About This Project:
Rheumatic heart disease (RHD) is an acquired autoimmune heart disease caused by prior Group A streptococcus (GAS) infection. RHD is a crucial public health issue worldwide. Every year the disease claims 288,348 lives of children and another 100,000 young adults (Dass & Kanmanthareddy 2021; Noubiap et al., 2019; Zuhlke & Peter et al. 2022). Despite the persistent high incidence and prevalence of RHD in low-income countries, well designed multi-pronged educational activities for healthcare providers and communities are lacking.
RHD is endemic in Rwanda with an estimated 40,000 children suffering from the disease. Rwanda has the second highest prevalence of RHD in the world (Mucumbitsi et al., 2017). In Rwanda, RHD is often diagnosed at an advanced stage after the patient has severe valvular disease leading to serious complications (Rusingiza et al., 2018; WHO,2018). More effective strategies are needed for the prevention and control of the preventable disease resulting in significant disabilities due to heart failure and premature death.
This project is building upon a 2023 pilot Rwandan Nurses Saving Lives project conducted by a group of master- prepared Rwandan nurses as a class project of research to clinical practice (These nurses were attending Rwanda's' 1st Specialized Cardiac Nurse course by Team Heart, a NGo, and the University of Rwanda). Thirty-two nurses working in remote Rwandan attended the 2-day conference to obtain knowledge and skills concerning RHD. These nurses were gifted with their first stethoscope. To support the continued use of the knowledge and skills (plus use of the stethoscope), the nurses were provided a 2-month virtual mentorship via WhatsApp. The groups had rich discussions on actual patients and outcomes. The pilot provides an excellent foundation to design the 2024 VTT to expand the impact of the conference and develop a process to transfer the full conference to Rwandans for a future national roll out. It is ready to expand to a VTT to allow a presenter train- the-trainer team, a conference management team, a stakeholder's team, and expand to include a community program for community workers and teachers to expand the knowledge of people to impact the community and save lives.
The Rwandan Biomedical Center (RBC) has identified five district hospitals in critical need of support for cardiovascular education. Team Heart Inc of Rwanda (and partner of this grant) has been given governmental approval to provide RHD education and training to the physician and nurses in these district hospitals. This project will be the education to focus on prevention (strep throat), identification (ARF, HF, and RHD), and clinical decision-making and care management. Team Heart, Inc is providing education on cardiac echosonography, pre-op and post op care of the RHD patient. Together these educational programs will provide a comprehensive RHD education impacting 1 million children and young adults living in these communities.
Ensuring integrity to the research and project design, Dr. Maria Kidner DNP, FNP-BC, APRN, FAANP was the lead faculty for the Specialized Cardiac Nurse program and is the International Rotary club's (Lander Club) project lead. She has worked in Rwanda as a volunteer since 2014 on several projects for the University of Rwanda and Team Heart. Her work in Rwanda has allowed her to build strong relationships with key nurses and physicians who now want to be part of this VTT.
The overall vision is to decrease the number of children with this 100% preventable, yet fatal heart disease. However, to obtain that vision a series of complex events need to take place with the first being this VTT.
The goal of this VTT is to provide education, support and mentorship to develop Rwandan nurses as RHD clinical experts in history and physical exams, clinical decision making concerning RHD, increased ability to teach and mentor conference content, conference management, build stakeholder relationships upholding the Rotary International 4-way test, and increase capacity to implement multiple conferences for a future national roll out.
To accomplish this goal this VTT is designed in three teams: Team 1 is a core group of nurses and physicians learning to become RHD conference experts. Together they will build the educational tools for nurses/physicians, teachers, and community workers. Team 2 is the conference management team working together to secure venue sites and all the supplies to be locally source along with publicity. Team 3 is the stakeholder's team where the core group will reach out to local businesses and governmental officials to build trust relationships needed to build a successful national roll out in the future.
The Goal of this Rwandan Nurses Saving Lives conference is to increase the knowledge, skills, and confidence of Rwandan nurses to improve their abilities in recognizing, treating, and referring patients with signs and symptoms of GAS Pharyngitis (Strep Throat), Acute Rheumatic Heart Fever, Rheumatic Heart Disease, and Heart failure. Expanding community awareness and impact, the 2024 conference will include a section for community health workers and teachers. The primary objective includes the review of the pilot and solution building to the recommended changes.
High prevalence RHD is well known in Rwanda and Sub Sahara Africa. Team Heart has tracked RHD data for years. There is published data for Rwanda at the 2nd highest prevalence in world with 6 RHD-positive children/1000. The lack of nursing knowledge was identified by the students in the post-masters Specialized Cardiac Nurse course while they were in clinical placement in District hospitals. It was through discussions with local nurses and watching their skills that the gap was clearly revealed. The nurses working in the clinical settings did not know that Strep throat was the cause of this fatal RHD.
Team Heart hosts volunteer surgical teams four times per year for RD valve replacement/repairs. The teams screen over 250 symptomatic children for each surgical time for the 10 slots available. Most of the children are too sick to handle surgery. Current data from Team Heart's work in the District Hospitals is those District Hospitals using echocardiograms to diagnosis RHD identify an average of 15 new cases per month. This brings an estimate of 600 cases in the country of symptomatic RHD.
Linking Strep throat to RHD through increase awareness in nurses, physicians, community workers, teachers, and students can increase public awareness and improve acceptability of antibiotic therapy for Strep Throat. Rheumatic heart disease (RHD) is an acquired autoimmune heart disease caused by prior Group A streptococcus (GAS) infection. RHD is a crucial public health issue worldwide. Every year the disease claims 288,348 lives of children and another 100,000 young adults (Dass & Kanmanthareddy 2021; Noubiap et al., 2019; Zuhlke & Peter et al. 2022). Despite the persistent high incidence and prevalence of RHD in low-income countries, well designed multi-pronged educational activities for healthcare providers and communities are lacking.
International Team: Train-the-Presenters team, Rwanda 01/05/2024 -06/05/2024
Rwanda Team: Providing training Rwanda 10/07/2024 - 31/12/2024
International Team: Conference Providing training, Rwanda, 06/07/2024 -03/08/2024
International Team: Conference #2, Providing training, Rwanda, 23/11/2024 -12/12/2024
How Projects Funds Will Be Used:
Lodging: US team members;
Lodging: Rwandan non-Rotarian team members, training and VVT teamwork
Lodging: Conferences, post conference review
Food@ team builds (3 teams) and conferences
Food: US Team members outside of group meals
Conference venue (without food)
Stethoscopes x 90
Otoscopes x 90
Monitor & Evaluation x 2 conferences
Post-implementation, evaluation, and planning (all VTT members and stakeholders) -25 people
Bags, pens, highlighters, name tags, markers, poster paper, ect
Pre and post questionnaires
Educational tool kits (Nurse/physician, Community health worker, teacher) #250 kits
Community/school posters (#250)
Training & Government required Stipend.
VTT Core non-Rotarian Team members and NCD nurse presenters x 19 & 2-month mentorships of Nurse participants (By Conference Presenters)
Nurse- participants x 75
Community Health Workers x 60
Teachers x 40
Skills lab models x 12
Airfare 2 US clinical experts (1 person x 3; 1 person x1)
Rwandan non-Rotarian Team meeting, education, and conferences
INTERNATIONAL ROTARIANS' INVOLVEMENT
1. Fund raising
2. Model development for the VTT
3. Core Clinical team: Train and support nurses to be presenters; Build a mentorship process for both the core team, the new presenters, and participants (the health center nurses); Assist in knowledge and skills transfer to the original Rwandan Train the trainer Team; and Outcome management
4. Conference Management Team: Guide the Rwandan team on conference design and management; and outcome management
5. Stakeholder Team: Support and work with the host Rotary Club to be assistant in explaining the project and aim to decrease the deaths of children from Rheumatic heart Disease; relationship building.
6. Design and develop Conference materials; Nursing/Physician RHD Manual and presentation Power Points; Nursing educational tools to support their ability to educate patient and families; Teacher manual & RHD teaching activities for students; and Community health worker manual & community posters.
7. Conference implementation assistance and mentorship
8. Outcome management and Data interpretation and use
9. Professional peer reviewed journal publication
10. Be part of publicity
11. Grant Planning
12. Presentations to U.S. clubs
HOST Club Members Will be Involved
1. Global Grant Planning
2. Contacts with governmental, university, NGO groups to secure support and MOUs when necessary.
3. Presentations to Rotary officials to obtain their support
4. Fund raising
6. Lead with Team Heart on conference management and local sourcing of supplies
7. Lead with stakeholder relationship development
8. Support with implementation of conference including pre conference site reviews at the district hospital
1. Kibagabaga Level Two Teaching Hospital
2. Rwamagana Level Two Teaching Hospital
3. Byumba Level Two Teaching Hospital
4. Kabgayi Level Two Teaching Hospital
5. Kibogora Level Two Teaching Hospital