As a volunteer with nonprofit Team Heart, Maine cardiologist Patrick Hohl travels to Rwanda once a year to help people who suffer from rheumatic heart disease and need heart valve replacement. Although the disease is rare in the United States, it’s a significant problem in Rwanda — a situation made worse considering the country has more than 12.5 million people but only a handful of cardiologists and no cardiac surgeons.

During its three-week annual mission, a team of American nurses, sonographers, cardiac perfusionists, nurses, cardiologists, anesthesiologists and cardiac surgeons sees close to 100 patients and offers 16 heart valve replacement surgeries. Team Heart also sees former patients for followups, works on disease prevention and helps educate the next generation of Rwandans so the country may take over its own rheumatic heart disease care some day.

For Hohl, it’s a job on top of a job — he takes vacation time to go to Rwanda for Team Heart and pays his own travel costs — but he can’t imagine not going.

Name: Patrick Hohl

Age: 36

Town: Cumberland

Family: Wife Anneke, son Liam, 6, and daughter Hannah, 4

Job: Cardiologist with MaineHealth Cardiology (Lewiston, Portland and Scarborough)

How does working in Rwanda compare to working in Maine? Patients in Rwanda suffer from rheumatic heart disease, which is rarely seen in the U.S. The condition often affects adolescents and young adults, so my patient population in Rwanda is much younger than those patients I see in Maine, who are often older and suffer from acquired cardiovascular disease such as coronary artery disease. Also, a lot of patients go without cardiac care until they are very sick, so we see a lot of complex valvular heart disease cases that you wouldn’t typically see in the U.S.

How do people respond when you have to say no to their surgery? The screening process involves a comprehensive evaluation of nearly 100 patients each year. We only have the ability to perform 16 surgeries during each mission. That means a lot of patients are not selected as surgical candidates. Some are too healthy and can be seen in followup the next year. Unfortunately, patients are sometimes too sick and unlikely to survive the surgery. Most times we cannot offer a definitive decision at the time of our screening examination, but for some of the sickest patients it is clear that they are not surgical candidates. Sharing this news is probably the most difficult part of the work. Even after hearing the news, however, patients are simply grateful that you gave them the time and consideration. This has been incredibly humbling.

How do they respond when you say yes? Patients and family are eager to have their underlying heart condition addressed. Most respond to the news with great joy. For women of childbearing age, however, this can be a difficult decision. Since we replace the affected valve with a mechanical prosthesis, they have to be on lifelong anti-coagulation with Coumadin, which can cause birth defects. As a result we ask that our patients commit to not becoming pregnant in the future following a heart valve replacement surgery. For younger Rwandan women who are not yet married this can be an incredibly difficult choice.

What does Rwanda need? The mission of Team Heart is to build a sustainable system of cardiac care in Rwanda. In addition to a capital fundraising campaign to build a cardiac hospital that can support a full spectrum of cardiac care, Team Heart works with Rwandan medical personnel to train and educate local health care workers. Team Heart has also supported the efforts of local Rwandan physicians-in-training to pursue advanced training in cardiac surgery. Unfortunately, there is no opportunity to do this in their home country and they have to travel abroad with the hopes that they return to Rwanda.

The best part of volunteering for Team Heart? The work is self-sustaining, in particular knowing that you can make a big impact in a few people’s lives each year.

The most challenging part? We see a lot of need during our time in the country and are often limited in what we can address. One of the hardest parts is seeing a patient that could easily be treated for a condition in the U.S. but will suffer due to lack of access to care or resources in Rwanda.

What made you go back this year? The Rwandan people are incredible and the need is great. Also, joining Team Heart as a volunteer is like joining a second family – we all look forward to seeing each other in Rwanda each year.

Who was your favorite patient? Israel Tuyisenge, an 11-year-old boy I met during my first mission in 2017. I met him on our first day of screening at the city hospital in Kigali where he rushed toward our bus as we entered the campus. He climbed onboard and gave each and every one of us a hug. It turns out he had been evaluated by Team Heart the previous year but was not offered surgery because he was too small. He managed to come back weighing just over 30 kg (about 60 pounds) and went on to receive a mechanical mitral valve on the first day of surgery that year. He had an electrifying smile and did really well through the surgery. He carried the spirit of the team that year!

Will you go back again? Yes, I have already volunteered for the 2019 mission.