Author Archives: Children's Surgery International

Today is our last day of surgery in Ethiopia. This week has gone by fast and I cannot believe it is the last day of surgery already. I am always awed and inspired on trips with CSI, during which a team of people who have never worked together as a unit, come together and provide the best possible care for children with orofacial clefting and urologic disease. These trips are soul saving for me in that I get to do what I love, without the daily bureaucratic tasks that are ever present in my daily life. The things that I love about my career are providing necessary surgical care for children and educating others to do the same. The Bahir Dar site provides both of these opportunities.

It has been a pleasure working with local surgeons, Drs. Melesse Gebeyehu (head and neck surgery) and Asnake Bitew Kassa (otolaryngology/ototlogy), and their trainees. They are not only talented surgeons who have quickly learned how to perform cleft surgery but are also passionate about what they do and building programs at this site. These are things that align with my own career interests, and it is wonderful interacting with like-minded people who share similar visions on a different continent.  We have talked about formal programs for cleft care that could be built here, especially since they have the drive and training for it.  They have great ideas about further building their skill set and adding subspecialists to their practice. I am proud to be a part of a CSI team that can help provide additional training. In addition, they are wonderful people who are a joy to be around.

We have had a busy week with some long days early on, but we have been able to help many more children than just the ones we operated on by continuing to train our local partners.  It is a testament to the team to carry on the mission during chaotic times in a new hospital setting.  We have had power outages that we had to operate through. Thank goodness I was wearing my battery-operated headlight when it happened during a case. It was an interesting experience operating in the dark. Everyone in the OR remained calm and got all the things we needed to keep the patient safe, and we were able to finish the case.

These trips make me realize how much we can do without the optimal conditions. When we run out of supplies, we improvise, and through the ingenuity of our team members, we always find a way to move forward and continue doing our work. It is a testament to the talent of our local surgeon partners that by the end of the week, I was able to scrub out and supervise from the background.

Part of me always feels a little bad that I go to different parts of the world to perform and teach surgery, but never really see much beyond the hospital and my hotel room. But traveling the world is not why I go on CSI trips. Providing education to local surgeons while being able to provide free surgery to children is why I do this. The icing on the cake is being able to work with the great people, now friends, I’ve met on various CSI trips.

Everyone who works with CSI is passionate about the mission of taking care of children and educating others to do the same in a high-quality fashion. I love that the group is committed to building long-term local partnerships at our sites. Drs. Melesse and Asnake are very skilled surgeons, and it is amazing working with them. I consider them friends and colleagues, and look forward to continued collaboration with them, whether here in Bahir Dar or remotely.

Raj Petersson, MD

More photos here.

Ethiopia is full of contradictions: a beautiful and also a difficult place. I walked two blocks today from the hospital to what I thought was a print/copy shop make copies of medical forms. In that two blocks, I saw examples of extreme poverty, destruction, and need. Even at the “copy shop,” which was basically an 8′ x 8′ open air room with a a dirt floor, the employee didn’t know how to operate the small printer on a table in the middle of the room.

But also along the way, I was met with smiles and people willing to help me find my way. When I reached the shop, a little girl smiled shyly up at me. She was beautiful. By the time I left, there were four girls and three boys crowded around the doorway, smiling and very curious about me. We had a great time taking pictures together, and then they followed me most of the way back to the hospital. I smiled the whole way.

At the new hospital, people often travel hundreds of miles to be evaluated by medical staff, either ours or theirs, or both. They sleep in every available space, and wake each day with renewed hope and persistence to get the care they need. It can be disheartening to see so much need, and to come face-to-face with the knowledge that it’s impossible to help them all. That’s the reality, and it can be a hard pill to swallow. 

And then I met Kalkidan and Zabisira, two little girls with huge hearts, immense joy, and incredibly giving spirits, both on our schedule for cleft surgery. They breezed into our pre-op area, smiling, dancing, and blowing kisses to us all. Sure they were nervous about surgery, but they didn’t let that stop them from making connections with every person they met. Having each girl willingly put one hand in a nurse’s and the other into mine, smiling up at us with trust and love…. just because. The beauty that shines through each of these girls transcends language, place, and the harsh surrounding conditions.

Being around such beauty makes this trip wonderful, and I’m so privileged to have met both girls.

Melanie McCall, CSI Board Chair and Medical Records Volunteer

more photos on our Flickr page.

Day 1 of surgery for the CSI Ethiopia team today. It was a LONG day, but productive! It is amazing to see how people, some who have just met, can problem solve and provide care as though they have worked together for years. The kids and families make it all worth it. Our team is so very grateful.

Despite it being a long day, we’ve got things dialed in now. We have a sweet OR set up, except for the fact that it’s 85 degrees! We get to work with a great CSI and local team.

This little guy was one of twelve patients that were operated on and cared for today by a hard-working group of committed volunteers.

We are off to sleep as fast as we can, preparing for another full day tomorrow……

See more photos here.

Today is surgical pre-screening day. The anesthesia team and OR nurses will be setting up our operating rooms while the rest of the team evaluates our patients and schedules surgeries for next week.

Screening is a super busy day, especially for our two medical records teammates, as well as the surgeons, pediatricians, and nurses.

Our team saw over 110 kids for screening. People walked as far as 2 days and waited as long as 4 months for this surgical evaluation. The first 10 patients were patients who weren’t big enough or strong enough to endure surgery during CSI’s last visit. The families were grateful and patient; some waiting nearly all day in line to be seen by our ENT and Urology team.

The hardest part of the day was announcing the surgery schedule knowing that not everyone would be able to be on the list. In contrast, the enthusiasm of families learning their child will get life-altering care is reason for celebration – not just for families, but for all of us. We have a busy week ahead – with 55 kids scheduled so far.

We left today feeling grateful and excited for the week ahead knowing the transformation to come will impact patients, families, and medical providers alike.

~ Monica Banach, CRNA & Emily Hall, MD ~ CSI Ethiopia Team Members

To see more photos from Ethiopia, Spring 2019, click here.

And they’re off! This team of amazing volunteers is on their way to Bahir Dar Ethiopia to change lives and make a lasting impact. This is the fifth Children’s Surgery International trip to Bahir Dar – we have made tremendous progress with our partners. This diverse team has members traveling from the U.S. – California, Kansas, Minnesota, Ohio, Philadelphia, Tennessee, and Virginia – as well as Italy and Liberia. Our focus will be to continue the training to help our Ethiopian colleagues build their surgical and medical skills as well as providing free craniofacial and urology surgeries to children in need. We have more than 30 families who’ve been waiting since our last trip in November.

Were very excited to be conducting the work at the new Tibebe Ghion Specialised Hospital on this trip. This project has been in the works the entire time CSI has been traveling to the region and it’s ready for us. Tibebe Ghion, which translates to “wisdom of Ghion” is a new facility operated by Bahir Dar University Medical School and will add significant medical capabilities and increase access to medical care for the region. Last fall several CSI team members had the opportunity to tour the new space.

We can’t wait to get going. After a little more travel and some rest, that is…

“An individual has not started living until he can rise above the narrow confines of his individualistic concerns to the broader concerns of all humanity.”  — Martin Luther King, Jr.

Our team has completed their work in Liberia and is heading home. CSI anesthesia volunteer Joanne Hill reminds us that on the eve of our U.S. national holiday honoring Dr. King,  this incredible team, our amazing partners and all who support CSI have, indeed, risen above to focus on that which is bigger than ourselves — to make a lasting impact in the world.

This week we screened nearly 130 patients, performed 97 surgeries and provided clinical training and lectures daily. We have more than 20 patients pending for next year as Firestone has graciously invited us to return in January 2020. Until next time, with deep appreciation and gratitude, we thank our partners and this CSI Liberia team:

Dr. Dave Andrews
Rose Andrews, RN
Dody Barr, RN
Emily Butcher, RN
Maggie Cavanaugh, RN
Cathy Cook, CRNA
Ashley Dingmann, RN
Jessica Driscoll, RN
Dr. Janelle Fox
Dr. Kevin Healy
Dr. Jesse Hennum
JoAnne Hill, CRNA
Monica Hooley, RN
Mary Johnson, RN
Dr. Micki Klearman
Anna Koppel, RN
Jim Koppel
Lora Koppel, RN
Sally Lannin
Dr. Eric Moore
Ethan Moore
Lloyd Nagbe, CRNA
Lynn Randall, CRNA
Dr. Dave Tetzlaff
Dr. David Vandersteen

Click here to see more photos from Liberia.

Today we met our first pangolin, brought to the hospital campus to be sold, most likely for stew meat. The pangolin is a small, scaled mammal that looks a bit like an armadillo. They are one of the most trafficked mammals in the world and are protected under national and international laws. Not unlike some of the human visitors to Duside, this pangolin, accompanied by a confident adult, seemed very unsure of what the day might hold.  

Fortunately for the children at Duside, what lay in store was a small amount of discomfort in exchange for a significant step toward a better life. The sting of an IV was followed by the elimination of a hernia or the restoration of the body’s normal anatomy. The pangolin was not facing such a fair transaction. This spurred a debate amongst several team members and visiting embassy members. A proposal arose: What if we pay the $10 (the going rate for 3 pounds of fresh pangolin), drive it a few kilometers past the gate, and return it to its bush home in a tree? “No, that’s not the official stance on endangered edible animal management in Africa,” one of the embassy members pointed out. That practice risks encouraging more pangolin trafficking.  

The philosophical conundrum got me thinking about the parallels in our week’s endeavors.  Sure, springing the pangolin may not stymie the hunting of her species or even affect her type’s declining numbers. But spending the liberating $10 would be a life-altering action for her. The same philosophy applies to our work here.  

Our seemingly small CSI presence may not change the existence of viruses like Ebola that can make an orphan of a 12-year-old within 72 hours. Nor can it change the fact that thousands of children are born with maladies that go untreated because they can’t access care. But for the 12-year-old orphan (who not only lost both parents to Ebola two years ago but also had lived his whole life with a giant hernia) and the other 90 children who had surgery this week, our presence ensured that tomorrow would be better than yesterday. And maybe, with the new skills and knowledge of our Liberian colleagues, we helped improve access to care for years to come.

At the celebration today, as 250 Liberians and Americans gathered to express mutual thanks, I think everybody was arriving at the same conclusion: You may not change the world, but you can make somebody smile, help somebody feel better, make somebody feel safe — and that makes for a good day.  

~ Eric Moore, MD, CSI surgeon

Check out more photos from Liberia here!

The day starts early at the Firestone Liberia guest house. If I listen closely from my room above the dining hall I can hear the staff at work on our breakfast by 4 a.m. There are eggs to crack, bacon to fry, pancakes to grill, and fruit that won’t cut itself. The food here is delicious, and I eat too much.

We are on the bus by 6:30 a.m. Some days I can see Venus in the west as we leave the guest house. We lose the sky to fog as we drive inland, winding our way through the rubber plantation to the hospital. By the time we reach the hospital, daylight is full and the air is warming.

My day starts off with a bustle as I gather supplies for the cases I’m assigned. I check the oxygen supply (twice), make sure there is anesthetic in the vaporizer and more at hand if needed, and prepare the drugs for the nerve blocks that I’ll perform once each patient is asleep. We have 25 surgeries scheduled for the day. General surgeon Dr. David Andrews spends time in the OR helping a Liberian colleague polish his surgical technique. Midday, CSI nurse educator Dody Barr takes a break from her work in the pre-op area to present a lecture on newborn resuscitation.

After work, it’s back to the guest house for dinner and relaxation. Dinner is on the table at 7:15 and we are finished eating by 8. The staff cleans up and does what prep they can as we will all be back at it again in tomorrow.

Doing, teaching and learning. That’s our day, and we are grateful for it!

~ Kevin Healy, MD – CSI anesthesia volunteer

Click here to see more photos from Liberia, 2019.

When our logistics coordinator asked for volunteers to write a blog post, my hand shot up. Not surprising to those of you who know me – I’ve always got a lot to say. I want to start this blog by saying that today was the first day I actually saw a couple of puppies walking around the hospital! I suppressed the urge to pet them, or even take one home in my carry-on bag.

Reflecting on my busy day in the OR, many amazing thoughts and memories put a smile on my face. Watching CSI’s two newest OR nurses spread their wings and fly solo with minimal assistance astounded me. I look at Emily Butcher and Monica Hooley and marvel at their enthusiasm and motivation. I know they will be hooked on CSI  for life, just like I knew I was on my very first trip. I am amazed at how universal OR nursing can be. The Liberian nurses are phenomenal at helping with our room turnovers – or should I say – table turnovers, as there are two tables in each of our ORs.

I want to tell you about Jackson. The details of his story are not completely clear to me or his pediatric urology surgeon, Dr. Janelle Fox. What we do know is that 16-year-old Jackson suffered a serious pelvic injury in an accident. As a result, he has lived with a suprapubic catheter for almost an entire year. Jackson has been living away from his family, staying with family friends who have more medical knowledge. Yesterday he underwent a life-changing surgery that will allow him to urinate in a way most men take for granted.

What is truly incredible about Jackson’s situation is his bravery and determination. As he came into surgery I noticed the OR staff remove his shoes and take them from the room. Normally we would hand them to waiting family members, but Jackson had no family accompanying him. The shoes would wait for him outside the door. I was really touched. Here was a young, stoic man who was going into surgery without any loved one near to offer him encouragement or support, yet he made sure he was properly prepared for surgery and signed his own surgical consent form. How completely remarkable and mature.  I am proud to have been able to serve Jackson, and all of our incredible patients here in Liberia.

~ Jessica Driscoll, RN, surgery

View lots more photos here!

Full disclosure: Today’s blog is written by a urologic surgeon. Feel free to gloss over as much as necessary to remain in your comfort zone.

As the sun still struggled to meet the horizon, a team of motivated CSI members arose around 5 a.m., strapped on headlights and left the Firestone Guesthouse where we reside. Why? To run in the 80 degree, 100% humidity environment and to enjoy one another’s company. (Writer of this blog was soundly sleeping, BTW.) These CSI team members reflect the spirit of our mission: teamwork, sacrifice and hard work. They support and encourage one another along the way as they climb the Liberian hills in the dark. They are rewarded by a magnificent sunrise and the ensuing endorphin rush.

It is a blessing to return to Liberia for the seventh time. As “frequent flyers” we have built strong bonds with our local colleagues. Within minutes of arrival at the hospital and the Firestone facility, we were able to reconnect and plan our work to help the children of Liberia as if we had never left.

The support we receive from Firestone and the local community is invaluable. The Liberian and Firestone communities provide us with the food, shelter, transportation and facilities to do this work. They prescreen patients, house patients awaiting surgery and provide dressings and other supplies necessary for us to be successful. Thank you, Firestone!

Reconstructive pediatric urologic surgeons perform staged surgeries that are completed over a number of years. So each year we return, we see the results of our prior trips and diligently work to restore these children to their full potential. Today, we had a return visitor whom we first met in 2012 following a traumatic injury to his bladder. At that time he was not able to urinate at all and had  been living with a constant indwelling tube extending from his abdomen that drained his bladder. We performed a Mitrofanoff procedure (presumably the first ever in Liberia), allowing him to live a normal tube-free life. He returned today, as a healthy, productive 27-year-old man!

We started the day with rounds to evaluate yesterday’s surgical patients, and all were doing well. Dr. Janelle Fox performed a urethral reconstruction in a young man who could not urinate because of a traumatic injury. Dr. Dave Andrews continued to save the world “one hernia at a time,” and Dr. Eric Moore was able to remove a disfiguring tumor from the head of a beautiful young girl.

The day was capped off by the families of our patients singing and dancing in gratitude. It was impossible to leave with a dry eye. It is impossible not to love this place and these wonderful people. xxxoooo, Liberia! 

~ Dave Vandersteen, MD

View more photos in our Liberia Flickr album.