Riley International Heart Missions

Archive for November 2011

Day 4 – Uganda VTT Mission 2011

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Wednesday, November 30th, Moving Day! Jen and Heidi said the night went very well. Faustine had some bleeding that kept them busy through the night. It takes 24 hours to get platelets after ordered here, so that was not a possibility. She is doing much better today after all of their work! They headed out back to the hotel.

First, I have to update events from last night…while the awesome OR team of Dr. Turrentine, Chass, Mike, Dr. Walker and circulating nurse Megan were finishing in the “theatre”, Dr. Cordes was asked to see 2 more patients by Dr. Lubega (the other Pediatric Cardiologist here at UHI). I find it interesting that last year when I would go with Andrea (a Fellow in Cardiology from Washington D.C.), we would drag her suitcase-like portable echo machine up 4 flights of stairs and up the hill to the inpatient wards to see a patient for consult. We were often back and forth several times for one patient. Dr. Cordes, on the other hand, is an ATTENDING, and Dr. Lubega or Dr. Lwuabi will ask him to come see them once the patient is here in UHI in the echo room. We literally walk no more than 20 steps down the hall to see them! Hierarchy…and yes, I got more exercise here last visit! Anyway, we saw a TINY 1 month old, apparently an abandoned preemie in the Wototo orphanage. He was supposedly 28 weeks at birth and weighed 2 kg (4# 6 oz), although not sure the dating of pregnancies here is that exact. He has needed assistance with breathing still (CPAP) but recently has been worse in terms of respiratory distress. He has had multiple blood transfusions and is still losing weight. He was found to have a heart problem (PDA and VSD) and was transferred here. Even in his tiny 1.5 kg frame (3# 4 oz), you can feel bounding pulses in his foot (classic for PDA). Dr. Tom decided he would get another theatre (OR) and do this himself. Solomon is currently in the theatre this morning. He then saw a 19 yr-old with a common atrium! She has been having mixing of oxygenated and non-oxygenated blood her whole life from this and only now is having more shortness of breath with exertion and terrible fatigue. She could not even walk to her wheelchair 3 steps away without assistance.
When Faustine returned from surgery last evening, Dr. Turrentine and Dr. Walker came back to the ICU and received their artwork from Charles- see below his artwork! Dr. Turrentine is convinced that Katie in particular is corrupting sweet and polite Charles. Dr. Walker has promised to draw a picture FOR Charles, so stay tuned for that one!

When we arrived this morning, Charles and our first patient of the morning, Ronald, were playing UNO. Ronald was giving Charles a run for his money! They seemed to be instant friends. Charles informed us that Ronald does not speak much English, but the boys speak the same language and Charles can translate for us. I learned that “Mwenya” is the word for smile (I checked the spelling with our resident expert, Charles). Ronald was nervous for his surgery, but Charles said he told Ronald that it will be OK! It had to be really helpful for them to “hang out” this morning. So, Ronald gave his mom a hug and headed back with Megan to the theatre.

Today we clear out the ICU for newcomers and that means the first 3 kids get some new scenery! Last year, we called this Step-Down Unit the “Happy Room” because the kids who never cracked a smile (especially Esther) were instantly smiling and chatty when moved. Charles is such a happy guy that I am not sure he could be any more chipper. He put on his new handsome outfit, so nicely donated for each of the children by Mr. and Mrs. Richards (Megan’s parents). He looks so handsome in his baby blue polo! Obama James could use a little dose of happy… He is quiet for the last 24 hours or so, but he is so serious. Apparently, his night shift nurse spoke his language and that really seemed to help. He told her that he “just wanted to be carried around”! He got his wish when the physiotherapist, Nancy, carried him out of bed. He then WALKED next door! Step by step in his little flip-flops, he made it.

Tabitha is much happier today. After getting her chest X-ray this morning, she spontaneously started waving to the X-Ray tech, even though she was still crying from the experience. This must be her defense mechanism- they won’t hurt me if I look cute when I wave! She had a little “cake” and she seemed to really enjoy that. She is such a cutie, especially since she is not crying incessantly now. We can really see her personality more. She is great at mimicking movement, like waving or shaking the rattle.

Faustine is waking up a little more and asking for “Mama” repeatedly. She enjoys drinking juice from a syringe. She has a bit of a cough, but nothing a few pats of the chest and some coughs will not cure over the next day or so…Her personality is really going to shine in that time as well! Her mother, Beatrice, was with her this morning. She had to pause to cry in the theatre to the corridors yesterday after leaving her daughter with Megan for surgery. Already today, she was stroking her recovering Faustine’s head and thanking us with a different kind of tears in her eyes! This is what it is all about… RILEY MISSIONS TEAM HITS A HUGE MILESTONE! Ronald’s case for his AV canal defect proved to be more difficult and challenging. Dr. Turrentine was worried briefly once he got him on the heart bypass and opened the heart to see the anatomy that he may not be operable. He worked very hard and made the anatomy work for a repair. As it turns out, Dr. Turrentine has counted up and Mukasa Ronald is the Riley Team’s 100th child operated on since mission trips began in 2007!!! What a huge milestone!!





The Day Ends Earlier than Planned… Harriet, the planned afternoon patient, continues to have a moist cough and despite her normal white blood cell count and no documented fevers, the UHI resident anesthesiologist is worried she has a pneumonia that could complicate her postoperative course. Therefore, it was decided that she should be put off until tomorrow in order to check some other labs. Brian Olef, a 3 ½ yr old boy from Northern Uganda (Apach district) with Tetralogy of Fallot has been here since Sunday. His grandfather, who speaks English pretty well and translates to mom, says Brian understands well, but has never spoken. Every day when I would go to the ward, Joel, his grandfather waved to me. His mother Sophia is here with his younger brother who is 6 mos old. They have been waiting patiently daily. They tell me they have been here about every 3 mos for 2 years after being called that they may be on the list for surgery for missions teams and turned away each time. He was quickly prepped to replace Harriet for today and went back to surgery. Dr. Walker discovered he had severe dental caries with abscesses. Unfortunately, the team cannot operate with this level of infection that could affect the new repair. All was not lost, though. A dentist was called and his infected teeth were pulled while he was asleep in the theatre and he will be ok to have surgery with the next mission. Joel was quite concerned that they cannot wait. He says they have sold everything to come to get his surgery done. It is a very long trip to get here. Rob says that one of the corporate sponsors will assist the family and ensure that they have money to get home and food to sustain them. It is possible, Dr. Turrentine says, that he may be added back on Saturday morning as an extra case or possibly added to the next mission list. This was very disappointing to much of the team, but he will already be much better without all the infection! Our fantastic and creative nurses on the team took up a “Tooth Fairy Collection” to pass on to Brian, a coin for each tooth removed. Hopefully that will help lift their spirit.


The day team waited for Jen and Heidi and headed back to the hotel about 7:45 PM while Rob, Grace, and I went to the RC of Kajjanci meeting. This was a long journey/adventure that at this late hour will have to wait until tomorrow!- Stephanie

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November 30, 2011 at 10:03 pm

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Rotary Club meeting in Kampala

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RC of Kampala North Meeting- by “Rotarian Stephanie”
Rob and Grace and I went to the Kampala North Rotary Club which meets at a neat little restaurant that to me looks like a hut from the outside. It is open with what look like bamboo bars in the windows. It is a very active and lively group of Rotarians. For my Greenfield Rotarians, I will say that they are quite formal. Although I have been a Rotarian for 8 ½ years, I have never addressed one of my fellow Rotarians at home as Rotarian Joe or Rotarian Wayne, but the Rotarians in Uganda observe all of these proper titles and observe all of the formalities. Always when offered the microphone to speak by the Sargeant at Arms, they will say, “Thank you, President”. They also end their meeting with a toast and unfortunately, the president passed the microphone to a very exhausted (after 2 nights with maximum 2 hours sleep and the jetlag really catching up with me!) and surprised “Rotarian Stephanie”. I had no idea what to say!! I also had no glass! So I finally heard someone tell me to say “To Rotary International” and I raised my neighbor’s glass. I tried to tell the President quickly as I passed the microphone back with my very red face that we do not do that in at our club. I am sure I left quite an impression and I am afraid not a good one! However, I did express to them our gratitude for their assistance and partnership in the global grant along with the Rotary Club of Lafayette which contributed greatly to this Vocational Training Team. It was certainly memorable! PDG Tusu, who is also on the board of Rotary International is a great leader in this club and it was great to see him again. PDG Salim Najjar and I went to this club last year on our VTT trip. Another Kampala North Rotarian had recently returned from San Diego on a Vocational Training Trip where he attended their District Conference. Guess who was the Rotary International President’s Representative, mentioning Gift of Life and our VTT Trip to Uganda last year in his speech?? PDG Salim!! What a small world! I look forward to our next meeting we are scheduled to attend to the other local club assisting in this trip, the RC of Kajjanci.

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November 30, 2011 at 2:54 pm

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Day 3 – Uganda VTT mission 2011

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Tuesday, November 29, 2011
We had a timely start this morning, getting to the hospital. Jen and Heidi tell us that they had a long night, but things went well. Charles did very well and James Obama was quite the wild child! Interestingly he is in the same bed as our wild girl from last year, Sonia. Medically, doing well, but James liked to try to get up and “walk away” with his chest tube drain and all the tubes hanging from him! Charles really enjoyed playing his new game of UNO all night with the nurses and Jen. He was so sweet, thanking the day nurses as soon as they came in for his bag of goodies from the Riley Child Life staff (especially Emily Routt). His English is excellent and he was full of information this morning. He says that he is from Kabujja village, about 10km from here. He says that his dad is a Statistician here at Old Mulago Hospital. His mom is named Rose (as I mentioned yesterday, he definitely inherited her beautiful smile) and she owns a shop of some sort. He is doing so well, he is challenging anyone who comes into his room to UNO, including Rob. He also told him that the girl with long hair “is not very good” (Kara!) He will be moved to the step-down unit today or tomorrow (for nursing efficiency). We have decided he is very bright. Rob says he may be president someday, but Charles says maybe a doctor- a surgeon.


James Obama is doing well today. His mom, Barbara, who apparently does not speak much English, has been by his side throughout the day today and he has been quite calm. He had some tea, but was really not too happy about it.


The first patient today is Tabitha. Tabitha is an adorable little 1½ yr old with an AP window. This causes her to have to take medicine to help keep her out of congestive heart failure. She is quite small for her age, only about 17lbs. Her mother Eve wanted to walk her back as far as she could to surgery as Tabitha was quite scared it seemed of the “Muzungu“(what the Ugandans call white people). She gave an adorable wave to her mom even as she was crying while Megan carried her into surgery.


Faustine is the second little girl for surgery this afternoon. She is 2½ yrs old with Tetralogy of Fallot and oxygen saturations in the 85% range. Her mother is Beatrice. She is from Jinja, which is the city we visited last year on our one day trip to see the source of the Nile. She was carried by the Anesthesia resident who is working with Dr. Walker today back to surgery.


During the time of the first surgery, Dr. Cordes and I saw Harriett who is the patient for tomorrow afternoon. She has had a bad cough in the last week her dad said. Her chest X-ray did not appear to show any pneumonia, so hopefully, we can proceed with surgery tomorrow.


We also evaluated a 10 yr-old girl, Aida, from a local orphan village who has a bad heart (MS/MR with pulmonary hypertension) from Rheumatic Fever. She came with a guardian and a woman (Iriana) who is originally from Holland who lives and works here with orphans with special needs like Aida. She says that Aida was diagnosed with this issue when she had bad congestive heart failure this August. She was very sick and was told that they cannot do surgery here on this sort of issue. Apparently, there is a family in the US who heard of her who already has a child who has had heart surgery and they may be interested in adopting Aida. Adoption in Uganda normally takes 3 years of the adoptive parents living here with the child, but apparently in a medical situation like this, it may be expedited. The question left to us was if this child can be arranged to have surgery soon enough (and with a charity) or can she be adopted, if they are willing, in time to get her to for surgery. Dr. Cordes says she needs a mitral valve replacement within at least a 9-12 months. We did a formal echo, made a CD of this, and copied her EKG. We have talked to Rob and Dr. Turrentine to form a plan for Aida to hopefully get her help.
Tabitha returned from surgery and seems to be quite the wild woman! Keeping her quiet and resting has been difficult. The UHI nurses in the ICU took care of her immediately postoperatively with our team nurses, Katie and Kara, available in the room only if they had questions. We have been quite impressed with their changes in the last year. They are organized, with specific jobs assigned to specific nurses. They have plastic sharps containers now in the ICU instead of the cardboard boxes we noted last year. They are a very bright group of nurses and they are doing a great job!


Faustine came back from surgery about 7:30 PM and was doing well. We turned over to Heidi and Jen who came in for the night shift that all were doing well. Charles has discovered the excitement of the iPhone and after playing until he beat me in air hockey, he found the music on the phone and challenged Kara to a dance-off when he has all of his wires and tubes out. He says he is quite the dance “expert”, as he says, but would tire easily and have to rest when dancing before. I pointed to his chest dressing and said, “Not now!”
This afternoon , we also had excellent news that the TEE probe is now working. After much hard work by Dr. Cordes in talking to the team from Jamaica who loaned us the echo machine, then waiting until it was daytime in England (where the probe came from), we finally got an activation code to activate the probe for the first time on this machine. Unfortunately, it was after Faustine’s case needed it. We will now have it for the rest of the week, though! Look out OR, here comes Dr. Cordes with the TEE!
We had 2 more interesting consults (well, really Dr. Cordes) while Faustine’s surgery was going on, but for the interest of sleep time, will blog about this in the morning. We are told a wireless router should be put in our conference room tomorrow! Yay! -Stephanie

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November 29, 2011 at 10:13 pm

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Day 2 – Uganda VTT Mission 2011

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Monday, November 28, 2011, Surgery Day #1
The team awoke early this morning to the sound of quite a thunderstorm. After breakfast at the hotel, the team was off to the Uganda Heart Institute by 7:40 AM. Charles Mukasa was ready and waiting with his mom Rose. It is obvious he inherited his mother’s beautiful smile! He is a very independent 12 yr old who came back for the echo yesterday all alone. He seems to have excellent English and a great sense of humor to match that gorgeous smile. He warmed up to the camera quite nicely! He walked back to the OR with Dr. Walker after a sweet hug from his mother and a wave good-bye.

Kara, Charles and Megan just before his operation (sinus venosus ASD and PAPVR)

Dr. Turrentine and Rob Raylman, Executive Director of Gift of Life International, met with the Deputy Minister of Health this am as the team prepped the OR and Charles for surgery. Dr T and Rob were discussing with the government the need for more support so that UHI will have the financial backing to continue to operate on at least 1 patients per week to keep up their skills between visiting teams if GOL supports 4 training visits a year. The ultimate goal is for UHI to operate on 200 children per year and to be fully funded by the Ugandan Government and local Ugandan corporations by 2014. Rob felt this was a promising meeting. They returned to get Dr T into the OR which was a little slow to get started. In the meantime, a large press conference was held in the hall of the UHI with all of the major local newspapers and TV stations and the Rotary Club of Kampala North representatives and the Rotary Club of Kajjansi as well as Grace Agwaru, GOLA and Rob Raylman, GOLI. Representatives from MOGAS, (MAESTRO OIL AND GAS SOLUTIONS) a Ugandan-founded corporation, presented a check for the Ugandan equivalent of $10,000 toward the current training trip. This was very exciting press coverage for the local Rotary clubs and GOLI!


In the operating room, the surgical teams were again getting used to each other’s preferences and routines. Chass and the Ugandan surgical scrub nurses were learning to work together as were Mike and Murra for the first time. Dr Mike and Dr Tom had not done an open heart case since the last mission 4 months ago, so things moved along steadily with a lot of teaching going on along the way. Dr. Turrentine allowed them to close the case at approximately 3 PM and Charles was moved to the ICU where Megan, Katie, Kara and UHI nurses Anna and Flavia (our ICU nurse friends from last year) have been studying up on the kind of ASD repair he required and are ready and waiting for his return!

Mike and Murra


I left to attend the Rotary Club meeting at Kampala North, (District 9200) the co-sponsors of the Rotary International grant for this Vocational Training Team along with RC of Lafayette from our District 6560. I reluctantly left the team at the hospital early, before the next case was started. It may be a late night for the team for the first day!

Dr. Cordes reviewed an interesting patient with Dr Lwuabi and I will let him blog more about this and the next case- James Obama. I do know that he was apparently not happy earlier in the day with his Betadine bath nor the hospital gown he was to wear, so they put 2 on him facing different directions so he could not reach the strings to take it off! He may be a tricky little guy! -Stephanie

… James Obama did finally get to OR and the case went very smoothly. Unfortunately our alternate TEE probe – brought to us in Amsterdam from England on the way here – did not work. So we waited until James was in the ICU to do a quick post-op check with a transthoracic echo. We hope we can fix this situation before too long as the intra-operative TEE is vital at the end of many open heart cases to be sure the repair is good and no other problems exist. During the case we all enjoyed taking care of Charles. At one point he pleaded for some water and we felt it was safe to let him have sips. The pleasure this gave him is captured below.

Response to a sip of water “ahhhhhhhhhhhhhhhh!”

Our day did end late with our team returning to the hotel after 8:30 pm. A little dinner, a little blogging and off to bed.- Tim

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November 28, 2011 at 8:49 pm

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Day 1 in Uganda-getting ready

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Sunday, November 27th, 2011
Today was the team’s first day at the Uganda Heart Institute! Sunday being the first working day for the team was undoubtedly out of the ordinary for the UHI physicians, but they were there and ready to get started discussing the surgery schedule and screening the potential patients. It was great to see Dr. Peter Lwabi (pediatric cardiologist), Dr. Tom Mwambu, and Dr. Dr Michael Oketcho (surgeons), and Cardiology Fellow Dr. Aliku Twalib who we all worked with last year as well. All started right to work after a meeting to finalize the surgery schedule for the week based on patients who arrived and the urgency of their need for surgery. Heidi, Megan, Katie, Kara and Jen worked on setting up the ICU and unpacking supplies as well as meeting the children. Dr. Walker went to set up his anesthesia supplies in the OR. Chass met the OR team and prepared the surgical instruments while Mike, along with the UHI perfusionist Murra, set up for all the perfusion needs. Murra has already told Mike, “Be ready to work”. No problems there!

Thirteen patients arrived for 10 slots on the schedule with another 2 patients scheduled to come later in the week. All were waiting in the ward and in the hallway outside the small echo room with their families when we arrived. Dr. Cordes proceeded with brief screening echoes to verify the surgical approach needed for each child with the above-mentioned UHI doctors and Dr. Turrentine watching over closely. I snapped pictures and enjoyed meeting the families. They are already warming up to the camera, so be ready to enjoy some pictures of these beautiful children! What was probably most difficult so far this mission was watching 4 children and their hopeful families leave UHI knowing they will have to wait for surgery. Many of them traveled very far with the hope that our team and UHI would operate on them this week, only to go home… Drake, Winnie, Harriet and Keith will have to wait along with the 600-700 others on Dr Lwabi’s list who need surgery here in Uganda. The need is great!
Pre-surgery case review and additional imaging with the Riley and UHI teams

Lilian and Drake

What a great difference we can see already in the communication between the Riley team and the UHI team! It is like we are just picking up where we left off last year. To start off with mutual respect and cooperation such as this will undoubtedly make for a successful mission!
We left UHI knowing that we are all ready to work tomorrow with 2 surgeries scheduled:
1) Charles Mukasa, an awesome 12 yr old with a BIG and beautiful smile and a sinus venosus ASD and 2) James Obama, a 3yr old with a VSD who came from Lira- over 180 km away from Kampala.
Charles Mukasa – tomorrow’s first case

James Obama- tomorrow’s second case

We were then invited for an informal dinner at Mama Ashanti’s Restaurant with the host Rotarians from the Rotary Club of Kampala North. What a wonderful welcome from my fellow Rotarians! The dinner was traditional Ugandan fare. The food was great and the conversations fabulous. Speaking of fabulous, the Rotarians were QUITE impressive in their harmony in singing “Happy Birthday” to our fearless leader, Dr. Mark Turrentine, celebrating his 29th birthday 🙂

Katie, Kara, Chas, Megan and Jen at our Rotarian dinner

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November 28, 2011 at 7:14 pm

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Vocational Training Team trip #2 – Kampala, Uganda

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We’re here!! The weary travelers- after nearly 30 hours of door-to door travel- were greeted last night by many familiar and smiling faces at the Entebbe Airport. Several local Rotarians and many past patients were a welcome sight for our team . After visiting some with Innocent, Fatuma, Onesmus, and Jemimah and their families, we loaded our 6 large trunks and all our luggage onto the bus (through the window) by our able helpers and driver. We arrived at the hotel at approximately midnight local time and checked into our rooms. Before 3 am, while I was still trying to start the blog and several members of our team were trying to get settled, the power went out at the hotel. It was several hours before the power returned. Last year, we experienced many power outages at the hospital, but never at the hotel at night. This was a new experience!
Today after a later start for breakfast at the hotel, we plan meetings, unpacking the trunks of supplies and seeing several of the children already admitted for preoperative work-up at the Uganda Heart Institute. We are so excited to meet the children and get started!!-Dr. Stephanie Kinnaman


Our team send off by Jim Graham

Fatuma and Innocent (previous Ugandan GOL patients greeting us in Entebbe

Katie and Onesmus

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November 27, 2011 at 2:47 pm

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