Author Archives: Children's Surgery International

We are embarking on the first trip for our Vesicovaginal Fistula (VVF) project. We have an exciting 2 weeks planned! I will be spending the first week performing surgery with Dr. Serigne Gueye one of the world’s experts on fistula repair in an outreach trip in Central Senegal, the second week we will be obtaining live video of surgeries needed to complete our VVF surgical simulator. I am so excited to see this project coming to fruition and the different parties aligning so well.

I made it safely to Dakar with a few hiccups on the way. I arrived at the hotel a few hours late and kindly the hotel restaurant owner has lent me some clothes till my missing bag arrives, so I can leave this morning for our outreach trip to Ranerou. In Ranerou they are planning on beginning a more formal medical program and we will be assisting by performing hopefully some fistula surgeries and other gynecologic procedures.

The team will be joining me this weekend at the Hotel Le Djoloff,  attached is a picture of the view from the rooftop.

Another full day of surgery! All of the families and children waiting for surgery are staying at our hotel and early in the morning when we get up and leave at 6:20 all the mamas and papas and grandmas are in the lobby with the patients waiting to be picked up. The littlest babies are already hungry because they haven’t been able to eat since midnight.

All of the surgeries have gone wonderfully; we are especially thankful for Coca and her daughter Laura from St Andrew’s Clinic for their vision which has kept the program going. What an incredible organization Coca founded 38 years ago. The children receiving surgery these past two days are the neediest clefts and palates from all the patients the clinic has seen in the past year. The legion of volunteers here at CIMA hospital are just incredible.

I want to also mention an additional member of the team; Heidi Peterson is on board this trip to evaluate Hermosillo as a site for our Youth Program. She has been doing a fabulous job of taking pictures pre and post op in the OR.

It is 6:10 pm and and two patients still need to go into the OR. Tomorrow morning after rounds the team will and catch the 11:30 am flight out of Hermosillo to head home. A few team members will stay behind for 24 hours to look after any patients who are still hospitalized. More later…..

It it Sunday at the CIMA Hospital in Hermosillo and CSI has a full day of Surgery. Dr. Bob Tibesar has 6 patients; Dr. Jon Grischkan has 5 and Dr. Mike Fritz 6. The cases vary in length depending on the complexity of the surgery to be performed. The patients getting surgery today spent the night at a nearby hotel and have been at the hospital since this morning waiting for their time slot. One of the patient’s mother works far away as a walnut picker. She didn’t have enough money to pay to come to Hermosillo so her fellow workers; others who pick walnuts, each gave up the money they spend each day on a soda, and donated it to her.

When the patients check in, they are met in pre-op by anesthesia staff who readies them for the OR. Dr. Chris Altman is the head anesthesiologist. The OR’s are staffed by CRNA Cathy Cook from the Mayo Clinic, nurse anesthetist Jim Ducharme, OR nurse Mary Johnson, CRNA Tricia Rude and OR nurses Staci Linn Swenson and Dee Ann Vander Pol, who is from Iowa. Surgeries are performed by Dr. Bob Tibesar from Minneapolis Childrens and Dr. Jon Grischkan from Columbus, Ohio, and Dr. Mike Fritz from the Cleveland Clinic. After the patients come out of surgery they are met by the pediatricians Dr. Paul Melchert and Dr. Greta Chen, as well as post op nurses Grace Nwaofune and Ann Schminski. After recovery they go to the pediatrics ward upstairs and are met by ward nurses Judy Nieuwenhuis from Iowa and Cheryl Shell from the Twin Cities.

The staff here at CIMA hospital is incredible, as are the many volunteers who arrive everyday and circle around repeating “is there anything that you need?” “What can I do for you?”. They help translate, keep us fed, fetch this or that, find patients, answer questions, get diet coke, drive us to Wal-Mart for supplies, track down lost luggage, etc etc etc. Each and every one of them make this mission a pure joy.

Seven of us arrived yesterday in time to tour the hospital, evaluate the screening room, meet with the SPECTACULAR volunteers of CIMA (the hospital) as well as with Coca and Llordes who have both made the St Andrews Clinic in Nogales Arizona function. This is critical because this non-profit clinic (founded 38 years ago by Coca) has brought literally hundreds of children across the border for care for years. Every year many patients are brought to the CIMA hospital here, and Childrens Surgery International flies in to screen, operate and care for the many children requiring care. This is truly a united effort, formed and implemented with love and care for the children.

Our advance team includes Lora Koppel as clinical coordinator, Dr Bob Tibesar as medical director, Dr. Jon Grischkan as surgeon, and Drs. Paul Melchert and Greta Chen as pediatricians, in addition to Mary Moore as medical records coordinator and Sally Lannin on logistics. All of the additional team members arrive later this afternoon. They will inventory the drugs that arrived in advance, and begin to prepare the operating rooms for surgery which will start early tomorrow. What follows are an assortment of photos from this first day of screening. We screened 79 patients today; approximately half of them will receive surgery.

Well, we all made it back to the states, more of us more or less in one piece. After a long day of traveling, the MSP Airport “Buckle Up” sign on the way out was a welcome sight for us all. Although most of us are well into our weeks, our recent experiences are still fresh in our minds.

All in all, the mission was a success. We performed a total of 37 surgeries total, ranging from bilateral hernia repairs to cleft lips. I believe we have strengthened our bond with St. Damien’s and their staff, and we are already planning our next trip back. The goodbyes were all ripe with “whens” not “ifs” which is also telling of the dedication and passion of our team. We all feel a strong bond to this particular site, and whatever the reason for this, it will move many of us to return on successive missions to Haiti.

[Roll credits]

Trish Valusek, Pediatric Surgeon: Master of the “Haiti Hernia”
Eric Moore, ENT Surgeon: Giver of new smiles (to both patients and families)
Scott LeBard, Anesthesiologist: The only person smart enough to being an umbrella to Haiti during the rainy season
Celeste Gaiser, CRNA: The singing anesthetist
Peter Melchert, Pediatrician: The cheerleader, pep-talker and motivator
Norie Wilson, Float Nurse: Keeper of the pace, and the peace
Trish Cabrera, Floor Nurse: Saint of the Salon de Ballon
Kendra Howe, PACU Nurse: “Santa” of the PACU
Laura Snyder, OR Nurse: Little Miss Sunshine
Arthur Treger, Biomedical Technician: Mr. Fix-it
John Hehre, Logistics Coordinator: Ansel Adams of the OR
Christine Hehre, Medical Records: Composer of the blog

Well, we’re all packed up ready to go in the morning. Quick note tonight tonight as we have a long day ahead of us.

This evening we went to the Sugar Cane Plantation for dinner and our Haitian counterparts from the hospital joined us. We made for quite the group as there were 31 of us in all! We really bonded during this time, singing songs in native languages to each other and learning everyone’s favorite animal as we went around the table introducing ourselves for those we hadn’t worked as closely with on the trip.

It was really great to be able to spend time with everyone in a social context. It is comforting and encouraging to know that there are people around the world whose work means as much to them as ours does to us. In the end, it’s all about the children, and St. Damien’s really understands that.

If you’re reading this and you are going to be collecting one of us tomorrow night at the airport, please make sure you have a pillow for the car ride home (if it’s a long one) and that the hot water heater is in tip-top condition because we’re probably going to want to take a nice, long warm shower.

You know you’re on a medical mission trip when the conversations don’t get filtered during mealtimes. Let’s just say the topics are barely fit for the blog let alone dinner. Which, frankly, just adds to the overall experience.

Today was another successful day. We got through all 8 cases on the schedule today by 7 p.m., which the entire team appreciated immensely, and were able to enjoy and early an leisurely dinner.

A couple notable events today. There was an emergency surgery (not our patient) that Dr. Trish scrubbed in on to learn about how and witness the differences between how we do surgery in the states and how particular cases are handled in Haiti. The particular hospital we are at does not have a resident surgeon, so being able to witness a case was a bonus.
Yesterday, a patient presented with a severe facial infection which, upon further examination, we determined would not require surgery. We were able to clean up and bandage the area, and today the patient looked better and we’re confident that, with some antibiotics and proper wound care, the patient will make a full recovery. Seeing this condition makes us immensely grateful for our own access to care at home. This infection likely started out as a minor, treatable wound; in the states, it would have never progressed to the life-threatening condition it became for this patient.

Another unforgettable moment on the floor today happened with one of our younger patients who had surgery for a cleft lip yesterday. The little girl is very small and undernourished, but she is the happiest, most optimistic baby we have seen this mission. She and her mother traveled over 7 hours to get to St. Damien’s to be screened for surgery, but since they arrived both have been smiles and good spirits. The mother had not brought any formula to he hospital so this afternoon we were able to get some and mixed up a serving of it for the little girl. We didn’t have a bottle, so we put it in a regular cup. Watching this little girl drink, both hands on the cup and practically needing a snorkel, was one of the most enduring memories many of us will take away from this trip. At one point we tried to take the cup away and wipe off her mouth, but with lightning speed she grabbed the cup and continued to gulp down the formula.

One very important aspect of follow-up care for the smaller cleft lip patients is teaching the parents how to properly nourish their children. Many cannot read, so showing them the proper mixture of water and formula to feed their children can make the difference for a quick recovery and thriving in the future. Rigan, a nurse who has joined our team for the mission and is doing a lot of the translating for us, has been doing the demonstration and making sure the parents understand what they need to do, and the importance of doing so.

We just have three cases tomorrow, and the goal is to—

On second thought, let’s refrain to saying anything that might jinx the schedule for tomorrow. We will say that we hope to see the city tomorrow, and have a goodbye dinner planned with our team and a few of the hospital. I think that the only expectation for tomorrow is that the bar at the restaurant has a well-stocked bar.

Most of us started out the day asking “what day is it again?” which is an indication of how hard and fast we’ve been running. And we’ve been on our feet for so long most of us have rather impressive cankles. For future volunteers on this mission, may we suggest compression stockings?

We started at 8:30 again this morning but thankfully were able to get through all 5 clefts and 3 hernias by 8 p.m. this evening. We did end up moving two cases from today to tomorrow to even out the schedule, so we’ll have 8 tomorrow as well; three are scheduled for Saturday.

Trish Cabrera, our floor nurse for this trip, deserves to be highlighted today. For the past three days, Trish has been on the floor keeping tabs on the children awaiting surgery, those arriving for surgery, and those recovering from their procedures. We all agree that Trish has one of the most difficult jobs on the trip: monitoring, vitals, charting, IV’s, meds, parents’ questions, the crying, wound care and making sure the kids don’t rip out their stitches, discharge coordination— the list goes on. The floor is definitely the most patient intensive aspect of the mission, and when you consider the language barrier as well as the differences in practices, not to mention the temperature on the ward has to be well over 90 degrees, this position is certainly one of the most intense jobs on the mission and we (well the children, really) are lucky to have someone so dedicated, passionate, and skilled working on the floor.

Trish is doing an amazing job on the floor een with everything she has on her plate. The one saving grace for this position though might be that she gets to witness the parents reactions when they see their child for the first time when they return to the floor after surgery. The reunion is always very emotional, filled with gratitude and relief. It is priceless to witness. One of our patients today was a very small girl with a cleft lip who, for various reasons, we initially said we wouldn’t do on this trip. But after speaking with the family, we were persuaded to go ahead with the surgery because they wouldn’t be accepted at home unless their child’s lip was fixed due to to stigma associated with the condition. When the child and parents were finally reunited after surgery, the smiles were so impossibly wide, we knew we had made the right decision.

As mentioned before, we have 8 cases tomorrow; 3 scheduled clefts and 5 hernias. Our goal is to be done again around 8 p.m. so we can get a good night sleep and try and get an early start Saturday as we have various activities planned for Saturday afternoon which we want to be done by 1 to get ready for. With only three cases Saturday though, this should be very doable.

It’s almost 10 p.m. and we have been doing surgery for over 12 hours now. The closure of this final case will mean the successful completion of 11 surgeries, anatomical remedies for 11 children, and relief for 11 families. Our work will never be done in Haiti, but the individual lives of the children we help on this mission should not be overlooked in light of the overwhelming need.

Dr. Eric Moore arrived today, so tomorrow we start the cleft cases. He will do all 6 in the morning and then Dr. Trish will finish up the day with 4 more hernia cases. All patients from yesterday were discharged before noon with no complications, and instructions to follow-up with the hospital in a week. We were able to get an earlier start and worked hard to keep the schedule moving. In addition to the 11 surgeries done today, we also screened 6 more patients, and are expecting more tomorrow as well. As of now, our goal is to fill the schedule through 3 cases on Saturday.

In truth, Wednesday’s success was brought to you in big part by our float nurse, Norie Wilson. Norie deserves to be highlighted today for her coordination, level-headedness in the face of potential chaos, and ability to keep everyone moving. Between keeping track of patient discharges, new patient admits, the surgery schedule, where each patient needs to be when, who is where when (patients AND team members), and what who is doing what where when, monitoring patient screening, and dealing with the random “situations” that arise, Norie’s coordination is essential to a successful mission. We are all so grateful for her “be calm and carry on” attitude as well as her universal understanding of how missions work and her ability to make it look effortless (she really embodies the essence of a “float” nurse). Although, don’t be fooled; Norie is working really, really hard.

Today was a testament to the fact that, while we may have fun on the missions (and in our blog), our ultimate goal is to make a difference in the lives of our patients and their families. Although they are often the most simple to fix, cleft cases are also the most heart wrenching. We were reminded of this in a big way when one family relayed how important it was their child receive surgery, as they had been all but driven out of their village due to the stigma associated with their child’s cleft lip. One of our patients is a teenage boy who was abandoned because of his appearance. It’s stories like these which keep us coming back, because we know how dramatically a simple fix can alter a child’s life.