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

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

Joanita

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.

Justine

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!

Justine 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…

Justine 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.

Dr. 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.

Dr. 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! 🙂 )