A Successful Day of Surgery for the Team and Families

The view from the hospital.

Successful cleft lip repair.

Urology surgeons collaborating.

Donna Schroeder, RN, with her Vietnamese colleague in pre-op.

And the families patiently and anxiously waiting:

First Day at the Hospital for the Vietnam Team

After a meeting with our partners at Thanh Hoa pediatric hospital, we began evaluating the many patients waiting to be seen by urology and ENT surgeons. Many patients and hopeful families had traveled long distances to see CSI.

Because we had a team here six months ago, we have the ability to see some children in follow-up who weren't ready for surgery at that time. Returning after just six months also allows for more continuity in our education and training models, as well as streamlining and improving our processes with the hospital staff and administration.

It was a very busy but interesting and successful day. More than 100 children were evaluated for potential surgery. Some will be ready for surgery this week, while others may need further testing and diagnostic work. To a few families’ joyful surprise, their children had normal examinations and did not require a procedure.

While the children were being evaluated, our OR anesthesia and nursing teams spent the day setting up the operating rooms, assuring they had all the necessary equipment ready to provide safe and comprehensive pediatric surgical care, and meeting with their Vietnamese colleagues.

Our team is enthusiastic, resourceful, committed, hardworking and fun! CSI is thrilled to have a few nurses and physicians with us in Vietnam who are new to CSI. It really doesn’t take long for a group of passionate people to become a cohesive team. The children and families waiting for us here give us the energy and focus to give them our best.

As always, our focus is on education for local health professionals. We will be working alongside Thanh Hoa hospital surgeons, physicians, nurses and administrators every step of the way this week.

~Linda Sedgwick

CSI Team Arrives Safely in Vietnam

Long travel days were the norm for the team traveling to Thanh Hoa. The journey included 28 hours+ flight times, an overnight in Hanoi and a bus ride to Thanh Hoa on Saturday. We enjoyed a welcome dinner with hospital physicians and administrators. Everyone is enthusiastic about getting started. Sunday will be spent screening children at the hospital in preparation for a full schedule of ENT and urology surgeries this week.

The CSI team in Vietnam includes 26 members from Minnesota, Virginia, California, North Dakota, Tennessee and Maryland.

A special thank you shout out to our guide Frederick, Father Joseph and our Vietnamese interpreters.

~Linda Sedgwick

The CSI team heads from Hanoi to Thanh Hoa.

Wyn Huynh, CRNA; Dr. David Vandersteen and his Vietnamese colleague, Dr. Thanh.

CSI board chair Tom Fansler with hospital director Dr. Hung and a local volunteer.

Cardiology Team Wraps Up Its Life-Changing Work in Ethiopia

Today we finished procedures and spent the balance of the day investing in teaching and knowledge transfer at the nursing, medical student, resident and fellow level.

We started our day at 8 a.m. with a lecture on ASCVD prevention and transitioned to rounding that went into the early afternoon. We had the pleasure of rounding with very energetic and bright medical students and residents as they were going on bedside rounds with the cardiology fellows.

The center caters to the underserved, and there are 14 beds in each room. The excess we take for granted in the United States is stripped down to the basics, where even the curtain and some extent of privacy between neighboring patients is now down to a few feet between beds in a large open space. Yet with no TV, no patients talking on the phone and no monitors beeping, these large rooms with their 14 patients were quieter than most single rooms I round in while in the U.S. Most of what could be heard was our large team of providers moving from bed to bed and room to room discussing each case in detail and teaching residents.

While the MDs were enjoying these bedside rounds, our multitalented nurse Colleen gathered up the nursing staff and took them through a series of lectures pertinent to cardiac care. The staff created a makeshift lecture hall for her in the middle of the ICU by moving a couple of the beds out of the way so the wall became the screen. (See photo below.) The ICU nurses did not want to miss out on the lectures, so nurses from other areas came over to the ICU and the class was good to go. Improvisation at all levels is the way of life for folks here and a remarkable gift.

Dr. Ben Johnson will do the last in our series of lectures. He will talk about atrial fibrillation, which is a condition common in our patients with valve disease.

I plan on having a series of meetings tomorrow that will hopefully facilitate the smooth entry of our items into Addis/Bahir Dar on subsequent trips.

~Dr. Woubeshet Ayenew, cardiologist at Hennepin County Medical Center and CSI volunteer

Cardiology Team Still at Work, Making a Difference in Ethiopia

Most of the CSI Urology and ENT team members have returned home after a successful week of teaching and completion of life-changing surgical procedures in Ethiopia. The cardiology team, including Dr. Ben Johnson, Dr. Woubeshet Ayenew, Dr. Ron Johannsen, Dr. Brinder Kanda, and Colleen Johanssen, R.N. continue their work in Addis Ababa. They are performing procedures in the cardiac cath lab that repair heart damage due to diseases uncommonly seen in the U.S. 

Sticking with the CSI mission, the cardiology team’s goal is knowledge transfer at all levels of the cardiac care model. Every interaction with patients, cath lab nurses, ICU nurses, staff physicians and cardiology fellows has been leading to care enhancement for patients here in Ethiopia. Since rheumatic heart disease is very common in the region, we are also indulging in the local expertise on certain aspects of disease management. Colleen Johannsen R.N. gave a lecture on ECG interpretation this week to approximately 60 medical students, resident and fellows. They are so eager to learn!

Visit our Flickr site to see more photos from the CSI Ethiopia mission.

Making a Lasting Impact with Collaboration and Education

Today I asked Ethiopian urologist Dr. Melesse what it has been like to work side by side with CSI surgeon Dr. Francis Schneck. "I have the opportunity this week to learn from a surgeon who is absolutely extraordinary; more extraordinary than I could have ever imagined," said Dr. Melesse. He also praises having the CSI team at the hospital, saying, “The way you people work together, the way you are a team, the way you work together with our people, the way you help our people. It is a gift."

Asked why he chooses to practice at this very poor public hospital, he says, “Because this is where I am from; this is where my wife is from; this is where our son lives; this is our home. You look down the hallways here and can see how very, very poor these people are. They are lying in the halls waiting for help. For most of them, there is nothing we can do for them. They have nowhere else to go.”

Our CSI team has learned so much from Dr. Melesse, and it is our hope that we have been able to share skills that allow him to provide even more comprehensive care for his patients.

The operating rooms are very hot, especially with the powerful lights on. OR nurses Mary Johnson, Jodie Pelkey and Dee Vander Pol are doing a fantastic job of keeping everyone well hydrated and everything as sterile as possible. They are also thinking about future missions here and determining if there is an opportunity to leave some of our CSI supplies behind for our next mission.

Trying to stay cool in the OR

Everyday it is a hunt for some needle in a haystack, and none of this would be possible without CSI Logistics General Extraordinaire George Steiner. No request is too daunting for George. Yesterday he was dispatched to find a very small fuse to fit in a cystoscope for the urology team. The fuse blew as it was turned on, and the patient, a young man who had been in a motorcycle accident, had been waiting all day. We cried with joy when we heard "George found the fuse." He was high-fived like he was carrying the flaming Olympic torch the final distance. Way to go, George!

Nurse Mary Johnson with one of her sweet patients

We would like to take a moment to thank Dr. Woubeshet Ayenew, a cardiologist at Hennepin County Medical Center and CSI volunteer. It was Dr. Ayenew who was aware of the serious cardiac issues of the children in Addis, and he was familiar with the hospital in Bahir Dar as well. He made the first overtures to Drs. Asnake and Melesse, who are now our main contacts here. This site is a dream CSI location.  Local physicians who not only want to offer free surgeries for their patients in dire need, but most importantly are committed and enthusiastic about learning to ultimately perform the surgeries independently.

Dr. Woubeshet Ayenew working with Ethiopian cardiologist

The Cardiology team in Addis also had another great day, continuing to teach local cardiologists and nurses during three additional procedures. Their work is changing the lives of children and young adults. Here are some photos from their day.

Drs. Johannsen and Kanda collaborating with the local cardiology team

Colleen Johannsen works closely with local nurses to determine proper medication dosing.

Dr. Ayenew and Dr. Johnson with some new friends.

By: Sally Lannin

Wednesday
From the Cardiology Team in Addis Ababa:
We had a very successful day today! We performed two cases and had great results for both of the children. They are recovering in the hospital overnight, and we are confident that they will already notice a difference in how they feel by tomorrow morning. Here are a couple of photos from the day.

One of our patients just prior to his procedure. He should feel much better tomorrow!

Teaching and team work in the cath lab

From the ENT and Urology team in Bahir Dar:
With the exception of two patients who ate right before surgery and thus needed to be rescheduled for tomorrow, it has been a great day. Dr. Fran Schneck performed a lengthy, 6.5 hour surgery in the 95 degree operating room, basically re-routing the plumbing on a 3 year old who had lived with an external bladder since birth. Tomorrow Dr. Schneck will repair a similar defect for a 14-month-old child. Drs. Tim Lander and Andrew Scott are tackling cleft lips, removing a tumor on a palate, and a neck mass on a brave 12 year old girl named Narda. The local surgeons are so very pleased to have the opportunities to observe, learn and participate in these interesting procedures. Some say they feel as though they are "walking on water"!

We had a large lunch brought into a room near the operating rooms in order to share our midday meal with the Ethiopian team members. Molly McIntyre and Amy Erlandson are keeping peace in the PACU with Drs. Paul Melchert and Dave Tetzlaff. The ward is managed by Norie Wilson with Maria Rubin and Victoria Vandersteen. Tonight a few from our anesthesia team (Drs. Zipporah Gathuya, Kevin Healy, and CRNA John Erlandson) will return to the hospital to administer another epidural to the little girl recovering from bladder surgery. This will keep her comfortable while she is healing.

Dr. Dave Tetzlaff with a proud and grateful father

We’re off to bed to rest up for another busy day tomorrow!

Successful Surgeries, Wonderful Families, plus Cardiology Team Update

Mom comforting child while waiting for surgery.

Tuesday
We have had a very, very busy day! Given the severe lack of resources in this public hospital, the work their staff is able to accomplish is incredible. Our urology and ENT surgery schedules have been full, and lots of good teaching and training has taken place. Dr. Scott was able to allow one of the Ethiopian surgeons to perform a considerable amount of an entire surgery with him coaching and correcting. This was a great feeling for everyone involved.

Having enough interpreters is a challenge in most countries where CSI travels, and Ethiopia is no different. In addition to four 4th- and 5th-year medical students, we recruited an Ethiopian man who works at the hotel and also happens to be a patient scheduled for surgery with us at the end of the week. He speaks English well, so we asked if he could come back to help us if we are able to return later this year. He haltingly responded that he didn't want to have to wait 6 months for his surgery. Of course we meant would he return to help translate, which he enthusiastically agreed to do.

Dr. Andrew Scott and CSI Partner Mary Moore

Everyone is working above and beyond, showing terrific flexibility. Our Ethiopian partners are all in and asking great questions. One minor challenge is the squat-only "hole in the floor" toilet at the hospital, giving men a technical advantage.  The CSI women who haven't been doing their squats in yoga back home are incented to not drink or eat all day, which is never a good idea when working 10-hour shifts in a foreign country!

The children and young adults we are caring for have the most beautiful eyes and ready laughs that make one momentarily forget how far apart our worlds are, yet hint at a surprising shared intimacy. When we take their photo and the flash makes them blink, others around them laugh and elbow them when we show the squinty result. The exact thing would happen to us at home. We blow a bubble wand and one lands on the dad's nose, causing the child to erupt with laughter. Just like us. The mother starts to cry when told we cannot help her child's affliction, and we immediately give her a hug because her response is exactly as ours would be.
These are all our children, and each one we see here cannot help but remind us of our incredibly good fortune.

Pediatrician Dr. Paul Melchert evaluating one of our sweet patients

Cardiology Team Update
Here’s a quick update note from Dr. Ron Johannsen and the cardiology team in Addis Ababa:
We had an exhausting but rewarding time with our cardiology colleagues at the Cardiac Centre - Ethiopia today.  We evaluated 22 patients with severe rheumatic heart disease, then chose and prioritized them for interventions starting tomorrow morning.  We had a wonderful mix of Ethiopian and U.S.-based cardiologists working and learning from each other.  The knowledge shared from our various experiences in Nepal, India, Ethiopia, and the U.S. with this devastating heart disease will go a long way in improving care not only now, but long term. A huge thank you goes out to Dr. Woubeshet Ayenew, who has been the glue necessary to make things run smoothly at our site.

Setting up the cardiac cath lab in Addis Ababa

Dr. Ron Johannsen teaching local cardiologists

A vital part of every Ethiopian visit!

Kids, Connections, Surgery, Teaching, Teamwork

Sunday

In an effort to accomplish our goals related to teaching and training, we are realizing the importance of connecting local professionals with CSI team members early in our mission. The success of our teaching model is contingent upon making certain as many local professionals as possible are ready to learn.

This week in Ethiopia, we hosted a wonderful dinner on the night before starting surgeries. CSI nursing, anesthesia and surgical staff were all seated with their Ethiopian counterparts from the Felege Hiwote Hospital to share a meal and make important connections. These early interactions will help us maximize our relatively short time here, so that we can share as much knowledge as possible with each other and make the biggest impact.  We are also making critical introductions throughout our entire CSI team, from the screening rooms to the surgical suites and on to the pediatric wards.

Monday

It’s Monday morning at the hospital, and the first day of surgery. Patients are checking in; others who weren't screened on the first day have shown up hoping to be added to the CSI schedule. We are getting our bearings as to what is happening in our different patient care areas. This hospital is the largest local public hospital, and it’s hallways are teeming with  patients - sitting, squatting and lying down.  We are a bit short on translators, so we are working to get additional help from a local tour company. 

The Asinuara Hotel has been accommodating, helping by delivering drinking water to the hospital, making our lunches to-go and transporting us. The Ethiopian people always say "thank you so much" when they learn we are here to help their children!

The cardiology interventional team will start their procedures on Tuesday in Addis Ababa. Their goal is to perform cardiac procedures on children who have suffered cardiac damage due to rheumatic heart disease and of course teach local cardiologists as well. We hope to get updates from them soon, and will keep you posted.

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.