Author Archives: Children's Surgery International

This morning we pack our things, the doctors make final rounds for the two patients admitted for overnight stay, and we say so long until next year to our St. Andrews and CIMA partners.  Our collaboration with them is a great model of teamwork and coordination for the benefit of children needing the medical services CSI can provide.  We feel privileged to have the opportunity to serve here!

The team is tired but extremely happy with the outcome of our trip, 44 surgeries accomplished!  We’re off to the airport and our home cities after one last breakfast at the hospital.

Great day of surgery today. The rest of our team members arrived last night and all 18 of us arrived at the hospital at 6:30 am. We got off to a slow start but by 11:30 pm we were all back at the hotel.

Six members of the CSI team arrived in Hermosillo yesterday. Today we were greater by 96 children and their families. This medical mission is a joint effort of the volunteers at St. Andrew Clinic in Nogalas, Arizona, the CIMA Hospital, in Hermosillo, Mexico, and the the Children’s Surgery International organization.

Of the 96, 44 children will be operated on in the 3 days we are here. The remaining children will be followed up by the St. Andrews clinic staff and hopefully will be back next year. The children are selected based on the complexity of their medical problems and the type of surgery we are able to provide.

Thanks to our team members we worked 12.5 hours and were able to see all 96 children. The screening team included: Dr. Daniel Sampson, Dr. Jon Grischkan, Dr. Paul Melchert, Lora Koppel RN, Marian Hehre and Leal McAuliffe  Medical Records.

This is turning out to be a great mission  We have done five cases so far; two yesterday and three today.  All of the children that we have operated on have spina bifida; the surgeries have been a combination of closing the spinal defects and placement of shunts that go from the brain to the abdomen to drain cerebrospinal fluid [to treat hydrocephalus].  This is not nearly the number of surgeries that we would do on a cleft mission, but these surgeries are much more complicated and take longer  The children are all doing great thanks to everyones hard work  The Souska Clinic is a very nice hospital and their staff are very well trained and competent, and they are a big part of our success.

Bags were packed and left for wonderful George Pezzimenti of Firestone who has done an A+ job of keeping us safe, sound and on time, with a can-do attitude that is a joy to be around. An extra hour or two to sleep this morning guaranteed smiles on all our faces.

Let me describe the scene as physicians came to make final rounds on the ward before the Farewell Program and lunch with hospital staff. All the children who had received surgery were in varying states of packing to leave, or eating breakfast, or slowly waking up. Their mothers or grandmothers or fathers were sitting at the foot of their beds. When the doctors arrived, one mother started singing in her bold a cappela, a well-known Liberian hymn of thankful praise. Within ten seconds every parent, who two days ago was unknown to every other parent, united in a groundswell of a hand-clapping hallelujah tune they’d all learned at their own parent’s knee or in some simple hall of worship. They were united in having children who have suffered, and now have benefitted from CSI’s presence at Duside Hospital.

As everyone who is a parent knows, most mothers and fathers would rather bear their children’s own suffering than have to watch them grimace while trying to urinate for years, be mocked for having a “split lip”, or have to wear a loose loin cloth instead of pants because of a huge hernia. They were certainly going to let everyone know about it with their booming voices all singing the same song in unison! There is something so pure and glorious about how the women here show joy, whether it how they laugh at a child’s funny gestures, or celebrate having their name drawn at our Farewell Raffle for staff. As they sang, the clapping became louder, hips were swaying, nurses were all in, and every child was grinning from ear to ear. It was a sight those who were there will never forget, and the sort of simple spontaneous show of emotion that makes countries like Liberia such a joy to visit. Being part of a CSI mission allows us to jet propel ourselves into the most private corners of the lives of our patients and their mothers/aunts/grandmothers/fathers/grandfathers/friends or nobody’s who have accompanied them to the hospital. What an unparalleled privilege.

The Farewell Ceremony included thoughtful closing words by Dr. Lander highlighting the transfer of skills that has taken place on this mission. A surprise presentation of a ceremonial robe to Lora Koppel for all of her contributions to the children of Liberia touched her immensely…” This is the highest honor of my entire professional nursing career,” she noted. A highlight for many was the presentation of the inaugural Mission Volunteer plaque, which went to Mr. Jackson, a hospital custodian, who worked tirelessly throughout the mission making spaces, and faces better wherever he went.

On all counts, the mission was a success. Everyone boarded the bus relatively healthy, and each bearing a beautiful oil painting of Liberian scenery, given by Wadei Powell and her Firestone/Duside team. The partnership, between CSI, Duside Hospital, and especially because of Firestone, allows our Liberian missions to line up exactly with CSI’s objectives.

Farewell beautiful faces and hearts of Liberia!

Some of the first names of the children here are spectacular: Precious, Faith, Joy, Prince, Marvelous, Handful, Princess, King, Miracle, Godgift. How can one not smile when a child named Wonderful grins at you?

It is a very busy final day of surgery with hopeful families and their children waiting for their name to be called. I just spoke with a father who has tried for 3 years to get his son’s hypospadias repaired. The first year he waited in screening and learned we didn’t have an urologist on the team, the second year he was cancelled at the last minute because one of our surgeons became ill. Finally Jason is heading into surgery – father and son just walked out the door with one of our nurse anesthetists and everyone in pre-op let out a huge cheer!

We awoke this morning at 5:30 a.m. to a fabulous first: torrential rain falling on the metal roof of the Guest House. It is rare for it to rain this time of year, and it was a welcome cleansing of the dusts of summer south of the equator. Every evening during our stay the Guest House we have been treated to the fare of a different country: Thai, Lebanese, Moroccan, International, Liberian Seafood (featuring a 4 foot barracuda, the head of which was consumed by team member Patience – of Liberian heritage), and tonight is Chinese. We are being treated so well by the Firestone staff!

Over the course of our stay here, the team screened 120 patients; of those 99 will have received surgery by the end of today. We have made a concerted effort on this trip to focus on training the Liberian professionals at the hospital. It has been far more important for the surgeons to teach the Duside doctors how to perform certain procedures than to rack up as many surgeries as possible. As a result, spirits are especially high and as Steve Muehlstedt said so poignantly tonight at dinner, “this has been an experience of true teamwork”.

And the patients are very happy, albeit sore. Without exception when I have asked a patient’s parent if they have any suggestions for CSI on our future trips, they say something to the effect of “thanks be to God for you people”. Shown also in this blog entry is a mother and son who both received cleft repair, courtesy of a combination of Tim Lander and Duside’s Dr. Sherman. We are amazed at the patience of the children who wait a long time to be called into surgery, especially those who are scheduled later in the day. No bickering over toys, no impatient parents, no fighting to jockey for position; just complete resignation to the process and a willingness to wait however long it takes for a chance to get the expertise of the “doctors from America”.

After discussions with Dan Adomitis and hospital administrators, it looks highly likely that CSI will return to Liberia in November of this same year, instead of waiting until January ’13. Because of this, we are boxing up supplies and storing them in a locked closet after taking inventory of what we are leaving behind.

Final post tomorrow after we get fully packed, make rounds on the patients and celebrate the successes with the Duside staff. PS- this added after dinner; the kitchen staff surprised us with a Thank you cake:) As I said before, we are spoiled…..

While two in our group visited orphanages, the rest of the team had a very busy day at Duside hospital. Dr. Dave Vandersteen started his day with a male 7 year old patient who has a penis but was born without the rest of his genitals; upon opening him up, he is in fact 100% female. Dave sought counsel with Duside’s Dr. Sherman, and met mid-surgery with the mother who gave support to make “him” a “her”. So he continued surgery and Joe emerged as Jolynn. In his 21 years of practice he has had girls really be boys, but never the opposite. In the U.S. this would have been detected at birth.

Dr. Sherman completed a cleft surgery on a 23 year old woman (with very little support from Dr. Lander who has been training the Liberian physician all week). An added bonus is that Dr. Lander operated on the woman’s child yesterday, so a mother/child cleft repair has been part of the week.

Clinical lead Katie Houle has been wonderful in this first time role for her. And all members of the team are in absolute sync, handing patients from one stage to the next with near perfect precision.

Lora Koppel, Katie Stewart and Sally Lannin went to Orphan Relief and Rescue where Debbie, the coordinator, headed up the assembly of 70 belated Christmas ‘bundles’ to deliver to two orphanages. Included in each bundle was an apple, pencils, a silly band, a ball, a sucker, candy cane and toothbrush. Attached to this blog entry is a picture of a child with his ‘bundle’. Prior to opening their Christmas gifts, the children serenaded us with “We Wish You A Merry Christmas” and “Away in the Manger”. Also attached are a number of pictures taken at both of the orphanages. In all honesty, the latter orphanage in particular was hard to see: 30 children, 12 of whom are under 2, being supervised by two elderly women who never stood up the entire time we were there. And when we gave each child their Christmas bundle, without exception we heard a ‘thank you’. Also included is one of the boy orphans wearing one of Dr. Dave Tetzlaff’s daughter’s t-shirts which we donated. In addition, when we come to these orphanages word spreads to the nearby village and “outside” children can be seen peering jealously through the concrete blocks.

Two very very busy days in every part of the hospital. After 23 patients on Monday, Dr. Steve Muehlstedt walked back into the Guest House and announced “that was by far the best run day of surgery I have ever experienced in all of my trips with CSI”. Go team go!!!

Monday also had Partner Katie Stewart and Sally Lannin visiting an AIDs orphanage for children and adults , run by Mother Teresa’s order of nuns. It was a very humbling experience. Team member Jody Pelkey donated a large bag of shoes. They then visited the Frances Gaskin orphanage and fed 80+ kids a great meal of rice jollof , cookies and Tang. Many went for seconds! Books were read, and donated to the school as well as a number of school supplies.

Today, Tuesday, was a very busy day with the U.S. Ambassador to Liberia Linda Greenfield visiting Duside Hospital. She spent time with all the team members as well as Dan Adomitis and his team from Firestone/Bridgestone. Ambassador Greenfield even had her first experience observing in the operating room. Patience and LouAnn of our team had the opportunity to spend more than 2 hours educating 20+ Liberian medical students in a number of areas. 21 surgeries took place today and by the time we left the hospital, the Peds ward was in high gear. Everyone wanted dinner, pain meds or to go to sleep. Parents as well!

I had an opportunity to speak at length with one of our patient’s father, who is 26 and studying computer science. Not only is he unusual in that many more mothers accompany their children than fathers, but he is far more educated than most. He spoke poignantly about being a school child in Liberia and hearing helicopters and shooting take place when Liberia was at war. He and his parents fled to Ghana and at times survived only on plants they found in the forest. Fortunately his parents were well educated and did everything they could to see to it that he got a good education after they got out of the refugee camp. He returned to Liberia in 2007 with a wife and child and an interest in continuing his education. His wife now teaches school and makes $60 US per month and he is studying and has a second child. I wished at that moment that I had brought an ipad to give this man so eager to learn. Another father had tried 2 previous years to get on the CSI schedule and finally “was accepted” this time with his son.

The day was saddened by one of the favorite Peds ward night nurses being in a serious car accident. She suffered significant injuries to her head and was brought into the OR for surgery by Duside’s Dr. Sherman. Dr. Lander of our team coached him on the eyelid repair and the good news is other than a nasty scar she should fully recover.

Tomorrow afternoon our second pediatrician, Dr. Tim Wood departs for the Twin Cities.This has been his first CSI mission and definitely not his last.

We left the Guest House at 6:30 am sharp in order to have the first patient on the operating table at 7:30 am. The first three patients (17 total today) were a proximal hypospadias, a huge umbilical hernia and a cleft lip. Dr. Lawrence Sherman of the Duside hospital participated in the cleft as Dr. Lander of our team is teaching him, step by step, how to complete these surgeries on his own. Dr. Lander was thrilled that Dr. Sherman was able to do much of two surgeries on his own with oral guidance.

The patients had been staying at the hospital overnight and hadn’t had anything to eat or drink since midnight last night. The staff and volunteers at the hospital have been extremely helpful. In particular, we want to give a round of applause to one volunteer who has returned from last year, a Physician’s Assistant student at Liberia’s biggest hospital, Mr. T.K. Abonoko Wiah. He has prepared IV’s, taken parents to the waiting area, comforted crying children and been invaluable as a translator.

We began handing out the beautiful hand sewn gift bags that have been so beautifully prepared by Benjamin Poore for his Eagle Scout project. Every girl patient receives a hand made doll from Dollies Making a Difference (a Pacific Palisades organization which reached out to CSI after reading an article about us in their local paper) and each boy receives a baseball hat courtesy of Zephyr Hat. School supplies, toothbrushes/paste, a school notebook, shampoo, soap and washcloth are also included in the gift bag.

One of the patients is a 13 year old boy named Menmeah who had an accident several years ago—his mother said he had fallen from the top of a tree through the branches to the ground. Ever since the accident, the boy has been having such difficulty urinating that he had to drop out of school and has been unable to attend for the past 4 years. He leaks constantly and walks with a rag between his legs. Because the boy’s father is handicapped the older 3 children receive school for free, but Menmeah is unable to attend. Dr. Dave Vandersteen operated on the boy this afternoon and pulled out a 3 inch stick that was lodged up inside him, now covered with calcification. When the doctor showed the stick to the mother after the surgery was complete, she burst into tears. Prior to surgery Menmeah was proudly showing the staff in pre-op (Katie Houle, Jan Martland and CSI Partner Katie Stewart) how he could write his name. He will be very happy to return to school, his mother says.

Tomorrow is another very full day with 23 surgeries. A few of the team members will be visiting an AIDS orphanage, and then traveling with Debbie from Orpha Relief and Rescue (orphanreliefandrescue.org) We’ll be preparing a meal, delivering clothing (one mother in Minnesota gave us all the baby clothes her twin daughters have outgrown).

Shown above is Dr. Lander briefing Dr. Sherman the Liberian physician performs his first cleft, two boys out of surgery sporting their hats donated by Zephyr Hat Company, and children with dolls from Dollies Making a Difference.

Yesterday we had a full day of screening at Duside hospital, and in the evening at dinner many of us felt it had been the most efficient, effective screening ever experienced on a CSI mission trip. What made a difference was having the surgeons positioned at the entrance of the hospital with Dr. Sherman, the local surgeon, who cycled his pre-screened patients to the appropriate surgeon who could make a quick determination whether or not surgery was possible before sending the patient up to get background information, vitals, a photograph and a screen by the pediatrician. We screened a total 109 patients, scheduling 104 for surgery. One woman had walked two days, and then taken a 7 hour car ride in order to get to screening; another walked two days and then took a bus for 4 hours. Dr. Tim Lander screened a number of cleft lips and palates, Dr. Dave Vandersteen a number of urological disorders, Dr. Steve Muehlstedt a number of general surgical issues, and the two pediatricians Dr. Dave Tetzlaff and Dr. Tim Wood screened everyone for surgical readiness. For example, does the patient have a fever, is he underweight, does he seem congested? Every single team member participated in some aspect of screening. Katie Stewart, this year’s CSI Partner, teamed with medical records head Jan Martland to create a chart for everyone and get essential background information. Sally Lannin took before pictures of all patients, Joel Johnson ran logistics which involves just about everything, Mary Johnson and the other OR nurses Jodi Pelkey and Katie Sweet got the operating rooms readied. Lynn Randall and team Mary Randall, Dan Chow, Tammy Skidmore and Mary Dudley unpacked all the drugs and machinery for anesthetizing patients with the help of Dr. Ryan Rekuski, our anesthesiologist. Others including nurses Patience Kankeh, Michele Stewart, Julie Hampton, Lora Koppel, LouAnn Randall and clinical lead Katie Houle either took vitals, floated where needed, escorted patients to and from the lab etc. It was all hands on deck for a very busy 8 hours.

Today members of our team lead trainings for Liberian medical students and other professionals, as well as screened a few additional patients, although we have a very full schedule of surgeries for the next 5 days. Shown in the photos is team member Kristi Holton taking vitals on a patient, as well as a look at the patients waiting hopeful their names will be called, as well as one happy patient.