It took a day’s travel, 34 travelling staff and more locals, an afternoon of unpacking, a morning searching for the last drugs and the frantic rebuilding of a cardiopulmonary bypass machine but the surgery isn’ just an abstract idea any more.
By the time this gets out there, the first three operations will be finished.
When you mention an aid trip, most people develop a quick mental picture of what that must mean. Sometimes that’s right. In this case it might be worth mentioning that while there are some particular challenges doing heart surgery on kids in Africa, there’s plenty about being here that is pretty familiar. Not every developing country is quite like what you imagine a developing country to be.
Rebuilding a Health System
The deaths of so many in the genocides left Rwanda with very serious ongoing problems. Less than 5% of the population had access to clean water. There was no banking system and no taxes being collected. AIDS, malaria and tuberculosis came in waves, killing more. Considered a lost cause, aid money was not flowing.
That is not the Rwanda of today. Many steps have been taken to rebuild the country and health has been a central part of that. For a system that had lost vast numbers of health workers that was a big challenge.
Here’s the recent numbers now for a country of around 11 million people:
* Between 2005 to 2011 malaria deaths fell by 87.3%.
* From 2000 to 2010 the maternal mortality ratio fell 59.5%.
* The chance of a child under 5 dying decreased 70.4% between 2000 and 2011. For that to happen, the absolute number of child deaths annually fell by 62.8% (over the same time the population increased by 35.1%).
* A focus on vaccination has led to greater than 93% coverage for the 9 vaccines in the schedule (including 93.2% coverage for all three doses of the HPV vaccine among eligible girls by 2011 – at the same time, the USA had less than one quarter covered).
While Rwanda has problems to deal with, it’s a stunning example of what investment in health can deliver for people. I look at those stats and I’m a little embarrassed by what passes for discussion about health back where I’m from.
Rwanda focussed serious efforts. Some would say cash counts, but it’s not entirely about that. The amount of money spent per person per year on health by the government is around $56 (US). Some would argue the focus on public health initiatives is partly due to the prominence of women in the rebuilding process. Few would say it’s not impressive.
So if it’s so great, are we just here for a holiday?
Big Cases for Little Kids
It turns out that cardiac surgery is not as simple as getting a toenail removed. Even when it’s a patient blue from low circulating oxygen getting a toenail removed. Getting a cardiac surgery program running requires people who have had quite a lot of training doing operations that aren’t entirely that easy plus ways to look after the kids before and after the surgery.
It’s also very cost and labour intensive. So given the choice between getting 93% of people vaccinated and investing large amounts of money in setting up a new surgical program, I’d choose the vaccination.
It turns out that teams need a certain amount of expertise and experience. In the UK, the guidance is that you need to be doing more than 400 major kids’ cardiac operations per year amongst 4 surgeons to continue with a paediatric cardiac surgery service. There’s debate about numbers like that but we probably can’t claim we’ve set up a franchise for east Africa.
So one day, we’d hope to put ourselves out of work, when the local health system has the luxury of making cardiac surgery a priority. The anaesthetists, surgeons, bypass specialists and nurses spending time with us will hopefully get bored by our presence soon enough and get on with it all alone.
Then we can get onto other debates, like whether to tempt fate in the slightly green swimming pool (actually there’s not much debate on that one). Or which music should be on the speakers in down times (if any of the team is reading, seriously no more John Farnham).
For now, we have to be here.
Most of the stats in here come from this review in the BMJ
There’s some interesting stuff in here from the NEJM.
And that UK guidance can be found in their review.
And don’t forget the other updates from Open Heart International at www.ohi.org.au