Save a Child’s Heart has conducted a successful Catheterization Mission at the Jakaya Kikwete Cardiac Institute (JKCI) in Tanzania from the 27th May – 2nd June 2019. This was a joint Israeli-Tanzanian effort to save children’s lives. Representatives from SACH Canada joined the mission to assist the team and to gain greater insight and understanding of the work performed by SACH and local doctors. During the week-long mission, the Israeli and Tanzanian medical teams worked together, teaching, sharing skills and jointly saving the lives of 18 children and 1 adult. The full list is attached. Furthermore, this mission saw the unveiling of a new echo machine. This mission and the acquiring of the echo machine was a Save a Child’s Heart Canada project.
A team effort:
This mission was carried out by a team of 10 talented medical personnel from Wolfson Medical Center alongside a local Tanzanian medical team of 32 from JKCI. Leading the Israeli delegation was Dr. Sagi Assa, a senior pediatric interventional cardiologist from the Wolfson Medical Center together with Save a Child’s heart Co-Founder and senior pediatric cardiologist, Dr. Akiva Tamir. Other team members include anesthetist Dr. Andrey Gluch, pediatric cardiology resident Dr. Sivan Alkarat, pediatrician Dr. Adi Prizan Ravid, Head Cath lab Nurse, Svetlana Katsovich, Cath lab technician Tal Sela, PICU deputy head nurse Revital Cohen as well as PICU nurses Efim Fainstein and Polina Pokrass.
Assisting the Israeli team was Dr. Alex Loth Ernest and Dr. Stella Mongella, both Tanzanian doctors currently completing a SACH Canada led two-year outreach training program in pediatric cardiac anesthesiology and pediatric cardiology at the Wolfson Medical Centre. Dr. Loth is being mentored throughout his anesthetic training by Dr. Gluch.
The Israeli team worked hand in hand with senior pediatric cardiologist Dr. Naiz Majani. Dr. Majani completed three years of training in Israel under SACH and is now leading an outstanding Tanzanian pediatric team, clinic staff, and nurses to successfully screen and treat children in need. Amongst the team was ICU doctor Dr. Vivienne Mlawi, who worked closely with Israelis Dr. Elkarat and Dr. Prizan Ravid in the PICU as well as Chinese pediatric interventional cardiologist Dr. Zhao Lijian, who performed caths alongside Dr. Assa. Also on the team was pediatrician Dr. Evelyne Furumbe, registrars Dr. Theophil Ludovick and Dr. Alexander Mrosso. In attendance were pediatric clinic staff: Nurse Husna Mzunga, nurse Prisca Kamugisha, Peter Yakobo, and block manager Hilda Karau. The Tanzanian cath lab team were led by Rogers Kibula and included Keyness Mng’anya, Rydiness Murashani, and Michael Lazaro. Kulindwa Kasubi managed Tanzanian technologists: Polycarp France, Godfrey Tamba, and Benher Wakonde- an Indian technician who worked closely with Israeli technician Tal Sela. Head Tanzanian PICU nurse Prisca Kiyuka worked in conjunction with Israeli PICU nurses Revital Cohen, Efim Fainstein and Polina Pokrass. Nurse Prisca’s team included Pal Bhadreshwara, Lucia Kabeyao, Daniel Yohana, Bruno Selege, Mary Haile, Jackline Urio and Moris Obwanga. Also present was Health Attendant Irene Isaac and pediatric ward nurses Theresa Marombe and Theresa J. Tarimo.
As in previous years, SACH coordinated and organized the logistics of the mission. The SACH Israel office secured flights, accommodation, travel and malpractice insurance, per diem and essential day to day needs of the international teams involved. The preparation process was a repeat of the previous CATH mission, which took place in January. As before, the SACH Cath lab team prepared the list of required equipment, devices, and disposable materials. SACH coordinated with the various medical equipment companies to receive the necessary equipment either through in-kind donations or through discounted purchases.
Arrival and mission commencement:
On arrival in Tanzania, the Israeli team were met by Godwin, Stella and official foreign ministry representative Mr. Hangi. Having secured visas for before arriving at the airport for the first time ahead of the mission the Israeli team were assisted smoothly through customs due to arrangements made by Tanzanian ambassador to Israel, Mr. Job Daudi Masima.
Early the next morning the Israeli team were ready and eager to begin preparing for the mission ahead. Both Israeli and Tanzanian teams worked together to unpack and organize medical equipment, set up the Cath lab, echo room, and PICU. Once completed Doctor Assa, Doctor Tamir, and Doctor Naiz Majani, a SACH trained Tanzanian senior pediatric cardiologist, began the important work of screening patients with the goal of saving the lives of as many children as possible. At risk patients had been invited to the clinic by the Tanzanian medical team to be examined and evaluated to identify which children could be treated by catheterization during this mission. Twelve-year-old Rehema was the first patient scheduled to undergo catheterization. Having been diagnosed with Patent Ductus Arteriosus, a persistent opening between the two major blood vessels leading from the heart, it was essential that she receive immediate treatment. The procedure complicated and required careful attention. Although the procedure was performed successfully, Rehema will still need further treatment in Israel.
Monday also saw the arrival of the SACH Canada team who were welcomed, alongside SACH Israel by JKCI hospital management. After giving an informative overview of the hospital and its cooperation with SACH, its director, Professor Mohammed Janabi, thanked all visitors for their attendance and support. Later that evening, the Canadian High Commissioner hosted a reception to honor the work of SACH. This event was held in her residence and attended by former SACH Canada chairwoman Riva Grinshpan, SACH Canada board member Jason Schwartz and SACH Canada Executive Director Marni Brinder Byk. Also in attendance were SACH Israel Executive Direction Simon Fisher and Tamar Shapira, Director of International & Public Relations.
The SACH medical team continued their work late into the night, screening and performing lifesaving laving procedures.
The heart of the mission - Tuesday 28.05.19
The dedication of both teams was evident as all began with enthusiasm early the next morning. While doctors continued to screen patients, medical relationships were further cemented through the partnership of Head Cath lab nurses Svetlana Katsovich from Israel and Roger Kibula from Tanzanian who worked tirelessly to ensure all procedures were meticulously prepared. Throughout the mission, Israeli doctors and nurses provided the Tanzanian team with ongoing formative and informative training, which added a new dimension to the mission.
Included in the patients scheduled to undergo catheterization during the coming week was Irine, a sweetly shy little girl suffering from Atrial Septal Defect, a hole in the wall between the two upper chambers of the heart which if left untreated, can damage the heart and lungs. The Canadian team drove for hours to meet Irine and her family. They spent time together, listening to Irine ’s story and learning of the hardships endured. The Canadian team brought Irine and her parents back to the KJCI to undergo lifesaving treatment. A further four catheterizations were performed that day on children who required urgent attention.
Following the catheterization, the children were transferred to recovery in the Pediatric Intensive Care Unit (PICU), where they stayed an additional 2-3 days. Israeli pediatric cardiology resident Dr. Sivan Alkarat and pediatrician Dr. Adi Prizan Ravid worked together with nurses Rivital Cohen, Efim Fainstein and Polina Pokrass as well as Tanzanian ICU doctor, Dr. Vivienne Mlawi and ICU nurse Prisca Kiyuka and her team to monitor patient recovery. The PICU team was assisted by Eden Schwartz, a Canadian third-year nursing student who joined the mission as a volunteer. Dr. Assa and Dr. Tamir continued to examine children post-catheterization, running Echo examinations, and ensuring the recovery was successful.
During this time, the Canadian team met with representatives from the Agah Kahn Hospital, a 170-bed multispecialty hospital providing general medical services, specialist clinics, and diagnostic services.
Day 3: Wednesday 29.05.19
Another early start saw the screening of numerous children, presentation of future catheterization cases, attendance of echo post-operative follow up appointments and treatment of five children from eighteen months to five years old all suffering from varying types of congenital heart disease.
While doctors worked assiduously, a press conference was held at the hospital with various media outlets in attendance. A moving ceremony was held in which a brand-new echo machine, purchased in Israel through Canadian donations, was given to the Tanzanian pediatric cardiology department. Later the same day a dinner party was held by the JKCI management team bringing together SACH representatives, doctors, former patients, and their families.
During the evening a catered event hosted by JKCI and SACH was held at the Protea Courtyard Hotel. Past Hospital management, medical teams, and SACH representatives attended as well as former patients and their families. Amongst the speakers was hospital director Professor Mohammed Janabi who thanked SACH and Tanzanian teams, welcomed families and spoke of the cooperation between the hospital and SACH. Both Simon Fisher and Riva Grinshpan spoke. Moving speeches were made by the mother of Mukadam, a former patient who was brought to Israel with a very complicated case who recently returned to Tanzania. His mother warmly thanked all those involved in helping to save her son’s life. Many were moved by Ferdinand’s speech, a now healthy 16-year-old previous SACH patient. He spoke about his time in Israel and how his life had changed on his return to Tanzania. Ferdinand spoke of his recent schooling accolades which were possible following the lifesaving treatment he received in Israel.
Day 4 Thursday 30.05.19 and onwards:
During the days that followed both teams led by Doctor Assa and Doctor, Naiz Majani continued to perform lifesaving catheterizations. Of the fifty-six children screened throughout the week, 18 children were found suitable for treatment during the mission while an additional four children will be flown to Israel for more complicated catheterizations
Complicated cases and personal accounts:
During the mission, the Head of Pediatric Cardiology was asked if a special exemption could be made to examine Twenty-nine-year-old Devota, a critically ill schoolteacher suffering from advanced stages of Congenital Heart Disease. Devota was suffering from Pulmonary Stenosis, a condition characterized by obstruction to blood flow from the right ventricle to the pulmonary artery. This obstruction is caused by narrowing (stenosis) at one or more points from the right ventricle to the pulmonary artery. Pulmonary Stenosis is a disease predominantly seen in babies and small children. Those suffering usually do not survive infancy, let alone adulthood. The disease had progressed so far that Devota was blue and could not walk a meter, leaving her utterly miserable. The seriousness of her condition meant she could die at any minute if left untreated. The SACH team could not overlook this case, and doctors began fighting to save her life.
The case was both medically and administratively problematic as Devota was not a child. This posed obvious problems, but thankfully, the decision was made to treat her. The solution was to perform an MV balloon which would open the narrow valve in the right side of her heart. However, placing Devota under anesthesia brought significant risks. Anesthetists were worried that she might not have the strength to wake up from an anesthetic. Furthermore, ICU doctors were concerned that they did not have access to all medication needed to support her afterwards if anything were to go wrong with the procedure. Discussions were held for hours between both medical teams (SACH & JKCI) and hospital administration. An agonizing night passed in which all involved deliberated on how to proceed. The next morning, a decision was made, and Devota was taken to the Cath Lab. The procedure was complicated as Devota was not stable, but Dr. Assa and Dr. Tamir worked skillfully alongside the brilliant Dr. Gluch’s who’s heroic measures, and anesthetic genius kept her alive. Israeli and Tanzanian Cath lab teams demonstrated their skill and dedication. Devota was closely monitored in the ICU, and changes in treatment were made according to her condition.
A few days later, a healthy, happy Devota walked out of ICU with her whole life ahead of her. Her life was saved through a one-hour minimally invasive procedure, two days in the ICU and a team of doctors willing to fight for her.
On the first day of the mission doctors screened twelve-year-old Rehema who had been diagnosed with Patent Ductus Arteriosus; a persistent opening between the two major blood vessels leading from the heart. This condition can be treated with relative ease during the first year of life through surgery or catheterization. However, because of her age, Rehema’s condition had progressed, making treatment far more complex.
SACH doctors performed a Cath to close the hole; however, the device used was not stable and had to be increased to its maximum size towards the end of the procedure. Rehema Was brought to the ICU to recover. During a follow-up examination some thirty minutes later, Dr. Tamir encountered the first of many complications. Having placed his stethoscope on Rehema’s heart, he heard a murmur that should not have been there following a successful catheterization. An immediate echo revealed that the device was not in the duct where it should have been but was instead in the left pulmonary artery. Rehema was rushed to the Cath Lab. Everything moved so fast that Dr. Assa barely had time to bring the anesthetist up to speed. For the next two and a half hours, Dr. Assa worked tirelessly to remove the device. Both medical teams watched from the viewing gallery with bated breath. The removal was complex and challenging, but thankfully, Dr. Assa succeeded without having to perform invasive surgery. You could hear the cheers and sighs of relief from the viewing gallery.
Unfortunately, Rehama’s disease has progressed so far that she now needs surgery, which cannot be performed in Tanzania due to potential medical complications. She will be flown to Israel to receive lifesaving medical treatment.
Marni Brinder Byk, Executive Director of SACH Canada testimonial from her journey to save Irine
The drive to Irine ’s house took approximately 45 minutes. We went from paved city streets to dirt roads, from buildings to homes that looked unfinished and scattered in a community. We were excited at the opportunity to witness Irine ’s living conditions, meet her family, and understand the reality of the children we serve in Tanzania. Their home was small but full of love. Irine ’s parents were full of pride for their family and home. They were dressed beautifully in bright colors; a stark contrast to the brown and greys of their home. Irine ’s parents drew up chairs and made us feel welcome as their guests. Communicating was challenging because of the language barrier, but we all did our best to exchange words and get to know each other as best we could.
Before embarking on our journey, Irine ’s father led the family in prayer. Their unwavering faith in the face of adversity was incredibly moving. The family were in good spirits; however, the mood turned solemn after prayer, having realized the gravity of the situation. Irine is their youngest child, and although this is her chance to feel better, there are certain realities of your child going to the hospital for a procedure. Irine was accompanied by her parents, who traveled with us on the bus back to the JKCI. Visiting Irine in her home was deeply rewarding and full of meaning, giving me and Gavin an opportunity to meet the children we work so hard to help.