Spokane-based medical team heals hearts in Rwanda
KIGALI, Rwanda – The youngest of the patients was dangling his legs off the side of his bed. The white coats were taking up most of the room, seven or eight of them with their manila folders. They spoke only English, but he could make out a few of the words. His eyes followed the group around the room as they pushed their laptop on a rolling table from patient bed to patient bed. Suddenly they surrounded him, removed the stethoscopes from their necks, and leaned close to listen to his heart.
Clomany opened his shirt to allow the doctors to listen for a moment before taking the stethoscope from one of them. He pressed it to his own chest.
“Can you hear it?” one of the young residents said.
“Oh, yes,” he said tapping his chest. “I’ve got a 4 over 6 systolic murmur.”
At least that’s how Dr. Hal Goldberg remembers it. He knew Clomany was special from the moment he began to review the boy’s case on the second floor of the Heart Institute at Providence Sacred Heart Medical Center in Spokane. Goldberg had watched images of the heart valves that had been recorded on an echocardiogram and projected onto the wall. Along with a team of doctors, he tapped his pen and tried to hypothesize how best to solve the puzzle.
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The group of doctors were from Healing Hearts Northwest, a Spokane-based nonprofit group that had spent the last year raising funds and donations of supplies for their annual two-week visit to King Faisal Hospital in Kigali, Rwanda. Goldberg – called Dr. Hal by nearly everyone – was largely responsible for the team being there.
He had first come in 2008 on an exploratory trip, somewhat begrudgingly, with only a backpack over his shoulder. There, he met Dr. Joseph Mucumbitsi, the only cardiologist in the country at the time. Mucumbitsi had returned to his country after the 1994 genocide that devastated Rwanda’s educated class. Estimates are that more than 70 percent of physicians had been killed or fled the country, many never to return. But Mucumbitsi couldn’t stay away, bringing his entire family with him to help with the process of rebuilding the country’s health care system.
Goldberg was lukewarm on the momentous task until his college-age son convinced him he would never have an opportunity to make such radical change to a county in rebirth. After meeting the patients and doctors in Rwanda who already were working with heart surgery teams across the world, Goldberg couldn’t turn back. Now seven years later, he’d returned with a team of almost 40 people who had brought more than 250 trunk-size boxes of supplies across the ocean.
Early this month, they would attempt to save the lives of 16 patients.
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Clomany already had been admitted twice to the hospital with heart failure from a backup of fluid in his heart. Two of his heart valves were leaking, severely, which caused his heart to work twice as hard. He would easily become short of breath and was unable to keep up with his friends in daily activities.
When Goldberg stepped from the back of the group of white coats and asked the boy’s father what medications Clomany was taking, the 14-year-old didn’t hesitate before listing them himself. It was as if he was reading them from a medical chart. Goldberg shook his head and laughed – most kids didn’t take their medications, much less know the names.
The doctors talked with Clomany and his father through a translator and explained the procedure scheduled for the following morning. They explained that with new mechanical heart valves, Clomany would need to take blood thinners the rest of his life. This was no small task, as missing a few pills would mean a stroke or death. If he was lucky, the surgeon, Dr. Neil Worrall, might be able to repair the actual valve, avoiding the need for the lifelong medication.
Clomany Mugisha at some point in his life had contracted strep throat, a bacterial infection common anywhere in the world. With a $1.87 dose of penicillin, strep infection is eradicated within a few days. Without it, Clomany’s body had produced antibodies to fight the infection that also attacked his own tissue, damaging his heart over the next months and years. Untreated, the sore throat had become rheumatic fever, which had progressed into rheumatic heart disease.
Most doctors won’t ever see a case like this in the U.S., but in developing nations it is still common, affecting 18 million people in Africa alone, most of them children.
Now, a few hundred miles from his hometown in Rwanda, Clomany was about to undergo open-heart surgery.
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Just down the hall, wandering from room to room, a former patient was checking on the new arrivals. Evariste Munyensanga was treated four years ago by the visiting doctors from Spokane. At the time, he had endured debilitating chest pain and shortness of breath that made it difficult for the former soccer player to even walk to school.
Goldberg met him in April 2011 and remembered how it took Munyensanga so much energy just to breathe. He couldn’t speak a word of English and he rarely spoke at all. Now, he was stopping to see every nurse and doctor he’d met during that life-changing year, and talking with the four new patients.
In the pre-operation room, he found Clomany lying in his hospital bed, staring intently at the ceiling. He told all the new patients that he was a former heart patient. Clomany was the only one to ask about his complications and life after heart surgery.
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In the theatre – what’s known in America as the operating room – Clomany was going under anesthesia. His eyes, normally bright and curious, were staring lifeless at the broken ceiling tiles. The nurses moved around him, stepping over dozens of power cords strung overhead and underfoot, powering the dozen or so machines that monitored the patients and kept them alive. The room was full of quiet activity as nurses prepped the tables of sutures and anesthesiologists monitored vitals. Clomany was lying still, except for his heaving chest that continued to rise and fall on the operating table as if trying to escape his 60-pound body.
With a breathing tube in place, the medical staff opened the boy’s chest with a power saw, clamped his sternum and maneuvered with handfuls of instruments around his broken heart. As the surgeon was preparing his heart for bypass, Clomany’s pulse suddenly jumped to 200 beats per minute. The heart monitor, which had been keeping constant tempo in the cavernous room, began to sound its tapping siren as if in Morse code. The surgeon reached in with two of his fingers and massaged the throbbing heart muscle. He called for the paddles and a nurse handed him what looked like barbecue tongs with two flat, white ends. He fit the defibrillator into the small cavity so it touched both sides of Clomany’s heart and sent a shock. The beeping pulse in the room steadied. The surgeon returned to his task of directing the blood to the heart bypass machine. The anesthesiologist standing near the heart monitor said the boy had died for a minute.
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Down the hall from the theatre, Munyensanga and Goldberg were sitting on a bench together catching up like old colleagues. Since his surgery four years ago, Munyensanga had gained weight, graduated from college, was working in the community and leading a Rwandan cardiac patient advocacy group. He never seemed to lose the smile he was wearing.
Goldberg arranged a checkup the next afternoon; Munyensanga said he was about to leave to go for a run. Goldberg patted him on the chest and they parted ways.
When Clomany woke up, his first word was amazi. It is the word for water in Kinyarwanda, the language spoken by most Rwandans. The nurses dipped a small pink sponge in a plastic bottle and touched it to his lips. He demanded more immediately, but the nurses said he had to start slowly. After shutting down his organs for more than three hours during surgery, he needed to wait for his body to restart.
He had awoken quickly after his surgery, and the intensive care nurses were still working on securing his IV drips and the plastic tubing that wrapped around his ears and into his nose.
“Why the oxygen?,” he said in English, as if he was ready to get up and walk home.
The nurses laughed and marveled at his understanding. Then they gave him a heart-shaped pillow to hold against his sternum to reduce pain and help with healing and a plastic windmill to blow on, an exercise for strengthening the lungs.
Munyensanga stood across the room as the dozen nurses and doctors who were working on Clomany began to disperse. He slowly made his way to Clomany’s side and stood at his bedside. He took his hand and they spoke in whispers. Rwandans often touch as they speak to one another; when walking together they may hold hands and speak softly. From a distance, it appeared as if Munyensanga and Clomany had known one another for years.
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By the end of the weekend, all 16 surgeries would be complete. A week later the patients would be at home recuperating and the doctors would be on their way back to the United States. But the work was far from over.
Goldberg and his team plan to return every year but hope that the expertise they bring eventually will be handed over to Rwandans. The size of the American teams has been shrinking as local medical personnel are able to step in.
Among the 80 patients treated by the Spokane medical teams over the years, there’s a brotherhood, one that extends across gender, economic or ethnic lines.
They call it the zipper club – those who have been lucky enough to go under the knife and come out on the other side healed.
Munyensanga is only one of the hundreds of heart patients whose lives have been changed in this hospital by four teams of medical professionals, including the group from Spokane, and one of dozens of patients who return every year to provide comfort and teach the new generation how they can learn to live in this changed world. It is Goldberg and Healing Hearts who are giving Rwandans a chance, but the Rwandans who are starting to take the reins.
As Clomany and the other patients recuperated, both of his parents were glued to his bedside, hoping to soon make the three-hour return trip home by public bus. While they waited, Goldberg, and later, Munyensanga stopped by. They gave the same advice – to continue to take his medicines, keep his scar clean and never stop exercising.
A few days later, everything would return to normal – Goldberg would return to Spokane, Clomany to his village and Munyensanga to his life in Kigali – at least for another year. It is the goal of the work: the creation of a new normal.