Loma Linda University Heart Surgery Team

Standing.

2008-11-20T14:26:00.000-08:00

This kid wasn't so sure about us-be we can't really blame him. After all, we cut open his chest! This is Jennifer, trying to gain some of his trust back.

He went for the high five!

Who are these clowns?

2008-11-20T14:22:00.000-08:00

The ICU team!

Video Tour

2008-11-19T14:21:00.000-08:00

Hello everybody!

Here's a video blog of the LLU Heart Surgery Team! It's a walking tour of the Alexandria New University Hospital and you get to meet some of the team! Check it out.

Flat Tire!

2008-11-18T15:14:00.000-08:00

Yesterday we got a flat tire!

So we walked instead.

Diary Entry #4

2008-11-18T10:36:00.000-08:00

Incredible Invention

By
Dr. Mudit Mathur
PICU Intensivist

And

David Seymour
Respiratory Therapist

In Egypt, supplies can be difficult to obtain. One can be very spoiled in the U.S. with all that we have available. Due to cost, it seems that some supplies can be rare or completely unavailable to both hospitals and individuals. For example, areochambers are very expensive so there were none available. They can cost anywhere between 150-200 Egyptian pounds, more than one month’s salary.

An areochamber is used to enhance medication delivery from an inhaler. To create an aerochamber, we had to do some on-the-spot creative thinking.
We built one using an ambo bag mask, tape, and an empty plastic bottle along with a pair of scissors. The device however, does not need the mask to work. A hole was cut in the bottom of a 500 cc Ringers Lactate bottle for the inhaler port. Tape was placed on the cut plastic to create a good seal when the inhaler is inserted.

Tape was also placed over the top of the bottle with a single cut through the middle to create a makeshift valve.

Now you have it! A functional aerochamber that you don’t have to take out a loan for!

Starting the Second Week

2008-11-16T11:22:00.000-08:00

Despite his lost luggage, Dr. Mathur is hard at work in the ICU after arriving on Friday night. Thanks to hospital scrubs and LLUCH shirts, he’s good to go.

Wondering what Alexandria looks like outside the hospital? Here you go:

The harbor at Alexandria.

It’s all smiles knowing that this baby is doing well. After Sam helped teach the mother how to care for her daughter, the baby will be able to go home tomorrow.

On another note, the Air France strike will prolong the trip. Dr. Hasaniya is still in New York. He was scheduled to arrive today to perform surgery tomorrow, however, his flight was unexpectedly canceled because of the strike. He will now arrive tomorrow. No need to worry, the Heart Team is prolonging their work an extra day to make sure all the children scheduled for their surgeries will still take place. What a team….

Cairo Trip

2008-11-16T10:27:00.000-08:00

The Egyptian Heart Team treated us to a trip to Cairo on Saturday. But we had to leave some of the our crew behind to keep an eye on the heart patients. Jennifer, Sam, Sabrina, and Dr. Mather deserve an extra pat on the back. Thanks guys.

First stop was the bathrooms. Not a bad view, huh?

They're serious about their tourism in Cairo.

"Hi!"

This is Penny, she's the new arrival taking Stan's spot as the anesthesiologist.

You can ride a donkey from the Sphinx to the Pyramids, but we rode the bus.

The Sphinx!

A school of orphan boys were also visiting the Sphinx. None of them needed heart surgery.

Mark is already adjusting to local traditions.

The Nile.

A Whirling Dervish.

Cairo at night.

Getting a little tired, but we're doing alright.

2008-11-16T09:57:00.000-08:00

This is Sam. he's working toward the tail end of a 12 night shift.

He was doing chest therapy on this patient all night long.

This is Madeline without her mask on-it's pretty rare to find her without it. She's a surgical assistant and has spent about 13 hours in the operating room each day. That's a really, really long time.

But it really pays off.

These girl was so close to death just a few hours before-it's so good to see her on her feet.

Getting better!

2008-11-14T11:35:00.000-08:00

So far, all of the patients are doing well! We've been able to send six kids home. The little guy above contracted a bit of an infection-things aren't so clean around here, but thanks to the night shift's dedication and expertise, today he's up and walking!

And I think this little girl needs a new eyeglass prescription.

Actually, those glasses are toys from the hospital. Thanks again to all those responsible for cheering up the kids after surgery. Things can get a little dismal when they're feeling bad-it's been really nice to have something to hand out. Some of the kids are too young to understand why this is happening to them, so it's nice to have a peace offering.

And this is respiratory therapist Dave-or Super Dave. All day long he's running back and forth from the ICU to the OR. Getting blood/gas readings and making sure all of the patients can breath. Right here he's giving a few pointers to an Egyptian nurse. It's so important that we try to teach them what we know. When we leave, hopefully they'll be able to do some pediatric heart cases on their own.

Our newest addition-she's another tetrology case, so she has quite a bit to recover from tonight. But she's in good hands-Dr. Abd-Allah and the ICU team is ready for just about anything.

Over the past few days, the average amount of sleep has been 4.5 hours. There are some real heros on this trip.

Diary entry #3

2008-11-12T14:13:00.000-08:00

By Jerry Daly
Director
Office of International Affairs

Our involvement with Alexandria University began three years ago when the mother of one of the Anesthesiologists at LLU visited our University. She worked in the School of Medicine at Alexandria University for Ibrahim Khadragi, MD the head of the cardio thoracic program there. She saw daily the needs of the children in Alexandria who require surgery to repair congenital defects. She came to Richard Hart, MD along with her son Ihab Dorotta—a medical graduate from Alexandria University and Abd-allah Shamel also from LLU to inquire about a heart team visiting Egypt to help. It took nearly a year to for the logistics to be in place and the first step was for the Egyptian team to visit LLU which they did in summer of 2006.

Eight members—surgeons, anesthesiologists, perfusionists, nurses and others observed at LLU to learn how we manage complex congenital heart defects in young children and babies. There was an immediate bonding between the two groups who worked together for nearly two months. The friendships that started that summer continue today.

It took almost another year for enough funds to be raised (largely from the Egyptian community in the United States) for LLU’s team to visit Alexandria University. On November 6th the team left LLU to initiate a 2 week visit to Alexandria where hopefully 20 to 25 young children and babies will have surgery and many more will screened and diagnosed. This trip is under the leadership of Leonard Bailey, MD and like most of these experiences others contribute along the way to its success. There are the administrators in each University who support these efforts in spite of financial pressures at home. These include Ruthita Fike, the CEO of LLUMC and Zareh Sarafin the Senior VP of the LLUMC Children’s Hospital; the President of LLU, Richard Hart, MD; the nurse managers at LLUMC who struggle with providing coverage while their employees are away; the other departments who have sent employees to help—particularly Surgery, Anesthesiology, Pediatrics, Pediatric Cardiology, Respiratory and Perfusion. This experience is not easy for our colleagues in Egypt either. Dr. Khadragi and his team have worked tirelessly to see that every detail is attended to. It is not easy to manage the individual needs of some 15 guests for so long a period of time. But our friends have done so with grace and smiles…

I’ve often thought what motivates people to participate in these experiences. It is often done with some personal sacrifice and inconvenience. What I have noticed is there is a common thread that transcends culture, language, and even religion—that is the willingness and need to help others.

I saw it Sunday when the Cardiologists were screening children for possible surgery.
You only had to get a glance at the anguish on the face of the grandmother holding her 2 month old grandson struggling to breathe. Something obviously was terribly wrong. He looked ashen blue and every breath seemed his last. He was in failure and there was fear he would not survive for long.

Whether this baby receives surgery or not is not the point—there are so many in need it is overwhelming. The point is that everyone—Egyptian and American—have come together to try to build something that did not completely exist previously. Their motivation is simple. They are all trying to relieve human suffering and for taking the time and spending a little effort each one will be blessed beyond measure and for that they are to be commended.

Recovery

2008-11-11T13:13:00.001-08:00

Elsayed is recovering! In just two days, she'll be able to go home. Below is a picture of her mother who is crying tears of happiness.

Her mother told me that she was going to change Elsayed's birthday to the day the surgery was performed. "She's starting her new life today," she said.

Tetrology case #2

2008-11-11T13:10:00.000-08:00

Meet the Mayor

2008-11-11T13:08:00.001-08:00

This is our anesthesiologist Stan Brauer. In his other life, he is the mayor of Loma Linda. Glad to have you with us Stan.

Going Under the Knife

2008-11-11T12:49:00.001-08:00

Today was our first day of surgery.

This is Mohamed Ahmed Elsayed. She’s about a year and a half old, weighs 4.5 kilos and she won’t be able to survive without a heart surgery.

She is a Tetrology patient, so, she has a specific genetic disorder in regards to the structure of the heart. It’s a combination of four defects. The first issue is that there is a hole in her heart and Dr. Bailey has to patch this hole. The second issue is that the aorta, or main blood vessel, is in the wrong position and has to be fixed for the blood to flow normally. Third, the ventricle, or the muscle that pumps the heart is abnormally developed. And finally, there’s a narrowing of the arteries that take the blood to the lungs. All of these things have to be successfully repaired in order for the patient to make a full recovery and it’s about a five-hour procedure.

Throughout the next few weeks, we’re going to be doing more Tetrology cases than any other because it’s one of the most common defects. But most importantly, the Heart Surgery Team is trying to teach the Egyptian Heart Surgery Team to repair the particular defect. When we leave, hopefully they’ll be able to perform the procedure on their own.

As with any heart procedure, the doctor has to cut through the chest and ribcage. It’s dangerous and you never quite know exactly how the patient is going to react. But today, things went beautifully.

When she first came in, her fingertips were blue because her heart wasn’t strong enough to circulate her blood properly. But now, after a few days, hopefully life will be a little different for Elsayed.

We just have to wait for now.

The Wonder Drug

2008-11-11T12:46:00.001-08:00

Milrinone is a drug that is vital to the heart surgery process. It is a dilator, which supports the heart and enables it to pump stronger. For many children, it can mean life or death. But for some reason, hospitals in Egypt don’t have it.

So we brought our own. A BIG thank you to all those who donated medical supplies. It’s really making a difference.

2008-11-10T19:37:00.000-08:00

Our First Patient

We'll let you know how it goes.

Diary entry #2

2008-11-10T14:14:00.000-08:00

Choosing the Patients

We're here in Egypt for two weeks, which seems like a long time-but yesterday, after seeing the hallway jammed with parents and sick kids, I realized that it wasn't long enough.We weren't going to be able to help everyone.

We could only pick the most urgent cases. The children who were going to die immediately were moved up the front of the line and the kids who would be able to make it another couple of years were put toward the end. There were some that didn't make it on the list at all and it was really hard to see the patients walk away. We just don't have enough time to help everyone.

But that's why Dr. Bailey and the rest of the team are training the Egyptian hospital personnel. When we leave, hopefully they'll be able to take over and save the kids we aren't able to do. Dr. Aijaz Hashmi explains how we chose our cases for the next two weeks.

Dr. Aijaz Hashmi
Pediatric Cardiologist

The first day was spent screening a hall full of children with congenital heart defects.
Each child was seen with his parent and all their investigation including echocardiogram and cardiac catheterization data, were reviewed in a conference setting with the cardiac surgeon, the anesthesiologists, the Egyptian doctors in training, and myself.
We were able to accept most of the presenting children for surgical correction. A complete repair is anticipated for all the selected children such that they will be restored to a normal cardiac physiology allowing them to grow and develop normally and fully participate in physical activities.
Unfortunately, some children were declined because their condition had advanced to a stage where surgical correction was no longer an option. Recommendations were made to improve their medical management.

Saturday Night Dinner

2008-11-09T14:23:00.000-08:00

Some of the local fare.

Journal Entry #1

2008-11-09T14:05:00.000-08:00

By Clarissa Larsen
CTICU Nurse

For me the 2008 Egypt heart trip is more than an amazing opportunity; it also represents the very first stamp in my very first passport. After traveling over 31 hours we are finally here, in Alexandria Egypt. It is a different world compared to our small, quiet Loma Linda. I am fascinated by the sites and sounds. I am intrigued by all the faces that I see. What is their story? And what do they think when they see me, an obvious American with a camera and a smile on her face?

The most powerful moment so far was getting off the elevator in the hospital for the first time. Here we are, with our suitcases filled with supplies, tired from days of traveling and when the elevator door opened we were greeted by a room full of families and children who had probably been waiting hours for our arrival. These children are the reason we are here. I was suddenly filled with a sense of humility that I’ve never felt before. I could see in their faces how excited they were for us to be there. Their sense of gratitude was overwhelming. It is for these children that we came half way around the world, and I knew after I saw the very first child smiling up at me, that this was going to be an adventure I would never forget and that I am truly blessed to have been given this opportunity.

The flight

2008-11-09T13:14:00.000-08:00

The trip began at 6:00 AM Loma Linda time.

We have no idea what we're in for.

A sandy desert somewhere over the middle east.

After midnight, we make it to the Acacia Resort. Thirty-five hours later.

2008-11-09T13:01:00.000-08:00

Ready, set, GO!

Top row from left to right: Mark Wenborne; perfusionist, Sabrina Kroetz; CTICU Nurse, Clarissa Larsen; CTICU Nurse, Madeline Chu; CTICU Nurse
Bottom row: Jennifer Newcombe; CTICU Nurse, Sam Mopera; CTICU Nurse, and David Seymour; Respiratory Therapist

Here we are in LAX. We just passed through security and we're ready to begin the trip to Alexandria, Egypt. This isn't the whole group just yet-we'll meet the others in Alexandria.