We just returned from our semiannual medical journey to Nicaragua, and I wished to give you a brief report of our activities. Present were Drs. Harry Adams, David Hannon, John Paar, and John Rose, and head nurse Donna Lou Edwards. Cardiology fellows Arjun Chagarlamudi and Carlos Espinoza were also there for a week.
In the adult cardiology clinic, we saw 260 patients, with a history, physical, echocardiogram, and discussion of plans for each patient. The vast majority of the people we saw had significant cardiac disease. A substantial number of them had mitral stenosis, mitral insufficiency, or mixed mitral valve disease, as well as aortic stenosis, aortic regurgitation, and mixed aortic valve disease. We also encountered numerous cases of adult congenital disease, with a large number of Secundum ASD’s, and also several cases of VSD’s, PDA’s, and one Tetralogy of Fallot. At least fifty of the patients were candidates for open heart surgery. Since we don’t have the capability of performing this many operations, triage is obviously a very difficult and challenging problem for us.
David Hannon, in conjunction with his colleague Dra. Nubia Berrios, examined fifty pediatric patients with heart disease, including a number of very unusual and complex patients. There is a team in Managua, the capital, which is capable of successfully performing congenital heart operations, and we are hopeful that some of these patients can be treated there. We recently developed a relationship with Dr. Evan Zahn at Cedars Sinai in Los Angeles, and his surgical team corrected a complex Tetralogy in an 8 year old girl from León about two weeks ago, and we hope that we can further develop a program with them.
Harry Adams rounded on a daily basis with his colleague, Dr. Armando Matute, in infectious disease and also met with Dra. Karla Tellez to discuss clinical opportunities for students in February.
Dr. Jeff Brumfield, now in Kentucky, but a member of our team, brought a group to León the week before we arrived, and ran an electrophysiology clinic and implanted a number of pacemakers and defibrillators as well. He also spent two days in Managua where he performed four ablations for supraventricular arrhythmias (I believe that this was a first for Nicaragua). We were able to see him in action as we were arriving and visited the hospital in Managua on our way to León.
We had a fruitful meeting with the new Dean of the medical school at UNAN-León, Dr. Jorge Aleman. He was very appreciative of our program, now more than four years old, of bringing two Nicaraguan students each year for a 6 week rotation at Brody/Vidant. He had some suggestions for expanding the curriculum of our students In León to include tropical diseases and more primary care clinical experience. I think he will also be helpful in supporting us as we thread through the intricacies of the medical bureaucracy in Nicaragua to bring supplies and medical groups into the country. I think that the collaboration between Brody and UNAN-León will continue to grow under his supervision.
We plan to return in February with our faculty members, nine medical students, Dr. Donna Lake and Debra Kosko with 4-6 nursing leadership and nurse practitioner students, cardiology fellows from here and Georgetown, Donna Lou Edwards and other nurses, and a cardiac surgical team that anticipates performing 11-12 open heart procedures. Coordinating this large group will be a challenge, but I anticipate an excellent experience.
I am proud to be a member of this group and to help expand the scope and influence of our school. Many thanks for your support in this endeavor.
John D. Rose, MD, FACC, FACP
Department of Cardiovascular Science