Author Archives: Children's Surgery International

Shown here are the CSI team in the bus heading to the hospital for screening, a patient at screening, and Lora Koppel, team ward nurse and CSI Board Chairman dancing with children in a nearby village

Arrived safely at Robertson airport last evening, and got to the Firestone Guest House safely, all accounted for, and all luggage in hand! Congratulations to our logistics team member this year, Joel Johnson, as well as all of the Firestone supervisory personnel dispatched by Dan Adomitis of Bridgestone Firestone and his team. We were met by wonderful Lillian, all of the Firestone staff, and many familiar faces as this is our third year back. In bed relatively early for everyone, and day one spent touring the capital of Liberia– Monrovia. We stopped at a museum, a marketplace, the first church of Liberia where the repatriated slaves worshiped after the Emancipation Proclamation gave them the option of being returned to their home continent of Africa, saw the US Embassy as well as the new UN building. The day also gave us a good chance to have a rest day as we hear tomorrow, screening ,will be very busy. A stop at the beach on the way home to see where the Atlantic Ocean meets the western coast of Africa, and back to the Guest House for an orientation talk by Dan Adomitis and our first team meeting led by Medical Team Lead Dr. Tim Lander. Shown in the pictures a photo displayed in the museum of what the streets of Liberia looked like following the Civil War, which ended in 2004; the streets literally littered with bullet casings. Also is a reflection in a new building in Liberia as well as a busy street corner in Monrovia

Set up in the OR with the whole team. Can you see the concentration of the whole team as we work hard to ensure that we capture the valuable imaging we need to make this project a success!

It has been an incredible trip. We have learned a lot through our collaboration with our Senegalese partners and created relationships that will allow for continued efforts in teaching fistula surgery throughout the developing world.

Our hosts have been incredibly gracious. We have had the pleasure of meeting religious and community leaders, members of the UNAFP, and medical personnel from the entire hospital as well as visiting doctors from the US. It is wonderful to see the excitement of everyone in working on this difficult issue.

Today we had the opportunity to round and interview on our patients and it was amazing to hear their stories again and how happy they are to be dry for the first time in many years.

This has been an amazing trip.

Hello again all! Sorry for not writing more regularly this week but I figured our update for the end of the week would be more meaningful! We have had a busy week of video recording and directing to obtain all the necessary material for the development of our surgical trainer. We have completed taping about 10 fistula surgeries showing a multitude of variations that will be critical for the learner.

Our hosts Hopital General de Gran Yoff and specifically Dr. Serigne Gueye and his team have been incredible! David and Pete made it here (albeit Pete a day late) with all our equipment in tact and in tow! They have been so accommodating in understanding the video process and ensuring the surgical steps are clearly delineated so that we can capture each step precisely for the trainer.

Here is a picture of our OR set-up which miraculously worked without a hitch! Thank you Tanya from Stryker and kudos to David and his technical genius!

I have lots more to share as our week comes to an end. Will add a longer post tomorrow but I wanted to get something up there to share with you all!

Couldn’t resist photographing these precious little toes. After surgery, the children go to recovery, where they are covered with blankets, made by the many csi volunteer, sand monitored until they wake up. Then the moms are called in to comfort them.

The days are packed! As of today we have performed 74 surgeries and screened many more potential patients as the fact that we’re in town is spreading. The list of patients for next year’s return has been started. We had to turn away two very little babies, one just 30 days old. Although they did not receive the answer they wanted, Jan showed the moms how to feed their babies with a cleft lip and/or palate and asked to come back next year. With this type of knowledge and skill, their children have a better chance of thriving and they have hope that we can perform surgery on them next year.

There have been so many highlights, wonderful moments, and just plain funny events. There are many things we see in the hospital here that one would probably (make that definitely) not see back in the states.

The hospital does not have air conditioning, except in the operating rooms, so many windows are open and all kinds of flying things enter the building. We are greeted by some beautiful butterflies fluttering along the halls, crickets peeking out from corners, and of course flies-even in the or. Hospital laundry can be seen hanging to dry on clothes line on the roof. And many hospital workers go barefoot, even into the OR!

We have delicious lunches made and packed by the staff at our guesthouse and there are wait staff in the “lounge” the make tea and coffee. The doctors here all have wait staff that deliver tea, water and meals .  It’s very different that home and is rather hierarchical. There are always people sweeping the halls and walls throughout the day and night, otherwise the hospital would be coated in a light layer of bugs and such. Bangladeshi brooms are made of long grasses bound together. One of our nurses commented how nice it would be to take one home and hang on her wall.

There have been a few minor crises, but nothing the collective genius of this group can’t tackle! Upon arriving at the hospital one day we found that the or surgery lights were not functioning. We put the word out that head lamps were needed and several of the team came through. This was after we we devised a way we could duct tape a flashlights to each surgeon’s forehead! Fortunately after a few hours the lights were fixed and we were back in business.

It’s been wonderful to witness the results of our gifted surgeon’s expertise. Babies and numerous adults have had their lives transformed and so many have expressed their gratitude with their smiling eyes and by placing their hands to their hearts. One young man in his early 20’s was accompanied by his best friend and together they traveled over 150 kilometers. The friend was so excited for this young man and could not contain his excitement. Another young woman had a severe facial cleft. She has never been to school, although has received her education at home, has no friends, and rarely has left her home in 22 yrs. Dr. Kofi said, “I really want to do this surgery for her.” He did and the results are amazing!

It has been a great mission and what we have witnessed here make us greatly appreciate what we have back home.

Here are some photos from our mission to Bangladesh. Be sure to check out the website for a full gallery from our trip! Below are some of the highlights…

On Saturday or day one, the team set off for the hospital at 7 am to set up for screening, unpack supplies and get the operating rooms ready. Upon arrival, we were greeted by a large contingent of hospital personnel and each of us were given a bouquet of flowers, that’s 23 bouquets! This also happened on Friday evening for the group that toured the hospital. Needless to say, the dining room of the RDRS Guest House, where we’re staying, is covered with vases of flowers!

Bangladeshi families are extensive and many family members traveled with their children, having heard about CSI over the radio and through a large hospital marketing campaign. The screening area (or screaming area, as it really should be called) was packed and by the end of the day we had screened over 90 patients. One little fellow showed his set of lungs right at the beginning of the screening process after all we did was put a sticky label on his shirt! More little ones got into the act when having their photo taken and by the time they were on to vitals the chorus was in full session. One of the most fascinating things was to finding out how families got to the hospital. Many had taken the bus from as far away as 120 KM, that’s about 70 miles and one family travelled 30 miles by rickshaw.

Since the hospital and our guest house are only a half mile from each other, some of the team decided to walk back to the guest house after screening was finished. The road is lined with small food stands, some with sections of meat hanging in the open air, brick workers making mortor for roads by chopping large bricks into smaller pieces, chickens, cows, goats, dogs, people welding iron for gates and glazing pottery. The most unique site was that of a man grinding mustard seeds to obtain the oil. He was sitting on an ox that was attached to a large grinder in the middle of his stand. On the road were trucks, rickshaws, three wheeled cabs, bicycles, and pedestrians. The sounds of horns, the smell of open cooking fires, and the sight of curious children staring at this large group of foreigners dressed in scrubs comple this rather exotic picture!

Today, Sunday, Kofi, Anthony, and Krista successfully completed our first 16 operations. We also screened several more patients who had heard through word of mouth that we’re in town and we’ve added three of them to the surgery schedule. One of them is a young woman with an extensive facial cleft. One of the best moments of the day came when a dad held the mirror for his 11 year old pig-tailed daughter to see her new face for the first time. He was absolutely beaming with happiness and a huge smile and said he never thought this would ever happen!

The hospital ward is filled this evening with 16 children, their new smiles and their moms. It’s a happy place. Heather and Michelle, our two night nurses, have taken over for the evening watch of these beautiful little kids.

We’re looking forward to day two of surgery and posting some photos too.

The second day in Ranerou began with a line of patients waiting to be screened for various medical complaints. After screening the patients we unfortunately did not have any more fistula cases but did schedule surgery for complete uterine prolapse in a young woman after childbirth and two large lipomatous lesions.

We completed our cases with the assistance of our surgical team and rounded on our patients from the previous day who were all doing well. The fistula patients will be cared for by the Ranerou team of doctors and will stay at the hospital till their catheters are removed in 1 week.

It was an enlightening trip to the heart of Senegal and a view of the daily lifestyle of the people here. The work being done by Ranerou’s medical team is impressive and shows their dedication to the care of their people and ability to adapt to limited medical equipment and supplies.

We left Ranerou with warm hearts and a full stomach after sharing in our communal meals and living with the medical team. I also left with some additional memories given to me by the mosquitos of Ranerou who feasted on my foreign blood (my bug spray was in my delayed luggage!).

Au revoir Ranerou and off to Dakar to plan for the filming and fistula surgeries scheduled for next week! (Below is a picture of one of the many small markets en route Dakar).

Hello All! I am back from our outreach trip to Ranerou in central Senegal. What a journey and experience this was! The drive to Ranerou was about 8 hours from Dakar, for the majority of the trip the road was well-paved and the smaller cities and villages a site to see. As we travelled further east the road became more dirt paved with various areas of construction slowing travel and requiring the expert navigation skills of our driver. Our team consisted of Dr. Niang a Urologist from Senegal and a midwife who would be working with the gynecologic team.

We arrived in Ranerou on the evening of the 25th and shared in a joint meal of rice, vegetables, and local chicken. Interestingly the meals are served in a large communal plate with each person sharing from their corner of the plate, delicious!

We met Dr. Rau who runs the hospital in Ranerou and his team of nurses and doctors as well as another physician, a professor of gynecology who works with the nurses in Ranerou regularly. On Day#1 we started the morning conducting clinic to evaluate and screen patients for surgery. We saw a variety of female patients with a number of different complaints. We found 3 women with fistulas and their stories are truly amazing. The picture below is of the women waiting in the hall outside for surgery.

The three women ranged in age from 28-40+. The first patient had been living with her fistula for 25 years without ever having an operation. She was lucky in that she was still married to her husband despite her condition. Our other two patients were divorced. One patient was 28 and had her first pregnancy at the age of 14 and subsequently developed a fistula. Our other patient had been operated on by Dr. Niang 1 year ago at another site and while her incontinence had dramatically improved she was still leaking some. Dr. Niang described that her original surgery had been very difficult as she had a complete transection of her bladder from the urethra requiring a difficult mobilization of the bladder and repair. On examination she now appeared to have only a small residual vesicovaginal fistula that could be easily repaired.

We then booked an additional few gynecologic cases and left for the city center to meet with the chief of the village to bless the opening of the new center.

We completed our 3 fistula cases as well as a repair of an anal sphincter injury during childbirth. All surgeries were completed successfully!

Gathering from Kenya, California, Maryland, Texas, Iowa, Minnesota, and Bangladesh our team and a mountain of luggage and supplies converged in Dhaka early on October 29th. It’s a big, bustling city of twelve million people moving to and fro on foot, bicycle, rickshaw, three-wheel mini-cab, car, van, truck, bus – all in a hurry, intertwining on streets without lanes or traffic lights: scenes of certain disaster, narrowly averted time after time. For the residents it’s just business as usual, and in the midst of all the frantic activity there are a surprising number of friendly smiles and waves.

Fazli, the Team Logisitcs coordinator set up an afternoon visit to a couple of local shops near our hotel. Bangladesh is known for its fabrics, porcelain, crafts and pearls among other things. We had a good time browsing and investing. In the evening we visited Fazli’s Father and Mother-in-Law’s house in Dhaka. We enjoyed their good company and warm hospitality in their lovely home while sipping on some delicious mango shakes and a sweet yogurt dessert.

Our 7:00 AM departure the next morning for Rangpur was delayed by a late arriving bus. On the road by 8:30 AM, we had a eight-hour ride, which one of our team members who had done it before, described as the “white-knuckle ride of your life.” It lived up to its billing. Fortunately we made good progress as lighter than normal traffic allowed us to get back on schedule. Arriving at the RDRS Travel House about 6:00 we unloaded the bus, and Jan and a team went to visit the hospital as other made up charts and went thought their supplies.

It’s currently 5:45 AM on Saturday, 10/29. We understand that there are about 150 patients waiting to be seen, and we’ll be screening most of the day.