Monday, October 31, 2011

Bangladesh 2011 - Photo Highlights

Here are some photos from our mission to Bangladesh. Be sure to check out the website for a full gallery from our trip! Below are some of the highlights...
Post-surgery a happy mother with her beautiful child
The ward full of Moms with their children after surgery
Lunch For The Team
Dee with a new found friend during screening
Scene from first day screening

Mother Signing Forms
Waiting expectantly
Rifat with his mother at screening

Sunday, October 30, 2011

Bangladesh 2011 Rangpur Screening Day and First Day of Surgery

Screening Day and Surgery Day 1

On Saturday or day one, the team set off for the hospital at 7 am to set up for screening, unpack supplies and get the operating rooms ready. Upon arrival, we were greeted by a large contingent of hospital personnel and each of us were given a bouquet of flowers, that's 23 bouquets! This also happened on Friday evening for the group that toured the hospital. Needless to say, the dining room of the RDRS Guest House, where we're staying, is covered with vases of flowers!

Bangladeshi families are extensive and many family members traveled with their children, having heard about CSI over the radio and through a large hospital marketing campaign. The screening area (or screaming area, as it really should be called) was packed and by the end of the day we had screened over 90 patients. One little fellow showed his set of lungs right at the beginning of the screening process after all we did was put a sticky label on his shirt! More little ones got into the act when having their photo taken and by the time they were on to vitals the chorus was in full session. One of the most fascinating things was to finding out how families got to the hospital. Many had taken the bus from as far away as 120 KM, that's about 70 miles and one family travelled 30 miles by rickshaw.

Since the hospital and our guest house are only a half mile from each other, some of the team decided to walk back to the guest house after screening was finished. The road is lined with small food stands, some with sections of meat hanging in the open air, brick workers making mortor for roads by chopping large bricks into smaller pieces, chickens, cows, goats, dogs, people welding iron for gates and glazing pottery. The most unique site was that of a man grinding mustard seeds to obtain the oil. He was sitting on an ox that was attached to a large grinder in the middle of his stand. On the road were trucks, rickshaws, three wheeled cabs, bicycles, and pedestrians. The sounds of horns, the smell of open cooking fires, and the sight of curious children staring at this large group of foreigners dressed in scrubs comple this rather exotic picture!

Today, Sunday, Kofi, Anthony, and Krista successfully completed our first 16 operations. We also screened several more patients who had heard through word of mouth that we're in town and we've added three of them to the surgery schedule. One of them is a young woman with an extensive facial cleft. One of the best moments of the day came when a dad held the mirror for his 11 year old pig-tailed daughter to see her new face for the first time. He was absolutely beaming with happiness and a huge smile and said he never thought this would ever happen!

The hospital ward is filled this evening with 16 children, their new smiles and their moms. It's a happy place. Heather and Michelle, our two night nurses, have taken over for the evening watch of these beautiful little kids.

We're looking forward to day two of surgery and posting some photos too.

Saturday, October 29, 2011

Dakar 2011 - Ranerou Second Day

The second day in Ranerou began with a line of patients waiting to be screened for various medical complaints. After screening the patients we unfortunately did not have any more fistula cases but did schedule surgery for complete uterine prolapse in a young woman after childbirth and two large lipomatous lesions.

We completed our cases with the assistance of our surgical team and rounded on our patients from the previous day who were all doing well. The fistula patients will be cared for by the Ranerou team of doctors and will stay at the hospital till their catheters are removed in 1 week.

It was an enlightening trip to the heart of Senegal and a view of the daily lifestyle of the people here. The work being done by Ranerou's medical team is impressive and shows their dedication to the care of their people and ability to adapt to limited medical equipment and supplies.

We left Ranerou with warm hearts and a full stomach after sharing in our communal meals and living with the medical team. I also left with some additional memories given to me by the mosquitos of Ranerou who feasted on my foreign blood (my bug spray was in my delayed luggage!).

Au revoir Ranerou and off to Dakar to plan for the filming and fistula surgeries scheduled for next week! (Below is a picture of one of the many small markets en route Dakar).

Friday, October 28, 2011

Bangladesh 2011 Mission Trip

Gathering from Kenya, California, Maryland, Texas, Iowa, Minnesota, and Bangladesh our team and a mountain of luggage and supplies converged in Dhaka early on October 29th. It’s a big, bustling city of twelve million people moving to and fro on foot, bicycle, rickshaw, three-wheel mini-cab, car, van, truck, bus - all in a hurry, intertwining on streets without lanes or traffic lights: scenes of certain disaster, narrowly averted time after time. For the residents it’s just business as usual, and in the midst of all the frantic activity there are a surprising number of friendly smiles and waves.

Fazli, the Team Logisitcs coordinator set up an afternoon visit to a couple of local shops near our hotel. Bangladesh is known for its fabrics, porcelain, crafts and pearls among other things. We had a good time browsing and investing. In the evening we visited Fazli’s Father and Mother-in-Law’s house in Dhaka. We enjoyed their good company and warm hospitality in their lovely home while sipping on some delicious mango shakes and a sweet yogurt dessert.

Our 7:00 AM departure the next morning for Rangpur was delayed by a late arriving bus. On the road by 8:30 AM, we had a eight-hour ride, which one of our team members who had done it before, described as the "white-knuckle ride of your life." It lived up to its billing. Fortunately we made good progress as lighter than normal traffic allowed us to get back on schedule. Arriving at the RDRS Travel House about 6:00 we unloaded the bus, and Jan and a team went to visit the hospital as other made up charts and went thought their supplies.

It’s currently 5:45 AM on Saturday, 10/29. We understand that there are about 150 patients waiting to be seen, and we’ll be screening most of the day.

Dakar 2011 - Ranerou First Day

Hello All! I am back from our outreach trip to Ranerou in central Senegal. What a journey and experience this was! The drive to Ranerou was about 8 hours from Dakar, for the majority of the trip the road was well-paved and the smaller cities and villages a site to see. As we travelled further east the road became more dirt paved with various areas of construction slowing travel and requiring the expert navigation skills of our driver. Our team consisted of Dr. Niang a Urologist from Senegal and a midwife who would be working with the gynecologic team.

We arrived in Ranerou on the evening of the 25th and shared in a joint meal of rice, vegetables, and local chicken. Interestingly the meals are served in a large communal plate with each person sharing from their corner of the plate, delicious!

We met Dr. Rau who runs the hospital in Ranerou and his team of nurses and doctors as well as another physician, a professor of gynecology who works with the nurses in Ranerou regularly. On Day#1 we started the morning conducting clinic to evaluate and screen patients for surgery. We saw a variety of female patients with a number of different complaints. We found 3 women with fistulas and their stories are truly amazing. The picture below is of the women waiting in the hall outside for surgery.
The three women ranged in age from 28-40+. The first patient had been living with her fistula for 25 years without ever having an operation. She was lucky in that she was still married to her husband despite her condition. Our other two patients were divorced. One patient was 28 and had her first pregnancy at the age of 14 and subsequently developed a fistula. Our other patient had been operated on by Dr. Niang 1 year ago at another site and while her incontinence had dramatically improved she was still leaking some. Dr. Niang described that her original surgery had been very difficult as she had a complete transection of her bladder from the urethra requiring a difficult mobilization of the bladder and repair. On examination she now appeared to have only a small residual vesicovaginal fistula that could be easily repaired.

We then booked an additional few gynecologic cases and left for the city center to meet with the chief of the village to bless the opening of the new center.
We completed our 3 fistula cases as well as a repair of an anal sphincter injury during childbirth. All surgeries were completed successfully!

Tuesday, October 25, 2011

Dakar 2011 - Day 1

We are embarking on the first trip for our Vesicovaginal Fistula (VVF) project. We have an exciting 2 weeks planned! I will be spending the first week performing surgery with Dr. Serigne Gueye one of the world's experts on fistula repair in an outreach trip in Central Senegal, the second week we will be obtaining live video of surgeries needed to complete our VVF surgical simulator. I am so excited to see this project coming to fruition and the different parties aligning so well.

I made it safely to Dakar with a few hiccups on the way. I arrived at the hotel a few hours late and kindly the hotel restaurant owner has lent me some clothes till my missing bag arrives, so I can leave this morning for our outreach trip to Ranerou. In Ranerou they are planning on beginning a more formal medical program and we will be assisting by performing hopefully some fistula surgeries and other gynecologic procedures.

The team will be joining me this weekend at the Hotel Le Djoloff,  attached is a picture of the view from the rooftop.

Priyanka Gupta, Urology Resident, University of Minnesota

Monday, October 10, 2011

Monday: Last Day of Surgery

Another full day of surgery! All of the families and children waiting for surgery are staying at our hotel and early in the morning when we get up and leave at 6:20 all the mamas and papas and grandmas are in the lobby with the patients waiting to be picked up. The littlest babies are already hungry because they haven't been able to eat since midnight.

All of the surgeries have gone wonderfully; we are especially thankful for Coca and her daughter Laura from St Andrew's Clinic for their vision which has kept the program going. What an incredible organization Coca founded 38 years ago. The children receiving surgery these past two days are the neediest clefts and palates from all the patients the clinic has seen in the past year. The legion of volunteers here at CIMA hospital are just incredible.

I want to also mention an additional member of the team; Heidi Peterson is on board this trip to evaluate Hermosillo as a site for our Youth Program. She has been doing a fabulous job of taking pictures pre and post op in the OR.

It is 6:10 pm and and two patients still need to go into the OR. Tomorrow morning after rounds the team will and catch the 11:30 am flight out of Hermosillo to head home. A few team members will stay behind for 24 hours to look after any patients who are still hospitalized. More later.....

Sunday, October 9, 2011

Sunday: First day of surgery in Hermosillo

It it Sunday at the CIMA Hospital in Hermosillo and CSI has a full day of Surgery. Dr. Bob Tibesar has 6 patients; Dr. Jon Grischkan has 5 and Dr. Mike Fritz 6. The cases vary in length depending on the complexity of the surgery to be performed. The patients getting surgery today spent the night at a nearby hotel and have been at the hospital since this morning waiting for their time slot. One of the patient's mother works far away as a walnut picker. She didn't have enough money to pay to come to Hermosillo so her fellow workers; others who pick walnuts, each gave up the money they spend each day on a soda, and donated it to her.

When the patients check in, they are met in pre-op by anesthesia staff who readies them for the OR. Dr. Chris Altman is the head anesthesiologist. The OR's are staffed by CRNA Cathy Cook from the Mayo Clinic, nurse anesthetist Jim Ducharme, OR nurse Mary Johnson, CRNA Tricia Rude and OR nurses Staci Linn Swenson and Dee Ann Vander Pol, who is from Iowa. Surgeries are performed by Dr. Bob Tibesar from Minneapolis Childrens and Dr. Jon Grischkan from Columbus, Ohio, and Dr. Mike Fritz from the Cleveland Clinic. After the patients come out of surgery they are met by the pediatricians Dr. Paul Melchert and Dr. Greta Chen, as well as post op nurses Grace Nwaofune and Ann Schminski. After recovery they go to the pediatrics ward upstairs and are met by ward nurses Judy Nieuwenhuis from Iowa and Cheryl Shell from the Twin Cities.

The staff here at CIMA hospital is incredible, as are the many volunteers who arrive everyday and circle around repeating "is there anything that you need?" "What can I do for you?". They help translate, keep us fed, fetch this or that, find patients, answer questions, get diet coke, drive us to Wal-Mart for supplies, track down lost luggage, etc etc etc. Each and every one of them make this mission a pure joy.

Saturday, October 8, 2011

Everyone is pitching in to help with these beautiful children

Our advance team includes Lora Koppel as clinical coordinator, Dr Bob Tibesar as
medical director, Dr. Jon Grischkan as surgeon, and Drs. Paul Melchert and Greta Chen as pediatricians, in addition to Mary Moore as medical records coordinator and Sally Lannin on logistics. All of the additional team members arrive later this afternoon. They will inventory the drugs that arrived in advance, and begin to prepare the operating rooms for surgery which will start early tomorrow. What follows are an assortment of photos from this first day of screening. We screened 79 patients today; approximately half of them will receive surgery.

Day One of Screening in Hermosillo October 2011

Seven of us arrived yesterday in time to tour the hospital, evaluate the screening room, meet with the SPECTACULAR volunteers of CIMA (the hospital) as well as with Coca and Llordes who have both made the St Andrews Clinic in Nogales Arizona function. This is critical because this non-profit clinic (founded 38 years ago by Coca) has brought literally hundreds of children across the border for care for years. Every year many patients are brought to the CIMA hospital here, and Childrens Surgery International flies in to screen, operate and care for the many children requiring care. This is truly a united effort, formed and implemented with love and care for the children.