Grant Enables Expansion of Cardiac Surgery at MTRH
People in western Kenya in need of heart valve replacements and other cardiac procedures will soon have increased access to the lifesaving surgery they need.
Emily Farkas, MD, FACS, associate director of Global Health in Surgery at Indiana University School of Medicine, received a grant for the “Systematic Development of Cardiac Surgery at Moi University” which will allow AMPATH partners to expand cardiac surgery at Moi Teaching and Referral Hospital (MTRH) and cardiothoracic education for trainees at Moi University School of Medicine. This grant is made possible by the generosity of the Thoracic Surgery Foundation (TSF), Society of Thoracic Surgeons and the Edwards Lifesciences Foundation. Through their “Every Heartbeat Matters” program, the Edward Lifesciences Foundation aims to improve the lives of 2.5 million additional underserved structural heart and critical care patients by the end of 2025.
Professor Barasa Otsyula (right) leads cardiothoracic surgery at MTRH.
Under the direction of Professor Barasa Otsyula, chief of cardiothoracic surgery at MTRH, a team from MTRH and Indiana University met in Eldoret this past winter to discuss the components needed for a successful program. Together they are focused on acquiring the equipment, supplies and resources to continue to improve on existing efforts to provide safe and successful surgery and support for patients after complex heart surgery as well as enabling one-to-one skill transfer and empowering local providers. “Many years ago, I was trained in cardiothoracic surgery in the UK and it has always been my vision to one day have the resources to fully develop this surgical capacity at MTRH. Now as I approach retirement, I am happy to see that vision becoming a reality,” said Professor Otsyula.
Cardiothoracic surgery includes operations above the diaphragm and below the neck including open heart surgery. AMPATH Consortium partners led by Duke University have helped support a robust cardiology center of excellence at MTRH that includes diagnostic imaging, specialized inpatient and outpatient care. For patients requiring cardiac surgery, some have received care at MTRH but others have had to be referred as the cardiac surgery service is not offered year round. This grant funding and new collaboration will help to develop the resources for expanded surgical interventions that are needed. For example, rheumatic fever is endemic in sub-Saharan Africa and leads to hardening of heart valves that require replacement or repair. If the valves aren't repaired or replaced, it can be a lethal condition.
Dr. Farkas joined Indiana University School of Medicine in October 2020 and is also developing a cardiothoracic surgery service at the Richard L. Roudebush VA Medical Center in Indianapolis. She describes the opportunity to participate in AMPATH Kenya as a full circle moment. Although she has completed over 50 cardiac surgical missions worldwide in the humanitarian sector, her first international medical experience was in Kenya as a medical student and solidified her commitment to making global surgery part of her career. “IU, with the history of AMPATH, was really compelling to me because I never thought I could bring the academic component of global surgery back into my career as a cardiac surgeon,” said Dr. Farkas. “The opportunity to advance the cardiac surgery program at Moi University and MTRH was very appealing to me.”
Members of the surgery team participate in a virtual fireside chat from IU House.
The initial grant focused on assessing what is needed to establish a cardiothoracic surgery service and the renewal allows for the acquisition of specific tools such as a transesophageal echocardiogram that can really look at valvular disease. “This is the standard of care when you're talking about valvular disease to see the complexity of the lesion,” said Dr. Farkas. “These tools are extremely expensive and this is where the contribution from Edwards and the TSF is so vital.”
Eventually Dr. Farkas and the AMPATH team would like to establish a regular rotation of surgical teams from the AMPATH Consortium performing cardiac surgery and teaching in Eldoret every eight weeks and eventually more frequently. These surgeries would include valve repairs or replacements, potentially bypass operations and eventually pediatric surgeries to repair holes in the heart and congenital abnormalities.
As the programs becomes more established, trainees from both Kenya and the AMPATH Consortium will have expanding opportunities to be involved with the eventual goal to establish a cardiothoracic fellowship. “We don't want to just go there and do surgery. We're going there to learn with our Kenyan colleagues and help build systems that empower local providers who are really ready to make this a foundational program at Moi,” said Dr. Farkas.