Every parent of a wee one knows that there is a mild, once daily little Hell through which we all must go. It doesn’t last nearly as long as it seems, and is regular enough that you can brace yourself for the ensuing onslaught. It’s when a three year old thinks to herself: “You know what might be fun? A tantrum. It’s lively, I’m the center of attention, and all that flailing is nice exercise!” Generally this thought occurs around 4ish or thereabouts, and it is a good an argument as I’ve ever heard for happy hour. I mean, of course, of the Witching Hour.
Sterner sorts call it the Adoption Hour, because somewhere in that deep smithy of the soul they know if some doomsday cult of baby snatchers come a’calling, they’d likely leave the window open. It’s the time of the inevitable, inexplicable kiddie melt-down that no re-scheduling of naptime or meals that can avoid. It happens, it’s a force of nature, and it’s the price parents pay so that in 20 years they’ll have kids who are sensible young men and women capable of eating at a decent restaurant and offer the potential for grandkids.
So what are we to make of the PICU nurse, and more specifically the ICHF volunteer, who trots off half-way across the globe to do the job for nothing, for children in far off lands? In twenty years this brave soul will be bracing another roomful of sick, put-off children. The average American has two kids. Picture having, say, eight. All of them ill or otherwise traumatized at the same time, speaking a foreign language, with massive chest wounds, and hooked up to equipment that pings and buzzes to tell you when they are off grumpy even when they’re sleeping.
If that’s not harrowing enough, picture the coming of four o’clock when they all melt down, at once, like some screaming Greek chorus telling you the next hour or so of you life has just been hi-jacked.
This, gentle reader, is a fair picture of the ICHF nurse. And yet, most of them are repeat volunteers. Before heading to Libya I got an email from a nurse I met in Ecuador; a sane, beautiful woman with a full life apart from her day-job. It said, more or less, that she was hooked and had arranged to go on for two more trips.
Is it masochism? A mild case of adrenaline addiction? Or is it simply that most jobs that are worth doing are hard. The passions that drive us to be better than we are, and sometimes better than we can even imagine ourselves, are always taxing. The tasks that produce that satisfied exhaustion and deep sleep of the faithful make us what we are.
Of course, it goes without saying that the Witching Hour would be a lot easier if wasn’t happening in a country that hasn’t seen a happy hour in 43 years.
It is always interesting to reckon what a child is thinking, but when the child has been born into a world utterly incomprehensible to the American child, the exercise gets really interesting.
As he is being transferred from the bed to the operating table, Mohammed is looking stoic and brave and very much a child who wants to make his father proud. I can only imagine that he does. But Mohammed, at eight years old, lived through a brutal civil war at about the same age that I was contemplating a career as Spiderman.
Libya is a country where hope is still so fragile that isn’t really given to flights of fancy. The parents know it, and as is always the case, the children know it too even if they can’t say why. But there is hope: the war is over now. For Mohammed, however, a danger lurks that is not from above but from inside. The boy has a hole in his heart.
His hopes, and those of his parents, are pinned on an Iranian-born Swiss surgeon, Dr. Ali Dodge-Khatami. He is performing the ASD closure in an operating theater that is better equipped than I was expecting. The issue in Benghazi is not one of equipment but of education and training, and that is why the ICHF has come. The Libyans know this and have sent staff from Tripoli to take part in the training.
In situations like these, there is always a mild dose of culture shock: in the scrub room the Libyan anesthesiologist kneels on a small rug, making his 5:00 prayers. The bypass machine to be used for the procedure is maneuvered quietly around him and into the theater. Mohammed’s chart has his nutritional status listed as “Normal” but from across the room nearly every rib in his chest can be counted. And he is. An American who could once believe that he’d have spidey-senses can afford to get fat, but this is a different world.
What he thought, as he woke in the long quiet of the night shift, was “Is the surgery over yet?” Those were the first words he uttered to his mother and veteran ICHF volunteer Andrea Hiebert. It was over, and it was a success. He’d be sore, but was well. He went back to sleep.
What then, did the boy think when he awoke to the handover from night shift to day, drifting out of a groggy sleep to find a dozen doctors and nurses from around looking, smiling and chatting away in a incomprehensible babble? Were they discussing him? They are friendly faces, ones that – so his mother says – are telling him that he is well now, he will live and play soccer and, if the mood hits, can consider a career as a superhero as long as he has a sensible backup plan.
I took his picture, and with now prompting gave me a thumbs up. I think we understood each other. He walked out of the ICU a few hours later on his own. He has hope and a realistic one at that.
Performing better than twenty heart surgeries in two weeks, producing rich world outcomes under emerging world conditions, the ICHF has never been an organization to waste a lot of time. This was vividly illustrated on November 26th, day one of the foundation’s second trip to Benghazi, Libya.
Dr. Kathleen Fenton, who has overseen Operation Babyheart in Managua, Nicaragua for the last five years, and Dr. Cameron Greydon of Australia both arrived in Benghazi a day ahead of the mission to assess patients. The rest of the mission was greeted with an ambitious schedule the first day: three procedures in two theaters, with herself and ICHF volunteer surgeon Dr. Ali Dodge Khatami from Switzerland to perform the two VSDs and a PDA.
Most of the team arrived in Benghazi at 8:30 am on Monday morning, but didn’t leave the airport when the donated medical supplies we were carrying were inexplicably impounded. This was as problematic as it sounds. Sorting through the donated supplies needs to be done before the first patient arrives in the PICU. After a lot of bad noise at the airport, the team arrived at the Benghazi Medical Center at two in the afternoon, roughly the same time the first patient, Asmaa, was coming out of the operating theater.
Janine Evans, the team coordinator for the Libya mission, called the charge and the nurses scrambled to change into their scrubs to care for little Asmaa – as well as sort the supplies and set up a modern ICU. The impounded bags arrived at the hospital about an hour later.
These sort of minor fiascos are simply part of the experience on a babyheart mission: pulling order out of chaos is what they do. Asmaa, thankfully, is a brave patient who appears to be able to face anything as long as her hair is in proper pigtails. A lady needs her hairdo, and who can blame her?
With two operating theaters going, at the end of the day shift two more patients arrived in a neatly ordered PICU. So day one ended the way a lot of babyheart missions do: from a morass of strange problems being hammer out in a foreign language to – somehow – a safe and ordered haven for recovering children.
During the week of November 10-17th, the International Children’s Heart Foundation program in Kharkiv, Ukraine received some very distinguished guests. US TV actress, Stephanie March of Law and Order fame, and a strong child health advocate, visited the Kharkiv Center of Cardiac Surgery, where ICHF volunteer medical missions average 5 trips a year, operating on 280 children in the past 4 years. She arrived with World of Children co-founders, Harry and Kay Leibowitz, who support Chernobyl Children International, represented by founder Adi Roche, who in turn, supports ICHF’s Babyheart medical missions to Kharkiv. As an actor, Stephanie makes a living pretending to be a lawyer on TV, although she is very aware of real world problems, such as congenital heart defects and is doing something to alleviate the issue. The Center’s director, Dr. Igor Polivenok and ICHF’s biomedical engineer, David Weiduwilt, took a day to provide a tour of the facility they worked so hard over the years to build.
One unique aspect of the Center is the observation dome directly above the operating room for visitors and students to obtain a rare bird’s eye view of a surgery. David and Igor took Stephanie and the group here first to view a surgery from the eyes of a surgeon. Then they guided them through rounds in the Pediatric Intensive Care Unit and the newly renovated ward rooms. Kay became very emotional here while visiting with the children. She experienced firsthand the children’s helplessness as they fight and cling to life following such an arduous experience for their tiny bodies. Stephanie and Kay visited every bedside to spend time with the kids. They left many gifts here for the children and left the remainder in a newly renovated play room. The gifts are a thankful diversion for children fighting through discomfort, pain and boredom as they recuperate. Then they shared lunch and Dr. Polivenok gave a presentation on the work of ICHF and its dedicated staff, illustrating the great sacrifices made by those who volunteer to provide medical care for patients and training for the local staffs. Afterwards Igor arranged for the visitors to enter the OR for a surgery and conduct a question and answer session to learn more about congenital heart defects. Sadly, many children here are affected by the “Chernobyl Heart,” from which the Oscar winning 2004 documentary featuring ICHF’s Founder and Medical Director, Dr. Novick, took its name. This is a condition of heart defects caused by the radiation fallout from the disastrous explosion at the Chernobyl nuclear plant in 1986. This event and the suffering it wrought upon the children inspired Adi Roche’s creation of Chernobyl Children International. The explosion happened 26 years ago, but much like the scar on a child’s chest from surgery, the effects are still being felt like a great scar across Ukraine’s landscape. The child’s scar will heal and go away, but we will never know if the radiation damage on these helpless children will ever go away. That is why this land is blessed by the medical teams of the International Children’s Heart Foundation.
Afterwards, David escorted the group to view the cath lab and then they viewed a video presentation. The representatives confirmed their continued support for this wonderful program and recognized the need to keep it going. Before finishing the day, the guests were able to see the transfer of a patient from the healing hands of the operating room ICHF staff to the caring hands of PICU ICHF staff. After some coffee, ICHF bid farewell to their special guests and they were on their planes back home to spread the word about the wonderful work being done around the globe.
The ICHF was delighted and honored to have World of Children representatives Stephanie March, and co-founders Harry and Kay Leibowitz, to travel so far to see firsthand the impact of their donations. The ICHF surgeons, doctors, perfusionists, and nurses all perform the work, day in and day out with one goal in mind: save kids’ lives who, without ICHF, would not have a fighting chance at life. While ICHF is very busy performing this great work, it is good, during this season of thanks, to give gratitude to the various caring organizations that offer monetary assistance to keep the teams on the planes, the operating rooms filled, the PICU staffed, and the new hearts beating, full of life, inside tiny chests.Bryan Artiles firstname.lastname@example.org
That is how little baby Rand Ahmed was with the latest ICHF Babyheart mission to Iraq. The beneficiary of International Children’s Heart Foundation’s unprecedented one year program, this precious little kid went through the full gamut of emotions: from surprised to mad to content. I think many parents of children with congenital heart disease (CHD) experience this same range of emotions. When a parent first discovers their child has a congenital heart defect they must feel surprised. They are in a state of shock as the elation of having a new baby in their world comes crashing down around them. They are surprised by this condition and the degree of complication of the defect which threatens to take the life of their new baby.
Then they feel mad at the world and wondering why this has happened to them, why there child cannot have a normal life and why their child will have to struggle day after day just to live. Frustration grows as they search for answers and who will be able to save their baby?
Then these feelings of surprise and anger subside to being content. Content with facing the condition and learning that there is an organization called International Children’s Heart Foundation that has the means and skill to save their baby. Being content gives way to new found happiness, almost equal to the happiness they felt when they first welcomed the baby into the world, when the ICHF Babyheart mission team has surgically repaired the heart and nursed the child back to full recovery, ready to leave the hospital and go home. This little one, Rand, was the 8th arterial switch in the history of pediatric heart surgery in Iraq, performed by none other than Dr. William Novick.
by ICHF medical volunteer Scrub Nurse, Becca Davenport
Two months ago Juan Carlito became the proud father to a beautiful little girl named Valeria. Only hours after receiving news of the birth of his first-born, Carlito also learned devastating news that the baby was born with a heart defect. He and his wife, first-time parents, were destroyed with the news that their child would most likely not develop into the healthy little girl that they had dreamed of. Chances were high the baby would die in infancy from her congenital heart defect. The remote village, in which the family lives, does not offer any medical support for children, like Valeria, born with heart defects. The family was left to their prayers, in hopes that their baby would be ok.
Later on this same week, the parents returned to the hospital for additional check-ups with the hospital’s top doctors. It was on this visit that the family found out that a team of American heart specialists would soon be in Guayaquil, (a city not far from their village), to operate on children with congenital heart defects. The new parents could not believe their ears! The American doctors must be able to help them, and they needed to make their way to the big city as soon as they could. The family packed up and was fast on their way to the Hospital del Nino, in Guayaquil, Ecuador.
The American team of cardiac specialists arrived in Guayaquil, quickly set up their supplies and base camp at the Hospital del Ninos, in preparation of seeing their patients. The medical team is a collaboration of volunteers that are actually from all over the world (not just America), and brought on this medical mission by the International Children’s Heart Foundation (ICHF). The ICHF’s mission is to provide cardiac surgical services to children with congenital heart defects, in countries where these surgical interventions largely do not exist. The program provides these services, in addition to training local medical professionals. The hope of the ICHF is that this training will allow for the local hospital to sustain these specialized cardiac services themselves.
Upon the arrival of the ICHF medical team, baby Valeria was able to receive a screening of her heart, and her diagnosis was identified as TGA, (transposition of the greater arteries). The anatomy of baby Valeria’s heart vessels, is backwards. This is a condition in which the aorta is in place of the pulmonary artery, and the pulmonary artery is in the location that the aorta should be. This anatomical defect causes the heart’s vessels to pump oxygen-rich blood from the lungs back into the heart, but the oxygen-rich blood stays mostly trapped within the heart. What this means is that the body is not receiving the oxygen-rich blood that is required for normal function and developmental growth.
With baby Valeria’s heart defect being identified as TGA, surgery was immediately scheduled for the placement of a B-T shunt. A B-T shunt is a preliminary procedure that directs blood flow from the aorta to the lungs and relieves cyanosis, until the baby can receive palliative surgery. This allows a higher percentage of oxygen-rich blood to reach systemic circulation. This procedure is just a preliminary and temporary fix to the heart defect, but it treats the patient’s hypoxia in order to then later treat the anatomical defect (the transposed vessels).
Valeria’s surgery was a success! The baby recovered wonderfully after only a few days in the ICU, and is now receiving a more adequate supply of oxygenated blood to her body. The young parents to Valeria slept in the hallways of the hospital (as many of the parents do), and were at her bedside daily. It was a pleasure for the whole team to see the looks of worry on these parents’ faces, soon be replaced with smiles, assured that their baby was on the path to recovery.
Baby Valeria is one of the 21 patients that received surgery from the ICHF team during the September trip to Guayaquil, Ecuador. The baby will need additional surgery on one of the future return trips that the ICHF volunteers will make, but for now she is stable. Many more children in Ecuador need these surgical interventions, but because of limited resources and time only a small percentage of kids are able to receive them. It is in the hopes of ICHF that one day in the future Hospital del Ninos will be able to sustain this need for cardiac surgery, and the team of volunteers will then venture on to new territories to start the entire process over again.
Matias was one of the first patients of the September Babyheart Mission to Guayaquil, Ecuador. He was scheduled as the second surgery on the first day of the mission. He was asleep in his father’s arms in a lonely corner of the operating room hooked up to an IV. The ICHF medical volunteer perfusionist Miguel Garcia came to introduce himself, assure the father, Jose his son was in good hands, and offer comfort. He asked if he could pray with him. They prayed together and then Miguel left Jose Luis and he continued to pray and talk to his son, tears dropping down onto Matias’ peaceful face. The gravity of the moment had arrived. A rush of memories must have flooded Jose’s mind at this time. He had to be thinking of Matias’s birth and their pediatrician telling them something was wrong with Matias but didn’t yet know. Then came confirmation of the devastating news of his son’s heart defect that without surgery, would eventually kill him, discovered at 2 ½ years old. This was followed by numerous visits to their pediatrician and visits to the heart clinic every two months. After this came visit upon visit and waiting hours upon hours in doctor’s waiting rooms and cold hospital floors only to learn that while his son’s condition was diagnosed they did not have the money for the type of surgery to save his life. Every two months they went to the pediatrician and heart clinics looking for answers. They ran into dead ends at every turn. The surgery he needed to save his son’s life was unavailable to him in Ecuador.
A glimmer of hope was seen as he made it to the Francisco Bustamante Children’s Hospital in Guayaquil. They learned about a United States –based organization called International Children’s Heart Foundation that leads a medical mission to Guayaquil, Ecuador about 3-4 times every year and they have surgeons that can fix his son’s heart condition. Jose and his wife Dexe pursued this but had to make more visits with cardiologists, both Ecuadorian and American and more evaluations which came with more time in waiting rooms and more 2 ½ hour trips to / from their home town of Quevedo. Then came the news that Matias was selected for surgery and despair gave way to new hope. Jose brought his son to the hospital expecting surgery thinking he was going to get his day but were turned away on two different missions because Matias had a cold. The child needs to be perfectly healthy to undergo heart surgery to minimize all risks. Then finally as the stars aligned and the miracle of ICHF came back to Guayaquil, he and Dexe made their third trip. This would be it. They could no longer watch their son slowly wither away and die. This time in September of 2012, on the 23rd ICHF Babyheart mission to Guayaquil, they made the trip and Matias was healthy and put on the list for surgery. His time had come. All these memories must have come to mind as he held his son in that lonely room. ICHF volunteer anesthesiologist, Dr. Sri Patankar came to take Matias away, still asleep and most assuredly dreaming of all the things he can do such as play, run, climb stairs, run all over a playground, things he cannot do with the current condition of his heart. Sri gently cradles him in his arms and takes him away from Jose. Sri lays Matias on the operating room table and set to the work of preparing Matias to be able to breath, stay soundly asleep and withstand the rigors of surgery.
ICHF full time staff surgeon Dr. Kathleen Fenton, who runs the Managua, Nicaragua program, oversaw the surgery. She was actually operated on another child in another room then afterward came in to assist Dr. Sergio Hernandez whom she trained herself through ICHF’s Managua program. This is the full ICHF mission statement, building sustainable programs, in live effect! ICHF staffer and medical mission veteran, Erin Brenner served as the RN, first assist on the surgery.
Four hours later Matias was wheeled out to the PICU a new boy, reborn. He came out with a bouquet of wires, tubes and chords pouring out of him. They rolled him into the ICU with surgeons Kathleen Fenton and Sergio Hernandez walking in tow. The team, led by ICHF head PICU nurse Frank Molloy, the bandana-wearing Britain, moved quickly to prepare Matias for the ICU. Frank is an ever present force in most ICHF PICUs as he is critical to research and responsible for the fast-tracking recovery methods that help ICHF patients get moving and untethered from all the tubes and needles and into recovery and out of the hospital into a new life. Dr. Patankar vocalizes the story of the surgery and alerts the staff to the chemicals and medicines coursing through Matias’ body. The course of surgery is critical knowledge to how the ICU staff will administer care. This expert staff was led by Intensivist Dr. Daniel Garros, Respiratory Therapist, Lindsay Bailer, and PICU RNs Lorraine Hodson, Michelle Miller-Payne, Colleen Griesuk, representing the Canadian contingent, and then there was PICU RN from Vanderbilt Children’s Hospital Kelly Davis and an RN from Seattle, Lisa Davidson.
An integral part of ICHF Babyheart missions is to allow the parents to enter the ICU and be with the children. Frank has proven case after case, mission after mission that parents are part of the child’s healing process. Jose Luis and Dexe came to see their son and never left his side, as they traded off shifts with him, due to limited space. This was a time of holding hands, softly whispering songs into their son’s ear and watching over him, comforting him during the brief episodes of pain. Then came the big moment when he gets to get up out of bed and give his heart a good test run. Matias got up and with his father at his side walked three laps around the nurse’s station. That means preparations are made to get him up to the recovery room. He is then unhooked and now he is living on his own with his new heart for the first time.
The perfusionist Miguel who prayed with Matias’ father pre-surgery now came to visit him post surgery. They visited and spoke together and Jose Luis called the ICHF medical team “angels” and implored them to continue their work to save lives. The first patient of the mission, Ignacio Solarzano and his abuelita, Angelina, kept bouncing balloons back and forth between each other with Matias. Miguel then gathered the two families together and led them in prayer, the first in pre-op a prayer of hope, now on the other side in recovery, a prayer of thanks. Miguel left, returning to the operating room for more life-saving surgeries throughout the week. ICHF sets to the work of healing hearts and the kids are able to get back to being kids, here on this 23rd Babyheart medical mission to Guayaquil, Ecuador.
The aptly named International Children’s Heart Foundation is just that. The “International” doesn’t apply just to the children served, or even the desperate locales Baby Heart Missions travel. It also encompasses an international collaboration of medical professionals coming together to address a very specific, global problem made infinitely complex by the impossible number of variables ranging from the abstraction of politics to the decidedly more visceral issue of plumbing .
ICHF doctors, and they are an international lot, have performed over 5,000 surgeries in 40 countries with a mortality rate comparable to that of the US. Thus showing that a dedicated group of international volunteers and supporters, being coordinated from Memphis on a shoestring budget, can change the world. In the process, it makes a high-minded international collaboration of politicians with unlimited funds like the United Nations look like a high-school debating society.
Pediatric cardiac surgeon Dr. Mila Stajevic Popovic, of Belgrade’s Mother and Child Health Institute of Serbia, headed the latest Baby Heart Mission to Kharkov, Ukraine. She brought with her two Serbian doctors from the same hospital, anesthesiologist Igor Krunic and cardiologist Sergej Prijic. The team was filled out with an intensivist from Germany, a respiratory therapist and two PICU nurses from America and a PICU nurse from New Zealand.
In any teaching situation, understanding is key. Most of the staff of Kharkov Regional Hospital has an understanding of English, but there are a number of what might be termed as cultural untranslatables. To this end, the Serbian doctors brought a certain insight to working and thriving in conditions of extreme economic hardship and, for that matter, the extreme political hardship of the former Soviet block.
Both Serbia and Ukraine share a common Slavic heritage and culture, along with a recent past dominated by the USSR through Moscow. And both nations shed their communist mantels in the early nineties and in neither case was the transition particularly smooth. Serbia emerged as Yugoslavia dissolved into civil war. At the same time, Ukraine’s centrally planned economy shuttered off the rails as it broke from Russia. The Serbian doctors have proven to be a helpful link in the transformation of the Kharkov program from its Soviet era protocols to the more modern realities of 21st century medicine. And while the efforts of the ICHF are life-saving to the patients, redefining for the host hospitals, they have a profound effect on the doctors as well.
The Mother and Child Health Institute of Serbia, and Dr. Stajevic Popovic, have a long history with the ICHF. She was in surgery with ICHF founder Dr. William Novick in Belgrade when NATO bombs began to fall on the city in 1999. And that program, now concluded, is proof that the ICHF is not only saving lives, but training medical professionals so that they can train others to Western standards as well.
Dr. Sergej Prijic, cardiologist, when asked what he thought about the program and his experience as an ICHF doctor, he said with a winning grin: “If I step out of window, I will fly.”
Last week Ukraine celebrated Independence Day. The Kyiv Post was full of stories about celebrations, self-determination, and a few pesky language issues like: Is a Ukrainian speaking Ukrainian oppressive to a Ukrainian speaking Russian? There was a long article on the modern “Independence Generation” – those born since 1991 when the country voted itself out of the collapsing USSR. It is a generation redefining itself, as one youth put it, “without the Soviet aftertaste.” But to an American of a certain age that sounds like a lot to wash out of your mouth.
Some 40% surveyed said that they couldn’t go a day without cell phones, Facebook or Twitter. The Ukrainian youth is tech savvy and outward looking in a way that their parents and grandparents never were. Considering these last two decades have been the longest stretch of freedom the Ukrainians have enjoyed in a thousand years, their ancient ancestors weren’t very outward looking either.
But futures, bright or dark, belong to the next generation. None of the children treated by the Baby Heart Mission to Ukraine lived under the Soviets, and few of their parents have much working memory of that era. But societies don’t turn on a dime, and the old aftertaste – assumptions, protocols, and systems – lingers.
The first ten years of independence saw the old centrally planned economy collapse and it wasn’t until 2001 that the economy began to grow at last. Modern buildings and luxury apartments are going up around town offsetting the sinister drabness of the Soviet aesthetic. Ukraine is redefining itself as a modern European country, and to do that it needs a healthcare system that can take care of its own.
To put it in words the youth of both America and Ukraine can understand, you can’t download the apps of the 21st century without upgrading the operating system. For four years now, Baby Heart Missions have been working with the Kharkov Regional Hospital – training staff, writing crucial protocols, and implementing operations that work within the existing system. While there are pediatric hospitals in the city, it is the regional center that has the technical capacity for cardiac surgery. What the Baby Heart mission does here, that few other institutions or foundations do, is provide the crucial leap from adult to pediatric cardiac surgery. A child’s heart is not just a small adult one: it is growing and developing, and when it is repaired, it must be done in a way that will allow for future growth.
So goes the heart, so go the people. For a medical system that has traditionally waited until adulthood to treat congenital heart defects that should be corrected in the first few years of life, this change couldn’t come soon enough.
People must have hope for their children if they are to have hope for the future. And the most perennial form of hope is to make healthy children out of sick ones. They need doctors with applied training and nurses who are taught to think and act critically for the sake of those kids. If they are to have hope for their new nation, Ukraine must be open and exchange life-improving technology with the rest of the world.
Think of it as a mouthwash to get rid of that pesky Soviet aftertaste that the youngsters won’t admit to having.
The ICHF team is here in Iraq, in the 2nd month of the one year program to help them establish a high quality program to provide cardiac surgical services to the children of eastern Iraq in the city of Nasiriya. Many children have received surgery and are on their way to a full life free of obstacles to a happy and healthy childhood. While much progress has been made there is much more work to be done.