Riley International Heart Missions

Riley/Rotary Vocational Training Team, Amman, November 2016- Final Day

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After an amazing Thanksgiving dinner last night at Na’el and Ruba’s, we said goodbye to our Chain of Hope friends Emma and Katy who departed to Uganda for another mission.  We can’t thank them enough for their partnership to make surgeries for these adorable children possible!

Dr. Lola also departed this morning as well.  She was very sad to have missed the last case of the mission.  We are very sad she isn’t here either…  She has been a huge help to Dr. Mark this week in the OR and overall just so much fun to have with us!  Her smile and enthusiasm are contagious!

Dr. Lola was awesome as Assistant Surgeon this week!


We had just one case today, an ASD and no lectures as Friday is the Jordanian Holy Day.  They are very kind to work with us today in the OR so we can help another child this week…

We first rounded on the kids in the unit.  Jad (AV canal) is doing well.  Still watching him closely…  stopping high flow oxygen to a nasal and will feed him.  Will likely get his chest tube out as well.  Amal is doing great.  More lines out for her today as well. 

Jad


Iman (Tet) will start to eat as well.  Looking good!  

Bashar is so incredibly sweet…  at postop Day 1, he has the sweetest smile every time we come in!  ❤️

Bashar


Al Saher, Maher, Sultan, and Jwan are all on the floor…

Only posting this one because the team and Na’el and Ruba found this pic by Dr. Tim so funny…  I’m going to caption it, “What?!  I have to scrub in with you on Friday?!”

For your entertainment… 😂


We went to the OR for Jood, an ASD.  She is an adorable 4.5 year old little girl from Jordan.  Jood came up with her father for her preop echo with Dr. Tim and Dr. Kal last night. This morning, we had a call that the hospital pediatrician was worried about a cough and little runny nose, but she had no fever, and has been on antibiotics for several days because of these symptoms. The team decided after looking her over that it should be fine to proceed with the surgery as planned.  

Jood and her Father


Jood’s case went well. Her ASD was patched and postop TEE looked good per Dr. Tim. She went up to the ICU, her parents were updated, and she was extubated and doing well. We made several rounds to check on the kids and pull tubes and pacing wires and check wounds to wrap up our work. In the meantime, many supportive GOLA partners came to visit the kids and the team as well. We herded everyone into a few group pictures and packed our trunks and said our goodbyes.

The Al Khalidi ICU team with our Riley/ Rotary VTT


Our Riley/Rotary VTT with the GOLA team


Ruba and Na’el and Claude took us for Shawerma from a late lunch. It was a sunny but chilly day in Amman, but it was nice to get out in the daylight a little. They said this Shawerma Rama restaurant was kind of like a Jordanian McDonalds! 😊

We went back to pack our things and rest a little before meeting Dr. Kal at Al Bashara for traditional hummus and then Kanafe at Habibah’s. It has become a tradition each mission and something we look forward to! We packed up back at the hotel and departed a little early for the airport since we would have the customs issues to deal with once at the airport. This went smoothly and Ruba and Na’el were so patient to wait to see that this cleared.

Ten surgeries in 4.5 operating days….

We cannot thank all of our hosts and partners enough. This was another amazing and memorable week in Amman! The Al Khalidi staff, GOLA members and Amman Rotarians have been amazing hosts and co-workers. We especially want to thank Dr. Kal who works day in and day out helping these children who have no availability to this kind of health care in addition to his private practice. Also, much gratitude to our Chain of Hope partners who have made financially possible the children’s surgeries and hospital care this week. We have had some great meetings regarding continuing this collaboration this week as well. We certainly thank Rob and Gift of Life International for bringing all parties together and assisting in the Global Grant through Rotary that makes this Vocational Training Team possible as well. We have to thank our families and coworkers at home who cover for us to travel for this week as well. Lastly, I want to thank this wonderful Riley Team. It is such a privilege to work and travel with this dedicated, amazing, talented, and incredibly intelligent group!

We have more VTT’s to come thanks to this same Rotary International Global Grant, so we have more work to do, more kids to help…. Plans are for a February/March timeframe. Until then, I leave you with one last picture of each child as we left the last day. ❤️

Al Saher blowing you a kiss!

Dr. Samer trying to talk little Maher into letting him check him out on one of his many walks in the hall- Can’t keep this cutie in the room!

Sultan is all smiles and going home!

Jwan is lookig great!

Sweet Jad!!

Amal will only smile for Ruba!

Iman is doing well…

… Ahmed her brother who last had surgery with Dr. Mark in the last year is also doing well!



Trying a video of Bashar… to end this with a special “Thank you!”

Written by stephkinnaman

November 27, 2016 at 11:48 pm

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Riley/Rotary Vocational Training Team, Amman, November 2016- Day 4

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Emma from Chain of Hope joined us today for breakfast and then the last day of lectures by Dr. Tim and Dr. Samer.  We (and the attendees) learned more about status epilepticus and syncope.  There will be no lectures tomorrow as Friday is the Jordanians’ Holy Day.  

Dr. Samer went back in to the hospital to check on Jad a couple times in the night.  He has been so dedicated and so incredibly helpful to the teams and also for a good postop course for these kids so far…  “inshallah”…  Jad was doing well, still on the ventilator as Dr. Mark wanted through the night.  Just a few changes through the night that Dr. Samer wanted to keep things in track.

We headed to the OR for the expected toughest case of the day…  Little Iman is 11 mos old and from Syria.  Her older brother showed immediate dramatic improvement with surgery with Dr. Mark and the team several years ago.  We didn’t realize the familial connection until we saw his father just after surgery! Dr. Tim did an echo 2 days ago with her mother…  she was so blue!  Sats mostly in the 70’s…She has Tetralogy of Fallot, but her pulmonary arteries look especially narrow.  Once in surgery, she was found to have the Tetralogy with a Perimembranous VSD, and MAPCAs.  Dr. Mark and Dr. Lola did a repair of her Tet with gortex patch and transanular patch and Monocusp valve and right pulmonary arterioplastly.  She had a lot of collaterals and she is small, so seeing things in the heart to repair was quite challenging, but she did well and returned to the ICU.

Little Iman

Jwan

After the case, Dr. Mark met briefly with Emma (COH) and Na’el from GOLA as well as a surgery team from France working with the French “sister group” of COH.  Then, he had 3 other patients to discuss with Dr. Kal- 2 outpatients and another he had just cathed… the two outpatients were what appear to be familial cardiomyopathies….  interesting and so sad.  That’s three cases today of 2 siblings in each family with significant heart disease!  How heartbreaking for these poor families…

We grabbed a VERY quick lunch, then while Dr. Mark went to the OR to start the second case, Dr. Lola and I went up to the floor to take out Al Saher and Maher’s chest tubes.  They look fabulous!  They were not particularly happy with that little procedure, but Dr. Lola is so sweet and reassuring to them in their native language!  (I actually have no idea what she was saying, obviously!  …but she did tell me that Al Saher called her a “donkey” and “stupid”…  maybe it’s better that most of us don’t know what these kiddos are saying to us!  😂)

Dr. Lola trying to sweet talk Maher into letting her take his dressing off and temive the chest tube

We got to the OR just in time for Dr. Lola to scrub and help drape and get started…

Bashar is a 10 yr old boy from Southern Jordan whose father has been working/waiting for 7 years for his son to get this needed Large secundum ASD repair!  He has been denied any coverage by their private health insurance for this necessary heart surgery, Ruba from GOLA has told me.  He is a sweet, quiet boy.  So polite when Dr. Tim did his echo yesterday.

Bashar and Dr. Tim

Bashar’s case goes well, the ASD was repaired and Dr. Lola did a great job assisting Dr. Mark on his surgery for her last case of this week.

Claude and Katy  with COH went to the Syrian refugee camp this morning.  They were able to see several of the kids from the September mission who look fabulous and active, they said!  Sultan moved off the ICU to the floor.

Dr. Lola and Sultan!

  Jad was extubated early this afternoon and doing well.  Iman was extubated as well later and tolerating this fine also.  Bashar was extubated before we left for the hotel.  All are off vents and should definitely behave themselves tonight! (And that’s an order!  😊)…  We have Thanksgiving to celebrate tonight with Na’el and Ruba!  We have so very much to be thankful for!!

The amazing Thanksgiving soread at Ruba and Na’el’s house!


More tomorrow!  It is late!!  :). Happy Thanksgiving to our amazing families!  

Written by stephkinnaman

November 24, 2016 at 11:24 pm

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Riley/Rotary Vocational Training Team, Amman, November 2016- Day 3

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Today will be a busy day…  Three cases planned…  Our Team had planned on 8 cases in 4 operating days this week.  To add on some extra cases and still allow the team to depart on time and feeling the patients will do well postoperatively, we are adding a third case today and a morning case Friday.  So many patients who are in desperate need of this team’s (Al Khalidi and the Riley Heart Team) combined skills and efforts…  So many sad and complicated cases…
We started with two more lectures to nurses and Peds residents.  Dr. Samer taught about pain management and sedation and Dr. Tim about dilated cardiomyopathy and myocarditis.  Again, very interesting and well- received.

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Dr. Lola studied to prepare to assist with today’s cases

We start today with Jad.  He is a 3 month old adorable boy with an AV Canal.  He has Down’s Syndrome.  Dr. Tim taught me some basics of congenital heart defects today: 50% of Down’s babies have congenital heart defects. 50% of those are AV Canal defects, and 50% of AV Canal defects are in Down’s Syndrome babies.  Jad came with his father yesterday for his echo.  He is a Palestinian, from the West Bank where he farms.  Mom is a teacher here in Jordan.  When little Jad was found to have his heart defect and the Cost of treatment was found to be not an option they could financially afford, her students actually told her about GOLA!  ❤️ They referred them to Dr. Kal.  Jad has three older siblings.  He looked sick when he came in for the echo…  Gray in color, working to breathe…

Jad

Jad’s tiny incision was of course difficult to work in and the anatomy was more complicated also once working in the heart, but his repair came out well.  He was transported to the ICU and the parents were told about his surgery and expected postop course with the help of Na’el and Dr. Lola. They actually speak excellent English and are so very thankful for Jad’s new chance on life!

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Nae’l helping Dr. Mark to translate to Jad’s parents

Mo had arranged for a second room to work out of and so the second case was ready to start before 1:00!!!  We were starting the surgery before 1:20!  So, although I don’t think Dr. Mark or Dr. Lola ever sat down between cases, off they went again…

All of the kids from Monday-Al Saher and Maher-  are moving off the ICU to the floor.  They look great!  They were taking a nap by the time I saw them, but the nursing staff said they both woke up and were busy busy since 4 AM.  Maher wants to keep walking.  It is hard to keep that boy down now!

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Maher

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Al Saher

Sultan was even up and about walking!  He is all smiles…  and so is Dr. Samer!

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Dr. Samer with Sultan and his Al Khalidi nurse

Amal is a 9 month old Syrian with a restrictive perimembranous VSD.  She was found to have this at 2 months of age when she was having swelling of her limbs.  She is quite small for her age (only about 15 lbs) and on Lasix for congestive heart failure.

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Amal with her mother and Dr. Tim doing echo in Dr. Kal’s office yesterday

 

In the meantime, Rob from Gift of Life International and Emma and Katy from Chain of Hope arrived to the hospital with Na’el (GOLA).  We had a great impromptu meeting about our partnership and continuing to work together to help more patients now and in the future.  We are so thankful to partner together all of these organizations- Rotary, Chain of Hope, GOLA, Gift of Life International, and our Gift of Life from Indiana with this Riley Heart Team- to do MORE!

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Katy and Emma from Chain of Hope with Claude (far right) and Jad’s parents

Amal’s VSD and PFO closure went very well.  Dr. Lola closed the PFO and Dr. Mark closed the VSD.  Lots of funny surgeon jokes between the two with this duo over that…  These two are definitely “mishkalgea”!

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Dr. Lola is closing her first ASD in this picture!

Dr Mark wanted it noted again that the OR staff sent for the third patient at 2:30 PM!  Then, it was started started by 3:20 (after they actually waited in Dr. Mark for a bit…). This was an add-on case we met at Dr. Kal’s office yesterday that Chain of Hope agreed to sponsor.  This add-on case went well and the work in the OR was done by  5:30!

We made rather extensive rounds in the ICU to end the day and Dr. Tim did an echo on the second case of the day for tomorrow.  We found this sweet gal walking to the I U door and greet family and friends coming to visit with gifts!  How sweet is she?!

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Juwan and Dr. Kal

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Dr. Mark with Sultan and his nurses

We had a very short time (less than 20 minutes!) to prepare for a dinner with our host club, the Rotary Club of Petra.  We had a little drive out to a lovely restaurant for Arabic food in Fuheis.  It was really well attended with many Rotarians, including my partner in the Global Grant for the VTT covering the team expenses- Usama! And our beloved long-time friend Mustafa Naserredin!  It was so great to catch up with him as PDG Mustafa is the one who had a vision for a Global Grant like this many years ago with Dr. Mark!

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RC Amman Petra President presenting me their Club Banner with my cohort in the Grant, Usama

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RC Amman Petra members were great hosts!

We had a big time getting back to the hotel for some of us…  Our famous local Cardiologist did not know even which direction to go to get us back to our hotel!  Unlike American men, Dr. Kal is not afraid to stop and ask for directions!  He stopped at a little market, and then to police officers on a circle as to which direction to go!  It was quite funny and yet we were back to the hotel in no time!  Dr. Kal is a good sport…  Especially since all the way, he was taking calls and giving orders on little Jan in the ICU (the AV Canal today).

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Dr. Kal asking for directions!

We had a long day and it is late to return to our hotel…  We have 2 more cases tomorrow… Our work is not yet finished, but today was a big day!

Written by stephkinnaman

November 23, 2016 at 12:33 pm

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Riley/Rotary Vocational Training Team, Amman, November 2016- Day 2

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Day two started with a much more rested team.  They were early to breakfast with smiles and looking great- excited and ready to go!  We left for the hospital thanks to Dr. Kal and Diala who gave us a lift.  Lectures by Dr. Tim and Dr. Samer again were well- attended and well- received.  Dr. Samer discussed vasoactive medications and Dr. Tim lectured on evaluation of the cyanotic newborn.

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After the lectures, we separated to go to the OR and the ICU.  Dr. Samer and Dr. Tim went on to the ICU with Dr. Kal and Dr. Lola and Dr. Mark proceeded to the OR to get the case started.  The first case of the day was mentioned yesterday…

Sultan is a 13 yr old boy from Syria here with his mother.  His tumor was discovered in April when he was having some unusual scrotal swelling.  It is malignant (Synovial Sarcoma of the pericardium) discovered with CT then paricardiocentesis.  X-ray was shown yesterday- displacing the heart so much that he looks like he has dextrocardia by the cardiac silhouette!  He underwent 5 rounds of chemo at King Hussein Cancer Center where he met Dr. Kal who works for them part time doing their echos…  Chemo did help, but now he needs a resection they cannot afford.  He is a sweet boy, complaining of no symptoms to us whatsoever, but he MUST be short of breath with exertion.  He admitted to the local team on admission that he did feel some chest tightness at times. Undoubtedly with a mass taking up that much space!

Al Saher is doing well this morning.  Off oxygen, drinking apple juice, you finally get a look at this little sweetie!  He still sounds a little junky, but doing well overall.

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Al Saher

Maher is doing well.  Still in some pain understandably, but sleeping when I took his picture for you to finally meet him as well.  His mother indicated he had been crying, since she was pleased he was resting now.

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Maher

Sultan’s case went so well!  It took some time to dissect out this HUGE tumor from all the surrounding structures, but it was completely resected as far as could be seen in surgery.  The phrenic nerve is still intact (which was a concern whether this could be saved- it innervates the diaphragm).  The tumor is over 14 cm and larger than his heart.  Just amazing that Dr. Mark and Dr. Lola could completely remove this mass!  Sultan’s father took the tumor over to King Hussein Cancer Center for pathology.

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it was quite a crowd interested in this case!

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The Tumor- larger than his heart!

Ruba and Dr. Lola both helped to translate to his mother how things went as well as we could have hoped.  She is so thankful and so relieved!  She waited with  his aunt, his brothers, grandmother, and cousins.  Ruba found for us that they fled Syria at the beginning of the crisis about 4.5 yrs ago and have lived in Amman since.  His father was finally able to flee just 2 years ago.  They are so relieved to have some good news in Mr. Sultan’s life.  There is a good chance he may still need some more treatment like radiation, but getting this tumor out should make him feel so much better!

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Dr. Mark and Dr. Lola explaining to Sultan’s mother that the surgery was successful!

Katy from Chain of Hope came into the OR during Sultan’s case and we were told that Rob from Gift of Life International was on his way to the airport with Na’el from GOLA to pick up our trunk.  I didn’t believe it until I saw it, but Customs did release our trunk finally!  Na’el has worked so tirelessly since late Sunday night to get to this point!  Thank you thank you thank you Na’el!!!!  He is the hero of the week!!

We went to the ICU and found Dr. Kal to discuss possible cases for tomorrow.  There is a 3 month old  AV canal that Dr. Kal wants us to consider for tomorrow.  Little Moh’d is the third of three children for his parents who are from Palestine, living on the West Bank.  He is so adorable, never fussed the entire echo for Dr. Tim.  Dr. Lola is clearly his favorite, though!  😉. He is cyanotic.  Variable O2 sats from 79-80’s%.  He was having some respiratory issues even with the Echo- some tachypnea and retractions, definitely some nasal congestion.  We will ensure he is healthy enough for surgery tomorrow.

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Little Moh’d with Dr. Lola

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Dr. T, Dr. Lola, Dr. Kal, and Moh’d’s father discuss the plans for surgery

We ran for a quick lunch… (Thanks to our friend Mo for setting this up for us!), then Dr. Mark ran ahead to get the second case started…  and Dr. Lola right after him!

Juwan is a sweet little 5 year old girl from Jordan who has an ASD.  She had an echo yesterday with Drs. Kal and Tim.

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Juwan

Juwan’s case went well in her teeny tiny incision…  Dr. Mark like to keep especially the female incisions at a partial   sternotomy and small incision.  Dr Lola incisted I take a picture of the “ridiculously small space with too many tubes”, something was said about “no space to work in…” as well!  Many comments like this out of our little firecracker, amazing assistant surgeon has definitely earned her the title of this mission dubbed by Dr. Samer and Dr. Mark: “Operation  Mishkaljea” (I might have to get spelling corrections from my Arabic- speaking friends later! )

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Juwan needed a patch to close her ASD as it had multiple fenestrations.  Her case went well, her TEE by Dr. Tim looked great, and Dr. Lola closed her incision.

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Dr. Lola closing!

Juwan was transferred to the floor and did  very well.  I looked out to see a little guy walking with his mama and was so surprised to see it was Maleh!  Less than 24 hours earlier, he was just finishing his open heart surgery!  He looks amazing!

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Maleh looks great!

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Al Saleh was not quite as happy about getting up to walk one day after surgery!

We then headed to Dr. Kal’s office to try to iron out the rest of the week’s surgeries.  Dr. Tim did an echo on multiple possible candidates and we think we have it figured out…  but this would include doing either 3 open heart cases tomorrow or doing 2 on Friday without a full team here.  It is going to be a busy finish!

When we finished the plans for the week, we rushed back to the hotel to ready for a dinner with our GOLA friends.  It was a wonderful dinner out for Arabic food with Rob (GOLI) and Katy (COH) as well.  It is wonderful to have everyone together to celebrate a great day!

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Written by stephkinnaman

November 22, 2016 at 5:27 pm

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Riley/Rotary Vocational Training Team, Amman, November 2016- Day 1

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It was a short night of sleep (for some too excited to get started, maybe NO sleep- Dr. Lola!), but we were all up for breakfast and departure to the hospital at 7 AM.  We started with 2 lectures for Pediatrics Residents and Nurses from Al Khalidi and the two other major private hospitals in Amman.  This was very well-attended- apparently 55 attendees.  Dr. Samer lectured on Pediatric airway management and Dr. Tim on VSD.

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Dr. Kal introducing Dr. Samer for his lecture

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It was a good turnout this morning!

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Dr. Lola excited and ready to be Assistant Surgeon this week!

 

Before off to surgery, GOLA had arranged for a local TV station interview- Dr. Mark’s favorite! (Hahaha!) Dr. Samer says this is a very popular station, and it will feature our work. They later came in to the OR and filmed some of the operation as well… We hope this brings some positive attention for all the partners involved with this mission and some hope to a region that needs more positive news!

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Dr. T giving an interview for local news.

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Dr. Kal’s interview

The first case today is an almost 4 year old originally from Syria with a secundum ASD.  As usual, the OR staff is so efficient that they were ready to go by the time we were to the OR.  Preop TEE was done by Dr. Tim as well as postoperative.

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Dr. Tim working with the TEE preoperatively while teachin Resodent/Fellow and dos issing the case with Dr. Mark and Dr. Lola

The case went well and in fact, the ASD had a nice rim and was able to be closed directly with suture (no patch).  Al Saher is from around the reef of Aleppo, but now living in Amman.

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Dr. Lola and Dr. Mark

 

He was taken to the ICU and extubated soon thereafter… Dr. Mark updated the family, with some wonderful assistance from Ruba of GOLA. The family had been so worried. This was not the first surgery for little Al Saher.  He was born with a cleft palate as well.  His heart defect was discovered when he was prepped for that surgical repair.  Dr. Samer took wonderful care of him with the Al Khalidi ICU staff.

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Dr. Samer checking out Al Saher just after extubation

The head nurse had given us some use of his office for wifi for work and messaging.  At the bedside teaching has already been wonderful in the ICU with Dr. Samer as well as Dr. Cordes working with Luna, a Pediatric Cardiology Fellow and Pediatrics resident interested in Cardiology.  Lots of teaching especially in echo and postoperative care while caring for the children.

After checking on Al Saher, we headed out to Dr. Kal’s office to see Adian and Noor.  Adian had her last 2 operations in Indianapolis at Riley with Dr. Mark in 2015.  Her last one was almost one year ago.  She is looking great!  They did an echo and made some plans for follow up and possibly a cath during the next mission possibly late February.  We enjoyed the hugs and the smiles!!

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Loved the hugs from Noor as much as Adian! ❤️

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Dr. Lola and Adian! Adian loves that she talks her language!

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Couldn’t resist a selfie with this little cutie!

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Dr. Mark and Adian

 

By the time we were back to the hospital, the OR staff was all ready for the second case.  Maher has a large (2 cm) ASD.  He has been Cyanotic (blue with any exertion or when upset) and short of breath since 9 mos old.  This family is from Homs, Syria.  This little guy certainly needed his big hole in his heart fixed!  Dr. Mark and Dr. Lola efficiently finished his surgery and all went will with patching him up.

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lining up for a nice incision for Maher

While Dr. Mark and Dr. Lola were mending little Maher’s heart, Dr. Samer and I were checking out the children for tomorrow’s line-up.  The first patient is a very interesting and sad case in a Syrian 13 year old boy with a pericardial tumor.  He has been worked up and it’s been found to be a synovial sarcoma.  He has had 5 rounds of chemotherapy and it appears it has decreased in size a little, but he needs surgical removal.

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Dr. Samer checking out Sultan

His Syrian family has no means to cover the cost of surgery, so he was referred to Dr. Kal to try to find him help to get this tumor out.  This is a huge tumor as seen by how much it enlarges the cardiac silhouette on chest X-ray (right side of heart).  His heart is actually quite small in all of this!

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Dr. Mark has agreed to go in and check it out surgically to see if he and Dr. Lola can respect this huge mass…  and hopefully get this boy on the road to some improvement!

The team contemplating Sultan’s Case

In the meantime, we unfortunately got some bad news about our second trunk of surgical instruments/disposables like decompression and cannulation items for surgery, iStats and cartidges.  Apparently, customs wants to go through the trunk, take an itemized list of all things in the trunk and then again as we depart and will charge us a customs tax for each item that does not leave Jordan!  Na’el, GOLA president and his wife Ruba have worked so hard to meet the requirements of the Customs officers, tirelessly calling and messaging people even after being at the airport until midnight last night!  Unfortunately, this appears to be their final answer and we are not willing to pay tax on things that are disposable and then spend hours at departure going through these items.  We will have to do what we can with the items at Al Khalidi.  This is so unfortunate as we save the hospital money by bringing in Dr. Mark’s favored items and patches for the heart, etc.  Through the years, he has found this to save time, money, and probably lives by using items he is most comfortable and familiar with…  it is really so disappointing that customs cannot see the value of this!

Despite our frustrations and disappointment, the team gathered after 3:30 for a late lunch in the employee cafeteria with Ruba and Na’el.  We then checked on the postoperative kids who are doing well and talked about tomorrow’s cases.  We have the tumor resection for Sultan in the morning first and then a boy named Juwan with an ASD.

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Al Saher and his father in the ICU

We headed back to the hotel for some blogging and an earlier bedtime to rest up for a busy day tomorrow!  We start early again for lectures prior to operating…  Hoping for a good night’s sleep despite our 7 hour time difference from home!  Good night friends!

Written by stephkinnaman

November 21, 2016 at 10:07 pm

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Riley/Rotary Vocational Training Team, Amman, November 2016- Arrival!

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Our arrival in Amman this evening marks Dr. Turrentine’s Riley Heart Team’s 20th trip to Amman for a surgical mission! Since 2007, he and many of the Riley Heart Team have traveled to work with the Al Khalidi Hospital staff to treat children needing congenital heart surgery. This is certainly a partnership worth celebrating already, but we also mark many important partnerships coming together to make this 20th mission possible…

This is the second of at least 4 planned Vocational Training Tram Trips for our Riley/Rotary Team, sponsored by a large Global Grant from The Rotary Foundation through a partnership between Rotary Club of Greenfield, Indiana and Rotary Club of Amman, Petra with many other generous contributions from Gift of Life Amman and Rotary Clubs in both Districts. The surgeries and children’s care are sponsored by our amazing partners Chain of Hope. We will be working with the Al Khalidi team this week for with skills transfer between the two teams at the bedside as well as a few didactic type lectures as requested by the local Rotarians and staff. Our team this week for the VTT is:

Dr. Mark Turrentine -our Medical Team Leader and Cardiothoracic Surgeon

Dr. Tim Cordes- Pediatric Cardiologist

Dr. Lola Chabtini- Resident Surgeon

Dr. Samer Abu-Sultaneh, Pediatric Intensive Care Specialist

Dr. Stephanie Kinnaman, Rotarian Team Leader 

We are so pleased to be again working as a team with Dr. Khaled Salaymeh, the local Pediatric Cardiologist who tirelessly works to help these kids year-round in addition to his private practice. Our friends with Gift of Life Amman are also our always-welcoming hosts! Our partners from Chain of Hope and Gift of Life International will arrive later this week to join us as well.

At arrival, we were greeted by our friend Dr. Kal.  Unfortunately, for the first time ever, customs would not allow our trunks of medical equipment through.  We spent about 2 extra hours trying to get out with all the trunks and baggage, but finally were allowed to leave with just one of the trunks.  We then took the trunk to the hospital and went on to the hotel. Na’el from GOLA came to the rescue and we are hoping was eventually successful in talkingthe customs officers into letting him take the trunk.  Talk of patient selection and plans for the week started right away in the car.

All smiles with the bags at arrival before the trunks debacle

 It will be a short night as we finished our dinner well after midnight… But, we look forward to a full day of work healing little hearts tomorrow! ❤️. 

Written by stephkinnaman

November 20, 2016 at 11:49 pm

Posted in Uncategorized

Riley’s Chain of Hope Mission to Amman Spring 2016- Day 5- Final Operating Day

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We are down one of our crew today as Lucy from Chain of Hope had an early flight back to London this morning.  It was so wonderful to get to spend some time with her and learn more about the wonderful work Chain of Hope does in the world!  Thank you Lucy for your coordination and contribution that has forever changed the lives of these children!  

After a quick breakfast, we found Dr. Kal already waiting for us outside the hotel.  It is Jordan’s Independence Day today, as they celebrate 70 years of independence.  The usual crazy busy traffic of the streets is not to be found as Jordanians celebrate their holiday.  We arrived to the hospital so quickly!

We checked in to the OR and found they were not ready with blood for the patient (for perfusion), so there was a slight delay.  Then off to the ICU we go to check on the children…

Salma was still having some heart rate issues despite medications to slow it.  She will get some medication to calm her to see if this will help.  Her father said she has not been sleeping much at all and seems to get anxious with all the constant stimulation (and especially our large team all staring at her for rounds!). We will try some “calming medications” to see if this is pain/stress causing done of her heart rate issues.  She is just beautiful!

Salma 9 mos (Transitional CAVC) POD #2

Rital is doing great!  She will transfer out to the floor later today.  She is Postop Day #2 as well of her peri membranous VSD repair.  Her parents are still smiling ear to ear when we see them!

Rital 18 mos POD #2 VSd repair

These two girls share a room, then the other three occupying the ICU are together in a larger room at the end of the hall… Little 4 month old Anas (POD #3 (lg VSD, PDA) is doing well, he may go out to the floor later today.  He has a little cough when he eats mom says.  He is still so alert and so sweet!

Anas looking to Dr. Kal for advice! 😊

Khalid is the 9 mos old POD #1 Tet repair. He is doing well.  No concerns.    He was sleepy , but so adorable as he kept kicking his leg up that had the sat monitor on his toe…like he was doing some heel stretches or something!  He will of course stay in the ICU today.

Khalid – 9 mos old POD #1 Tet repair

Khalid’s morning stretches!

Noor was hurting of course this morning.  Not happy…  Medically doing great in her postop day #1 VSD repair.

Noor- 6 yrs of age- POD #1 VSD repair

Then we floated down to the floor…  Roulan will go home today after her interventional cath yesterday.  She is doing great and room air sats were 84% today. That is a noticable improvement  for her!
Raghad looks like a new girl!  Ear to ear smiles!  She will go home today as well POD#3 lg VSD/ASD repair.  Raghad is one of the younger of her mother’s 9 children.  She will go home to Jerash, Palestine today.

Raghad walking the halls with her mom

The first patient of the day was Owais.  He is a 3 yr old boy from Palestine who presented to Dr. Kal with shortness of breath with exertion and not growing well…  He has an ASD.  Dr. Sammy the anesthesiologist who has worked so hard with us all week wanted us to clear him before going to sleep as he has a rash on his face…  We checked out this sweet little guy who has a non-itchy rash of mostly his face in the last couple days.  No fevers, feeling fine. Not on the chest.  Seems non-bacterial, so we proceeded with surgery.  His surgery went very well patching the ASD with a Dacron patch and he was sent to the ICU.  

Owais in the OR with Dr. Kal and his father


The second case of the day was one we saw in Dr. Kal’s clinic yesterday.  Abd Alrahaman is a beautiful Iraqi boy with thick hair and a sweet face.  He is 13 months old and has been operated once for his VSD with a pulmonary artery band as he was a “blue baby” or cyanotic since birth…  He also had a cleft palate with a failed repair the first time and bilateral inguinal hernias that have been repaired. In other words, the poor little guy has had a lot of surgeries in his short life… He seemed to have more than the typical amount of bleeding from the start of the case, unfortunately…  More adhesions (scarring) to take down given his previous banding surgery.  So, in all, this became a longer case than expected as he just kept bleeding.  Extra blood products were given (which can take a long time depending on the blood products needed. Platelets tonight took a while).  Lots of trying and waiting for the bleeding to slow, and finally seemed to be improving a little and platelets infusion (which should help the most to stop the bleeding!) owas starting, so we closed.  Dr. T knew we would be watching him closely tonight…

Abd Alrahman


Then, we had added Ala’a as a third case.  She is the Syrian girl with a small VSD and cath and echo numbers that just “don’t add up”…  She is a very sick little 2 year old with very low SATs, low heart rate, shortness of breath, etc.  she is very sick.  Dr. T and the team did her Tetralogy of Fallot repair in September.  She was initially doing well and then was suddenly dick and getting sicker…  This tiny VSD that is now there is a mystery.  Definitely not there after surgery in September, a cath by a different cardiologist recently and a ballooning of the pulm valve has now not seemed to help her current situation either.  She was the topic of the long case co defense yesterday.  It was then after 7:00, I believe, when we were taking her back to the OR… We planned to do a TEE (echo) when she was asleep and possibly a pacemaker.  The question is, does she need the small VSD repaired and will that fix her problem?  The TEE still shows a small 3.5-4.5 mm VSD …  Some clips of this were recorded to share with the Riley case conferences at home to help decide what may be the best next steps for this sick little girl…  She needs medically “tuned up” it was decided, before doing anything more (pacemaker, VSD repair, etc…)

Ala’a in the OR with Dr. Kal and Dr. Turrentine discussing the wcho and plans for her


We then counted instruments and packed out OR supply trunks from home for departure tomorrow.  We checked on the children in the ICU.  Have to share this gorgeous smile from sweet Noor with her beautiful quilt given to all the kids from GOLA!

Noor Postop day #1 (evening). 😊


We then departed straight from the hospital to the Gift of Life Amman (GOLA) dinner at Na’el and Ruba’s house.  We were already late to the party, but what a lovely celebration outside in their courtyard of a full week, a new, vibrant GOLA board, our Chain of Hope partners, Rotarians in fellowship, and Na’el’s birthday!  Such incredibly warm and hospitable hosts our Jordanian friends are!!

Many but not all of the guests at the lovely GOLA dinner!

Our amazing hosts tonight and so often this week- Ruba and Na’el- GOLA president


While we were at dinner, Dr. Kal called to talk to Dr. T.  Unfortunately, little Abd had taken a turn for the worst after being extibated.  His SATs and heart rate suddenly dropped and he had to be put back on the venitalor.  He was still having troubles, so after several calls to and from Dr. Kal, it was decided we must go back to the hospital.  DG Mustafa drove us to the hospital in all the crazy Independence Day celebratory traffic!  It was an interesting sight!  But traffic was crazy!!  We finally arrived to the hospital before Dr. Kal had arrived.  Dr. T instantaneously started troubleshooting the possible problems. When Dr. Kal arrive do, echo was fine and showed the repair and heart overall looked great!  He seems to be in fulminant pulmonary edema, with bloody frothy sputum from his ET tube… Meds started and actions taken and his SATs and BP were coming up, so Dr. Kal encouraged us to get back to the hotel to start to pack for our fairly early departure.  He said he would manage the rest of the night by phone for this little guy.  He is so dedicated and a wonderful doctor and friend!!  We pray that little Abd Alrahman will pull out of this rough patch!  It is still going to be a rough night of not yet knowing for this sweet little man.

We depart the hotel early tomorrow morning.  We cannot thank enough our GOLA hosts, Chain of Hope for sponsoring these children’s care, Gift of Life D6560 Indiana for sending the team and of course Riley for allowing Mike and Dr. Turrentine to get away to treat these children who needed them so much this week!  Thank you to the hard-working and talented Al Khalidi staff and the incredible Dr. Kal!  We have completed 10 open heart surgeries, 2 Caths and one procedure (TEE)  in 5 operating days!  It was such a productive and memorable week!  We thank everyone for their wonderful support of this amazingly fulfilling work!  “Mending little hearts,” as Chain of Hope says, is quite an awesome accomplishment, but it truly takes amazing teamwork of so many- in the “theatre” (OR) and soooooo many more “behind the scenes”!  

Written by stephkinnaman

May 26, 2016 at 12:26 am

Posted in Uncategorized