Open Heart

Screening of Oscar nominated short documentary and panel focus on cardiac repair in sub-Saharan Africa

Days after his Hollywood debut at the Academy Awards, Rwandan pediatric cardiologist Emmanuel Rusingiza Kamanzi joined a panel of Boston-based experts to discuss the challenges of preventing and treating deadly rheumatic heart disease (RHD) in resource-poor settings on Feb. 26 at Harvard Medical School.

The event included a screening of Kief Davidson’s Open Heart, an Academy Award nominated short documentary film focusing on Kamanzi’s work with eight Rwandan children with critical rheumatic heart disease who travel to Sudan, to Africa’s only free-of-charge, state-of-the-art cardiac hospital, the Salam Center run by Emergency, an Italian non-governmental organization.

A still from Kief Davidson’s <i>Open Heart.</i>

Spotlighting need for care

Kamanzi spoke after the screening, along with Ceeya Patton-Bolman of Team Heart and Kim Wilson, assistant professor of pediatrics and associate director of the global pediatrics program at Boston Children's Hospital. The panel was moderated by Gene Bukhman, assistant professor of medicine at Brigham and Women’s Hospital, assistant professor of global health and social medicine and of Partners In Health. There was also a videotaped presentation from Agnes Binagwaho, minster of health of Rwanda and HMS senior lecturer on global health and social medicine.

Kamanzi said that he hopes that the film and his trip to the Oscars will help raise awareness about the great need for prevention and treatment for children with rheumatic heart disease in Rwanda and elsewhere. “I was excited to go and meet movie stars, but I was even more excited to be able to be a voice for children who need cardiac care,” he said.

RHD is an inflammation of the heart that occurs following strep infection. It can be prevented by treating acute sore throats with antibiotics, and it can be treated with antibiotics. In severe cases, surgery is required to repair damaged cardiac valves.

While the disease has become rare in the developed world since the 1960s, largely due to the widespread use of antibiotics to treat strep infections, at least 15.6 million people are estimated to be currently affected by RHD, principally in sub-Saharan Africa, south-central Asia, the Pacific and indigenous populations of Australia and New Zealand. RHD is responsible for about 233,000 deaths annually, according to the World Heart Federation.

International programs like Emergency and Team Heart, which rely on foreign doctors and visiting surgical teams, are an important short term solution for some of the most critical patients, the panelists said, but the overwhelming number of patients who need care can only be treated by developing sustainable local capacity and health systems.

Pushing the frontiers of global health

In the last decade, Rwanda has had remarkable success in treating infectious diseases and building equitable health systems, Binagwaho said, raising life expectancy from 28 years to 60 years.  “Global health is not just about immunizations or HIV,” she said in a video-taped address that was originally presented to the 2013 World Congress on Pediatric Cardiology and Cardiac Surgery.

“We cannot save people from HIV and not save them from RHD.” Attacking non-communicative diseases, improving prevention and training local health care providers will help move beyond the current frontiers of global health, she said.

Wilson has been working to develop medical educational initiatives in Rwanda as part of Harvard’s work in the Human Resources for Health, an innovative program of the Rwanda Ministry of Health to address the critical shortage of health care workers there and to help built an independent, sustainable health care system.

In the last decade, Rwanda has cut its child mortality rate in half, she said, largely by addressing diseases of poverty—malnutrition, diarrhea and pneumonia. Taking the next steps to developing an equitable health system will require many more health care professionals: with approximately 11 million children, Rwanda has fewer than 15 pediatricians working in the entire country.

HMS, along with more than a dozen other leading U.S. medical schools, is helping to establish residency programs in Rwandan teaching hospitals. HMS researchers will also collaborate with Rwandan physicians to develop research tools and programs that will help improve the evaluation and implementation of health delivery systems.

“Human Resources for Health can be critically important in addressing not just cardiac care but a lot of the common non-communicable diseases in children and adults in Rwanda,” Wilson said.

The screening and panel were presented by the Department of Global Health and Social Medicine, Program in Global Non-communicable Disease and Social Change at Harvard Medical School, Team Heart, Brigham and Women’s Hospital, Division of Global Health Equity and Cardiac Surgery, Partners In Health and Boston Children’s Hospital, Global Pediatrics Program.