CardioStart’s 5th Mission to

Kathmandu University / Dhulikhel Hospital

&

2nd Mission to

 Human Organ Transplant Center

 

Dhulikhel & Bhaktapur, Nepal

June 2-10th, 2017

 

The Himalayan Range at sunrise from Dhulikhel

On June 2nd, 2017 an international team of 13 volunteers traveling from Ghana, Nigeria and the United States came together to assist the people of Nepal.

This was CardioStart’s fifth visit to Kathmandu University hospital in Dhulikhel, Nepal.  Our first mission to help initiate the cardiac surgery program in May of 2015 overlapped with the devastating earthquake and aftermath that claimed more than 9000 lives.  The CardioStart team partnered with the clinicians of Dhulikhel Hospital in the earthquake relief efforts throughout the Kathmandu Valley and at the primary hospital, which served as a major center to which casualties from most of eastern Nepal were directed.

Although no cardiac surgery was pursued under those circumstances, the people of Nepal and specifically those at Dhulikhel hospital showed their remarkable strength and resilience by wishing to move forward with the cardiac surgery program only a few months later.  This choice was primarily made for the countless patients in desperate need of cardiovascular care, but also because it represented a sign of progress and recovery following the tragedy.  Therefore, in November of 2015, the CardioStart team returned to Nepal to assist in the establishment and performance of the first heart surgeries at Kathmandu University.

Two years later, CardioStart returned for its 5th visit to Kathmandu University / Dhulikhel Hospital (DH) and 2nd visit to the Human Organ Transplant Center (HOTC) to progress and advance their cardiovascular programs through education, skill transfer, and further partnership with our Nepali colleagues.  The HOTC location is staffed by the same clinicians with whom we have worked in Dhulikhel Hospital, but an important difference is the availability of a government stipend for the indigent at this facility.  Although CardioStart uniformly provides care free of any charge, this  government designation often compels many families to seek treatment there.  HOTC is poised to be a critical collaborative partner with Dhulikhel Hospital and the two institutions will work together to provide access to cardiovascular care for the first time to much of Eastern Nepal.

 CardioStart missions are built upon four major objectives: Donation, Education, Clinical Care & Outreach.

  

OBJECTIVE I: DONATION

CardioStart aims to position programs for safety and success.  In November of 2016, CardioStart sent the second of two 40-foot shipping containers packed full with donated supplies for the 2 programs in Nepal to utilize.  Donations of special note and value include an echo machine for transesophageal echocardiography, an Intra-Aortic Balloon Pump for the safer conduct of high-risk interventions, and sponsored establishment of a blood bank for the first time at Kathmandu University / Dhulikhel Hospital.

OBJECTIVE II: EDUCATION

As a primary focus of all CardioStart missions, training and education are prioritized in every area of clinical practice.  This begins with a comprehensive ‘dry run’ that examines every stage in the continuum of care for the cardiac surgical patient, beginning with the pre-operative evaluation and establishing logistics of every step from preparation to conduct of the actual operation, with progression through each benchmark of the peri-operative hospitalization.  This process engages the entire CardioStart and local team in collaboration to identify safety or efficiency concerns prior to the any patient undergoing an actual operation.

Once this has been satisfactorily achieved, one-to-one skill transfer is accomplished in every major area: surgery, cardiology, anesthesia, perfusion, ICU and OR nursing, and even areas such as biomedical engineering and family social support.  Each one of these critical areas contributes as equally and meaningfully to a successful outcome as the surgery itself.

An important adjunct to this unique one-to-one training is complimentary didactic lectures and educational curricula.  In Nepal, CardioStart has achieved this goal through opportunities such as a daily structured ICU RN review program, hands-on cardiology symposia on trans-esophageal echocardiography, and participation by CardioStart experts in local multidisciplinary medical society meetings.

OBJECTIVE III: CLINICAL CARE

Surgical Cases

Date	Id No: (HIPAA applies)	Age	Procedure	Outcome
4th Jun 2017	BT	61 yrs (F)	Aortic Valve Replacement	Developed acute renal insufficiency and died 4 days after surgery
5th Jun 2017	CB	53 yrs (M)	Coronary Artery Bypass Grafting x 3	Satisfactory
7th Jun 2017	SB	47 yrs (M)	Aortic Valve Replacement	Satisfactory
8th Jun 2017	SD	45 yrs (M)	Mitral Valve Replacement	Satisfactory

This mission allowed four patients and families to receive complex cardiac surgical care, along with numerous others who were evaluated and treated  for future interventions at both Dhulikhel Hospital & Human Organ Transplant Center.

The local team performs an increasing number of heart surgeries in the intervals between missions,  and prepares more complex cases for assistance during CardioStart team visits. 

 

 OBJECTIVE  IV:  OUTREACH

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 & conduct outreach clinics in the remote valleys and mountainous terrain areas where access to local medical care is rare or impossible.   That experience and intel revealed a need for more skilled manpower to screen large communities for rheumatic heart disease and other cardiovascular problems in those areas.

Therefore, this mission marked a new initiative to enroll individuals in an ongoing  CardioStart-sponsored “Echo School” where selected nurses will be trained in the capacity of an Echo Technician (a role that doesn’t currently exist in Nepal).  This will occur through the combination of a certified online curriculum and a scheduled rotation of volunteer cardiac sonographers, sponsored by CardioStart  International to travel to Nepal for 2 weeks every month to provide one-to-one hands-on training.   Once fully trained, these physician-extenders will allow increased access to evaluation & care with echo screenings & diagnostic studies in remote satellite clinical locations.

THE TEAM:   

Emily Farkas MD (Mission Director, Cardiac Surgeon, USA)

Matthew Plourde RN  (Mission Coordinator, USA)

Jay Pal MD (Cardiac Surgeon, USA)

Tom Hilton MD (Cardiologist, USA)

Cory Alwardt CCP (Perfusionist, USA)

Ariyo Idowu CCP (Perfusionist, Nigeria)

Amos Dantene MGhIE (Biomedical Engineer, Ghana)

Laura Ladwig RDCS (Cardiac Sonographer, USA)

Jolie Dietzen RN (ICU RN, USA)

Mollie Raymond RN (ICU RN, USA)

Brittany Gabrielle RN (ICU RN, USA)

Carise Blenkhorn RN (ICU RN, USA)

Angie Hutcherson RN (Database Coordinator, USA)

 

ACKNOWLEDGEMENTS

CardioStart International wishes to extend their sincere thanks and appreciation to:

1. Edwards LifeSciences Foundation / Thoracic Surgery Foundation / Society of Thoracic Surgeons for grant support through the “Every Heartbeat Matters” initiative.
2. Edwards LifeSciences Inc. for equipment and medical disposables donations.
3. Medtronic / ATS for donation of heart valves and cardiothoracic disposables.
4. Maquet Medical Systems USA for cardiovascular device and disposables donations.
5. Scanlan Inc., for surgical instrument availability and donations.
6. Abbott Point of Care for I-Stat equipment and disposables.
7. AmeriCares Medical Outreach Program for equipment, medications, and medical disposables donation through the “Safe Surgery Initiative” program.
8. ThedaCare Appleton Medical Center for medication, surgical supplies, and disposable materials donation.
9. Amy Lauth Foundation, Roanoke, VA for logistical help in Tampa, Florida and container expenses.
10. John Tylee Wilson and the J. Tylee Wilson Family Foundation.
11. Joe and Brenda Adeeb
12. Ashley and Will Slagle
13. Bahram Hashemi and Accuware Consultants for logistical assistance and facilitation of medical donations.
14. Shari Maguire & colleagues from CardioStart ReSale Thrift Foundation, Oregon, for their donation for database and general fund support.
15. Janine Henson, Charlotte Kozlin & Nadine Nuchovich for CardioStart Office Administration & Logistics.
16. All of the generous donors and volunteers who have supported our programs in Nepal and worldwide.