Thursday, April 21 (day #7)

Today is our final day in Amman. It has been a fast week filled with lots of hard work and emotions. We arrive at the hospital at our usual 7:30 time.
The first patient we looked at today was Ahmed Abood, the Syrian boy that we operated on yesterday. What an amazing difference–he came to the OR yesterday so blue with oxygen saturations in the 40′s….Today his color is pink and his nail beds are pink and his oxygen saturation is 90% !! He is resting comfortably with Grandma at his bedside.
Hiba looks great (and sweet)…she will be transferred to the floor this morning. Raneem, Dua’a, Ahmed, Marah and Maryam remain in the ICU but all are very stable and doing well.
We are only doing one case today. It will make a total of 14 for the week–a mission record for our team. Our patient is Jana Tawfeeq Ibraheem U’wais, a 3 1/2 year old Egyptian girl from Amman. She is an adorable little girl who has Down’s Syndrome and Atrioventricular Canal. The case went very smoothly and she was sent to the ICU by noon.

Jana in the OR

After the surgery, post op rounds are done on all patiens, echos completed as needed, the instruments and equipment are packed into the travel trunks and many good byes are exchanged. The staff at Al-Khalidi no longer ask “if” we will be returning, but tell us that “when” we come back, their new operating rooms will be open and that they think we will be quite pleased with our new rooms. We look forward to it.

Jill packing up our supplies
!

Then its back to the hotel to pack our personal belongings, shower and check out. We are planning to go to a place for dinner tonight called The Panarama, a restaurant that overlooks the Dead Sea, The West Bank, Jericho and Jerusalem. Following that, we will be dropped off at the airport for the 19 hours of travel to home.
Amman is such an amazing place. It is rich with history, culture and spiritual energy. It is beautiful and inspiring. And we have made so many life long friendships here with people who are caring and genuine. This is good bye for this trip, but the people and life in Amman are in our hearts every day. We’ll see you all again Spring 2011..Insha’allah.

Wednesday, April 20 (day #6)

We said good bye to Mike and Anne last night as they both had obligations to return to back in Indy. So we started Wednesday after some much needed sleep, still early but with a slightly smaller team.
Our 1st case is Ahmad Abood Issa Masoud, an eight year old from Syria. He has Pulmonary Atresia, VSD. His oxygen saturation on room air is around 40% so he is very blue. Even under anesthesia, on 100% oxygen, his O2 saturation lingers around 80% so he needs increased flow to his lungs. Dr. Turrentine and Dr. Khoury plan to put a patch from his right ventricle to his pulmonary artery which will be an RVOT reconstruction to augment that flow and increase his oxygen. He was super scared as he entered the OR — just kept saying (in Arabic) that he wanted his father, wanted his father…….
The case went really well. The surgeons and the cardiologist were all quite pleased with the result. The consensus is that he’ll have a lot more energy and feel a lot better following this procedure.
During the change over of our room, we were visited by our patient from a year ago, Rulan and her mother from Jericho. She had an echo with Dr. Kal which looked fine. we thought she looked great! Her color was good, she has lots of energy and spunk. (prior to surgery, she was very very blue with really low oxygen saturations and according to here mother, could do very little-she was basically carried everywhere). She’s still pretty shy, but extremely fashionable…..so good to see them!
The 2nd case is Dua’a Khairi Kamal Hindi. She is an 11 month old Egyptian girl who lives here in Amman. She has Tetrology of Fallot and is pretty cyanotic. The surgeons closed her VSD, put a patch across her pulmonary outflow and at 4:30 she was up to the ICU. As soon as her father looked at her, he said “she is so much better-her color is pink now!”

Murtada, Husein and Maryam were discharged today-all doing very well and happy.

Hussein is stealing my heart...what a smile:)

To those of you that don’t know…Marah was the very 1st GOLA patient that was done in Amman about 5 years ago. She had her first surgery, a PDA ligation as an infant. Rudy Habesch, our are dear friend from GOLA who has been instrumental to the success of these missions, provided me with a picture of Marah during her first sugery. Also pictures of her in Dr. Kal’s office eating cheetoes after surgery. I am adding the recent pictures of her this week so you can all see how’s she’s grown. We are thrilled to have been able to complete her surgery in all one stage

Marah as a baby after first surgery

Marah eating cheetoes in Kal's office after 1st surgery

Dr. Fadi and Marah (now) before her second surgery

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Tuesday, April 19 (day #5)

Monday night:

Just as everyone got back to the hotel and started to think about showers, Anne received a call that Moh’d (our last case today) had declined. When they removed his breathing tube, he went into a sudden cardiac arrest about 20 minutes later. Mark and Anne immediately rushed back to the hospital soon to be joined by the team to start a long night.
The doctors did CPR on this little one for nearly an hour and then he stabilized enough to be taken to the operating room for exploration to see if there was a bleeding vessel or some other problem. When
Mark was satisfied that nothing else could be done in the OR, he
was returned to the ICU and we were all very hopeful that he might
turn around because his blood pressure and heart beat had returned
to somewhat normal. At nearly 1:00 am, Anne and Megan settled in to spend the night in the ICU to manage care on Moh ‘d
and everyone else tried to get some sleep.
He remained critical all through the night but with no significant
changes. However, by the time the team had all arrived at 7 am, Moh’d was again declining and had another brief episode requiring resuscitation.
There was a lot of consideration to returning him once again to the
OR to try a different operation but then grave neurological exam and a CT of his head revealed that he had severe neurological deficits as a result of his arrest.
There are no treatments that can reverse such a situation so most
sadly the hardest conclusion and decision had to be made which was
to end the resuscitation efforts on Moh ‘d. Throughout this whole
ordeal, the parents openly prayed and anguished and obviously were
devastated by this. But likewise, the father has also told Manal that
he feels that he gave the child the best chance. He says that “he
believes God wants him back and no one can rule above God.”. The
team has also suffered immeasurable grief and sadness. It is
horrible and sad and devastating. We keep reminding each other
that this is the reality of heart defects…. sometimes….. there are
times that no matter how hard you try or how much you do,these
kids are sick and thankfully not often, but occasionally their small
bodies just cannot deal with their defect or attempts at correction.
Clearly it is a blow to the team.

To the memory of Moh'd Sadeq

We only have a short time to regroup and then have to go on with their purpose so we start Tuesday:

The first case brought to the operating room is A. Rahman Husain Qandeel A. Aleem (Abud), a 1 year old Egyptian boy from Aqaba Jordan. He has a VSD (hole between the lower heart chambers). It is a straight forward, relatively simple repair done in just a couple of hours.
The 2nd cases Hiba Farid Khamis Mawad, who is an 11 month old child from Amman Jordan. This little one has Down’s Syndrome and a PDA (patent ductus arteriosus). Her surgery to ligate the ductus will be done as a thoracotomy and does not require the heart lung machine. It’s a quick case and by 3:30 she is out of the room.

Hiba after surgery

Update on Nour: she came back to the catheterization lab on Monday afternoon and with the help of an interventional radiologist, we were able to coil the rest of her collateral blood vessels on the left. We now hope this will allow her own small pulmonary arteries to grow better without competing with the extra blood vessels. We don’t feel surgery is needed at this time and hope for better and bigger pulmonary arteries for next year’s mission
To finally complete her surgery. She spent the night and this afternoon I find her, Maryam and Mortuda having a party in Their room. Kids from Iraq and Syria together..what an amaZing site, smiling, and much needed after just having lost another precious child. Nour will head home today and the other 3, including Hussain will all home tomorrow.

Zainab and Matti both arrived in clinic this afternoon, anne and Kal did echoes on them, they look great and will probably return to Iraq in the next few days.

Zainab in clinic after discharge

In the ICU, Hiba and Abdullah Rahman (Abud) settle in and look good. Abud get extubated shortly after returning to the ICU. Marah and Raneem are now roomates look great.

Raneem looking better each day

Marah is already asking for chocolate!
We want to thank all the Rotarians and people from GOLA that have come by and spent many hours supporting not only the familes and childre, by our team as well. They have constantly been at our sides, especially Manal Karasheh, translating, providing food for families, translatingmedical information, buying toys for the chidlren,. making trvel arrangements. None of this could be possible without the support of our friends here in Amman.

What is a Fontan?

So Monday was clearly Fontan day. Just in case you’re wondering why these surgeries are more complex and take so much longer….here is a brief summary of Fontan….
Most people know that the heart has four chambers; two atrium and two ventricles which work together to move blood the proper direction for circulation, right? But some congenital heart defects, like the ones Marah and Moh’d have, leave them with one 3 chambers – missing one ventricle of the heart! So to correct the problem, the ASD is closed and the right atrium is connected directly to the pulmonary artery. Blood then enters the right atrium and passes directly to the pulmonary artery and the lungs completely bypassing the ventricle. In patients with these unfortunate, unusual
defects like tricuspid atresia, the blood will flow passively, with the
pumping of the ventricle into the lungs.

Monday, April 18 (day #4)

First case in the operating room today is Marah Fayez Odeh Dahini, a 5 year old Palestinian girl who lives in Amman. She has a complex combination of heart defects which include an Atrioventricular Canal, Pulmonary Stenosis, ASD and Single Ventricle. Her operation is a Fontan.

Marah in her new Minnie mousse dress before surgery

Our visitor in the OR today is Joana Hindeleh (Daoud’s wife). Towards the end of the case, we were informed that this patients’ mother had become overwhelmed with anxiety and emotion and had fainted just outside the main OR doors, so we put Joana to work translating and reassuring mom that Marah was doing well during the repair and that the doctors were pleased. Everyone has a job here! The case goes very well but its a bit more involved and complex so we don’t get out of surgery until after 12:00. Our 2nd case is Moh’d Sadeq Nafea Zora Al-Fandi, who is almost 3 years old from Baghdad, Iraq. He is a gorgeous boy with great big brown eyes. We met him and his very nice parents 1 1/2 years ago on a prior trip.

Moh'd Sadeq getting his pre-op evaluation

They came at that time hopeful that Moh’d could be part of the GOL program with a surgical repair, but after the cardiac catheterization, it was decided that his pulmonary arteries needed more time to grow before he could safely undergo the procedure. He will also need a Fontan procedure to correct his complex problem which includes tricuspid atresia, VSD, single ventricle. The operation is long and fairly tense, but we finally finished up with him around 5:00. As Dr. Turrentine and Dr. Fadi go out and start talking with the parents, they are clearly elated. The mother grabs the nurses with hugs and kisses; they are all smiles and gratitude– great relief on their faces.
Moh’d joins the others in the ICU as Dr. Turrentine and Dr. Fadi go find Dr. Farrell and Dr. Salaymeh to make rounds on everyone.

Drs. Fadi, Kal and Mark with Matti

Megan walking with Murtada and Mariam

Marah right after surgery! Trying to muster a smile

Once content that everyone is doing ok, they leave around 6:30 to return to the hotel.

Sunday, April 17 (day #3)

We started Sunday much more refreshed after some much needed sleep! Back to the hospital by 7:30 and ready to get started on a busy day. Anne and Mark headed off with Dr. Kal to look in on the post op kids and the O.R. people went to set up for case #1 for the day. Once again, the day started early and running fairly smoothly.
Everyone looks really good today. They have all had a good night. Matti is on a full a diet today, lines coming out. We did a brief echocardiogram on him to reevaluate the size of his VSD. It still appears to be small enough to wait and see if it might continue to close on its own with time. We will reevaluate in next day or so
before we make final decision on whether to operate or not. He is being transferred to the floor today.
Mariam and Mortuda both look good, lines will comes out, diets
advanced today.

Mariam already feeling better

On the floor, Zainab has been walking, up and out of bed, regular diet today and will probably be discharged

Zainab before going home

The first case of the day is Hussein Abu-Naba, a 5 yr old Palestinian boy from Jordan. he has a large ASD secundum that we were able to repair.

Hussain shortly after surgery, already smiling!

The second case of the day is Raneem Khader Nimer Shae’r, a 14 month old Palestinian girl from Jordan with TOF and absent pulmonary valve, more complicated case. she receives an artificial pulmonary valve, called a Contegra bovine jugular graft valve (comes from the vein in the neck of a cow which has natural valve within the vein). She has had many breathing issues prior to this and chest infections because of her heart disease. She was recently in the hospital about 15 days ago.

Raneem before surgery

Her case goes very well and she is in the ICU by 2:00. Because the day is running so smoothly, we are able to do a third case, a 5 month old baby names Maryam Wael Abu-Azem Arafa, an Egyptian girl living in Jordan. She has had significant failure to thrive, weighs only 9 lbs. At 5 months of age. She has a large PDA (artery that persisted after birth and did not close) and pulmonary hypertension. The case goes well and everyone is back in the ICU by 3:30 pm.

Baby Maryam shortly after surgery

We were fortunate to have visits from some of our former patients. Team favorite Farah came to visit with her family, (she as you might remember is the girl in the refugee camp we visited several years ago)! She looks fantastic and we are always happy to see her and her family. She will be starting school in the fall, can’t believe it.

Farah, she's such a big girl

Jill and Mike with Farah during her visit

The team with Farah and her family

We also had visit from a patient from Syria, who had TOF with absent pulmonary valve, Same heart disease as Raneem had that we operated on today. We operated on Ahmed in Indianapolis about 3 years ago. He came with his twin brother and his parents from Damascus! They were all over the place and looked great. It’s fun to do clinic visits with office visits thousands of miles away!

Ahmad and his twin brother Assyad

Finished off the day with great hummus and local food in Amman with Dr. Kal, his wife Rania and her wife and their 4 beautiful children!

Anne with Kal's girls Hanah and Jude

7 cases performed at the end of the day….in only 3 days!, think
this is a record for us thus far!
Thanks for all your comments..we love reading them at the end of a
long day!

Saturday, April 16 (day #2)

We arrived back at Al-Khalidi at about 7:30. While Jill, Becky and Mike went to the operating room to get prepared, Mark and Anne went to the ICU to echo the child scheduled for the first case. After review of this child’s defects, Maryam Jubran Ayshoa Qarmaza was brought down to the O.R. She is a beautiful 7 year old from Mosul, Iraq who has a VSD (hole between the lower chambers of the heart) and a tiny hole between the upper chambers as well. The surgery goes well and she joins the other 2 patients in the ICU before noon.

Our 2nd case starts by about 1:00; a sweet little 4 year old, Murtada Ra’ad Jasib Al -Nasari, from Basrah, Iraq who coincidentally also has a similar defect to our 1st case today. (VSD and muscle bundles in his right ventricle)
(don’t you just love these names?)
Things go very smoothly during the case, he is in the ICU by 3:00.
Our other 2 patients in the ICU are doing well. Zainab is up in a chair and will go down to the regular floor today. All her lines are coming out today.
Matti got his breathing tube out first thing this morning when we made rounds. He has been “complaining” all da after that that he is thirsty and hungry so finally about 1:00, he finally got his first few sips of pedialyte. He finished his bottle in no less than 5 seconds!
His mother was laughing; it’s nice to see the parents able to relax after they know their children are doing well.
We headed back to hotel and spent a lovely evening with one of the GOLA members at her home. The weather here this evening was absolutely beautiful.

Friday, April 15th (Day# 1 of the mission)

After a wonderful evening celebration last evening at the Dead Sea with our many friends from Rotary CLub Amman and a good night’s sleep, we are ready to go!!
First patient this morning is a 16 year old girl from Basra, Iraq, Zainab with an ASD (hole between the upper chambers of her heart). We have our medical team colleagues from Al-Khalidi Hospital here working on their usual day off, but we are already operating by 9:00 am.

She does well, hole is closed and back to ICU in stable condition by 11:00 am.

Second patient for the day is an 11 month old baby boy, Matti, from Mozul, Iraq who has a PDA and coarctation ( narrowing of aorta) and a VSD.

We are going to ligate the PDA (blood vessel you are born with that didn’t close) and repair the aorta. We may close the VSD at a later date or hopefully will continue to get smaller with time and may close on its own or need to be addressed in the future.
The aorta is repaired through the side of the chest . He does well and is in ICU by 2:00.

One of out favorite patients, Nour, a 7 year old girl from Syria, who we operated on twice in the past, first in 2009 and then again last year, is here today for her 3rd operation during is mission. She has complex heart disease, pulmonary atresia and VSD, we opened up her lung artery last year to promote growth of her very small lung arteries, and then he to close her VSD this time as well as give her a new artificial pulmonary valve. She is having a cardiac catheterization today to assess her readiness for surgery, which we have scheduled for tomorrow. When we first met her two years ao, she was quite blue, saturations 60% and so small.
Two years later, she has grown, goes to school, is beautiful and saturations were 93% today when we first saw her!! She ALWAYS comes with a smile built on her face!

Dr. Mark and Nour

Nour’s cath showed large blood vessels from another source supplying her lung vessels, ones she doesn’t need and actually may prevent her small lung arteries from growing. Dr. Kal puts coils in her right sided collateral vessels, we are unable to reach the left sided collaterals. She recovers fine after the cath and we are deciding what the next step is for Nour at this time. Her lung arteries are still not the size we would like to do her full surgical repair.

We ended the first day with a wonderful dinner at the home of the Rotary Club president Jai’ed and his wife Tania. The food and hospitality were amazing, as always and the perfect end to a successful first day!

Mission 8 Begins!

We left Wednesday morning for Amman Jordan to undertake our 8th mission trip. Seven prior trips have been to this same location, one included a side trip to Sulamaiyah for a site visit/clinic and one trip to Uganda. To date, we have operated on 61 children from the Middle East and 11 children from Uganda including families from Jordan, Syria, Iraq, Eqypt, and Uganda. There are 12 children on the surgery schedule for this trip which includes 6 children from Iraq. The team members making this trip are the original 6 people who went on the very first trip:
Dr. Mark Turrentine (heart surgeon) Dr. Anne Farrell (pediatric cardiologist), Mike Horner (perfusionist), Becky Clark (O.R. Nurse), Jill Riley (O.R. Nurse), Megan Richards (ICU Nurse).
A lot of planning and preparation goes into each of these trips. Months before we
leave, clinical information is sent from various contacts on children who are in need of heart surgery. Those are reviewed, diagnoses are made, and patients are selected for the potential schedule. We take with us 2 large trunks of medical equipment to use for the care of these kids. Items such as suture, graphs, catheters are gathered from our medical companies and of course funding for the trip is secured. Though only 6 people make the 7000 mile flight from one side of the world to the other, we have many to thank for making it possible:
Rotary international. Gift of Life
Tom Deierlein Foundation (www.tomdeierleinfoundation.com)
Abbott laboratories
W.L. Gore company
Medtronic
Cook medical…Bruce Gingles
Men and women at Cook Medical for constructing the antibiotic coated catheters that were donated to the mission
Skyway Travel, Ginny Fakhouri
Riley Hospital Administration
Operating Room Staff of Riley Hospital (especially those who helped cover Jill)

Day #8, February 25

Today starts in the OR with Eakam Jamal Jalal Bewanee (Akam) from Iraq.   Before we ever met this boy, he was well documented on the blog with his struggles to get form Iraq to Amman for this surgery.  Fortunately, he made it, was echoed last evening.  His oxygen saturations are in the 60’s. But despite that, he actually didn’t look as deathly ill as billed from the airlines standpoint.  I think that they are obviously not as used to seeing blue babies as we are, at what doesn’t look too bad to us (from a cyanosis standpoint) may appear to be one breath away from death to those not used to babies with heart disease.  This little one’s defect includes Double Outlet Right Ventricle, very severe pulmonary Stenosis, and Hypoplastic  Pulmonary Arteries.  Dr. Turrentine repaired the DORV with a patch and then reconstructed the right ventricle to pulmonary artery pathway with a monocusp patch.  We actually performed his entire repair instead of the original shunt to by him time that we had originally planned for.  He will not need future surgery at this point. We were so excited to be able to accomplish this, for many reasons, most of all that he needs no further surgeries and is completely pink now!! (check out the blog pictures from yesterday of him and notice how purple and blue his lips were)  Surgery went well and Eakam was up to the ICU by 12:30.  

 

Akam playing shortly before surgery

saturations now 100% Akam after surgery

The team with Akam

Akam after surgery...really pink now

The second case is Abdul Rahman Nader Sa’eed Abujeyab.  This is an 11 month old Palestinian child who lives in Amman.  Dr. Kal and Dr. Anne saw this patient in clinic just 3 days ago to make the diagnosis of an Atrial Septal Defect and a large Ventricular Septal Defect with high pulmonary pressure and failing to thrive.  He was an add-on to the mission schedule, and the family is extremely grateful  that there child was able to get care that would otherwise have not happen for a long time. 

Abdul before surgery

Our Jordanian medical student and Abdul

Nour looks great on the floor today. Is up playing with roommate Abdul this morning, before he heads off to surgery. She is going home today. She and her family are staying north of Amman in Irbil with friends, she will be checked on Saturday and then will go home to Syria.  Her father helped raise funds from friends in Syria to pay for the medical expense of Isr’a.  We are truly grateful and hope he can continue to raise awareness of the mission back in Syria and help contribute funds to future mission.  We can’t wait to see her again next year, hopefully to complete her repair (VSD closure). 

Noor looking very happy to be leaving the hospital

Naser is doing very well on the floor. Eating well, off oxygen today and will likely be discharged tomorrow. 

Naser getting better each day

Sadeen  looks fantastic today. Holding her own bottle, waving, smiling for her mother.  She is dressed in a beautiful pink sweater and looks like she never went through heart surgery 2 days ago!! She is being transferred to the floor today and could go home as early as tomorrow. It has been wonderful to see the change in her mother is less than one week.  We first met her at the reunion. She was clinging to Sadeen for dear life, crying, extremely worried for her impending heart surgery as any mother would be, asking so many questions. Today, 6 days later, 2 days after surgery, her mother is smiling constantly, making Sadeen laugh, she picked her up for the first time, and genuinely appears relaxed and at peace. Great feeling to see that. As moms (this  is Becky and Anne) we can relate completely to her on this level, no matter what the cultural differences are. 

Sadeen and um sadeen (her mother)

Sadeen...can you eat with no hands like me!!

Isra’a  had her lines, chest tube removed today.  She is off all BP medications. We are trying to get her up in a chair today. Her color looks amazing. Saturations 96%.  She is very shy, not too excited about all the commotion surrounding her.  Not sure she realizes yet how much better she is going to feel, really soon. She will be one we will look forward to seeing in the future. 

 

Ahmad, who had the ASD repaired yesterday, smiling and actually looks nearly as good as he did 2 days ago before surgery.  Going to the floor as well today and most likely will be discharged tomorrow. 

 

Omar is sound asleep this morning.  He settled down after some bleeding last night. He is able to eat today and that should help immensely. We will keep him in the ICU one more day. 

 

We said all our goodbyes at Al-Khalidi tonight, both to the staff and the patients and their families. We always feel sadness when we leave but now we know that we will always be coming back in the future. We have built friendships and bonds that have extended well beyond the mission. 

Numerous Rotary clubs have come together to jointly coordinate this trip.  Countless other companies and organizations have donated money or services to help achieve these goals.  And most importantly, to date, 61 children in this Middle East Region have received cardiac surgery who might otherwise not have survived.   Thanks to all who supported this project in the many various ways and for the continued following of the progress.  Tomorrow morning we’ll leave this place, but we’ll never forget those we’ve met here.  In’sha’alla and peace to all.

Leaving you with this lasting image...Sara and Maj'd before discharge