Picking Patients

The success of Open Heart International’s program is dependent on the patients selected.

It takes months of research including constant analysis of the patient’s health data as well as local medical referrals, even before the team arrives to operate.

Cardiologist for Open Heart International’s current Rwandan-based team, Andrew Bullock, explains he works closely with the local cardiologists before arriving to commence the screening program for Kigali.

“Prior to us coming to the country, the cardiologists working in Rwanda, Dr Emmanuel Rucingiza and Dr Joseph Mucumbitsi, are conducting their paediatric cardiology practices where they have many children under their care with various cardiac problems,” Andrew says.

“As the mission to Rwanda approaches, the local cardiologists think about who will be suitable for surgery.”

The local cardiologists create a list of potential candidates for surgery, which forms the screening program.

“They send the list to me a few weeks in advance and I go through the list and other information available and try and identify those who are most likely to have an operation and those who are less likely to be surgical candidates,” Andrew says.

“There will be another group of names that will be just for an opinion, which include unusual or rare cases, or those the cardiologists are just not sure about.”

Andrew, who is a cardiologist at Princess Margaret Hospital in Perth, and the chief nurse of the ward (Beth Chidlow) arrive a few days before the rest of Open Heart International’s team to see potential patients every day.

(Patients are scheduled on successive days and through that process we will assess all the children and perform an echocardiogram)

“Otherwise, if we just open up (to the community) we will have 50 to 70 patients in the waiting room and they will wait there all day and all night to see them,” Andrew says.

“Instead we schedule the patients on successive days and through that process we will assess all the children and perform an echocardiogram, an ultrasound, to scan their heart to confirm the diagnosis and make sure there are no other complicating diagnosis that might influence the decision.”

At the same time, the cardiologists have to consider other issues affecting suitability for surgery, such as the patient’s condition, and weight, and whether the child has any other significant problems.

“Virtually all of these children are malnourished, which is a consequence of heart disease and that is a significant factor in getting a good result after surgery,” Andrew says.

“I have to take all of those things into consideration, then I start to prioritise those into high priority.”

Andrew explains Open Heart International will operate in Kigali for six days.

“We are here for a short time which is another reason why it is important we pick the most suitable candidates,” he says.

“It wouldn’t take very much to create a bad list, so I have to be diligent in selecting the best possible patients otherwise we would have some bad outcomes.”

Andrew, a valuable member of the Open Heart International team who is on his ninth trip to Kigali, says the best screening list was presented this year.

“I really noticed this time that it was harder to select because there were so may more appropriate cases,” he says.

“The other thing was that the cases the local cardiologists presented, not necessarily for surgery but for a second opinion, show the cardiologists’ abilities had gone up a notch because they had a good grasp over things that were challenging them.”

This is the first year Open Heart has screened patients at the University Teaching Hospital of Kigali.

“Previously we used to set up a clinic and we would bring the patients to King Faisal Hospital,” Andrew says.

“Since the majority of patients come from the public hospital we have for the first time completed the screening process from the public hospital and found that from a patient point of view, it was a lot more familiar for the Rwandan people.”

This year’s screening program identified a minimum of 15 patients, some of which commenced their surgery Saturday 16 April.

(This is the first year Open Heart has screened patients at the University Teaching Hospital of Kigali.)