Dr Augusto Papalardo and his team guiding and monitoring the young physicians while a pacemaker is being implanted at Ayder3AT AYDER - MEKELLE UNIVERSITY HOSPITAL:
By: Dr Abraha Hailu Weldegerima, assistant professor of internal medicine, MU-CHS

Mekelle university-college of health sciences, department of internal medicine-cardiology unit in collaboration with an Italian Based organization (MILENA NON PROFIT ORGANIZATION/NPO) led by Dr Elisabetta Zachara and her team has stepped up the practice of cardiology in our college, by implanting PACE MAKERS to three patients at Ayder hospital, to a historic landmark in the region and in the history of peripheral university hospitals in Ethiopia. The team from Milena NPO comprising of Dr Elisabetta, Dr Augusto Pappalardo(The electrophysiologist) , Barbara and Ascanio arrived On the week of June 3, 2013 with three Pacemakers, one MEDTRONIC PROGRAMMER and all consumables needed for the pace maker  implantation for free!
The pace maker implantation procedure was held from June 3-7, 2013 at the Major Operation Theater in Ayder equipped with C-arm fluoroscope. It was a fascinating experience for the young physicians and nurses in the cardiology unit who aspire to develop state of the art cardiology center in Ayder. They had the opportunity of hands on training in inserting pace maker for the first time (land mark experience for the cardiology unit team and for the hospital) guided by experienced team whose hands own many years of experience.
Fig below: Medtronic Programmer and Pacemakers donated to Ayder Hospital from MILENA     
 Medtronic Programmer and Pacemakers donated to Ayder Hospital from MILENA 1Medtronic Programmer and Pacemakers donated to Ayder Hospital from MILENA 2

Fig below: Dr Augusto Papalardo and his team guiding and monitoring the young physicians while a pacemaker is being implanted at Ayder

Dr Augusto Papalardo and his team guiding and monitoring the young physicians while a pacemaker is being implanted at AyderDr Augusto Papalardo and his team guiding and monitoring the young physicians while a pacemaker is being implanted at Ayder2


Dr Augusto Papalardo and his team guiding and monitoring the young physicians while a pacemaker is being implanted at Ayder3

About Millena NPO:

Milena NPO is a non-profit organization (NPO) founded in Ethiopia. The organization has been making constant progress in the diagnosis and treatment of heart disease while also working towards prevention, health education and the training of local staff. The project began in November 2005. To present day, thanks to Milena NPO, 161 children have undergone cardiac surgery in Sudan and Italy and most of these children are currently being followed at Ayder Referral Hospital in the cardiology clinic. Having witnessed the complexity of the local health status, the organization is planning to pursue in continued research and in assisting in the establishment of cardiology interventions that would solve a good percentage of the local cardiac problems (valvuloplasty for favorable Rheumatic valve diseases like the most common culprit lesion-Mitral stenosis, closure of congenital cardiac defects, etc...). As part of this endeavor, a team of interventional cardiologists are coming in August 2013 to do interventions like PDA (Patent Ductus Arteriosus) closure and they will train our surgeons and cardiology teams in our college. This will be another boom of our collaboration and effort!  
 Team members of Milena NPO and cardiology unit of MU-CHSTeam members of Milena NPO and cardiology unit of MU-CHS2Team members of Milena NPO and cardiology unit of MU-CHS3Team members of Milena NPO and cardiology unit of MU-CHS4
Fig above: Team members of Milena NPO and cardiology unit of MU-CHS

About the cardiology unit in the department of internal medicine-Mekelle university/CHS:

The cardiology unit within the auspices of the department of internal medicine, MU-CHS - at Ayder hospital in its own internal capacity is also striving to do its best to give care to patients in need with the already available state of the art medical equipments like Echocardiography (both Transthoracic and Transesophageal), Resting and Stress Exercise ECG Testing, 24 hour ambulatory Blood pressure and 24 hour cardiac Rhythm monitor /R-Test/, which are currently at hand. So far we have done 2100 echocardiographic studies in a year and half period of its official establishment. If we include the echocardiography studies done by Milena too, the number would be more than 5000 patients. To augment the above services and also satisfy the public needs of cardiovascular care , with a supportive and truly committed leadership from the college (the outgoing Dean Dr Zerihun and his team) and university management team (specifically the offices of the president, Dr Kindeya, and the office of the vice president for research and community services, Dr Abdulkadir), the department of internal medicine cardiology unit is on its way to establish a catheterization Lab (CATH LAB) for invasive interventional cardiology services in our university hospital in a year time and save the dollars spent by patients going abroad for angiography. It is needless to mention that the establishment of a CATH LAB in Ayder would need immense (most of them expensive) basic and consumable material resources and skilled interventional cardiologists and hence the need to clarify issues well ahead and be prepared particularly in terms of sustainability of the CATH LAB with its consumables and skilled nurses and physicians. The department will continue cooperating with other stakeholders nationally and internationally to build its inner potential and as the same time will be receptive for the kind and benevolent support that it receives from any organization to help in man power training and any help to our community.

About the patients who had the free pacemakers implanted:

The first patient who received the first pacemaker at Ayder was a retired teacher Tilahun Mekonnen who was diagnosed to have systolic Hypertension, Bradycardia plus Atrial fibrillation with slow ventricular rate.  The second patient was Ato Kassa Atsbeha who was diagnosed to have complete heart block (third degree Atrioventricular/AV/ Block) with Dilated Cardiomyopathy and impaired LV systolic function. The third patient was ato Gebrekiros Gebremedhin who was diagnosed to have symptomatic trifascicular Block. All patients were told /advised/ by their physicians to have a pace maker implanted long ago but was not possible for they can’t afford. The cost of a pacemaker in a private hospital in Addis Ababa is 40,000.00 to 50,000.00 Ethiopian birr which is far from the capacity of these three individuals and most Ethiopians. All received a rate responsive single chamber pacemaker (VVIR) of the MEDTRONIC SENSIA SES R01 type without a penny. It has been a great pleasure for the team to witness how grateful these pleasant gentlemen, our patients, were on the golden opportunity they have received from MILENA NPO and our university. It is a great pleasure for the cardiology unit team to follow them for the years to come.
We are well aware and would like to foreword our concerns that, there are many of them who would need preventive and curative interventions not only in pacing the heart but also in many other fields of medicine. As the pace makers are relatively expensive and require trained Eletrophysiologists, the cardiology unit currently is not in a position to pace all patients we have who need cardiac pacing at our hospital and hence I call up on all stakeholders to help our unit sustain this huge stride forward! The essence of this manuscript is to acknowledge all parties involved in this humane initiative and to spark the idea of ‘’YES I CAN DO IT’’ to our university community and the public.  Hence, let us be proactive, join together and harmonize our efforts to tackle the diversified ailments that are facing and will be facing our community in the future as our nation is in a state of Epidemiologic transition (a shift driven by industrialization, urbanization, and associated lifestyle changes), a transition from pestilence and famine &receding pandemics (still affecting the many Ethiopians)  to a fifth stage, characterized by an epidemic of inactivity and obesity (major cities like Addis Ababa and Mekelle are facing this stage currently as to our observation in the past few decades).