Medical Mission to Morocco

Why did you personally want to get involved? What is your role in the mission? How many medical missions have you taken part in previously?

Medical missions in Morocco are part of the professional life in our department, and have been performed for 20 years now under Prof. Nadir Saoudi’s direction, who was the pioneer. The Monaco-Morocco Cardiology Association was created in 2007.

In Rabat, we perform the ablations and implantations with Dr. Tazi, who is responsible for the patients. This will be my fourth mission. Personally, I have been interested in humanitarian medicine since reading about the actions of Médecins Sans Frontières (Doctors Without Borders) all around the world when I was young.

How many and what types of cases will be performed?

We have 7 procedures planned: 2 AVNRTs and 4 AVRTs, as well as a biventricular pacemaker implantation.

What staff members will be accompanying you on this medical mission? Does a different team of people travel each time for missions?

We will be traveling with one of our cath lab nurses as well as one EP fellow. The exact composition of the team changes for each mission, but generally includes two physicians and one nurse from our department.

What are the costs associated with these medical missions?

All costs (approximately 3000 euros per mission) are covered thanks to the Monaco-Morocco Cardiology Association (Dr. Naïma Zarqane serves as President and one of our staff members). This includes flights and hotel accomodations. Significant financial support is provided each year by the Croix-Rouge monégasque (Red Cross of Monaco) as well. The devices (new and non-reused) and catheters are provided thanks to donations by Medtronic, Abbott, and LivaNova (previously Sorin Group).

What kind of equipment is available?

Cheikh Zaid Hospital has an angiography room dedicated for interventional cardiology and radiology, as well as pacemaker implantations. Dr. Tazi also just acquired a new EP recording system (Abbott). However, the lab is shared with other physicians, so at times during missions, we have to make way for an urgent STEMI between ablations.

What are often some of the biggest challenges during a mission?

The interventional room is well equipped in Rabat, but some missions are performed without EP equipment, so when needed, we bring a portable EP recording system miniaturized within a simple laptop. In other institutions, procedures are performed in the orthopedic or gynecological operating room. Prof. Saoudi also once performed an ablation with the fluoroscopic image at his back! Another time, I remember being stuck at the airport in Rabat for several hours because of an administrative obstacle; therefore, we were unable to take our materials/equipment to our patient, who was in a fasting state while waiting for their implantation.

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

Among the patients treated, I will never forget a young imam (30 years old), who was saying a prayer as he entered into the lab for his WPW ablation. Everything with the procedure turned out fine, but sometimes it’s not so reassuring for the operator to hear their patient praying before a procedure!

I also remember having to cancel a dual-chamber pacemaker implantation because the patient who was scheduled had an active infection. The last day before our departure, a 25-year-old male presented at the ED in Rabat for syncope due to a complete depletion of his pacemaker battery (congenital complete AV block). He had a battery replacement the same day, just before we flew back!

Tell us about the people and the culture in Morocco. 

Moroccan people are very optimistic and thankful, and have great respect for their doctors. Some patients may express a little bit of fatalism in their daily actions. Moroccan physicians and paramedics have a lot of imagination, because they are able to be creative with the limited tools they have.

Tell us about the support provided for Moroccan fellows to come to your center for EP training, as well as for young Moroccan patients to receive treatment at your center due to a collaboration with the Monaco Collectif Humanitaire?

Since the creation of the association, 7 fellows have received financial support to come and train at our center (4 in EP, and 3 in cardiovascular imaging training). Under the hospice of the Monaco Collectif Humanitaire, we often receive children (under the age of 15) from Morocco for SVT ablations or device implantations. They are hosted by families in Monaco during their stay. At present, more than 20 young patients have been managed.

Any final thoughts?

Medical missions are wonderful experiences to experience and share. A lot of exchanges occur during these periods. It is also an opportunity for our nurses to train the local nurse team. We also give some local educational lectures concerning EP/cardiac pacing. Our experience from 2016 was documented in Europace.¹ 

Lastly, I would add that this experience was made possible thanks to the strong support of the Government of the Principality of Monaco as well as the administration/direction of our institution (Princess Grace Hospital).

Disclosure: The author has no conflicts of interest to report regarding the content herein.  

Reference

1. Bun SS, Latcu DG, Errahmouni A, et al. Pacemakers implantation and radiofrequency catheter ablation procedures during medical missions in Morocco: an 8-year experience. Europace. 2016;18(7):1038-1042.