World Journal of Surgery

, Volume 38, Issue 9, pp 2205–2211

Partnership for Sustainability in Cardiac Surgery to Address Critical Rheumatic Heart Disease in Sub-Saharan Africa: The Experience from Rwanda

  • JaBaris D. Swain
  • Daniel N. Pugliese
  • Joseph Mucumbitsi
  • Emmanuel K. Rusingiza
  • Nathan Ruhamya
  • Abel Kagame
  • Gapira Ganza
  • Patricia C. Come
  • Suellen Breakey
  • Bonnie Greenwood
  • Jochen D. Muehlschlegel
  • Cecilia Patton-Bolman
  • Agnes Binagwaho
  • R. Morton Bolman
Article

DOI: 10.1007/s00268-014-2559-2

Cite this article as:
Swain, J.D., Pugliese, D.N., Mucumbitsi, J. et al. World J Surg (2014) 38: 2205. doi:10.1007/s00268-014-2559-2

Abstract

Importance

Rheumatic heart disease (RHD) in the developing world results in critical disability among children, adolescents, and young adults—marginalizing a key population at its peak age of productivity. Few regions in sub-Saharan Africa have independently created an effective strategy to detect and treat streptococcal infection and mitigate its progression to RHD.

Objective

We describe a unique collaboration, where the Rwanda Ministry of Health, the Rwanda Heart Foundation, and an expatriate humanitarian cardiac surgery program have together leveraged an innovative partnership as a means to expand Rwanda’s current capacity to address screening and primary prevention, as well as provide life-saving cardiac surgery for patients with critical RHD.

Evidence review

Interviews with key personnel and review of administrative records were conducted to obtain qualitative and quantitative data on the recruitment of clinical personnel, procurement of equipment, and program finances. The number of surgical cases completed and the resultant clinical outcomes are reviewed.

Findings

From 2008 to 2013, six annual visits were completed. A total of 128 prosthetic valves have been implanted in 86 complex patients in New York Heart Association (NYHA) class III or IV heart failure, with excellent clinical outcomes (5 % 30-day mortality). Postoperative complications included a cerebrovascular accident (n = 1) and hemorrhage, requiring reoperation (n = 2). All procedures were performed with participation of local personnel.

Conclusions and relevance

This strategy provides a reliable and consistent model of sophisticated specialty care delivery; inclusive of patient-centered cardiac surgery, mentorship, didactics, skill transfer, and investment in a sustainable cardiac program to address critical RHD in sub-Saharan Africa.

Copyright information

© Société Internationale de Chirurgie 2014

Authors and Affiliations

  • JaBaris D. Swain
    • 1
    • 2
  • Daniel N. Pugliese
    • 1
    • 2
  • Joseph Mucumbitsi
    • 3
    • 4
  • Emmanuel K. Rusingiza
    • 3
    • 5
  • Nathan Ruhamya
    • 3
    • 4
  • Abel Kagame
    • 3
    • 5
  • Gapira Ganza
    • 3
    • 6
  • Patricia C. Come
    • 2
    • 7
  • Suellen Breakey
    • 2
    • 8
  • Bonnie Greenwood
    • 2
    • 9
  • Jochen D. Muehlschlegel
    • 2
    • 10
  • Cecilia Patton-Bolman
    • 2
  • Agnes Binagwaho
    • 11
  • R. Morton Bolman
    • 1
    • 2
  1. 1.Department of Surgery, Division of Cardiac SurgeryBrigham and Women’s Hospital-Harvard Medical SchoolBostonUSA
  2. 2.Team Heart, Inc.BostonUSA
  3. 3.Rwanda Heart FoundationKigaliRwanda
  4. 4.King Faisal HospitalKigaliRwanda
  5. 5.Kigali University Teaching Hospital (CHUK)KigaliRwanda
  6. 6.Kanombe Military HospitalKigaliRwanda
  7. 7.Harvard Vanguard Medical AssociatesBostonUSA
  8. 8.Massachusetts General Hospital Institute of Health ProfessionsCharlestownUSA
  9. 9.Department of PharmacyBrigham and Women’s Hospital-Harvard Medical SchoolBostonUSA
  10. 10.Department of Anesthesiology, Perioperative and Pain MedicineBrigham and Women’s Hospital-Harvard Medical SchoolBostonUSA
  11. 11.Rwanda Ministry of HealthKigaliRwanda