us soon by going in to our volunteer interest form and registering your interest. If accepted, you will then receive a Selection letter listing all the required documents. There is a $40.00 (USD) registration fee to be paid on the website as a “donation”. This helps us in our preparation and mailing of documents to Nigeria’s Ministry of Health. Selection will be on a “first come – first served” basis and according to positions needed for the team.
All pre-mission information will be sent by e-mail from our Tampa office. Therefore, we request you give us your personal e-mail address (not employment address) so that you can receive electronically derived information and attachments about the mission. (Volunteers using hospital or company web servers sometimes find that their institution’s spam filters block attachments and group mailings).
Helping us to Prepare:
We need help with Cardio/Vascular/Thoracic OR instruments, ICU disposables, central lines, oxygenators for heart surgery bypass, and general medical equipment and disposables to donate to the Hospital. If you hear of any equipment to donate, please contact our Tampa office. (Info@cardiostart.org). Please ALWAYS obtain written consent from your department Head, when receiving donations. We can provide a disclaimer to the donating institution and tax information. If you live in Florida or Oregon, we will require that you make at least one visit to assist the warehouse sorting and preparation that goes on throughout the year. In supporting the success of the mission we will also you to bring an extra (old) suitcase that can be filled with suitable donations, emptied on site then left behind.
These are in discussion and volunteers will be notified later.
Any tour arrangements should be made for the time period after the mission ends. This time is considered a personal vacation and is not part of the mission; therefore, CardioStart canot assume responsibility nor directly help you. The local team will be able to advise about best choices. During the interval weekend, the local team may also organize an outing, so it is to wait and make internal tourist travel arrangements during the week you arrive.
Within the country…
There are coastal, jungle trips and other adventures are worth considering.
Tanzania has large national jungle parks and game reserves spread throughout the country. Collectively they contain an abundant diversity of fauna, (buffaloes, roan antelopes, chimpanzees, crocodiles, hippopotamuses, hyenas, giant forest hogs, lions and leopards, as well as fascinating and diverse flora.
The Serengeti is a massive national park that is a two-hour flight from Dar es Salaam, and it is famous for its annual migration of over 1.5million, white-bearded wildebeest and 250,000 Zebra. There is a chance one can see the “Big Five“ (Buffalo, Elephant, Lions, Leopards, & Rhino).
The Ngorongoro Crater is also accessible – the largest inactive crater, housing about 25,000 large animals. In this area is the Oldupai Gorge – considered to be the seat of humanity, following the discovery of the earliest known specimens of the human genus, Homo Habilis, as well as early Hominidae.
Mount Kilimanjaro is the highest mountain in the African continent and tallest free-standing mountain on earth, at 5,895 meters (19,341 feet). It is accessible through a one-hour flight from Dar es Salaam.
Surrounding areas of interest…
The island of Zanzibar..
Zanzibar, in the Indian Ocean is a 30-minute flight (or ferry) across. It has soft sandy beaches, a strong Arabic influence, a collection of spice farms and a World Heritage Site, the historic city of StoneTown. The Jozani Forest is home to over 50 species of butterfly, 40 species of birds and, the nearly extinct Zanzibar Leopard.
Accessible by air (but not by a direct route), are some astonishingly beautiful sights, such as the Victoria Falls.