Children’s Hospital International Services

Today was our first day of surgery.  We arrived at the hospital at 7 a.m. and immediately began preparing for the patients. We are occupying two operating rooms, one is staffed by Wallace Neblett, M.D., Andrew Murphy, M.D., Chris Karsanac, M.D., Melanie Francis, C.R.N.A., Merewyn Chambers, R.N., Veronica Ross, L.P.N., and Kay Moss, scrub tech. The other is staffed by Stephen Morrow, M.D., Julia Shelton, M.D., Chris Lemelle, M.D., Roni Nylander, C.R.N.A., Julia White, R.N, and Keith Lee, L.P.N.

The first surgeries began at 8 a.m..  Neblett’s first patient was Micaela, a 9-year-old girl who had two lymphatic malformations on the right side of her neck.  Drs. Neblett and Murphy worked diligently to tie off the lymphatic channels in communication with the tumors, to ensure no leaking would occur after the masses were removed.

After completing the procedure, Micaela was moved to the recovery area and placed in the care of Summer Bartz, R.N., and Juli Reynolds, R.N. Neblett went to the waiting room to share the surgery’s success with Micaela’s mother.  Her mother was extremely apprehensive because, in Neblett’s words, “not only had she traveled a long way with her daughter to get help in a place that was strange for her, but also she did not speak the local language.”

With help from Carlson, who speaks Spanish, Neblett’s message was translated from English to Spanish, and then Spanish to Quiche (with help from a local translator).  Once the phrase “it was a success” was understood, Micaela’s mother immediately began crying and expressing her sincere gratitude.  Carlson admits it was a very touching moment.

“I fought back tears.” she explained.

Jazmina’s surgery was next for Neblett’s OR team.  Jazmina is a 21-year-old woman who was in serious need of a colostomy reversal.  When Neblett and Murphy screened Jazmina in clinic on Sunday, they learned she had been injured by a stray bullet at age 16.  The injury resulted in a colostomy, and because she had been unable to obtain proper supplies for her colostomy, she was using grocery bags to collect her stool.  According to Murphy, the surgery will drastically improve Jazmina’s quality of life.

Morrow’s OR team performed five cases and Neblett’s team performed three.  Our team is noticeably tired after a long day’s work.  We’ve just finished preparing the operating rooms for tomorrow, and are about to load the bus and make our way back to the hotel.

Dr. Neblett, Dr. Murphy (assisted by Kay Moss) performing surgery on Micaela.

Our team has been very busy since arriving on Saturday afternoon.  While I know Guatemala is a developing country, the critical need became clearer when our plane began its descent.  The widespread poverty in Guatemala City was evident even before landing at the airport.  As our team unloaded from the plane, a Guatemalan man stopped and expressed his appreciation for us coming “to help his country.”  We are happy to be here to lend an able and helping hand.

After getting through customs smoothly, thanks to the help of Maria Jose (of The Shalom Foundation), we filed into a van and made our way to the hotel.  We unloaded our bags and medical supplies and then were taken to see The Shalom Foundation’s Moore Center for Children’s Health, currently under construction and scheduled to open sometime in 2010.  We then gathered back at the hotel for dinner and some much needed rest.

This morning the group split into two groups. One team, including Merewyn Chambers, R.N., Kay Moss, Keith Lee, Veronica Ross, L.P.N., and Julia White, R.N., Melanie Francis, C.R.N.A, and Roni Nylander, C.R.N.A, helped to set up the operating rooms in preparation for a long week of surgeries. The remainder of the team, myself included, went to the clinic to assess and screen patients.  As we walked into the clinic and began setting up our work stations, the clinic waiting room quickly filled.

Thanks to guidance from our team leaders, we were able to quickly identify a patient flow system: a child would be called for assessment and vital signs by Summer Bartz, R.N., and Juli Reynolds, R.N.  After gathering their blood pressure, temperature, etc., the child would then receive an evaluation from either Drs. Stephen Morrow, Julia Shelton, and Kate Carlson, and a Guatemalan medical resident, or Drs. Wallace Neblett and Andrew Murphy, and a Guatemalan medical resident.  If it was determined that the child was a surgical candidate, he or she would then meet with either  Chris Lemelle, M.D., or Chris Karsanac, M.D., both anesthesiologists.

Of the 35 total patients screened in this manner, 32 are scheduled to have surgery.  Types of procedures the team will be performing include hernia removals, circumcisions, facial masses and cyst removals, orchiopexies, a lymphodemia incision and a colonostomy reversal.  The many families we met in clinic were very warm and kind – it’s obvious they are grateful our team is here to help the children in need.

Tomorrow our team will perform eight surgeries.

Now that we’ve returned to the hotel, everyone is gearing up for our team Super Bowl Party, to take place in the hotel lobby (the team seems evenly divided between the Colts and the Saints – go Colts)!

A very full clinic

Kate Carlson, M.D., general pediatrician, and Julia Shelton, M.D., general surgical resident, with Sharly, who is scheduled for surgery later this week.

After each patient was screened, the physicians and PACU nurses created the surgery schedule for the week.

For the sixth time since 2006, Monroe Carell Jr. Children’s Hospital at Vanderbilt is sending a team of Vanderbilt faculty and staff members to perform general surgeries on impoverished children in Guatemala City, Guatemala. This will be the first time that a general surgery team will make the trip. 

Led by Wallace Neblett, M.D., and Chris Lemelle, M.D., and nursing team leader Merewyn Chambers, R.N., the team will arrive for the week-long stay in Guatemala City on Feb. 6. 

Other team members include: Drs. Stephen Morrow, Chris Karsanac, Kate Carlson, Andrew Murphy, Julia Shelton; and Roni Nylander, C.R.N.A., Melanie Francis, C.R.N.A., Julia White, R.N., Veronica Ross, L.P.N., Kay Moss, Keith Lee, Juli Reynolds, R.N., Summer Bartz, R.N., and myself, Caroline Hale, the project coordinator. 

Also joining the Vanderbilt team is Cindy Bhavsar, program director for the Shalom Foundation, which is our wonderful partnering agency.  I plan to share with you daily the highlights of our team’s experience, so please check back frequently for updates! 

Wish us luck!

There were lots of smiles, hugs and handshakes exchanged. It was a day 10-year-old Cristian Chavez and his mother, Maria, had waited years for: finally learning that Cristian’s damaged heart was healed.

On Monday, Nov. 30, after a quick examination of the scar indicative of open heart surgery that runs down Cristian’s chest, pediatric cardiologist Donald Moore, M.D., happily declared, “it looks perfect.”

Nearly three weeks earlier, Cristian underwent eight hours of complex surgery to repair a heart defect he was born with. Called Tetralogy of Fallot, the defect is a combination of abnormalities that affect the structure of the heart and its outflow to the lungs.

Left untreated, Cristian would have experienced progressive loss of oxygen and, eventually, early death. Cristian already was unable to keep up with his seven brothers and sisters, and did not have the energy to play with his friends.

Cristian is from Puerto Cortes, Honduras, the most important port in Central America. His mother stays at home with her children, and his father works in construction. When Cristian was 3 months old, his mother took him to see the doctor because he had a fever and cough. At that time, the doctor told her that there was something wrong with Cristian’s heart.

Click here to read more about Cristian and see a slideshow of his time at Vanderbilt.

A team of 16 pediatric surgeons, anesthesiologists, nurses, residents and staff traveled to Guatemala City on Sept. 19 to perform urologic surgeries. The trip marked the fifth time faculty and staff from the Monroe Carell Jr. Children’s Hospital at Vanderbilt have traveled to Guatemala to perform surgeries through a partnership with The Shalom Foundation. In a 5 day-span, 50 surgeries were performed on children in need.

John Pope, M.D., associate professor of Urologic Surgery and Pediatrics, and Chris Lemelle, M.D., assistant professor of Clinical Anesthesiology, were co-team leaders.

Urology Surgery Team, September 2009

Maria Jose de Gallardo, the program director for Guatemala at The Shalom Foundation got to catch up with Joseline, the cherubic toddler who had a massive growth removed from her neck here last summer.

When de Gallardo first met Joseline during a medical mission trip, she learned Joseline had the growth since birth. Sacs filled with lymph fluid grew steadily over the years until the growth was so large it began to affect her ability to eat, play, and sometimes even breathe normally.

“It had become so heavy that when she played, she tilted toward that side, and she stopped turning her head so much,” de Gallardo recalled.

Steve Goudy, M.D., assistant professor of Pediatric Otolaryngology at the Monroe Carell Jr. Children’s Hospital at Vanderbilt, agreed to do surgery since all other efforts to reduce the growth’s size had failed. The Children’s Hospital agreed to donate almost all the costs involved, with the Shalom Foundation picking up the rest, and arranging for Joseline’s transportation to the U.S., and her accommodations with volunteers while she and her mother, Veronica, were here.

The last time Goudy saw her was in September just before Joseline and Veronica headed back home. de Gallardo returned to Guatemala City as well. She lives there with her family, working with the Shalom Foundation long distance most of the time.

This past week, de Gallardo decided to meet with Veronica and Joseline for a shopping trip.

Joseline, her mother Veronica and Sofia, de Gallardo’s daughter

“My daughter, Sofia, needed supplies for her pre-school class and so we arranged to meet a mall close to where Veronica lives,” de Gallardo said. “Joseline was shy at first, as she always is, but I was struck by how much she has grown. She is now starting to say more words and communicate easier than before. She has gained weight; her cheeks have filled out, even her hair looks better. She just looked so healthy.”

de Gallardo invited Veronica and Joseline, who will turn 3 in May, to come home with them for doughnuts.

“She went on a ride on Sofia’s scooter.  I got her on it and pushed her slowly because she is still tiny, we have a wide street so she was very happy to play,” de Gallardo said.

And de Gallardo’s involvement through the Shalom Foundation will continue. Goudy had told the family that says if they want more cosmetic surgery in future, they could do a follow up procedure. For now, she is being seen by local physicians, and Veronica has just asked for a summary of her case from Goudy. Once de Gallardo receives it, she will go over what it contains with Veronica so she can share it with Joseline’s local physician.

“Joseline’s whole family is doing much better. Veronica feels more confident that Joseline will be ok, so that she is now looking for a job to help her family’s income. It was a life changing experience for their entire family and an amazing life story that I was blessed to be part of.  We are grateful to God and to the combined efforts of the Children’s Hospital and The Shalom Foundation,” de Gallardo said.

Added Goudy, ”The whole medical team that cared for Joseline here at Children’s Hospital is thrilled that she is doing so well. It is a testament to the resilience of children and shows how much can be accomplished by a community effort.  We are hopeful that she will be able to integrate easily into the age appropriate activities, with school not too far off. On future missions we hope that we can monitor Joseline’s progress. We are all very proud of how far Joseline has come.”  

Today’s schedule for the mission team was very busy.  Eight surgeries were performed and there were no cancellations for the first time this week.  There were two cleft palate surgeries, three cleft lip surgeries, one scar revision, one frenulectomy (tongue tie release) and an excision (removal) of a cyst.  All patients recovered successfully and discharged to the inpatient unit.  Dr. Goudy was also able to see Josie today.  Josie’s family brought her to the hospital so that Dr. Goudy could see her before he left Guatemala.  Josie’s condition continues to improve and her family is very pleased and thankful for the care she received from Children’s Hospital physicians and nurses.  The team will visit El Nino Jesus one more time tomorrow morning to ensure that all patients are doing well and can be under the care of the local pediatricians. 

The last thing on our agenda at the hospital was to pack up the supplies for transportation back to Children’s Hospital.  Many hands made work light and we were able to secure all instrumentation, etc. for the plane ride back to the United States. 

Every team member was proud of their contribution to the work that was done at El Nino Jesus this week.  27 cases were completed successfully.  Good relationships were formed with the pediatricians as well as the nursing staff.  Several El Nino Jesus staff members requested that Children’s Hospital mission groups come back to Guatemala and hopefully very soon.  All of us will never forget the beautiful children that we were allowed to participate in the care of.  The staff who didn’t necessarily know each other very well were able to come together as a team under some very difficult conditions.  They were able to many surgeries and even perform a successful resuscitation.  Congratulations to everyone who participated and many thanks.  Many thanks also to the administrative staff who arranged this blog on the Children’s Hospital website.  I am hopeful that this blog helped every staff member’s family.  One picture says a thousand words!  Adios amigos and hasta la vista…baby!

The ENT mission team started the day with good news.  Baby Maria, who had been transferred to the government hospital the day before, had a good night.  She was to be discharged from the hospital later today.  The news lifted the team’s spirits as they prepared for the upcoming surgeries. More illness caused a cancellation of one of the cases, two patients never arrived at the hospital and one patient had an NPO violation (the patient ate or drank before surgery). It sounds like a typical day back in our home operating room, doesn’t it? 

We were able to complete six surgeries. Three surgeries involved repairing cleft lips, and the other three were oronasal and plate fistulas.  All patients were discharged successfully to the nursing unit on the third floor. 

The team was finished a little early today and decided to get some R and R.  Some members of the team (all of the girls) decided to walk a couple of blocks from the hotel to explore a Guatemalan shopping mall.  They were surprised at the sheer size of the facility.  It was four stories and had lots of American type stores.  There was even a McDonald’s at the mall!  It struck the team as odd that there was such a modern facility in the midst of the extreme poverty that we have seen around the rest of the city.

There are eight cases scheduled for tomorrow.  We are hoping that the illness that seems to be prevalent among some of the children doesn’t affect any more patients.  Stay tuned….

The ENT mission team started the second day of surgeries without one of the surgeons.  Dr. Cofer developed a viral illness and had to stay in bed for the day.  Drs. Goudy and Wittkopf stepped up to this challenge and worked with Dr. LeMelle to coordinate a schedule that would accomodate all of the patients who had been originally scheduled.  As the team began preparing the O.R. we were informed by the El Nino Jesus staff that two of the patients would not be coming that day because they had fever.  Later in the day two more patients failed to show- also because of fever.  Another patient showed up at the hospital and we were able to operate on him.  In total, five cases were done- three cleft lips and two cleft palates.  One of the cleft lip patients had been discharged from the PACU to the floor and developed a complication requiring emergency resuscitation by the team.  The Guatemalan physicians ran with the baby from the floor to the PACU where the baby was successfully resuscitated.  The hospital physicians were uncomfortable leaving the baby on an unmonitored bed for the night, so they transferred the baby to a government hospital by ambulance.  There are nine cases scheduled for Wednesday.  The team hopes to be able to complete all of these surgeries without as many changes to the schedule!  Stay tuned….

filed by Lori Graves, R.N.

The surgeons on the ENT team performed eight surgeries today.  Three palate surgeries, two cleft lip surgeries, one hemangioma (benign blood vessel tumor) removal and two frenulectomies (releasing “tongue tie”) were completed.  One surgery was cancelled because the patient had fever. 

The team was able to function smoothly and really didn’t encounter any major obstacles.  Two of the patients were able to go home the same day, with the rest of the kids spending the night in the hospital.  The children are monitored very carefully by the mission staff as well as the hospital staff when they are transferred to the floors for care. 

The Guatemalan pediatricians are very careful not to discharge patients prematurely as the family could encounter great difficulty when attempting to return to the hospital.  Most of the patients come to the hospital by city bus and that is not always the safest and most reliable transportation. 

    
Postop patients

After the final hospital rounds were made by the surgeons and the anesthesiologists the ENT mission team were given a special dinner sponsored by the Pediatric Foundation of Guatemala at Los Cebellos.  The team was greeted by the Shalom Foundation Medical Director and two physicians employed by the Shalom Foundation.  The food was very good and included the best guacamole that we have had yet on our trip.  

One of our team members was surprised by the restaurant staff singing Happy Birthday to him and placing a large sombrero on his head.  The only problem was that it wasn’t his birthday and therefore he was quite surprised.  The restaurant staff are very enthusiastic about birthdays and gave Dr. Watkins a very nice photo of this event.  Maria Jose (Shalom Foundation staff member and interpreter) explained to Dr. Watkins that this was his welcome to Guatemala!  Tomorrow there are eight scheduled surgeries.  These will be similar to the cases done today.  The team will continue to work with the El Nino Hospital staff to continue to ensure the success of the mission.

 
A very tired crew!