Author Archives: Children's Surgery International

One aspect that makes traveling with a CSI team so wonderful is everyone’s willingness to dig in and do what needs to be done.

Despite being exhausted after a busy first day of surgery, Dr. Eric Moore, Ashley Dingmann, RN and Ethan Moore (pre-med student at Colorado College/Eric’s son) all pitched in after dinner to print and apply labels on multiple pages of 26 charts for tomorrow’s surgeries. It was not necessarily a fun task at the end of the day, but it was an important one nonetheless and was made easier with additional hands.

At least 15 new patients walked in amid all the surgeries today, and Clinical Lead Lora Koppel gave each one her thoughtful review, determining which team member should be consulted and how to proceed. Surgeons collaborated to maximize efficiencies in the ORs. Dr. Janelle Fox gave a urology lecture to a room full of Liberian physicians and nurses. It was a productive first day! 

We are grateful to the many Liberian volunteers who help make this week a success.

Melvin Wonyenene is volunteering for the first time this year. He was encouraged and touched by the surgery CSI performed for his nephew previously. Melvin hit the ground running, and his eager attitude landed him the job of inflating all 47 of the soccer balls our fans donated over the past year. Thank you, Melvin!

Zaccarhas Sinyan is a community health assistant who works for the Liberian government and was trained here at Firestone Duside Hospital. He is volunteering his time with CSI all week at the hospital. Zaccarhas works in rural areas where “there is no health care at all — none.” The most important focuses of his health education efforts are the use of mosquito netting and the importance of hand washing. Zaccarhas, 36, was born in Liberia and “wants to carry the health message to the people of Liberia.”

Miracle is a 1-year-old boy who was our last patient today. His 24-year-old mother brought him in for a hernia repair after seeking care a couple of months ago at a community hospital. She is happy that the care is free because she doesn’t make enough money to afford surgery by selling dried fish in the market. She thanked the CSI doctors and said, “I am praying to God that my son will be well.”

~ Sally Lannin, Logistics Volunteer

Many more photos in our Liberia Flickr album – 

It is end of a very busy day. We screened 90+ patients and currently have 78 scheduled for surgery. Our four CSI volunteer surgeons — Dave Vandersteen and Janelle Fox (urology) and David Andrews (general pediatric surgery) and Eric Moore (ENT) — will be performing surgery this week, as well as teaching local surgeons and residents. Many of our patients from 2018 have returned for follow-up or for the second phase of their urologic surgery.

Screening day started off with making a medical record for each potential patient. This was done by Jim Koppel, Ethan Moore and Micki Klearman — all first-time CSI mission team members. Basic information was gathered, and photos were taken before the children and their mother/father/auntie were directed to see the appropriate surgeon.  

Patients were assessed, and if they were a good surgical candidate they were then seen by our nurses to check weight and vital signs. The last step is to see one of our pediatricians, Drs. Dave Tetzlaff and Jesse Hennum, to make sure the children are healthy enough for surgery.

The Firestone Duside physicians, led by Dr. Wollor, have done a thorough job of prescreening potential patients during the year before our arrival. Parents and patients wait all day until everyone is screened and the surgeons create their semifinal schedules.

Parents are so thankful that they jump up and down when the schedule is read. The patients and a parent are able to stay on the Firestone hospital campus — sleeping and eating free of charge until their day of surgery. Unfortunately, as always, we had to turn away patients as our schedules quickly filled up. We do our best to either have the surgeries performed by in-country physicians or to keep the patients’ contact information for our next trip.

The team is tired after a busy day, but we are excited for the week ahead as we will be performing life-changing surgeries on many deserving children.  

~ Anna Koppel, RN

View our entire photo album from Liberia here.

Today the entire team acclimated to our new environment here in Africa. We enjoyed a lunch presentation from those who live and support health in Liberia, visited an orphanage and shopped in the local market in Harbel. We learned more about the inner workings of the Liberian health organization and the access to health care for the Liberian people.

Our trip to the orphanage gave us the opportunity to see how the children are raised, provide deworming pills and play some games with the children. The children are educated at the orphanage and may advance to the community school when they are ready, while continuing to live in the orphanage.  

At the Harbel market we were pleased to find a seamstress and learned that sewing increases women’s economic state in Liberia.  

Each of today’s activities allowed the team to obtain vital information for our work and build strong relationships.

We are a team of 25 CSI volunteers, plus several key partners from Firestone Natural Rubber here in Liberia. We all ended our day with a team meeting to plan for meeting our patients and families at screening tomorrow.

Rose Andrews, RN

This is my first CSI trip, and it was an experience I will never forget. While performing surgery for cleft lip and palate was certainly rewarding, the best part of our visit was working with our Ethiopian partner surgeons, Dr. Melesse and Dr. Asnake.  Both were extremely talented surgeons and eager to learn techniques for repairing cleft lips and palates. They are enthusiastic and ambitious about learning even more. Both surgeons have completed advanced training in otolaryngology. Dr. Melesse completed a head and neck oncology and reconstructive surgery fellowship, and Dr. Asnake completed an otolaryngology residency in Addis Ababa, Ethiopia.  While we may have been helping them perform craniofacial surgery, both surgeons are extremely proficient.  Dr. Melesse performs advanced head and neck oncologic surgery regularly at Felege Hiwot Hospital in Bahir Dar. In fact, on our last day he performed a revision radical neck dissection for a patient with recurrent spindle cell sarcoma. Dr. Asnake, who just completed his training, will be performing the first ear surgeries at the new Bahir Dar University Hospital next month and will be the only ear surgeon in the region. He will perform surgery for chronic ear disease for patients in Bahir Dar and the surrounding provinces. In addition, they plan to start the first otolaryngology residency program at Bahir Dar University next year. It was truly a pleasure to be able to work with these talented individuals.

On our last day we toured the new University hospital with Dr. Melesse. This new facility will add significant medical capabilities for the region and increase access to medical care for the people of Bahir Dar.  The current hospital at Felege Hiwot is busy. There are 130,000 outpatient visits every year and 6,000 inpatient admissions every quarter. The new hospital building will significantly increase bed availability and access to outpatient care.  The new University Hospital is a 600-bed facility and houses 20 major operating rooms and 10 minor operating rooms, along with state-of-the-art neonatal, pediatric and adult intensive care units. In addition, patients will be admitted to four-person and two-person rooms, a significant upgrade from the 8+ patient rooms at their current hospital. The new hospital is situated within the campus of the new medical school, creating a state-of-the-art graduate medical education center for the region.  

While it is sad to leave Bahir Dar because of the amazing experience I had, it is exciting to see the growth of both the providers in Bahir Dar and the medical infrastructure in which they work.

Greg Kelts, MD ~ CSI Surgeon

Click here for more photos from Ethiopia – Fall, 2018

You don’t need to share the same language, live in the same country, or even look the same physically to play. Play can start from something so simple, like a smile, and become contagious to all those around. As a child life specialist in Minnesota, play is the at the core of what I do.  Here in Ethiopia, I realize the power and influence of play – not only on the kids but the adults too. It is something that is therapeutic for everyone – play is medicine. 
      

Eleven-year-old Kidus had to wait the longest for his urology surgery at the end of the schedule today. At first, he just watched as the younger kids played with bubbles and colored. But after a few invitations he joined right in. Age doesn’t matter. Kids want to be kids. His favorite thing was to create a mini basketball hoop out of pipe cleaners and tape. After some modifications, we were able to shoot baskets and even come up with trick shots to perform. It was entertainment for Kidus as well as our cheering section of parents and families. 

Today 3-year-old Natanael loved playing with everything we had. We spent hours doing stickers and coloring, laughing, trying to catch the bubbles, and playing with little wood cars. Right before he went in for surgery, Natanael was playing with a small beach ball. Fast forward a couple hours to once surgery was done, the one thing he was crying for was the beach ball. Play is powerful and integral in helping kids understand and cope with their medical care. 
      

The local surgery team is getting a chance to perform what they are being taught from the CSI surgery team and at the same time, kids are getting a chance to practice what they are learning through play. Play is the work for kids. Our CSI team is changing lives in more ways than one, one surgery and one activity at a time.

Sarah Stenson ~ CSI Medical Records Volunteer

Click here to see more images from Ethiopia.

When we first arrived at Felege Hiwot Hospital in Bahir Dar, Ethiopia, the amount of assistance required needed no clarity or introduction, as it was obvious that these gracious people needed help. The despair in the eyes of the families who came to us seeking help was overwhelming. We are very glad to be here and glad to help. We are changing lives one procedure at a time, and the gratitude and impact that we’ve made here is evident on the faces of the family members who greet us, shake our hands and hug us. Their smiles need no translation.

Our team has cared for many small children, many who were ridiculed for their conditions, and their parents were distraught over their child’s situation. We worked hard preparing them for surgery, in the operating room, and in recovery. I had the chance to leave the operating room today to visit the patients and their families in the recovery ward. The parents had smiles so big they could not hide them, and they showed their beautiful babies off to me and thanked us for our help.

One special case today was 6-year-old Mednekia, with a bilateral cleft lip. Yesterday, she and her father traveled 1.5 hours to Bahir Dar in hopes of receiving help from us after being turned down six times by other organizations. Because of her cleft lip, Mednekia has not attended school. She is a sweet girl who waited patiently for hours for her surgery.

Local surgeon Dr. Melesse performed her surgery under the guidance of CSI surgeon Greg Kelts. While she was in recovery, Dr. Kelts came to talk to her father and showed him a picture of Mednekia. Through our translators, he expressed doubt that the photo was of his daughter. He was finally convinced, and his joy spread to the other parents as we showed them the photos of Mednekia before and after surgery. When she finally got out of surgery, the waiting area erupted with excitement. We know the future has improved for this young girl, and I was happy to have a role in her transformation.

We are grateful to be here and want nothing more than to exhaust ourselves of supplies, energy and time to help change the lives of these children and their families. Thank you for the support back at home – I wish you could be here.

Josh Kenzie, CRNA ~ CSI Anesthesia Volunteer

Dr. Melesse took a rare pause from his hectic schedule to take a selfie with CSI Clinical Lead Linda Sedgwick and team members Maria Rubin and Amy Fischer.  CSI’s work in Bahir Dar would not happen without Dr. Melesse – He works tirelessly to prepare his staff for our visits. He is a leader and clearly also the heart of Felege Hiwot Hospital, carrying a heavy surgical schedule along with his teaching duties.  He is the go-to physician, frequently stopped in the halls by patients seeking a consultation. His calm demeanor and compassion are inspiring and impressive.

Yesterday, on our first day of surgeries, we were still adding patients to the schedule.  Twelve-year-old Cikeradis and her father came at the end of the day seeking surgery for her cleft lip, which she covered with her scarf and which often kept her from attending school.  She and her father had traveled a full day with no guarantee that she could be helped. We were able to screen and clear her for surgery almost immediately – She was added to the end of our full day of surgeries. The results are dramatic! 

The educational component of the CSI mission was in action today. CSI operating room nurse Tina Nelson, with the help of our Ethiopian translators, offered training to a local nurse colleague on the proper technique to share instruments with surgeons. And CSI Nurse Educator, Maria Rubin taught CPR and choking rescue to a group of hospital nurses.  But the education and training did not stop there.

Dr. Asnake was a key partner and colleague during the very first CSI trip to Bahir Dar in 2016. He has been away gaining valuable training, but we are thrilled to again have the opportunity to work with him this week. Dr. Asnake has experience with the less complex cleft lip surgery.  Today, with training and support offered by CSI surgeon Dr. Jon Robitschek, he performed a cleft palate surgery. We hope he will have the opportunity to further strengthen these skills during the week and when CSI returns to Bahir Dar in March. Our twice-yearly trips allow us to work closely with local surgeons to learn new techniques and improve their skills.

Our very first patient this week, six-year-old Nathael, was discharged yesterday but came to the hospital this afternoon with his dad before heading home to Addis Ababa. They wanted to say goodbye and thank you to CSI surgeon Dr. Alonso Carrasco and other members of the team who helped give him new hope.

Amy Fischer ~ CSI Logistics Lead

Click here for more photos from Ethiopia!

As I walked into the operating room this morning, I was met with many emotions. The most significant was the excitement to care for children whose lives would be forever changed and to work beside those who would make that happen.

As a nurse in a small rural hospital, there is a feeling of camaraderie with those I work with. I can tell you that the feeling here is much the same. To work with people of varying specialties and background, who wish to improve the lives of children, along with the willingness to share this knowledge in order to reach even more, is remarkable.

Today, as I held the hand of a little girl as she drifted off to sleep for her surgical procedure, I realized how different life would be for her when she woke. It is humbling to know what trust patients and their families have in another’s ability to make that happen. It also validates how important it is that this kind of work continue in order to change as many lives as possible.

I am just as excited for the following days and the thought of the very same wonderful and life-changing events to come for so many more little ones. I know that they have certainly changed mine.

Malane Thelan ~ CSI OR Nurse

Click here to see more photos from Ethiopia

My first trip to Bahir Dar, Ethiopia, with Children’s Surgery International was two years ago. Today was the first day of CSI’s fourth trip here. We started with all the excitement that the screening day brings. Do we have all the supplies? Are our interpreters here? Are our patients here?

Yes, we had supplies, and the few we were missing we could buy in one of the many tiny pharmacies surrounding the hospital. Yes, the interpreters were present and eager to help us. Yes, the patients had arrived, and the waiting area was full of parents and children. It was quite a surprise for me, because two years ago there were probably a quarter as many patients.

I started the day helping with vital signs on our young patients. As screening progressed, we identified infants who could not have cleft lip or palate repairs because they were too small for their age or because they were too young, including a three-day-old baby. Feeding children with cleft palates in particular is challenging for parents. This is when my role as a nurse educator with the team became necessary. Education is a key part of CSI’s mission – education for health care workers and also for families, to provide access to learning that may otherwise be unavailable to them. With the help of a trusted interpreter, we started teaching moms how to feed their babies with special nipples. The moms fed their babies and the dads were very supportive, asking questions and assisting the moms. We discussed that babies had to be a bit larger for surgery and would be seen at CSI’s next visit in less than six months. Although it was not the outcome they wanted, they understood why we had to wait. We will be eager to see them again next time.

After evaluating 80 children, our three surgeons have scheduled about 60 surgeries, which will begin Monday. Tomorrow, we have a day of rest to enjoy beautiful Ethiopia, so our team will be energized for the week ahead.

Maria Rubin, RN ~ CSI Nurse Educator

Click here for more photos from Ethiopia Fall 2018