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New Articles:New comments:Arequipa – Peru 2007CONGENITAL CARDIOLOGY TODAY articleby Dr Illan, PhD. & Dan Levi, MD
On January 15, 2006 an enthusiastic group of pediatric healthcare professionals and volunteers arrived in Arequipa, Peru’s second largest city. Their mission: Help as many children with congenital heart defects as possible by performing heart surgeries and using transcatheter procedures that will minimize risk, costs and recovery time and maximize the benefits to the children. The mission, staffed predominately by doctors and nurses from Mattel Children’s Hospital at UCLA, did most of their work at the Nacional Carlos Alberto Seguin Escobedo Hospital in Arequipa. Peru. Two weeks later the happy, but tired, team boarded a plane homebound to the USA, realizing that their success was the result of not only good fortune, but also good planning. Using the Hearts with Hope Mission as an example, this paper will detail some of the key ingredients for successful medical missions to third world countries. The Los Angeles based Hearts with Hope Foundation (also known as Corazones con Esperanza) was founded in 2003 and is supported by individual donors and by major cardiac device manufacturers. It is headed by Dr. Juan Carlos Alejos, an interventional and transplant cardiologist at UCLA. The mission of Hearts with Hope is to provide medical and humanitarian aid to children with congenital heart disease and their families throughout Latin America. Dr. Alejos has led three previous missions to South America. Direct contacts with the health care community led to the fourth mission taking place in Arequipa. This is the fourth and largest team that has been led on behalf of the foundation. At the end of the two week stay in Arequipa, the team had performed 23 transcatheter interventions (in children aged from 2 months to 15 years) ranging from valvuloplasty to ASD and PDA closures to stenting of native coarctations. During the second week, ten surgical cases were performed by Dr. Christian Pizarro. To screen, select and follow-up patients, over 200 echoes were performed. All the procedures were completed as planned and all patients were discharged in excellent condition with minimal hospital stays. The mission marked the first time for transcatheter closure of ASDs (six ASDs were closed with devices donated by AGA) and PDAs (NitOcclud devices were donated by pfm Inc) to be performed on children in southern Peru. Pediatric open heart surgery had also never before been performed in this region. The milestones were widely reported on the front page of local papers. Mission Team
The cadre of workers on the Hearts with Hope Team included pediatric cardiologists Drs. Daniel Levi, Greg Perens, Juan Alejos and Josephine Isabel- Jones, who performed most of the interventional procedures and echoes; pediatric anesthesiologists Drs. Mike Sopher and Swati Patel; cardiac perfusionist Juan Obado; cardiac ICU nurses Denise Brown, Jennifer Correa, Ai-Jin Lee and Giselle Mata; and OR and cath lab technicians and assistants Samuel Olmeda, Chris Gatica and Annie Meyer. As mentioned above, Dr. Christian Pizzarro, a congenital cardiac surgeon from the Nemours Cardiac Center at the Dupont Hospital for Children performed all of the surgical procedures. Finally, Dr. Jessica Greenwood coordinated the movement of patients from the echo diagnostics to the Catheter Lab and occasionally the OR. Yolanda Peneda, a family liaison with the Medical Home Project at UCLA recreated her role in Arequipa and dealt with families, insurance issues and coordinating catheterization lab procedures. The UCLA team also included medical students, a photographer and several volunteers without specific medical expertise. Having a large and diverse team, over 20 in total, the Hearts with Hope Team was able to benefit every pediatric hospital and orphanage in Arequipa through a variety of charitable, educational and medical activities. By having more than “just enough” time and personnel, there could be an emphasis on education as well as patient care. The doctors, nurses and perfusionists were able to hold seminars on the caring for children with congenital heart disease at both Hospital Nacional and Goyeneche Hospital. Each team member had a well defined primary role and each one also worked hard to accomplish specific goals during the time in Arequipa. Without volunteers and students in addition to doctors, nurses, surgeons and other specialists, our primary and secondary goals could not have been accomplished. Domestic Financial and Industrial Support The willingness of all companies approached to help with our mission was perhaps the most impressive aspect of the Hearts with Hope Mission. Even given last minute requests, pfm-Ag Inc. donated eleven NitOcclud devices, AGA Medical donated six ASO devices and delivery systems, and Johnson and Johnson/Cordis Corporation donated a wide range of equipment for use in both surgeries and transcatheter procedures. In addition to donating pacemakers, computers to interrogate pacemakers, prosthetic Hancock II heart valves and pacemaker leads, Medtronic allowed one of their present employees (Annie Meyer) to come on the mission. Because of generous cooperation of the airline LAN Peru, the UCLA medical team was able to transport directly to Arequipa about 50 massive duffel bags full of medicines, medication, transcather and surgical materials as well as a dozen carefully packed boxes with sensitive instruments. Although the team’s plane tickets were purchased with money raised by the Hearts with Hope foundation silent auction fundraiser, all of the catheters, syringes, guide wires, transcatheter devices, medicines, pacemakers, monitoring equipment and other supplies needed for the planned procedures were transported to Peru on the commercial airliner without additional charge. (All unused supplies were inventoried and left in the hospital – we came back with nothing but gifts for our families). International Staffing International support is most important for the identification of potential patients and for the follow-up of these patients after the mission. It is important for a pediatric interventionalist or cardiothoracic surgeon to prepare for a mission with detailed knowledge of the patients to be treated. In the case of the Hearts with Hope mission, a dedicated team of adult cardiologists, intensivists, nurses and operating room technicians were available, motivated and prepared to assist in the Hearts with Hope Mission. Drs. Pedro Torres, Alejandro Basso and Nassip Llerena were able to send a DVD of ECHOs to us. Having a database of ECHOs several months prior to the trip was invaluable in preparing the equipment and personnel needed for every potential candidate for intervention by our team. In addition to screening more patients for the next mission, these same doctors (adult cardiologists by training) are now following up on children who had surgical and transcatheter interventions. Given the proper financial support and cooperation from an international airline, it is possible to bring nearly all the equipment and medicines needed for a medical mission in pediatric cardiology. However, no one wants to bring “sand to the beach.” Valuable resources can be saved if the appropriate contacts exist at the international site. To further insure that only necessary equipment is transported while no critical items are excluded, an advance trip by a knowledgeable “scout” can prove invaluable. The scout would be well advised to take many pictures and even video footage to share with the volunteer team prior to its departure. These visual aids and available equipment lists will allow each physician to thoroughly visualize their planned procedures and list all the devices, facilities, medicines and support required to successfully complete each intervention. Properly Equipped Location In addition to the dedicated and competent staff at the hospital in Arequipa Peru, the hospital was adequately equipped to support the mission. Anesthesia carts, ventilators, single plane fluoroscopy and a basic cardiac operating room were available and reserved for our use. Missions like the Hearts with Hope can maximize their impact by serving regions where transcatheter and surgical congenital cardiac interventions are not available for children, yet where some basic OR facilities and diagnostic and imaging equipment are in place. The Arequipa hospital was well equipped for cardiac surgery for adults and the resident cardiologists and surgeons limited their work to adult patients. The adult facilities were easily modified to provide the basic equipment needed for pediatric ICU care and pediatric catheter-based and cardiothoracic surgical interventions. Charitable/Good Will Component The Hearts with Hope team developed special ties to several children’s hospitals and orphanages. One volunteer, Bill Sears, himself a heart transplant recipient five years ago, was the medical team’s goodwill ambassador. Prior to the Arequipa mission, Sears collected several large duffels full of small toys, coloring books with crayons, yo-yos and other common toys. With help from local volunteers, Sears delighted the local children by handing out hundreds of toys at several hospitals and orphanages. Dr. Alejos and team coordinator Jolanda Peneda took the time to assess the most urgent equipment needs of the hospitals in the area, with the intent of supplying the critical equipment with help from US companies and the Hearts with Hope Foundation. Three more large duffels were filled with freshly laundered hand-me-down children’s’ clothes donated by American families. These were also distributed and fitted to grateful children by local associates of the Foundation. Medical missions certainly have the power to spread goodwill into even remote parts of our world. Education
Local surgeons participated in most of the interventional cardiac procedures that were performed at The Hospital Nacional Carlos Alberto Seguin Escobedo. The cardiac surgeons who routinely operated on adult hearts were eager to observe pediatric repair of congenital lesions including, Tetralogy of Fallot, Double Outlet Right Ventricle, Ventricular Septal Defect with a SubAortic Membrane and Atrial Septal Defects. While the teaching extended into the ICU and nursing staff as well, it always involved both teams of professionals learning from one another. Our team was also fortunate to have eager UCLA undergraduate pre-med students on our trip. While these students were a great help to our mission (they consistently brought pizza to the on-call doctors), they were also provided with a unique educational experience. Dr. Greg Perens, a UCLA fellow in pediatric cardiology, described his experience as the best learning experience of his fellowship, “These missions are the ultimate cultural and medical learning opportunities.” Fun and Recreation The mission to Arequipa was not all work for the Americans. A series of parties, dinners, receptions, shopping excursions and an optional weekend sidetrip to Cusco and Machu Picchu all added an element of fun and bonding among the Americans and their Peruvian hosts. We can assume that these recreational and social activities were an extra bonus to the team members adding to the satisfaction they all felt with the impact of their medical endeavors. The social and professional links established between the American volunteers and the Peruvian doctors and nurses will surely serve as a strong foundation for future, perhaps annual missions from Los Angeles to Arequipa. Upon arrival the team was treated to a tour of the town. Perched in the Andes foothills at an elevation of 7700 ft and surrounded by snow capped volcanic peaks, the town is known for the pearly white volcanic rock, known as sillar, used in many of its buildings. The team was treated to both welcome and farewell barbeques. Complete with traditional Inca music, each of these festive meals included dancing, singing and “pisco sours” (the local drink). While shopping for bargains, drinking Chilean wine and karaoke were favorite evening activities, seventeen members of the mission traveled over the weekend to Cuzco with a visit to the extensive archeological site of Machu Picchu. Perhaps most memorable is the friendliness and gratefulness of the parents, children and the entire Arequipa community. Tears of gratitude flowed freely at the EsSalud Hospital as Dr. Alejos and his team bid farewell to the dozens of children and parents whose lives they improved and who can now not only hope but actually realize life for their children with healthy hearts. 09.12.2007. 18:54 |
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