Blog : Team

Cardiac Alliance returns to Ecuador

 

With our trip sponsors With Every Heartbeat, The Fialeny Foundation

Novick Cardiac Alliance worked at Hospital del Nino’s Dr. Francisco Ycaza Bustamante in Guayaquil, Ecuador April 28 – May 12, 2018. This was the first time our team returned to Hospital del Nino since 2014. This trip was made possible by the generous donations from our partners “With Every Heartbeat, the Fialeny Foundation” and support from Ecuadorian charity “Fundacion El Cielo Para Los Ninos.”  Our team consisted of 17 medical volunteers from 12 different centers in the USA and Argentina. 

 

Over the two week trip, NCA Cardiologist Dr Mark Gellat evaluated nearly 70 children, performing echocardiograms and assessing these children for heart defects. Led by NCA pediatric heart surgeon Dr Marcelo Cardarelli, fifteen children received life-saving heart surgery in 8 days of operation. We were pleased to discover that the local team in Guayaquil had been continuing their education and teaching new staff skills to become more competent in pediatric cardiac care and surgery. The local surgeon Dr Hernan Montero has been operating in the absence of visiting teams and the ICU has been led by Venezuelan Intensivist Ricardo Briceno. Each morning during patient rounds, Dr Briceno quizzes nurses and new doctors about a specific defect or complication in order to expand their critical thinking skills.

The ICU team was led by PICU nurse educators Farzana Shah and Roslyn Rivera. Our ICU physicians and nurses provided 24 hour care for these children before and after surgery the entire two weeks. Many of the children were discharged from the hospital within 48 hours of surgery. The majority of the children we operated during this trip were between 5-12 years old, with simple heart defects that require surgery in order for them to survive into adulthood. These children have been on a waiting list for surgery for several years, but there are not enough surgeons in Ecuador to provide surgery. The babies born with more complex heart defects are often not as lucky. Complex heart defects require early intervention for babies to survive to age one. Our trip to Guayaquil helped enhance the medical skills of the surgeons, doctors, and nurses so they can continue to provide treatment for children with heart disease in their country. 

Milan is a baby with a complex heart defect that requires immediate surgery to survive.

For four months, Milan’s mother watched her baby turned dark blue whenever he would cry. Several times, she took him to the doctor in the village where they live, but the doctor would say that Milan would “grow out of it.” Searching for answers, Milan’s family brought him to the pay-clinic in Guayaquil. There the doctors told her he had a serious problem with his heart and he needed to see the cardiologist at the Bustamante Children’s Hospital. As if by fate, the next day, NCA cardiologist Dr Gellat saw Milan. Just from seeing his blue pale appearance, Dr Gellat knew immediately that Milan did indeed have a complex heart defect. The echocardiogram showed that Milan had pulmonary atresia, meaning blood was not flowing the normal way into his lungs to receive oxygen. His blue color was from severe lack of oxygenated blood. Our team discussed a plan and Milan received surgery to create a pathway for blood to flow to his lungs. 

Milan had a difficult recovery after his surgery, but was doing very well when our team left the country. We have received updates from Milan’s parents that is now home and happily growing. His parents were immensely happy to see their baby boy finally looking well.

It’s babies like Milan that remind us how desperately advanced pediatric cardiac care is needed in developing countries. Our teams strive to educate local teams about pediatric cardiology so that babies like Milan can be properly diagnosed and treated early, and given a chance to survive. 

Volunteer Story – Erin Serrano

PICU nurse Erin Serrano recently joined our team on her first medical mission trip to Ukraine. Erin shares her unique story about why she began her career as a pediatric cardiac nurse and how volunteering with Novick Cardiac Alliance was a dream her entire life.

My journey to pursue a career in the Pediatric Cardiac Intensive Care Unit began the day I was born. Just a few days after birth, I was diagnosed with a congenital heart defect and underwent multiple cardiac surgeries and procedures to save my life. Volunteering with Novick Cardiac Alliance to help patients and families with similar stories as my own wasn’t a choice, it was something I knew I had to do. It was my destiny. 

Coming to Ukraine and stepping into a healthcare system that I knew nothing about was one of the most challenging things I have ever done. After just a few days, I realized that leaving my comfort zone was more than worth it. From the first day that we arrived at the hospital, I learned just how resourceful the staff members had to be, considering their limited medical supplies, equipment, and medications. Imagine being a parent of a child requiring cardiac surgery and you are responsible for providing part of their medical supplies because the hospital simply cannot obtain enough. I was astounded to see the local nurses using resterilized supplies. These supplies would most certainly be thrown away after one use in the United States. I realize that we take for granted the abundance of simple supplies and they are precious items in developing countries like Ukraine. 

Despite the obvious language barrier that exists, Cardiac Alliance has been successful in educating the Ukrainian medical team in everything from basic ICU care to the most complex cardiac surgeries. To be a part of that education process was the most rewarding part of my trip. 

One out of every 100 babies is born with a congenital heart defect and CHD’s are the most common cause of infant death among birth defects. If I have helped just one nurse better their practice while caring for these patients, then I know my time spent was worthwhile. I certainly hope I can volunteer with Cardiac Alliance again and again. Thank you NCA for allowing me to be a part of your incredible mission and to the entire Ukrainian team for teaching me more than I could have ever imagined. 

Perspective from a Perfusion Student

Brooke managing the bypass machine in Kharkiv

Brooke Tracy, a perfusion student from the US, recently joined our team on a trip to Kharkiv, Ukraine. She describes her experience as a student on her first medical mission trip.

“There are no words to describe how amazing and influential my first mission trip with the Novick Cardiac Alliance was, but I can say with absolute certainty I would recommend it to anyone! Not only was the team amazing and so well versed in healthcare skills, but they also were some of the most empathetic and passionate people I have had the opportunity to work alongside. Not to mention the local Ukrainian team. They all were very excited to learn from NCA in ways to improve their practice, and they were incredibly welcoming and appreciative of all that NCA has done for their hospital system.

As a perfusion student, I didn’t really know what to expect as our field is pretty dependent upon technology and supplies. I had done some research on the Ukrainian healthcare system, but was vastly underprepared when it came to fully understanding the difficulties in which the local team has in acquiring, what in our practice, is simple equipment. But the lack of equipment never stumped the local perfusionist. Alex and Olga were some of the most innovative perfusionists I’d ever met. In order to make the most of each piece of equipment, their circuit design and construction was innovative. Both were incredibly knowledgeable, but it was humbling to see how much they each were looking to learn more and grow in their practice.”

NCA Perfusionists John and Brooke working alongside Kharkiv perfusionists Alex and Olga

What she gained as a student: 

“In the end, the most inspiring thing about this trip for me was to see the passion and moral of the local team. The nurses were so compassionate and went out of their way to comfort their patients. They really did an amazing job, especially those that were medical students working night shift to gain experience! You could tell that this hospital served their local community in more than just physical care, as the empathy was overflowing with every patient. The parents were allowed back in the ICU with their children post-op and it made a world of difference in the recovery of our patients.

After returning from this trip, not only had I gained a ton of knowledge and skills from both the NCA team and the local team, but I also had a better appreciation for all of the resources that we have at our disposal in the US. I have developed some new practices and little tricks that make my perfusion practice more resourceful and limit my medical waste since returning from the mission.

Brooke with patient Sofia, who had 60 minutes on bypass during her operation.

I can not only recommend missions to anyone in the field, but especially to students because I feel that it gives you a advantage to being a resourceful, motivated, and passionate perfusionist, which is exactly what this world needs more of.”

-Brooke Tracy, Perfusion Student, South Carolina, USA

Perfusion Without Borders Scholarship Winner

Each year, the American Society of Extracorporeal Technology offers a scholarship to one Perfusion student to travel on a medical mission trip with an organization of their choice. This year’s winner is perfusion student Kim Morris and she will be traveling with Novick Cardiac Alliance to Ukraine early next year.

Kim Morris, Perfusion Student, USA

Kim moved across the United States from Alaska to New York to pursue education in perfusion. From her experience, she has learned that “a successful perfusionist is reliant on gaining the trust of a room full of people that may come from completely different backgrounds. You treat your patient with your equipment and knowledge, but you also treat the surgeon and a room full of professionals with careful communication and a calm demeanor to ease a stressful situation.”

Several years ago, Kim was a medical volunteer in Ghana and from that experience realized she aspired to gain more personal knowledge to more directly help people in need on her next volunteer trip. Becoming a perfusionist was her answer. She now is feeling more qualified to utilize her skills to directly assist those in developing countries. Kim is excited to join Novick Cardiac Alliance as a perfusion student, honestly stating, “I’ve learned to participate in a highly skilled team to give a patient a permanent, life changing surgery.”

Kim volunteering in Ghana.

We look forward to having Kim join our team as a perfusion student in Ukraine!

Volunteer Story – Natalie Constantin

By Natalie Constantin, PICU Nurse Volunteer, Melbourne Australia

Volunteering had been on my mind for about a year before I heard about Novick Cardiac Alliance. Friends of mine were planning on going on a trip to Tehran with NCA, and I picked their brains about what they were expecting and what NCA’s priorities were. On their return, I learned working closely with local teams, educating and upskilling their practice were at the forefront of the organisation. Deciding that I wanted to take the leap and join NCA, I sent off an email and was then asked to join them on a trip to Russia.

Not much can prepare you for what to expect when working with NCA in another country, far outside of your comfort zone. Equipment is different, or simply not available. You don’t have all your diagnostic tools around. Your stethoscope, hands and eyes become your best friend. You learn to identify a change in your patient without blood tests and scans, simply because they are not resources that is readily obtainable. You work with staff from different educational backgrounds, who have not had the opportunity to be orientated into a busy paediatric cardiac surgery unit under the guidance of preceptors and educators, there to answer your questions and guide your practice. But, the truth is, children with congenital heart defects are born around the globe every day, and just because a state-of-the-art centre doesn’t exist in their home country doesn’t mean that they are any less deserving of care and treatment. NCA fills that void, meeting locals at the level they are at, guiding them in clinic, theatres and the ICUs.

Education at ground level is continuous, with NCA staff always eager to answer questions, offer guidance and work side-by-side with local health professionals. My skills as a paediatric ICU nurse were welcome, and I was immediately welcomed as part of the crew. The focus is on preparing local teams to continue what NCA has started, with the priority being that children, wherever they are born, will be able to receive treatment, against the odds that borders, resources and lack of funds may bring.

Volunteering with NCA has given me a new awareness of how lucky we are in developed nations. I will always consider it a privilege to have worked alongside NCA in giving children a new lease on life, regardless of where they may call home.

Meet Narjis, our first patient of 2017!

Meet Narjis, our first patient of 2017!

Narjis was born in Baghdad, Iraq in October 2016. When she was about two weeks old, her parents Akar and Nor Maseer noticed she was breathing fast. They took her to the doctor and an echocardiogram showed she had two holes in her heart, an atrial septal defect and ventricular septal defect. The doctor gave her medicines and told the family to return in 1 week. After this week, Narjis did not improve and the doctor said she needed surgery. Unfortunately, there is no hospital or heart surgeon available for babies in Iraq, so doctors advised Narjis’ parents to take her outside Iraq.

Advocating for his daughter, Narjis’ father Akar found a new doctor in Baghdad, but this doctor said her lung pressures were too high and surgery would now be impossible. Not losing hope, Akar found yet another doctor for his daughter, but still the same answer: his family must travel outside of Iraq for her surgery, and if they didn’t she may not survive until her 1st birthday. At two months old, Narjis barely weighed as much as a newborn baby because of her heart defect.

Still searching everywhere for a better solution, Narjis’ father saw an advertisement on Facebook from Al Kafeel Super Specialty Hospital in Karbala with the news that Dr Novick and his team would be coming to provide heart surgeries for children. Narjis’ parents packed their bags and drove to Karbala to meet our cardiologist on the first day of our arrival. Her heart surgery was scheduled for the next day.

Now 3 months old, Narjis received her life-saving heart surgery to close those two large holes on January 16th. She recovered quickly and was back in her mother’s arms on the ward within two days. Narjis’s parents are very thankful that their sweet little daughter is healing and eating better. Just two weeks ago they were fearful they may lose their newborn baby, and now they see her future is bright.

Upstream

Upstream

“Where does the blood flow come from? And where does it go?” Dr. Rodriguez paused a moment before repeating “Where does the blood come from, and where does it go?”

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Dr. Rodriguez was talking as much to himself as he was to the local cardiologists beside him. He carefully studied the illuminated echocardiogram screen, then turned back to the cardiologists. Dr. Miriam passed the ultrasound wand over each child’s chest—again and again honing in on particular spots of each small body. They spent as long as necessary with each child to figure out their own unique physiological puzzle.

But isn’t every heart the same?

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When an adult develops a heart condition, doctors look for disease or damage to a “normal” heart. The doctor knows exactly where to look, and has a good idea what will be found before ever seeing an image of the heart. “Normal” hearts are all made pretty much the same way.

In children born with congenital heart defects, every heart is different. Some children have 3 heart chambers instead of 4. Some are missing ventricles, or have them crossed. There are countless problems and variations, so it’s a challenge to determine exactly what path the blood takes.

Dr. Rodriguez coached the cardiologists to look further than the defect itself—to figure out the larger picture. Often the first answer—the obvious answer—doesn’t provide the best solution for the child’s overall health.

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Zaid and his heart provide a perfect metaphor for Libya and the troubles it’s facing.

Libyan children need heart surgeries—so providing heart surgeries is the best solution. Unless, of course, it isn’t.

When we provided Zaid with heart surgery, we helped him and his family. When our doctors and nurses spent crucial time teaching local doctors and nurses—honing diagnostic skills, developing new surgical techniques, reinforcing best nursing practices—we didn’t just help Zaid. We helped the whole country.

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Libya doesn’t have the skilled professionals it needs to take care of it’s own children. Every time we return, pairing surgery with education, we bring them closer to never needing us again. We work toward rising the tide in the Libyan health care system—encouraging a culture of highly skilled excellence.

The situation in each country we work in is a little different. And just as we make sure that each child’s heart gets the right correction, we make sure that the solutions we bring to each country help the broader needs. When you donate, that’s what you help to make happen.

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Setting the Scene—What Goes Into Prepping A Hospital for Surgery

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In the Hollywood version of surgical scenes, a surgeon bursts into the operating room using his hip to push open swinging doors. His scrub cap and face mask are already in place, and his freshly scrubbed hands and forearms are held high in the air to keep them sterile. He enters a busy, equipped operating room, his patient ready on the operating table. We don’t see the intensive care unit until later in the episode, but it too is equipped and ready to receive the mended patient.

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I guess it goes without saying—we don’t work in Hollywood.

Each country is a little different, but every time we arrive at a developing cardiac programme like the one in Libya, we arrive to virtually empty rooms. The largest equipment is in place, but there are no supplies at hand, and no stations ready for patients. Before we can see a single patient, we have to create the space.

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The first day of every mission in Libya is filled with cleaning and unpacking, counting and inventory-taking, sterilizing and strategizing how to best use scarce supplies. There is equipment to be calibrated and tested, batteries to be replaced, and instruments to be repaired.

It’s not glamorous work, but it is essential for everything that comes after. When we finally have all of our supplies and medications at our fingertips, know what we have to work with, and know what must be carefully conserved, we are ready to begin surgeries.

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Being fully prepared, and methodically assessing what we have at our disposal isn’t just for our own sake—it reinforces what we teach local staff: the importance of effective systems, of testing, creating functional stations, keeping careful tracking of tools and equipment, and of preventative maintenance.

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Consistency sets the stage for everything else we do, and that starts from the very first day on site.

Two Parts Engineer, One Part Macgyver—The Biomedical Engineer

Two Parts Engineer, One Part Macgyver—The Biomedical Engineer

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The bright operating room lights were trained on the precise place where the repair needed to be made. It was a delicate operation—getting to the heart of the problem.

But the “patient” in this case wasn’t a Libyan child—it was the anesthesia machine, and things weren’t looking good. And without an anaesthesia machine—no surgery.

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When we think about heart surgeries, we imagine surgeons cutting and stitching, and doctors and nurses managing patient recovery. We see beeping monitors, and patients attached to tubes, and wires—and we assume it all just works.

Until it doesn’t.

There is one member of our team you rarely hear about: the biomedical engineer.

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Meet David (left side of above photo). David makes everything work.

For programmes in developing countries like Libya, David goes in far ahead of the rest of the team. He helps to design operating room and ICU lay-outs, consults on needed equipment, and problem solves practical issues that are are obvious to him the moment he walks into a room—for example, knowing how many machines should be at each bedside, you can immediately see when there aren’t enough electrical outlets at each bed.

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Our most recent surgical mission in Libya provided countless instances which illustrated the biomedical engineer’s integral role with the medical team. When the mechanism that raises and lowers the operating table broke mid-surgery, David began to diagnose the problem as soon as the patient was wheeled out of the room. He was able to make the needed repairs quickly, so the afternoon surgery could go ahead as scheduled, and a critically ill child didn’t need to wait any longer to get their lifesaving surgery.

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He sorted out oxygen supply issues at patient’s bedside, repaired sorely needed monitors languishing in hospital storage and put them back into service, and he tackled the problem with the broken anaesthesia machine—which ultimately involved bringing in a machine from another hospital and getting it functional.

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With his specialized bags of tools, years of experience around the globe, and curious nature, David keeps operating rooms and ICUs functioning, which allows the surgical and critical care teams to do their jobs well.

David’s work not only makes our surgical trips possible, but he leaves hosting hospitals in better shape than when we arrived.

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