Pacemaker Mission launches a new generation of care
Written by Jodi Grahl, Pacemaker Program Director
In early December, three days after celebrating my ten-year anniversary with Solidarity Bridge and almost two years since our mission trips were halted due to Covid-19, it felt wonderfully appropriate to be landing in Bolivia to carry on the Solidarity Bridge mission as it all started—with a stock of donated pacemakers for Chagas disease patients and others in urgent need of heart care.
Dr. Marta Vakulenko and Dr. Paola Rodriguez prepare materials for a pacemaker implant while Medtronic pacemaker technician Erick Cossio observes. December 7, 2021, Clinica Maria de los Angeles, Cochabamba, Bolivia.
As our long-time supporters may recall, Solidarity Bridge started with a plea in a Bolivian cemetery to our founder, Juan Lorenzo Hinojosa: “We need pacemakers”. Low-income farmers and laborers were dying from Chagasic cardiomyopathy. It was 1999, and little global attention was paid to Chagas disease, sometimes referred to as the silent killer. Since then, global organizations such as Doctors Without Borders and Bolivian national efforts such as the health ministry’s Plataforma Chagas have made important progress controlling the vector that spreads Chagas and connecting patients to treatment. Worldwide, Chagas patient numbers have dropped from an estimated 18 million in 1990 to eight million in 2005 and around six million today. But Chagas disease in the Americas is still responsible for the loss of more than seven times as many disability-adjusted life-years as malaria. Bolivia remains the country with the highest per-capita infection rate, with over 6% of the population suffering the ravages of this cruel disease.
I was accompanied to Cochabamba by a new missioner, Dr. Marta Vakulenko. Marta is an electrophysiologist (EP) from Kaiser Permanente Medical Center in Los Angeles, California. Marta was eager to share her EP skills and in turn to learn about Chagas, which is increasingly diagnosed in the South American immigrants among her California patients. Marta also approached our visit with keen insight into what it is like to be a doctor in an under-resourced country like Bolivia. As the Ukrainian-born daughter of two pediatricians in what was then the Soviet Union, Marta understands the frustrations of having the skills to diagnose patients but limited access to the equipment and supplies to treat them.
Marta was particularly impressed by the résumé of the cardiac surgeon she would work with to implant the donated pacemakers, Dr. Paola Rodriguez. Originally from Oruro, Bolivia, Paola has completed sub-specialty training in cardiovascular surgery in Argentina and a fellowship in pediatric cardiovascular surgery in Colombia. A few months ago, Paola reached out to Puente de Solidaridad to express interest in becoming a pacemaker partner, joining the ranks of four or five other Bolivian cardiologists offering their services to diagnose and treat low-income Bolivians with irregular heart rhythms.
This mission trip would provide the opportunity to connect Dr. Vakulenko and Dr. Rodriguez for peer-to-peer support extending beyond the duration of our visit. Bolivia has only three or four electrophysiologists in the whole country — outnumbered by the nine EPs at Kaiser Permanente alone. Although cardiac surgeons like Paola are fully qualified to implant pacemakers, certain cases may benefit from consultations with an EP. Such a case emerged on the first day of our visit, when we met Alina, a 12-year-old girl born with an exceedingly rare condition in which there is no detectable rhythm in the upper half of her heart, leaving the bottom half struggling to keep up. Even Marta had never seen such a case, so she messaged her colleagues back at Kaiser. One after another, the eight other Los Angeles EPs shared their opinions, developing consensus around the plan to implant a single chamber pacemaker to allow Alina to grow into adulthood. Fortunately, the Medtronic donation we carried to Bolivia included a device specifically designed for smaller patients. Alina received her implant on December 7 and went home the next day. Before they left, I reminded Alina’s family that this was just the beginning of life-long care for her unique heart condition. I also reassured them that they are not alone—that Alina is now “our patient” and we are committed to continuing to accompany and support the family.
Implant patient Maria was all smiles the morning after her surgery. She is accompanied by a patient advocate from the Bolivian health ministry’s Plataforma Chagas program and by Dr. Marta Vakulenko.
Alina’s needs did not derive from Chagas. But the next day, December 8, we implanted a pacemaker for María, a 49-year-old Chagas patient from the central-Bolivian town of Aiquile. María had been told months earlier that her existing pacemaker, which she received almost a decade earlier through a Doctors Without Borders program, needed a new battery. María lives in a small community in the mountains outside Aiquile, and speaks only Quechua. When she heard about our mission trip through the Plataforma Chagas program, she walked five hours and then took a five-hour bus ride to reach the Cochabamba office of Puente de Solidaridad. In her case, given her previous implant, we opted to provide her a pacemaker received through a different recent donation from Boston Scientific. We are incredibly grateful for the generous donations from both of these leading pacemaker manufacturers—Medtronic and Boston Scientific—giving us important options to meet the diverse needs of our patients.
As I observed Dr. Vakulenko and Dr. Rodriguez working side-by-side in the operating room, it dawned on me that both of these women in their early 40s had barely started medical school when Juan Lorenzo first responded to the call to build the bridge of care between the U.S. and Bolivia. Since then, both the Chagas scenario and the field of heart disease treatment have greatly evolved. Marta and Paola represent a new generation of surgeons who will continue to build our bridge in the coming decades. God willing, Chagas numbers will continue to decline, and options for Alina and María and so many other patients will continue to expand and improve.
On behalf of Alina and María, as well as Epifanía, Raymunda, Farudi, Claudio, Paulino, Emiliana, Ipólito, Georgina, Oscar, and Germán—all beneficiaries of the Solidarity Bridge/ Puente de Solidaridad Pacemaker Program this past month of December 2021—Thank you Marta and Paola, thank you Medtronic and Boston Scientific, and thank you to all our partners, missioners, donors and supporters.