Broken Hearts

Broken Hearts Healed: Caring for Rwanda

-by Kate Vanskike

“Why would I go to Rwanda?”

 That was Hal Goldberg’s response when asked to participate in a medical mission in Rwanda, the tiny African nation most known for its tragic genocide. The cardiologist was the same when asked a second time. But when his college-aged son said he would go, Dr. Goldberg conceded. Reluctantly, and cursing under his breath at every thought of it, the long-time Spokane heart healer agreed to making the trip with other health professionals to evaluate medical needs in a country where there were only two cardiologists to serve 10 million people.


That was 2008. The following year, he was—willingly—gathering a group of people to return to Rwanda to perform heart surgeries. That was the beginning of a new non-profit, Healing Hearts Northwest, which has sent teams back for this purpose four times now and plans to continue doing so for a long time to come.


Exploring a need

The effects of the 1994 genocide in Rwanda have been long-lasting and devastating in multiple ways. When almost a million people were killed, 75 percent of the nation’s medical professionals were either among the dead or fled the country. More than a decade later, a chronic shortage of qualified physicians continued, and life expectancy had dropped to just 52 years, due to malaria, tuberculosis and rheumatic heart disease.


In 2007, a Gonzaga law student attended a human justice conference in Rwanda and learned of the opportunity for American physicians to extend their education and connect their profession to human rights work. That word reached Adie Goldberg (no relation to Dr. Goldberg) who worked with physician Pam Silverstein and the idea of an exploratory trip for Spokane caregivers was born. That first team included a mix of physicians, medical students, nurses and cardiac experts in pacemakers and electrophysiology. When they arrived at a small county hospital near Kigali, they quickly learned of the vast difference between their well-equipped American facilities and those of the third world.


“It was an eye-opening experience,” shares Dr. Goldberg. “To see that a hospital that takes care of trauma didn’t have a defibrillator. To learn that we couldn’t do labs to check potassium levels on a heart failure patient because there were no [blood collection] tubes. To find that the patient couldn’t have his blood evaluated at a city lab because it was Saturday.”


“What it made me realize,” he says, “is that we’re too data driven.”


In other words, they had to learn how to provide good medicine without relying on all the tests and procedures and equipment they always have at hand in the U.S.


From there, Dr. Goldberg went to King Faisal Hospital and met Dr. Joseph Mucumbitsi, a Rwandan pediatric cardiologist, and asked whether he was interested in having cardiac surgeons come to help him.


“We had a five-minute conversation that changed our lives for the next six years and counting,” Dr. Goldberg adds.


The making of a successful surgical mission

Back in the States, Dr. Goldberg and his wife Sandy, along with a dozen other Spokane caregivers, established a new non-profit that would organize surgical mission trips to Rwanda. Thus was born Healing Hearts Northwest. They took a trip back to King Faisal Hospital to take inventory and photograph every machine, every plug-in, every detail they would need to determine the supplies they’d have to bring along on future trips. Another visit was necessary to screen and evaluate patients who needed heart surgery. They’d bring all of the patient data back home and spend three solid days determining which patients were in the greatest need and made the best candidates for their life-saving operations. They chose 16 patients and 5 alternates, and based on those patients’ needs, the team would set about collecting all the appropriate supplies: surgical saws, heart valves, pacemakers and more.


The Goldbergs and others who help orchestrate the work of Healing Hearts Northwest have become overnight pros in the details of international service. They know it takes $150,000 (100,000 for flights) to fly a team of 45 people to Rwanda (even with the help of Fly for Good, which provides discounted flights for medical missions), and months of correspondence with the Minister of Health to gain proper approval and access.


In addition, the team must prepare new volunteers to face the realities of trauma that took place in this country two decades ago, leaving so many without families. The poverty is beyond understanding for many Americans, the Goldbergs say. Rwandan patients often walk hours to reach a bus station, ride for hours more, then take a motorcycle taxi to get to a hospital.


“It’s important to know the history and the genocide, and not to ask people questions about their background or experience,” Dr. Goldberg advises.


Participants must understand the sensitivity of many other topics that are addressed when dealing with heart disease. For example, certain blood-thinning medications necessary for treating the disease can limit a woman’s potential for pregnancy.


Goldberg explains, “In a society where women are valued by their ability to produce children, this is tough. It has to be handled with sensitivity through a translator. We are now starting to ensure those discussions with family are starting two months in advance.”

The team’s experts do plenty of education to providers in Rwanda while in country, too. They hold conferences to train nurses about intensive care, and they invite their Rwandan colleagues—surgical residents, anesthesiologists and others—to work alongside them for training.


The great work of Healing Hearts Northwest doesn’t stop there. Most remarkably, the Spokane-based organization enjoys a deep level of cooperation with other teams that work consistently in Rwanda. Physicians across continents, from Australia, Saudi Arabia and Belgium to Boston and Spokane, attend an annual congress on humanitarian cardiovascular medicine to create a better system of care. They have addressed a common surgical warehouse where every team can store supplies, tools and pharmaceutical items, reducing duplication of efforts and cost of shipping. They have developed one common patient information form and an agreed-upon list of preferred medications, all to ensure that the Rwandan caregivers have consistency in doctors’ orders. Their goal is to have a unified Rwandan heart program rather individual programs working independently.


“We’ve made a lot of progress in a short time,” Goldberg says.



Funding and Resources

The members of Healing Hearts Northwest organize fundraisers every year to keep the mission going strong. Annually, these events typically raise about $30,000-50,000 to cover the supplies and medications patients will need, as well as to support some team members who aren’t able to pay their own expenses or gather support from friends and family.


Providence Health International supports service teams like Healing Hearts Northwest in several ways. Its mission supply warehouse ships outdated-but-usable hospital equipment and tools to countries where these items can be put to good use. In 2013, Providence Sacred Heart Medical Center contributed a heart-lung machine that had been decommissioned from service in Spokane but would provide life-saving support in Rwanda.

Healing Hearts Northwest also secures donations from cardiac device manufacturers, including Medtronic International, Edwards Life Science and St Jude Medical Inc, which provide the artificial heart valves needed for Rwandan patients. Rotary International pays for medicatons and supplies , Terumo donates perfusion packs for each patient and Alere Home Monitoring donates the machines to check patients who are on blood-thinning medications.


In addition, there are many local physicians, organizations and individuals who contribute to ensure this mission continues well into the future.


Learn how you can help at