First Day of Surgery!!!

Day 4- First Day of Surgery

We left the Guest House at 6:30 am sharp in order to have the first patient on the operating table at 7:30 am. The first three patients (17 total today) were a proximal hypospadias, a huge umbilical hernia and a cleft lip. Dr. Lawrence Sherman of the Duside hospital participated in the cleft as Dr. Lander of our team is teaching him, step by step, how to complete these surgeries on his own. Dr. Lander was thrilled that Dr. Sherman was able to do much of two surgeries on his own with oral guidance.

The patients had been staying at the hospital overnight and hadn’t had anything to eat or drink since midnight last night. The staff and volunteers at the hospital have been extremely helpful. In particular, we want to give a round of applause to one volunteer who has returned from last year, a Physician’s Assistant student at Liberia’s biggest hospital, Mr. T.K. Abonoko Wiah. He has prepared IV’s, taken parents to the waiting area, comforted crying children and been invaluable as a translator.

We began handing out the beautiful hand sewn gift bags that have been so beautifully prepared by Benjamin Poore for his Eagle Scout project. Every girl patient receives a hand made doll from Dollies Making a Difference (a Pacific Palisades organization which reached out to CSI after reading an article about us in their local paper) and each boy receives a baseball hat courtesy of Zephyr Hat. School supplies, toothbrushes/paste, a school notebook, shampoo, soap and washcloth are also included in the gift bag.

One of the patients is a 13 year old boy named Menmeah who had an accident several years ago—his mother said he had fallen from the top of a tree through the branches to the ground. Ever since the accident, the boy has been having such difficulty urinating that he had to drop out of school and has been unable to attend for the past 4 years. He leaks constantly and walks with a rag between his legs. Because the boy’s father is handicapped the older 3 children receive school for free, but Menmeah is unable to attend. Dr. Dave Vandersteen operated on the boy this afternoon and pulled out a 3 inch stick that was lodged up inside him, now covered with calcification. When the doctor showed the stick to the mother after the surgery was complete, she burst into tears. Prior to surgery Menmeah was proudly showing the staff in pre-op (Katie Houle, Jan Martland and CSI Partner Katie Stewart) how he could write his name. He will be very happy to return to school, his mother says.

Tomorrow is another very full day with 23 surgeries. A few of the team members will be visiting an AIDS orphanage, and then traveling with Debbie from Orpha Relief and Rescue (orphanreliefandrescue.org) We’ll be preparing a meal, delivering clothing (one mother in Minnesota gave us all the baby clothes her twin daughters have outgrown).

Shown above is Dr. Lander briefing Dr. Sherman the Liberian physician performs his first cleft, two boys out of surgery sporting their hats donated by Zephyr Hat Company, and children with dolls from Dollies Making a Difference.

Additional Photos from Liberia 2012- Surgery starts tomorrow

Shown here are the CSI team in the bus heading to the hospital for screening, a patient at screening, and Lora Koppel, team ward nurse and CSI Board Chairman dancing with children in a nearby village

Day 3 in Liberia

Yesterday we had a full day of screening at Duside hospital, and in the evening at dinner many of us felt it had been the most efficient, effective screening ever experienced on a CSI mission trip. What made a difference was having the surgeons positioned at the entrance of the hospital with Dr. Sherman, the local surgeon, who cycled his pre-screened patients to the appropriate surgeon who could make a quick determination whether or not surgery was possible before sending the patient up to get background information, vitals, a photograph and a screen by the pediatrician. We screened a total 109 patients, scheduling 104 for surgery. One woman had walked two days, and then taken a 7 hour car ride in order to get to screening; another walked two days and then took a bus for 4 hours. Dr. Tim Lander screened a number of cleft lips and palates, Dr. Dave Vandersteen a number of urological disorders, Dr. Steve Muehlstedt a number of general surgical issues, and the two pediatricians Dr. Dave Tetzlaff and Dr. Tim Wood screened everyone for surgical readiness. For example, does the patient have a fever, is he underweight, does he seem congested? Every single team member participated in some aspect of screening. Katie Stewart, this year's CSI Partner, teamed with medical records head Jan Martland to create a chart for everyone and get essential background information. Sally Lannin took before pictures of all patients, Joel Johnson ran logistics which involves just about everything, Mary Johnson and the other OR nurses Jodi Pelkey and Katie Sweet got the operating rooms readied. Lynn Randall and team Mary Randall, Dan Chow, Tammy Skidmore and Mary Dudley unpacked all the drugs and machinery for anesthetizing patients with the help of Dr. Ryan Rekuski, our anesthesiologist. Others including nurses Patience Kankeh, Michele Stewart, Julie Hampton, Lora Koppel, LouAnn Randall and clinical lead Katie Houle either took vitals, floated where needed, escorted patients to and from the lab etc. It was all hands on deck for a very busy 8 hours.

Today members of our team lead trainings for Liberian medical students and other professionals, as well as screened a few additional patients, although we have a very full schedule of surgeries for the next 5 days. Shown in the photos is team member Kristi Holton taking vitals on a patient, as well as a look at the patients waiting hopeful their names will be called, as well as one happy patient.

Day 1 in Liberia: CSI Mission to Liberia 2012

Arrived safely at Robertson airport last evening, and got to the Firestone Guest House safely, all accounted for, and all luggage in hand! Congratulations to our logistics team member this year, Joel Johnson, as well as all of the Firestone supervisory personnel dispatched by Dan Adomitis of Bridgestone Firestone and his team. We were met by wonderful Lillian, all of the Firestone staff, and many familiar faces as this is our third year back. In bed relatively early for everyone, and day one spent touring the capital of Liberia-- Monrovia. We stopped at a museum, a marketplace, the first church of Liberia where the repatriated slaves worshiped after the Emancipation Proclamation gave them the option of being returned to their home continent of Africa, saw the US Embassy as well as the new UN building. The day also gave us a good chance to have a rest day as we hear tomorrow, screening ,will be very busy. A stop at the beach on the way home to see where the Atlantic Ocean meets the western coast of Africa, and back to the Guest House for an orientation talk by Dan Adomitis and our first team meeting led by Medical Team Lead Dr. Tim Lander. Shown in the pictures a photo displayed in the museum of what the streets of Liberia looked like following the Civil War, which ended in 2004; the streets literally littered with bullet casings. Also is a reflection in a new building in Liberia as well as a busy street corner in Monrovia

Dakar 2011 - Filming in Dakar

Set up in the OR with the whole team. Can you see the concentration of the whole team as we work hard to ensure that we capture the valuable imaging we need to make this project a success!

Morning discussion with Dr. Gueye as we plan our steps for the day.

Team meeting in our lovely hotel to review the hours of imaging we obtained and to make sure we are capturing each step of the fistula surgery.

It has been an incredible trip. We have learned a lot through our collaboration with our Senegalese partners and created relationships that will allow for continued efforts in teaching fistula surgery throughout the developing world.

Our hosts have been incredibly gracious. We have had the pleasure of meeting religious and community leaders, members of the UNAFP, and medical personnel from the entire hospital as well as visiting doctors from the US. It is wonderful to see the excitement of everyone in working on this difficult issue.

Today we had the opportunity to round and interview on our patients and it was amazing to hear their stories again and how happy they are to be dry for the first time in many years.

This has been an amazing trip. 

Dakar 2011 - Week of Filming

Hello again all! Sorry for not writing more regularly this week but I figured our update for the end of the week would be more meaningful! We have had a busy week of video recording and directing to obtain all the necessary material for the development of our surgical trainer. We have completed taping about 10 fistula surgeries showing a multitude of variations that will be critical for the learner.

Our hosts Hopital General de Gran Yoff and specifically Dr. Serigne Gueye and his team have been incredible! David and Pete made it here (albeit Pete a day late) with all our equipment in tact and in tow! They have been so accommodating in understanding the video process and ensuring the surgical steps are clearly delineated so that we can capture each step precisely for the trainer.

Here is a picture of our OR set-up which miraculously worked without a hitch! Thank you Tanya from Stryker and kudos to David and his technical genius!

I have lots more to share as our week comes to an end. Will add a longer post tomorrow but I wanted to get something up there to share with you all!

Bangladesh Mission - 11-2-11

Walking from the hospital to our hotel.
The RDRS Guest House is about a half mile from the hospital. Saturday is the only day we walked as we have been working 12+ hours the rest of the days.

View from the Post-Op Ward showing a busy street below. This is the same street that leads to our hotel.

Zipoorah, our Pediatric Anesthesiologist from Kenya, reviewing the Surgery Schedule with RCMC Head of Anesthesiology

Zipporah gently walking a young 13 year old girl to surgery. The older children and adults walk, while the babies are carried.

Lead surgeon, Kofi Boahene, performing surgery and teaching one of the Rangpur Community Medical College and Hospital doctors.

Krista Rodriguez-Bruno performing cleft lip surgery and teaching the fine techniques of such procedures to an eager Bangladeshi surgeon.

Anthony Brissett with his Rangpur doctor counterpart. Here he is coaching and the Rangpur surgeon is learning by doing.

Many hands working together result in a new beautiful smile for each patient.

A mom with her son, in the ward after his surgery. Mom's and babies spend the night in the ward, then are discharged in the morning after, Dr.'s Kofi, Anthony, and Krista make morning rounds.

This is our little Rifat and his mom post surgery. Check out the previous blog to see the before surgery pictures!

Dr. Kofi and Fazly, out head logistics person and translator. They are

giving the parents discharge and care information. This is one happy group. the exit is a stairwell behing the large support column. The dads and other family members wait here for their children and wives.

Couldn't resist photographing these precious little toes. After surgery, the children go to recovery, where they are covered with blankets, made by the many csi volunteer, sand monitored until they wake up. Then the moms are called in to comfort them.

The days are packed! As of today we have performed 74 surgeries and screened many more potential patients as the fact that we're in town is spreading. The list of patients for next year's return has been started. We had to turn away two very little babies, one just 30 days old. Although they did not receive the answer they wanted, Jan showed the moms how to feed their babies with a cleft lip and/or palate and asked to come back next year. With this type of knowledge and skill, their children have a better chance of thriving and they have hope that we can perform surgery on them next year.

There have been so many highlights, wonderful moments, and just plain funny events. There are many things we see in the hospital here that one would probably (make that definitely) not see back in the states.

The hospital does not have air conditioning, except in the operating rooms, so many windows are open and all kinds of flying things enter the building. We are greeted by some beautiful butterflies fluttering along the halls, crickets peeking out from corners, and of course flies-even in the or. Hospital laundry can be seen hanging to dry on clothes line on the roof. And many hospital workers go barefoot, even into the OR!

We have delicious lunches made and packed by the staff at our guesthouse and there are wait staff in the "lounge" the make tea and coffee. The doctors here all have wait staff that deliver tea, water and meals . It's very different that home and is rather hierarchical. There are always people sweeping the halls and walls throughout the day and night, otherwise the hospital would be coated in a light layer of bugs and such. Bangladeshi brooms are made of long grasses bound together. One of our nurses commented how nice it would be to take one home and hang on her wall.

There have been a few minor crises, but nothing the collective genius of this group can't tackle! Upon arriving at the hospital one day we found that the or surgery lights were not functioning. We put the word out that head lamps were needed and several of the team came through. This was after we we devised a way we could duct tape a flashlights to each surgeon's forehead! Fortunately after a few hours the lights were fixed and we were back in business.

It's been wonderful to witness the results of our gifted surgeon's expertise. Babies and numerous adults have had their lives transformed and so many have expressed their gratitude with their smiling eyes and by placing their hands to their hearts. One young man in his early 20's was accompanied by his best friend and together they traveled over 150 kilometers. The friend was so excited for this young man and could not contain his excitement. Another young woman had a severe facial cleft. She has never been to school, although has received her education at home, has no friends, and rarely has left her home in 22 yrs. Dr. Kofi said, "I really want to do this surgery for her." He did and the results are amazing!

It has been a great mission and what we have witnessed here make us greatly appreciate what we have back home.