HEAVY BUT HAPPY HEARTS

As we wrap up our mission here at the Hospital del Ninos Bustamante, our hearts are heavy. Heavy with relief, joy, sadness, and every emotion that we have felt over the past two weeks. We have watched as a heart surgeon hand massaged a babyʼs heart and started it beating again. We have witnessed a mothers' pure joy when she heard that her child who had no chance of survival without surgery had come through the surgery. We have experienced crushing sorrow when we lost little Mateo, a six-month old baby with severe heart disease. And we rejoiced when Richard didn't lose his battle and rebounded from critical condition to live another day.

These are the daily milestones we live for and fight for. These children are who we work for. These are the parents who are our heroes. This is why MKI exists.

We would like to thank all those that make this happen. We have doctors and nurses from all around the world helping us; volunteers; local nurses and doctors; many government officials in Ecuador; the staff and management of Hospital del Ninos Bustamante; our MKI staff; and the Fundacion El Cielo Para Los Ninos Del Ecuador and many, many others.

Most importantly, we would like to honor the people of Ecuador for giving us their faith; welcoming us to their country, trusting us with the lives of their sick children, and allowing us the awesome responsibility of performing surgery on them. And to think...they thank us.

Gracias mis amigos. Vaya con dios.

CON PESAR, AUN CUANDO NUESTROS CORAZONES ESTAN FELICES

Al terminar nuestra misión aquí en el Hospital de los Niños Bustamante, nuestros corazones están apesarados. Apesarados por el descanso, alegría, tristeza, y otras emociones que hemos sentido durante las últimas dos semanas. Hemos observado a un cirujano masajear el corazón de un bebé y hacerlo latir de nuevo. Hemos sido testigo de un niño desahuciado por falta de cirugía y de la alegría de su madre cuando escuchó que la cirugía lo había slavado. Hemos sentido un gran pésame al perder al pequeño Matéo por su enfermedad del corazón. Y nos llenamos de alegría cuando el pequeño Richard no perdió su batalla y se recobró de su condición crítica.

Estos niños son nuestras metas diarias por las que vivimos y luchamos. Trabajamos por ellos. Ellos son los padres heroicos. Es por eso que MKI existe.

Queremos dar las gracias a todos los que hacen ésto posible. Tenemos enfermeras y doctores de todas partes del mundo ayudándonos, voluntarios, enfermeras y doctores locales, muchos oficiales de gobierno del Ecuador, los empleados y jefes del Hospital de los Niños Bustamante, nuestro cuerpo de MKI, y la Fundación El Cielo Para Los Niños del Ecuador, y muchos, muchos más.

En principal, queremos honrar a la gente del Ecuador por su fe en nosotros, por acogernos en su país, por confiarnos con las vidas de sus niños y permitrnos la gran responsabilidad de ejecutarles cirugías. Y pensar ... que ellos nos dan las gracias.

Gracias, amigos. Quédense con Dios.

Photos by Juan Ramirez

Our Party

Today is our last day in Guayaquil, but the work that MKI and ICHF did will last forever in the lives of the children that we have saved.  We will be back becuase we are not only here to save lives when we're on a mission, but we're here to help the local Ecuadorian doctors save more lives on their own.

ICHF Nurse Frank, told us how at his UK hospital there are about 100 PICU nurses who cover about 600 pediatric cardiac surgeries a year--so each nurse covers about 6 surgeries.  Well the four nurses at Hospital del Nino Bustamante covered 27 surgeries these past two weeks--meaning this intensive experience equals years of learning in only weeks. 

So we celebrated MKI saving lives and supporting the local healthcare professionals today at a wonderful half-day long party.  

OR Update
Dr. Gilbert and his surgical team are doing one more TOF surgery this morning at Hospital del Nino Bustamante.  That surgery will make it a total of 24 surgeries performed by MKI and ICHF in these last two weeks.

PICU Update

The team is doing a great job watching over the last couple patients in the PICU.  Right now we have three young babies who are being cared for by Dr. Vohwinkel, Nurse Frank and Nurse Michelle.  Dr. Clark pulled another 24 hour shift in the PICU that ended this morning.  And Dr. Vohwinkel volunteered to stay another three days, until Monday, to watch over the babies recovering.

Recovery Update

Stephanie was moved up to the Recovery room.  Scarley is doing well and her sister is staying by her bedside.  Richard is up and moving and giving away fresh strawberries to staff and other patients as a way to say "thank you."

Baby Justin is recovering and lit up when MKI Interns Jeremy and Jordan came in to say "hi" this morning.  

OR Update
MKI patient, Carlos, just successfully had his aortic valve repaired and is resting in the ICU at Clinica Guayaquil.  He'll stay at this ICU for two days or until stable and then he'll be transferred to Bustamante del Nino Hospital.

The surgical team was pleased with Carlos's results.  They took a moment afterwards to take pictures in the doctor's lounge to celebrate the occasion of MKI working with both Clinica Guayaquil and Hospital del Nino Bustamante.  Then the surgical team took a short break for lunch and just went back into the OR for another surgery--the second aortic valve repair for today.

MISSION UPDATE
We had an early morning today.  Our team had to gather our medical gear at Hospital del Nino Bustamante and travel to Clinica Guayaquil (the oldest private hospital in the city) in order to set up a new OR today for surgeries.  Clinica Guayaquil has been supporting our mission at Hosiptal del Nino Bustamante for the past week and a half by lending equipment and monitoring machines for the PICU room.  They extended their support today, by inviting Dr. Chris Gilbert and his surgery team to perform two surgeries on MKI patients.  The transition this morning was seamless.  MKI travels light and fast!  We packed up suitecases with the necessary sutures, gauzes, sterile equipment, and loaded the buses; 45 minutes later we were setting up in our new OR and our first MKI patient of the day, Raphael, was being wheeled into the OR.

PICU UPDATE

Our team is split up, with the ICU team staying at Hospital del Nino Bustamante and the surgery team coming to Clinica Guayaquil.  But with donated walkie talkies and cellphones, we're easily keeping track of the two operations.

RECOVERY ROOM UPDATE

The kids are doing well.  Genesis is running around.  Richard is up and walking around.  Our MKI Interns, Jeremy and Jordan, will be playing with the kids later today and getting them ready for our big party tomorrow.

A New Opportunity
Another hospital in town, Clinica Guayaquil, has been a key player in the success of our mission here at Hospital del Niño Bustamante.  Their Medical Director, Roberto Gilbert, M.D., no relation to our Dr. Gilbert, has kindly requested our assistance with two children who are MKI children but who were not on our surgical schedule.  Our Dr. Gilbert has agreed to perform two surgeries tomorrow at Clinica Guayaquil with Dr. Roberto Gilbert.  Our PICU is practically overflowing with recovering children and we are nearing the end of our mission here.  We have no surgeries scheduled for Friday and perhaps one more child for tomorrow.  So Drs. Gilbert will work in tandem to save two more precious lives at Clinica Guayaquil.

OR Update

During lunch, Dr. Gilbert told Beth (ICHF Intern) that we are still on for four surgeries today.  But it looks like the PICU needs to get some additional equipment or one of beds need to become available.  

PICU Update

The hospital team added a seventh bed into the PICU in order to care for the next couple surgeries, but we are still short the monitoring equipment, so things are a bit up in the air this afternoon.  Other than bringing in more beds and looking for equipment all the kids are doing well.  Geovanny is up and was receiving a back massage from a local nurse in order to ensure that his lungs are functioning well.  Below is a video.

Recovery Room Update

The kids are looking great.  Below is a great video of Genesis walking around.  Genesis is the girl who amazingly quickly recovered after complications with her surgery required Dr. Gilbert to come back into the OR and fix her pulmonary artery that was leaking.

OR Update
We might only do three surgeries today instead of four.  Dr. Gilbert is concerned that there is not enough room in the PICU--our beds are nearly full.  Will keep you posted . . .

Electricity Went Out
The electricity went out this morning, but the back-up generators kicked in.  Ray, our Bio-mechanical Engineer, explained that this hospital, like nearly every other hospital, not only has on-site generation but two sets of outlets.  The dark orange or red outlets run regardless of municipal power and the white outlets are tied to general power sources.

PICU Update

Geovanny is doing well.  Here is a short video of a local PICU nurse massaging Geovanny's back to make sure that his lungs are properly draining.

All is well this morning mid-week through the final week of our time in Guayaquil, Ecuador.

OR Update

Today we are doing four surgeries!  This is the most we have done in a day and it's due to the hospital's strong support for our mission.  The hospital has brought an additional cardiovascular perfusionist, and anesthesiologist to support Dr. Gilbert.  Additionally they have opened a second OR room, so Dr. Gilbert and his team can quickly move from one completed operation to the next.  

PICU Update

The beds are still full.  We have a short 20-second video below showing Jose and Stefanie, both teenagers, resting.  

Recovery Update

The evening went well. . .  all the kids are feeling stronger.  Richard is walking around a lot.  Amazing -- Richard was brought in last Monday in critical condition.  He suffered through a 12-hour car ride with his father to get to Hospital del Nino Bustamante because they knew Mending Kids' doctors were here. We'll have pictures and video of Richard later on.

Examination Room Update
For the past six days that we have been seeing patients, we often tell parents that their children either need surgery now or they will need surgery when we come back on the next mission.  But today, we had a wonderful experience when two families who were told by local doctors that their children needed surgery, were then told by our doctors that their children would be fine -- no surgeries required.

Tomorrow, we'll post video about the powerful conversations we had with the kids' families.

Operating Room Update
Today, Dr. Gilbert and his team were scheduled for four surgeries, but it looks like we're just going to be able to do three--still an awesome feat.  They operated on Nayeska, a 9-month old girl; Stephanie, a 12-year old girl; Jose a 13-year old boy, who waited through four other MKI missions until he was finally selected; and the last surgery scheduled was Steven, a 7-year old boy, who will likely be rescheduled for tomorrow.

PICU Update
Dr. Clark reports that all has gone well today.  All five beds in the PICU are full.  The room is buzzing with all the monitoring machines blinking and sounding off.

Recovery Room Update
Today MKI intern's Jeremy & Jordan spent most of the day playing with the kids recovering.  Jeremy remarked that the recovery room was pretty quiet when they got up there in the morning, although it was full.  But within minutes, Jordan and Jeremy really pumped the place up--playing board games with the kids, playing a couple movies on a loaned iPad and generally goofing around and having fun.

Update: Dr. James Performs An Echocardiogram on Geovany

Dr. James just performed an echocardiogram, and everything is "as to be expected."  Below is Dr. James monitoring Geovany's heart rate.

Right now the ICU is nearly full, and there is at least one other surgery happening today.

14-Month Old Geovany Is Re-Intubated

Yesterday, 14-month old Geovany had a BT shunt and pulmonary artery band procedure.  He was taken into the ICU after surgery.  In the afternoon they extubated him (e.g. taking out his breathing tube and drainage tube), but a couple of hours after these tubes were removed they had to re-intubate him.

Dr. Clark explains that Geovany's body was producing too much acid after extubation and that's why the change was made.  He says that Geovany will be fine, but that they just needed his body to be better supported.  All a part of the process of mending hearts –– and kids.  Stay tuned for further updates on Geovany's progress.

Nayeli's Surgery

After Waiting Five Years, A Little Girl Can Live Normally

Nayeli, a beautiful 7-year-old girl, lives with her family in Manta, Manabi, a town on the north west coast of Ecuador. Since she was 7 months old, when Nayeli was diagnosed with Tetralogy of Fallot, she has been waiting for surgery. On Sunday, she traveled 4 hours in a bus with her family to Hospital del Nino Bustamante, even though they did not know if she would be accepted into surgery.

As her mother told us, “she and her family only had hope.” When they came into the hospital and MKI’s team saw Nayeli, her smile was contagious. You’ll see her infectious smile in the video below, after she has had surgery and is receiving another echocardiogram.

At home in Manta, Nayeli use to have a dog named Negra.

But because of her health, the local doctors advised her that she should give Negra away. Having a heart that poorly circulates her body’s blood for it to be oxygenated, has not just taken a toll on her health but has taken away precious childhood experiences.

She told us that she always wanted to be a normal kid and do things like run, play soccer, and swim; but even walking for a short period of time, left her feeling tired and needing rest.  Dr. Gilbert is optimistic about how much Nayeli’s health and quality of life will improve after the surgery.

As with so many other pediatric cardiac cases, Nayeli’s condition was diagnosed when she was a baby and the local doctors told her family that she would have to wait at least five years for an operation.  Operating on infants is more complicated and requires Pediatric Intensive Care Unit (PICU) resources that MKI brings along on these types of surgical missions. And these are the types of resources that MKI is helping the local doctors develop for themselves, so that other children will not have their surgeries delayed like Nayeli.

After surgery she is feeling a lot better—breathing

is easier, she is able to stand up without shortness of breath and she is looking forward to becoming strong enough where she can play with her friends and family. Having traveled hundreds of miles from the coast of Ecuador on the faith that she would be selected to have this life saving surgery, Nayeli and her mom are looking forward to going home.

Her mom said that she is “grateful to the doctor and everyone who helped. It is a miracle that she will grow up a healthy girl now.”

-Zak Kidd

Years of Waiting Come To An End: William's Surgery

William is seen by Dr. James and Dr. Chris.

William and his family traveled four hours on a rocky road from Manabi to Guayaquil's Bustamante Children's Hospital.  They drove to Bustamante because William had been diagnosed with a heart defect when he was three years old, but the local doctors offered few solutions.  The result of the heart defect was that he tired easily and had not been able to keep up with his friends at home.  Unlike most children, William has never played a full game of soccer or run down the street at full pace.  During the car trip, William's mother thought that this might be the only chance that her son could live like a normal boy.  

When MKI first saw William in the hospital's hallway, it was immediately clear that his blood was poorly oxygenated because of the blue tint in his fingers and toes.  The question for the medical team, was not if William had a heart defect (that was obvious), but rather if his heart defect was operable.

William hours after surgery

As it turned out, he had a Tetrology of Fallot a very serious condition.  If untreated, 30% of children will die within 6 months, 50% will die within 2 years, and less than 10% will reach the age of 21.  Luckily this is an operable condition.  The procedure would resolve four different heart defects; a stenosis (or hardening of the arterial wall), an interventricular communication (or a hole that allows for blood flow to go between the left and the right ventricles), deviation of the aorta from left to the right, and in the right ventricle, hypertrophy (hypertrophy is a thickening of the muscle wall due to overuse).

The surgery begins with the cutting the sternum, where the rib cage falls to the sides, and the surgical team exposes the beating heart.  The team then works in concert with the profusionist and the anesthesiologist to stabilize the body.  First the anesthesiologist monitors the heart and lungs before the patient is put onto the bypass machine.  The surgical team begins to connect the bypass machine to the vena cava (where blood normally enters the heart) and then the bypass machine is connected to the aorta (where blood leaves the heart).  At this point, the heart is bypassed and the profusionist is operating the bypass machine to keep William alive.  The aneshesiologist is still responsible for the analgesic (pain killer) and aneshetic (sedation) drug administration.

 Beth, ICHF Intern, with William after Surgery

Dr. Gilbert successfully led the three hour operation.  William came into the ICU Monday early afternoon and in the early evening was extubated, where the respiratory tubes and drainage tubes were removed.

William is now resting on the hospital's fifth floor, and with his heart properly functioning he has lost the blue tones in his skin.  Early next week, William will be traveling back to Manabi where he'll grow stronger and soon play a game of soccer.

-Zak Kidd

Hospital del Nino Bustamante's First Pediatric Open Heart Surgery

Kenny's Successful Surgery

Kenny who is 4 years and 9 months successfully had open heart surgery where his Atrial Septal Defect was closed with sutures.  Dr. Gilbert performed the three hour surgery that was also the first pediatric open heart surgery at this hospital.

Frank & Erin Consulting Before Surgery

Kenny's Mother

Kenny's heart challenge was that he not only had an Atrial Septal Defect he had a left Superior Vena Cava.  To treat Kenny, Dr. Gilbert closed the Atrial Septal Defect with sutures allowing for oxygenated blood to flow into the left ventricle.

Kenny is from Cantonoboro, Ecuador. Cantonoboro is an hour and a half away from Guayaquil.  His mother accompanied him, and waited patiently in the hallway as the medical team operated.

Kenny's Story

Kenny hours after surgery

Kenny was diagnosed when he was 9 months old and was recommended to see a cardiologist that diagnosed him with tachycardia. However, when he came to Hospital del Nino Bustamante he was diagnosed with a heart murmur and was prescribed medication that did not help.  In May 2010 Kenny learned that  surgery was the only option to correct his condition. Kenny's mother learned about our medical team on TV and during the May surgical mission,  it was determined that Kenny's surgery required additional time and that he would be put on the wait list for the August mission.  His mom told us that she was surprised when she learned only on Sunday that Kenny would be operated on Monday--the first patient for this mission.

Kenny's Outcome

Kenny Blowing Bubbles

This morning, two days after surgery, Kenny was well on his way to recovery, eating and even walking.  His mom fed him solid food, and he even gave our intern, Julia Terk, a small picture--this made her day.

Kenny should be heading home, back to Cantonoboro in the next couple days.  Check back with us to find out about his progress. . .

Our first full day--touring the hospital

Dr. Chris Gilbert, from International Children's Heart Foundation, leads the surgery team along with Dr. Jorge Crespo who is the local cardiac surgeon.   Starting with a 7 am breakfast, we headed to the hospital with more than 30 large boxes in tow carrying medical supplies from the US.  Erin Brenner, our lead OR Nurse, brought sutures and other expensive medical supplies donated by US hospitals.  Other supplies were coordinated by Zorayda, our local medical coordinator.  The hospital took the delivery of the supplies so seriously that after we stored them in one of the two ORs we're using, the hospital staff changed the locks on the door and gave our team the keys without any other staff keeping copies.

After supplies were couriered to the second floor OR, we began a hospital tour.  The Ecuadorian government has a new initiative to upgrade the public hospitals, committing more resources and capital to improving the quality of care.  Caren, MKI's Mission Coordinator who arrived in Guayaquil several days before the entire group, told us that most of the hospital was repainted, small repairs made, and a general scrub down of the facility was done.  This work was evident when we came into the recovery room where they had emptied out 14 beds, all for MKI patients that are being treated over the next two weeks.

Last week there was a 7.2 earthquake though, and although there was no structural damage to the hospital, the elevator, the only elevator, stopped working.  They repaired it, but like I would learn soon, there are so many interdependent moving parts to make a mission work.  For instance, without the elevator, the patients could not easily be transferred from the first floor OR and ICU to the third floor recovery room.  To prevent any mechanical instance from distributing our mission, the hospital director would dispatch the elevator mechanic to stay on the hospital grounds throughout our stay.

After our tour, Dr. Gilbert reviewed the children who are seeking surgery.  In a small room, crowded by doctors, nurses, and staff, children between the ages of 5 and 14 were laid on the table where echocardiograms were taken of their chests.  In the next two weeks, we'll be able to do about 18 surgeries on children with some form of heart defect.  Often these defects prevent the kids' blood from delivering adequate oxygen to the body and as a result you can see a blueness in their fingertips and lips.  The kids can also struggle with low energy levels because of the low oxygenation.  We hope to see in most of the kids significant changes after their heart repair surgeries, changing their lives dramatically from one major surgery.

Zak Kidd, MKI Surgical Mission Volunteer

Almost There

I'm hours away from landing in Guayaquil.  30,000 feet crossing over
the equator, I think about what the next couple weeks will hold for
me, and the rest of the MKI team.  For me, this is all new--my first
mission with MKI, my first trip to Ecuador, and my first stay at a
hospital telling the stories of children and their families receiving
life changing medical care.

I've traveled to other developing countries and it follows that
healthcare infrastructure is generally weak--either in terms of
coverage, service expertise, or both. But right now, my thoughts are
less on the what the hospitals will look like, what the state of
medical care is, how Ecuadorians receive basic and advance medical
care, but to how the families we'll be treating in the next couple
weeks found out about MKI.  How must it feel, to know that a foreign
medical team is flying into your city to help your child?  As
Americans, distance is nearly meaningless.  But for most everyone
else, distance to medical providers can be so great that the reality
of modern medicine is unknown.  So, I think about how the children
were first diagnosed, what they were told their treatment options
were, and how whatever treatment they received did not solve their
health challenge.  MKI's doctors and this mission must be rich in
promise within their eyes.

And to know that all that is happening, the volunteer college
students, the volunteer nurses, the volunteer surgeons, all have been
packing their bags, picking up Ecuadorian travel guides, telling their
loved ones that this will be a time well spent even though they'll be
apart, and heading to airports throughout the US to converge on the
small country in South America to help fulfill the biggest needs of a
number of families, is heart warming.

On a daily basis, I will be writing about our surgical mission here in
Ecuador.  Telling the stories of the MKI staff providing care and
comfort.  And I hope to write and tell the stories of strength and
dignity of the children and their families overcoming medical
challenges.  In addition to writing, we'll be video recording, and
tweeting.  I encourage those interested to read through MKI's website,
contact us, and get involved if you wish.

Zak Kidd, MKI Surgical Mission Volunteer

Twenty Tiny Hearts

Our Mending Kids surgical mission team leaves for Guayaquil, Ecuador this weekend.  The 18-member team includes top cardiac surgeons, nurses, and volunteers from around the globe – all working seamlessly together to save lives.  Twenty children will receive life-saving, open-heart surgeries over the next two weeks and families will be mended, making all the hard work and months of planning and preparation worth every minute.  Each life saved will cost just $3,000 per child. Thank you to our donors who helped to make this trip possible.

Please follow us on this blog as we embark on our journey south and enjoy the photos that capture the spirit of the trip.