MISSION REPORT

Adult acquired and congenital heart surgery 

At the Jakaya Kikwete Cardiac Institute (JKCI) Dar Es Salaam, Tanzania, Africa 

October 26 – November 5, 2022

After a year of COVID restriction, CardioStart was finally able to return to missions and a fourth return mission to JKCI (The Jakaya Kikwete Cardiac Institute), Dar Es Salaam.   This mission was cautiously undertaken as Tanzania’s medical systems were severely stretched by the covid pandemic. It was ambitious in intent with a program that included resuscitation techniques, surgery, cardiological teaching and outreach projects. It was successful and will assist the hospital hold a firmer footing in providing advanced cardiological care. Accordingly, a team of 21 volunteers joined together to bring their talents and commitment to educating others in their specialties.  

EDUCATION:

Under the direction of Emergency physician, Prof. Richard Harper, Dr. Barbara Ferdman, and Derek Rivera, the team included EMT/paramedics and nurses provided lecture and hands-on training in ECG, ACLS, PALS & ECHO interpretation. The education team assisted JKCI in presenting a three day course “Updates in Emergency and Critical Care”. The program provided 20 hours of much needed CME credit for hospital staff.  Topics in adult and pediatric care were covered. The course was well received by those attending the sessions. The course was made possible by the hands on assistance of many of the mission team and the kind donation of equipment used for training by Mr. Mike Pyalora of CalMed TC.

CARDIOLOGY:

This was a non-interventional cardiological mission as  another charity was visiting and covered most aspects of interventional care. CardioStart’s cardiologist, Dr. Rolando Rodriguez made regular rounds, helped prepare patients for surgery and gave general educational recommendations for peri-operative patient management.  

SURGERY:

Each operative scenario was held with the local team operating mostly in the primary surgical position and CardioStart surgical team working as assistant surgeons.  Technical skills in coronary revascularization, valve repair and replacement were given special attention. The local perfusionists were supported by two expert perfusionist and an Amsect student. The local perfusionists were provided with protocols and practical educational tips as part of their program development.  Generous perfusion-related disposables were donated to support the caseload being undertaken during the week of operations. 

ANESTHESIA:

Our CardioStart anesthesiologist, Dr. Michael Schupp taught intra-operative echo techniques and finer points of anesthetic intra-operative management. 

NURSING:

CardioStart ICU nurses led by Ms. Rachal Dorval, worked in the ICU area to develop protocols of clinical management, and during the week they provided help to put formal and bedside teaching routines into daily practice.  

DATABASE EVALUATION:

During the mission, CardioStart’s Statistical biosystem research expert, Prof. John Connett evaluated the level of efficiency to improve and advise on techniques of data recording and information gathering for patients passing through the surgical programs.  Ms. Sylviah Nyamu carried out the clinical assessments and documentation in all cases. 

OUTREACH:

Help was offered with some of the needs of the Valentine Children’s Home in Buza, Dar es Salaam where 32 children live in extremely poor conditions.  Over 40% of the children have been victims of trauma and suffer from frequent urinary infections / bed-wetting due to the lack of fresh drinking water when the pump goes out; the team leaders have very few medical supplies and receive almost no instruction on general medicine and antibiotic use. Hand-held Water filtration systems were donated by Wine-to-Water co inc.  Roof repair, mosquito window netting and other vitally important construction projects were undertaken in collaboration with an engineer introduced by the Valentine Project.  Sunglasses, crayons, pencils, were also donated

SURGICAL CASES

Some members of the CardioStart team

*Led outreach team projects

Acknowledgements:

We acknowledge with deep gratitude several individuals and corporations who facilitated this mission and/or made generous in-kind and/or financial donations

• Dr. Mohamed Janabi, Dr. Peter Kisenge and colleagues at JKCI: (local organization, hospitality and logistics).
• Dr. Peter O’Brien’s team and colleagues (Madaktari charity). 
• Accuware Consultants Inc. Ohio, USA (equipment). 
• CardioStart Administration Team USA (logistics).
• CardioStart ReSale Thrift, Oregon, USA (Funding for outreach flight).
• Americares USA  (donation of meds and sunglasses). 
• Eugene Southtowne Rotary Club, Oregon, USA (Equipment donations & Logistics).
• United Methodist Church, Lake Oswego, OR, USA) (patch dolls, hearts & patient hygiene kits).
• Mrs. Jennifer Fielding and the Splendid Church Foundation: (outreach support).
• Mrs. Jennifer Fielding & JBK Enterprises, LLC, & Mrs.Susannah Galloway (perfusion supplies)
• VSP Vision – additional donation of sunglasses. 
• Wine-to-Water Company (donation of water filtration systems). 
• California Medical Training Center, Mike Pyorala, RRT (emergency training equipment and shipping).
• Mrs. Lynn Cooper, BFW Inc. (Donation of headlight for local surgical team).
• Amy Lauth Foundation, Virginia, USA. (logistics expenses). 
• Tisgen Inc. California, USA. (pericardial membrane for surgical procedures). 
• Peace Health Hospital, Springfield, OR, USA, donations of equipment.