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Team Heart use RHD Action Small Grant to promote health education for RHD patients following surgery in Rwanda

13 August 2019
(L-R) Jessica Sewase, Josee Uwamariya, Maili Gasakure; Team Heart staff, at RMH, Kanombe

Country Director: Jeanne Umuhire
Program Manager: Jessica Sewase
Small Grant Project title: “Improving Health Education Among Post-Operative RHD Patients”

Rwanda is recognized among African countries for the outstanding improvements in their population’s health status over the last generation. The WHO reports: “Rwanda has made remarkable socioeconomic progress in the past decade with real GDP growth averaging 8.2% annually. This has translated into improvements in the health situation. Major health reforms took place, including the health insurance improvement, which aims to guarantee access for all to health care... All targets related to the three health-MDGs were met, with a notable success in reduction of child mortality and considerable improvements in maternal health.”

Acknowledging the Rwandan Ministry of Health (MOH) for these huge accomplishments and for sustaining their efforts toward these advancements, the Kigali-based office of Team Heart, an international NGO focused on bringing sustainable cardiac care to Rwanda, decided they could contribute by reaching out to the most vulnerable communities of people affected by rheumatic heart disease (RHD) and other non-communicable diseases (NCDs). Ms Jessica Sewase, program manager, commented: “The success that the MOH has achieved in the fight against infectious diseases has uncovered the need to tackle NCDs as life expectancy has increased. Rwanda represents a resource-limited setting; currently, there are less than 10 cardiologists available to treat the entire population.”

 (L-R) Jeanne Umuhire, TH Country Director; Josee Uwamariya, TH Prevention Officer; Dr. Evariste Ntaganda, Director of CVDs - RBC; Gratiana Fu, TH Health Informatics Officer; Christiance Mwamikazi, Nurse Coordinator; Chance Mwungunzi, Nidelie Ingabire, Innocent Nsabimana, Elina Mukagasigwa, four patients operated on in 2018

Currently, cardiac surgery is only available in-country to Rwandans on an annual basis by visiting teams of international volunteer medical specialists. More than 400 Rwandans have undergone valve surgery over the past 11 years and Team Heart has operated on more than 180 of them. Team Heart works in conjunction with the Rwanda Biomedical Center (RBC) - the implementation arm of the Rwandan MOH on these health initiatives. For their RHD Action Small Grant project, the Team Heart office in Kigali chose to focus on the challenges post-valve surgery patients face when trying to access care and medications, compounded by the financial burden of out-of-pocket expenses.

The Team Heart project team proposed to conduct four day-long health education workshops for post-operative RHD patients and NCD nurses at selected district hospitals throughout Rwanda. Their objective was to improve front line health workers’ and patients’ knowledge about medication adherence, family planning, nutrition, and lifestyle/behaviour changes to  better inform and enable patients to improve their health and well-being.

For this project, Team Heart collaborated with the NCD Division within RBC to coordinate the workshops. Posters and pamphlets with information about symptoms, prevention, and treatment of RHD were developed and produced for participants to take home. These materials, as well as workshop presentation materials with case studies, were jointly developed by Team Heart and the RBC team with input from the Rwanda Heart Foundation.

The Rwanda Cardiac Patients Network were consulted to identify potential participants for workshop invitations. To maximize the number of attendees, workshops were scheduled on the same dates as the hospital INR clinics. The project team stretched their funding and conducted an extra workshop at Kanombe Military Hospital in Kigali. Attendance was highest at this final workshop and in all, more than 160 patients and two NCD nurses participated in these events. A pre- and post-test questionnaire indicated good post-test knowledge improvements.


Participant at the workshop in RMH - Kanombe

Conducting workshops at the district level supported the Ministry’s overall decentralization strategy. In retrospect, Team Heart feels this collaboration with government helped bridge a communication gap between the patients and the health providers. Each workshop ended with a town hall session, during which patients interacted with health providers and received immediate feedback on the challenges they experience. The presence of government representation seemed to improve patients’ faith and confidence in the health system.
A symposium was held by Team Heart at Marasa Umubano Hotel in April 2019 to disseminate the results from the workshops, discuss the challenges identified by post-operative patients regarding family planning, and establish recommendations for standardized prevention and treatment of these patients. A range of cardiac stakeholders attended that included specialist physicians, nurses and representation from the RBC. Patient feedback expressing a lack of resources, support, and knowledge about family planning was presented. A plan was made to establish a technical working group that would meet regularly to produce recommendations to address this issue.


Patients with workshop posters, Rwinkwavu District Hospital

As a result, Team Heart has developed a plan to improve health worker knowledge and skills for treating post-surgical cardiac patients by working more closely with NCD nurses at the district hospitals. Their plan also targets the home-based care practitioners and other community-level health workers who provide care for these patients. “We learned from patients during the workshops that effective and appropriate care is difficult to access at the community level. By training health practitioners, we aim to bolster the continuum of care for patients from the district hospitals down to the health posts in the communities.”

This Small Grant project was only a small part of Team Heart’s larger country-wide initiative to address the burden of RHD through collaboration with multi-national teams promoting awareness, prevention and early intervention to increase public knowledge by empowering people living with RHD. We at RHD Action are pleased to have had this opportunity to contribute this Small Grant funding to Team Heart’s ongoing commitment to address RHD in Rwanda.


Elina Mukagasigwa & Nidelie Ingabire, operated on in 2018