Heart disease is a leading cause of death in Bolivia. It is most prevalent among the country’s poorest communities, where many villagers develop heart complications from Chagas disease, a parasitic and potentially life-threatening illness that is spread primarily through contact with infected insects. For the past three decades, Brigham cardiologist David T. Martin, MD, has made it his mission to alleviate suffering among this vulnerable population.
Martin, vice chair for Network Development and Innovative Care Solutions in the Department of Medicine, has spent a week or two in Bolivia nearly every year since the early 1990s volunteering with local partners, cardiologists and hospitals to implant donated pacemakers for patients in need.
This June, he and a team of 15 colleagues returned from their latest trip — the first since 2019, as the program was paused during the height of the COVID-19 pandemic — to deliver pro bono, lifesaving care.
“One of the patients we saw is a lovely woman I first met in the ‘90s who is now on her fourth pacemaker,” said Martin. “Because of the pacemaker, she has been able to raise a family of children, and it’s made a huge, huge difference in her life. When you see that, it really gives you a sense of the incredible benefit that these people get from pacemaker treatment.”
Putting Cardiac Care within Reach
Most people with Chagas disease are infected as toddlers, but serious heart problems usually develop 10 to 20 years later, he said. Patients may present with dangerously low heartbeats in their 30s, 40s and 50s, although Martin said his youngest pacemaker patient ever was just 11.
According to Martin, as much as 50 percent of the Bolivian rural population is infected with this parasite. Most people get it from living in close proximity to livestock, and about 20 percent of those who are infected develop serious heart concerns. A pacemaker, a surgically implanted device that keeps the heart beating at a healthy rhythm, can mean the difference between life and death. But the cost is out of reach for most rural Bolivians.
“When people are living on less than $1 a day, a $1,500 pacemaker is just way more than anyone could afford,” Martin said.
“Some patients have sold their homes to be able to afford pacemakers,” said Jorge Romero, MD, director of Arrhythmia and Electrophysiology Research and associate director of the Ventricular Arrhythmia Program, who traveled to Bolivia with Martin on his recent trip. “When they are not lucky enough to have a house, they often die waiting for a device.”
Geography is another barrier for many Bolivians. For some, the nearest hospital is days away by walking and hitchhiking. However, thanks to a network of local physicians and community advocates, patients find their way to Martin’s clinic any way they can. This year, during the team’s weeklong stay, they implanted 36 pacemakers, checked on the pacemakers of previous patients and evaluated more than 200 new patients — a tangible boon to the community.
Making a ‘Very Visible Difference’
The team left with a waiting list of 13 patients for their next trip, which is planned for early 2024. Their work is supported by the Brigham, as well as by donations from pacemaker manufacturers and Martin’s patients in the U.S.
“A lot of what we do has been funded by grateful patients over the years,” he said. “We appreciate the support from everyone who has donated to this program.”
The program typically involves a team of about 15, including international physicians from countries such as Argentina, Colombia, Venezuela, the U.K. and Canada; technicians from the pacemaker manufacturing companies; and medical residents and fellows in training.
One such trainee on this year’s trip was Brigham cardiology fellow Ezimamaka Ajufo, MD, who said the experience was a positive one, professionally and personally. She was touched by the compassion the team demonstrated and the care everyone took to make sure she was working within her skillset and supervised appropriately.
The trip also helped solidify her interest in electrophysiology: “You really make a very visible difference in many people’s lives by giving them these devices,” Ajufo said.
Personally, she enjoyed making new connections. “It really brought together a diverse group of people who were unified in volunteering. It made for great cohesion and integrity. I got to know the group quite well and thought it was an incredible group of people.”
She hopes her experience will inspire others to consider international pro bono work.
“It opens up opportunities to engage with the wider medical community and gain more exposure to how health care works and how people live in different parts of the world,” she said. “And I think that can only be a good thing.”