March 11, 2008

Technical difficulties

When you're around all the incredible machinery it takes to perform cardiac surgery and care for the children after they've had it, it's easy to forget that we're in a third world country. But there are times when we're reminded just how much we take for granted that we'll have consistent access to technology in the U.S.

Internet access here is spotty at best and the computers are typically several years old (that doesn't include the "Internet cafe" in downtown Kumasi where I tried to do some work yesterday; it had computers from circa 1984 and an Internet connection of a similar vintage).

This applies to the hospital as well. During the first surgery on Sunday, there was a brief brown out that had everyone from Children's looking around in disbelief (it didn't have any impact on the surgery) and when the team arrived at the OR yesterday morning, they found that there was no power to the bypass machine. The problem was quickly solved, but it was a not-so-subtle reminder of the challenges this team - and any other group of clinicians doing similar work throughout the world - face when they take on these missions.   

To me, it makes the work they're doing even more amazing.

- Matt Cyr

PS - The aforementioned technical problems have kept me and others from posting today, but now that we've gotten them sorted out, I think we'll be adding several items tonight (it's 7:30 pm here now), so stay tuned.

March 10, 2008

Playing catch-up

I didn't have a chance to post any photos of the first surgery yesterday, but finally had a chance to do so today. Check out the gallery.

It's all good news from the OR and ICU, where David and Favour have already been moved to the pediatric ward, where they're being cared for by Ghanaian nurses. Their beds have been filled by today's two surgery patients. The first, Felicia, has already been extubated.

- Matt Cyr

A trip to Trede School

Wow is the only word I can come up with for what we just experienced.

As Mary mentioned in her entry last night, we visited the Trede Roman Catholic School today to deliver school supplies donated by the students at Mary's daughter's school back home. The visit was one of three to local schools, an orphanage, a shelter and a day care center that members of the team will make during this mission to bring needed items to those who don't have the things we take for granted (pens, paper, crayons, etc).

School_3 None of us were prepared for the scene that awaited us when we drove up. Literally hundreds of school children, all dressed in either bright green or white uniforms, were gathered in their open-air classroom beneath the trees.

Many of them yelled greetings to us when we got off the bus, and before we knew it, a group dressed in traditional clothes began playing the drums and dancing for us. It was their way of thanking us for the gifts we brought them, and I can't imagine a more amazing show of gratitude.

Words can't do it justice, but hopefully pictures can. Check out the gallery.

- Matt Cyr

March 09, 2008

We've Done it Again!!

We have just completed our first day of surgery in Kumasi, Ghana. It is amazing to work with such experienced colleagues, and have such positive outcomes! This is my second mission with the Hearts and Minds of Ghana Team and I am more amazed each day and with each mission at what we can accomplish with team work in a third-world hospital.

Dsc_6915 Our first patient today was an 11-year-old boy named David. He was a very dehydrated transitional AV canal with aplastic anemia and active conjunctivitis. Because he had been on steroids and was anemic, we had to manage him without the normal IV access we would have in Boston. He was extubated within two hours of arrival in the ICU despite his elevated blood pressure and heart rate. This is a huge accomplishment for both the patient and the team. We are rapidly moving these patients through their post-operative course in a safe, controlled environment. This is the ultimate ICU nursing experience, and nothing I have ever done in my career will compare to this!

Dsc_6879Our second patient was a beautiful 10-year-old girl named Favour, who was admitted with a ventricular septal defect. She was extubated one hour after arrival to the ICU. Again, as her nurse I am both amazed and thrilled to be part of her recovery period. Nothing compares to the sense of satisfaction I feel after an exhausting day spent caring for critically ill patients, in the heat of Ghana. These were the first two patients I have had contact with on this mission, and I am amazed by their strength, bravery  and resiliency.

Tomorrow, I have the privilege of delivering the donations from my daughter's school to the Trede Roman Catholic School. I can't wait!

Mary Eisenhaur, RN in the Cardiac ICU

The first surgery is complete

The first patient of the day was an 11-year-old boy named David. Francis and Isaac reparied his atrial septal defect, ventricular septal defect and cleft mitral valve. He's recovering now, and everything seems to have gone very well.

In the OR, the surgeons and nurses were a well-oiled machine, and when they brought David out of the OR and into the ICU, the rest of the team swept into motion. Each person knew their role and their spot at the bed exactly, and worked quickly and efficiently to stabilize David and make him as comfortable as possible as quickly as possible. The Ghanaian staff pitched in and got great on-the-job training from the Children's staff. It was amazing to watch the whole process up close.

I'll check back in later with some details from the second surgery (a beautiful little girl named Favour) and hopefully upload some pictures from the day.

- Matt Cyr

First day of surgery

It's hot this morning as the team eats breakfast and gets ready to head to the hospital for the second day of clinic and the first day of surgery. I'll check back in later with an update on who is having surgery and how things went.

Also, I was finally able to upload a few photos to a gallery. They're a bit distorted for some reason, but they'll give you a sense of what things are like here. I'll add more as soon as I can.

- Matt Cyr

March 08, 2008

The day isn’t over

The clinical team didn't get back from the hospital until nearly 7 pm, but after dinner they reassembled in the hotel conference room at 9 pm to review the tough cases they saw today, look at the echocardiograms and debate who should get surgery in the impossibly small window of time that we're here.

Because the numbers just don't add up. Of the roughly 80 children who will be seen, 80 percent would already be on an operating schedule if they lived in the
United States. But maybe only 30 are candidates for surgery here given the limitations the team faces. There are five surgical days scheduled while we're here, and there's only time for two, maybe three, surgeries per day. That's an absolute max of 15 children, but it won't be that many.

So doctors and nurses used to being able to do just about anything at just about anytime in the U.S. have to make tough decisions about who gets surgery and who doesn't. They have to decide which patients can have surgery, recover and leave the hospital before we leave the country (because there's no one here who can take care of them once this team leaves)? In short, who can be reasonably expected to live a normal, healthy life once the last surgical stitch has been sewn?

It's 10 at night after a 12-hour work day and almost everyone is here. The surgeon. The intensivists. The OR and ICU nurses. The anesthesiologist. The respiratory therapist. The pharmacist. The perfusionist. And they're all reviewing medical charts and looking at echos on a TV that's most often used by soccer fans, talking through the minute clinical details and hoping to find some way to help every one of the children they met today. Will medication help? Can we operate on them next time we're here? Can we send them somewhere else in the world and get someone to pay for their surgery? Can we do something, anything, to help.

Not every one of the children they saw today will survive, but many of them will. And that's why they're all here.

- Matt Cyr

Time of my life

Hello All,

My time here is wonderful!

This is a dream come true for me. Thanks to Bev Small and Dr. Fynn-Thompson.

The children have taken my breath away. This is an experience of a life time I will never forget.

What I've seen and witnessed will last a life time. We are doing great things here.

The children's faces will forever be embedded my mind. It's just great for me to be a part of what's going on here. The people are simply fascinating and I was embraced like family. As my thoughts continue, my eyes water with such emotion I didn't think would over come me. Day 1 was great. I can't wait for day 2.

Monique Lewis

8 South CICU

The hard work begins

The sign that greeted us as we drove up to the Komfe-Anokye Teaching Hospital (KATH) shortly after 7 this morning should have given us an idea of what to expect. "Free pediatric cardiac surgeries!! In conjunction with the Boston Children's Hospital of the Harvard University, USA."

Who could turn down that kind of offer?

We arrived to find a crowd of nearly 80 families waiting to be evaluated for possible surgical repair. Last time there were 50, eight of whom ended up having surgery (all of whom are here today, by the way, looking wonderful and healthy).

The families today came from all over Ghana, having been told by their doctors that the Children's team might be able to help them. Some arrived as early as 3 am. As I write this (about 11 am), the waiting room is still full, despite the fact that the doctors, nurses and technicians have been quickly and steadily evaluating children all morning. 

People are waiting very patiently. The hallways are lined with children doing coloring projects. Mothers and fathers hold their kids and try to keep them occupied while they wait. A Ghanaian TV crew has been interviewing staff and families and videotaping consults and tests.

The members of the team who aren't involved in the clinic portion of the day are busily setting up the operating room and the ICU, getting them ready for the first surgery tomorrow. The hope is that the team can operate on two to three children per day.

The quote of the day so far comes from a father named Festus, whose son, Felix, has a hole in his heart, so is not growing the way a normal 18-month-old would. "When we see you here, we feel joy because it gives us hope that he will live a normal life."

I'll check back in later.

- Matt Cyr

March 07, 2008

We're here!

It’s been quite a day, beginning with a 10-hour flight from New York and ending with the longest bus ride in recorded human history (at least it seemed that way). Our unofficial welcome to Africa and Ghana came in the form of a beautiful pink sunrise over the Atlantic Ocean while we were cruising at 30,000 feet and a Ghanaian woman singing tribal songs to herself in the seat next to me. It was quite an introduction.


Before I knew it, we were descending through heavy clouds and watching the outside air temperature quickly climb to about 80 degrees; winter in Boston was a distant memory. Accra materialized slowly through the murk as a low-slung town of red-roofed buildings separated by wide swaths of open, tropical-looking land. Smoke from trash fires dotted the horizon.


Our big jet landed easily, and when the captain announced his welcome to Accra, many of the passengers who were returning home to Ghana applauded. We stepped onto the tarmac at around 8 am local time to humidity and warm air, but neither were as bad as I’d been expecting.


The hallways leading to customs were papered with posters for the Africa Cup, a continent-wide soccer tournament that took place at the soccer stadium here in Kumasi from late January through the beginning of February. They were posters we saw throughout the remainder of the day on billboards, buildings and anywhere else space could be found.


Once through customs, we made our way out to the front of the airport, where a giant blue flatbed truck waited to be filled with our many (many) bags and a gloriously air-conditioned bus waited to take us on the final leg of our journey, here to Kumasi.


In my previous post, I said it would be a five-hour ride, but it ended up being nearly seven hours (including a stop for lunch) on bustling and bumpy roads. Needless to say, we were glad to finally get off the bus here at the Rexmar Hotel and ready to be done with travel for the time being.


Despite being longer than any of us would have liked, the ride was fascinating. Everywhere I looked I saw women carrying huge plates or bowls on their heads filled with items for sale. Radiant yellow fruits were stacked pyramid-style, waiting for buyers. Babies were strapped tightly to their mothers’ backs in brightly colored slings. Buildings seemed to be either in a state of construction or disrepair, with many of them looking utterly abandoned. People slept in random places and random positions (one man I saw was actually slung, sound asleep, between two horizontal poles on the back of a moving truck). Goats, chickens and geckos were almost as numerous as children. Large items, like couches, TV stands, bed frames, custom-made doors, coffins and large metal gates for driveways were for sale along the streets nearly the entire trip. Almost none of it was covered, and I wondered what they did with everything when it rained.

Check out a few pictures from our trip.

Two interesting parallels between the U.S. and Ghana: they’re also having a presidential election late this year and one of the issues being debated is whether the country should provide universal health care coverage to its citizens.


The people of Ghana, a lot of whom seem to speak English, have so far been incredibly friendly. I expect to start getting to know them a lot better tomorrow, when members of the Children’s team head to Komfe-Anokye Teaching Hospital to set up the operating room and intensive care unit. At the same time, cardiologists will begin evaluating children to determine if they’re good fits for cardiac surgical repair, the first of which is expected to take place this Sunday.


Check back in later to hear how things went on the first day in clinic and an overview of the project the team is here working on.


Farewell for now from Kumasi.


– Matt Cyr and the rest of the team from Children's Hospital Boston


PS - The slower Internet connection here is making it difficult for me to include photos. I'm working to get the problem sorted out and hope to have a gallery up and running tomorrow.