US cardiologist brings expertise and technology to Zimbabwe

By uchealth.org

In a country of more than 16 million people and only a handful of heart specialists, cardiac care is desperately needed in Zimbabwe but difficult to find, especially for those living in remote communities

That is slowly changing through a partnership between medical professionals in the African nation and their stateside colleagues, spearheaded by Dr. Mark Keller, a cardiologist at the UCHealth Lone Tree Medical Center.

Keller first went to Harare, the capital of Zimbabwe, in 2019. He was part of an exchange program to work with local doctors and increase their cardiac training, as well as instruct them in the use of easy-to-use digital equipment that makes diagnosing heart problems much easier for medical staff and more convenient for patients.

“We can now go out into the smallest clinics in the most rural villages, meet with patients and send the results back to the iCloud, where they can be read by doctors here in the U.S.,” Keller said. “It feels really good for all of us to be doing this since so much of the population there doesn’t have access to good cardiac care and are suffering because of it.”

Keller didn’t travel alone on his trips to Zimbabwe, including a second, more recent one this spring. He brought along valuable companions – Butterfly IQ ultrasound probes and SmartHeart digital devices. Both portable digital devices can be used on patients being seen for cardiac problems, including hypertension, chest pain and edema, with results captured, uploaded and stored in a secure iCloud via a smartphone.

Keller didn’t travel alone on his trips to Zimbabwe, including a second, more recent one this spring. He brought along valuable companions – Butterfly IQ ultrasound probes and SmartHeart digital devices. Both portable digital devices can be used on patients being seen for cardiac problems, including hypertension, chest pain and edema, with results captured, uploaded and stored in a secure iCloud via a smartphone.

Keller has helped train local doctors in Zimbabwe to use these “point of care” echocardiograms (ECHO) and digital electrocardiogram (ECG) devices to identify high-risk patients. The results can be relayed back to locally trained practitioners there, as well as interpreted by cardiologists like Keller here in Denver.

An ECHO is a graphic outline of the heart’s movements. An ECG is a test that measures the electrical activity of the heart, with both tests measuring the health of the heart. “Point of care” means testing that is done near or at the locale where a patient receives treatment, as opposed to traveling a long distance to a hospital.

“After we screen these patients and diagnosis them, many of them can be treated with the proper medication and achieve a positive outcome,” Keller said.

Because ECHOs and ECGs are currently only offered in two cities in Zimbabwe, patients historically have faced long waits, travel hassles and higher costs to seek care for potential heart abnormalities. Which is where the new technology comes in.

“Over 70 percent of Africans lack access to timely cardiovascular specialists, and these services need modernizing,” said Dr. Integrity Mchechesi, one of several Zimbabwe-based medical specialists working with Keller. “Over 1 million people die of heart diseases every year.”

Heart disease is growing in Africa, including Zimbabwe, where it is now the fourth-leading cause of death because of chronic contributing medical conditions such as diabetes, hypertension and HIV/AIDS, along with diet and sedentary lifestyle issues.

But by offering “point of care” diagnostic services – where local doctors trained to use these hand-held cardiac devices travel to patients and not vice versa, a much wider net can be cast to improve health outcomes for greater numbers of Zimbabweans in their own communities.

To further move the needle on the country’s sobering health statistics, Keller and the team in Zimbabwe, many of who began working with him when they were medical interns four years ago at Harare’s Parirenyatwa Hospital, have formed a telehealth organization called Azanza Telehealth.

“The impact of this has been huge. What we really want to do is expand our efforts by bringing healthcare to you, whoever you are and wherever you’re at,” said Dr. Tinotenda Michael Simemeza, who is training to be a neurosurgeon.

Along with cardio services, the ECHO and ECG devices can be used for pregnancy and general ultrasound support. For instance, the devices assist in checking for issues with thyroid, breast, prostate, kidney and musculoskeletal problems. Eventually, Azanza staffers hope to ramp up technology amenities so that patients can order medications online and for those suffering from hypertension and cardiac disease, receive medical advice 24-7.

For the Azanza team, the point-of-care philosophy aligns with its vision of delivering better healthcare to Sub-Saharan Africa. That includes:

• Developing good screening tools to diagnose problems initially.
• Helping patients with medication when necessary.
• Referring patients to specialists for further treatment if needed.

While patients with more complex cardiac issues usually travel to South Africa or India for treatment, that may change in coming years as Zimbabwe health professionals hope to develop a system that enables more local doctors to become medical specialists, such as cardiologists.

Simemeza’s colleague, Blessing Chikuwadzo, a sonographer, said he wants Azanza to be at the forefront of screening for cardiovascular disease and making access to those screenings easier and more economical for patients throughout the country.

“My dream is by 2030 to screen everyone who needs it in Africa for heart disease and provide early detection and early treatment to improve the lives of people. We want to play our part, so people get screened, treated and live healthier lives, and build an Africa that is free from heart disease.’’

A Gates-funded Investing in Innovation Africa grant has boosted Azanza’s profile and allowed it to purchase more screening devices, create a central facility in Harare to serve as a hub where abnormal heart results are read and expand its reach throughout the country. Those efforts include opening cardio clinics in the neighboring country Botswana, and Keller and Chikuwadzo recently went to the country of Lesotho, where they trained doctors in a pilot program they started.

Keller – or “Prof Keller” to his former students – continues to meet and advise them and other physicians on Zoom, where he reviews screenings, and he’s also an Azanza team member. He has interpreted thousands of ECGs these past few years, and during the COVID-19 pandemic was especially busy as the group was the only one performing these types of cardiac services.

He recently started an Africa Telehealth Cardiovascular Project Fund to help with travel costs to and from Zimbabwe and to purchase more cardiac devices.* See below for fund information.“Eventually, the goal is to make this a sustainable local program that is not dependent on American doctors to interpret data pro bono,” he said.

His colleagues in Africa who have big hopes for Azanza want the same. To them, the mission is a personal one, as they have seen firsthand how an increased level of care has helped so many Zimbabweans.

“Azanza is an African fruit tree that is drought resistant,” Mchechesi said. “The word Azanza means ‘African’ and ‘surviving.’ And it perfectly resembles the aspects of resilience and fitness we are trying to impart to the African people.”