Welcome

 

In 2022 the Lander Rotary Club had an inspiration to create a nurse developed, nurse-delivered to nurses to decrease Rheumatic Heart Disease. In 2024 Lander Rotary Club was the international partner to the Kigali Rotary Club and local cardiology NGO, Team Heart, Inc to implement the Rwandan Nurses Saving Lives project (GG #2459030).

 

This is our story:

The Need- The Disease:  Rheumatic Heart Disease (RHD) is endemic in Sub Saharan Africa (SSA), Asia, and Oceania (the Islands from Japan to Australia) (Simpson MT et al., 2023). RHD is an autoimmune reaction to an untreated, or under treated, Streptococcus pyogenes throat infection (commonly known as Strep Throat) or skin infection called impetigo. These infections are very common in the endemic area. Plus, the strain of the bacteria is more virulent, and the human genetics allows the autoimmune response to occur easier. In these endemic countries, the likelihood that a sore throat is strep is 40% whereas in Europe and the US, it is 10%.

RHD is a fatal valve disease that occurs after the body immune system is tricked by the bacteria and initiates and autoimmune response to normal tissue and proteins found in cardiac valves. Although early in the disease process the whole heart, brain and joints are involved, ultimately it is the cardiac valve destruction resulting in profound heart failure and death.

In Rwanda, the estimate is RHD impacts 40,000 children. However, the ability to detect RHD us limited making the estimate most likely low. These children are usually identified after RHD has progressed to profound heart failure with years of suffering fatigue, shortness of breath, inability to fully work or help with family chores. Many children have been beaten, bullied, chastised, and ridiculed for being “slow”, “lazy”, and “worthless”. Yet, these children had- and have- a 100% preventable fatal heart disease.

We can make a difference….

 

The Need- The Healthcare Providers: Rwanda’s health system is similar to many SSA countries with a decentralized process of health posts to health centers to district hospitals to provincial hospitals and lastly national hospitals. Typically nurses staff health posts and health centers, whereas physician lead decisions in District hospitals and above.  2023 Rwandan government records estimated that healthcare begins in the health posts and health centers for up to 80% of the population. In Rwanda, nurses are trained at four levels:  A2 nurses graduate from high school; A1 nurses graduate from a 3-year college education; A0 nurses have a bachelor’s degree; and mastered-prepared nurses have a graduate degree in a specific aspect of care (neonatal, pediatric, critical care, leadership, oncology, and perioperative).  Currently nursing education does not include physical assessment knowledge and skills that are necessary for nurses who are providing direct patient diagnosis and care.  A gap in healthcare provider knowledge and skills is present.

 

The Gap- RHD has been identified by WHO as a preventable disease. In May 2018 the World Health Assembly passed resolution WHA71.14 to prioritize action to address the global burden of RF/RHD.

 

 

(CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo).

 

Developing a model-

A primary aspect of developing a Vocational Training Team (VTT) is to develop a process that leads to a transfer of knowledge and skills for the host country to have the ability and capacity to continue the project without the support of the VTT project experts. To accomplish this a train-the-trainer model was expanded to allow continued education in a vertical process (health posts to national hospitals) and horizontal (to community).

Our Model- A Core Team of eight selected nurses and physicians were asked for a commitment and desire to participate in this project. Ultimately seven Rwandans become the Core Team and the country’s experts in the project design and content. The Core Team then trains selected nurses from each district hospital. Rwanda has a unique training for nurses called “NCD” or noncommunicable disease nurses with training in heart, kidney and liver diseases. Our model trains these nurses to be the project advocate for District hospitals, health centers, and health posts.