Author Archives: Children's Surgery International

Tuesday
We have had a very, very busy day! Given the severe lack of resources in this public hospital, the work their staff is able to accomplish is incredible. Our urology and ENT surgery schedules have been full, and lots of good teaching and training has taken place. Dr. Scott was able to allow one of the Ethiopian surgeons to perform a considerable amount of an entire surgery with him coaching and correcting. This was a great feeling for everyone involved.

Having enough interpreters is a challenge in most countries where CSI travels, and Ethiopia is no different. In addition to four 4th- and 5th-year medical students, we recruited an Ethiopian man who works at the hotel and also happens to be a patient scheduled for surgery with us at the end of the week. He speaks English well, so we asked if he could come back to help us if we are able to return later this year. He haltingly responded that he didn’t want to have to wait 6 months for his surgery. Of course we meant would he return to help translate, which he enthusiastically agreed to do.

Everyone is working above and beyond, showing terrific flexibility. Our Ethiopian partners are all in and asking great questions. One minor challenge is the squat-only “hole in the floor” toilet at the hospital, giving men a technical advantage.  The CSI women who haven’t been doing their squats in yoga back home are incented to not drink or eat all day, which is never a good idea when working 10-hour shifts in a foreign country!

The children and young adults we are caring for have the most beautiful eyes and ready laughs that make one momentarily forget how far apart our worlds are, yet hint at a surprising shared intimacy. When we take their photo and the flash makes them blink, others around them laugh and elbow them when we show the squinty result. The exact thing would happen to us at home. We blow a bubble wand and one lands on the dad’s nose, causing the child to erupt with laughter. Just like us. The mother starts to cry when told we cannot help her child’s affliction, and we immediately give her a hug because her response is exactly as ours would be.
These are all our children, and each one we see here cannot help but remind us of our incredibly good fortune.

Cardiology Team Update
Here’s a quick update note from Dr. Ron Johannsen and the cardiology team in Addis Ababa:
We had an exhausting but rewarding time with our cardiology colleagues at the Cardiac Centre – Ethiopia today.  We evaluated 22 patients with severe rheumatic heart disease, then chose and prioritized them for interventions starting tomorrow morning.  We had a wonderful mix of Ethiopian and U.S.-based cardiologists working and learning from each other.  The knowledge shared from our various experiences in Nepal, India, Ethiopia, and the U.S. with this devastating heart disease will go a long way in improving care not only now, but long term. A huge thank you goes out to Dr. Woubeshet Ayenew, who has been the glue necessary to make things run smoothly at our site.

Sunday

In an effort to accomplish our goals related to teaching and training, we are realizing the importance of connecting local professionals with CSI team members early in our mission. The success of our teaching model is contingent upon making certain as many local professionals as possible are ready to learn.

This week in Ethiopia, we hosted a wonderful dinner on the night before starting surgeries. CSI nursing, anesthesia and surgical staff were all seated with their Ethiopian counterparts from the Felege Hiwote Hospital to share a meal and make important connections. These early interactions will help us maximize our relatively short time here, so that we can share as much knowledge as possible with each other and make the biggest impact.  We are also making critical introductions throughout our entire CSI team, from the screening rooms to the surgical suites and on to the pediatric wards.

Monday

It’s Monday morning at the hospital, and the first day of surgery. Patients are checking in; others who weren’t screened on the first day have shown up hoping to be added to the CSI schedule. We are getting our bearings as to what is happening in our different patient care areas. This hospital is the largest local public hospital, and it’s hallways are teeming with  patients – sitting, squatting and lying down.  We are a bit short on translators, so we are working to get additional help from a local tour company.

The Asinuara Hotel has been accommodating, helping by delivering drinking water to the hospital, making our lunches to-go and transporting us. The Ethiopian people always say “thank you so much” when they learn we are here to help their children!

The cardiology interventional team will start their procedures on Tuesday in Addis Ababa. Their goal is to perform cardiac procedures on children who have suffered cardiac damage due to rheumatic heart disease and of course teach local cardiologists as well. We hope to get updates from them soon, and will keep you posted.

We have safely arrived in Ethiopia, and most of us on the CSI Ethiopia team finally have our internal clocks turned around after the long journey. During our one hour layover in Jeddah Saudi Arabia we saw several gentlemen making the long pilgrimage (hajj) to the sacred city of Mecca, garbed in traditional white sheeting.

After a night in Addis Ababa, we took a morning flight up to Bahir Dar, the 3rd largest city in Ethiopia on Lake Tana. We had a small snag with seven pieces of luggage delayed in customs, but after some terrific interventional work by our team member and cardiologist, Dr. Woubeshet Ayenew, the bags were released. Also, a big shout out to Habtamu of Taitu Travel for driving the final pieces of luggage 560 kms to Bahir Dar. His terrific efforts allowed us to proceed on without missing our flight.

Our hotel, Asinuara Hotel, is conveniently located just two blocks from the Felege Hiwote Hospital.  We were able to walk to there for a tour and introductions when we arrived yesterday. Drs. Asnake and Melesse have been our Ethiopian partners since the CSI site team made their first visit to Ethiopia 6 months ago to begin planning for this surgical and teaching mission. The hospital is a well matched partner for CSI. Not only are there enthusiastic physicians interested in being trained, but the entire hospital administration and staff is committed to our knowledge-transfer model. Apparently there is no shortage of service organizations willing to come to the region to perform large numbers of surgeries over a number of days, but what this hospital really wants is training. They ultimately want to be able to perform the surgeries independently, and this is a perfect fit for CSI.

After an evening of catching up on sleep, dining at the hotel, or riding tuk-tuks to a lovely local restaurant, we were all awake early and ready to roll for screening day at the hospital.

Set up was efficiently completed, and the patients started flowing in to either the urology or ENT screening room. The urology team is managed by Dr. Francis Schneck, new to CSI from Pittsburgh and a fabulous addition to our team. Medical records team member Katie Stewart, Victoria Vandersteen and others worked with Dr. Schneck to screen the urology patients.

The ENT screening room was shared by Drs. Tim Lander and Andrew Scott, with assistance from Medical Records team member Aliza Ameen. Aliza and CSI Partner Mary Moore demonstrated their resourcefulness by finding the mop closet where they grabbed a mop, bucket and soap to clean up an “oops” on the floor of the pediatric exam room. It was teamwork at it’s best.  Mary was also taking photos, and moving the patients from the surgeon’s screening area to the Pediatricians/Vitals area managed by Norie Wilson, Maria Rubin, Dee Vanderpol, Amy Erlandson and Molly McIntyre. CSI Pediatricians Drs. Dave Tetzlaff and Paul Melchert examined the patients, ordered labs, and made decisions about which children were ready for surgery this week. All in all it was a very successful screening day. Sunday will be a day off for the Sabbath, which is honored throughout Ethiopia, and we will start surgeries on Monday.

We are on the last day of surgery! So far, the theme of our work here is twofold: teamwork and flexibility. Each is necessary to do the work of helping more than 50 children this week. Fortunately, everyone here on the CSI team, as well as our partners in this mission, excel at both.

I just had a conversation with one of the wonderful volunteers here at CIMA Hospital in Hermosillo. She needed to convey some information to me that I then needed to pass along to a surgeon in the operating room. Her English is almost as bad as my Spanish, but with smiles, some hand gestures and a lot of patience we managed to understand one another. Working as a team, we were able to achieve what we needed to say and do.

Another example of teamwork and flexibility: A mother and father came to the St. Andrews Clinic in Nogales looking for help for their son. He lost his ear in an accident last year, and although he is now recovered, the taunting and bullying he suffers as a result of his appearance is terrible. Clinic volunteers brought him to see us, and CSI surgeons and a local CIMA plastic surgeon examined him this morning and made a recommendation about the best way to help this boy.

The players here are numerous: volunteers and staff from CSI, St. Andrews Clinic, CIMA Hospital and the CIMA volunteer organization. The beautiful thing about this trip is that it all the components work so well together. All of us have the same goal: helping children and families in need. No matter what language we speak – or don’t speak – or what our priorities might be at home, we all work as a team here to bring smiles back to so many faces. I’m honored to be surrounded by so many talented people, working together toward a common goal.

Saturday was our screening/evaluation day at the CIMA Hospital in Hermosillo, Mexico. We saw 104 patients, and 49 were scheduled for surgery with CSI this week. For a variety of medical and surgical reasons, the remaining children were not ready for a surgical procedure at this time. With our extra surgical day in Hermosillo this year, and energetic team members, we will be able to accommodate all of the children who were ready for surgery.

Sunday was our first surgical day for the week. We had 18 patients on the operating room schedule, a mixture of cleft lips, cleft palates, bone grafts and one rhinoplasty. This was an extremely busy day, with operating rooms busy into the evening.

Some cleft lip and palate repairs require several surgical procedures over time, with the rhinoplasty being the third or fourth procedure. Children in developing countries with clefts may never have an opportunity for even the initial repair, let alone subsequent procedures such as rhinoplasty. Because of the ongoing partnership with the St. Andrew’s Children’s Clinic/CIMA and Children’s Surgery International, we are able to offer this high level of care to the children of the region who deserve as much as anyone to proudly share their beautiful smiles!

Docs are making rounds on the final patients. The rest of the CSI team members are packing up, counting charts, paying bills and blogging. After evaluating many more potential patients than we imagined this week, the team was able to perform surgery on 28 urology and 31 ENT patients. So many grateful families; so many changed lives!

Our team was also able to incorporate an educational curriculum into the busy week, which was an important goal for the mission.

The week’s finale last night was a team-building dinner with our Vietnamese counterparts at a restaurant of their choosing, complete with karaoke, an essential part of Vietnamese entertaining. Very, very funny!!  It’s been a memorable, successful week in Thanh Hoa. Here are few final photos before we start our long trek home.

As I write this, only three patients are still in pre-op, waiting for today’s surgical cases. One is a little fellow named Van, who is ONE UNHAPPY DUDE because he hasn’t had anything to eat or drink since midnight in preparation for surgery. It is 4 p.m., and he’d give anything for a little something to nibble on. We’ve tried music, coloring and puzzles, but he just wants food! It won’t be long now, and he’ll be off to sleep and ready for his surgical repair.

The second fellow is Tam, a 17 year old who nicely borrowed my computer and immediately tried to sign on to Facebook, but alas no Wi-Fii at the hospital. How can we be in the middle of nowhere in the north of Vietnam and he wants the same entertainment as our 17-year-old kids at home? The world is definitely growing smaller.

Last in the room is a wonderful 42-year-old woman named Thuong, whom we squeezed onto the surgical schedule. Thuong has had a disfiguring cleft lip that led kids in school to mock her. She stopped attending school in the 2nd grade. With the hands of a 70-year-old woman, she gestures that she worked in the rice fields since she was 3 feet tall. Thuong is envious of the white skin of one of our nurses of Swedish heritage, and we tell her that we try to get our skin the color of her brownness by lying in the sun. Her sister tells us that she is able to read only five or six words, but can write her name, albeit very slowly. Thuong’s smile is utterly beautiful, and her personality, with plenty of giggles, shines through. She will continue to be followed by local health professionals after CSI leaves for continued care and support.

We officially screened 74 urology patients and 65 craniofacial patients. We evaluated an additional 150 patients, but for a variety of reasons we were not able offer surgery at this time. We have collected names and contact information for this group. They will either be seen by our Vietnamese medical colleagues, or we will contact them when our CSI team returns in 2016.

Our logistics head, Con Nguyen, had a very productive meeting with a group of local physicians as we fine-tune our process on our first visit. We have drained the team of translators, as one of us always seems to be calling out “may we have a translator in here”? There are very specific processes in the hospital that we are learning as we mesh how we manage pain, communicate with families and provide care for patients. Of course we have the same goals, and there are many great learning opportunities for both our team and for the people here.

Posted Wednesday by Sally Lannin

It is Tuesday afternoon here in Thanh Hoa, Vietnam. When we arrived at Thanh Hoa Pediatric Hospital (THP) for screening on Sunday three times as many patients were waiting to be screened as we had anticipated. Our partners here in Vietnam, specifically Father Joseph, who is a Jesuit priest affiliated with IPSAC in Peoria (www.ipsacvietnam.org), and THP, did a wonderful job of getting the word out that the team from CSI was arriving so that parents could bring their children to be considered for surgery. And come they did, from all over the country, many traveling very long distances to be evaluated.

Patients and their families were standing 20 feet deep waiting to be evaluated by the team. Logistics head/CSI Board member and Vietnamese-American Con Nguyen was flying from room to room managing the translators, patient flow and answering hundreds of questions. Nurses were preparing children for evaluation. At the end of screening day, surgeons Dr. Dave Vandersteen (Urology) and Drs. Rajanya Petersson and Christopher Discolo (ENT) had the difficult task of prioritizing and creating four very full surgical days. Many of these decisions were heartwrenching, considering so many families were hoping their children would be included.

It was a late night for the medical records team of CSI Partners Cindy Halverson, Johnine Adomitis and Kaitlin Nelson. They needed to create schedules, assemble charts and have everything organized for surgery in the morning. We brought medical record supplies for 60 patients, and ultimately screened more than 100 children, piecing together pages wherever we could get them. Thank goodness for that printer Johnine carried in her luggage all the way from the U.S.

Monday, Day 1 of surgery, started bright and early. Volunteer videographer Nolan Morice is recording, interviewing and snapping great photos of these children. Team members scavenged for sterilization supplies, gauze, gloves and other necessary supplies. Logistics co-lead Stacey Brown even got stuck in the elevator while transporting a giant cart of IV fluids. (No harm done.) Lora Koppel and Sally Lannin carried a solid steel fan up five flights of stairs to try to get some air circulation. Thankfully, Leon Randall was able to get the fan to work. Leon’s helpful can-do attitude is spectacular!

Pediatrician Erin Novak started having gripping stomach pain and was sent back to the hotel to rest. The crack PACU team of Dr. Bruce Ferrara, Anna Koppel and Mary Bye rose to the occasion and handled the post op/PACU patient situation, despite being one team member short. We scavenged empty offices, storage closets or restrooms looking for underutilized fans in an effort to get air circulating in the PACU. Bruce gave a big thumbs up once the air started to move.

The pre-op team of Nikki Lavin and Katie Houle readied patients for the handoff to anesthesiologists Drs. Raj Sarpal and Craig Smith, and CRNAs Lynn Randall, Monica Bultena and Michael Gotzsche. We had three or four operating tables going simultaneously. The OR wonder nurses Charlee Kimmes, Nancy Corcoran and Jessica Driscoll (on her first trip ever outside of the United States — what a way to get the passport stamps started!) are keeping things moving and sterile.

By early afternoon as patients came out of PACU, things started hopping in the ward. There is very little space in this area. Children are three and four to a bed with no air conditioning, and parents primarily are responsible for the patient aftercare. Floor nurse team of Patience Kankeh and Patrick Faunillan have their hands very full not only looking after our patients, but also using every opportunity possible to provide theVietnamese nurses with aftercare training.

Late in the day, team member Dr. Erin Novak returned to the hospital with severe abdominal pain. After evaluation and ultrasound, she was headed to the OR to have her appendix removed! Thankfully, our IPSAC partner Dr. Holterman (a general surgeon in Peoria) happened to be onsite and was able to perform the surgery within an hour. She very thoughtfully called Erin’s husband in the U.S. to let him know the surgery went well, and the outcome looked excellent. Erin rested at the hospital for an hour and walked back in the front door of the hotel just as 200+ Communist Party members in evening dress were gathering for a large regional meeting. The juxtaposition was almost humorous. This was a first for a CSI mission — we’ve never had a team member on the OR table. When Erin Skyped her practice partner Dr. Dave Tetzlaff, CSI Medical Director, the first thing he said was “did you take the appendix out yourself?”

Tuesday, Day 2 of surgery, we were ready at the crack of dawn as a complete team! Yes, even Erin was up and at ’em after a great night’s sleep under the care of nurse Anna Koppel, who stayed with Erin to monitor her medications and vital signs. Patients were gathered from various locations in the hospital and the process began again. Bubbles were flowing to entertain anxious children in pre-op. Grateful families were cradling their children. Wonderful handmade dolls and teddy bears donated by the volunteers of Dollies Making a Difference were distributed to patients in post-op as well as donated beautiful fleece blankets. Nurses Patience and Patrick are doing everything possible to teach, train and care for these precious children after they come out of surgery.

More tomorrow on some of the individual stories of the patients and the families we have had the privilege to meet.

The CSI 2015 Vietnam team has made it safe and sound to Thanh Hoa City, Vietnam without a hitch. We kicked off the trip by breaking bread in a seaside dinner with Bien Vien Nhi’s doctors and local charity members. We discussed the weeks’ agenda, collaboration and patient load. Patient screening will begin tomorrow morning – stay tuned!

Screening Day is summed up with one word – WOW! It is amazing the lengths people will go to for family. Some waited all day and traveled even longer to be seen. All patients who showed up were evaluated for surgery. Thanks to a great group of flexible volunteers and hospital staff, we have a full week of facial and urological surgeries ahead!