Saturday, February 13, 2016

CSI Ethiopia Surgical Mission is Underway!

We have safely arrived in Ethiopia, and most of us on the CSI Ethiopia team finally have our internal clocks turned around after the long journey. During our one hour layover in Jeddah Saudi Arabia we saw several gentlemen making the long pilgrimage (hajj) to the sacred city of Mecca, garbed in traditional white sheeting.

After a night in Addis Ababa, we took a morning flight up to Bahir Dar, the 3rd largest city in Ethiopia on Lake Tana. We had a small snag with seven pieces of luggage delayed in customs, but after some terrific interventional work by our team member and cardiologist, Dr. Woubeshet Ayenew, the bags were released. Also, a big shout out to Habtamu of Taitu Travel for driving the final pieces of luggage 560 kms to Bahir Dar. His terrific efforts allowed us to proceed on without missing our flight.
Minneapolis departure group - ready to meet up with others along the way enroute to Addis Ababa. 
Our hotel, Asinuara Hotel, is conveniently located just two blocks from the Felege Hiwote Hospital.  We were able to walk to there for a tour and introductions when we arrived yesterday. Drs. Asnake and Melesse have been our Ethiopian partners since the CSI site team made their first visit to Ethiopia 6 months ago to begin planning for this surgical and teaching mission. The hospital is a well matched partner for CSI. Not only are there enthusiastic physicians interested in being trained, but the entire hospital administration and staff is committed to our knowledge-transfer model. Apparently there is no shortage of service organizations willing to come to the region to perform large numbers of surgeries over a number of days, but what this hospital really wants is training. They ultimately want to be able to perform the surgeries independently, and this is a perfect fit for CSI.

After an evening of catching up on sleep, dining at the hotel, or riding tuk-tuks to a lovely local restaurant, we were all awake early and ready to roll for screening day at the hospital.

Set up was efficiently completed, and the patients started flowing in to either the urology or ENT screening room. The urology team is managed by Dr. Francis Schneck, new to CSI from Pittsburgh and a fabulous addition to our team. Medical records team member Katie Stewart, Victoria Vandersteen and others worked with Dr. Schneck to screen the urology patients.

The ENT screening room was shared by Drs. Tim Lander and Andrew Scott, with assistance from Medical Records team member Aliza Ameen. Aliza and CSI Partner Mary Moore demonstrated their resourcefulness by finding the mop closet where they grabbed a mop, bucket and soap to clean up an "oops" on the floor of the pediatric exam room. It was teamwork at it’s best.  Mary was also taking photos, and moving the patients from the surgeon's screening area to the Pediatricians/Vitals area managed by Norie Wilson, Maria Rubin, Dee Vanderpol, Amy Erlandson and Molly McIntyre. CSI Pediatricians Drs. Dave Tetzlaff and Paul Melchert examined the patients, ordered labs, and made decisions about which children were ready for surgery this week. All in all it was a very successful screening day. Sunday will be a day off for the Sabbath, which is honored throughout Ethiopia, and we will start surgeries on Monday.




Tuesday, October 6, 2015

Teamwork for kids in Hermosillo

We are on the last day of surgery! So far, the theme of our work here is twofold: teamwork and flexibility. Each is necessary to do the work of helping more than 50 children this week. Fortunately, everyone here on the CSI team, as well as our partners in this mission, excel at both.
I just had a conversation with one of the wonderful volunteers here at CIMA Hospital in Hermosillo. She needed to convey some information to me that I then needed to pass along to a surgeon in the operating room. Her English is almost as bad as my Spanish, but with smiles, some hand gestures and a lot of patience we managed to understand one another. Working as a team, we were able to achieve what we needed to say and do.
Another example of teamwork and flexibility: A mother and father came to the St. Andrews Clinic in Nogales looking for help for their son. He lost his ear in an accident last year, and although he is now recovered, the taunting and bullying he suffers as a result of his appearance is terrible. Clinic volunteers brought him to see us, and CSI surgeons and a local CIMA plastic surgeon examined him this morning and made a recommendation about the best way to help this boy.
The players here are numerous: volunteers and staff from CSI, St. Andrews Clinic, CIMA Hospital and the CIMA volunteer organization. The beautiful thing about this trip is that it all the components work so well together. All of us have the same goal: helping children and families in need. No matter what language we speak - or don't speak - or what our priorities might be at home, we all work as a team here to bring smiles back to so many faces. I'm honored to be surrounded by so many talented people, working together toward a common goal.

Monday, October 5, 2015

Off to a great start in Hemosillo - October 2015

10/5/2015 Hermosillo

Saturday was our screening/evaluation day at the CIMA Hospital in Hermosillo, Mexico. We saw 104 patients, and 49 were scheduled for surgery with CSI this week. For a variety of medical and surgical reasons, the remaining children were not ready for a surgical procedure at this time. With our extra surgical day in Hermosillo this year, and energetic team members, we will be able to accommodate all of the children who were ready for surgery.

Sunday was our first surgical day for the week. We had 18 patients on the operating room schedule, a mixture of cleft lips, cleft palates, bone grafts and one rhinoplasty. This was an extremely busy day, with operating rooms busy into the evening.

Some cleft lip and palate repairs require several surgical procedures over time, with the rhinoplasty being the third or fourth procedure. Children in developing countries with clefts may never have an opportunity for even the initial repair, let alone subsequent procedures such as rhinoplasty. Because of the ongoing partnership with the St. Andrew's Children's Clinic/CIMA and Children’s Surgery International, we are able to offer this high level of care to the children of the region who deserve as much as anyone to proudly share their beautiful smiles!

Friday, September 18, 2015

Friday morning in Thanh Hoa

Docs are making rounds on the final patients. The rest of the CSI team members are packing up, counting charts, paying bills and blogging. After evaluating many more potential patients than we imagined this week, the team was able to perform surgery on 28 urology and 31 ENT patients. So many grateful families; so many changed lives!

Our team was also able to incorporate an educational curriculum into the busy week, which was an important goal for the mission.

The week’s finale last night was a team-building dinner with our Vietnamese counterparts at a restaurant of their choosing, complete with karaoke, an essential part of Vietnamese entertaining. Very, very funny!!  It’s been a memorable, successful week in Thanh Hoa. Here are few final photos before we start our long trek home.

Wednesday, September 16, 2015

Wednesday, Day 3 of Surgery

As I write this, only three patients are still in pre-op, waiting for today’s surgical cases. One is a little fellow named Van, who is ONE UNHAPPY DUDE because he hasn’t had anything to eat or drink since midnight in preparation for surgery. It is 4 p.m., and he’d give anything for a little something to nibble on. We’ve tried music, coloring and puzzles, but he just wants food! It won’t be long now, and he’ll be off to sleep and ready for his surgical repair.

The second fellow is Tam, a 17 year old who nicely borrowed my computer and immediately tried to sign on to Facebook, but alas no Wi-Fii at the hospital. How can we be in the middle of nowhere in the north of Vietnam and he wants the same entertainment as our 17-year-old kids at home? The world is definitely growing smaller. 

Last in the room is a wonderful 42-year-old woman named Thuong, whom we squeezed onto the surgical schedule. Thuong has had a disfiguring cleft lip that led kids in school to mock her. She stopped attending school in the 2nd grade. With the hands of a 70-year-old woman, she gestures that she worked in the rice fields since she was 3 feet tall. Thuong is envious of the white skin of one of our nurses of Swedish heritage, and we tell her that we try to get our skin the color of her brownness by lying in the sun. Her sister tells us that she is able to read only five or six words, but can write her name, albeit very slowly. Thuong’s smile is utterly beautiful, and her personality, with plenty of giggles, shines through. She will continue to be followed by local health professionals after CSI leaves for continued care and support.

We officially screened 74 urology patients and 65 craniofacial patients. We evaluated an additional 150 patients, but for a variety of reasons we were not able offer surgery at this time. We have collected names and contact information for this group. They will either be seen by our Vietnamese medical colleagues, or we will contact them when our CSI team returns in 2016. 

Our logistics head, Con Nguyen, had a very productive meeting with a group of local physicians as we fine-tune our process on our first visit. We have drained the team of translators, as one of us always seems to be calling out “may we have a translator in here”? There are very specific processes in the hospital that we are learning as we mesh how we manage pain, communicate with families and provide care for patients. Of course we have the same goals, and there are many great learning opportunities for both our team and for the people here.

Posted Wednesday by Sally Lannin

Tuesday, September 15, 2015

It is Tuesday afternoon here in Thanh Hoa, Vietnam. When we arrived at Thanh Hoa Pediatric Hospital (THP) for screening on Sunday three times as many patients were waiting to be screened as we had anticipated. Our partners here in Vietnam, specifically Father Joseph, who is a Jesuit priest affiliated with IPSAC in Peoria (, and THP, did a wonderful job of getting the word out that the team from CSI was arriving so that parents could bring their children to be considered for surgery. And come they did, from all over the country, many traveling very long distances to be evaluated.

Patients and their families were standing 20 feet deep waiting to be evaluated by the team. Logistics head/CSI Board member and Vietnamese-American Con Nguyen was flying from room to room managing the translators, patient flow and answering hundreds of questions. Nurses were preparing children for evaluation. At the end of screening day, surgeons Dr. Dave Vandersteen (Urology) and Drs. Rajanya Petersson and Christopher Discolo (ENT) had the difficult task of prioritizing and creating four very full surgical days. Many of these decisions were heartwrenching, considering so many families were hoping their children would be included.
It was a late night for the medical records team of CSI Partners Cindy Halverson, Johnine Adomitis and Kaitlin Nelson. They needed to create schedules, assemble charts and have everything organized for surgery in the morning. We brought medical record supplies for 60 patients, and ultimately screened more than 100 children, piecing together pages wherever we could get them. Thank goodness for that printer Johnine carried in her luggage all the way from the U.S.

Monday, Day 1 of surgery, started bright and early. Volunteer videographer Nolan Morice is recording, interviewing and snapping great photos of these children. Team members scavenged for sterilization supplies, gauze, gloves and other necessary supplies. Logistics co-lead Stacey Brown even got stuck in the elevator while transporting a giant cart of IV fluids. (No harm done.) Lora Koppel and Sally Lannin carried a solid steel fan up five flights of stairs to try to get some air circulation. Thankfully, Leon Randall was able to get the fan to work. Leon’s helpful can-do attitude is spectacular!
Pediatrician Erin Novak started having gripping stomach pain and was sent back to the hotel to rest. The crack PACU team of Dr. Bruce Ferrara, Anna Koppel and Mary Bye rose to the occasion and handled the post op/PACU patient situation, despite being one team member short. We scavenged empty offices, storage closets or restrooms looking for underutilized fans in an effort to get air circulating in the PACU. Bruce gave a big thumbs up once the air started to move. 

The pre-op team of Nikki Lavin and Katie Houle readied patients for the handoff to anesthesiologists Drs. Raj Sarpal and Craig Smith, and CRNAs Lynn Randall, Monica Bultena and Michael Gotzsche. We had three or four operating tables going simultaneously. The OR wonder nurses Charlee Kimmes, Nancy Corcoran and Jessica Driscoll (on her first trip ever outside of the United States — what a way to get the passport stamps started!) are keeping things moving and sterile.
By early afternoon as patients came out of PACU, things started hopping in the ward. There is very little space in this area. Children are three and four to a bed with no air conditioning, and parents primarily are responsible for the patient aftercare. Floor nurse team of Patience Kankeh and Patrick Faunillan have their hands very full not only looking after our patients, but also using every opportunity possible to provide theVietnamese nurses with aftercare training.
Late in the day, team member Dr. Erin Novak returned to the hospital with severe abdominal pain. After evaluation and ultrasound, she was headed to the OR to have her appendix removed! Thankfully, our IPSAC partner Dr. Holterman (a general surgeon in Peoria) happened to be onsite and was able to perform the surgery within an hour. She very thoughtfully called Erin’s husband in the U.S. to let him know the surgery went well, and the outcome looked excellent. Erin rested at the hospital for an hour and walked back in the front door of the hotel just as 200+ Communist Party members in evening dress were gathering for a large regional meeting. The juxtaposition was almost humorous. This was a first for a CSI mission — we’ve never had a team member on the OR table. When Erin Skyped her practice partner Dr. Dave Tetzlaff, CSI Medical Director, the first thing he said was “did you take the appendix out yourself?”

Tuesday, Day 2 of surgery, we were ready at the crack of dawn as a complete team! Yes, even Erin was up and at ’em after a great night’s sleep under the care of nurse Anna Koppel, who stayed with Erin to monitor her medications and vital signs. Patients were gathered from various locations in the hospital and the process began again. Bubbles were flowing to entertain anxious children in pre-op. Grateful families were cradling their children. Wonderful handmade dolls and teddy bears donated by the volunteers of Dollies Making a Difference were distributed to patients in post-op as well as donated beautiful fleece blankets. Nurses Patience and Patrick are doing everything possible to teach, train and care for these precious children after they come out of surgery. 
More tomorrow on some of the individual stories of the patients and the families we have had the privilege to meet.

Monday, September 14, 2015

A picture is worth a thousand words

The CSI Vietnam surgical mission team is so busy helping as many children as possible that the narrative blog post will come later. Go team, go!