Volume 27 – Issue 6 – June 2019
An interview with Mubashir Mumtaz, MD.
We speak with Dr. Mubashir Mumtaz, Chief of Cardiovascular and Thoracic Surgery and Surgical Director of Structural Heart Program at UPMC Pinnacle in Harrisburg, Pennsylvania, about his recent humanitarian work in Pakistan.
By Jodie Elrod
June 5, 2019
How did this medical mission trip to the Tahir Heart Institute in Pakistan come about? Tell us about the involvement of UPMC Pinnacle and Humanity First Pakistan.
Tahir Heart Institute (THI) was established in 2007 to provide cost effective and charitable medical services to the population around Rabwah (Chenab Nagar) in Pakistan. The institute has also gained significant recognition over the years due to its humanitarian work with patients who come to THI from Pakistan and all over the world for treatment.
My friend Dr. Muhammad Khalid Nuri, a congenital heart surgeon in Seattle, had worked as a volunteer for 4 years to establish the Department of Cardiac Surgery at THI. After his departure in 2011, various heart surgeons have dedicated time at the institute on a regular basis. I started volunteering at THI in 2010, and have made several trips since.
I presented the idea of doing humanitarian work at THI to UPMC Pinnacle’s administration in 2010. They were very supportive and over the years, have given me time and material support for this important work. UPMC Pinnacle’s CEO, Phil Guarneschelli, even helped me transport a used heart-lung machine to Pakistan. One of my anesthesia colleagues, Dr. Zahid Khan, also decided to volunteer at THI on a yearly basis. Upon our return from trips, we would always share our positive experiences with our colleagues and medical staff. This built further enthusiasm and our colleagues started to inquire about how they could accompany us on these trips. We utilized the support of Humanity First USA, part of the global Humanity First organization, which utilizes domestic and global resources to relieve suffering caused by natural disaster and human conflict, promote peace and understanding, and strengthen people’s capacity to help themselves. I have since been involved in several missions over the last 8 years.
Why did you personally want to get involved?
I belong to the Ahmadiyya Muslim community (AMC). We are Muslims who believe in the Messiah, Mirza Ghulam Ahmad (1835-1908) of Qadian. Ahmad founded the AMC in 1889 as a revival movement within Islam, emphasizing its essential teachings of peace, love, justice, and the sanctity of life. The head of the community, Hazrat Mirza Masroor Ahmad, currently residing in London, has asked community members and especially physicians to spend their time in service of humanity without any discrimination of religion, skin color, gender, or national identity. The majority of patients at THI do not belong to the Ahmadiyya Muslim community — our only purpose at the institute is to help them on humanitarian grounds. The community has also recently started a hospital in Guatemala, and already runs several hospitals in Africa. Plans for many more hospitals in Africa are underway.
Tell us about planning for the most recent mission to Pakistan.
We started planning for the trip in early 2018. The team included the following members: Aaron Rastoka, Physician Assistant; Mark Moquin, Physician Assistant; Cathy Drenning, Scrub Tech; Anthony Stebbins, Scrub Tech; and Dr. Zahid Khan, Anesthesia.
Humanity First helped with logistics in Pakistan. Dr. Zahid Khan and his family also helped tremendously by hosting the group in Pakistan. Some of us were able to take care of our own travel costs; however, for others, we approached UPMC Pinnacle Heart and Vascular Institute’s leadership. They were kind enough to provide help with the rest of the travel expenditure.
How many patients were treated during this most recent trip?
We were able to perform surgeries on 8 patients. We generally know about the kind of surgeries we will perform a few days ahead of time. One of the patients had travelled from Indonesia for heart surgery. We performed 5 coronary artery bypass surgeries and 3 valve operations. Since our entire team was participating, and our specialization is in minimally invasive valve surgery in which more than 80% of our procedures are performed via intercostal surgical valve repair/replacement (iSVR), we wanted to bring the same benefit of less invasive surgeries to our patients in Pakistan. Therefore, the team collected instruments and devices to help with these operations, which were very generously donated by UPMC Pinnacle. As a result, we were able to perform 2 mitral valve replacements for rheumatic heart disease via intercostal approach utilizing minimally invasive techniques (we were told these were the first operations of their kind in Pakistan). Rheumatic heart disease is common in Pakistan due to poor access to medical care. Patients are generally very young, in their 30s and 40s.
We also performed an aortic valve reconstruction utilizing the patient’s own pericardium. Aortic stenosis is common in Pakistan, once again due to rheumatic heart disease. Since the patients are young, the treatment becomes challenging. Ideally, these patients would benefit from the use of mechanical heart valves; however, due to limited medical access, anticoagulation management becomes challenging. Despite adequate counseling, patients either stop taking the anticoagulant or do not closely follow their INR levels. In women of childbearing age, the issue of contraception still remains in some parts of the country, due to cultural and social taboos associated with its use or a simple lack of accessibility. The use of tissue valves is also problematic, as the durability of these valves in younger patients is much shorter. When I came across these challenges after initial visits, the idea of using the native tissue became very attractive, in addition to this technique being very economical.
During a valve conference, I learned of a technique to reconstruct the aortic valve using native pericardium by Dr. Shigeyuki Ozaki in Japan. Dr. Ozaki has presented data on 850 patients using this technique over an 8-year period, and according to his data, only 17 patients required a re-operation over this period, most of which were due to infection in the valve. To gain more insight, I arranged a meeting with Dr. Ozaki during his trip to a conference in the U.S. Dr. Ozaki later invited me to Japan to learn this technique. Once again, I approached our CEO, Phil Guarneschelli at UPMC Pinnacle, and presented the possible benefit to our patients here in the U.S. as well. He very graciously agreed to support the trip. I obtained approval from the Institutional Review Board at UPMC Pinnacle, as this was a relatively new technique in the U.S. Since learning the technique from Dr. Ozaki, I have performed more than 60 Ozaki reconstructions for aortic valve disease both in the United States and Pakistan.
What are the costs associated with these medical missions?
The costs usually involve taking time off from work as well as travel/flight expenses. Transport and accommodations are taken care of by local organizations, which in our case was Humanity First Pakistan.
What do you find are the biggest challenges of these missions?
In our experience, the biggest challenges were obtaining the necessary visas and appropriate documentations for the trip. Other challenges included calming the fears of the loved ones among family and friends who were concerned about our safety.
Who have been some of your most memorable patients?
One patient that comes to mind is a young male who had come from Kenya with his brother for repair of his coarctation, which had not been diagnosed when he was a child and therefore went undetected until he was 19 years old. Now he was having issues with high blood pressure and decreased perfusion in his lower extremities. Coarctation is rare in adult patients and I had limited experience with it. However, with help from Dr. Khalid Nuri who was still working there, we were able to successfully operate on him. He made a full recovery and returned to his native country.
Another memorable patient came from another town in Pakistan. His sister was a nun in a convent a few hours away. This gentleman, who was in his 40s, had severe mitral stenosis due to rheumatic heart disease. He had liver dysfunction and his liver was palpable up to 4 inches below the costal margin. We were very concerned due to his risk for surgery. However, his sister was very understanding and knowledgeable, and wanted the best for her brother. After many prayers and due diligence, we proceeded to perform his surgery and replaced the mitral valve. The patient initially did well for a few days, but subsequently went into liver failure and then developed hepatorenal syndrome. Despite all our efforts, his liver did not improve and he passed away a week later. It was very discouraging, but his sister was very appreciative of all our efforts.
Tell us about the people and culture in Pakistan.
Pakistan is the sixth most populous country in the world. The people are generous and very hospitable. However, poverty is rampant and healthcare access is poor. The culture is diverse, with many ethnic groups speaking many different languages. The literacy rate is less than 58%. The first Pakistani to receive a Noble Prize in science was Dr. Mohammad Abdus Salam in 1979, who was also an Ahmadi and underwent persecution due to his faith. Pakistan has many natural resources, including 5 rivers, as well as gas and mineral deposits that are not efficiently utilized. It has some of the highest mountain peaks in the world, such as K2 (the second highest mountain in the world) and Nanga Parbat (ranked the ninth highest mountain in the world). Pakistan has a rich culture and history that dates back thousands of years.
Will there be another medical mission trip to Pakistan in 2019?
Yes, we have several missions planned for 2019 and beyond, through Humanity First. We encourage others to get involved.
Rabwah (official name Chenab Nagar) is a city in the Punjab province of Pakistan, located along the bank of Chenab River. Rabwah has a high literacy rate, with numerous government and private secondary schools and colleges. The people of Pakistan are generous and very hospitable. However, poverty is rampant and healthcare access is poor.