Riley International Heart Missions

Riley/Rotary Vocational Training Team Trip 2013 to Uganda Heart Institute-Saturday’s Good-byes

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Saturday started by noting that Brittany and Trina had not returned early morning as planned as Moses apparently developed low oxygen sats. They have been working to fashion a CPAP of sorts from the ventilator and this seems to have helped when percussions to his chest did not. As soon as our driver meets the rest of us at the hotel, we are off. We had planned to do brief rounds, say good-bye to all the patients, have a brief debriefing with the UHI staff, and then leave the hospital by 10:30… Best laid plans…Moses’ chest Xray showed significant fluid in the left lung and required re-intubation (on a ventilator again).

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Most of the team at Moses’s bedside

Again, ventilation is a struggle as the power is out in the area of the oxygen supply this morning. Dr. Mwambu wheels in a huge oxygen tank to attach to the ventilator directly as backup. Will increase his Lasix, watch him on the vent, and Dr. Mwambu will keep us updated via email. The rest of the children are doing very well. Riana is recovering well in her first day post-operatively.

20131103-175407.jpgRiana and her father

Catherine is recovering well, eating and no problems. She is getting stronger

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Catherine

Redeemer is still paced at this time by pacemaker, but we are still hopeful this resolve in the next week. Otherwise, she is looking great.

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Gloria is in the step-down unit and doing well postop day #2. She was blowing bubbles and smiling a lot with her mom.

20131103-174213.jpgGloria

Yasin looks so much better! He was the most dramatic improvement in the last 24 hours. He was started last evening on their equivalent of the antibiotic Zosyn in addition to the starndard cephalosporin antibiotic and he is smiling again. Afebrile, and eating when we first peeked in the unit. So happy to see this handsome guy’s big turn-around!

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Joanita is doing great as well and should move to the ward today after her lines and chest tubes are removed.

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Joanita

Pius has mellowed and is doing well also. He almost musters a smile at the crazy Mazungas in the room…almost!

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Kato’s diarrhea has resolved in the ward. His mother says he wants to nurse all the time…She has been trying to offer other nourishment as she feels she does not have enough to satisfy him.

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Kato

Sharif is looking so much stronger! he is walking about confidently now in the halls!

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Justine is still sleeping a good bit, it appears and is not happy about getting up to walk over to cut the cake! Her parents have typed up a sweet thank ou note and posted at the foot of her bed!

20131103-180246.jpgJustine

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Rose and Sherna have long left to home (last Thursday’s surgical cases).

Given all the work to stabilize Moses, the cake-cutting in the ward for the children and to say good-bye to the families is delayed and still quite difficult to get everyone together for one picture as a large group. Hopefully someone has a copy of the entire group with the families, but I do not… This is one we found with some of the team, but still not all…

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After giving all the moms hugs and drying Justine’s tears, we convene in a tiny room to discuss the week in a debriefing with Dr. Omagino (Director of UHI), Dr. Mwambu, Flavia and Anna from nursing, and our entire team. Strengths are noted with challenges to conquer as well, nearly all in facilities, equipment, and supplies.

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Debriefing

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We finish the debriefing after 12:30, pack the trunks and pile in the van to get back to the hotel. There is a little time for packing, some eat lunch, and others go our our favorite spot in the mall next door, Banana Boat for gifts for home. We had hoped to enjoy some of Entebbe before getting to the airport for check-in, but the team is tired and would prefer just to get to Entebbe to sit. Grace recommends the perfect place for a quick dinner with beautiful views of Lake Victoria. We enjoy sunset there before checking in at the airport and bidding our dedicated drivers for the week good-bye. George, Patrick, Paul, and Moses waited long hours for us daily, not knowing when we would leave the hospital. We so appreciate everyone’s dedication!

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What an amazing week at UHI…so productive in terms of number of patients treated, skills transferred between the teams, and improvements noted. The UHI staff, cardiologists and surgeons are a dedicated, intelligent group of Ugandans, well-skilled and ready to treat their Ugandan patients with congenital heart disease. They still need continued equipment, financial, and facilities support to meet the quality of their skills now to build more capacity.

Our Riley/Rotary VTT is so thankful to have been touched by this collaboration for four years to date. In addition to our thanks to this amazing crew at Uganda Heart Institute, we want to thank the following:
Gift of Life International has set the groundwork to bring 4 teams a year to help with the infrastructure of governmental assistance as well…
The Rotary Club of Kampala North as the Host Sponsor Club and Rotary Club of Greenfield as the International Sponsor Club with contributions from the Rotary Club of Indianapolis and District Funds from D9211 and D6560, then matched by The Rotary Foundation of Rotary International make this logistically and financially possible…
The friends and colleagues who cover for the amazing, dedicated team members from Riley Hospital for Children (as well as my hard-working American Health Network-Greenfield colleagues covering me while I blog from the other side of the world!)…
Our wonderful, patient, supportive families…
Our supply donors (names may be updated in the near future)…
The Cheer Guild at Riley who sent the gift bags for the patients…
RC of Greenfield and D6560 for the iStat Machines and in a previous year, the headlight for Dr. Turrentine
Grace Agwaru for her in-country coordination of patient information for follow-up and our hotel and food arrangements

And most importantly, this selfless group of Riley physicians and health professionals who may not yet be Rotarians, but demonstrate Service Above Self in their everyday work and here on their vacation time as well…Engaging Rotary and Changing Lives!
We may be changing the patients’ lives, but our lives are forever changed in the process…What an honor to work with each and every one of them!

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Cath Team

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OR/ ICU Team
Who knows what the future will hold for this group? Another trip to Uganda in 2014, and/or expanding to new areas of the world?

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Dr. Turrentine leaving the OR after the final surgery in Uganda at UHI…

Written by stephkinnaman

November 3, 2013 at 11:15 pm

Posted in Uncategorized

Riley/Rotary Vocational Training Team Trip 2013 to Uganda Heart Institute- The Final Friday

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The final day of operating starts with a quick breakfast and all team members left together instead of the 2-wave approach like the last 2 days. The children did well overnight. Trina and Brittany with Dr. Joel have them all settled. The Chest X-rays are done and put up on the viewer all ready for rounds. Joanita looks great, is sucking her thumb and is ready to move to the step-down unit. Gloria is doing well. Her mother is by her side nearly all the time. Catherine is fussy. Her mother is bedside as well and tries to keep her calm.

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Catherine
Redeemer is sleeping, had some pleural effusions and will require a little more work before taking out her chest tubes.

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Redeemer
Justine is looking good and will move to the ward today.

20131102-005410.jpgJustine in the ward

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Sharif
Sharif will move to the ward as well…in fact, I caught his picture as he moved! Slow and steady, he made his way to his family in the ward. It is a triumphant walk for these kids to make the approximately 30 yards walk to the ward. Although they are still quite sore and it is difficult, they are greeted by excited family members there. Many of them could not have walked that far before surgery. They are big steps for these children given the Gift of Life!

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Sharif walking

Sheila told me of a discussion she and Sharif had yesterday…she had offered him Goldfish. He ate only a few and then wanted to tuck the rest away. She kept telling him to eat them all, they are all for him, but he refused. he finally said to her “No, I will need them for tomorrow.” Amazing that at 7 years of age, he already knows how to ration himself. Hopefully, he and his family can be signed up for the Nutrition program through Gift of Life Uganda so he will never have to eat just a few Goldfish at a time again!

Pius is lethargic today. He has quit fighting everyone and being grumpy, so we wonder what is up. Labs come back and he is terribly anemic (hct 18). He receives some blood and has a little fight in him now.

Yasin is a little febrile. Antibiotics are added and will be watched still in the step-down unit.

Moses is our first patient of the day. Moses in a 24 month old little guy of only 17 lbs from Kampala. He is the youngest of 3. He has multiperforate ASD and a subpolmonic stenosis and currently on no meds, but the loudest murmur you’ll ever hear! It is hard to hear his breath sounds for the continuous, loud murmur!

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Moses

During his surgery, DG Emmanuel visits UHI again. this time at just the right time to witness one of the surgeries here firsthand. He and Asst Governor Dorcus, Rotarian Harriett, and Rotarian Margaret, and the Country Chair. all were introduced in the OR and welcomed by Dr. Turrentine himself. Dr. Mwambu even gave a play-by-play for the crew for some time as the patient was prepared to stop the heart and go on bypass. We are so happy to partner with D9211! making amazing things like this project to build this program is what Rotary is all about, working together across the world to change lives! thank you DG Emmanuel and RC Kampala North for your partnership!

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DG Emmanuel in OR

He has a closure of the ASD and Pulmonary patch. His surgery goes well with just a small gradient across the pulmonary valve found on post-bypass TEE by Dr. Cordes and Dr. Lwabbe. As has become customary it seems, the electricity goes out, but for the most brief time of the week. Moses’ chest is closed up by Dr. Oketcho and Dr. Alfred and he comes back to ICU. The UHI nurses get him all shocked up to the monitors and his mom is able to come back to see him soon after.

Dr. Walker, Chas, and Dr. Schimmelpfennig go straight to work to ready the room for the next patient. Mike is already getting his pump ready also. Sheila and Dr. Cordes are busy in the ICU with Moses and all the other patients as well. We cycle through for a brief lunch and Riana is brought back to the OR.

20131102-011608.jpgRiana yesterday

Riana is a beautiful 7 year old girl who we met last night with Dr, Walker and Dr. Schimmelpfennig. She has an ASD and Pulmonary Stenosis as well. She will have a pericardial closure of the ASD and a PA Patch. She too is tiny for her age at only 30 lbs. Her mother had several questions about her condition and if surgery was really necessary last night. Mom had tears in her eyes as we left her. What a difficult process for these families, knowing it is the child’s only hope, but so difficult to think of a big procedure by doctors you have never met before…little do they know, the Riley Team is the best for the job! (says a non-associated Family Physician who would never allow anyone else to do my child or my patients’ surgeries if up to me!) :)

Riana on way to OR today

Her surgery goes well and while Dr. Mwambu closes, Dr. Turrentine and Chas ensure all we brought from home will be returned in the trunks. Riana is brought back to the ICU for her recovery. Mike and Dr. walker and Dr. Schimmelpfennig also pack up their trunks. Riana is wheeled back to the ICU before 6 PM and is doing well immediately postoperatively. The children have been given bags of goodies that are age-appropriate by Child Life at Riley. Trina and Sheila came upWith a great idea to print a picture of each child with their surgery date on a cute plastic frame. The parents are so loving them that the newly operated children’s parents are asking for them! Here is Moses’ framed pic…

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A plan is made for tomorrow’s rounds, then a full plan is made during evening rounds with Dr. T, Dr. Mwambu, Dr. Cordes and Sheila with the UHI nurses. We round on the ward as well where we last see Justine. She had just awoke from a nap and was signaling us to come to her. she held my hand one one side of the bed, then still reached for Dr. T with her other hand. Justine held his hand while they talked. What a sweet moment!

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It was a big 2 weeks here…24 caths, 13 surgeries- the largest mission to date with our Riley/Rotary VTT! We celebrated by accepting an invitation from the wonderful Kampala North Rotarians to dinner at the Ndere dance troupe Center where we enjoyed a Ugandan meal and amazing African dancing! What a great experience thanks to our host club sponsors!

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Written by stephkinnaman

November 1, 2013 at 1:51 pm

Posted in Uncategorized

Riley/Rotary Vocational Training Team Trip 2013 to Uganda Heart Institute- Thursday is VSD Day

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Dr. Walker and Dr. Schimmelpfennig are bound and determined to get started even earlier today! Dr. Walker announced even last night that the first wave of the team would leave at 6:58 AM…and they did just that! The second wave left as soon as our driver George arrived with Trina and Brittany. Rush hour traffic is pretty crazy around these circles in Kampala! A lot of motorcycles weaving through the traffic (notably more helmets on the drivers this year!) and honking and traffic police whistles…a crazy scene! Brittany and Trina report a good night. Joanita is doing very well with no more wheezing. She has had a good night.

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Justine is doing well and ready to move to the step-down room. Sharif had a good night and was resting comfortably this morning. Redeemer had some BP issues overnight, but is doing very well also.
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Justine
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Sharif

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Redeemer

In the step-down unit, Yasin is sitting up in a chair and smiles on cue as soon as you get the camera out!

20131101-011643.jpgYasin (before his chest tubes this morning)

Pius is still his grumpy self… Not sure he got the memo that long ago this team dubbed that the Smiley Room!

Pius

All the chest X-rays were done and up on the board when Dr. T and Dr. Cordes arrived…what a wonderful effort the UHI staff are making…what a huge improvement over the first year’s trip in 2010! Unbelievably, Dr. T is told when he arrived that they are already prepping the patient in the OR! Wow!! True to Dr. Walker’s goal, the case starts even earlier- just after 8:30! The lights go off again while on the bypass and it seems the overhead surgical lights don’t stay on long thereafter for some reason, but bypass works well thankfully and the headlights make it possible to still see the surgical field. Dr. Oketcho operates with Dr. T and Dr. Alfred.

Gloria is our first patient in the OR this morning. She is a little 7 year old girl (only 30lbs!), the 3rd of 4 children. Gloria has 2 VSD’s and a small ASD with some pulmonary hypertension. Her cath in February by Dr. Craig Sable’s group from Washington D.C. showed her pulmonary hypertension is reactive. Gloria had a cleft lip and palate repaired when she was 5 months of age. One of Dr. Sable’s geneticist feels that given her compilation of congenital problems, she likely has a chromosomal abnormality. Her mother, Grace, is listed as a “saloonist” (?!) and her father is a primary school teacher. They live here in Kampala. Gloria’s symptoms of shortness of breath and palpitations with feeling tired easily have been well-controlled on her medications, the parents think…but she will feel so much better now!!

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Gloria and her mom at the preop echo last night

In the ICU, Dr. Mwambu and Dr. Walker (when not in the OR) have been busy with chest tubes in the units. Redeemer has 2 chest tubes placed for large pleaural effusions and her heart rate is slowing so the Amiodarone is decreased. Yasin also has a chest tube placed, so Dr. Walker certainly had his exercise back and forth from the OR and the ICU giving sedation. What a huge blessing to have 2 Anesthesiologists this trip!

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Dr. Walker and Dr. Schimmelpfennig

The second patient of the day is Catherine, a 26 month old who has a VSD (supracristal). She is the 9th child born to “peasant farmers”… She is a sweet little gal all bundled up next to mom asleep with her thumb in her mouth when Dr. Schimmelpfennig goes to the ward to get her with John to translate. Mom walks to the “sterile line” near the ICU and hands her over to go on to the OR. She is still quite small for her age (as all these children with congenital heart disease are) only nearly 20 lbs, about the size of a 9-12 month old baby. She will be so. Much stronger and grow better now!

20131031-183706.jpgCatherine with her mom, Dr. Schimmelpfennig and John

Catherine is put to sleep and they are starting the second case by 1:30! Another amazing first! They are all working so hard here this week. Ben and John, the scrub nurses are super busy and really prepared. One will be the scrub nurse with Chas at the back table if they need any help and the other will circulate. They have been there all week for very long hours. They are doing great! Chas was here last in 2011 with them and they have picked right up where they left off. Chas is doing an awesome job keeping track of the instruments brought from Riley with us as well as teaching Ben and John some of her knowledge from experience in CV surgery with Dr. T at Riley for many years. She knows how to be prepared for his next step all the time. She is so sweet and patient with all of us!

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Chas and Ben

Mike and Murra have worked together on perfusion here in Uganda since 2011. Murra was off in other parts of the world being trained on perfusion during our first trip in 2010. She does a great job and Mike just exchanges some of the finer points of perfusion now. Their supplies are different as well. Mike brought several of Dr. T’s favorite connectors and equipment, but we were told they had a new chemical sterilizer that would allow us to resterilize this kind of equipment. However, we were told it was not yet useable once we arrived. Therefore, Mike has been quite the Macgyver in the OR, making things work as if you would never know this isn’t the usual set-up!

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Mike and Murra at the heart-lung bypass machine

Sheila has been crazy busy in the ICU. With 4 patients in the ICU and 4 in the step down unit (2 of which are still really quite sick), she is hopping! The UHI nurses are staffed it appears 2:1 in the step down unit and 1:1 in the ICU, but Sheila is 8:1! Dr. Cordes has been so helpful in orders and calculating doses, but she is doing so much hands-on nursing with kids being sedated for chest tubes, removing lines, moving patients, etc. She has earned her dinner and more every night!

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Dr. Cordes goes to teach the residents again in parts previously unknown in Mulago Hospital. There is a little 7 year old girl who has been in the ward for a week already… She has what appears to be stroke symptoms and a history of one day of fever and then back pain before this stroke. She is unable to move her entire left side. She was fond to have a loud murmur and then found large growths (6mm vegetations) on her mitral valve. Cultures have been done and labs ordered, but they won’t be back for another week. She is on IV Ampicillin for this endocarditis, but no other drugs are available for free. They have asked for recommendations and teaching about her from Dr. Cordes… These smart residents are definitely working under different constraints than we do at home!

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Dr. Cordes with Dr. Aliku doing TEE

TEE is done and the repair looks good and our patient Catherine is returned to the ICU before 5 PM! She is settled in to the OR and the patients are tucked in for the next couple hours by the team when Trina and Brittany arrive by 7:00 for their night shift with Dr. Joel.

20131101-005716.jpgCatherine postop with UHI nurse Harriett

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Evening Changeover from Sheila to Brittany and Trina who are doing a GREAT job with Dr. Joel on nights!

We have two more cases scheduled tomorrow, but 5 of the UHI staff will be leaving for their own Rotary-sponsored VTT tomorrow late evening to Texas. It is our last operating day at UHI this trip…hard to believe! The District Governor of 9211, DG Emmanuel came by again today hoping to get in to see the surgery, but the team was so efficient that by 11:30 when he arrived, it was all over! He hopes to try again tomorrow to see the UHI and VTT teams together in action in this product D9211 helped to bring together!

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DG Emmanuel with Assistant Governor and Country chair and Rotarian Harriett from RC Kampala North, also on the VTT Committee

Written by stephkinnaman

October 31, 2013 at 8:56 am

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Riley/Rotary Vocational Training Team Trip 2013 to Uganda Heart Institute-Wednesday’s Tets

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Wednesday starts with an early breakfast and a quick start. Most of the team catches the van early for transport to UHI first to get the OR ready for the first patient. When we arrive and round with the UHI team and get changeover from Dr. Joel, we find that Joanita had a pretty good-sized pneumo last night and has already had a chest tube to replace it. Vital signs are looking better now and vent settings are adjusted some. Yasin is still requiring a little oxygen to keep up his sats. Justine is doing well postop, but not too happy when her chest is touched at all. Dr. Cordes did an echo after rounds to check cardiac output as well for Joanita and her morning sugar on labs was very low. Meds were adjusted and glucose bolus given and she is looking to be extubated this evening hopefully. By that time, she will be out of the worry time for a pulmonary hypertensive crisis.

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Yasin with night nurse Alex

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20131030-212202.jpgRedeemer with our old friend, Anna

Dr. Walker and Dr. Schimmelpfennig with the 2 UHI residents helping with anesthesia make quick work of the set-up and we are starting the incision by 9 AM! What a great start!

20131030-213247.jpgAn Early Start!

Redeemer is the first patient of the day. She is a little 2 year old with Tetralogy of Fallot. Her family was called in yesterday when there was an opening for today. They live close, so could come right in to UHI. She has low sats as well at 70-80%.

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Redeemer

The case went well, will be paced for a little while due to some heart block when off bypass, but this is not uncommon. She had some oozing issues, so it was a longer case than anticipated, but all is well in the end and she is taken to the ICU awake and doing well.

There is some time for a lunch (as usual, only for some as anesthesia and Sheila in the ICU are too busy once the surgery is over)…then Dr. Schimmelpfennig and Dr. walker and Chas with the UHI team are ready for the next patient. In the meantime, a large contention of Rotarians come to visit to show the District Governor the project he helped to make possible. DG Emmanuel from this Rotary District, D921, is from Kampala and contributed DDF (Designated District Funds for the non-Rotarians) to the Global Grant funding this trip. He and the Assistant Governor and country chair came back to the OR and cath lab to see the facilities. The group also came back to see the patients in the units. It was wonderful to see DG Emmanuel and the Assistant Governor and Country chair as well as PDG Tusu, President Fred and my Rotary counterparts for this grant, Rotarians Oskar and Harriett! Look at what working together across the world in Rotary can do for the world…Engage Rotary, Change Lives!

Then, we are ready for the second patient of the day, Sharif. Sharif is a 7 year old TOF patient from nearby as well who was called in yesterday from the alternate list. Sharif comes from about 3 hours out from Kampala. He was unable to even walk until about 1 year ago when his condition was found and he was started on Propranolol. Even with medications, he can walk only 20 yards without getting short of breath and needing to squat. he has had to drop out of school for now because he is unable to walk to the school which is far. What a wonderful difference this surgery will make in his life!!

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Sharif

Technically, it is felt that his pulmonary valve could be spared by echo. He was such a big boy walking back to the OR. Then he asked once in the OR if he could visit the restroom first. John took him back after a “short call” and he did very well getting up on the table and cooperating to go to sleep. Dr. Turrentine waits to scrub in after Dr. Mwambu and Dr. Alfred opened and did all the work to get cannulated and ready to go on bypass. His repair is done and his case goes well. Dr. Mwambu and Dr. Alfred closed alone as well and Sharif was returned to the ICU after 8:00. Brittany and Trina come in for the night shift, get changeover and are ready to take back Sharif in the ICU.

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Night shift changeover

20131030-213712.jpgJustine has a ball blowing bubbles with Brittany!

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Discussion starts about the patients for tomorrow. Noel is a 2.5 yr old with Tetralogy of Fallot who travelled 3.5 hrs to get here when he was called from the alternate list. Unfortunately, he has a terrible cough, runny nose, and infiltrate on chest Xray. He is not a good candidate for surgery at this time. Gloria has come in and has a VSD. She is a little 7yr old who previously had a cleft lip repair. She is adorable and Dr. Cordes checked her out with echo and discussed with Dr. T, Dr. Walker, and Dr. Oketcho. She will be operated first tomorrow and a little gal Catherine with a VSD also will be second.
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Noel

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Gloria and her mother

20131031-000404.jpgCatherine with her mother and Dr. Oketcho

The plan is made, Sharif returns to the ICU at 8:40 PM and is settled in….the day team returns to the hotel for a late dinner again, but after 2 good cases and Joanita is off the vent.

20131030-235958.jpgJoanita is off the vent!

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Our usual dinner place…late, but we love it!:)

Written by stephkinnaman

October 30, 2013 at 2:43 pm

Posted in Uncategorized

Riley/Rotary Vocational Training Team Trip 2013 to Uganda Heart Institute- Tuesday

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Our team’s day starts earlier today. We are hoping to get the case started earlier as well.

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Joanita is our first patient this morning. She is 22 months of age and still only about 19 lbs. She is the second born of 3 children. Joanita was diagnosed at 8 months with her large VSD when she was easily tired and sweating profusely with nursing. She already has pulmonary hypertension, but her diagnostic cath last week by the cath team showed she will do well to have her VSD repaired as well as an ASD (her pulmonary hypertension is “reactive”). There is discussion about banding now and operating later, but given her family and social situation, Dr. Lwabe suggests it would be best to do the repair now. She will need watched closely on the ventilator for at the very least overnight. There is certainly risk involved with this approach. Her surgical repair goes very well. She has several episodes of an arrhythmia in the beginning which made getting on to bypass a hurry-up approach. However, the team worked efficiently together and her case was done by about 1:30. She was taken to the ICU on the ventilator still due to the worry for pulmonary hypertension.

20131030-150802.jpgJustine

Dr. Schimmelpfennig and Dr. Walker went straight to getting the next patient prepared. Justine is a beautiful girl of 9 yrs with a VSD and Mitral Regurgitation. She is such a sweetheart! She wanted Dr. Schimmelpfennig to carry her to the OR, although she looked nearly as long as her!

20131030-151022.jpgJustine with her mother and Dr. Schimmelpfennig

She did so well getting to the OR and loved the little bracelet Chas had brought for the girls. Her surgery goes very well and looks good on the post bypass TEE done by Dr. Cordes and Dr. Aliku. The case is finished by 4:30! She is awakened from anesthesia and transferred to the ICU doing well by 6:00. There were troubles with the ventilator for Joanita and a lot of trouble with the monitors in the ICU this evening. Poor Sheila had a crazy night getting her settled in with Dr. Joel and the UHI ICU nurses just due to the monitors and cable connectors! She was moved to another room, but then back again. Finally had it all settled out when Melad, the clinical engineer came in from home and worked it out. Definitely some equipment issues to work on here at UHI…

20131030-184136.jpgJustine fresh back with the ICU nurses

In the meantime, Dr. Cordes and Sheila have been busy all day in the ICU, Kato has moved to the ward to make room for Joanita and Justine. He can now be with his twin and his mother there as he continues to recover and ready for home in the next couple days. Yasin’s is quiet and drifting in and out of sleep. Pius is still a little on the wild side. Hard to tell if it is all the meds and immediate postop care, because he is definitely afraid of us Mazungas!

ICU pic

Dr. Cordes also spent a good part of the afternoon teaching the Pediatrics residents in the general wards on rounds. They presented the case of Gad, an 11 yr old boy with Tetralogy of Fallot who was originally on the schedule, but has problems that his platelets are low. He would be too high risk for bleeding problems if operated this week.

20131031-111808.jpgDr. Cordes Teaching on the Ward

After the last operation of the day on Justine, it was decided more discussion was needed about Barbara, a 19 year-old teen with a large VSD and pulmonary hypertension. A cath last week in the cath lab showed she had some reactivity, but given the circumstances of one patient already on a ventilator (with some mechanical issues with that already), we want to be careful not to put her at risk. Se needs an operation as she had to drop out of school because she is unable to get through a school day due to her shortness of breath and weakness. Dr. Tom tells us to send her to a country with nitrous oxide to best check her reactivity in a cath would be $18,000 and her family cannot of course afford this. Dr. Turrentine, Dr. Cordes, Dr. Walker, Dr. Mwambu, and Dr. Oketcho discussed the plan and looked at echos for her and others if her case is not done. Dr. Mwambu has called in several other patients who may be operated in the next 2 days instead. It was an excellent meeting and the cases were set for the next 2 days.

20131030-185242.jpgDr. Cordes, Dr. Mwambu, Dr. Oketcho, Dr. Walker and Dr. Turrentine

Trina and Brittany came to start their night shift with Dr. Joel and Dr. T took the call phone as well. The team returned for dinner at the hotel and an earlier start to sleep. Some have hit the exhausted point at the middle of the trip here and needed some catch-up sleep (hence the delay in the blog! :) )

Written by stephkinnaman

October 29, 2013 at 3:21 pm

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Riley/Rotary Vocational Training Team Trip 2013 to Uganda Heart Institute- Monday, Our Work Begins…

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The team awoke ready for a fresh start this morning…Trina and Brittany had a very uneventful evening as Kato is doing great! They kept busy preparing goody bags for our upcoming patients. We sent them on their way and the OR team went straight to work getting our first patient back. We met all of our next 2 days’ patients in the ward in the process. Yasin is the lucky first guy back! You might think that an 8 year-old might be a little scared to come back with us for surgery, but he and his parents smiled ear to ear when we called his name and asked if he was ready. He is a sweet boy of only 48 pounds but a huge beautiful smile with Tetralogy of Fallot. His father says they are from Kakira, Uganda. He is definitely old for a Tet patient to be repaired. He has significant clubbing of the fingers and toes. His preoperative sats were recorded as 65%. He was hand-selected before our arrival specifically to be repaired by our team.

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Yasin with a smile even as he is walking by himself to the OR
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Yasin’s clubbed fingers
His surgery goes very well other than a period of about 30 minutes of no power! the lights went out other than the surgical lights for aome time, then the surgical lights went out as well! Thank goodness for Dr. T’s battery-powered headlamp, again from the RC of Greenfield!! He didnt miss a beat despite no lights!

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Darkness except for the headlights
Yasin does very well and he goes back to the ICU about 2 where Sheila and our wonderful friend and UHI nurse, Anna, await him. He asked Sheila for his new car given to him before surgery…True to his personality, he smiled when she handed it to him!
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Yasin’s postop smile

During Yasin’s surgery, a large contingency of people gathered at the hospital for a press conference as the Honorable Minister Rugunda and Rotarian Sara came for a visit. Rotarian Minister Sara is another minister for the government of Uganda instrumental in getting the MOU signed between GOLI and the government. Rotarians from Kampala North, most of the UHI physicians, and Rob, Robbie and Grace joined the group to show The Hon. Minister Rugunda and Rotarian Sara around UHI and visited several patients. Many of the press stayed after to come in the theater to document Yasin’s surgery. This will hopefully help the government understand the continued need for financial support while GOLI continues to help coordinate the visiting teams like our Riley/Rotary VTT. We are so happy to see the continued progress here at UHI for our friends the physicians, nurses and staff, and the most importantly, the children of Uganda!
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Press conference

We also see some of the cath patients in the ward on our way through the tour. Sherna is walking around looking great. Rose was eating and oh so cute sitting up and rocking herself back and forth. Justine is a little doll, awaiting her surgery tomorrow.

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Rose

There was a little time for a traditional Ugandan lunch and then ready to start the second surgery of the day! Dr. Schimmelpfennig and Chas went to meet Pius in the ward. The nurses seemed surprised we were ready to go! He was sleeping so soundly on his bed with his mother, Deborah, that it was hard to waken them! Pius is a 3 year old with a perimembranous VSD. The complete UHI team does the case all alone up to the point of starting bypass when Dr. T scrubs in. The surgery went well and Pius was returned to the ICU at 8:30 PM. He was settled in and Trina and Brittany with Dr. Joel were ready to go!
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Pius

We will have an earlier start tomorrow…it was great to have a good day! :)

Written by stephkinnaman

October 28, 2013 at 4:51 pm

Posted in Uncategorized

Riley/Rotary Vocational Training Team Trip 2013 to Uganda Heart Institute-Sunday’s Unexpected Operation

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Today (Sunday) we were to have a day of fellowship and touring some of the prettiest nearby parts of Uganda with our Rotarian friends all day. However, Dr. Turrentine was called early by Dr. Oketcho (who stayed overnight) that Maria was not doing well. Her oxygen sats dropped this morning and were not recovering. Dr. Turrentine, Dr. Cordes, and Sheila went to UHI to see her. Dr. Cordes did an echo and found Maria’s VSD device had “migrated” into her left ventricle (not where it should be…). She would need an operation today to retrieve it and repair her heart. The only “non-critical” OR people remaining would be three of us and we could not enjoy our day out when an emergency calls.

The whole team except for our new night shift of Brittany and Trina loaded up to take care of business in the OR (because Brittany and Trina would be needed at night). Most of us assumed we would be doing this emergent case as the Riley Team in UHI, but the entire UHI team was there! From all the surgeons, Dr. Mwambu and Dr. Oketcho, to Dr. Lwabi (cardiology), Ben the scrub nurse, Dr. Joseph(anesthesia), and Moses (anesthesia help-and several others whom I haven’t learned their names yet). They were all there! It was a full-on team effort to care for little Maria. We started the surgery about 10:30 AM and by 3:30 it was apparent that things were not going well. The VSD device was successfully retrieved and positioned back into proper placement, then stitched into place so it would not move again. The dilated main pulmonary artery was made a little smaller in case it was causing airway compression. Unfortunately once off the heart-lung bypass machine, her blood pressures and oxygen sats dropped. Her lung blood pressure was severely elevated. Multiple interventions were tried to improve the overall situation. There were some encouraging short-term improvements. Enough to make us feel that she might pull through. Sadly she was never stable for long and ultimately passed away this evening at 7:30 PM.

Every UHI and Riley/Rotary Team member worked so hard together to utilize every way available to help Maria, but her heart condition was just too severe. Despite the Riley team’s years of experience, this is never routine. Sheila provided wonderful support to the family today during this very long surgery, and was with her father as he grieved after the news. It is a terribly tough loss and we pray for Maria’s family in this difficult time.

The Kampala North Rotarians were very understanding and kind, and stopped by to grieve with the team and the family. They were not expecting this news when they came to the hospital. Everyone feels this loss…but we are motivated to help more…Earlier identification and treatments can help to prevent the loss of children like Maria. This is why we are here, to continue to empower the UHI team to do more of the surgeries so that they can be done at an earlier age. We will carry on for Maria and many others lost much too early in life to congenital heart disease.

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In Memory of Maria

Written by stephkinnaman

October 27, 2013 at 10:12 pm

Posted in Uncategorized

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