Minneapolis Heart Institute Foundation leads effort to train heart surgeons in Ethiopia

Doctors from developed countries routinely travel to impoverished nations on "medical missions," working through nongovernmental organizations to provide free health care not available in local clinics.

Some missions provide surgical services. The Children's Heart Fund of Ethiopia has benefited from charitable support from the Minneapolis Heart Institute Foundation and medical device companies like Medtronic and St. Jude Medical to perform surgeries on hundreds of kids whose heart valves are severely damaged from failing to get penicillin for strep throat.

But performing heart-valve surgeries one at a time is an expensive solution that can't address the underlying problems that make rheumatic heart disease the most prevalent heart condition in children and young adults in Ethiopia, a nation of 94 million people.

A 2015 study by doctors in Minnesota and Ethiopia found that one-third of 6,275 patients with cardiovascular problems treated at Ethiopian hospitals had rheumatic valvular heart disease, typically caused by strep throat progressing to rheumatic fever without treatment.

Rheumatic valvular heart disease is a major problem for kids and teens in countries lacking access to cheap antibiotics. Stamping it out requires both innovative prevention strategies and also treatment for advanced cases that will inevitably turn up through increased outreach efforts.

By 2012, indigenous and international efforts had led to construction of a new heart hospital in the Ethiopian capital, Addis Ababa, and the establishment of a revenue stream to run it, using rental income from apartment buildings that were built to support the hospital.

But a dearth of local specialty talent in heart care left the hospital unable to operate without regular medical missions of physicians from Europe and the U.S., including several from Minnesota. Worse, there was no training program in Ethiopia that could prepare a full-time team for pediatric heart surgery.

"You need a building that is modern enough to do the work, you need an operating budget and you need a team that is trained to do the work. They had two out of three. And then Dr. [Vibhu] Kshettry came in and said, 'I'm going to come up with an innovative way to get an entire team trained that can then be established to work in the hospital.' "

Dr. Vibhu Kshettry is a cardiothoracic surgeon at the Minneapolis Heart Institute, and also a co-founder of the Friends of Children's Heart Fund. A native of India with an extensive professional network, Kshettry knew of a major heart hospital in Bangalore, India, where a team of Ethiopian physicians could train to become specialized in pediatric heart surgery.

"It's one of the biggest heart centers in the world," Kshettry said of the Narayana Institute of Cardiac Sciences in Bangalore. "The founder of that heart center, I've known him since they were not that big, and I've helped them over the years."

The Ethiopian Ministry of Health selected a small cohort of promising indigenous doctors, who were screened by Kshettry. Then they were sent on scholarships for multiyear specialized medical training at the Narayana Institute so that they could return to Ethiopia and staff the country's first nongovernmental pediatric cardiac surgery program.

That team included cardiac surgeons, anesthesiologists and cardiologists; some are graduating this month, and the rest will complete their specialized training next year.

The ultimate goal is even larger — to create a successful, indigenously staffed heart hospital capable of training specialists from across Ethiopia in treating rheumatic heart disease.

"The hope is that they will come back with a sense of being a team that can really start an entire field in their country," Bennett said.

Medtronic and St. Jude Medical both have supported the Friends of Children's Heart Fund with donations, Kshettry said.

In addition to humanitarian benefits, health care companies may also see a long-term business motive for supporting such a charity: A country with a good cardiac care system eventually will need to buy the products to support it.

"You have to hope that they are going to be buying your products and training more people who will be buying your products," Bennett said. "Success here is getting multiple teams like this set up in Ethiopia that can offer the same range of care and services that we would have in a setting in South Africa or, frankly, in the U.S."