UVA Heart Valve fellow Mike Saji with a patient during a recent trip to the Dominican Republic.
Strep throat is a common childhood ailment here in the U.S. — but its potentially deadly consequence, rheumatic fever, is much less so, thanks to the widespread use of antibiotics to treat strep.
For those in resource-challenged countries, however, with limited access to healthcare, strep that turns into rheumatic fever and leads to heart damage is an all-too-common reality. The serious complications that can result, which include scarring and narrowing of the heart’s mitral valve, are a major source of morbidity and premature death in poor countries, imposing a substantial burden on fragile healthcare systems.*
The Dominican Republic is among the countries with a relatively high prevalence of rheumatic fever and rheumatic heart disease. Dr. Scott Lim (above) took on that challenge when he founded UVA’s Dominican Republic Heart Mission in 2008. Funded by a grant, renewed annually, from the Edwards Lifesciences Fund, Dr. Lim leads groups of UVA physicians and trainees on trips to the Dominican Republic (DR), where they provide free heart care and life-saving treatments. Team members also spend time with DR physicians, conducting training in advanced cardiovascular care.
For 2016, the Edwards Lifesciences Fund increased its annual grant to the UVA program from $50,000 to $75,000; the additional funding will support expanded educational activities.
UVA Dominican Republic Heart Mission, 2015: (l-r) Dominican physician Erika Perez, MD; DR pediatric heart patient; UVA’s Scott Lim, MD.
I spoke this month to Dr. Lim, who also heads the division’s Cardiac Valve fellowship program, and asked him for an update on DRHM’s activities.
When was your last trip to the Dominican Republic, and how many trips do you typically take each year?
Our most recent trip was this past December; we typically go on four to five trips a year.
How many UVA participants do you usually have on each trip — and who pays?
Usually between 3 and 6 people, depending on the nature of the trip; they can include internal medicine residents, cardiovascular fellows, cardiovascular and cardiac surgery attendings and fellows, pediatric residents, and other UVA health professionals, like echocardiogram technicians.
UVA’s Scott Lim, MD, with pediatric heart patient in Dominican Republic (2015).
I pay for their travel and accommodations from the Edwards Fund, and they donate their services. Typically our volunteers use their own vacation time for these trips. And they work long, hard hours – typically 6:30 am to 9:00 pm – so there is no time for play! I am grateful for their generosity and dedication.
In return, I ask trainees who participate to “pay it forward” in their future careers, by volunteering in or helping to start similar programs elsewhere. Former trainee-participants have gone on to start heart mission programs in Pakistan and West Africa.
Mortality rates from rheumatic fever & rheumatic heart disease, by country (click to enlarge). Source: World Health Organization.
What kinds of services does DRHM provide, and in what settings?
It depends on the focus of the trip. Last October was a surgical mission; on those trips, we typically perform 6 to 8 procedures, including mitral balloon valvuloplasty, transcatheter aortic valve replacement, and open heart surgery to repair or replace damaged valves. These, of course, are hospital-based procedures.
On our March 2015 trip, the focus was heart valve screenings; we typically perform 500 to 800 screenings (echocardiograms) on these trips, and it’s 100% clinic-based. If problems are detected, we make recommendations for follow-up intervention. Some of the clinics are in urban settings, others in rural areas.
How do you determine who receives surgical treatment?
We bring our own equipment from the U.S., so first of all, they must be procedures we are equipped to perform. Beyond that, our time is limited and resources are tight, so we look for relatively straightforward cases where we don’t anticipate a lot of complications.
Who is your on-the-ground partner in the Dominican Republic?
Our terrific partner for the last eight years has been Cedimat, a leading healthcare institution in Santo Domingo. This year, however, we have a new partner — a program associated with the Instituto Tecnológico de Santo Domingo (INTEC). INTEC is one of the top universities in the DR.
What impact has your work had on the physicians in the DR with whom you work?
I see improvements in their ability to recognize and provide appropriate treatment for their patients’ heart conditions. And speaking of paying it forward — some of the physicians in the DR we have worked with are now volunteering with a program in Pakistan that was launched by one of our alumni!
* The World Health Organization estimated, in a 2004 report, that rheumatic fever accounts for up to 60% of all cardiovascular disease in children and young adults in developing countries. Source: http://www.who.int/cardiovascular_diseases/resources/en/cvd_trs923.pdf.
Filed Under: News and Notes
Tags: Cardiology