MEAK Heart Mission Report
M. P. Shah Hospital, Nairobi, January 24th – 3rd February, 2018
2017
MEAK are very happy to report yet another highly successful heart mission in conjunction with our loyal sponsors March to the Top. The mission was conducted for the second year running at the M.P Shah Hospital in Nairobi, in conjunction with the clinical team from the Evelina London Children’s Hospital.This year the team was led by cardiothoracic surgeon Mr Caner Salih. Mr Salih is the paediatric cardiac surgical lead at the Evelina & this was his first mission for MEAK. He figuratively stepped into Prof Anderson’s theatre shoes & worked brilliantly with the team, conducting 21 operations in the 7-day operating period – quite an achievement!
This was MEAK’s 22nd surgical heart mission to Kenya since we began operating in Kenya in 2002. To date, MEAK has performed heart surgery on over 465 children, clearly illustrating the ongoing success of the heart programme.
Mission achievements:
- 21 paediatric cardiac operations performed
- 174 children receive Echocardiograms & clinical reviews in cardiac clinic
- Paediatric Life Support training programme delivered to nurses in the Paediatric Intensive Care Unit
- Paediatric Echocardiography training to physiologist from M.P Shah Hospital
- One day clinic held to review children from Dadaab refugee camp
- Cardiology review of Kenyan children for UK charities Chain of Hope & Healing Little Hearts
Patient Demographics:
Child: |
Age: |
Area of Kenya |
Operation: |
M, female |
11 years |
Kilifi |
Patent ductus arteriosus (PDA) ligation |
C, female |
9 years |
Kilifi |
Closure of atrial septal defect (ASD or “hole in the heart”) |
S, male |
8 years |
Kilifi |
Total correction of Tetralogy of Fallot |
P, female |
8 months |
Kilifi |
Closure of ventricular septal defect (VSD or “hole in the heart”) |
L, female |
10 years |
Nairobi |
PDA ligation |
E, male |
2 years |
Nairobi |
PDA ligation |
L, male |
7 years |
Mombasa |
Total correction of Tetralogy of Fallot |
J, male |
10 years |
Nairobi |
Repair of ASD and pulmonary valvotomy |
S, male |
3 months |
Nairobi |
PDA ligation |
N, male |
3 years |
Nairobi |
Total correction of Tetralogy of Fallot |
A, male |
7 months |
Nairobi |
Closure of VSD |
M, male |
9 months |
Mombasa |
Closure of VSD and pulmonary valvotomy |
F, male |
5 years |
Nairobi |
Total correction of Tetralogy of Fallot |
H, female |
3 years |
Mombasa |
Closure of VSD |
Z, female |
9 months |
Nairobi |
PDA ligation |
C, male |
5 years |
Nairobi |
Closure of VSD |
P, male |
8 years |
Nairobi |
Closure of VSD and relief of muscular RV outflow tract obstruction |
K, female |
8 months |
Mombasa |
Closure of VSD and pulmonary valvotomy |
F, male |
4 years |
Nairobi |
PDA ligation |
S, female |
10 years |
Kitale |
PDA ligation |
On this mission we operated on more children from the Kenyan Coast than we have previously. This is a direct result of the smaller, non-surgical Coastal clinic that we run in Mombasa and Kilifi in October, prior to the surgical mission. This clinic provides a window of access for Coastal children as surgical options are extremely limited on the Coast. Nearly 100 children were seen in the clinic & of these 8 of them were triaged to surgery in Nairobi. Thankfully, not all the children we see on this clinic are in need of surgery & a great many are patients that we have operated on previously, which we really enjoying following up.
Despite all the planning, there is always one problem that we can never overcome; we always see more children in need of urgent surgery than we have operative slots. At MEAK our commitment to these children doesn’t end when the surgical team fly back to London. We then begin working to get these children operations via other charitable routes. Thus far, we have facilitated;
- 4 children to have surgery in London or Aswan in Egypt via UK charity Chain of Hope.
- 2 to have valve replacement surgery at the Salam Centre in North Sudan.
- Several others have been referred for keyhole procedures (cardiac catherization) by another visiting UKteam to the M.P Shah hospital in May.We are incredibly grateful to our colleagues at the Paediatric Support Group in Mombasa who perform the vital task of helping families with the necessary paperwork & visas to allow them to travel abroad for their surgery or arrange for transportation & accommodation for those who need to travel to Nairobi for cardiac catheterization. This activity enables us to bridge the gap between this mission & the next & provides another chance at an operation for those children who did not receive surgery in Nairobi this time.
Teaching, improving from last visit & great collaboration:
The working relationship between the MEAK team & the M.P. Shah team lead by intensivist Dr Bhupi Reel continues to flourish. Thanks to WhatsApp technology we have been able to be in constant communication through the year to discuss equipment needs & plan the cases for the visit.
At the end of the last mission we asked for suggestions from the team as to what we could improve to make the trip better. We were able to implement many suggestions on this trip, such as
- Giving the children certificates of bravery for having had cardiac surgery;
- Presenting the nursing team with certificates to recognise the learning they have done while the team wasoperating, including partaking in the paediatric life support training;
- Introducing toothbrush kits for the children to enable them to learn how to brush their teeth well & toeducate them how important it is to maintain good oral hygiene now that they have had cardiac surgery
Two patient case studies from MEAK Trustee, Mr Martin Nighy:
Martin attended the mission to assist Mike with managing the team. He kindly wrote for us a trip diary of his experience. It is always very useful for us to have a different perspective on the mission. As medical people, we are often very focussed on the cardiac anatomy and the outcomes, but we often completely miss the personal side of the interaction as we juggle operative slots. Below is an excerpt from Martin’s diary:
Sharon’s ‘Path to MEAK’.
Early in the trip MEAK Director Mike Belliere gave an interview on Radio Africa. This interview was heard by a policeman in Kitale, 380km away on the Ugandan border, who knew of a little girl called Sharon who had a heart problem.
10 year old Sharon was so sickly & breathless that she was unable to leave her house to play with her friends. In an extremely selfless act, the policeman drove Sharon & her mother 7 hours from Kitale to the M. P. Shah hospital. He arrived just as the team had decided to close the clinic for the trip.
Luckily, the clinic team were still there & they agreed to see Sharon, having heard the story of her journey. Sharon was found to have a very large PDA which if ligated, would completely change her life. However, the operating list was full. Several phone calls were made. Would everyone be prepared to add one extra case to the list for the last day? Of course, the answer was yes. Mr Salih would do her operation the next day – the very last procedure of the Mission.
Sharon’s Mother, Priscaca, said ‘When my friend heard Mike on Radio Africa talking about the MEAK Heart Mission in Nairobi, he quickly came and told me and drove us for 7 hours to come to the M P Shah Hospital. It was God’s will that, although they had closed for the final day of the Mission, Alexandra agreed to screen Sharon and it was decided to give her an operation the next day! God is Great!’. Sharon has since made a full recovery and is doing extremely well.
Sharon in hospital with her mother, after the PDA ligation had been performed
Clara’s ‘Path to MEAK’.
Clara Mwachiru aged 10 from Kikambala, in Kilifi County, Coast Province, was always a small & listless child, but her parents did not think she had a serious problem.
It was only when Clara’s father, Timothy Mwachiru was in hospital in September 2017 for a blood pressure problem that they began to realise that Clara was not well. His wife Margaret came to visit him as an inpatient, bringing their then 9 year old daughter Clara with her. In Timothy’s words, “Clara had a fever. A nurse had her checked over & found that she had a heart problem. She was always small and grew slowly – her grandfather called her “Kidogo”, (meaning ‘small’ in Swahili). The Cardiologist confirmed that she had a hole in her heart.
“Dear God I thought what can we do? I do not have the money for an operation. Margaret and I wept. So, I discharged myself from hospital and went to Nairobi get help, going to all the Hospitals begging for help for Clara. I was told that the operation would cost Ks1.2 million! (approximately $12,000) So much money! What to do?”
“My Indian friends told me to “Google for help”. I saw that MEAK were going to be at KEMRI Hospital in Kilifi so I went there from Mombasa and God be Praised I met Tanuja (from the Paediatric Support Group) and Alexandra (from MEAK)”
“The doctors checked Clara again and agreed that she needed open heart surgery. We waited for 3 long weeks and then Tanuja called me and said “Come to the M P Shah Hospital in January 2018 and MEAK will operate free of charge” and here we are – I am so, so happy”
Clara’s procedure went very well but her post-operative course was rocky. Thanks to the expertise of the medical team and the facilities at the M.P Shah hospital Clara made a full recovery. Within 48 hours of her surgery she was out of bed and in another 48 hours, to our great relief, she was fit to travel home. The MEAK team will continue to follow up Clara on subsequent visits to Kilifi.
Trip Review:
As you have just read the MEAK medical team worked efficiently & tirelessly. Despite the long days and being extremely busy everyone really enjoyed the opportunity to help these children go on to have brighter, healthier lives. They thoroughly enjoyed interacting with the families & working with the M.P Shah medical team again. Again, we focussed on empowering and educating the local team by providing as much teaching & hands-on experience in managing paediatric cardiac patients in every stage of the recovery process. The coordination of the visit by the M.P Shah administrative team was again excellent & the level of enthusiasm & engagement of the M.P Shah medical team was as good as ever. Needless to say, everyone is looking forward to next year!
Next year:
Having had two very successful missions at the M.P Shah hospital we have very much cemented our relationship with the unit as our centre of preference. Plans are already underway to secure dates for the next mission to continue to support their cardiac programme & to help the Kenyan children who desperately need cardiac surgery.
Thank you from MEAK:
Whilst MEAK coordinates the mission, it is very much a team effort from many people to achieve success. Without the sponsorship from March to the Top this mission would simply not happen. We are also incredibly grateful for the expertise of the medical team who volunteered their time to participate.
On behalf of us all at MEAK we would like to thank everyone who contributed to making the mission such a big success, including, but not limited to:
- March to the Top, whose sponsorship of the mission has completely transformed the lives of another 21 children & their families. We cannot thank you enough & we look forward to continuing our strong working relationship long into the future;
- The M.P Shah hospital & staff for accommodating us so well;
- Our ever-faithful supporters, Pollman’s Tours and Safaris, whose provision of our transport in Nairobi forthe duration of the heart trip makes it all possible. Pollman’s have been supporting us for over ten years &truly believe in our charity. We are incredibly thankful for their support;
- The Mamujee Brothers Foundation for their continued & unwavering support of our Coast patients;
- Tanuja, Tina & Misha from the Paediatric Support Group in Mombasa. They work tirelessly in co-ordinating& supporting the ever-growing numbers of patients from the Coast. Their patient liaison service provides essential Swahili/English translation allowing us to manage the patients effectively and for families to understand what is going to happen every step of the way. Thank you also for all your hard work in managing these families long after we have travelled back to the UK;
- MEAK’s Nargis Kasmani, who managed many of the logistics, especially with the equipment and the essential medical supplies.
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