A photographer’s first voyage on ICHF’s first Babyheart medical mission to Skopje, Macedonia
Humanitarian missions are a labor of love, with equal parts of each. They’re also full of hows… How are things going to go, how will the kids do, how is the culture different to what I’m used to? There’s an excitement to not knowing any of these things and a similar excitement as the answer to each question is found through experience.
There are always two aspects to any mission. The external aspects that generate the questions above and the internal aspect of team and patient where there are no questions at all. I KNOW the team is here to fight for the patient, I KNOW the skills of each individual is beyond question, I KNOW the mother and family of each child we see loves their kid with the utmost intensity. I KNOW what’s at stake.
Macedonia, from my perspective, was a beautiful experience. After a grueling flight from Denver I was rewarded by a pretty morning and short drive from the airport to the hotel where the team was staying. No matter where I go, the drive from the airport to the city always sets my impression of a place and this drive was no exception. We passed small parcels of land that had obviously been farmed for a long time, new housing developments and older homes long abandoned. I saw old men fishing in what looked like drainage canals and groups of kids playing basketball at a graffiti covered rec area. I saw in abundance what I call “the sameness” of everywhere I’ve ever been, people going about their day, working hard to support their families. The thing that was different here, was the destruction. There are places you had to look for it but there are small reminders in Skopje of the devastating earthquake in 1963 that set this country back so far. The best example is the train station in Downtown Skopje that was left as it stood the day of the quake, stopped clock and all.
My job as photographer is twofold, to document what the team is doing to show both the world and you as a donor the good works you make possible and to give the kids and their families a voice. It’s a visual voice but that’s enough to start a dialog between them and the viewer. I feel this is the most important aspect of my job, to make that connection between two people who will probably never meet, between two people, one in desperate need for help and one who CAN help. Here in Macedonia there were no shortage of children in need of lifesaving help and fortunately a team here who could provide that help, the Babyheart medical mission team.
On my first day I was introduced to a woman and her son who’s story was tragic. I wish I could post photos of her son but at her request I won’t. She had had 6 miscarriages and her little boy with the sick heart is her last chance at having a child in her life. Even though her son was scared at being poked and prodded and apprehensive about the army of strangers around him, you could tell he was all boy inside. You could also tell the bond he had with his mother was deep and unshakable. Although I can’t go into too much detail about his case, I can tell you his story had a happy ending…
There were 11 cases done on this mission. I’m unique as far as the team goes because I can’t compartmentalize. Each medical team member has a specific role to play, surgeon, scrub, cardiologist, SICU… I am a participant in my own way for the entire case. I’m there in the beginning for the screening, I’m in the OR for the procedure, I wait with the family for their child to come up from surgery, I’m there in the SICU post op when a family member gets to come in and see their baby for the first time and hopefully I get to come back at some point and see a happy healthy kid playing at his home. This breadth of experience gives me a unique position to be able to comment on the miracles that the ICHF team does with your support. Every volunteer and donor should be proud of the lives they touch because saving innocent children is the highest calling a person can answer.
The stories of each of the families on this mission was different and compelling. As the photographer, I have the privilege (sometimes curse) of really getting to know the families. I share their joy when cases go well and their grief when there’s nothing that can be done. I hope through my pictures from this trip, you’re able to share some of that too.
Babyheart photographer and guest blogger
“When I was a girl, the oath we took said – in part – ‘May fire rain down on America’. I didn’t want to say it. I’d lived in America and had friends there. I was nine, so the teachers let it slide. They didn’t believe it either. Had I been in high school I would have been punished.” Madia, an anesthesiologist resident told me. She continued to talk about the revolution, her eyes coming alive, “It was the best time of our lives! There was such solidarity. We all came together.”
Now the US – along with France, Turkey, Qatar, and the UK – are considered friends of the revolution. The flags of the countries can be seen in the graffiti that covers nearly every vertical surface in the city. A careful student of 21st century American foreign policy might note that this in not always the case with the nations we try the ‘help’.
A hated tyrant was ousted, without invasion or intrusive nation building, and a loose group of put-upon citizens were able to take their country back. Libyans are grateful for the help, as well as, in the end, being allowed to drive their own revolution. And why not? People and societies must own their victories, or they aren’t really victories.
To that end, taking care of your own children is written into the operational model of the ICHF. Certainly the care for the children is a part of the mission, but the true endgame is creating a sustainable model for a pediatric cardiac unit that works: Writing protocols and technical training to international standards as well as working within the cultural framework of the host country. It is crucial distinction that separates the ICHF mission from the medical safaris. They no doubt to good work and save lives, but when they head back to their comfortable lives, no much more gets done. When ICHF volunteers head back to their comfortable lives, they know that they have left not only a mark, but that mark is part of building a sustainable solution.
The importance of this cannot be overstated – people must own their victories to get anything out of them: the systems must make sense the to the doctors and nurses and all the others who use them. They must take pride in it for it to work. Without pride and a sense of ownership of the many volunteers and supporters of the International Children’s Heart Foundation, it wouldn’t work either.
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.
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.
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 4:10 flight from Istanbul came in a little early. Even though many of us had been up all night traveling, the ICHF team was excited to get to work. Nabwa Qaragholi, the determined Executive Director of Living Light International, met the team at the Basra Airport. With a lethal combination of kindness and pushiness, Ms. Qaragholi handles the backstage logistics in Iraq to make sure the extended program launching this week will run smoothly.
After loading our kit for the drive, we met our army escorts and rolled out into the desert. There is a certain stark beauty to Iraq that grabs romantic figures like T.E. Lawrence and Captain Sir Richard Burton. The sand has a barely pinkish hue and is very fine, so when it kicks up it stays there. The affect is that, without any real point of reference, you can’t tell where the land and sky meet at the horizon. It blurs like a finger dragged across a line of chalk.
In the light traffic the drive through the desert is featureless but quick. As we approached Nasiriyah, the landscape got greener, sort of. In these brutal summer months the only thing growing is sparse scrub. The dry brush gives way to the tall, thick reeds of the marshes fed by the ancient Euphrates River, and when you cross it you are in the Fertile Crescent where civilization started. In fact, we are only about an hour away from Ur, the biblical city considered the oldest settlement in the world.
Nasiriyah is hard to conceive. There is still rubble that hasn’t been cleaned up from the war, but there is new construction going forward as well. Large walled homes abound, painted gloriously in a riot of color. Older buildings are the color of the khakis my wife won’t let me wear out of the house.
At the Ministry of Health guesthouse, Dr. Novick and the ICHF team are greeted warmly as old friends embrace and have a laugh. This is the first trip of an extended yearlong program, but friendships have been cemented over several shorter ICHF Mission trips over the last two years. The famed Arab hospitality is lavish and an Iraqi friend is a friend for life. It is one of those scenes that makes the troubles of the last decade seem far off – where they should stay.
We were fed an enormous traditional meal of chicken and rice with peppers. Set out on platters around the tables was a blackened fish called silva, a creature about 14 inches long. Eat it with our fingers, and once you learn the trick of taking some without a getting a mouthful of bones, it is excellent. Being Ramadan, our hosts were fasting and didn’t join us.
And while this was a happy occasion, both the ICHF team and our hosts know that it is time to get to work: the year ahead will be trying but triumphant as well, for the volunteers, Iraq and mostly its children.
A single mother of three makes the decision to give her newborn son up for adoption. Since birth the only home Wadson has ever known is the children’s home in Des Pinos, Haiti and his parents the 32 staff members who work there. Whether it was because of his heart defect or just the financial burden of raising a child in one of the poorest countries in the world, no one knows why his mother made such a decision. And it’s a question that according to the staff at the children home, is forever present in his eyes. As sad as this story may be it does have it’s silver lining, like all things in life, without the love and care of the staff at the children’s home, who helped to bring Wadson to the Dominican Republic and ICHF, he might never have received the life saving treatment he needed for his heart defect. Wadson has had his surgery and is recovering well, he also received the news that he would be adopted by Melissa, the children’s home owner, who has played the role of mother to him the past few years.
Three-year-old Skerlyn, might be sick, but he still manages to keep all the nurses wrapped around his pinky, for what he lacks in health he possesses in charm. And you can always find him in the arms of one nurse or another, he’s ever loyal subjects are there to carry him around. His parents first learned of his condition one month after his birth, in which the doctor immediately ordered surgery for Skerlyn. Due to his heart defect Skerlyn frequently suffered from falls, fainting spells, and he tired easily when playing.
After receiving his surgery on Tuesday, Skerlyn has resumed his throne, this time in the recovery room, and he orders his subjects to fetch him “ague” every chance he gets. Soon Skerlyn will be well enough to conquer new territories and to that we say “¡Viva el Príncipe”
Sometimes it’s hard to imagine how congenital heart defects really affect children, when we ourselves are not affected. Some children experience minor symptoms like shortness of breath or dizziness, whereas with other children, like Hilda Moronta Lora, their heart defect robs them of their entire childhood.
Due to her condition Hilda has been unable to walk on her own, go to school, or even play. Because she could not attend school due to the severity of her condition, Hilda, who is now eleven years old can only write her name, she cannot read, write, or even count past ten. The effects of her condition do not end there. At a time when most children in the United States are entering puberty, Hilda barely weighs a hundred pounds. Despite the obstacles her condition has caused she has a fighting spirit, one that has impressed the team of doctors, nurses, and volunteers who work with her each day.
Having received her surgery Monday, Hilda is recovering remarkably well and is now walking. And there is no doubt that soon she will be flying.
Sunday was our first official day in Santiago, Dominican Republic, we didn’t know what to except when we arrived at Hospital De Ninos Dr. Arturo Grullon for patient consultations, maybe a room full of extremely sick children on gurneys? It was not however the image of a seemingly healthy looking and carefree seven-year-old Jasmin Alcantara who in fact suffers from Tetralogy Fallot, a condition involving not one, but four defects of the heart.
Made only more severe by Jasmin’s age, but she is not one to let a heart defect keep her from showing off her dance moves or playing catch with the team volunteers. Jasmin shows resilience, a trait she shares with her mother, Ms. Alcantara, who first became aware of her daughter’s condition two years ago, when she witnessed her active child over exert herself while playing and begin to turn purple. Unfortunately circumstances would prevent any effective treatment till recently. The single and unemployed mother of three, heard about the International Children’s Heart Foundation through a visitor to her daughter’s school. Though it was an extreme financial strain on her and her family, Ms. Alcantara traveled 6 hours from the town of Las Matas de Farfan and even borrowed the six thousand pesos(the equivalent of $157.89) necessary to make the corrective surgery possible for her daughter from another patient’s mother at the hospital.
For two day’s Ms. Alcantara sat by her daughters side, separated only when Jasmin was finally taken to the operating room. After four hours with Surgeons: Dr. Iguidbashian, Dr. Ramirez, Dr. Gilbert, Cardiologist: Dr. Desessa, Anesthesiologists: Dr. Stenquist, Dr. Steward, and team of dedicated nurses and volunteers, Jasmin came through her surgery and is currently resting her feet so she can dance down the halls of the hospital tomorrow.