Medical Mission to Bolivia: Collaboration with Project Pacer International

In this interview, we speak with Dr. Adelqui Peralta, Director of Project Pacer International, about recent humanitarian work in Bolivia. Dr. Peralta is an Assistant Professor of Medicine at Harvard Medical School and the Director of Cardiac Electrophysiology for the VA Boston Healthcare System. Project Pacer International is a nonprofit organization that provides cardiac care to indigent patients in the developing world.

Tell us about Project Pacer International, and how you got involved with this organization.

Project Pacer International is a Boston-based nonprofit organization that aims to bring modern cardiac therapies to the developing world. I took my first trip with them in 1999, and have been with them for almost 20 years now. I learned about Project Pacer while training at Lahey Clinic in Burlington, Massachusetts — Dr. David Martin, the EP program director at the time, had done work in Bolivia with Project Pacer. The organization has been active in many different places, including India, Africa, and South America; however, Bolivia has been the most constant place that we have traveled to. We attribute this to our excellent working relationship with Hospital Viedma in Cochabamba, as well as the local help we get from one of the cardiologists, Dr. Oscar Ferrufino. We travel there every year, so there are a lot of patients that we have treated and get to see every year. Every time a Project Pacer trip is scheduled, it is advertised on TV and in the newspapers there, so many people travel to this hospital. We do a week of work seeing new patients, implanting devices, and checking all the patients that we have seen over the years. We usually arrive on a Sunday, and when we get to the hospital, the waiting room is always full. We start seeing patients that day and make preparations for pacemaker implants during the week. A lot of the patients travel long distances to Cochabamba, sometimes traveling by bus for more than 24 hours before making it to the hospital!

Why did you personally want to get involved in these missions, and how many have you taken part in so far?

I’m originally from Argentina, so when I came to the U.S. and saw the opportunity to travel to places where people don’t have access to cardiac therapy, I absolutely wanted to get involved. I was also inspired by my mentors at Lahey Clinic at the time, Dr. David Martin, currently the President of Project Pacer, and Dr. Roy John. I’ve been traveling with Project Pacer almost every year for the last 20 years, and it’s been a very rewarding experience. Our funding principles consist of indigent care with tangible benefits, but without compromising quality (we need to have the necessary facilities and support), as well as professional development, offering education to staff, trainees, and students. In simple terms, it’s a great opportunity to provide care to indigent people who cannot afford a pacemaker.

Tell us more about your most recent trip.

Our most recent trip was in November 2018. We had a shipment of pacemakers that had been stuck in customs for quite some time, so when they were released, we traveled there to implant these devices. Because of this, our trip was relatively short — we implanted less than 20 devices this time (we generally implant about 40-50 devices and see somewhere between 200-300 patients during a one-week trip). However, I still consider this trip to have been very productive.

Do you perform mainly pacemaker implants, or do you also perform ablations?

We have done ablations in previous years, but not this past year. On this last trip, we only implanted pacemakers, some biventricular devices, and a couple of defibrillators. One of the challenges that we had was the hospital’s fluoroscopy equipment was not working in the cath lab, so we had use of the only C-arm in the hospital, which was in the operating room. Therefore, we would switch between rooms doing implants, while doing generator changes in another room with no fluoroscopy.

How many volunteers join you on these trips?

We usually take about 4-5 electrophysiologists, a couple of EP techs, 2 mid-level practitioners (e.g., PA or NP), and a nurse, or about 10 people in total. For some of the trips, we have cardiology or EP fellows come with us, interns, as well as some medical students or a translator. Consider that we have 2 operators in the OR, 2 electrophysiologists seeing patients in the clinic, and 3 workstations for device checks.

What are the costs associated with these missions?

The trips are not cheap — all of us pay our own airfare, food, and lodging, and we use personal time off from our jobs. Some fellows and residents are sometimes able to get some form of funding. However, I think the biggest challenge is all the logistical issues that need to be in place for us to go. There are very strict regulations in Bolivia right now, so you cannot bring in any type of resterilized material — every pacemaker that we use has to be new. This means that we have to go to device companies for donations. In this regard, I want to acknowledge the generosity of Abbott, Boston Scientific, and Medtronic in providing devices and leads — without their help, our missions would not be possible. Once we have the donations, our head of logistics, Anthony Moulton, prepares a lot of paperwork that needs to be in place to be able to enter these materials into Bolivia. It’s a significant challenge that takes many months in advance to prepare.

What have been some of your more memorable patients on these previous missions?

There are many! For example, there was a young kid, Felipe, who experienced loss of consciousness (due to heart block) every time he played soccer. We implanted a pacemaker, and the boy grew up. We eventually did a generator change, and he now has a family. However, he recently had a stroke. This patient suffered from Chagas disease, which not only causes heart block, but also left ventricular dilation, apical aneurysm with thrombus in it. We saw him this past November, and he’s doing well. One of the challenges with Chagas disease is that many patients need to be anticoagulated, but many live in the countryside where access to anticoagulant therapy is difficult. A year ago, we met Diana, a teenager who came looking for help in need of heart surgery for a ventricular septal defect with pulmonary hypertension. We don’t perform heart surgeries; however, Dr. Kashif Chaudhry (head of development) organized an online fundraiser, and within 24 hours, enough money was raised. She underwent surgery and had an uneventful recovery; we saw her in November, and she is doing great.

What can you tell me about the people and culture in Bolivia?

Bolivia is a beautiful country with many treasures, but its greatest treasure is their people. They are wonderful — the patients and physicians are great, and they are extremely grateful. The physicians there are very good, but just do not have the means. Chagas disease affects many people living in poor and rural areas, so these patients have no economic means. In addition, Chagas can affect patients in their 20s and 30s, during a very productive period of their life. Therefore, implanting a pacemaker in these patients really changes their lives. It’s a very touching experience for us.

When is the next trip scheduled to take place?

During my last trip in November, I traveled to Sucre, the capital of Bolivia, to meet Ximena, one of the doctors who had come to Cochabamba with a group of patients. I visited a couple of hospitals and the local health department. Consider that our visit, although beneficial for patients, can be disruptive to the hospital since we need exclusive use of the only C-arm they may have. There is a lot of enthusiasm to launch a pilot mission in Sucre after the summer. We’re discussing details with the health department on the logistics needed for the trip. We’re very excited and looking forward to this opportunity.

How can others get involved with this?

Anyone who is interested in volunteering can go to the Project Pacer International website below and click on the “Get Involved” tab. From there, they will find a link where they can apply; the form can be emailed along with their CV. We always have a pool of volunteers, and we definitely welcome new people as well! If they speak Spanish, that is much better, because we are in real need of bilingual people once we go there — most of our team members are not bilingual.

Is there anything else that you would like to add?

Thank you for giving me this opportunity — it was a pleasure. Organizations such as Project Pacer recognize that there is an unmet need for pacemaker implants in places where Chagas is endemic, such as in South America, so we try to do what we can to help them. 

For more information, please visit www.projectpacer.org