Children’s Hospital International Services

During a surgical trip to Guatemala City in 2008, Steve Goudy, M.D., a surgeon at the Monroe Carell Jr. Children’s Hospital at Vanderbilt, evaluated Marleny Fabiola Lainez Ambrocio. Marleny is a 14 year old girl from San Marcos, Guatemala. Marleny was born with a large mass that expanded into her sinus creating an obvious cosmetic deformity and disrupting her ability to eat.

Without treatment, the mass would slowly enlarge and cause further deformity, prevent her from eating normally, and impede her ability to function in society.  Due to the large nature of her mass and need for reconstructive surgery, it was determined that Marleny needed to travel to the United States for her treatment.

Marleny with her parents

The Monroe Carell Jr. Children’s Hospital at Vanderbilt and Marleny’s doctors donated the surgery and treatments.  Her care was provided by Steve Goudy, M.D., assistant professor of Pediatric Otolaryngology; Christopher Wootten, M.D., assistant professor of Pediatric Otolaryngology; Louise Mawn, M.D., assistant professor of Ophthalmlogy and Neurology; and Kathryn Carlson, M.D., assistant professor of Pediatrics.

The Shalom Foundation, a non-profit organization, sponsored Marleny’s trip from Guatemala and assisted with living arrangements while in Nashville. 

Marleny had surgery on March 25, 2010, and was well enough to return home to Guatemala on May 27.

Dr. Steve Goudy M.D. explains the procedure to Marleny

Kate Carlson, Marleny and Marleny's Mom

Thursday was our last day of surgery. We had prepared to operate on eight patients, but unfortunately three did not show up.  In total, our team performed surgery on 35 Guatemalan children.  Without our weeklong visit, the patients would likely have had to wait several months, or even years, before having their surgical needs addressed (if ever).  Our team is proud of the work we’ve done. While we’ve helped to improve the lives of several dozen children and their families, we have received just as much, if not more, in serving them. Today is our last day in Guatemala City. 

 Click here to see a slideshow of pictures of our team in action.

It’s Tuesday, the second day of operating, and our team has been extremely busy.  By the day’s end, the team completed 12 surgeries.  Nine procedures were originally scheduled, but three were added because new children came to the waiting area of the hospital seeking help.  Although the children missed the clinic screening visit on Sunday, Morrow and Neblett agreed to take a short break between cases to evaluate the children’s conditions.  Those in need of surgery were added to today’s schedule.

It seems as though everyone has been on their feet all day – constantly receiving new patients, reassuring fearful children, and communicating, by translation, with anxious family members. Every member on our team seems to be emotionally vested in our work here.  I am admittedly awestruck by our team’s composure.  Each person is playing a vital role in changing young lives for the better — and it’s all in a day’s work.  With a full caseload, Keith Lee, scrub tech, Kay Moss, scrub tech, and Veronica Ross, L.P.N., have been working tirelessly to turn over the operating rooms after a surgery has been completed.

This morning our team leaders, including Neblett and Lemelle, and Merewyn Chambers, R.N., as well as Morrow and Carlson, video-chatted with leadership at Children’s Hospital.  While the video-chat was underway, as you can see by the picture below, work continued for other members of our team.  It is now 3:55 p.m., and two cases remain.

In the picture below are Lemelle, Roni Nylander, C.R.N.A, and Julia White, R.N., consoling Manuel, a 4-year-old boy about to undergo surgery to remove a dermoid cyst.  The caring nature of the Vanderbilt staff in the picture is evidenced by Manuel’s embrace.

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.”