ICHF Associate Medical Director, Dr. Christian Gilbert, was preparing to fly to Basra, Iraq to begin a new program of Babyheart medical missions there when he had to take a detour. There was an emergency waiting in Kharkiv, Ukraine and Christian answered the call. A one-week-old child named Michael had a transposition of the great arteries and a VSD. He underwent an emergency balloon septostomy and needed an arterial switch procedure. Below is Dr. Gilbert’s account of the trip and the remarkable progress of Dr. Olga Buchneva. This account exemplifies what a Babyheart Mission is all about: a healed heart, a surgeon taught.
I performed this with Dr. Olga Buchneva, a local surgeon trained by the ICHF staff. She has done one before with my help and did not feel comfortable doing it on her own. So a call went out to ICHF for a surgeon to come and help Olga and it turned out I was going in that direction to Iraq. So arrangements were made for me to fly to Kharkiv a few days early. After some early trouble and flight delays I arrived at 2am, Friday morning. The team was doing an adult emergency which finished as I was arriving. We all got some good rest and started the switch procedure around 10:30 the following morning and finished at 2:30pm. The operation went very smoothly as if Olga had done hundreds! I was so proud of her. The baby is in excellent condition in the ICU and the team is gathering for some food and refreshments as I write this. After the baby we did a 6 year old girl with a very rare coronary artery aneurysm and fistula who had had several attempts to close in the cath lab without success. In surgery the fistula was closed off bypass and she is recovering nicely. All in all it has been a very productive trip. I will send more on the remarkable progress I have observed in Kharkiv.
To give some perspective. I first came to Kharkiv in 2009 and at that time the only cases being done on kids were when ICHF teams were here. And the cases were simple ASDs and VSDs. Today I saw the schedule for next week, no ICHF team, and there were 10 cases on the list, most if not all were kids. That is huge. The volume of complex adult cases being done is increasing by leaps and bounds, most of them by Olga, which will only help her be a better congenital heart surgeon. The ICU was caring for 7 patients and was doing so without any help, really cool.
Today’s case, done entirely by Olga, was amazing. The baby was in the ICU 5 hours after starting, chest closed, no bleeding, looking fine. Really impressive. This is truly an ICHF success story if there was ever was one. And I am so thankful to be a very small part of it.
– Dr. Christian Gilbert, Associate Medical Director, ICHF
Almotasim’s cousin told us that the patient was an active boy. Colette, the Canadian ICU nurse, assured him that the 12 year old was about to be a lot more active.
At about eight thirty the previous evening, Almotasim had come up to the ICU from surgery with the usual array of kit and tubing snaking out of his chest and throat and was extubated in short order by the night shift. This was followed by a thankfully uneventful night.
A crucial part of the training the ICHF provides its hosts goes beyond immediate issues like, Exactly how does one repair an ASD? And Just what does extubate mean and how or why is it done? Other, less obvious details – like how to manage patient lists to keep the required number of beds in the ICU open – are also important, even crucial. To perform four complex surgeries that will likely require long post-op stays in the ICU, will create a bottleneck with the limited beds available for the next day’s patients. These are the sorts of management details that can often make the difference in a successful program.
Nine days into the Benghazi mission, after a few surprises and a one-day break from surgery, the ICU was very full. So it was with great relief, both to the ICHF staff and, presumably to Almotasim, that he was ready to leave for the pediatric ward after 20 hours. Which is the goal for ICHF pioneered Fast-Track Recovery program. It is a hard and fast rule of Fast Track that no patient who could walk into the hospital leaves the ICU under anything but his own steam. If a child needs to be carried out, he isn’t ready.
The boy was still dazed from his ordeal, granted, but he got out of bed and wasn’t particularly interested in getting back in. He and Colette took a walk down the long hallway and back, at which point he picked up that he was being transferred out of the ICU. Which in and of itself was welcome news, but he grew concerned about the modest amount of swag he’d accumulated. Could he take it with him?
The ICHF nurses traditionally pack small treats for the children: coloring books, blow-ticklers, small toys for their charges. Lindy, a South African born perfusionist working in Holland, brought a bag of stuffed animals with her. Almotasim had grown attached to his lion, and who can blame him? Once he’d cleared up the matter of taking his animal up to the ward, and facing the prospect of getting back into bed, the boy opted for another walk. Then he said goodbye to the other 12 year old in the ICU, with whom he’d made friends.
He went up about mid afternoon, where his cousin walked with us up to the pediatric ward – decorated with Disney characters and other American cartoons – where his parents and little brother were waiting. Almotasim was pleased to be getting out of the ICU, and a little less pleased to be getting plopped into another bed – but if it had to happen, at least he was going to have a decent roommate. He asked about getting his friend sent up to the neighboring bed. Colette said she talk to someone about it.
So what does the future hold for our friend Almotasim? He’s an active kid with a strong heart; he’s loyal to his friends – even the stuffed ones – and has the good sense stay in bed even when he doesn’t feel like it. He seems to ask for what he wants in life, and is a hair stubborn about it. Well, apart from aggravating his parents for the next few years, he’s going to be just fine.
FREEDOM is spray painted, in English, on nearly every wall in Benghazi. It’s all over the walls in the countryside as well. The Arad world is very fond of walls, so that is a lot of spray paint. Arabic graffiti abounds, but some 40% of the slogans denouncing Gaddafi, screaming freedom and the hope that is the new Libya, are in English. On a drive out to the Biblical city of Cyrene, I asked a young man I’ll call Ahmed why the graffiti was in English.
“We want the broadcast our message, the new Libya, to the world – not just to the Arabs, but to the whole world.”
“I thought Gaddafi struck English from the school curriculum. Who can read it?”
He thought about this, “We learned.”
Ahmed is a pilot in training in Tripoli. He has an idea for an invention in the aerospace field and is learning English himself, not to spray paint on walls, but to go to the US or Canada to produce his invention. Libya is moving ahead, but not fast enough for him. “Do you plan to stay in the West?”
“No, I’ll bring it back to Libya.”
He is a young man and this entrepreneurial attitude is new among Libyans who left their country or dismissed it as hopeless during the Gaddafi regime. Since the revolution of 2011, hope and pride abounds. Pay for doctors has increased literally tenfold, to bring it to a level that is still not quite competitive, but the gap has narrowed. If the Libyan citizenry is still relatively poor, the country is rich. They can afford the new pay-grade and are investing in themselves. There is more to a first rate medical center than simply buying it. It is a matter of training, procedure and practice. For the ICHF, missions to places like Libya filled with the hope and desire to make the most of their resources are heartening. For Libyans, their world changed on February 17th, it opened up and a great many things suddenly became possible.
Hope may spring eternal, it may overcome all, but the fact of the matter is that it is very, very fragile. Freedom is not easy. Its most glorious aspect is also its most dangerous: it is exactly what you make of it. Libyan driving – bad by the lively standards of the Arab street – is a little too free, making it largely an exercise in faith and tightly calculated physics. In downtown Benghazi, shell blasted buildings still stand amid an alarming amount of the rubble. Libyans talk about a blooming tourism industry but to that they are going to need a broom. Still, the war damage is being repaired at an impressive rate for a nation that doesn’t have a permanent government.
There are those, few but out there, who are nostalgic for the old regime. They say that it was, if nothing else, stable. Which was true if you didn’t have political opinions or ambition. It is true that freedom is a messy affair. Churchill was right when he said that democracy was the worst form of government other than every thing else that’s been tried.
Self-determination is hard work when it’s old hat, when it’s is new it can be brutally traumatic. It leaves scars. It requires people to believe that a risky common goal can be achieved, and for everyone to do their part to make it happen.
The same can be said for open-heart surgery. You should see these once hopeless children immediately post-op. It is raw and aggravated and heart wrenching and just plain gruesome. Then consider the alternative.
Despite the heroic efforts of a shoestring staff in Memphis, it often appears that these Babyheart missions are held together by luck and, to channel Blanche Dubois, the kindness of strangers. The trick to a successful mission isn’t just the doctors, nurses combined with the competence and enthusiasm of our hosts. Sometimes it is an unexpected cocktail of little things we take for granted.
I’ve never been in a hospital, for example, that ran out of gauze pads or pain killers, and for that matter, neither have you. To that end, Martina Panvanic in the Memphis headquarters asked Janine Evans, ICU nurse and the Benghazi mission’s coordinator, to put out the call for supplies. A team email went out and volunteers from Australia, Canada, Belarus, Holland and the US asked their respective hospitals for “disposables” to bring with them. Leaving from Memphis as I was, Martina gave me a huge black duffle that weighed in at 26 kilos.
Traveling with the marauding doctors and nurses of the ICHF is a good way to meet people you wouldn’t normally run across. Granted, most of them are medical professionals, or at someone who desperately needs their help. Every once in a while, though, you get a hail or some help from completely unexpected places, like from behind the counter at an airport gate.
The first leg of my flight to Detroit was delayed long enough to ensure that I’d miss the connection to Paris. The fellow working the Delta counter, Larry, started to do the math to see how to reroute me. “I’ve got a checked bag I can’t lose.” I said, which I’m sure is something he hears eight times a day.
“Describe the bag.”
“You could park a car in it.” I started to say you could fit a body in it but the modern airport is a place with little to no sense of humor. I couldn’t recall any Fiat-in-a-bag terror plots.
“What’s in it?”
“Donated medical supplies.”
“Why are you going to Benghazi with a massive duffle of donated medical supplies?”
It’s a fair question in this day and age, and not one that is answered quickly. I launched into ICHF pitch and the weird perimeters of a Babyheart mission. Larry gave me a determined look, “Pediatric cardiac surgery, huh? I had three open-heart surgeries before the age of 12. Don’t worry, we’ll get your bags there.” Larry turned to the Delta lady beside him, “What’s the number for Salt Lake?”
“That’s the wrong direction.” I pointed out helpfully. He held up a finger in the universal signal that I should stop being helpful.
I was rerouted to a flight that was about to leave for Minneapolis/St. Paul that was scheduled land about five minutes after my connection to Paris was to start boarding. Even on this tight schedule, our approach was delayed as we circled the airport overhead while another plane lingered on the runway.
With fifteen minutes before my next take off, I set off in a mad dash through the airport to the connecting gate. This, I’m sure, was hilarious as I’m built for comfort, not speed. At the gate a Delta employee looked up and fairly screamed, “Mr. Murff!” She more or less pushed me into the plane.
Within a few minutes I was in the air and on my way to Paris. Anyone who travels at all know that if you hustle you can occasionally make a flight by the skin of your teeth. Your luggage is rarely so lucky. And now I had eight whole hours to think about this development.
We landed on time at Charles De Gaulle airport, which is very French: sleek, good-looking, and utterly convoluted. It’s a wildly held belief among Americans who watch too much television that you can see the Eiffel Tower from every window in Paris. This is wrong. I ambled through CDG, found my gate, and asked the stylish clerk about my baggage. “It is here at the airport.” She said with a pretty smile. “Is there a problem?”
“Not at all.”
The bag, and everything in it, made it to Istanbul and onto our final flight into Benghazi…where it was impounded for several hours for no good reason. But that’s hardly Larry’s fault. I’ve really got to thank him.
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 email@example.com
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.