Riley International Heart Missions

Archive for December 2011

Day 8 – Uganda VTT Mission 2011

with one comment

Sunday, December 5th
Well, today is our last day and we are excited but sad to see the kids for the last day…We were able to sleep in a little later and left the hotel by 9:30. We rounded on all the kids and all were doing well. Lilian had found her beautiful smile again (still in the ICU, even!) and was waving. Harriett will only eat or drink if her dad is with her. Kato Elisha was still sucking his left index and middle finger upside down and rubbing his right ear to soothe himself. Keith is in somber mode…he seems to be a nervous boy…a bit like Ronald. He wanted his mom when we were there he told the nurse in Lugandan (their language in Kampala). Next door in the step-down unit, Solomon, the little preemie boy was actually doing better. He was only on oxygen and breathing well. His cry sounded stronger. Ronald was doing better as well- looking better, sitting up in a chair. He was cold at the time we went in and Charles had just come over to visit. It was so sweet when Charles took his own jacket off and put it over Ronald’s bare shoulders! Over in the ward, Faustine was like a new woman! She was smiling and laughing and bouncing. James Obama was a little serious today. Tabitha is doing well and even offered us some waves again. The highlight had to be that Charles danced for us! We will miss him! He will do big things someday….

20111205-200133.jpg Lilian

20111205-200152.jpg Harriet

20111205-200357.jpg Kato

20111205-200420.jpg Keith

20111205-201435.jpg Ronald

20111205-201202.jpg Faustine

20111205-201519.jpg Tabitha

20111205-202122.jpg James Obama with Heidi

So, we headed back to the hotel and got a late lunch after packing up and consolidating into one big room since we have such a late flight out (11:30 PM). We had about an hour of free shopping time. It had been raining, so unfortunately no going to the craft market (well, the guys would say “Whew!”) Then we packed up the bus (again through the window) and jammed in for the little over hour drive to the airport. We had a brief return to the hotel when Dr. T. thought he may have lost his second iPhone in 3 years in Uganda, but then he found it!
He is already discussing a possible return next year. We have made some good friends in Uganda in Dr. Lwabe, Dr. Michael, Dr. Tom and all the staff…not to mention that we cannot wait to see these children next year DANCING!

Dr. T. contemplating a return trip in 2012?

We have so many people to thank for this wonderful experience…and we also should list this entire, hardworking, compassionate group who took their personal vacation time to make a difference in the lives of these 9 (10 with Solomon) children. There will be many more beautiful children helped in the future because of the team-building that has been going on in the last 2 years at UHI! THANK YOU VTT team from your Rotarian friend…Rotarian Stephanie!

20111205-203615.jpg

Vocational Training Team #2-Kampala, Uganda ,2011

Dr. Mark Turrentine, Pediatric Cardiothoracic Surgeon

Dr. Tim Cordes, Pediatric Cardiologist

Dr. Scott Walker, Anesthesiologist

Jennifer Helman, Pediatric Nurse Practitioner

Mike Horner, Perfusionist

Chassity Mays, Surgical nurse

Megan Richards, ICU nurse

Heidi Harris, ICU nurse

Kara Laliberte, ICU nurse

Katie Snyder, ICU nurse

Dr. Stephanie Kinnaman, Family Physician(American Health Network) , Rotary Club of Greenfield

The Vocational Training Team would like to thank the following individuals and corporations for their time, effort, and donations without which missions like this would not be possible.
Jill Riley and Becky Clark– our Mission Veterans, for their long hours of organizing items, helping to set up our blog access and blazing the way for so many missions before us! We missed you!
Rob Raylman, Executive Director of Gift of Life International, for the mission logistics and financing of the hospital expenses and for his presence throughout the trip and all of his hard work in making this a sustainable operation in Uganda.
Grace Agwaru, the first ever Gift of Life child who came to New York at only 5 years of age and now gives back to the very organization who made that possible by organizing Gift of Life International in Africa. She worked many hours to make sure everything was in order for our accommodations and Rotarian involvement in Uganda.
Jack Kelly, Rotary Club of Lafayette, who wrote the grant to Rotary International for our VTT and made many arrangements for our trip. We wish you could have joined us!
Dottie Hancock and Jim Graham, the foundation of this group’s mission activities.
Rotary Club of Lafayette and District 6560– for the work in getting the Global Grant and matching grant funds.
Rotary Club of Greenfield for all of their work in raising money for Gift of Life which supported some of the expenses of this trip and for obtaining the grant and supporting the first completed Vocational Training Trip in 2010!
Kit Werbe– for assistance with marketing and credentialing.
Gene Ford-for assisting in blog site access.
IU Health-donated surplus and “unusables”
Debbie O’Donnel– for Foley cather donations
W.L. Gore– donated patches
Cook, Inc.– donated Central Lines
Mr. and Mrs. Richards for the adorable outfits donated for each child (and then some!!)
Child Life Staff, especially Emily Routt– for the bags of age-appropriate toys and activities for each child.
Chain of Hope, England– for allowing us to borrow Echocardiogram equipment.
Luxtec– for donating Dr. Turrentine’s headlamp
Abbott (Melissa Mancinelli)-donated istat supplies
IU Health Point of Care (Melissa Jordan)– donated istat machines
Baxter– for donated Coseal
Cryolife-for donated Bioglue
Medtronic– for donated Contegra and pacemakers and wires
Riley Sterile Processing-for processing supplies
Chris Thomas– Riley Cardiology PharmD and the Outpatient Pharmacy group

Written by tcordes757

December 6, 2011 at 1:54 am

Posted in Uncategorized

Special Thanks

with one comment

I want to write a quick note of appreciation. The cardiology doctors, nurses and OR team members get lots of well deserved kudos during these missions and in this blog, but I want to be sure thanks and appreciation go to Dr. Stephanie. She is our Rotarian team leader from Greenfield, Indiana. She is also a valuable member of our medical team. She has gathered a great deal of helpful information and history from our patients and their families – clearly evident from the background info about our patients on this blog. She has kept detailed notes on them on which we have all relied. She often gave a ready hand to help our ICU nurses, me with consults, and Rob with the many Rotarian functions that were going on all week. And on top of all of that she wrote the blog. Anyone who has written the blog on past missions knows how much work that is. My role was to add pictures and uploaded the blog each night. Which is why it says it is written by me. But I simply am publishing Stephanie’s words. So this mission owes a great deal of thanks to Stephanie, and blog readers who have enjoyed the daily reports can thank her as well. – Tim Cordes

20111205-205114.jpg Dr. Stephanie with Ester

Written by tcordes757

December 6, 2011 at 1:54 am

Posted in Uncategorized

Day 7 – Uganda VTT Mission 2011

leave a comment »

December 3, 2011
The team headed for the hospital this morning knowing the Fauza’s INR was 1.56. However, we had used all the FFP to get it there. Only 1 unit of packed red blood cells, 2 units of whole blood and one unit of platelets would be available. That is certainly not enough to safely proceed with a re-do sternotomy, so unfortunately the case had to be cancelled. Plans are in the works to transport her for a Gift of Life surgery elsewehere as it seems unlikely there will be enough blood products here to complete her surgery at the right time that a mission team is here. So, the team rounded on the other patients then packed the trunks for departure. Dr. Lwabe, Dr. Tom, Dr. Michael and Dr. John took the team on a trip to the new cath lab and surgery theater that is under construction. We are told this should be completed in February. This will greatly improve the cardiac diagnostic and interventional capabilities here at Mulago Hospital. It will be a really great addition.

20111205-184712.jpg

20111205-184335.jpg

In the meantime, Rob, Grace and I met President Godfrey from the RC of Kampala North at a radio station in downtown Kampala for a one hour radio show hosted by a Dr. James who is a cardiologist from Mulago Hospital. He weekly does a public health show. He and the DJ, Jamie, were very smooth! The show went well and Rob, as usual, was such a great spokesman for Gift of Life.

When we all reconvened back at the hospital, Ronald appeared to be in some mild distress and was generally not reassuring. He was worrying Dr. Turrentine all morning. His sats were lower than expected, low BP, and lots of ectopy. We were told later that he told his mom that he felt like he could die during that time. A repeat echo was done by our good Dr. Cordes and found a large pericardial effusion. Kara and Katie took care of that! They worked hard at stripping his chest tube and got out 300cc! A repeat echo showed minimal residual effusions, and Ronald was doing much better.

20111205-191209.jpg

We had our debriefing session with the entire day team along with Dr. John, Dr. Tom, Dr. Michael, Dr. Lwabe, Dr. Alike, Gertrude and John from the theatre and Frances representing ICU nursing. It was an excellent meeting in which everyone shared reflections on our week here and recommendations for future improvements. At the end of the meeting, they were so kind to give us each a frame with a certificate for us to remember this team building experience. So kind!

After the work on Ronald, we left the hospital at about 3:30. The former Gift of life patients had been at a local park for the reunion since 2… Unfortunately, it had rained heavily in that time. There was cover for them, though! When we arrived, approximately 100 kids ran up to all of us to hug us! It was so exciting to see familiar faces right away! The children had practiced before our arrival a special dance and performed for us. We have to post a link to the video…you MUST see these children who have all had heart surgery by Gift of Life dancing! (we are still figuring this out)

20111205-193205.jpg

It was so very emotional for all of us to recognize the children and see them so healthy and bigger one year later! Nine of the eleven children from last year on our VTT trip were there! I will speak for only myself that I could not stop the happy tears!(but I think most if not all of the other women were, too) I recognized Esther and Fatuma, the little girls who became fast friends in the Step-Down unit last year…There was Onesmus who is an amazing dancer now, but last year could not walk far from his bed for all of his weakness and shortness of breath (he is a dance MACHINE now!). There was Nathan who never cracked a smile last year the entire time, but now was dancing and having so much fun with his buddy Fred. Fred who was the little guy sitting in the chair reading the paper like such a little man in the ward just days after his surgery was all dressed in a suit and tie! Jemimah has grown so much and is still just so adorable! Maria was there as well- smiling and dancing and giving hugs. And Sonia was there… PDG Salim’s absolute favorite from last year who puffed her hair for us on the first day and then turned into quite the little wild woman after surgery. She was so small for her age and too weak and thin to stand on her own and walk last year. Now her mom says she can walk and run and play and dance (although she was too shy to be in on the big group dance). This was the absolute highlight of the week! Now we can’t wait to see the children from this week dance next year!

20111205-194957.jpg

After this, we headed back to the hotel to quick ready for a dinner out with the team and the staff from UHI at an Italian restaurant called Mamba Point. It is really great and such a perfect outside setting for a large group to enjoy each other’s company. Dr. Lwabe and his wife, Lucy, Dr. Michael and his wife, and Dr. John and his wife as well as our great ICU nurse, Anna and her husband joined us. It was a great night of fun and conversation! We learned that we really MUST try grasshopper…they taste like shrimp (Charles, the Mr. Expert on everything, had also told me that). There was also a deal made about if UHI does another operation on their own in December that Rob will go out on a rat hunt in the bush…apparently a seasonal hunting thing in Uganda (although these are no New York sized rats- more like the size of a large cat!!!) And, yes, the Ugandans eat them…”Tastes like chicken, only better,” Lucy said! It was such a great night. Thanks, Rob!! And we cannot wait to see pics from this rat hunt!

20111205-195426.jpg

20111205-195445.jpg

Written by tcordes757

December 6, 2011 at 12:56 am

Posted in Uncategorized

Day 6 – Uganda VTT mission 2011

with one comment

Friday, December 2, 2011
So, much happened last evening since the post was added earlier….Harriett’s surgery went well. She was not really interested in waking up, though. Remember she had a cough before surgery and her chest X-ray showed that to keep her on the ventilator overnight would be helpful. Dr. Walker worked a lot on making the vent settings just right and giving orders for her sedation and changes needed for the night with Jen and Heidi prior to our departure. Lilian in the bed next to her was starting to wake up a little and I gave her the little soft puppet Heidi brought. She smiled so sweetly and cuddled it to her face as she went back to sleep. So sweet! 20111202-231621.jpg

I also had to add the picture that Dr. Walker made for Charles. Most of us thought this was an excellent caricature, but Charles didn’t quite understand and noted “But I have a big head”! He is such a character!

20111204-154457.jpg

We went back to the hotel about 9PM and made our way up to “Seven Hills”, the sixth revolving restaurant established in all of Africa. It was a great view of Kampala. It takes about 90 minutes to make a complete revolution and see the whole 360 degrees view. It was a nice ending to a good day!

This morning, we planned what could be a very difficult case…Fauza is a 21 yr old woman who had a mitral valve replacement on a Gift of Life mission trip to India in 2007. She now rather urgently needs an aortic valve replacement. We have worked all week to try to figure out if we can work her into the schedule even though as a “redo” this could be a very difficult case. However, this morning we discovered that her INR is too high and she cannot have the operation today. She can get some more IV blood products and Dr. Turrentine hopes that she could be added on for tomorrow morning. That may be difficult to arrange on a Saturday, even if her lab results are better…

So…Kato Elisha was taken back to the theatre by Megan. He is 2 years old with a ventricular septal defect (VSD) and quite the social butterfly. He is another orphan from a local group with about 50 children at their home. The guardians here with him have been very attentive every day since they arrived Sunday. Each time we would go to the ward, he would wave and smile, often saying “Hi” and “Bye”. He is now a twin. He was originally a triplet, but one child died some time ago, so he and his brother are quite close. I have learned that the name “Kato” is an identifier that he is the younger boy twin. His older twin would be “Wassa”. This is a regional thing, so that when he was in his original Kitgum region, he would have been called “Ocen” and his brother “Opio”. So, little Kato Elisha will be fun to watch recover! His surgery went very well. When he returned from surgery, he gave everyone a little scare about 1 hour after he returned to the ICU. He decided to take entirely too long between breaths and started having some issues. This certainly got everyone’s attention! Dr. Cordes was checking on Solomon, (the tiny 3lb baby who is not doing well) when he heard Katie yell down the hall from the ICU for him. After evaluating him with Dr. walker, he responded well to some Narcan (to wake him up some more) and is doing fine. 20111202-233132.jpg
20111202-233252.jpg
Kato at his pre-surgery echo and on the way to the theater

The minister of Health of Uganda also made a visit to Uganda Heart Institute Today! Not sure they have ever had so much attention in one year, let alone one week! This is very exciting for UHI and for Gift of Life! Rob presented her with a Gift of Life pin. She is a pediatrician and trained right here with Dr. Lwabe. She is also very supportive of the MOU. 20111202-233754.jpg

We also had the chance to add another child for this afternoon. Dr. Aliku, the Pediatric Cardiology Fellow, knew of a boy Keith who lives close and would readily come in for surgery. Keith is a 5 yr old boy who has tricuspid atresia and a VSD. He is an only child who is quiet today. His mother, Irene, is so excited she says when she got the call today. She says “This is what we have been waiting for!” 20111202-234349.jpg

Things in the theatre are going very well. Mike says that Murra is doing a great job as the perfusionist. Today, Mike says she was all set up and ready to go completely on her own when he got here this morning. Chass says things are great with John, the UHI scrub nurse as well. Both have really moved to more of an oversight role as the UHI team has accepted more and more of the primary responsibility. Dr. Michael and Dr. Tom are working well with Dr. Turrentine also. They are planning on scheduling several cases on their own after we leave to continue to keep up everyone’s skills. Again, great progress is being made and we have seen this in even the last 5 days! Now with the MOU signing and the funding that provides to help pay for them to continue to do these surgeries, UHI will be well on their way to take care of their own children completely for all kinds of cardiac anomalies in the near future! 20111203-001744.jpg

Tabitha made her trip to the ward! She is down with all the families again. Her mother carried her there and at 1 ½ yrs, she is not necessarily excited about the move.

20111204-155634.jpg

When checking on Faustine this morning, she was all smiles! The “Happy Room” seemed to be working for her finally. Anna, our stellar nurse from UHI, was taking care of her throughout the night. She said that she was whining through the night that she had to go potty “susu”. Apparently she did not want to go in her “Pamper”. She wanted a “toilet”. Anna tried to convince her it was ok, but then finally got her a bedpan and she went 450 cc! For the non-medical people reading this, that is a LOT of urine for a little 2 yr old. This is what made her smile for hours after this! We went to check on her some time later and that smile was gone…she was tired of us and she made that quite clear! 20111202-235319.jpg

Ronald moved over to the Step-Down unit, but he is still having some breathing issues. Needs a little more meds to help…so, he could not walk. We encouraged Charles to go down to play UNO with him. We were sure this would make Ronald smile! This did cheer him up in the afternoon! We learned all kind of information…Ronald’s mother told Grace that passed on the story of when he first went to the theatre. He said he told Dr. Walker that he had to “make a short call” or “susu” just so he could run out! Through interpretation of Charles, Ronald is now denying this 🙂 . He says, “No, I really had to susu!” They were laughing and having a great time. We love these guys! 20111202-235632.jpg

Now underway in the theatre is Keith’s surgery. We are happy to report that much of our team is not even scrubbed in!! Well, Dr. Turrentine TRIED not to scrub in, but it couldn’t last the whole surgery…He is now second assisting and teaching. I also took Rob back to the theatre. He has never been back to the UHI theatres he says. He is lucky I found him scrubs that fit! Tusu from the RC of Kampala North, our co-sponsoring club for the global grant also came to the theatre for Kato Elisha today. 20111202-234956.jpg

We are told that Fauza’s INR is now 1.6…they will try to get enough blood products (a HUGE problem here) and recheck her INR in the morning. Dr. Turrentine hopes this may make it a possibility to do this redo surgery tomorrow.
Tonight, the RC of Kampala North and the RC of Kajjinsi are hosting a “Farewell Dinner” this evening. Unfortunately, we will definitely be late. From the time I am writing this, we are supposed to be there in 1 hour. However, Keith and the entire team are in the theatre and our night team does not come until 7:30. We will be going straight from the hospital…not necessarily the most presentable! 20111203-000702.jpg

Tomorrow, we will look forward to the Reunion of the Gift of Life children. About 100 children are expected to come. We really hope to see a lot of familiar faces!

Written by tcordes757

December 2, 2011 at 9:19 pm

Posted in Uncategorized

Day 5 – Uganda VTT Mission 2011

with one comment

Thursday, December 1, 2011
It is a big day today! The First Lady of Uganda, the Honorable Janet Museveni, is visiting Uganda Heart Institute! She will meet with UHI physician leaders, Rob and Grace, and Rotarian leaders and will announce the signing of the Memorandum of Understanding (MOU). This has been a project that they have been working to get the Ugandan government to agree to for 2 years. It commits the government to financially supporting 100 surgeries per year at UHI.
Even as we drove up to the hospital, it was apparent that things were different today. There was a lot of security at the gate. And all along our normal route once on the hospital grounds. We changed over with Jen and Heidi who said that the patients slept pretty well through the night. They made a lot of important adjustments for Ronald who is doing really well. Heidi and Jen are doing an amazing job at night! The daytime nurses and staff started right away hustling about tidying things. Lilian was brought to the OR by Megan to get the first case started. This did not go as quickly as Dr. Turrentine would have liked. However, Lillian’s surgery was started with the plan that Dr. Mike and Dr. Tom would leave for the meeting with the First Lady.
Lilian is a 5 year-old adorable little girl from Mbale (240 km away) who came with her dad, Mike. She has more impressive cyanosis (or lack of oxygen), at 74% from her Tetralogy of Fallot. She has been here since Sunday waiting for surgery in the ward. Any time one of the team would go into the ward, she would run over and hug us. Sometimes I would be talking to a parent or a nurse in the ward and I would suddenly feel arms around my leg and there was Lilian. She is usually fully accessorized and dressed in an adorable dress. She was smiling in the OR, Chass says, even to the time she had the mask placed!

20111201-190150.jpg

After rounding on the patients, lines were pulled and patients were moved…Charles moved down to the ward with his family. He was so excited to get up and going. He did show me a little dancing, but no music was available at the time. We will have to do the dance-off soon! He pointed out to me after standing, dancing, and walking about the room a little, he still did not feel tired! We walked to the ward and his family was obviously emotional as mom had tears streaming down her face. Of course, he showed her his classic perfect smile!

20111201-191253.jpg

20111201-191044.jpg

Faustine still has her chest congestion, but is doing well. She was moved to the Step-Down unit also. In the ICU we still have Solomon, the little orphan 3# former preemie from Wototo who had the PDA surgery by Dr. Tom done on his own in an adjacent theatre yesterday. We are still helping to manage his postoperative care. His respirations are really low with long periods of apnea, so we started treating that (Theophylline). We are starting to feed him as well through his NG. He is looking better, but still has a LONG way to go. We are not posting pictures of little Solomon as it may disturb some, but mostly that his caretaker from Wototo has asked that I not post pictures publicly. Obama will likely move later today to the ward as well, but for the first time today, we saw him SMILE! Heidi brought a light-up toy that he loves. He looks adorable in his outfit from the Richards, and now accessorized with a smile!

20111201-191700.jpg

Ronald is doing well. He will not complain! Even less than 24 hours after surgery, we ask if he has pain and he says, “No”. He had some water this morning and thanked Katie for helping him. He looks forward to Charles coming to visit so that he can play UNO with him again. He has his own set of cards now!

20111201-191836.jpg

Tabitha is doing well. She looks super cute in her little dress. Now that her chest tube is out, Kara really enjoyed holding her. When she is not being cuddled by the nurses, she likes to hold on to her baby doll. She is so quiet now compared to her immediate postop period. She is like a different child!

20111201-191954.jpg

Harriett is the next case of the day. She is a 2½ yr old cutie who has TAPVR (Total Anomolous Pulmonary Venous Return) with an oxygen sat of 87%. She comes from Fort Portal. This is in the far western side of Uganda. The staff estimates this is about 400km from Kampala. She came with her dad, Joseph. She is the sweetheart you saw in the picture with her Dad after her echo in a previous blog post. Her cough is a little better and her labs looked favorable. The surgeons still think it is possible she has malaria, but while this sounds dramatic to us, this is everyday stuff here. She can be treated just the same and it does not affect her surgery.

20111201-192609.jpg

Obama made his big move to the ward and is with his family there. He looked so cute walking in his little outfit and flip-flops, but he was not happy about the walking. However, he held his toy light globe and would hold it up and turn on every few steps.

20111201-192752.jpg

In the meantime, we have GREAT news to report! The First Lady’s visit went wonderfully. Dr. Cordes acted as professional photographer and most of us had the opportunity to personally meet her and shake her hand (except for Mike, Chass, and Dr. Turrentine who were in the OR). This meeting included her announcement that the MOU MUST be signed! This will undoubtedly help UHI to further expand their services and expertise!

20111201-193508.jpg

Harriet’s surgery went well. Dr. Cordes and Dr. Turrentine liked the look of the repair on the echo in the theatre and she was finished about 7:00 PM. She should be out about the time that Jen and Heidi will be coming in…we hope for some dinner and sleep time!

Written by tcordes757

December 1, 2011 at 4:36 pm

Posted in Uncategorized

Rotary Club of Kajjansi Meeting 11/30/2011

with 3 comments

Rotary Club of Kajjansi Meeting
Wednesday evening, Rob, Grace, and I went to the Rotary Club of Kajjansi meeting. It seemed quite a bit farther out than we anticipated, but especially because of the traffic. We left the team at the hospital and quickly ran by the hotel. We had 35 minutes to get to the meeting, but with the traffic jam it took more like 1 hr and 20 minutes. We arrived 15 minutes before they closed the meeting! The Rotarians were anticipating our arrival, so after we offered many apologies, we were asked to speak about our team and the progress. The Rotary Club of Kajjansi allocated $10,000 donated by MOGAS as mentioned in previous posts to this VTT project, sponsoring 4 children. They are a delightful group and served us “Luwumbo” which we are told is quite a special treat. In the kingdom of Buganda (the largest in Uganda), this is served when you have a special but familiar guest in your home, like your family or friend. Despite our long drive, I was definitely happy to express our gratitude to our partners for their allocation of these funds to this mission. The hope is that this spurs more local corporations to get involved like MOGAS in these vocational training trips. President Peace Taremwa and the entire club were great hosts! Incidentally, it only took less than 25 minutes to return to the hotel. -Stephanie

20111201-144533.jpg

20111201-144549.jpg
This is the Luwumbo

Written by tcordes757

December 1, 2011 at 11:47 am

Posted in Uncategorized