Kenya, 2023 - The International Medical Volunteer Experience

Background

When the Thoracic Surgery Foundation offered an opportunity to participate in global cardiac surgery, I was fortunate to embark on a transformative experience that reaffirmed my passion for global outreach.

On my cardiac surgery mission trip to Eldoret, Kenya, I was able to appreciate the devastating consequences of resource limitations in global healthcare. Most patients we encountered had severe rheumatic valvular disease as a result of the significant barriers to accessing quality healthcare, resulting in delayed diagnosis and progression of disease. The experience in the United States stands in stark contrast where rheumatic valvular disease is often a topic found in textbooks and much less frequently in clinical practice.

Our Goal

The goal of this mission was to help develop a sustainable model for cardiac surgery while assisting in treatment of rheumatic valvular disease. On the first day in Eldoret, we met our fellow nurses, cardiologists, surgeons, anesthesiologists, and perfusionists to discuss patients in a multidisciplinary setting. The stream of education flowed bidirectionally, with critical insight on customs and beliefs among a culture that was foreign to many of us. At every patient bed, I couldn’t help but notice how young each patient was with such severe heart failure symptoms.

Despite the severity of disease described in their chart, their gratitude and smiles radiated through the ward.

In the Operating Room

The following day was the first case, a young man who underwent a double valve replacement and struggled to come off bypass. Typically, in the U.S. these patients are placed on a balloon pump or ECMO (extracorporeal membrane oxygenation) to provide support and time for myocardial recovery, but there was no ECMO and a shortage of Helium in Western Africa precluded the use of a balloon pump. In the face of limited resources, I could see and feel the gut-wrenching emotions going through many of my colleagues who could not imagine having to walk away from a 24-year-old on the table. That evening, after hours of collaboration and teamwork between all of us in the operating room, we ultimately were able to successfully transfer the patient to the ICU.

That evening we sat together to debrief a stressful, terrifying experience that we couldn’t have gone through without each other. The day highlighted how sick and frail these hearts are from rheumatic disease and to tackle this level of complexity is not an easy feat with limited resources.

Arguably, an equally intimidating aspect of this mission was the task of developing a sustainable program where fellow Kenyan colleagues could be educated and trained to take on these cases with excellent outcomes.

The following day, our first patient was extubated and we continued forth. Every case highlighted new challenges that we brainstormed our way through and clinical decision points included aspects we often take for granted in the United States. For instance, running out of a valve size brought forth an ethical dilemma of whether we proceed and settle for a valve that might be too small or too large versus delay a case that would prevent another patient from having heart surgery during our limited time in Kenya. Despite the challenges we faced logistically, our Kenyan colleagues welcomed us and were eager to learn. It was gratifying to empower the local providers to continue providing surgical care after our departure.

The Impact

The cumulative effect of these experiences changed my perspective on healthcare, making me acutely aware of the immense privilege we often take for granted in developed nations. Providing access to cardiac surgical care worldwide is not an easy task. However, the experience ignited a fire within me to advocate for equitable access to surgical care and continue efforts to address the global health disparities that exist.

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Irsa Hasan, MD
University of Pittsburgh Medical Center
Cardiothoracic Surgery Fellow