Screening Day

Sunday - November 11th, 2012

Screening Day

We woke up early and headed to the hospital after eating a big breakfast.  The screening began right away and so did the chaos!  It was a fast paced day filled with many families anxious to see their outcome.  Screening took longer than usual, but the children and their parents were unbelievably patient and respectful throughout the process.  The Liberian nurses were a great aid in translating Liberian English for us to understand.  We screened 127 patients in total and found that a majority of them were here for hernias.  

The kids contently coloring while waiting for their lab results. 

All of the families lined up in the hall to meet with the surgeons.  We screened 127 patients today.

Tired and hungry, we were fortunate enough to enjoy a Moroccan feast cooked for us by a local restaurant.  The food was delicious, but after such a long day, we were all ready for a good nights sleep.  

Sightseeing & Orphanage

Day 2 - Saturday, November 10th, 2012

Sightseeing & Orphanage

Today the group split up, one group going to see the historical sights in Monrovia and the other going to a local orphanage.  

Dr. Tetzlaff and Dr. Moore with 2 kids at the orphanage

Kids at the orphanage during one of their dance numbers.

The first option was to go to Monrovia  to experience the culture and vibe of the downtown area.  On our way into town, we stopped at the beach to put our toes in the sand and dip our feet in the Atlantic.  Once we arrived in the city, many locals and their kids were out at the market selling anything from toilet seat covers to expensive fabrics.  We were able to stop at a collection of art vendors and several of us purchased carvings and paintings from local artists.  Peter was even able to find a helicopter made out of old flip flops.

The second bus picked up Debbie from Orphan Rescue and Relief and headed out of town to go to the Francis Gaskin orphanage.  We were able to play with the kids and had such a great time.  The kids even put on a little show for us, entertaining us with songs and dance numbers.  On our way home we were able to stop at a market as well to purchase souvenirs and other local goods.  

We arrived back to the Guest House to a delicious Thai buffet, complete with pad thai, curried chicken and vegetable, and fresh pita bread.  

We all went off to bed early to prepare for our busy screening day tomorrow.

Finally Arrived!!!

Thursday - November 8th, 2012

Finally Arrived!!!

Even before we arrived in Liberia, our adventure began!  Friday morning we found out that our last flight between Ghana and Liberia was cancelled, potentially causing the mission to come to a halt.

We made it to JFK in New York, still unsure of the plan once we arrived in Ghana.  We didn’t know if we would have to spend the night in Ghana or if another airline would be available to take us all the way to Liberia.  Our plans in Ghana didn’t matter at this point as Delta wasn’t going to let us on the plane, due to the fact that we didn’t have Visas for Ghana.  Sue worked tirelessly to get us Visas for once we arrived in Ghana, but Delta wanted us to have them before they would let us on the plane.  After hours of verbal persuasion and negotiating, 2 plane delays and potential bribery, we were finally able to board the plane.  12 hours later, a representative from Firestone met us at the Ghana Airport, informing us that a Kenya Air flight for Liberia would be leaving shortly; unfortunately our bags would not be able to make the flight.  

More Firestone representatives met us in Liberia.  They took all of our passports allowing us to bypass customs.  We were then transported immediately to the Firestone Guest House where we were finally able to eat dinner and relax after a very stressful day of travel.  

It is a miracle that we finally made it here!

Day 5 Hermosillo 2012 Heading Home

This morning we pack our things, the doctors make final rounds for the two patients admitted for overnight stay, and we say so long until next year to our St. Andrews and CIMA partners.  Our collaboration with them is a great model of teamwork and coordination for the benefit of children needing the medical services CSI can provide.  We feel privileged to have the opportunity to serve here!

The team is tired but extremely happy with the outcome of our trip, 44 surgeries accomplished!  We're off to the airport and our home cities after one last breakfast at the hospital.

Day Four Hermosillo 2012

Today we had only 10 surgeries and most of the patients were discharged from recovery.  We kept two patients overnight to make sure they were up to discharge in the morning.

As with any mission, there were some inspiring and heartbreaking stories of several of our patients. One of our 15 year old patients was abandoned when he was younger, 5 or 6 he thinks, and has beenliving at a service station since they took hime in several years ago.  They would find him sleeping in the shop for shelter.

Another young woman, now 17, was separated from her parents while trying ot cross the U.S. border on their way to a better life in the States from Guatemala.  She never reuinted with them until this week through a phone call, which made her very happy!  During the years of their separation she had been liing with friends or relatives when she was younger and then made her way to Mexico at the age of 13 or so.  She was then taken in by a family in Hermsillo as a housekeeper.  She has been wanting to improve her life, but she cannot speak!  She came to screening, thanks to Coca and Laura (of St. Andrews) and the CSI team knew after evaluting that they could and would help her.  She came through surgery beautifully and was smiling, talking and giving the thumbs up right after waking up in recovery!  Her first words were "thank you" to the CSI team and all the volunteers who made this happen for her!

Tonight we celebrate: the success of the mission; the collaboration of all the teams; and the making of wonderful new friends at the traditional "banquet",  fiesta style!

This little guy stole our hearts. CSI could not do his surgery last year and told him to come back this year.  Here is is with Coca (the saint) of St. Andrews and Dr. Paul Melchert, pediatrician, waiting to a hospital gown and gear on for surgery.

OR nurse, Ana Vazquez Rojas with patient in pre-op
 

From left to right: Laura, Lola, Elsa, and Coca
The ladies in pink run St. Andrews Clinic and Elsa is one of the CIMA hospital volunteers.

Dr. Sampson (left) and Dr. Grischkan (right) team up 

Dr. Fritz in Surgery

Young lady with voice recovered giving the thumbs up!

Lora Koppel, CSI Clinical Coordinator, CIMA nurse Alan,  and patient along with his  papa in recovery

Dr. Paul Melchert reasuringly holds the hand of an apprehensive patient

Day Three Hermosillo 2012

Today, Monday is our second day of surgery and we have 16 scheduled.  This is the first trip to Hermosillo where bone grafts are being performed by Dr. Dan Sampson of Minneapolis.  These surgeries average about 3 hours in duration.  Dr. Sampson did 4 bone grafts yesterday and 4 today.  Because of their complexity and the need of patients to remain overnight in the hospital, he will not do bone graft surgery on Tuesday, but rather assist Drs. Grischkan and Fritz as needed in OR #1.

We have terrific support in every aspect of this mission due to all the volunteers from St. Andrew's Clinic and CIMA, which includes nurses too who are here on their days off!  They also provide us with  delicious Mexican food for lunch and breaks.

Dr. Mike Fritz setting up lip repair surgery

Drs. Dan Sampson, Jon Grischkan of CSI and Dr. Moreno of Hermosillo

These two little guys became buddies at the hotel as they were roommates and just happened to be in pre-op together due to moving one of them up on the schedule!  They were also in surgery at the same time and in the same OR too, as well as recovery together!  They were checking each others heart prior to surgery and were having a great time playing the role of doctors while waiting.

CRNA Corrina Kettner and little patient on the way to surgery

CRNA Mitch Chermack and his patient on the way to surgery

Day One Hermosillo

Hermosillo, Mexico
Oct. 6, 2012
Six members of the CSI team arrived in Hermosillo yesterday. Today we were greater by 96 children and their families. This medical mission is a joint effort of the volunteers at St. Andrew Clinic in Nogalas, Arizona, the CIMA Hospital, in Hermosillo, Mexico, and the the Children's Surgery International organization.

Of the 96, 44 children will be operated on in the 3 days we are here. The remaining children will be followed up by the St. Andrews clinic staff and hopefully will be back next year. The children are selected based on the complexity of their medical problems and the type of surgery we are able to provide.

This child had her lip repaired last year and is back for palate surgery.

                                             This child is awaiting palate surgery.

                                              Paul and Lael are organizing the medical records.
Thanks to our team members we worked 12.5 hours and were able to see all 96 children. The screening team included: Dr. Daniel Sampson, Dr. Jon Grischkan, Dr. Paul Melchert, Lora Koppel RN, Marian Hehre and Leal McAuliffe  Medical Records.

Tomorrow we hope to complete surgeries on the first 18 children.

Day Two Hermosillo

This patient received a new pair of shoes plus surgery!

                                         
                        Cheryl Shell, Julie Hampson and Katie Pownell in the recovery room.

                                             Dr. Mike Fritz and CRNA Corrina Kettner

Dr. Jason  Pope, Anesthesiologist

Oct. 7, 2012
Great day of surgery today. The rest of our team members arrived last night and all 18 of us arrived at the hospital at 6:30 am. We got off to a slow start but by 11:30 pm we were all back at the hotel.

Tunis September 2012 - End of day 2

This is turning out to be a great mission  We have done five cases so far; two yesterday and three today  All of the children that we have operated on have spina bifida; the surgeries have been a combination of closing the spinal defects and placement of shunts that go from the brain to the abdomen to drain cerebrospinal fluid [to treat hydrocephalus]  This is not nearly the number of surgeries that we would do on a cleft mission, but these surgeries are much more complicated and take longer  The children are all doing great thanks to everyones hard work  The Souska Clinic is a very nice hospital and their staff are very well trained and competent, and they are a big part of our success  

We have at least four more cases scheduled but there could possibly be more  The Tunisian television crews have been covering our mission and now we have parents bringing their children as walk ins because they saw us on TV and are hoping against hope that we might be able to help them

We are in Tunis operating on Algerian children and consulting with Tunisian patients  Dr Azzedine Stombouli, who was born in Algeria but is now an American citizen, arranged for these families to come here hoping to get help for their children with spina bifida  These parents have brought their children almost one thousand miles from Algeria as this is the first hope that they have ever had to be able to help their children; their gratitude is beyond words

Off to bed as we are getting an early start tomorrow to get as many surgeries done as possible

Final day of Liberia Mission Jan/Feb ‘12!

Bags were packed and left for wonderful George Pezzimenti of Firestone who has done an A+ job of keeping us safe, sound and on time, with a can-do attitude that is a joy to be around. An extra hour or two to sleep this morning guaranteed smiles on all our faces.

Let me describe the scene as physicians came to make final rounds on the ward before the Farewell Program and lunch with hospital staff. All the children who had received surgery were in varying states of packing to leave, or eating breakfast, or slowly waking up. Their mothers or grandmothers or fathers were sitting at the foot of their beds. When the doctors arrived, one mother started singing in her bold a cappela, a well-known Liberian hymn of thankful praise. Within ten seconds every parent, who two days ago was unknown to every other parent, united in a groundswell of a hand-clapping hallelujah tune they’d all learned at their own parent’s knee or in some simple hall of worship. They were united in having children who have suffered, and now have benefitted from CSI’s presence at Duside Hospital.
As everyone who is a parent knows, most mothers and fathers would rather bear their children’s own suffering than have to watch them grimace while trying to urinate for years, be mocked for having a “split lip”, or have to wear a loose loin cloth instead of pants because of a huge hernia. They were certainly going to let everyone know about it with their booming voices all singing the same song in unison! There is something so pure and glorious about how the women here show joy, whether it how they laugh at a child’s funny gestures, or celebrate having their name drawn at our Farewell Raffle for staff. As they sang, the clapping became louder, hips were swaying, nurses were all in, and every child was grinning from ear to ear. It was a sight those who were there will never forget, and the sort of simple spontaneous show of emotion that makes countries like Liberia such a joy to visit. Being part of a CSI mission allows us to jet propel ourselves into the most private corners of the lives of our patients and their mothers/aunts/grandmothers/fathers/grandfathers/friends or nobody’s who have accompanied them to the hospital. What an unparalleled privilege.

The Farewell Ceremony included thoughtful closing words by Dr. Lander highlighting the transfer of skills that has taken place on this mission. A surprise presentation of a ceremonial robe to Lora Koppel for all of her contributions to the children of Liberia touched her immensely…” This is the highest honor of my entire professional nursing career,” she noted. A highlight for many was the presentation of the inaugural Mission Volunteer plaque, which went to Mr. Jackson, a hospital custodian, who worked tirelessly throughout the mission making spaces, and faces better wherever he went.

On all counts, the mission was a success. Everyone boarded the bus relatively healthy, and each bearing a beautiful oil painting of Liberian scenery, given by Wadei Powell and her Firestone/Duside team. The partnership, between CSI, Duside Hospital, and especially because of Firestone, allows our Liberian missions to line up exactly with CSI’s objectives.

Farewell beautiful faces and hearts of Liberia! 

Last Day of Surgery: Thursday at Duside

Some of the first names of the children here are spectacular: Precious, Faith, Joy, Prince, Marvelous, Handful, Princess, King, Miracle, Godgift. How can one not smile when a child named Wonderful grins at you?

It is a very busy final day of surgery with hopeful families and their children waiting for their name to be called. I just spoke with a father who has tried for 3 years to get his son’s hypospadias repaired. The first year he waited in screening and learned we didn’t have an urologist on the team, the second year he was cancelled at the last minute because one of our surgeons became ill. Finally Jason is heading into surgery – father and son just walked out the door with one of our nurse anesthetists and everyone in pre-op let out a huge cheer!

We awoke this morning at 5:30 a.m. to a fabulous first: torrential rain falling on the metal roof of the Guest House. It is rare for it to rain this time of year, and it was a welcome cleansing of the dusts of summer south of the equator. Every evening during our stay the Guest House we have been treated to the fare of a different country: Thai, Lebanese, Moroccan, International, Liberian Seafood (featuring a 4 foot barracuda, the head of which was consumed by team member Patience - of Liberian heritage), and tonight is Chinese. We are being treated so well by the Firestone staff!

Over the course of our stay here, the team screened 120 patients; of those 99 will have received surgery by the end of today. We have made a concerted effort on this trip to focus on training the Liberian professionals at the hospital. It has been far more important for the surgeons to teach the Duside doctors how to perform certain procedures than to rack up as many surgeries as possible. As a result, spirits are especially high and as Steve Muehlstedt said so poignantly tonight at dinner, "this has been an experience of true teamwork".

And the patients are very happy, albeit sore. Without exception when I have asked a patient's parent if they have any suggestions for CSI on our future trips, they say something to the effect of “thanks be to God for you people”. Shown also in this blog entry is a mother and son who both received cleft repair, courtesy of a combination of Tim Lander and Duside's Dr. Sherman. We are amazed at the patience of the children who wait a long time to be called into surgery, especially those who are scheduled later in the day. No bickering over toys, no impatient parents, no fighting to jockey for position; just complete resignation to the process and a willingness to wait however long it takes for a chance to get the expertise of the “doctors from America”.

After discussions with Dan Adomitis and hospital administrators, it looks highly likely that CSI will return to Liberia in November of this same year, instead of waiting until January ’13. Because of this, we are boxing up supplies and storing them in a locked closet after taking inventory of what we are leaving behind.

Final post tomorrow after we get fully packed, make rounds on the patients and celebrate the successes with the Duside staff. PS- this added after dinner; the kitchen staff surprised us with a Thank you cake:) As I said before, we are spoiled.....

Wednesday in Liberia

While two in our group visited orphanages, the rest of the team had a very busy day at Duside hospital. Dr. Dave Vandersteen started his day with a male 7 year old patient who has a penis but was born without the rest of his genitals; upon opening him up, he is in fact 100% female. Dave sought counsel with Duside's Dr. Sherman, and met mid-surgery with the mother who gave support to make "him" a "her". So he continued surgery and Joe emerged as Jolynn. In his 21 years of practice he has had girls really be boys, but never the opposite. In the U.S. this would have been detected at birth.

Dr. Sherman completed a cleft surgery on a 23 year old woman (with very little support from Dr. Lander who has been training the Liberian physician all week). An added bonus is that Dr. Lander operated on the woman's child yesterday, so a mother/child cleft repair has been part of the week.

Clinical lead Katie Houle has been wonderful in this first time role for her. And all members of the team are in absolute sync, handing patients from one stage to the next with near perfect precision.

Lora Koppel, Katie Stewart and Sally Lannin went to Orphan Relief and Rescue where Debbie, the coordinator, headed up the assembly of 70 belated Christmas 'bundles' to deliver to two orphanages. Included in each bundle was an apple, pencils, a silly band, a ball, a sucker, candy cane and toothbrush. Attached to this blog entry is a picture of a child with his 'bundle'. Prior to opening their Christmas gifts, the children serenaded us with "We Wish You A Merry Christmas" and "Away in the Manger". Also attached are a number of pictures taken at both of the orphanages. In all honesty, the latter orphanage in particular was hard to see: 30 children, 12 of whom are under 2, being supervised by two elderly women who never stood up the entire time we were there. And when we gave each child their Christmas bundle, without exception we heard a 'thank you'. Also included is one of the boy orphans wearing one of Dr. Dave Tetzlaff's daughter's t-shirts which we donated. In addition, when we come to these orphanages word spreads to the nearby village and "outside" children can be seen peering jealously through the concrete blocks.

Monday and Tuesday at Duside Hospital in Liberia

Monday and Tuesday in Liberia

Two very very busy days in every part of the hospital. After 23 patients on Monday, Dr. Steve Muehlstedt walked back into the Guest House and announced “that was by far the best run day of surgery I have ever experienced in all of my trips with CSI”. Go team go!!!

Monday also had Partner Katie Stewart and Sally Lannin visiting an AIDs orphanage for children and adults , run by Mother Teresa’s order of nuns. It was a very humbling experience. Team member Jody Pelkey donated a large bag of shoes. They then visited the Frances Gaskin orphanage and fed 80+ kids a great meal of rice jollof , cookies and Tang. Many went for seconds! Books were read, and donated to the school as well as a number of school supplies.

Today, Tuesday, was a very busy day with the U.S. Ambassador to Liberia Linda Greenfield visiting Duside Hospital. She spent time with all the team members as well as Dan Adomitis and his team from Firestone/Bridgestone. Ambassador Greenfield even had her first experience observing in the operating room. Patience and LouAnn of our team had the opportunity to spend more than 2 hours educating 20+ Liberian medical students in a number of areas. 21 surgeries took place today and by the time we left the hospital, the Peds ward was in high gear. Everyone wanted dinner, pain meds or to go to sleep. Parents as well!

I had an opportunity to speak at length with one of our patient’s father, who is 26 and studying computer science. Not only is he unusual in that many more mothers accompany their children than fathers, but he is far more educated than most. He spoke poignantly about being a school child in Liberia and hearing helicopters and shooting take place when Liberia was at war. He and his parents fled to Ghana and at times survived only on plants they found in the forest. Fortunately his parents were well educated and did everything they could to see to it that he got a good education after they got out of the refugee camp. He returned to Liberia in 2007 with a wife and child and an interest in continuing his education. His wife now teaches school and makes $60 US per month and he is studying and has a second child. I wished at that moment that I had brought an ipad to give this man so eager to learn. Another father had tried 2 previous years to get on the CSI schedule and finally “was accepted” this time with his son.

The day was saddened by one of the favorite Peds ward night nurses being in a serious car accident. She suffered significant injuries to her head and was brought into the OR for surgery by Duside’s Dr. Sherman. Dr. Lander of our team coached him on the eyelid repair and the good news is other than a nasty scar she should fully recover.

Tomorrow afternoon our second pediatrician, Dr. Tim Wood departs for the Twin Cities. This has been his first CSI mission and definitely not his last.