Advancing Science, Compassion, and Efficiency

Making a difference in the developing world

“When I went on my very first humanitarian trip, it was actually very distressing to see a patient in the hospital who had complications from rheumatic heart disease…”

Most physicians have a cluster of letters after their names marking their degrees and designations. Dr. Rizwan Manji is no exception, but he is one of the few who can include the letters MBA as ingredients in his alphabet soup.

Dr. Manji, who moved to Canada from Rwanda as a child, had been studying and working in Edmonton before moving to the University of Manitoba to train in critical care, a branch of medical practice that works with patients facing life-threatening illnesses and injuries. While training, he expressed his interest in business and gained special permission to simultaneously pursue a Master of Business Administration degree. He saw it as a way to enhance his contribution to medical research and practice.

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“With an MBA, a lot of what they talk about is efficiencies, and cost-effectiveness. I think that’s one of the things that we need to work on in health care,” says Dr. Manji. “Some of the research I have done has been related to cost-effectiveness. I’ve done a number of studies where we’ve looked at the cost-effectiveness of one drug versus another drug in the treatment of a particular condition or one method of prevention versus another in avoiding a certain disease from occurring.”

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Inspired by his modest early years, and by parents who preached hard work and giving back to the community, Dr. Manji has been relying upon his diverse background to make a difference in cardiac care in the developing world.

One recent area of research focuses on cost-effectiveness in heart disease prevention strategies in Africa where cardiac surgery is very resource-intensive and difficult to access. Through advanced mathematical modelling, Dr. Manji and his colleagues arrived at data-supported recommendations that can vary by region.

A second area of work focuses more squarely on rheumatic heart disease. “It’s probably the most common adult, older child/young adult problem that exists in the developing world that you can do surgery for,” explains Dr. Manji. It is a devastating condition for many. If rheumatic heart disease does not kill the patient, it could leave them disabled for life. It usually is caused by an infection as simple as strep throat. Because antibiotics are difficult to come by in parts of Africa, strep infection can lead to rheumatic fever, which can become complicated and cause rheumatic heart disease. The condition is common, pervasive, and comes with family and social impacts.

“A lot of the people are in their 30s when they get affected, and so not only can they not work and cannot provide for their families, their families now have to take care of them and so they can’t work either. This creates a constant cycle of problems that worsen poverty for patients in Africa,” says Dr. Manji.

Dr. Manji’s work goes far beyond the theoretical and the conceptual. He has been on the ground in Africa to truly understand and observe the nature of the cardiac care challenges and to help patients.

“When I went on my very first humanitarian trip, it was actually very distressing to see a patient in the hospital who had complications from rheumatic heart disease and was in a rapid atrial rhythm,” recalls Dr. Manji. “They were trying to shock him out of it. They didn’t have the proper pads to put on his chest and the patient wasn’t properly asleep and they were shocking him and he was jumping off the table. It was really distressing. That’s actually what got my interest going in this problem, because I saw this and it was devastating. The patient died. He was 25 years old with a young family. It became important to say, ‘These problems need to be addressed.’”

Among other involvements, Dr. Manji became involved with Team Heart, a U.S.-based non-profit organization that seeks to bring sustainable cardiac care to Rwanda and East Africa. In February/March of 2016, Dr. Manji , along with three ICU nurses from Winnipeg, went to Rwanda with Team Heart as part of the surgical team that operated on 16 patients, installing mechanical heart valves.

Dr. Manji notes, though, that while the surgeries save lives and improve communities, mechanical valves come with challenges as well – including the need for effective long-term follow up.

Another challenge with the mechanical valves is that they require patients to take Coumadin (a blood thinning medication) which poses social issues for women, because when you are on Coumadin, you can’t get pregnant.

As an expert in xenotransplantation (the transplantation of organs and tissues between species), Dr. Manji is hopeful that his research could change the cardiac surgery landscape in Africa and elsewhere.

A conventional operation to install a mechanical valve requires a long hospital recovery and, of course, Coumadin. What Dr. Manji wants to see is a system where the patients would receive a “percutaneous” procedure that would allow a non-mechanical valve to be inserted through a small incision in the groin. The valve would be replaced with a “xenograft” (tissue from a different species, typically pigs). Recovery time is measured in days, not weeks; and the patient need not take Coumadin. The procedure is already in use at St. Boniface Hospital for older, more frail patients who might not be able to withstand the rigours of conventional surgery.

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“There are millions and millions of people who need treatment for rheumatic heart disease in Africa, and you could basically then fix their problem,” says Dr. Manji. “You wouldn’t have to worry about Coumadin. You wouldn’t have to worry about women not being able to have children afterwards. All of that would be gone. Potentially, then, these patients would be well.”

Dr. Manji’s work in Africa is only one part of his contribution to medical research and practice. Among numerous areas of interest, he is looking for ways to prevent transplanted animal valves from breaking down; he is looking at outcomes of elderly patients who have had cardiac surgery; and he is looking at hospital wait times, staffing models, and other areas related to achieving efficiencies. But Dr. Manji is not interested in efficiency for efficiency’s sake. He is interested in identifying strategies that promote efficiency toward improved patient care in Winnipeg, in Rwanda, and around the world.

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