It is a rare moment in life when you get to see so many selfless people come together to help others. ICHF is honored to be an organization that hosts moments like these in 45 missions this year alone. For the past 20 years, ICHF has held missions where experts in pediatric cardiac care donate their time, money and skills to save the lives of children worldwide from congenital heart disease. These experts set aside much deserved time off from their careers to attend our missions and heal the hearts of children in need. Below is an excerpt from our guest blogger Babyheart PICU Nurse Educator and Coordinator, Farzana Shah, who has generously aided our missions for the past year:
“I heard of ICHF through a flyer in the ICU that I work at in Philadelphia…it’s like saying you met your future husband at the bar…not exactly romantic, but that was the seed. I did some research and heard only good things about Babyheart. I saw how many people are helped by this one organization and I was hooked. I had to learn more. So, I completed the online volunteer registration form and scheduled my first trip with ICHF to Najaf, Iraq in September 2012.” (During this mission, with the help of a team of volunteers including Farzana, we healed the hearts of 14 children with CHD’s. Farzana has now volunteered on five of our Babyheart missions).”
During her 4th Babyheart mission (our 14th mission to Guayaquil, Ecuador), Farzana helped save the life of a 5 year old boy named Ricardo. Ricardo suffered from a complex heart defect known as tetralogy of Fallot which is characterized by the combination of four CHD’s:
1. Pulmonary valve stenosis, due to the absence of his pulmonary valve, Ricardo’s pulmonary artery is abnormally narrow impeding blood flow from his right ventricle to his lungs.
2. Ventricular septal defect, resulting from the hole between Ricardo’s two ventricles permitting oxygen-poor blood from the right ventricle to mix with oxygen-rich blood from the left.
3. Right ventricular hypertrophy, characterized by a thickening and enlargement of the muscles of Ricardo’s right ventricles.
4. Overriding aorta, where the main artery exiting his left ventricle appears at the opening of both his left and right ventricles, permitting oxygen-poor blood to flow through the VSD into his aorta.
Because of the severity of Ricardo’s defect, he suffer from “blue” spells where he would turn blue due to the lack of blood permitted to the lungs preventing oxygen to reach his body. Without a corrective operation, the lack of oxygen would not only damage Ricardo’s heart, but also his brain.
Ricardo would need to receive multiple operations. When Ricardo was 2, his heart was in such bad condition, Babyheart Founder Dr. William Novick had to perform a preliminary procedure to prepare him for his future operations. Ricardo received two more corrective procedures this year on July 30th from Babyheart surgeons, Dr. Marcelo Cardarelli and Dr. David Maldonado Gonzalez. He will come back early next year to be evaluated for his next operation which will hopefully be his last.
Ricardo came to visit our team during our 15th mission to Guayaquil this past September. While playing his all-time favorite, Angry Birds, on Farzana’s phone, she recounted her passion for helping these children:
“I can’t say enough about the positive experiences that I have had working with ICHF. With each good and sad situation, you learn to bring the best care possible to these children while adapting to different environments and dealing with the lack of resources, while also ensuring that you are supportive to the family and caring for them as well. Seeing Ricardo come back this mission, and looking like a completely new child; inquisitive, smiling, happy- I could have kissed his cheeks till they turned red and it still wouldn’t have been enough to show how happy I am to know he is doing well.
My experience with ICHF has given me so much growth, both personally and professionally. The ability to be flexible and open to learning has made me a stronger, better nurse. I have worked with some of the most talented people that I would have never had the opportunity to meet if it wasn’t for ICHF and the friendships I have made are incredible.
These trips are like little the wonders of the world…you meet everyone the first Sunday of the trip, some familiar faces, some are first timers, all from different walks of life, and everyone clicks. We find a rhythm and our common goal: to help…help the children, help the families, help our local colleagues learn, help make the lives of those people we come across a little better. When you are asked by someone “how long have you all worked together?” They don’t believe it when you say, “3-4 days”. It’s unexplainable even to me still, the teamwork and dedication that happens in just two weeks with so many variables- a relationship that would take years to build, comes together in just days.
If I could thank each donor and sponsor for making it possible for me and others alike, who have this passion to breakdown social and economic walls in order to provide a child a chance at life; it could only be expressed by looking at Ricardo, and seeing that he has a chance, because of them.”
Lifetime with a Healthy Heart on the Horizon!
Ufuk is a Turkish name that means Horizon and Ufuk was part of ICHF’s inaugural medical mission to Macedonia and was the very fist arterial switch ever done in Macedonia. It was a complicated heart defect that required a difficult surgery that only ICHF’s Dr. Novick could perform. When the team left, Ufuk was still in the ICU with a wound infection but was recovering well and eating. He had his operation at 15 days of age, on March 28th by Dr Novick, and was 3.6kg at the time. He recently returned with his family from his hometown south of Skopje to see the next mission team and be evaluated. He came back to receive his ECHO by our Babyheart team and the local cardiologists. He is just over 6 months old, is a healthy 7.8kg and thriving and better than ever! Ufuk has a new life on the “horizon” with his new heart.
Frank Molly, ICHF ICU Coordinator and Clinical Educator, helped get us the news of Ufuk’s recovery.
Donation Already Saves Lives in Macedonia
Everyone knows the great work of Arkansas Children’s Hospital’s efforts to save lives at home but did you know they are active in saving lives abroad? By making a simple donation of equipment to the International Children’s Heart Foundation they are doing just that. Thanks to the collaboration of 2 biomedical engineers, Kevin Haralson, Director of Clinical Engineering /Biomed at ACH and Roy Morris, biomedical engineer for ICHF.
In order to provide the best technological care for their patients Kevin ordered a new heart-lung bypass machine for the hospital. He now had an older model on his hands that was still fully functional machine but had to be completely discarded. Kevin did not want to see it go to waste and he knew who to call, Roy Morris of ICHF. They both worked in the same field together in Little Rock when Roy was in the private sector. Now Roy works for Babyheart full time and has done an outstanding job of partnering with hospitals around the country to obtain equipment donations for medical missions. In this case he needed a heart lung bypass machine for a medical mission in the East European country of Macedonia. The function and purpose of this equipment is when an ICHF pediatric heart surgeon must stop the heart in order to operate on it. The child’s blood is then diverted and oxygenated via the heart lung bypass machine, operated by a perfusionist, thus keeping the child alive. These machines are expensive and very difficult to come by. Without this equipment the operations could not be performed. Children would have to remain on the waiting list for surgery and many young lives are put at risk, some will die. Then Arkansas Children’s Hospital came through with their donation and the mission could continue. Kevin Haralson facilitated the donation and ensured the equipment was in good working order. Then Roy got it shipped overseas to the operating room in a Skopje, Macedonia clinic, ready for surgery! The donated bypass machine was put to use by professional medical volunteer perfusionist, Swee Huang, and it has helped the mission in Macedonia already operate on, and save the lives of, over 30 children! According to Roy and Kevin, with proper maintenance this machine will last medical missions for at least another 5 years. With ICHF running 3 Babyheart missions per year, operating on 20 children per mission for another five years, this Arkansas Children’s Hospital donation will help save the lives of at least another 300 children!
Babyheart Team Gets to Work Before De-boarding Plane
On a flight to Kharkiv, Ukraine an older man that felt dizzy and disoriented. Then the man fainted and collapsed at the rear of the plane. Luckily, members of an ICHF Babyheart medical team were on board traveling to the next mission in Kharkiv. Dr. Marcelo Cardarelli, PICU Nurse, Roslyn Rivera, and Dr. Herwis quickly got up to help him. As many ICHF medical volunteers will tell you, you must travel well prepared on a medical mission. Roslyn carried a pulse oximetry & wrist blood pressure cuff that they used to check the man’s vitals. They discovered the man apparently had a history of low blood pressure and he appeared to have fainted due to that. He ended up being ok by the time they landed, and refused further medical attention. He walked off the plane himself & didn’t utilize the ambulance they called for him. All in a day’s work for a Babyheart team.
Elizabeth Set to Receive Heart Surgery
Elizabeth Torres’ mother submitted a request for assistance with the International Children’s Heart Foundation earlier this year to help her daughter receive surgery. She is from Ecuador, has been evaluated by a doctor and on a list for surgery but her defect is complicated. Only Dr. Novick has the ability to correct her defect, called an Ebstein Anomaly, a defect of the tricuspid valve which causes a backup of blood into the lungs and insufficient oxygenated bloodflow to the body. Elizabeth is suffering from this heart defect now and it will eventually take her life if we don’t act. Well, Babyheart donors and supporters did act! Via an online crowdfunding campaign on Gofundme.com, they contributed to her heart surgery, which is a fraction of what it would cost here in the United States. Now Dr. William Novick is on his way to a Babyheart mission in Guayaquil to perform the operation scheduled for Monday, Sep. 30th. We are happy for Elizabeth, her mother and family.
Below is an excerpt of a letter from Elizabeth’s mother.
….I know you to be a people of great heart and that have helped restore hope to many children who have all the will to live, I ask with all my heart to help me with my girl and cause I have great suffering and emptiness in my life if I lose her and it is the light that illuminates our lives with strength and love of life has given me the courage each day.
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
A Flat World, Full Hearts….Facebook, Globalization and Technology come together to Mend Baby’s Hearts
ICHF receives thousands of requests for assistance from parents of children with congenital heart defects all over the world. Babyheart Volunteer OR Nurse, Becca Davenport, had the opportunity to sit with one of these parents and hear her inspirational story of how a group of people from different parts of the world came together to save her child.
Last October, we received a request from Corazones Guerreros Unidos (Heart Warriors United), a Facebook support group for Latin American families of children with congenital heart defects. They had a mother in Ecuador whose two year old daughter was given little to no chance of living because of her multiple heart defects. When Paula was born, she suffered from a small heart murmur. A few months later, Paula’s parents were informed that the heart murmur was even more pronounced and that their baby’s blue-tinged skin color was a sign of low-oxygenated blood. Paula would need an echocardiogram in order to determine her condition. After an agonizing wait, the echocardiogram result’s arrived. Unfortunately, they revealed that Paula suffered from multiple heart defects, several holes in the septum of her heart, and consequently pulmonary hypertension. In the United States these defects are fairly easy to treat if detected by doctors early enough, and subsequently done when the baby is very small. However, in Ecuador there are no resources for children to undergo the necessary cardiac surgery to fix these issues, and thus the doctors treating Paula had nothing positive to tell her parents, only that there was no hope for their daughter.
Paula’s mother was especially distraught to hear that their child’s doctors had nothing to offer them, and it was at this time that she decided to take matters into her own hands. Paula’s parents invested many long hours pouring over the internet, desperate to find someone who could help the young girl. It was a few months after the search that the Facebook support group for Latin American families heard of ICHF. They were astounded to find a non-profit organization that performs life-saving cardiac surgeries all over the world, and even in their country of Ecuador! With the help of the friend from the group as a translator, Paula’s parents were able to communicate with the ICHF, and they were nothing short of persistent, as they knew this might be the only organization able to save their baby’s life.
After reviewing Paula’s medical records, Paula’s family was advised to bring their daughter to the Hospital del Nino Dr. Francisco de Ycaza Bustamante for our next Babyheart mission to Guayaquil, Ecuador. Two months after initially contacting the International Children’s Heart Foundation, Paula and her family undertook the 7 hour trek (via bus) to Guayaquil, Ecuador, where surgeons would be able to fix their baby’s heart. At last, the little girl received her life-saving heart surgery, courtesy of ICHF and the volunteers that make it possible. Surgeons repaired the child’s atrial septal defect and multiple ventricular septal defects (holes in the septum of the inner heart chambers). Two days in the ICU, a few more up on the recovery floor, and Paula was well on her way to healthy new start on life.
Paula’s mother was in tears at the end of the interview. She later said that she was not able to communicate in words the magnitude of the International Children’s Heart Foundation impact on her family’s life. She says that she feels forever indebted to the organization, and the medical professionals who have been able to save her baby’s life. Thank you to the donors and supporters, even if she will never be able to thank them in person.
En español: Un mundo plano, Corazones completo …. Facebook, la globalización y la tecnología se unen para reparar los corazones del bebé
ICHF recibe miles de solicitudes de asistencia de los padres de niños con defectos congénitos del corazón en todo el mundo. Voluntarios Babyheart OR enfermera, Becca Davenport, tuvo la oportunidad de sentarse con uno de estos padres y escuchar su historia inspiradora de cómo un grupo de personas de diferentes partes del mundo se unieron para salvar a su hijo.
En octubre pasado, recibimos una solicitud de Guerreros Corazones Unidos, un grupo de apoyo de Facebook para las familias latinoamericanas de niños con defectos congénitos del corazón. Tenían una madre en Ecuador cuyas dos años mi hija se le dio poca o ninguna posibilidad de vivir a causa de sus múltiples defectos cardiacos. Cuando Paula nació, sufrió de un pequeño soplo en el corazón. Unos meses más tarde, los padres de Paula fueron informados de que el soplo del corazón es aún más pronunciado y que su bebé azul teñido de color de la piel es un signo de baja oxigenada sangre. Paula necesitaría un ecocardiograma para determinar su estado. Después de una angustiosa espera, el resultado ecocardiograma ha llegado. Por desgracia, reveló que Paula sufría de múltiples defectos cardiacos, varios agujeros en el tabique de su corazón y la hipertensión pulmonar en consecuencia. En los Estados Unidos estos defectos son bastante fáciles de tratar si se detecta a tiempo por los médicos, y posteriormente se realiza cuando el bebé es muy pequeño. Sin embargo, en Ecuador no hay recursos para que los niños se someten a la cirugía cardíaca sea necesaria para solucionar estos problemas, por lo que los médicos que tratan a Paula tenía nada positivo que decir a sus padres, sólo que no había esperanza para su hija.
La madre de Paula fue especialmente consternado al saber que los médicos de su hijo no tenía nada que ofrecer, y fue en ese momento que decidió tomar el asunto en sus propias manos. Los padres de Paula invertido muchas horas que vierten sobre el Internet, desesperado por encontrar a alguien que pudiera ayudar a la joven. Fue unos meses después de la búsqueda que el grupo de apoyo de Facebook para las familias latinoamericanas oído hablar de ICHF. Ellos fueron sorprendidos al encontrar una organización sin fines de lucro que lleva a cabo para salvar vidas cirugías cardiacas en todo el mundo, e incluso en su país de Ecuador! Con la ayuda del amigo del grupo como un traductor, los padres de Paula fueron capaces de comunicarse con el ICHF, y eran nada menos persistente, ya que sabían que esto podría ser la única organización capaz de ahorrar la vida de su bebé.
Después de revisar los registros médicos de Paula, la familia de Paula se aconseja llevar a su hija al Hospital del Niño Dr. Francisco de Ycaza Bustamante para nuestra misión Babyheart junto a Guayaquil, Ecuador. Dos meses después de que inicialmente contacto con International Children’s Heart Foundation, Paula y su familia emprendieron la caminata horas 7 (en autobús) a Guayaquil, Ecuador, donde los cirujanos sería capaz de solucionar el corazón de su bebé. Por fin, la niña recibió su vida para salvar la cirugía cardiaca, cortesía de ICHF y los voluntarios que lo hacen posible. Los cirujanos repararon el niño defecto del tabique auricular y múltiples defectos septales ventriculares (agujeros en el septo de las cámaras del corazón interiores). Dos días en la UCI, un poco más arriba de la planta de recuperación y Paula estaba bien en su manera de nuevo comienzo saludable en la vida.
La madre de Paula estaba llorando al final de la entrevista. Más tarde dijo que ella no era capaz de comunicarse con palabras la magnitud del impacto International Children’s Heart Foundation en la vida de su familia. Ella dice que ella se siente siempre en deuda con la organización, y los profesionales médicos que han sido capaces de salvar la vida de su bebé. Gracias a los donantes y simpatizantes, aunque ella nunca será capaz de darles las gracias en persona.
By ICHF guest blogger and medical volunteer, Sigurdur Stephensen
We are standing by the side of the road in the desert and staring into the distance. The sand is grayer than I had expected, somewhat grayish yellow and it stretches as far as the eye can see. No camels, no donkeys, no Beduin tents. Only this straight road like a pencil mark on a grey piece of paper. Outside it is 20 degrees Celcius and I wonder what I was thinking when I decided to travel here wearing a fleece jacket.
We are waiting for the police escort that was supposed to follow us from the airport in Basra to our destination in Nasiriyah. In Basra we had only been greeted by two bearded guys dressed in suits. I travelled together with Don, a perfusionist from Chicago, who is here for the second time. He recognized one of the men – Ahmed – from his previous trip. Ahmed walked straight up to Don, kissed him on both cheeks and said: “I love you.“ Don looked rather surprised by this warm welcome. I on the other hand received no kisses and no confessions of love. Then we headed in to the desert in an old van. After half an hours driving the police called and wondered where the hell we were.
We bend down and look at the small stones by our feet. Their surface is smooth as if it’s been polished, which is excactly what it has been. Sand polished for centuries. I throw a green stone into the sand. Now is the religious festival of Shia muslims in Iraq, when pilgrims march to the city of Karballah to remember the death of Hussein ibn Ali, who was a cousin of the prophet Mohammed. Because of recent bombings directed against the pilgrims, many of them walk all dressed in white, like a burial shroud, so they will be ready in case they die on their journey. I mention the bombings to Don. He had heard on his last mission that often the terrorists aren’t necessarily looking for a specific target. They just go out driving on the roads and wait until they find a target worth blowing up. “Like a couple of a whities” I think to myself. “Two representatives of the coalition of the willing, who stand sweating by the side of the road.” Despite the fleece jacket and the heat outside this new information gives me shivers down my spine. I just want to crawl back into the van. Maybe hide under the backseat.
International Children’s Heart Foundation and moral speculations
We have come to Iraq as part of a team from the International Children’s Heart Foundation (ICHF) (www.babyheart.org). This organization was founded by Dr. William Novick, a pediatric heart surgeon from Memphis, TN. The aim is to treat children with congenital heart defects in the developing countries and train the local staff so they can, in due time, acquire the knowledge and experience necessary to treat the children without external help. In the year 2011 thirty two missions were organized by ICHF to twelve countries where 450 heart operations were performed. In 2012 the number of operations doubled. I discovered the organizations, like ICHF online and went for my first medical mission to Honduras in October, 2010. Honduras is a poor country in central America that was hit by hurricane Mitch in 1998. Five thousand people lost their lives, 33000 houses and 70% of the roads were destroyed. In the beginning I couldn’t decide wether to join these highly specialized help organizations, or some other that focus on more common health problems. Diseases like congenital heart defects are highly specialized and the treatment is expensive. A heart operation done by ICHF costs on average $2500, which is much more than the treatment of other more common and serious diseases – such as pneumonia, diarrhea and malaria – although, in comparison to the Western world, these operations are relatively cheap.
Back to Iraq
We drive from the guarded guest house, a kind of “safe house”, to the hospital with police escort. Blue lights, sirens and loaded machine guns. I think the escort draws unneccessary attention and people stop in the streets to watch. I would have preferred walking to work. Or riding a donkey. Dressed in burqa. But I get used to the false sense of security and now it’s time to go to work. But it all starts pretty miserably. In the first operation an eleven year old boy dies. He came from the Kurdish region and was basically asymptomatic when he arrived for an operation for a ventricular septal defect and aortic stenosis. The following day a two and a half year old girl is operated for an atrioventricular septal defect. The operation goes well but during the night she develops pulmonary hypertension that does not respond to intensive treatment. Heart operations in the developing countries often pose increased risk in many senses. The children often have lived with their heart defect for a long time which has created additional problems such as pulmonary hypertension (PHT) and since they are often malnourished they are more vulnerable in the perioperative period. Secondly the knowledge and experience of the local staff is limited which increases the risk for mistakes. The general treatment customary in most pediatric intensive care units in the Western world can often not be provided. Medicines such as nitric oxide, used for PHT, and extra corporal membrane oxygenation is generally not available.
After the difficulties of the first days things start getting better. We suffer no major incidents even though two children have to be reoperated. My job is to examine the children pre- and postoperatively, do echocardiography and take part in deciding which child will need an operation this time and which one can wait. It is evident that we are only going to be able to treat a fraction of the long waiting list. We operate on 15-20 children in two weeks, but each year 30,000 children are born in Iraq with a heart defect that will need an operation.
Teaching and training of the local staff is a big part of our job. The doctors usually speak good english but the nurses and other staff usually do not. The nursing staff are almost exclusively men and often they have not chosen their profession themselves. Therefore not everyone is in the profession because of interest or vision which can be reflected in how receptive they are to our teaching. I try to share my knowledge but I also learn a great deal myself. In Western countries congenital heart defects are usually detected in the first months of life and the patients that require surgery are operated within a few months of birth, or before they develop a lot of symptoms. Therefore, we seldom see the longtime effects of an untreated heart defect. For instance, when I was in Honduras I saw a 7 month old child with transposition of the great arteries, which generally is repaired within a few days of birth in the West.
Iraq was never hit by a natural catastrophe like Honduras. Perhaps more like a man-made catastrophy. But the prize was much higher. The tornado Saddam Hussein created didn’t just blow over the country in a few days – he had 24 years to go about obliterating his own people. The only pediatric cardiologist in Nasiriyah – and one of only ten pediatric cardiologist in the whole country of 30 million people – put it rather mildly the other day. He said: “The main problem of this country is that it has never had a decent leader!“ As long as I can remember Iraq has been at war. I remember recurrent news of casualties in the Iran-Iraq war, that led to nothing in a nine years period (1980-1988), than one million fallen soldiers. Next on the program was the invasion of Kuwait in 1990 and ongoing use of chemical weapons against the Kurds in northern Iraq. And then came the invasion of the West in Iraq in 2003 with the unprecedented participation of Iceland as one of the parties in the so called “coalition of the willing”. The last soldiers from that miserable mission left the country about a month before our arrival. I had expected to meet people suffering from post traumatic stress disorder after decades of fighting and fear of suicide bombing, that have escalated after the evacuation of the American soldiers. On the contrary I met positive, smiling and brave people who didn’t look as if they had endured fear, suppression and war for decades. After repeatedly asking a local pediatrician about the effect of the fighting and the insecurity on daily life, he admitted that war had probably become a part of daily life for the Iraqi people. A help organisation member from America, Preemptive Love Coalition, who originally brought ICHF to Iraq, stated that the first months after the invasion in 2003, foreigners were greeted as friends and invited into peoples’ homes, even if they were total strangers. But as the occupation dragged on and there were no major improvements the hospitality of the locals declined. Now they are more careful and avoid associating with foreigners.
But Saddam Hussein can’t proclaim all the honour of Iraq’s miserable health system. In that matter the United Nations (UN) have a heavy cross to bear. Before the year 1990, 93% of the Iraqi people had access to a health system that was among the best in the Middle-East. After the invasion of Kuwait the UN put sanctions on Iraq and as a result the economic status, as well as the health system, plummeted. Saddam Hussein restricted expenses to health system by 90%. Hospitals and outpatient clinics were closed, there was a shortage of medicine and medical equipment and health personnel fled abroad. The incidence of congenital defects escalated as did malignancy amongst children and adults. This is believed to be the effect of the use of chemical weapons against the Kurds in Northern Iraq, where the incidence of congenital heart defects has multiplied. But the sanctions of the UN also directly affected the people’s health status. Child mortality, under five years of age, doubled from the year 1989 to 1999. Many died of hunger. Maternal malnutrition and failing maternal care also increased the incidence of congenital defects. When the willing nations invaded the country in 2003, the weapons were used against the main pillars of society such as roads, power stations, water supplies, sewers and health institutions. So-called depleted uranium was used in the warheads. This is a radioactive metal with a prolonged halftime. The dust from the explosion, which is thought to be carcinogenic, becomes dispersed in the atmosphere and settles in the soil. Thus the incidence of many malignant diseases has increased at the same time that the means for diagnoses and treatment has diminished. Actions, such as the sanctions used by the UN, reflect the deficiency of the organizations, their naive view of the world and the indifference for the real consequences caused by these actions.
End of the road
In our trip to Iraq seventeen children underwent heart operations on defects such as ventricular septal defect, transposition of the great arteries, tetralogy of Fallot, atrioventricular septal defect, aortic stenosis, double outlet right ventricle, subvalvular aortic stenosis, single ventricle and persistent arterial duct. Two children needed reoperation and two children died. A few children that had waited in the hospital for two weeks for surgery could not be operated this time. Hopefully they will be first on the list when the next mission arrives in three months.
Three days before our departure reporters from several TV stations arrived at the hospital. They were informed about the purpose of the mission and interviewed some of the staff. To keep a low profile this was not supposed to take place until the last day. When one of the chief physicians was asked why they had changed the schedule, and if this wouldn’t jeopardize our safety, he replied: “Don’t worry. You are low value targets.”
Early one morning in late January we are two low value targets – one from Iceland and the other from Belarus – sitting in the back of an old van driving along the same pencil mark as before. We are on our way to the airport. It’s still pitch dark and we are freezing in the back. This time I am glad that I brought the fleece jacket with me. The driver is drowsy and it looks to me that he is about to fall asleep at the wheel under a full moon. I keep an eye on him in the rear view mirror. We lag behind the police escort and when we finally catch up with them the drivers get into a heated argument. That’s all good because our man is suddenly wide awake. Gradually the day awakens and the desert sand gets a reddish hue in the morning sun. The Iraqi nation is at a crossroads. In some aspects it is like a man waiting by the side of the road in the desert. The invaders are gone, at least for the time being and the people have their own government and president. However, down under is disagreement and hatred between groups of Shia muslims, Sunni muslims and the Kurds, that has been boiling for centuries. I certainly hope that the people will make the right decisions and choose to have peaceful communications with their fellow countrymen and neighbours. And also that the nations that represented the coalition of the willing, now live up to their expectations and prove that the reason for the invasion in 2003 was really concern for the Iraqi people and not something completely different. That can be done by supporting help organizations like the International Children‘s Heart Foundation in this war-torn country.
“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.
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.
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.