Projects

While the infrastructure for cardiac surgical care in Rwanda has grown considerably over the past twenty years, the referral pattern for surgical management continues to be delayed. One potential solution for the lack of access to specialized care is the training and mobilization of the 8,500 non-communicable disease (NCD) nurses available in Rwanda. The objective of this project is to improve referral patterns for RHD in the interest of optimizing resources and ensuring timely surgical intervention on fit patients. We plan to expand the current echocardiography curriculum, assess the quality and accuracy of images obtained by trainees in the community, improve skill and knowledge-sharing with multidisciplinary educational conferences, and establish a general set of guidelines for cardiac surgical referral. By addressing these critical components of the cardiac care infrastructure, we anticipate significant improvement in the quality and timing of cardiac surgical referrals.

In patients with heart failure due to RHD, surgical repair or replacement of their heart valves is often necessary. Mechanical valves predispose patients to severe complications such as strokes and blood clots, therefore patients are required to be on lifetime anticoagulation postoperatively. This poses an enormous burden on female patients of child-bearing age, as the most common anticoagulant (Warfarin) is teratogenic and associated with risks of bleeding, therefore women are advised not to become pregnant. However, desire for children and social expectations often become overwhelming, and many do become pregnant despite the high risk to themselves and their fetuses. The main goal of this project is to identify the outcomes in Rwandan women who have received life-saving valve replacement due to diagnosis of RHD and who have subsequently gotten pregnant. This will provide an opportunity to improve the medical management of this group of patients and will allow an avenue for advocacy.

RHD can be costly both to the patient and the country, with financial burdens including long term medication use, recurrent hospitalizations, lost wages from time spent unable to work, and in many cases, need for surgical intervention. Evidence suggests that the costs associated with living with chronic illness contribute to cyclical poverty in low-and-middle income countries (LMICs) such as Rwanda, indicating that investment in timely management of RHD is not only in the interest of the patient, but also in the interest of the nation itself. This study proposes investigating the cost-effectiveness of RHD interventions by weighing the costs of RHD interventions against the benefit. In so doing, this study aims to justify additional funding of RHD screening and interventions in the nation of Rwanda.

The importance of simulation in surgical training is widely acknowledged. Simulation training has been shown to decrease operative time, increase accuracy, and help with management of adverse events and produce safer surgeons. In low-resource environments, training opportunities can be limited, rendering simulation training especially valuable. Despite these known benefits, current simulation platforms are limited by multitude of barriers, including affordability, portability, accessibility, and ease of implementation into existing training programs. We have created a solution to these barriers by designing a low-cost, adaptable surgical simulator to overcome resource constraints, allowing for easy and affordable implementation.