May 23-30, 2009

Albania, a country being reborn. After centuries of being controlled by outside forces, dictators, and foreign powers, they are finally beginning to control their own destiny. Known as Shqiperia, “the land of the eagles” by its people, it is a mountainous beautiful Mediterranean country.

They began forming a democracy in 1992 and formalized it in 1995 . With that the abuses of the last several rulers/leaders the country was largely in shambles. Food supplies were extremely short, most had no money, no job, and a very dismal outlook for the future. 10’s of thousands had left the country, thousands more killed. What was once a proud and strong people, was now fragmented, broken, with no public services available for health, sanitation, or law and order. Yet a spark survived, and from that spark a democracy was born. Not a perfect system by any means, but it was a start. The various parties of the country were still vying for position, for control, for popularity, yet it seems to have begun to realize they need to find ways to work together.

And so they are making progress. Incredible progress in recent years. Over 2000 churches were destroyed or taken over during the communist era, now some are being rebuilt or opened as churches again. The Health system of the country was easily 100 years behind that of neighboring European countries, one of the new government’s early initiatives has been to try to improve the health service for its citizens. Along with paving roads, building infrastructure, building adequate, safe, efficient housing for the thousands of Albanians that have been returning home. Incredible progress has been made in recent years. Whole sections of cities, especially Tirana, the capitol, have been totally renovated, complete with numerous high rise hotels, businesses, and apartment buildings. The health system is largely a public system. Health services are offered free to all citizens, currently, almost all technically advanced diagnosis and treatments, are currently only available in Tirana at Mother Theresa Hospital. Basic services, and basic surgery are the only services available at the other 16 Regional Hospitals.

And so the need for a Gift of Life program in Albania. For every 1000 births per year there are 7-9 children that are born with congenital heart defects that will most likely require surgical repair if the child is to live a fairly normal life. Mother Theresa Hospital has been able to develop its pediatric program to the point where they can do some pediatric heart surgery. Currently, they have one cardio-thoracic surgeon and 3 cardiologists that see children. It is the only place and these are the only doctors in a country of 3.5 million where people can bring their children for help. Obviously, there are thousands of people, many, if they have survived, are now in their adulthood, doing the best they can. Thousands more children are also hanging on to a hope that maybe, somehow, soon, they will be able to receive the Gift of Life. Everyone we spoke with agreed that this is the current situation. Noone knows for sure how many are suffering and waiting or dying from CHD (Congenital Heart Disease). Noone knows because the country is still too fragmented to have that kind of information centralized. Even the cardiac team at Mother Theresa does not currently have a running list of patients they have not been able to help. Yet they are doing the best that they can. There is an Italian team that has been coming for 6 years, 3-4 times per year to perform surgeries there. Albanian, Dr. Boboci continues to operate on as many children as he can, those surgeries that he believes he can handle, in between the Italian teams visits. All in all, they are able to perform 80 – 100 surgeries each year. Unfortunately, that is not enough. There should be about 200 children born each year in Albania that need corrective heart surgery, plus there is the backlog of children born from all the years that surgery was not available anywhere in Albania. Currently, no children under 2 years of age or 21 kg are receiving surgery. For some of these, it means they are destined to die, since their parents do not have the means or the know how to send them elsewhere for help.

Needless to say, there is much we can do. And so we have taken the first steps to giving the Gift of Life to many children of Albania that need it. Our Gift of Life program has worked in many countries, yet not Albania, yet. Fortunately, Peter Kikot is married to a wonderful girl of Albanian descent. Erinda (Begeja) Kikot who also has a heart to help children worldwide, and now in Albania also. And so Peter, Erinda, and myself (Andrew Topp), travel to Albania to see what we can do. Rotary began in Tirana in 1996 and has recently branched out to 2 other cities of the country with a 4^th club, in Elbason, having its charter meeting on June 15. The beauty of Rotary International is the almost automatic cooperation we received from the Tirana Rotary club, in particular, from its current president, Adrian Shehu. Adrian is thrilled to be making this one of their first international cooperative projects, and so he was eager to set up appointments for us with anyone and everyone that he could.

Remember, Albania is still in a very delicate political state. In order for any program to succeed, it will need the blessing of political powers, administrators, and chiefs of staff.

And so, on Monday, we begin our week with a meeting with Deputy of Parliament - Alira from the Albanian Children’s Foundation; a government supported charity (chaired by the Prime Minister’s wife). Meeting in Adrian’s office, she is very interested in what we are proposing and believes that we can work in partnership with each other. In order to make it clear how we will work together she asks if we can draw up a Memorandum of Understanding which will outline what each of us expects the other to do. Once we both agree on the details, we will both sign and then begin our work!

Next Adrian has arranged a meeting, for Monday afternoon with Dr. Sasha Shashenka, the head intensive care Dr. at Mother Theresa Hospital PICU unit. She was extremely helpful and very interested in working with us. She was especially interested to find out if we can find an Echocardiogram Machine for their use. They currently have to share time on the one machine that they have in the hospital, that does not work very well. They really need one dedicated to the Pediatric department.

Next we head downstairs to the cardiology dept to see their one echo. Machine in action. It is used for both adults and children, doesn’t always give a complete picture and will not make any recordings—the one piece of information that our cardiologists really need to make a good decision when evaluating potential cases. For this reason we are trying to obtain a working echo-cardiogram machine as soon as possible.

Monday afternoon we have a meeting scheduled with Minister of Health Mrs. Zonia Godo. We have an impressive meeting, talk at length about the scope of the problem as well as the various approaches to solve some of the problems. Mrs. Godo also makes the suggestion that we may want to look into the possibility of working with some of the regional hospitals and working out a system of cooperation with them and Tirana Hospital. We were already thinking along the same lines!

Mrs. Goda calls her good friend, the General Director of Mother Theresa Hospital, Mrs. Gjeorgjina Kuli-Lito who is also a pediatrician to set up a meeting for us with her on Tuesday. General Director Gjeorgjina Kuli-Lito was very interested in getting all the details worked out to help us and so she quickly set up a meeting for us with Dr. Ariel Como – Deputy Director of Mother Theresa (in charge of the Cardiologists). She also sets up a meeting for us with Dr. Baboci.

Tuesday morning we have a meeting first with Dr. Arben Baboci- Cardiac Surgeon who does some surgery in between when the Italian team comes to help out. He agrees that there are many children who they are not able to help, but it really is the cardiologists who would have a handle on those cases. Many of them are either more complicated than what they can handle there or the babies are too young and small.

Ariel actually stopped in to meet us briefly and scheduled a meeting for Thursday with himself and the 3 cardiologists that worked also with pediatrics there. He was most concerned with going over the details of how we would proceed. He was also very interested in coming up with a way to keep track of patients that come to them for help and for one reason or another did not get it. Currently, if they cannot help them, they just send them home with whatever records might have been produced, there is no record of how many patients have been seen or who they are. Our meeting concludes with thank-you’s (filomenderit) and goodbyes (mirumpopshoo).

We spend a few moments over coffee outside in the warm Albanian weather with Dr. Ariel Como, getting to know him better and the makeup of the hospital better. He tells us we have made all the right connections and have gotten all the right support and so our progress should be good. By this point its almost dinner time for us, but in Albania, that’s not till 8 or 9 pm, so we stop at Erinda’s house, pick up her dad, and go out for some “coffee” and light snack until it is Albanian dinner time, while Erinda and Zana do some shopping.

Wednesday, we have a meeting scheduled with Albana, the President of the newly formed Rotary club of Elbason. She is going to introduce us to the head of the Pediatric department of the Regional hospital in Elbason. It is about a 1.5 hour drive through winding mountain roads. A beautiful drive, as long as you don’t get car sick! We all survive and stop several times to take photos. Elbason is a larger picturesque town in the middle of a large flat valley, with a river running through and mid-sized mountain peaks all around. In spite of the huge steel mill spread out through much of the town, (it is only partly operational), the town still retains much of its mid-evil charm, including the remains of several castle walls which now frame the downtown shopping and business area.

We go with Albana to meet Dr. Arben Paralloi, director of Hospital at Elbason, who is extremely nice and seems thrilled to meet us. He explains that their hospital is the only hospital in the region and serves about 400,000 people.

Still they only have the basics, they do some emergency care, some general surgery, some outpatient procedures and care. For everything else, most people either go to Mother Theresa in Tirana, out of country if they can afford it, or if they cannot– accept their fate.

A very interesting finding comes to light in our meeting, they have a good working ultrasound cardiology machine that will make DVD recordings! Only trouble is, they do not have a cardiologist trained to use it on pediatrics and they many need a different transducer to make it work effectively. Our next step then to help them and in turn to help more children, is to get them whatever parts they may need to be able to do echo-cardiograms on kids, and then bring one of the cardiologists here for training. That way early detection and diagnosis could be performed right in this regional hospital and they could be sent straight to us; saving time, money, red-tape and quite possibly, a good number of children’s lives.

After meeting with the cardiologists and checking out their equipment, we stop to have a cup of coffee with everyone, while we are socializing, the father of a good friend of Erinda and Peter’s, who lives in the US., but is from this town, stops by to pay a visit! I’m not sure if it’s another sign that it’s a small world, or this is just a small country! It is a joyous occasion nonetheless, and it feels good to feel like we have family everywhere we go!

Back through the mountains to Tirana, a little bit of down time, getting ready for Erinda’s step-mom’s 50^th birthday party that is scheduled for Wednesday night! They put it off purposely so they could hold it while we were there. We have a great time, get a real taste of Albanian hospitality, food, music, dancing, vino, raki, and fun!

Thursday- We get back to our hotel around 2 AM, only trouble is, we have to be up at 5:30 AM to drive to Durres for a ½ hr. live news conference on UFO, and educational/news channel that is broadcast in many parts of the country. We look a little bleary eyed on the screen, but all in all the piece turns out very well! It plays not only then, but also at 4:30 pm, and then again on Saturday. We give an overall explanation of the Gift of Life program and how we hope to help Albania. The host of the show wraps it up with an invitation for any families with children needing surgery to contact one of the country’s Rotary clubs for more information. By the end of the day we are already hearing good comments from people that have seen the coverage! Great advertising not only for GOL but also for Rotary International.

We would all love nothing more than going home and sleeping for a while, but we have a 10:30 meeting scheduled with Dr. Ariel and the 3 cardiologists. Adrian has a driver pick us up and we meet him and the others at the hospital. After introductions, we get down to the key business that we have been hoping to accomplish since we arrived, to determine for sure that not only are they willing and eager to work with us, but that they have some cases of children waiting to be helped. They admit they don’t keep records on kids that have come to them that they could not help, but they do know of 5 at the moment that were not helped by an Italian team of surgeons that was just there two weeks ago. They propose to get records together and to us as soon as possible. We have since received emails from them with their contact info and are awaiting the charts of these children that need our help.

Next we make plans to go up to the top of Dayti Mountain by cable car to get a good look at the layout of Tirana, and have lunch. On the way we talk about the benefit of at least stopping in at the US Embassy to visit the consular office to introduce ourselves. One of the key components to helping people get a US visa to come to the US for treatment, is having a good relationship with the Embassy. If they get to know us there and we have a good record of making sure people return to their home country, they are much more likely to issue visas when requested. We are tired and would rather go home to rest for the late afternoon, but this is important.

On the cable car, we are seated with 3 other people, we assume are Albanian, turns out one lives in the US in NY and knows a friend that Peter and Erinda know very well, and the other two are good friends with one of Erinda’s uncles! What a small world!

After a delicious lunch and many photographs; of the city, the people, the WWII bunkers still visible in many of the hills, we hire a taxi to take us to the Embassy.

They will only allow Peter and I in, so we drop off Ashok and Erinda waits outside while we make our introductions and leave some brochures. They look forward to working with us and are glad to know that we already have a clear understanding of what is required for them to issue medical visas.

Next, we need to go to the Tirana Rotary meeting! Remember, Peter and Erinda and I are still operating on 3 hours sleep! We are really starting to show some wear and tear!

The Rotary meeting goes great, a wonderful group of folks who are very interested in making Gift of Life one of their first International projects. Peter, Erinda as translator, and I give a good program overview, we exchange cards, take some photos and then its off to dinner, finally! (although we would rather we were going home to sleep!) Adrian tells us that there is another Doctor in his Rotary club that wants to meet with us and he really thinks we should meet with him after dinner tonight. (OH NOOOO! We are soooo tired…) This Dr. is a good friend of Dr. Baboci, he is a general pediatric surgeon and besides wanting to help us work out the details of helping children with congential heart defects, he is also interested to know if we can help some of the children he sees with other difficult conditions. We tell him of our other foundation, International Humanitarian Aid Foundation that will consider other cases. We promise to keep in touch and finally—its time to go home and crash!!

Friday morning we are hoping to take some free time to travel south to see a little more of the country, Adrian has other plans! There is a possibility that we will have a meeting with Mrs. Berisha, the wife of the Prime Minister of Albania, unfortunately her schedule doesn’t work out for us to meet, but Peter, Adrian and I, do have a meeting at 1 with Dr. Zaneta Shatri of USAID. She is also a pediatrician by training but is now in charge of health development within Albania. She is very interested in what we are doing and how Rotary works in a country like Albania. She also has similar ideas on how to work with the Regional hospitals, taking some of the burden off of the Tirana Hospital. It’s a very informative meeting for both of us!

We leave there with a great sense of accomplishment for the week. We hope and pray that many or all we met with will follow up with their part and that we can get all the support that we need to make this ongoing, life saving project a reality. We agree with Adrian and this year’s Rotary theme, that together, we can “Make Dreams Real”! Yours in Rotary International Gift of Life service, Peter and Andy

Gift of Life Honduras – November 2007

Wow, Its already Monday Nov. 11, here in Honduras, all of us have been here since Friday, a few a few days before to set up and to start doing echocardiograms on some the first surgical cases. We have all been very busy since arrival so this is the first I have had a chance to sit and write, still at the hospital (its 5:45) and we have a few cases to go yet in the cath lab and at least one more open heart surgery. Its been an incredible several days, the doc.s have seen some things they don’t usually (if ever) see at home, many of them have been let go way too long, that’s why we’re here. Its amazing to see the caring of the teams, doctors and nurses alike—wanting to help each and every kid if at all possible. We have seen some very difficult cases, some not even operable. Dr. Ngyuen has been doing his usual incredible job, started surgery yesterday, Sunday. They had some trouble with the first girl so it took much longer than it should have, but everyone stuck it out and by 8PM 3 surgeries were complete, 3 more lives saved! It’s a great feeling!

Saturday I spent a lot of time with Kevin Feely, the PA tech guy from St. Joe’s, working out suction and oxygen for a PICU meant for 3 patients and we want to set it up for at least 6 patients. Ran around to a medical supply house, an auto parts store and ACE Hardware to get tubing, connectors and such! Kevin seemed very happy with what we came up with. Dr. Bob Sommer and Dr. Fuad Kablawi, started doing catherization procedures, a few were diagnostic to give us more info for surgery but Sunday began repairs thru catherization, either inserting devices or doing balloon procedures to open up constricted arteries and heart valves. I am in the cath lab now, sitting on the back side of the protective glass for when they turn the xray tube on to locate the probe and such. Everyone in the room has to wear heavy lead lined aprons to work, I watched several procedures the other day and its just amazing to see how many people are working together to save one child’s life. When you think about it, besides the 6-10 people that are in the room at almost any one time, there are probably another 6-10 people at home that helped to pack all the equipment and supplies that we are using as well! One little girl we had in here yesterday, Melissa, is an extremely cute good natured kid in spite of her obvious poverty filled life, she had a large ASD and Pulmonary Stenosis, was very blue, turns out also has scabies and lice. Bob decides the best we can do for her is to open her restricted pulmonary artery, improve her O2 level, and then in December, when another team is coming to do heart surgery, she can have her ASD closed. It was very difficult to get the catheter into her left femoral vein so Bob finally decides to go thru the artery in her neck. It took a very long time to complete, but today she is much pinker, 02 saturations in the 90’s and is happy, smiling, and sent home by noon time!

At this point in the mission, the cardiac catherization team has already examined and/or treated 15 kids! One especially disappointing case was Belsy. Her echo showed a coarctation of the aorta with a restriction. Upon catherization exam, Dr. Sommer realizes that she has no operating corrated arteries to her brain! There are some smaller capillaries that have grown and the increased pressure in her aorta, because of the restriction, is necessary in order to keep some blood flowing to her head! This all explains why this beautiful 14 year old girl has been complaining of dizziness and seizures for some time now. There is most likely little if anything that can be done for her, and we all feel the mother’s pain and tears when she is told. It is also moving to see how one of the other mom’s comes over to pray with her and hug her.

Then there is Iris, yesterday was a long day, started out rough because we had what was thought to be an easy case to try out a new closure device for an ASD that a rep. from “Cardia” brought a bunch of here for us to tryout. They are not licensed to be used in the US yet but have been used in Europe for ten years, about 10,000 to date. Bob could not get that device to sit properly in a large ASD no matter what, her atrium was too small to allow for proper maneuvering. He then tried two other devices that wouldn’t work either and finally had to give in and put her on the waiting list for surgery. The good news is that we had another child, Angela-with long beautiful hair, canceled from surgery because of illness, so she was put in that slot today and is now doing great! I took a picture a little while ago of one of our nurses, Valerie, brushing her hair! Beautiful! So when they started the last case of the day- 15 year old Iris, they fully expected to just be confirming the echocardio report that she had tetrology of Fallot with several other severe complications and there was little or no hope that she would survive any surgery. After an extensive catherization study, it was determined that she most likely would survive surgery, there is a lot of work to be done on her, but there is a good chance for survival and a greatly improved life! Khan squeezed her into Wednesday’s schedule! We cant wait to see how she does, this morning when she was told she would have surgery, she cried with happiness that she has a now has a chance!

Everyone here is working together so beautifully, even when Ingrid or Alex blow up with their German way of responding to tension, the rest just take it in stride, knowing that its just part of how much we all care about what we are doing here!

There is so much to tell that has happened already, I realize I am jumping around the timeline here a bit, but that’s how it goes in the brain. Things like Fuad not being able to get on the plane on Thursday because he is from Jordan and needs a visa for Honduras, Alex and Ingrid from Germany, and we spend most of Friday sending them to the Honduran consulate in NYC, and calling everyone we know to convince them to give them a visa with no problems—obviously they all got their visas in just a few hours! Or the mountains of “luggage” that we brought with us, 28 passengers with 75 pieces-boxes, duffles, & two 6”PVC tubes I made for catheters so they wont be bent, the agent that first insisted,$100.00 per extra item, the supervisor that said “no” I saw an email about this and it is all fine! Or Ray and Reubens’ flight that tried three times to go from San Pedro Sula to Tegucigalpa before being able to land to pick up a car and all the supplies we shipped ahead of time! And yet we are here and everyone is working furiously, (or sometimes waiting furiously when things get held up for one reason or another!) Khan is working on the 6th surgical case and will hopefully be finished soon! 11 or 12 more to go before the end of Thursday. Beverly, Ruben, Ray, John and Joe are all keeping busy coordinating food, gift packs, toys, stuffed animals, payments of bills, etc, etc., all those things that round out what we are doing here so that we are sending everyone home feeling good in their heart, even if we were unable to provide heart surgery for those few. Well, I guess that’s it for now, this PDA has been successfully closed, 4 yr. old Keiglin is doing well and on her way to PICU in a few moments, this part of the team is on their way to the hotel for some much needed rest until tomorrow’s early hour to start all over again! Buenos Noches, hasta manana! Andy

This is most of us on the bus on the way to hotel

Emely before a catherization—turns out she is inoperable.

waiting echocardiogram.

Emely - a very good patient!

waiting room full of patients and families – Ruben giving out a stuffed animal

Debbie with Edwin, a very happy kid

You know this guy doing a little magic for Angela.

Wow Again! Its Wednesday already! I am sitting in the Cath. Lab, behind the xray proof glass, a good place to watch and not have to wear those heavy lead aprons! They kinda feel like a suit of armor, but after a while, according to Dr. Chan, they get really heavy! Right now we have 9 year old Anderson on the table asleep, I told him “No Snoring!” He laughed, he seems like a great kid with a very good attitude, We love helping all these kids and kids like Anderson make it easy! He has an ASD so maybe Dr. Sommer can use another one of the Cardia devices that saleman Peter brought! Peter was very helpful in the cath lab while he was here for a few days and a lot of fun! (but definitely a salesman!)

Ingrid just sent word down that she will be beginning sedation on Iris in about 5 minutes, Kar-Mei Chan wanted to see the new IV insertion device that Ingrid is using so she will run over to OR soon to watch and learn, I will go to take photos!

Yesterday, amongst the cases that went smoothly, we had one unique case that was pretty scary for a while. 8 month old, Jafet Abisai Martinez Barahona (they always have long names!) had severe Pulmonary Stenosis—a pulmonary valve that doesn’t open all the way so that the pressure in the right ventricle is very high. The standard fix is to go in with a balloon catheter and expand it until it quite literally, tears the restricted valve open! Dr. Fuad Kiblawi and Dr. Bob Sommer did an excellent job doing just that, the valve opened, the pressure released, and then apparently the heart developed something called “suicide RV”! When I first heard the term I thought maybe someone had seen how I drive a motorhome! But of course it is potentially much worse than that. The way Bob explained it to me, the right ventricle develops as a much stronger muscle than normal because of the restricted valve. When the valve is opened, now there is no pressure build up and the muscle squeezes just as hard as it used to and all the blood is pushed out and the chamber basically collapses, now there is no opening left to receive new blood and the other side of the heart keeps all the blood. Jafet quickly became purple with a severe lack of oxygenated blood to the rest of his body. Dr. Chan worked feverishly to stablize the child and after injection of some “miracle drugs” to relax the overconstricting heart muscle, Jafet’s color came back. He was sent to PICU on a ventilator, paralytic drugs, pain killers, and muscle relaxants/beta blockers to give his heart a chance to get used to a new way of operating. Kar-Mei Mai worked especially hard and it was amazing to watch her wolf down two peanut butter and jelly sandwiches and two more slices of bread covered with chocolate crème! For such a petite woman, she sure ate a lot! Well deserved!

Just ran up to take some photos of Ingrid showing Kar-Mei how to put in central lines on Iris using a small echo locator to assist in making sure they are cannulating the internal jugular vein. Its amazing how quickly Ingrid works, most of the people involved in surgery seem to work very quickly. I think I will go back to surgery soon to watch Iris’s progress, she has become something of a star for us, she thought she had no hope for a normal life and has been so elated that she now has a chance. We all pray that she will do well and cant wait to take photos after surgery so that we can compare her color with all the before surgery photos we have. Now, more sad news for the cath. Team and for Anderson, his ASD was so huge the closure device Bob and Henry Issenberg tried on him, at first looked good, but with a little tug, it popped loose. Not a good thing to happen when he coughed or something, so they pulled it out and decided he would have to wait until December or February when another team is coming to do more surgery—they will have to put a patch over the hole. Ok, up to OR to see how Iris is doing, Kar-Mei asked if I can get a close up of the heart during repair, she is a bigger girl, so I may be able to get a good shot. Hasta luego! Andreas

Thursday AM— WHAT AN INCREDIBLE AFTERNOON! Iris did beautifully! A very long surgery to say the least! She went under sedation about 11:30PM, Khan actually began surgery about 12:30 and she wasn’t closed up again until 6:45PM! She was on the heart-lung bybass machine for a good 4 hours out of which the stopped all circulation for a total of 60 minutes!! (10-20 minutes at a time!) According to all indications she was deceased—yet her body temperature had been lowered a great deal, her head was packed in ice, and now, after what is definitely a miracle of modern medicine and a lot of concentrated work by our team and especially Dr. Nguyen, Iris is awake, alert, and this morning greeted me with a weak but determined “Buenas Dias!” It certainly is a good day for Iris! Iris’s color is so much different already, one of the night nurses, Sylvia I think, brought a large wall mirror in for her to look at herself! When asked how she feels, she said “Good”! Its hard to imagine how she can feel good after all she has been thru. She came out of surgery on a ventilator and was on it until sometime during the night when Dr. Srivastava, (Shooby we call her), extubated her.
I was able to get some incredible photos of Iris’s heart, including the inside of it! The construction that Khan did in order to create proper pathways for Iris’s blood was amazing to watch. Using some of her own tissue, Dacron patches, and some specialized hardware Iris is now getting the proper blood flow to her lungs and her body! When they reintroduced the blood flow to her heart and warmed her up, with just a little persuasion from a pair of defibrillator paddles, her heart began beating again and her new life began! Khan is sitting next to me now on the couch in the break/supply room along with Henry Issenberg. We are wondering what kind of euphoria someone like Iris, must feel, someone who has never had full blood flow to her whole body until now?! Maybe she really does feel good in spite of everything!

Things are actually happening faster than I can find time to write about them! Yesterday, during Iris’s surgery, in between my running back and forth to the hospital blood bank to get plasma and platelets for Iris several times, we learned that today’s first surgery case had a high fever and would have to be postponed until February when another team will be here. At first, Lori, who has been coordinating all these cases, (she works for the Ruth Paz Foundation) thought a 5 month old boy who has been in heart failure (0xygen levels of 45%) would be a good candidate. Unfortunately, he has already left the hospital and cannot get back in time, so guess what? Anderson, the ASD cath. Case that needs surgical correction, he got his chance! He has already had his surgery,(that’s why Khan was in the break room) and he is on his way to recovery!

As for Jafet, the one with the “suicide RV” (Henry clarified—“attempted suicide RV” thankfully not successful!) is doing well and going home today! The Cath. Team thought they were going home early yesterday after three cases, but of course another one came up at the last moment which they took care of and for the first time they got back to the hotel in daylight! I heard they were going shopping! When the rest of us finally got back after Iris’s surgery, most of us went to a local Italian restaurant that we were invited to free of charge, by Leon Greene from Action International Ministries. Some of the kids that we have been treating are ones that he and his wife are trying to help. They live and work about five hours from here.
At the moment, I believe the Cath. Team has looked at and/or treated 25 cases, with 5 more to go for today, and surgery has completed 15 with 2 more to go! The progress that has been made has been incredible. We are so glad we brought as many supplies as we did, we are leaving a lot behind but there have been a lot of things that we thought we had plenty of and then ran short. We even had a FED-Ex shipment arrive yesterday at the hotel I ran over for at 3:30, some temperature probes to measure inner body temp and monitor it constantly, by 3:45 we had on Iris!
Time for me to insert some photos and then get this out to all! It has been incredible so far and we are now getting anxious for the reunion party tomorrow night with all the kids that we have had come to the US for surgery! Until next time—Va con Dios! Yours in service, Andreas

Iris before surgery Iris after surgery!

Anderson with Steve Walker before his Catherization

This is Vallery, quite a drama queen! Going home today!

Dr. Khan Nguyen, his assistant Dr. Henry Tannous and Adam as OR tech

The Catheterization team at work!

Vallery’s mom reading scripture to her daughter.

Debbie and Kar-Mai preparing another patient

Sighhhh…Its Monday, November 19, 2007! On our way home!! What an incredible last few days! We finished up with the following numbers: 29 children received cardiac catherization procedures and 17 had open heart surgery! An incredible of 46 children treated and/or diagnosed for future treatment of life threatening congenital heart defects! On Saturday, When we left for a few days of much deserved relaxation, all the children except for 5 had either gone home or had gone to “Barnabas House”, a low cost rehabilitation/medical mission facility about an hour away. Before I left with Dr. Issenberg and Steve Walker for the Copan ruins, I stopped in to see our last kids one more time. Iris and her mother wanted to see a photo of her “new” heart! I had told them (with Ruben’s help) the night before that I had photos of it and they said they would like to see it. So at 6:30AM, Ruben and I stopped in and showed them, they were so amazed! They said that now that she had a new life she would go back to school (has not been able to walk that far since 6th grade)! I told Iris that we wanted to receive a phone call or a note in the mail inviting us to her wedding some day (John Hartman used to tell the kids that!) both Iris and her mom blushed and laughed and but then got kind of serious as the mom explained to Ruben, that they had been told after her heart surgery Iris would not be able to “have relations” with a man!! I told her perhaps before her surgery that was true, but now the only thing she would not be able to do was play American football! She can now do anything she wants to do and be anything she wants to be! Iris and her mom seemed much relieved and happy! Mom said she is a very smart girl and will be glad to go back to school and live the rest of her life! Hugs and kisses were shared all around both her in the PICU and then with the moms and kids still on the step down floor! What a wonderful experience! To top it all off, Iris is our 500th Gift of Life child!! With the help of so many people we have now provided life saving heart surgeries for over 500 children! Congratulations to all!!
Friday night we also had the distinct pleasure to have 25 or so of the 30 Honduran children that have come to the USA for treatment gather with us for a celebration dinner. It was wonderful to see how those children have grown and matured! We ate great Honduran food, danced, and had a great time together! Dr. Nguyen and others got to see and hear how their work and dedication is making a huge diffenence in these children’s lives! They are growing strong, do everything they want to do and feel great doing it!

Saturday morning, our group slowly dispersed, a few had to head straight home for work or to help care for ailing older relatives, much of our group went to the beach about an hour away, Henry Issenberg, Steve Walker and myself headed south to Copan to visit and explore the ancient Copan Mayan ruins! We had a terrific time! Went horse back riding into the hills to see some ancient artifacts there as well as to visit a small village, La Pintada where they make cute cornhusk dolls to help sustain them selves. Children mobbed all around us as we entered their village on horseback, chanting, Vente, vente, vente…! (they wanted 20 lemperas for each doll! About one dollar!) A few of the children could be seen almost everyday downtown also selling their dolls for the same price—and there was no bargaining with them! Oh well, Steve and I both bought dolls! After a beautiful Saturday we rode back into town by moonlight for some much needed rest. Sunday we visited the main Mayan ruins nearby, a fascinating visit! And later we went to the Macaw Mountain, a rescue and preserve for injured and donated parrots of several types—they have over 450 or so now. They were beautiful to see and hold! They also grow and sell (of course!) excellent coffee there! The coffee bean plants seem to thrive in the mountain air, shaded by all of the large rain forest trees. Of course we brought some home!

Monday morning, All of us that were left met up at the airport, split up the boxes of equipment we were bringing home, shared photos, hugs, reminisced, and soon boarded the plane. An incredible job well done by all! We cant believe its over already, the kids are all doing great and so we all look forward to getting back to our family and friends! Dr. Nguyen is eager for us to return to Vietnam and follow up on the work we did there almost two years ago now. With everyone’s continued support, we hope to be able to put together another mission like this one, in about a years time! There is no doubt that the lives of many children were saved on this trip—but there continue to be so many more. Everyone should be very proud of what ever part they played to help make medical mission trips like this one a reality! Lets keep up the incredible work! Yours in Rotary International Gift of Life service, Andy Topp- Program Coordinator

Ray and Debbie trying to cheer up Iris before her surgery…

Beverly with a very happy family!

Any explanation necessary?? Cute thru and thru!

Most of our crew at the celebration party!

supporting the Copan economy…

Our last two in PICU — Our last three in PICU!

Three of our previous success stories—enjoying the Gift Of Life! Thank-you!

Dr. Issenberg riding off into the sunset… (you always have to finish with a “riding into the sunset shot!)

It was a warm rainy night in January.  A bit unusual, should’ve been colder, but then it would be snow and would cause problems with our trip plans.  It feels like this is the “big trip” for many of us.  A first in one way or another for each of us. The Gift of Life sponsored Surgical Mission to Vietnam, is what we are talking about of course.  Jan. 11, 2006.  Many of us involved in running the Gift of Life program for our district (Northern NJ- District 7490), have been talking for several years at least, that the best way to have the most significant impact possible on the worldwide problem of congenital heart disease, is to be involved in Medical missions.   That is sending your team of experts to a part of the world where medical services are difficult or impossible to find, and then diagnosing or treating as many children as possible in a short period of time.

There is nothing quite like the experience of bringing a child and mother from a third world country to the US for treatment.  Just watching them going through the stages of wonder, surprise, amazement, and then deep appreciation and gratitude, while a young child’s life is saved and brought back to health in the midst of a land overflowing with blessings, is an experience that makes you want to do it over and over again.  And we do, do this, I pray that we always will, but that is only one child at a time.  The  expense involved, if applied to a medical mission, can probably triple the number of children and families helped by our efforts.  When Dr. Nguyen approached Ray, in hopes that we would take on the sponsorship of a surgical mission that he was already planning, after his sponsor had backed out, it was almost a “no brainer” to decide it was something our GOL program wanted to be involved in.

So here we are.  15 of us at Newark Liberty International Airport, EVA airlines.  39 bags and boxes of luggage, medical supplies, and teddy bears, in the midst of dreams, adrenaline, and nerves.  3 non-medical folks, (Ray Hough, Joe Laureni, and myself), Debbie Worrall- cardiac nurse from St. Joes, Dr. Khan Nguyen, his son Matt (3rd. year at Columbia – pre. Med) and 9 others from Mt. Sinai hospital in NYC (I’m sure we will get to names as we go along) all with different areas of expertise and reasons for going.

Khan’s group arrives at the airport first and already has there, small mountain of bags and boxes stacked up at the front of the check in line.  The ticket Counter is not open yet, but that’s ok, because it gives us time to get a few bites to eat, and begin to get acquainted.  Good thing we brought along names tags, I am eager to pass at least some of them out.  (I am very bad with names, this helps a me a lot!)  I’ve also discovered it helps to identify us to strangers  who are then sometimes more inclined to help us out.  For instance, those 39 bags I mentioned?, as we are checking in, we are told, it will cost us an extra 900.00 for the extra 9 pieces, but after much explaining our mission, and talking to every supervisor we could find, someone finally made the decision to let us go, since it was a “medical mission”!.

Its funny, you always assume when you start off on a trip like this, with a lot of people who are new to you, involved, that they most likely have more experience than you.  But as I began to meet new faces, I find that many have never been out of the country before, for some this is the first time they have had a passport.  I’m not sure about the California team, (yes there are more, including 3 from London), I believe many of the CA team have gone before and its part of the reason we are hooked up with them.  I talking with Heip (adult cardian surgeon,who was born in Vietnam) this is like a homecoming, he hasn’t been there for 31 years, you can just feel the tension and excitement in his voice as we share small talk.  And then there are some like Ingrid, (strong German accent, and style for that matter) she has been on two previous trips like this (Russia, and Bulgaria?).  She was obviously involved in the packing of boxes and is familiar with what is fragile and what is not as we check everything in.  She seems very much in charge of supply and demand sort of things (good thing, since she is also in charge of the blood supply).

Alex is the other one who has made his presence felt already.  He was not at all happy about the extra charge for the luggage, and went off right away to find a supervisor or someone who could straighten things out.  The next problem that we began wondering about was our arrival in Ho Chi Min City.  At that point we will have to collect our 39 bags and boxes (pray they are all still there), go through customs, and check in again with Vietnam Air.  If it takes this long all over again plus customs, we will not make our flight to Hue, our final destination.  Alex begins making inquiries to see what can be done to speed up that process once we arrive Vietnam.

We finally make it through security, find our gate, and wait for delayed boarding and takeoff due to fog.  11:45PM or so, we are finally on our way.   It feels great to be on board this 747, which is now only about 1/3 full.  I make early plans to occupy at least 3 seats and try to get some decent sleep.  The legroom of the exit row Joe and I are in is great, but stretched out on a few seats is better.  I don’t even miss or notice dinner being served or the movie, as we cross the US in the middle of the night.

Arrival in Seattle around 5 AM home time (2 AM there) for a one hour layover and filling the plane with more passengers.  Back on and not many empty seats now, really glad I slept earlier.  Khan’s son, Matt seems a little unnerved that he did not sleep at all, and asks for some Benadryl to help with the next flight.

Khan asked me at one point, if we had any success contacting the 3 orphanages in the area we are working in.  I told him yes,  we hope to have several meetings to see what other medical needs their children have that a new foundation (Our Children International) would like to help out with.  Something of an offspring of GOL, OCI was started by my daughter Erica and a friend and GOL host mom, Sue Vallese.  Independent of Rotary, OCI is advocating for the medical needs of children in third world countries, especially orphans, and seeking treatment for any correctable conditions we can find doctors to help with.  Only began officially in May, 2005, OCI already has a cornea transplant, for an 11 yr. Old boy from Ghana, scheduled in Chicago in Feb. and a benign brain tumor removal from a 14 yr. Old Macedonia girl at Valley Hospital, Ridgewood, in April.  Erica made sure I have copies of OCI application forms, visa request forms, and Power of attorney forms, just in case I come across a child that should come home with us.

I am curious if Khan and his son speak Vietnamese, Khan was born in Vietnam but has been gone since he was 17.   He tells me that he does speak the language and Matt confesses to being able to speak some.  Matt is largely along for the experience, to see if he still wants to go into medicine after this trip, so when I invite him to be my interpreter if we are able to arrange meetings at the orphanage, he agrees and his dad thinks it’s a great idea.  Its amazing how some problems just seem to solve themselves!  Have faith and just keep moving forward is probably a good motto for this trip.

It feels kinda strange, not being more in charge of things on this trip, Khan, Ray, and a girl from the west coast, have done most of the planning and logistics, stuff I have done on several trips before.   Its kind of nice, a little more relaxing—but I am also looking to see where I will best fit in.

I am sure that’s enough of this story for now, we are someplace over the Pacific ocean, have been flying for 7 hours since Seattle, have 5 more to go to Taipei and our next flight to Ho Chi Min.  Its been dark since we left Newark—we are following the night.  I am already confused as to what day or time it is, and have no idea what day it will be when we reach Hue, either there or at home.  Doesn’t really matter that we lose a day here because we gain it back again at the end of the trip!  Until later,  Andy

—-Second entry– Its much later now—Sat. morning here, Friday night back home.  What a journey to get here! 4 flights, a short bus ride (at the Taipei airport—to the plane) and then 4 passenger vans full of luggage and us.  Some 36 hours of so of traveling—Debbie said it feels like we have been gone a week already—she can’t wait to have a shower and a bed to crash on!  In Ho Chi Min, there is a little bit of mass bedlam as  we try to collect our 39 precious pieces of luggage in an over crowded and completely unorganized luggage handling system.  Miraculously,  all bags and boxes are recovered one by one as we sort, climb, jostle and haul them all to one corner where Matt and Luella are keeping guard.

We now have to somehow get everything through customs and then on to our next flight on Vietnam Air to Hue.  Only problem is, Debbie and I discover we do not have a ticket included in our pack from the travel agent for the flight to Hue.  After much discussion (and a trip up to the office for Deb and I) with Vietnam and EVA airlines people, they agree they will re-issue the tickets for $50. US cash each.  For some reason they cannot give us a receipt now but will “fax” it to our hotel sometime later.  We also discover that Deb and I do not have tickets to return home!  We both assumed that Ray had those or they would be issued at check-in.  (We still have to work that one out)  In any case we arrive in Hue without any other problems except for the mass bedlam again at the luggage claim area.    Memories of Port au Prince, Haiti airport come back immediately.  Again we find all of our bags and boxes, match up the claim tickets, and are released to our home for the next 8 days or so.

We are relieved to find that two gentlemen from the hospital, thrilled with our coming to help them, have arranged for several vans to take the hospital supplies to Hue Central Hospital, and us and our luggage to the hotel.  The hotel is beautiful!  A little over 100 years old, it is spacious, a lot of laquered and polished wood trim, marble floors, and it looks like quite a few rooms.  Very comfortable for everyone here.  The LA group is supposed to be here already, having arrived a few hours before, but we haven’t seen them yet.  Ray sends word to all their rooms that we are here and plan to have a meeting to go over details at 8PM.  The rest of us head to our rooms for much needed showers.  Ray, Joe, Debbie and I decide to meet for dinner at the beautiful courtyard restaurant at 6:30.

Over dinner, we discuss the ride from the airport to here.  Joe and Ray are shocked by the conditions of “homes” or shacks that we passed and the amount of dirt in the air.  Their first impression is that it is extremely poor and dirty, crowded.   Watching out the front window of the van as bicycles, cars, three wheeled carts, zig zag at you and around you makes it seems like everyone has a death wish.  Khan (our surgeon) tells me that they have a huge incidence of head trauma here—he is surprised to see many people wearing helmets (maybe 1 in 10)!   I am not so nearly surprised since I have seen much worse, dirt, poverty, and congestion in Haiti and Mexico.  After some discussion, we realize even though it seems extremely poor by our standards, it did seem like everyone was keeping busy, there really was not that much dirt or garbage around, and its probably not as bad as first impressions might make you think.  Joe is still surprised by the dust and grime that is in the air, and he soon felt on his skin—shower time was greatly appreciated!

Debbie sure has her heart in the right place,  she can’t wait to see the kids!  One of the gentlemen from the hospital told her that 8 kids or so with their families, were already there preparing for our arrival.

(Its time for breakfast now (7:30) so I will end here till later. We meet at 8:30 to go to hospital. Andy

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Entry 3-  WOW.  We have not begun surgery, but what a day!  I doubt I will be able to describe all that we did and felt today, certainly not in the short time and space we have here.  During breakfast  Ray, Debbie, Joe and I discuss the video problem.  .  Our video guy hasn’t arrived yet, not till tomorrow night, had some visa/flight snaffoos.  Zach’s video is not focusing,  and we really want to video tape the kids and families getting their gift packs, as well as the unpacking and prep work for surgery tomorrow.  So guess what? Joe and I head out to buy one.  Hopefully that uses the same DV tapes that I have a few extra of; Joe and I had quite an experience finding one video-camera in this city!   It took about 2 hours, but we found one video camera that seems comparable to the one I have that’s not working.  About halfway through the search, we decide we need a different mode of transportation to cover more ground (also don’t want to wear out Joe in the process).  So we hire two “sitlows” to drive us around.  This turns out to be a good move.  The driver I had, Tau, asks every photo/film store we see, where we can find a video camera with very little luck. One store had one, but it was quite expensive and they were not willing to barter much at all.  Tau finally learns about another one across the river.  So off we go, and sure enough, they have a very nice Panasonic model.  Its probably still a little more expensive than home, but not too bad a deal.

We head back to the hospital to see what is going on.  Negotiate payment with our two sitlow drivers–$80,000.00Dong for each driver for about 2 hours!  (that’s about $5. US each—might sound cheap to us, but considering the average wage here is probably $2 -$3 per day, they can each take the rest of the day easy!

At the hospital—Have you ever gone into a situation with a certain perspective and attitude, and come out of it with something completely different?     I suppose just about everyone who might read this, has been to the hospital at one time or another.  When you walk into a hospital environment you expect a fairly clean, well maintained environment, with doctors, nurses, patients, and one or two visitors for many of the patients.  It’s a bit of a surprise to find a small city environment within the hospital—complete with moms, dads, and some siblings, basically living within the hospital compound.  When we were told that some of the kids were already at the hospital with their families, they really meant “families”!  The family is responsible to provide meals for the patient and to do laundry and help with the care of the patient.  Consequently, there are many  more people than just the patients hanging around, there is laundry hanging and drying everywhere, on walls, on scaffold that is set up for some repairs, on leader pipes and wires.  Many of the kids we are providing surgery for are not well enough  to be very active, but their brothers and sisters are, and so you  see them, climbing on window grates, playing, and generally just trying to stay busy.  You begin to realize how much we take for granted.  I even saw a woman, not a hospital employee, sweeping the floors in the area her child was in.  Think it would fly at home?  It might help with hospital costs…no, probably not.

Our medical team is planning on doing 15 surgeries in the next few days, beginning 7AM tomorrow.  Only problem is, there are many more than 15 kids that need heart surgery that are living in the hospital.  Khan is thinking that we may try to squeeze a few more in while we are here, but also, there are several more complicated that could only be done at home.  St. Joes cannot handle the more complicated cases (still need to ask him why not?), Mt. Sinai wants too much money.  Khan would like to talk to Sinai to see if  they would consider it, but I suggested presenting those cases to Montefiore or Westchester.  There is a possibility that we could bring one or two home with us or soon after.

You would not believe the condition of some of these kids.  Some have been living here for 10 months or a couple more than a year.  Not sure why they cant live somewhere else nearby, they must be getting treatment here as needed but they are not on the surgery list yet.  Several we saw today were so blue, one maybe 6 or 8 yr. old boy, looked so listless and blue, I cannot imagine him living much longer.   Some of the kids had great personalities and loved getting their photo taken. It seems many of the kids have mom, dad, and maybe an aunt or two here with them.  They bring in food for them, do their laundry, hang it on a hospital wall to dry and try to do most of the nursing care that they need.  there are also a good number of brothers and sisters here with them. Quite an experience, I kind of expected it, but the others in our group were quite shocked.

We unpacked everything, set up two ORs, echoed a boy who had surgery a few weeks ago that is still not doing well, and then one of our team, John, received a rather bad shock and burn, when he touched a piece of equipment and a metal cart it was on. He is fine now but has a good burn on his arm where current went in and another mark on his side where it must have come out.  The electricity here is one of their biggest problems.  Last year they had all the power go out in the middle of a procedure.  I spent some time checking on the problem.  Apparently the shock originated from the battery charger.  Just not sure if it was because John touched a charging contact and a ground, or if there is a short in the charger.  The charger seems to be working properly now.  But it was sitting on a metal cart which we think was involved in the circuit.  We decide to keep the charger off the metal cart and on the  floor which will not conduct electric.

We also blew out one of the extension cord/multipliers when someone from the hospital plugged it (using an adapter) into a 220 volt outlet.  We thought we may still need it, so I rewired it to bypass the on/off switch and built in circuit breaker.

We were pretty well unpacked and ready for surgery by 1 o’clock or so, so, Son, coordinator at the hospital, offered to take us on a tour of Tu Ducs palace and tomb.  Of course everyone is interested in going, but first we stop for lunch at a Vietnamese vegetarian restaurant that Pierre (cardiologist from LA) knew of from his last visit here.  It was an excellent lunch, and even the tofu, that looked like beef or something was very tasty along with all the vegetables and spices.  The local beer is not bad either and unlike the water, is quite safe to drink.  Everyone is concerned about getting sick—some (like me) are trying to be very careful, others are not used to all you have to do to avoid picking up something from bad water and are taking a few chances.

We pile into three vans after lunch and head off to Tu Ducs place.  It’s a beautiful area, away from the river and the very busy area that we are in.  We are awed by the colorful displays of incense for sale on the side of the road.  Once inside, everyone takes a lot of photos, and some of the girls go as far as paying a fee to get dressed up in concubine costumes for pictures.  There is a lot of joking about Tu Duc once we learn that he had 102 wives and unknown  numbers of concubines!  And he was only 4’ 10” tall!    They all have a lot of fun and we take some “potential blackmail” photos!  Its interesting to watch this group of strangers slowly get to know one another and begin to become friends.    Its also a bit of fun spending time with Debbie who I have known since we were in kindergarten together!  I teased her all through grammer school because she was always the shortest and I was always the tallest.  Tu Duc has some soldier statues that are about her size because none of his soldiers were allowed to be taller than him.  Debbie stands between two of them for a photo.  Its great working on a project like this with someone you grew up with!

From TuDuc’s we head to the Imperial Forbidden City.  There are some real mixed emotions there  as we learn that quite a few parts of this historic treasure  were lost during the Vietnam war and especially  during the Tet Offensive bombing.  (Tet –Chinese New Year celebration- is in 10 days)  It good to see a lot has been rebuilt, but there is still a long way for them to go to repair everything.  Some of the group is tired and heads back to the hotel early, we are embarrassed to learn that we left 3 members back at Tu Duc’s palace but we learn they called a cab and went on to do other things.  The rest of us head back for showers and dinner plans, and getting good rest for an early start tomorrow, Sunday.

I will most likely go to the hospital early with Kahn and a few others to film the first surgery.  Its decided that the first case, an 8 month old boy named Sam, will be at 7 AM.   Two more boys will be done after that.  You can begin to feel everyone’s tone changing a bit.  There is a bit of tension I think, because of the seriousness of the surgery we are about to engage in, and then there is the tension of working with new people, hoping that everyone gets along well and everything works smoothly.  The biggest worry is the power supply.  Noone wants to go through another black out like last time (that was with a somewhat different team)  when a few of these folks were here.  Most of us head off to bed early, some send e-mail and share the experiences of the day with family and friends back home.

Sunday Morning—almost everyone is down in the courtyard area for the breakfast buffet at 6 AM except for a few of the folks who are on the later shift.  Dr. Nguyen and his son Matt are down,  Dr. Nguyen seems calm, focused and confident that all will go well.  He is doing the youngest child first to give him more time to recover.  There is some discussion between various team members, checking  on supplies and procedures for the cases ahead.  Ray and I discuss the filming, Debbie seems satisfied that the blood supply will not be a problem  Each family has been able to donate several pints as needed and have not posed any contamination risks.  Several of us are prepared to donate in case family members have too many other health issues to do so.  Its interesting to learn that 95% of people in Vietnam are all Rh +.  My type, O+ would work fine.  I might as well give here, since I won’t be able to give blood at home again for about 2 years since we have been here.

We walk the four blocks or so to the hospital and walk through the guarded gates and into the OR area.  Everyone who is going into OR or ICU is in green or blue scrubs, those of us going into the Operating rooms also wear a mask and hat.  We hear that baby Sam and his mom are waiting in the preparation area, so Ray and I go out to film them before surgery.  Mom seems quite nervous and Ray is afraid to get to close to Sam, because every time he saw him yesterday he started to cry.  Once they start the IV’S and such, with Sam screaming until the sedatives kick in, we head off to surgery and the team goes to work on Sam’s chest, airway, anesthesia, etc…  The filming is incredible, I don’t mean the film is incredible, I have no idea how that will come out.  It is just incredible to watch and film a group of people working intensely together to make corrections to a childs heart that will save his life.  Sam has  Tetralogy of Fallot, a fairly common defect that requires major heart surgery to correct but once correted, the child can live a fairly normal life.  With out correction, he would most likely not make it through his teens.  This boy also has a few other minor birth defects that will need to be corrected in 6 months or so.

Khan’s son Matt goes in with me and offers to take photos with the digital camera I also have (Erica’s camera).  There is also a full contingent of local nurses, technicians and a few Doctors who are observing and learning.  Matt and I stay through out the whole 3 hour procedure, using up all of one 90 minute tape and part of another, along with countless photos.  Several others from the hospital and even some of our team are also taking photos and even some video.   Matt and I, I think, are both testing ourselves to see if seeing this much blood, cutting, suturing, and cauterizing, would bother us.  Matt has seen a little surgery before for EMT training, but he has never watched his father work before.  I’ve been involved with our Gift of Life kids for years and so have seen plenty of stuff, but never all of this.  I am surprised how fascinating it all is.  At one point I count 26 people in the operating room at one time and at least half of them are all busy checking, repairing, setting up, changing things around etc.  The heart/lung bypass machine is working fine, Jared and Julie are keeping everything runny smoothly and adjusting as Dr. Nguyen calls for it.  Ingrid and Alex are monitoring and adding aesthesia as needed, Pierre is working with the Echo machine that he is having problems with.  Apparently the power level here is not very stable and the echo computer keeps rebooting, or won’t run at all.  He gets a portable one to work enough to give Kahn the views he needs to know all the repairs are working fine.

All the repairs are finished, the step by step procedure of taking Sam off the bypass and closing his chest moves along smoothly and the rest of the team begins prepping the next boy in the OR room across the hall.  Now if only Sam will come off the respirator with no problems, it will be smooth sailing to keep moving.  Its great to watch Khan and his friend Hiep operate together.  They are both so focused and have obviously done this together before, every step of the way they just seem to work almost without talking, Teresa, who is assisting by preparing all the instruments and passing them one after another and then taking them back again, keeping everything sterile, moves like a well oiled machine—quick, exact, and always has what the doctors need ready at hand.  All this to help children half a world away, to help train others to be more effective with their own work, and to spread a little good will in the process.  The total impact of a trip like this has to be incredible.   I pray that all goes smoothly all week long and that we can have a big celebration of some sort with everyone involved.

I filmed a lot of this first case, but had difficulty getting really good close-ups because of the baby’s size and all the people around.  So after a few bites of lunch in the “Canteen”, an outdoor cafeteria with cooking over wood fires, local people cooking and serving, several dogs running around, we head back inside to film a little more of the second surgery.  The footage is incredible!   I get shots of the first cuts into the chest, cutting the sternum, spreading, and then eventually we can clearly see the heart itself, quite large and beating with a lot of movement.  Its incredible to think they will drain the blood out of it, stop it from beating, make repairs, put everything back together and when the blood flow begins to come back from the bypass machine, give it a flick and it starts beating again!    Its obvious everyone here is well trained in what they are doing and it will be interesting to get their reactions later as to how the day went.

Several times throughout the day, we noticed small crowds of people trying to see through some of the windows or doors to get a glimpse of what was going on.  They must get bored to tears hanging around here and I’m sure they all know who is getting surgery when and how things work out.  We were hoping to get some film of Dr. Nguyen telling Sam’s mom how he was, but he was busy getting ready for the next case and she could not be found right away.  I did get film of the second boy’s dad being informed everything went well, he did not seem too concerned, said thank-you and went back outside to continue the waiting; he’s not allowed to see him until he goes to the step down area, hopefully tomorrow.

I quess that’s all for now. Can’t wait to talk to all tonight and then check on patients again!  Now I am going to try downloading some of the video and photos and see what we can do with them.  Until tomorrow,  Andy

Its Monday, January 16, 2006, and already it seems like we have been here for quite a while.  Its been another phenomenal day!  The weather was beautiful and so was all the work and cooperation that it took to get it done!  That does not mean everything went smoothly, there have been a number of changes and ups and downs, but Doctors Nguyen (pronounced Win) (that’s what we have been calling Dr. Kahn Nguyen and his surgery partner Dr. Hiep Nguyen), but Doctors Nguyen and the whole surgical and Intensive care team of doctors and nurses have dealt with every bump today, so that they were still able to perform 4 surgeries in one day!  Even with one of them having to be switched with another patient that was on our backup list.  Everyone is so in tune with what is going on in the OR, that you can  feel an easing of tension each time someone comes out and says, “they have just taken him off bypass, and everything looks good”.

I know everyone came “home” tonight with a great feeling of satisfaction for today!  This morning began at 6 AM with breakfast for most of us, but there were several that spent the night at Hue Central Hospital taking care of our patients there and were waiting patiently for their relief.  Two of yesterday’s three children have already been moved into the step down area but baby Sam needed some more time in ICU.  As long as he is ready to be moved by the time our fourth comes out of surgery at the end of the day, we will be good.

While surgery is continuing throughout the day, there are also many other things going on.  There is a constant flow of activity and discussion while monitoring, adjusting, and keeping a close eye on each child’s progress.  Suggestions are made by Dr. Pierre Wong or Dr. Duncan Macrae or one of the other ICU or recovery nurses caring for these patients on what to adjust or do to help each child along.  Its another level of relief, each time one of these kids moves into step down area where their parents can come to be with them again.  In a slightly different area of the ground floor level of the hospital, Debbie and Luella have a room where they are seeing each of the kids who are scheduled for surgery.  There they collect blood samples on all the children scheduled and on those who are on a backup list.  There are many more children, already here, basically living in the hospital waiting for surgery, than we will ever be able to do this week, so coming up with a back up patient does not seem to be a problem.  Once it is determined that a child will be having surgery, blood is collected from family members at the hospital’s blood bank, to be kept on hand for their child as needed.  It all has to be tested for any infectious disease and prepared in time for each surgery.  We had a bit of confusion at one point, when a child whose surgery time was switched with another’s who was not feeling well, and the blood bank did not have the blood ready, even though the child was prepped for surgery and waiting.  But it all worked out, and the hospital has promised us a constant interpreter to be with assigned to us now, to make sure that orders issued will be clearly understood and carried out.

A few rooms down from Debbie, Pierre, a cardiologist, has been doing echocardiograms on some of the other children that are there who still need a full diagnosis and evaluation before they can be considered for surgery in the future.  Many of these children can have surgery performed here by Dr. Foo (that’s how its pronounced, not spelled), but some will have to be brought either to a more experienced surgery center (there’s only three in the country) or some may be considered for surgery at home by us.

This area of the hospital, where Debbie and Pierre are working, is a bit more active, since its open to patients who are in rooms right next door.  There are always children and parents hanging out in the hallway and the courtyard watching  what is going on and especially looking out for anytime we might give something out.  Twice now, we have given out gift packs of goodies for the children and their parents.  Each time there is a bit of mass confusion as we are almost smothered with kids and parents crowding around to receive a gift!  After the second go around, everything was gone, I was left behind talking and playing with some kids, and Ray and Joe, told me later, they thought maybe I had not made it out alive!

Drs, Hiep Ngyuen and Pierre Wong after a long but rewarding day.

Monday, January 16 –Since I am pretty well caught up with the things I planned on doing so far, its time to try and make connection with the three orphanages in the area that I have contact info for, to see if any of them have need of the services of Gift of Life or Our Children International.  I had tried calling the two phone numbers I have earlier at the hotel with no success.  The people I wanted to meet were either not available or their was no answer that early.  Now I ask Son, one of the hospital administrators who has been helping us coordinate things, if he can help make these phone calls.  You would think that if you have someone’s home, business, and cell phone numbers you would be able to reach them…not so easy.  After about a dozen calls, Son finally gets through to Khan, the director of an orphanage with 30 children that is funded by a foundation called “Friends of Hue” based in CA, USA.  It is a very nice, fairly new facility but they do not have any “special needs” children there.  They do however run mobile clinics every month to out lying areas and often come across children that have medical needs.  In fact, there is one boy from a mountain area, who badly needs heart surgery, Do Lan Huong.  Because he lived far away and needed some medical intervention now and surgery as soon as possible, his family moved into the hospital, 6 months ago.

Friends of Hue has been trying to find a sponsor to fund his surgery since then.  They had recently found someone, but the surgeon and Hue Central was not comfortable performing his Tetrology of Fallot repairs, so guess what?  He was on our list for children to have surgery!  His surgery was supposed to by Wed. but was moved to Monday, until he came down with a fever. Now his case was postponed until he was better, and hopefully he would not lose his chance for corrective surgery.  Kahn thinks there  is a good possibility they will come across more cases that either need sponsoring or may need to be sent out of country for help.  He is very please to meet with us, gives a nice tour of their facility, we meet with some of their children, some are in school on a split schedule, and he offers to have one of his teachers go with us to interpret at the next two orphanages Debbie and I are to visit.

Next we meet with Hoand Thi Tam, a gynecologist who now is the chairwoman for the “Commission for Population, Family and Children of Thua Thien Hue Province.  She is supposed to be in charge of the government orphanages in the area.  She too is interested in what we are offering.  The way she explains it, the government pays for part of the medical expenses special needs childen require, but it is up to Tam to find funding for the balance of each child’s medical treatment.  They often do not receive treatment until the hospital has the money in hand.  We meet at her mid-town office, have the usual tea, introductions, and discussion of the needs and process of this government sponsored orphanage.

Tam offers to have a driver of hers take us across town to the orphanage for us to see it.   Upon arriving, we realize that this setting is already quite a bit different than the last one.  Much poorer, a little larger, (about 40 children live here I think), most of their children are in school there now, and they all smile and say hello, as we stop by their open air classrooms.  I am not sure if she was a teacher or some type of supervisor, but a woman there was very interested in the OCI information, expecially since they have a boy there with birth defects in his right foot and left arm.   Some surgery has already been done on his right foot and ankle.  He is able to walk on it without much limp, but it appears he has no control of his left arm from the elbow down.  It may be a case we could help with, it may not, we won’t know unless someone can give us his medical records.  The woman we are speaking with, says she will see what she can do to send us the information.   There is also a dayschool program being run here for children with mental handicaps.  They are singing and playing a dancing game—seem to be having an great time!

We have been asking each of these people that are involved with orphanages that we meet with, “how many orphanages are in the Hue area?  One says three, one says 6, and one says about 10.  After leaving, Debbie and I conclude there has to be other government orphanages, there is no way this is all the kids there are in the area that need the care and support of an orphanage and it seems a logical conclusion, that the larger orphanages, which there must be, are somewhere out of public view and most likely run very differently than what we have seen.  This one is definitely on the poorer side, very stark, somewhat dirty, but the kids and their dorm rooms, seem clean enough and cared for enough.  As long as they don’t have any major medical needs.

From here Debbie and I hire a taxi to take us to Chua Duc Son, a community about 10 miles out of Hue, where a group of 14 female monks run a pagoda (Quy Su) and an orphange.   It is headed off by a monk named Thieh Nu Minh Tu.  As we arrive we see some boys, maybe 10 or 12 working with some men doing mason work near the entrance.  Kahn, at the first orphanage was telling us, how if a child cannot afford the uniform and books for school, they go to work at an early age.  Some of them go to school at the government orphanage at some night classes they run there—here is an obvious example.

We pull into an enclosed compound, in front of some stark but very clean concrete and wood buildings, and are greeted almost immediately by 6 or 8 children and a young woman with a cloth over her shaven head.  We explain why we are there, and she quietly asks us to follow her to the reception/sitting room.  The room is divided up into 6 different sitting areas with 4 or 5 chairs each and a hand carved coffee table set in the middle.  We are told Minh Tu is busy meeting with someone else at the moment, and we see her there at the sitting area next to us.  Our host quickly goes to get a setup of tea for us, as I walk around to take a few photos.  There is an older Monk (still with shaved head) playing with a child nearby, so I ask her if I may take the photos.  She motions that it is fine.  There is a large impressive carved trunk,  with many Buddha’s, dragons, fruits and vines, all stained and polished beautifully, in the room next door in front of an altar of some kind.   Debbie comes over and begins to talk with the old woman, there is a list of names on the wall, organized by grade, they have 200 children here at this orphanage!  Many of the older ones are at school at the moment but some of the younger ones are here now, and she asks if we would like a tour while we wait.  Of course we will.  There are groups of children in several classrooms, working on homework and some being tutored, each group stops what they are doing at the woman’s command and sing a greeting to us.  They seem very happy to do so, and we are pleased each time!  Of course we take many photos.  There is one group of 6 or 7 boys, scrubbing some laundry on the concrete floor of a central play area.  It appears that they first scubbed the concrete, because that seems to be very clean itself.  One boy is working by himself, very seriously and carefully hanging up a pile of shirts on some clothesline, there is a small concrete elephant behind him and I get a great photo of both.  To think that we have trouble at home even getting our children to pick up their laundry from their bedroom floor—here they are each scrubbing their clothes on the ground, with a scrub brush and some soap, by hand, and they seem to be having a good time at it!  They are scrubbing, rinsing, and wringing with a great deal of excitement and energy!

The old woman then brings us into the nursery where we are a little shocked to see several heavy metal swinging cribs with several babies in them.  Debbie immediately asks if she can pick up one child who is not sleeping and seems to want to be held.  Another perks up and seems very interested in our presence, so I ask if I can hold him,–wouldn’t you know it, I pick him up, and he promptly pees in his pants, no diaper.  Believe it or not, this has happened to me before, the last time in Beijing at a TGIF restaurant there!  I think its good luck, isn’t it?  Either that or maybe I look like a fire hydrant?  In any case, a woman takes the baby and changes him, while Deb learns that they don’t wear diapers in daytime, because they are too expensive.

Next three 7 or 8 year old girls following us around, are asked to sing that greeting to us, which they do beautifully.  I record them with the video setting on the digitial I have, and then play it back for them.  They are entirely amused!  Another girl joins them and then another, and they sing again, Happy Birthday in English and Vietnamese as well as counting to 40!  Each time I record and play it back for them, and they giggle and laugh like crazy!

We head over to see their kitchen, complete with wood fires and large pots steaming over the fires,  the kitchen walls and ceiling are blackened with soot from the fires.  Two dogs lie next to a girl who is cleaning vegetables for that evenings dinner.  In the courtyard outside the dining area, there is a large pile of old tree stumps, I wonder why, until I see the wood carvers shop area behind them.  Our host, now a much younger monk, explains that an old carver comes every day to teach some of the children how to carve.  There is a large trunk with multiple roots/now legs, all being carved into different shapes and designs,  our host rubs the bald head of a Buddha there, and says “like me”!  We all laugh at her joke at herself!  The work is beautiful already and will take about one year to complete.  It may then be sold to obtain money for the children or it may be kept as another special piece in their collection.  We take time to go through all the details of what our two foundations are offering and prepare to leave some brochures, when finally Minh Tu finishes her other meeting and turns to us.  She is brief, and at the moment it sounds like she does not need our services, but they do go into some remote areas frequently, and may need us in the future.  She thanks us for our visit and turns her attention to another visitor—appears to be another monk in an orange robe.  As we are leaving the younger girl that was helping us, runs into an area that almost looks like a small shop, and brings out a carved gift with inlaid pearl, it is in the shape of type of heart and says on it, “Tam” or Heart, in Vietnamese.  What an appropriate gift!  We thank her profusely and head back to Hue in our taxi with our interpreter.

Back at the hotel we discuss our impressions and experience and decide that even though the children at the pagoda had the most stark environment, except for the beautiful carvings and a few meaningful decorations, and having the largest number of children in one place, still seemed to be the happiest and most loved and cared for of the children we had seen today.  It was a wonderful afternoon and leaves us thinking deeply about the state of children  here and in many other even poorer countries.

We head back to the hospital to see the progress of the 4 patients from that day and to share the information we discovered about how some of the patients at the hospital have been living there with their families for more than 6 months, with no assurance that they would ever receive corrective surgery!  All is well at Hue Central and we head back to Hotel Saigon Morin after another long day!

Tuesday, January 17, 2006   - One re-surgery was performed this morning on a boy that was operated 2 weeks ago by the surgeon here and was still on a  respirator.   Dr. Kahn and Dr. Heip worked together with Dr. Phu, and all went well, although it took longer than expected.  Only two more surgeries were completed after that.  We now have 10 children in ICU and step down, recovering nicely.  Had some time today to do a magic show for all the pediatrics and their families this afternoon, a great time was had by all, we finished by passing out Candy, Ray and Joe picked up this AM to all.

Also did magic for the recovering kids that were doing well enough to watch.  One young boy, Trang, was trying so hard not to laugh too hard because then it would hurt and he would cry.  I ended up teaching him a “disappearing knot trick” that he was practicing in his bed when we left.  We (5 of us) had a crazy long ride in 5 sitlows to go shopping (quite an experience and another story in itself!) and went to a restaurant the sitlow drivers recommended for Vietnamese food.  It was excellent and quite different, had the most incredible spring rolls and beef wrapped in mint leaves.  Our sitlow drivers hung out and drove us for 3 hours, it cost 150000 Dong, about $9.37US, each.  That’s probably about 2 weeks pay for the average Vietnamese.

Joe, Ray, Debbie, Michael (the videographer) and I,  are all going back to the hospital at 9:15 pm to check on the kids and the night crew, who we don’t see very much of otherwise.

Things are going pretty well here so far, but it looks like we may not be able to perform 15 surgeries by Thursday night.  The biggest problem is that we have two kids on ventilators that they have not been able to remove yet, plus two more who are not quite ready to leave ICU.  They are hoping to be able to remove one of them tonight, but not sure if he will progress enough.  If not, they can only do two surgeries on Wed., provided the first one is intubated before leaving surgery.  The plan was to finish all surgeries by Thurs.  Go sightseeing or whatever on Friday and check on Iast ICU patients, hopefully getting them all out of ICU by Friday end, and then most of us leave on Sat.   We are all praying that things go better than expected and we may be able to stay on schedule.  Even if they don’t, It is an incredible thing that the doctors with us have done so far, 10 surgeries in 3 days plus at least 4 or 5 more (maybe 6)!

Wednesday, January 18, 2006,  Luck or God’s blessings seem to be with us at first, as of this morning only one baby, an 8 month old, is still on the ventilator.  This clears the way for 3 possibly 4 surgeries today—Khan Nguyen announces at breakfast that he would like to do 4 if at all possible.  The only other possible snag is if the first surgery takes longer than expected.  Sure enough, it was a very difficult one, a Rastelli procedure, and the boy, Manh Duc Nguyen has some extra abnormalities besides.  The rest of us try to keep busy while the surgical team works to repair a very abnormal heart and save this child’s life.  The child’s mother stops us in the courtyard to see if there is any word on her baby.  Debbie, using her Vietnamese dictionary, tells the mom that he’s not finished yet, but things are OK right now.  Ray, Julie, Sandra Debbie, joe and Myself, decide to hand out the dolls and trucks they bought at the market last night.  Knowing it will be a bit of a free for all, we let the girls have all the fun this time while we take pictures and video.   After the predicted stampede and confusion is over, there are several moms and dads, bringing us their children, showing us their very blue hands and feet and asking if we can get surgery for them.  The other day, one mother begged Deb to stick her child’s finger for a blood test, because she believed that would mean her girl would then receive life saving surgery.  Deb was  almost heart broken with the desperate hope that each parent clings to.  All of us are moved by the dedication that these parents have, living at the hospital with the remote hope that someone will be come forward to fund their child’s surgery, or that the doctors here will somehow do it for free.  Some of them are too complicated to be done here by the local doctors, but some could be and other sent to Ho Chi Min.  If only we can help provide funding for some of these!  And possibly bring the most difficult, doable cases home.

Debbie and I leave around 1 PM to finish up shopping she wants to do, Ray, Mike and others who are not otherwise on duty find other things to do, while we all wait to see what happens with this difficult case, that now makes it look unlikely that Kahn and team will fit 4 in today.  I have not been back to hospital since we left at 1, its 6 PM  now.   I wanted to get caught up with this journal.  Will go now to see what has happened and try to report back later.  Until then, Yours from Vietnam,  Andy

I don’t like to leave folks hanging too long with where I left off before,  have just returned from Hue Central Hospital and you would not believe the day they have had.  Manh, the Rastelli repair case, was extremely difficult but he made it through surgery.  After some time in PICU, he had a serious downturn or “crash” but the Intensive care doctor and the three or four intesive care nurses that were there, did everything right in correcting what was wrong, getting his heart beating again, and stabilizing all his vital signs.  There is still a way to go, but it looks like he will make it.

With the toughest case out of the way, Drs Nguyen, kept right on moving making repairs on 3 more children this afternoon, finishing with Manh Duc, the child that has been waiting here for six months.  Dr. Nguyen even took a few minutes at the end to remove an extra finger this little boy had on one hand.  We pray that all the kids continue to heal and improve and that all will be out of PICU by the time we leave early Saturday.  So, in 4 days, this team of dedicated nurses and doctors have been able to perform successful surgeries on 14 children!  Quite an accomplishment!  Tomorrow we are set for 2 more, which Lord willing will bring out total to 16!  Two incidences stand out from the past two days, one has to do with Alex, our sometimes intense, German, anesthesiologist.  He looks like a big tough guy, but he is one of the ones who advocated the most to work a little extra to make sure Manh Duc did not get left out after waiting here for 6 months! (We now know what a soft heart he really is!)

And then there was a comment I overheard after the first day when 4 surgeries were performed in one day, I believe it was Son, the administrator who said to one of the young pediatric doctors, he said “He (the pediatrician) wants to be a surgeon,” and then he turned to the young doctor, and says, “you better study hard to be able to do 4 in one day!”

Its getting late now, so I will leave off here, on the way out of the hospital, with backpack on his shoulder, Dr. Kahn Nguyen, stopped to tell the last two moms he had seen from the days surgery, one was the difficult Rastelli case who is still in serious danger,  he told her the condition of things, she was concerned and rightly worried, but thankful, then he turned and told Manh Duc’s mom how well he did and they even removed that extra appendage, and she was ecstatic!  She was standing next to Debbie who she had been asking often if her son would not be forgotten, and she hugged her over and over again, and then went and found someone to interpret to say thank-you to all of us in many ways!  It was a beautiful sight and experience.  A great way to end another long day!  Goodnight!   Andy

Thursday morning,  the day shift slowly congregates around the outdoor breakfast buffet between 6 and 6:30 AM.  One of the highlights each day has been the breakfast buffet. With a combination of traditional Vietnamese soups, fruits, and Western omelets and breads, it’s a pleasure for everyone.  We have a chance to go over yesterday cases and the two scheduled for today.  You can tell everyone is a little anxious to find out if the 4 children in PICU have made good progress during the night and perhaps one or two have come off the respirator and moved to the “step down area”.  Its important that they keep making progress to make room and free up the respirator for the next child.  A now much closer group of doctors, nurses, and GOL people head over to start the last day of surgery and then pack things up to go home.

By this point, we have already given out all of the care packages that we brought or made up here, to the children and their parents, so while shopping in the market the other night, we purchased many more items to hand out to the children.  We have a good pile of trucks and dolls to hand out and there is always such a mob scene that we decide to have Debbie, Julie, and Sandra take the front line.  They have a good time doing it, (it only takes a couple minutes with all the mobile children and parents mobbing the blood bank office where we pass them out).  Many others patient family members who live in the courtyard, gather around to get a glimpse to see what is happening again.   Joe Laureni and the videographer, Mike, film a few of these times and also have a great time letting the kids look into the camera to watch themselves on “TV”.

Each time we have passed out things, (I think its been at least 4 times so far), there are 2 or 3 moms that will bring their very blue kids to us to ask if we can get them their surgery that will save their life.  It breaks our hearts to not know when the hospital will be able to get to their case, but we reassure them anyway, that it will be soon.  The only problem with this, is that we know the staff here is doing what they can for each child but it is difficult for them to get to every surgery that needs to be done, in time to save the child’s life and to prevent further developmental damage.  Further, there are some cases they are just not equipped to handle here, and those children should be sent somewhere else, either to Saigon where they have a larger pediatric heart surgery program and can do most of the more difficult cases, or to the USA.    Debbie comes across one such case during the week, when the mom writes a beautiful pleading letter, begging for a chance for life for her 2 year old son, Gnoc.  They have been living at the hospital for  8 months or so.  They have even paid the full amount to have surgery done on their child, even though the surgeon here  will not do the type of procedure he needs (its another Rastelli).   This child was on our list to be done this week, but when he developed a cough on Monday, another child was put into his place.  With the difficulty of his heart repair and the somewhat longer recovery he will require, it is decided his case will have to wait and be sent elsewhere.  As we discuss this with one another and a few of the doctors from Hue Central, we learn that it is unlikely that this child will be sent to Saigon, something about some rivalry and perhaps “saving face”.  We decide that there must be something we can do and so we set about to call the hospital and cardiology office in Saigon (Ho Chi Min City), to see how we can work this out.  Noone wants to break this mother’s heart.  You can see in her face how desparate she and her husband must be.  They have been at Hue Central for more than six months now, waiting for her child’s chance for life.  Two of our cardiologists were here two months before to diagnose and line up which cases we would be working on, this family already has their hopes up.  If we leave without at least trying to obtain surgery for Gnoc, we will not only break their hearts, but will feel a bit like we failed also.  Ray, Debbie and myself talk carefully about the sequence of things to be done to make this happen.  First we have to see if its possible to arrange with for the hospital in Saigon to see this boy, and will they accept him for surgery, then we have to figure out the best way to get mom, dad, and baby to Saigon and find out how much it will cost.   If that all looks doable, then we need to meet with the parents, probably not at the hospital, to determine if they agree with our plan of action and are ready to travel.

At the hotel, one of the girls at the reception desk, helps me to get the phone numbers I need.   I call and talk to a secretary at the cardiology office who asks me to call back in a little while to talk with one of the doctors.  Back at the hospital, a little later, with Rob’s help, (Rob is Intensive care Dr.) we make about a dozen calls and work out all the details of where the family should go, when , and which Doctors to see.  Once we determine that it is possible for us to send them, we ask the mom and dad if we can talk with them at the hotel to present them our plan.  They readily agree.  We are trying to be very careful about this, because we don’t want to upset anyone at the hospital.  Joe gets a taxi to wait by the ER entrance while Ray, Debbie and I bring the mom, Dad, and Gnoc to the taxi, they head off to the hotel, while we hop into another one.(it feels a little bit like we are acting out a James Bond movie)  At the hotel, a young man on the hotel staff interprets for us as we try to determine if the mom and dad are able and willing to make the long train trip to Saigon (18 hours on the express train).  We explain everything, they ask a few questions, (like what happens to the money they already paid the hospital here—its most likely gone), but they agree this is what they must do, and both mom and dad seem relieved.  While we talk, Gnoc is actively playing and looking out the window at the thousands of scooters, bicycles, and sitlows that constantly go by, honking frequently, it seems he is as amused by the organized chaos  of the traffic here as we are.  I wonder if he will ever know how desperately his parents want life for him and how many people are now involved in helping them provide it.  Gnoc has an older brother at home (4yrs.  I think) that a neighbor will continue to watch over.  Dad is a brickmaker, we all wonder how he can afford to take this much time off from working, they tell us how they have already borrowed 24 million dong, (about $1,500.00 US) to prepay for his surgery here.

We take them back to the hospital, of course meeting Son, the administrator who has been coordinating things for us, we immediately split away from Gnoc and his parents, both of us knowing we don’t want to seem suspicious.  Gnoc’s mom and dad have already agreed to keep all of this very quiet and to not tell anyone else at the hospital what we are doing.  Not only do we not want to make any waves with the hospital staff, but we also don’t want other parents, who are also waiting, to get the idea that we will be able to do the same for each of them, as much as we might want to, we realize it may be difficult.  Later, Joe, Matthew (our translator) and  I go to the train station to purchase tickets, check on the schedule, and length of the trip.  We purchase first class tickets in the sleeper car with lower level bunks.

Later that afternoon, I type up a letter of introduction and plan of payment to send to the cardiology office to try to confirm that they will accept him and work out how we can wire money for the surgery to them.  On Friday,  the director of the pediatric cardiac program in Saigon, sends us a fax back to the hotel, confirming that they will see Gnoc on Monday, and will forward us the wire transfer information soon after.  Duncan, (Intensive Care Dr. from London) who is staying in Hue a few days extra with his wife who has just arrived, agrees to take them to the train station on Sunday morning for their 10:30 train.  All seems set, and we are all silently holding our breath that everything will work out well for this active, loveable little two year old.

Our final meal, after 16 successful surgeries, at the hospital “cafeteria”, a partially outdoor “canteen”.

Back at the hospital,  its early afternoon, and the second surgery or the day, our final for this incredible week is just winding down.  Everything goes well with today’s two children, and only one child is currently on a ventilator in PICU.  All the others have been moved to the step down area, which now looks a little like a busy recovery room in a much larger children’s hospital.  Its such a wonderful sight to watch as parents see their children come into the step down area.  They are not permitted to see them in PICU, for some that may mean several days or a week, all the while, they are told very little about their child’s progress.  Its one thing that we become acutely aware of, each time one of our team members is out in the public area, one of the parents or relatives of one of our patients, tries to ask in limited English or in Vietnamese with hand signs, how their child is doing.  We do our best to reassure them, but wish we could communicate better.  When they are finally reunited with their children, they are with them constantly.  Looking over the 10 beds of the step down area, you can see several mothers sleeping close to their less than one year old children, at times they are nursing their babies, other times they are stroking hair or singing softly to console their healing children.  The parents with older children, ( I think the oldest to receive surgery was 10), are still often sitting in bed next to their child, helping them to sit up, cough, trying to cajole them out of the sometimes painful mood they are in.  One girl, Quay?, catches Ray’s attention early in the week, she is looking extremely sullen and afraid to move. Everything he tries, (and each of us also) is initially met with a blank stare.  Her mother tries to encourage her to respond with a smile or thank-you, or something with no success.  Finally, by Thursday night, she is beginning to smile slightly for Ray, and as I am doing magic tricks for some of the other children, I catch her looking at me, and moving just her eyes, trying to signal me to show her a card trick.  It’s enough of a signal, and I am happy to see her interested.  She actually moves her hands a bit to pick a card and show her mom.  Progress!!  By that night, I hear she has been out of bed and on Friday she moves back to the regular floor.

The hospital chief administrator and Dr. Phu have invited all of us and some of their staff to a reception/celebration Thursday evening at a nearby hotel.  Its at 7PM, some of our team arrives late as they finish their shift and the night crew doesn’t make it at all.  But the dinner is elegant and we have a delicious variety of Vietnamese dishes.  Ray and I  thank our hosts for their hospitality and  offer congratulations all around as many toasts are made and wine and beer glasses clinked.  Each of us is presented a gift from the hospital along with a letter of congratulations and appreciation.  Some receive plagues of historic palaces or temples, other jewelry boxes with inlaid pearl.  I present Dr. Phu and Mr.    With our Rotary District 7490 Banner.

I am somewhat embarrassed as I am introduced and thanked by some of the Vietnamese doctors, as the “king of magic”!  I had put on a magic show for the kids Wed. afternoon, and then did magic for each of the kids in recovery that were old enough to enjoy it, but it was nothing all that extraordinary, still it was nice to be appreciated and we all had fun.

Most head back to the hotel to crash, a few of the hardier (or perhaps crazier?) in our team, stop at the DMZ bar for drinks and unwinding.  Ray wants to stay up until 12:30 AM, so he can call his club during their meeting at Season’s restaurant.  We also would like to bring the night crew some food, pizza or something, since they tend to miss out on all that is provided for the others during the day.  Debbie, Joe, Ray, and I decide to join the crew at the DMZ to see how crazy they might be getting.  They are just beginning to loosen up and joke around when we arrive, another round of drinks and Houda beer is ordered for everyone as our group takes over a few more tables and all the extra chairs we can find.  Houda beer is a locally made beer (produced across the river from our hotel) made from a Danish recipe and has become everyone’s favorite here.  It has been unseasonably warm, (you may notice some sweaty team-members in some photos), so the cold brew often tastes very good.

The relief and celebratory spirit flows easily around the table as we joke and tease each other about some of the weeks’ events.  Its interesting to hear that still, In the midst of the frivolous conversation, there are still questions of concern for some of the children who are not yet fully recovered, and we answer more than one question about Gnoc’s arrangements.   This team, which it now can truly be called, is not just here for sightseeing and fun, but there is a genuine concern for these children whose lives have been saved and extended, children who we had never met before, and probably will never see again, yet to whom we are now somehow mysteriously connected.

Most head back to the hotel to crash, a few of the hardier (or perhaps crazier?) in our team, stop at the DMZ bar for drinks and unwinding.  Ray wants to stay up until 12:30 AM, so he can call his club during their meeting at Season’s restaurant.  We also would like to bring the night crew some food, pizza or something, since they tend to miss out on all that is provided for the others during the day.  Debbie, Joe, Ray, and I decide to join the crew at the DMZ to see how crazy they might be getting.  They are just beginning to loosen up and joke around when we arrive, another round of drinks and Houda beer is ordered for everyone as our group takes over a few more tables and all the extra chairs we can find.  Houda beer is a locally made beer (produced across the river from our hotel) made from a Danish recipe and has become everyone’s favorite here.  It has been unseasonably warm, (you may notice some sweaty team-members in some photos), so the cold brew often tastes very good.

The relief and celebratory spirit flows easily around the table as we joke and tease each other about some of the weeks’ events.  Its interesting to hear that still, In the midst of the frivolous conversation, there are still questions of concern for some of the children who are not yet fully recovered, and we answer more than one question about Gnoc’s arrangements.   This team, which it now can truly be called, is not just here for sightseeing and fun, but there is a genuine concern for these children whose lives have been saved and extended, children who we had never met before, and probably will never see again, yet to whom we are now somehow mysteriously connected.

Ray and I order 3 pizzas to take to the night crew and head off a little before midnight to make a special delivery.  It also gives us a chance to check on the progress of our last surgery patients.  They are doing well, although one of our kids, who had been off the respirator, has developed too much fluid build up under his lungs, and is put back on the respirator along with some drainage tubes to give him a little more time to heal.  The pizzas disapper quickly, testimony to the hunger and appreciation of the night crew!

Its another late night, Ray and I head back to the hotel, he makes his phone call to the club, and I shoot out a quick update to the district back home to let them know whats happening.  Its kind of fun keeping some of the folks who made this trip possible, updated and getting a lot of positive, encouraging e-mail back from them while we are still here.

Friday is tour day!  Ray has made arrangements, at the suggestion of Son, for all of us to travel by bus, to Danang and Hoi An to see some of the country side, the mountains, beach, and a quaint historic village.  A few opt not to go, since they will be spending some time in that area after some of us go home.  It turns out to be another beautiful day, stopping at a fishing village, Terry tells me how this was her father’s home town and they even have a family monument in the cemetery.  As a young man, her dad, not wanting to go into the local fishing business, had enlisted in the French army.  He was eventually captured by the North Vietnamese and had to march hundreds of miles to Hanoi where he was a POW until being released at the end of the war.  At another stopover, high in some hills, we do a little exploring of some bunkers, obviously left over from the “American war” (as it is known here in Vietnam”).  There is a beautiful prayer pagoda set up nearby, where folks stop to remember lost relatives and countrymen and women, by lighting candles and incense.  Continuing on, we stop at an incredible stone yard where local men and women are carving huge statues and small delicate collectibles alike with hand chisels and power carving tools, out of marble and granite.  A good number of us spend some of our American dollars as well as Vietnamese Dong, bargaining is difficult here, I suppose because they get a lot of buses and don’t have to settle for less.

We later see  some of the same items in some small shops, for considerably less, although there is not the variety to choose from.  Many in the group load up with souvenirs and gifts to bring back home or to keep as a remembrance of our time in this beautiful, hardworking, even if poor, country. On the trip home, Some catch up on sleep while others reminisce about the week’s events and talk begins about planning another cardiac surgical mission somewhere or coming back to here.  We in District 7490 have already been working on plans for a mission to Honduras, this trip was part of the learning process for us, and although we would love to return to Vietnam soon to continue work there, at the moment our sights are set on Honduras.  Many, if not all on our team have already expressed interest in working together again.  This really has been a great experience for everyone and we hope that we will be able to put it all together again soon.

This seems as good a place as any, to trail off into the sunset.  We make plans to meet up at a larger Vietnamese restaurant at 8PM for our final meal together.  I think its 14 of us will be heading to Saigon Saturday morning, from where we will again split up to head home or to spend a few more days sightseeing and relaxing.  As I mentioned, Angela will check on Gnoc’s progress in Saigon, while she is there,(which she has since done, and all is well—he’s been admitted and will be having the first of two surgeries soon).  Many hugs, kisses, handshakes and hopes for healthy, safe journeys home are shared by all.  Some make an early last visit to see our patients, take a few last photos, pack the last bags, and its off to the airport Sat. at 7.  Back to our regular lives with a new sense of how so many others in our world have to live and struggle while we are blessed with so much.  We have made a small dent in the ongoing problem of children’s congenital heart disease, but for those who received surgery for their children, for those doctors and nurses who experienced a new more effective way of performing surgery and follow up care, it has been a life changing experience that I know will grow and expand through time beyond anything anyone of us can imagine.

Until the next trip,  yours in Rotary International Service Above Self,  Andy Topp