Author Archives: Children's Surgery International

After extensive travels, including 4 airports and a very long bus ride, CSI’s team of volunteer surgeons, anesthesiologists, nurse anesthetists, pediatric nurses and support staff have made it safely to Thanh Hoa, Vietnam!
We were welcomed with open arms by friends both old and new. We are fired up and ready to work this week for these beautiful kiddos on the other side of the world. Keep watch for news to come – screening day is tomorrow. Now for some much needed sleep…..

The team has finished up the final day of surgeries. In our short time here, the CSI team performed 56 surgeries. This morning the surgeons made their final rounds and signed off to the local Urology and ENT Departments who will follow the children In the hospital for a few additional days, as is their typical protocol here.

A few CSI team members toured different areas of the hospital during the course of the week, including the NICU, pediatric ICU and the emergency department.

The CSI team has been honored to care for the families and children of the Thanh Hoa region this week. The children’s sweet smiles and the grateful eyes of the parents make the work a pleasure.

Adminstrators, surgeons, physicians and nurses from Thanh Hoa pediatric hospital invited the CSI team and our translators to a farewell gala to celebrate the week of collaborative work on behalf of the children. It was a festive night filled with friendship, laughter, toasting, speeches and, of course, Vietnamese karaoke!

Here’s a fine example of the karaoke, performed by Dr. David Vandersteen, urologist, left, and Leon Randall, biomedical support.

A special shout out goes to a very enthusiastic and dedicated team of translators who have been with us the entire week.

Today was spent visiting a floating river village and Trang An, a national heritage park. Three generations live on this floating home.

The team will disperse tomorrow. Some head home to the U.S. while others extend their stay to explore Vietnam and Thailand.

Jet lag, 12-hour workdays, exhaustion, and sometimes a rumbling stomach are “part of the deal” on a surgical mission. But what is so very wonderful is that every morning I wake up thinking about the kids we cared for yesterday, and remembering the smiles, the tears, the parents’ expressions of hope, worry, and ultimately gratitude. I can’t wait to get back to the hospital to see how the kids fared during the night. Did her labored breathing settle down, did he drink some fluids, did the bleeding stop, is her pain under control, did the parents get some rest?

The weather has been beautiful this week, sunny and 75 degrees. The morning walk to the hospital is filled with the sights and sounds of the city. Walking into the bustling Thanh Hoa Pediatric Hospital gives us renewed energy. It’s a large and very busy regional pediatric center, with 500 beds and currently about 800 patients.

Today, the rhythm and flow of the CSI surgical day in Thanh Hoa were nice. The team members are all settling into their roles, finding their way around their work areas and the rest of the hospital, and getting to know their Vietnamese colleagues better. We are becoming more efficient and synchronized every day.

The urology and ENT patients that are assigned to the CSI team stay with us in the Anesthesia Department for the first day and overnight. At that time they are transferred to their respective ENT and Urology Departments where they will be in the hospital for several more days.

The surgeons, anesthesia and OR nurses (CSI and Vietnamese) have two cases going simultaneously in each room. With two ENT and two Urology surgeons with us, we are performing cleft lip and palate repairs, as well as the repair of a variety of urological abnormalities.  Some of these can be quite complicated and may require additional procedures in the future.

Off to the last day of surgery. Stay tuned!

~ Linda Sedgwick

Tuesday, March 1 – A beautiful morning to start the day in Thanh Hoa. The teams are starting to hit their stride. We are seeing great collaboration and information sharing among our surgeons, pediatricians, anesthesiologists and nurses as they work a busy slate of urological and maxillofacial cases. The ENT team has been working through seven cases today, mostly cleft palates, and there has been an opportunity to work side-by-side sharing ideas and procedures with our Vietnam colleagues.

The urological team had a rare epispadias case this afternoon, something which our surgeons had only seen five times in their 50 years of combined experience. It’s estimated to occur at a rate of 1 in 250,000. We were well-equipped, and working with our Vietnamese colleagues, the repair procedure went very well. During the day, anesthesiologists shared techniques on airway management and regional blocks. Pre-op and post-op nurses worked together on procedures and kept the whole system operating smoothly. The days are long, wrapping up around 8 p.m., but there has been strong engagement and support across the teams.

By Tom Fansler, CSI Board Chairman

After a meeting with our partners at Thanh Hoa pediatric hospital, we began evaluating the many patients waiting to be seen by urology and ENT surgeons. Many patients and hopeful families had traveled long distances to see CSI.

Because we had a team here six months ago, we have the ability to see some children in follow-up who weren’t ready for surgery at that time. Returning after just six months also allows for more continuity in our education and training models, as well as streamlining and improving our processes with the hospital staff and administration.

It was a very busy but interesting and successful day. More than 100 children were evaluated for potential surgery. Some will be ready for surgery this week, while others may need further testing and diagnostic work. To a few families’ joyful surprise, their children had normal examinations and did not require a procedure.

While the children were being evaluated, our OR anesthesia and nursing teams spent the day setting up the operating rooms, assuring they had all the necessary equipment ready to provide safe and comprehensive pediatric surgical care, and meeting with their Vietnamese colleagues.

Our team is enthusiastic, resourceful, committed, hardworking and fun! CSI is thrilled to have a few nurses and physicians with us in Vietnam who are new to CSI. It really doesn’t take long for a group of passionate people to become a cohesive team. The children and families waiting for us here give us the energy and focus to give them our best.

As always, our focus is on education for local health professionals. We will be working alongside Thanh Hoa hospital surgeons, physicians, nurses and administrators every step of the way this week.

~Linda Sedgwick

Today we finished procedures and spent the balance of the day investing in teaching and knowledge transfer at the nursing, medical student, resident and fellow level.

We started our day at 8 a.m. with a lecture on ASCVD prevention and transitioned to rounding that went into the early afternoon. We had the pleasure of rounding with very energetic and bright medical students and residents as they were going on bedside rounds with the cardiology fellows.

The center caters to the underserved, and there are 14 beds in each room. The excess we take for granted in the United States is stripped down to the basics, where even the curtain and some extent of privacy between neighboring patients is now down to a few feet between beds in a large open space. Yet with no TV, no patients talking on the phone and no monitors beeping, these large rooms with their 14 patients were quieter than most single rooms I round in while in the U.S. Most of what could be heard was our large team of providers moving from bed to bed and room to room discussing each case in detail and teaching residents.

While the MDs were enjoying these bedside rounds, our multitalented nurse Colleen gathered up the nursing staff and took them through a series of lectures pertinent to cardiac care. The staff created a makeshift lecture hall for her in the middle of the ICU by moving a couple of the beds out of the way so the wall became the screen. (See photo below.) The ICU nurses did not want to miss out on the lectures, so nurses from other areas came over to the ICU and the class was good to go. Improvisation at all levels is the way of life for folks here and a remarkable gift.

Dr. Ben Johnson will do the last in our series of lectures. He will talk about atrial fibrillation, which is a condition common in our patients with valve disease.

I plan on having a series of meetings tomorrow that will hopefully facilitate the smooth entry of our items into Addis/Bahir Dar on subsequent trips.

~Dr. Woubeshet Ayenew, cardiologist at Hennepin County Medical Center and CSI volunteer

Long travel days were the norm for the team traveling to Thanh Hoa. The journey included 28 hours+ flight times, an overnight in Hanoi and a bus ride to Thanh Hoa on Saturday. We enjoyed a welcome dinner with hospital physicians and administrators. Everyone is enthusiastic about getting started. Sunday will be spent screening children at the hospital in preparation for a full schedule of ENT and urology surgeries this week.

The CSI team in Vietnam includes 26 members from Minnesota, Virginia, California, North Dakota, Tennessee and Maryland.

A special thank you shout out to our guide Frederick, Father Joseph and our Vietnamese interpreters.

~Linda Sedgwick

Most of the CSI Urology and ENT team members have returned home after a successful week of teaching and completion of life-changing surgical procedures in Ethiopia. The cardiology team, including Dr. Ben Johnson, Dr. Woubeshet Ayenew, Dr. Ron Johannsen, Dr. Brinder Kanda, and Colleen Johanssen, R.N. continue their work in Addis Ababa. They are performing procedures in the cardiac cath lab that repair heart damage due to diseases uncommonly seen in the U.S.

Sticking with the CSI mission, the cardiology team’s goal is knowledge transfer at all levels of the cardiac care model. Every interaction with patients, cath lab nurses, ICU nurses, staff physicians and cardiology fellows has been leading to care enhancement for patients here in Ethiopia. Since rheumatic heart disease is very common in the region, we are also indulging in the local expertise on certain aspects of disease management. Colleen Johannsen R.N. gave a lecture on ECG interpretation this week to approximately 60 medical students, resident and fellows. They are so eager to learn!

Today I asked Ethiopian urologist Dr. Melesse what it has been like to work side by side with CSI surgeon Dr. Francis Schneck. “I have the opportunity this week to learn from a surgeon who is absolutely extraordinary; more extraordinary than I could have ever imagined,” said Dr. Melesse. He also praises having the CSI team at the hospital, saying, “The way you people work together, the way you are a team, the way you work together with our people, the way you help our people. It is a gift.”

Asked why he chooses to practice at this very poor public hospital, he says, “Because this is where I am from; this is where my wife is from; this is where our son lives; this is our home. You look down the hallways here and can see how very, very poor these people are. They are lying in the halls waiting for help. For most of them, there is nothing we can do for them. They have nowhere else to go.”

Our CSI team has learned so much from Dr. Melesse, and it is our hope that we have been able to share skills that allow him to provide even more comprehensive care for his patients.

The operating rooms are very hot, especially with the powerful lights on. OR nurses Mary Johnson, Jodie Pelkey and Dee Vander Pol are doing a fantastic job of keeping everyone well hydrated and everything as sterile as possible. They are also thinking about future missions here and determining if there is an opportunity to leave some of our CSI supplies behind for our next mission.

Everyday it is a hunt for some needle in a haystack, and none of this would be possible without CSI Logistics General Extraordinaire George Steiner. No request is too daunting for George. Yesterday he was dispatched to find a very small fuse to fit in a cystoscope for the urology team. The fuse blew as it was turned on, and the patient, a young man who had been in a motorcycle accident, had been waiting all day. We cried with joy when we heard “George found the fuse.” He was high-fived like he was carrying the flaming Olympic torch the final distance. Way to go, George!

We would like to take a moment to thank Dr. Woubeshet Ayenew, a cardiologist at Hennepin County Medical Center and CSI volunteer. It was Dr. Ayenew who was aware of the serious cardiac issues of the children in Addis, and he was familiar with the hospital in Bahir Dar as well. He made the first overtures to Drs. Asnake and Melesse, who are now our main contacts here. This site is a dream CSI location.  Local physicians who not only want to offer free surgeries for their patients in dire need, but most importantly are committed and enthusiastic about learning to ultimately perform the surgeries independently.

The Cardiology team in Addis also had another great day, continuing to teach local cardiologists and nurses during three additional procedures. Their work is changing the lives of children and young adults. Here are some photos from their day.

By: Sally Lannin

From the Cardiology Team in Addis Ababa:
We had a very successful day today! We performed two cases and had great results for both of the children. They are recovering in the hospital overnight, and we are confident that they will already notice a difference in how they feel by tomorrow morning. Here are a couple of photos from the day.

From the ENT and Urology team in Bahir Dar:
With the exception of two patients who ate right before surgery and thus needed to be rescheduled for tomorrow, it has been a great day. Dr. Fran Schneck performed a lengthy, 6.5 hour surgery in the 95 degree operating room, basically re-routing the plumbing on a 3 year old who had lived with an external bladder since birth. Tomorrow Dr. Schneck will repair a similar defect for a 14-month-old child. Drs. Tim Lander and Andrew Scott are tackling cleft lips, removing a tumor on a palate, and a neck mass on a brave 12 year old girl named Narda. The local surgeons are so very pleased to have the opportunities to observe, learn and participate in these interesting procedures. Some say they feel as though they are “walking on water”!

We had a large lunch brought into a room near the operating rooms in order to share our midday meal with the Ethiopian team members. Molly McIntyre and Amy Erlandson are keeping peace in the PACU with Drs. Paul Melchert and Dave Tetzlaff. The ward is managed by Norie Wilson with Maria Rubin and Victoria Vandersteen. Tonight a few from our anesthesia team (Drs. Zipporah Gathuya, Kevin Healy, and CRNA John Erlandson) will return to the hospital to administer another epidural to the little girl recovering from bladder surgery. This will keep her comfortable while she is healing.

We’re off to bed to rest up for another busy day tomorrow!