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!)