“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.
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.
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.
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.”
The International Children’s Heart Foundation (ICHF) is pleased that you are visiting our Blog! This will be a great way for you to keep up-to-date with all the exciting developments occurring around the world with and through ICHF.
ICHF is a 501(c)(3) headquartered in Memphis, TN. The mission of ICHF is to bring the skills, technology and knowledge to cure and care for children with congenital heart disease to developing countries. ICHF does this regardless of country of origin, race, religion or gender. We travel to these countries with a complete medical team and provide surgeries to the children for free. We also train the local medical professionals to perform these surgeries on their own eventually.
This fiscal year we have 33 two-week trips planned around the globe in countries including: Honduras, Dominican Republic, Nicaragua, Colombia, Ecuador, Brazil, Ukraine, Belarus, Russia, Egypt, India, China, and the Philippines. We are on pace to provide life-saving heart surgeries to more than 800 children around the globe! On each trip we take a complete medical team of surgeon(s), anesthesiologists, perfusionists, intensivists, cardiologists, OR nurses, PICU nurses, etc.
We will be Blogging about: the trips we take and the lives we save; interesting stories about the children we serve around the world; stories about our various volunteers and staff; links to helpful information about Congenital Heart Defects; Links to other organizations around the globe helping children with heart defects; interesting statistics about congenital heart defects, etc.
We will include pictures and video. We will have Guest Bloggers. And….of course, we welcome your comments on ways to enhance this Blog!
This week we have full medical teams in Colombia and India. In the 1st Quarter of 2010 we operated on 172 children and expect to reach 180 children in the 2nd quarter!
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