Day 4: Two new heart repairs...these kiddos are tough!

 The first thing I did when I got to the hospital this morning was to check on Grecia in the CICU. She was alert, a little sad, and trying oh-so-hard not to cry, even though tears were rolling down her cheeks. It hurt MY heart to see her uncomfortable, and yet so strong. Many of us on the team packed our luggage with candy and little toys and games. The nurses have it stashed in a box in a room adjacent to the CICU. Twice I saw Grecia slide out of bed and walk with her nurses to the treasure chest. She wasn’t really happy about the trips, but the bribe of a treat was motivation enough.

Grecia giving Dr. nita a shot. Grecia wants to be a Doctor when she grows up! 

                                                             Grecia up and walking!

The first surgery of the day was 4 year old Even. He had an AV canal repair. When Even was assessed his mother mention he had a speech delay. She was hoping that when his heart was repaired his speech would catch up. Alas, not so. After surgery, Even was asleep most of the day. The intensivist explained that the children get a good dose of medication before extubation, and then they usually don’t receive pain meds, other than extra strength Tylenol. I couldn’t believe that these little ones were recovering from open heart surgery with no pain meds. One of the Canadian nurses said they make North American kids look like wimps.

                                                                  Little Even

Next, I went to the clinic to observe Pediatrician Nita doing assessments on the children waiting for heart surgeries. The actual clinic was being used to treat adults this morning, so we were able to create and “open-air clinic” outside under the covered porch, with a nice breeze. That was a relief since today we were given masks to wear in the clinic, due to all of the sick (contagious) adults and children.

Most of the parents learn about their child’s heart defects soon after birth, but have no money or insurance to obtain the surgery. So they come to the clinic when they know that the ICHF team is in country. And they come back day after day, driving long distances, and waiting for long hours, sometimes outside, with no amenities. (We have been asked to bring the roll of toilet paper in our hotel rooms to the hospital each morning. Many of the bathrooms at the hospital don’t even have any! And no paper towel dispensers, just a communal hand towel hanging on a nail.)

Dr. Nita asks each set of parents a list of questions that gives some insight to their child’s heart problem. Then she does an oral exam, and listens to their heart on both chest and back. She asked me if I had ever heard a heart murmur. No. So she had me listen to 13-year-old Erich’s heart, in three different places. In each I could hear a woosh, woosh, woosh, but I couldn’t really make out the heartbeat. Then she placed the stethoscope on her own heart and asked if I could tell the difference. I felt a little embarrassed  because I really couldn’t pick up her heartbeat. She explained that you really don’t hear much with a healthy heart, and that the wooshing I heard from Erich’s heart was the murmur. Nita said that murmurs are rated 1 -6...and a 6 is hardly ever heard. Most murmurs for surgery are a 4, including Erich.

                                                                         Erich

Soon after Erich came four-year-old Yair. He had an unusual barrel-shaped chest and what Nita called a “thrill”...a spot on his chest wall where you could actually feel the murmur, and see it. Nita said that Yair was a 5 on the murmur scale...very unusual. Unfortunately, Yair had a cold that made him ineligible for surgery during this 3 week mission. More waiting. Yair was delighted with the little bottle of bubbles that we gave him and didn’t want to quit blowing.

There were other interesting cases...beautiful children...worried parents, but I’ll save them for future posts, if they get on the surgery schedule.

After clinic I snuck into the back of the room where all of the doctors from our team and the Honduran doctors got together to view the echocardiograms and select the surgery roster for the next few days. I was fascinated listening to all of the dynamics that needed to be considered to put the schedule together. It looks like we won’t get to take over the ICU, due to the contagious illness (and that feels fine to me.) We have converted the recovery room into the ICU. This works while ICHF is here because the OR is reserved for us and no other surgeries will be performed. But there are only 5 beds. So we can’t accelerate the surgery schedule if there aren’t beds available. And there is only one vent, so we have to primarily select patients and repairs that will be extubated in the OR. We only have one intensivist, who can’t work 24/7. We want to give him a break. We need to get the difficult cases in so they have enough time to recover, but the difficult cases will take up beds for long periods, decreasing the total number of surgeries that can be performed. But some patients are too sick to wait until the next mission, which could be 6 months away. Some of the patients need more than one repair, but only the most critical one would be repaired. Can you imagine having to make such difficult decisions?

Dr. Boston from St. Louis Children’s Hospital arrived towards the end of this consultation with all of the docs, and they began assigning some up-coming surgeries to him. We met, and both said, “I’ve heard good things about you”...but didn’t get a chance to chat yet.

While they were reviewing the echos, the docs decided that our young Erich (13 years old and described above) was a great candidate for surgery on Wednesday. So while I was still listening to the consult, Erich and his parents came back into the clinic to get the news that Erich’s surgery would be done right away. I could see that Erich was really upset, and fighting back tears. Remember, he was a strong, serious, stoic young man, but he turned around and wrapped his arms around his mother’s neck...who was slightly shorter than he was. My heart melted. I knew that if someone told me I was going to have open heart surgery tomorrow, I’d be crying too. His mother explained to the staff that Erich was holding onto hope that he could have an orthoscopic repair through the groin. But Erich had the murmur that I heard through doc’s stethoscope, and it obviously needed a serious operation..

Today’s second surgery was a 20-year-old young man, Alan. He had recently signed up to join the Honduran Army, but a hernia was detected when he was enlisting. When he went for the hernia repair a heart defect was discovered. While the surgery may keep him from having to go to war, being a soldier brings one of the best incomes in this country. Alan was out of surgery and recovering in the ICU when we left.

                                                                             Alan

                                                                 Alan with his parents.

So tomorrow, little 14-month-old  Sebastain will have surgery in the morning, and Erich is scheduled in the afternoon. Please keep these boys in your prayers. They are both beautiful. I understand so little Spanish, but fear and love and pain are part of a universal, non-verbal language that I do understand.

My brother Gary told me, “you will stand out in Honduras. You are much taller than them, and you will look like a tourist no matter what you do”. My mere presence gives me an aura of importance, since everyone there knows the ICHF team. And since I’m walking around with doctors and nurses, everyone assumes I am one, too. Even the other doctors and nurses. But the camera gives me another veil of importance. I get the feeling that they think if I am interested in taking their child’s photograph it may mean a better chance of being selected for surgery. I wish I could tell them the truth.

As scary and ominous as open heart surgery is I can see how it becomes objective. The patient is draped and sedated. The surgeons have tunnel vision for this one specific part of the body. The perfusionist and the anesthesiologist deal with the rest of the person. The strong tug at my humanity and compassion is heightened as I watch these families wait patiently with great hope for their child’s healing. And then again watching the children move through their post-op recovery. I think we all agree that we never want to see children in pain.

PS I had a conversation with the cardiologist this morning. I told him:  “Please, if I get sick, don’t admit me to this hospital. Drag me to the airport and send me home”. Outside of the units that ICHF has control of, the rest of the hospital is abysmal. He assured me, “We take care of our own. If someone on the team gets sick, we take care of them.” Relief.

PPS I don’t mean this as a partisan political statement, but ...  I think if everyone could see what health care looks like in an under-developed country we would stop squabbling over the Affordable Health Care Act.

Day 3: Heart-Stopping: Grecia Maria’s and mine!

(Becky: Tonights report on Day three and the message connie attached
Connie:

Becky,

I had an incredible day. Can't really sort out all of the emotions. I learned so much and was amazed by so much. I have the utmost respect for all of the people and organizations that are making this happen, despite the obvious resistance of some local forces. But at the end of the day, it's the sick babies and the worried mothers and fathers that we are here to serve. And it seems that our surgeons and leaders are determined that now we are here we are going to do it! 

I wasn't sure I could do this, and so far I've sort of impressed myself. The first lesson in Brene Brown's on-line Oprah course is: I'm imperfect and I'm enough. It fits.

Love you,

Sending some photos, too....

Mom)

 As soon as we arrived at the hospital this morning, I borrowed some scrubs and wandered into the OR where my new friend Jenny, the perfusionist from Toronto, was setting up the by-pass machine. I stayed and watched the buzz as the momentum began to build. Nurses and techs kept bringing in equipment and sterilized items, moving tables, and threading electrical cords around the room. After almost two hours of set up the team was ready for the first heart surgery patient: 6 year old Grecia Maria.

Grecia was wheeled into the room, awake and scared. She was lifted onto the operating table and immediately the team began soothing her and prepping her for surgery. In a short time she was cozy and sleeping with the help of Victoria, the anesthesiologist, and some nice medication. Everything paused briefly as Nurse Sarah prayed out loud in Spanish. It took me a few seconds to realize what was happening, but the mood in the room changed briefly. I felt so moved that they were taking the time to create Sacred Space and to invoke God, the Holy Spirit, and Mary to protect and comfort Grecia, and to guide their minds and their hands during the procedure. (Of course, I couldn’t translate what was actually said, but this was the prayer in my heart. I pictured Mary walking Grecia away from the OR to a little dance studio where she danced without fatigue or pain.) As the prayer ended “Amen” came in unison. And we were ready to begin.

I stood against the wall, taking occasional photos when I got a shot between all of the doctors and nurses lined up around the operating table. When our ICHF cardiothoracic surgeon approached the operating table, after all of the prepping was over, I decided to move to the other side of the room so I could get her face in my shots. I took a few steps and three Spanish speaking nurses with scowling faces threw their hands in the air in stop-sign fashion and told me to stay there. I think they would have tackled me if I had taken one more step. What I discovered later was that I was about to breach a sterile zone. The scrub nurses had spent hours elaborately placing all of the instruments, gauze, sutures, etc on table draped in sterile cloth. I was starting to walk between the instrument table and the operating table. I quickly flattened myself back against the wall while they slid the instruments toward the end of the operating table. When everything was set up one of the nurses waved me over to the middle of the room; she had brought in a step stool and placed it about two feet below the instruments and motioned to me to step up.

The surgical team included Dr. Fenton and two Honduran surgeons (Arlette and Jorge); Scrub Nurse Sarah and her assistant; Victoria and an anesthesiologist assistant at the head of the table monitoring the equipment; and Jenny (perfusionist) and David (bio/med tech) were on the side with the bypass machine. During this time they opened Grecia’s chest and sternum, exposing her heart. Standing on the stool, I was able to follow what was happening more clearly. When the surgeons’ hands cleared away, I was able to see the top curve of Grecia’s little heart bobbing up and down as it beat!

At one point while the docs waited for medication levels to change. Dr. Fenton invited me to come to the head of the operating table where the anesthesia station was, and David carried the stool. From that vantage point I could look down over the drapes and watch little Grecia’s heart beating rhythmically. Dr. Fenton pointed to Grecia’s heart chambers and explained what she was getting ready to do. That’s when my heart stopped! And shortly after that Grecia’s heart stopped, too (for less than 30 minutes) as she went on bypass and the abnormal opening in the dividing wall between her upper heart wall chambers (atria) was repaired. Once that was over the sutures and the clean up went pretty quickly, and she was extubated right away.

I followed sleeping Grecia as she was wheeled into our makeshift ICU. (The two TB cases and the H1N1 case are still quarantined in the hospital’s ICU.) She was eagerly greeted by about 10 NICU nurses, respiratory therapists, and intensivists who have been waiting for two days to fulfill their mission. I thought a lot about Grecia’s mother, who was waiting to hear how her daughter did, but I didn’t get to see them re-united today. Although objectivity is crucial during such a serious procedure, I was completely impressed with the respect and gentleness everyone extended towards their little patient.

Baby Sebastian’s surgery has been pushed back. Today is National Armed Forces Day in Honduras, so it is a holiday. There was an issue about transportation home for the nurses if we proceeded with today’s second surgery, lasting until after 6pm. Many of the hospital staff rely on public transportation to return home at night. Since the holiday shut down the usual transportation extending the surgical schedule would make it dangerous for them to travel to some of the outlying areas after dark. So our organizers agreed to quit after only one surgery, because we wanted the nurses to be safe and to come back to assist for the rest of the 3 week mission. There was a lot of confusion about all of this. The locals knew it would be a problem but didn’t tell our team. The worst consequence was that little Sebastian had been denied food since midnight last night and his mother was anticipating his surgery all morning. They had to be told to wait two more days; the docs didn’t want to make Sebastian fast two days in a row. He will return on Wednesday. But tonight we have one little girl recovering in the ICU, surrounded by a wonderful team of nurses. I think she is dancing in her dreams!

     Gracia after surgery. Extubated and resting as the nurses are watching her numbers on the monitor.

Day 2: Meeting Some of the Children

(Becky: Here was the message attached to this update

Connie: Here's my reflection for today. It was a great day. Little Sebastian especially is on my mind tonight. Eager to get back tomorrow and follow him through his day.)

The day began with a wonderful breakfast buffet on the Veranda of Hotel Honduras Maya. There was a wonderful spread of fresh local fruit, omelets, a variety of bread products, beans, tortillas, granola, and of course, coffee.

The bus picked us up by 8:00 and we were off to the hospital. Many hurdles are being worked out to proceed with the surgeries. 1) Some of the equipment brought to the hospital on previous missions has not been maintained. So our bio-med tech has been working diligently to get the equipment working again. 2) Local doctors and nurses are “on strike” because the Ministry of Health has not paid salaries, and some of the local medical team is refusing to come in to work. 3) The ICU, where we planned to set up our CICU has 2 TB patients, and one with H1N1 flu. An alternate space in the hospital has been allocated so that we can set up our CICU in a safe location. The medical specialists on the ICHF team seem well equipped to “go with the flow” and come up with alternate plans.

When we approached the Clinic, there were parents and children lining the walls. Worried mothers. Sick children. While the ICHF team moved efficiently along the corridors on their mission, I tried to smile at the children and make eye contact with the parents, wanting to communicate some understanding. Even though I couldn’t communicate with them directly, if one of the mothers made eye contact with me I would point to my camera and then to the child they were holding and “ask” if I could take their child’s photograph. All of the mothers offered their child for the photo. Most of the children didn’t seem to have the energy to even change their expression. But a few were lively and seemed to enjoy the attention. Or they simply enjoyed the distracting from the long wait.

Two surgeries are still scheduled for Monday: Sebastian and Grecia. Part of my day was spent shadowing Dr. Nita Moharty, an ICHF pediatrician, as she examined and assessed children who are being considered for surgeries this week. Nita was born in India, but grew up, in the US, and joined the team from Chicago. Nita speaks fluent Spanish and was very easy and animated in her exchanges with the children. As she spoke to the parents and examined these children I was allowed to move around the room and snap some photos of Grecia and Sebastian.

Sebastian caught my eye the first time I walked down the hallway. His pallor was very noticeable. He had a sweet and soulful expression, and he didn’t show much energy. Sebastian is two, and his diagnosis is VSD (ventricle septal defect). The surgery is a fairly simple corrective repair with a good prognosis. Later, I stepped into an exam room where Dr. De Sessa was performing an echocardiogram. Sebastian was unhappy to be down on his back, but his mother was trying to entertain him by holding her iPhone over his head while he watched a music video. It took me a few minutes to recognize the tune...but it was the Beach Boys song, Barbara Ann....in Spanish. (You know: Ba-Ba-Ba, Ba-Barbarann. Made me smile.)

When I first tried to photograph him, when he was being checked out by Dr. Nita, he fussed and turned away. (Unlike my grandchildren who smile and perform antics for the camera.)  Eventually, he looked right at the camera and I was able to take some close ups of his sweet little face.

Next we met Grecia, a six year old cutie with a long brown braid. Grecia was very curious and handling the whole ordeal with an admirable amount of independence. She was curious about the camera, and finally gave me a smile. Dr. Nita burst out laughing while examining Grecia’s throat because she had a wad of gum tucked away on the side. Grecia has asthma, and her diagnosis is ASD (atrial septal defect). She is a dancer and is feeling a lot of chest pain when she dances.

(Becky: Both VSDs and ASDs are considered "holes in the heart".  Information about both defects, including illustrations comparing both to a healthy heart can be seen here.)

This hospital would never meet our expectations in the US. We would be horrified to leave one of our loved ones there for treatment.Very few areas are air conditioned. Most of the windows and doors are left open for ventilation, despite the fact that mosquito bites are the cause of Malaria and Dengue Fever. Malaria is not a problem in Tegucigalpa due to the altitude, but there was a recent outbreak of Dengue in Teguc. (This mission was originally supposed to happen in August, but was cancelled because of a Dengue Fever outbreak & the hospital didn't have room to accommodate the ICHF mission.) One of our in-country hosts pointed out a huge reservoir of water right next to the open wards, a hospitable breeding ground for those disease-ladened mosquitoes.

Please say a prayer for Sebastian and Grecia, and their families. The children, especially, don’t know what’s coming. But with grace, and a little recovery time, they will be enjoying the normal fun activities of healthy children. 

ICHF Baby Heart Mission - Honduras - first to arrive

Taking a tour of the hospital

Families lining the hall ways waiting to be seen.

Grecia with her mother waiting

Smiling Grecia

Sebastian

Asleep in Moms arms after some of the excitement subsides.

Sebastian smiling as his Mom talks to Nita.

Later in the day I got this note. I think it was meant for me, but it just adds to Connie's story and I had to share!:

I'm trying to keep up with FB, and all, but I'm not using my computer at all during the day at the hospital. Spent the day with the camera hanging around my neck. I can't believe the freedom they have given me to be anywhere I want and photograph. ICHF really wants the exposure.

My fears are greatly reduced. I feel safe, staying with the group. The team is AMAZING, funny, friendly, experience, unique people. I'm really enjoying them and they are treating me like equal. I'm probably the oldest, but keeping up quite well. The food is working out and the host org knows I'm vegan and want to accommodate me. All is well. Most fears are alleviated.

I'm a little nervous about going into the OR tomorrow to photograph, but I'm going to do it. Just have to. Wish Yvonne and Elaine were here. Wish you had been able to come. You definitely should some day. Jeff and Sarah should be here to do oral surgeries. I want to go on all of the missions!!! Okay, not really, but it is a wonderful experience. Don't worry about me. Internet access is difficult a lot of the time. I'll do my best to send you something every night.

Thank you for offering me this opportunity.
Love you,
Mom

Day 1 In Country: Arriving in Tegucigalpa & Meeting Some of the Team

(Becky: Connie's first blog entry came in with the note: Pooped. Headed to Bed. But it's going to be amazing!)

I was up at 3, dropped off at Will Rogers International at 4, and sitting on the tarmac having the plane de-iced at 6! (In Oklahoma in October.) That was a crazy start to an amazing day. The next amazing thing was realizing that almost the entire, booked flight from Atlanta to Tegucigalpa was filled with missionaries from North America. There were multiple groups from all over the US flying in to perform all nature of humanitarian works. And they were a joyful lot. I don’t know if I’ve ever been on such a noisy flight.

Honduras is simply beautiful! Approaching from the air we could see the terrain; not mountainous like the Rockies, but ragged hills covered in green with clusters of civilization hanging off of the sides of the bluffs. The flight’s grand finale came when all passengers braced themselves as the airplane shuddered to an abrupt halt on the abbreviated runway and then burst into spontaneous cheers and applause.

Immigration and customs in Honduras was uncomplicated. Once through, I began to meet other members of the team. Those assembled visited in a little airport cafe and got to know each other a bit as others arrived from all over (Vancouver, Toronto, Lexington, Memphis, Boston, Chicago, Austin....so far.) I am the only non-medical personnel, alongside of these amazing specialists. Meeting them outside of their professional settings was a delight. Mostly, I was a silent observer, trying to learn all I could. But when my curiosity got the best of me, and I asked a question, they were so helpful and patient giving me in-depth answers.

I learned that David is the BioMedical member of the team. And what does a BioMedical Technician do? He is responsible for the maintenance and calibration of all of the high tech (or not quite so, in the case of developing countries) medical equipment that the surgeons, perfusionist, anesthesiologists, nurses and pediatricians will use in their work. Without his expertise, no one else could work their magic. And what is a perfusionist, I asked? A perfusionist manages the oxygen and blood flow, and pressure, and body temperature (and many other important things) of the heart surgery patient, while the pediatric cardiac surgeon repairs the baby’s heart. And what is an Intensivist? An intensivist is the doctor responsible for all of the patients in the Intensive Care Unit...round the clock, when the procedures are over and the others go back to the hotel to sleep.

Tomorrow morning we go to the hospital and the ICHF surgeons will consult with the local pediatric cardiac team to begin to determine which children to treat during the next few weeks. Andrea is our organizer and front team. She arrived early to make sure that everything was prepared to maximize the productivity of the mission. She explained that the first two days may include a few less complicated surgeries so that the two teams can become familiar with working together. During the following few days, the more complicated surgeries will occur, giving those patients the longest recovery time possible, before the ICHF mission is over. I had never thought about the amount of preparation and strategizing that would be required to pull off this mission.

I kept the camera stuffed in my day pack, so I could ease into the transition and just hang out with the team. Tomorrow the camera comes with me and I’ll begin to document the goings-on at the hospital. We will be organizing supplies and setting up the OR. I got to meet Shaun, a staffer from ICHF, whose mission will be taking videos of many of the same things I’ll be taking photos of. While the medical team is focused on healing babies hearts, we’ll be collaborating to bring you some of the touching stories involving the families who are hoping against hope that their little ones will receive one of these life-saving surgeries, and have a chance to have a normal, healthy childhood.

All through the day, the others asked me, “So what is your role on the mission, Connie?” Pointing to the MOHF logo on my tee shirt, I briefly shared the story of Oakes, and the amazing foundation that we are all helping to create and perpetuate. I could see the look of genuine awe in their faces. These are wonderful, skillful, talented professionals. They are devoting their careers to healing, and donating their vacations and free time to volunteering because they want to share their expertise with children who would not have a shot at life otherwise. And yet, in each of their reactions, I could see that they really got it...the understanding, on some level, of what these frightened, exhausted  families go through as they cling to the hope of a miracle. And how the families need some healing of their own. ICHF is doing tremendous work. There will be 45 international medical missions this year to underdeveloped countries...three of them beginning this week. They are a wonderful partner for MOHF, raising the money to send these teams around the world, and working out all of the in-country logistics. I am honored to be here, and ready to help in every way I can.

The surgeries won’t begin until Monday morning, but tomorrow I hope to bring you so photos and introduce you to some of the wonderful men and women who are assembling in Tegucigalpa to begin the work of healing hearts.