We were at the brightly painted and ambitiously named El Cielo Para Los Niños de Ecuador – Heaven for the Children of Ecuador – a foundation run by the ambitious Dra. Zorayda Figueroa. The good doctor is our liaison with the Hospital del Niño Dr. Francisco de Ycaza Bustamante, as well as the mission team’s local handler. She evidently possesses some practical magic when it comes to massaging Latin American bureaucracy and paperwork. Some seven hours earlier, I’d somehow been waved through customs at her insistence. She had also conjured up an army bus and flatbed for the International Children’s Heart Foundation. The truck was pulled halfway up on what passes for a sidewalk in front of the cinderblock building, and Sunday traffic roared by as the volunteers loaded the boxes that had been sent forward for the ICHF mission in Guayaquil.
The team flew into Ecuador from all parts of North and Central America. Most met for the first time the day before or, in my case having arrived at the hotel at two in the morning, at breakfast. On ICHF Medical Missions the team gets to know each other on the job. And it is loading an army truck that will take us and our supplies to Bustamante Hospital that it is beginning to dawn on the team the parameters of the medical situation into which we’ve flown.
The per capita income of Ecuador is only $5,820, and at 3.5 million citizens, Guayaquil is its largest city. Unfortunately, it also has the highest unemployment rate in the country at around 13%. Bustamante is the public hospital, serving the poorest citizens, many coming in from the Andes and further still from the Amazonian region. The dominant health problems are typical of poverty: malnutrition, diabetes, and – the leading cause of death – heart disease. The infant mortality rate is 19.6 per 1,000 live births compared to 5.9 in the US, so congenital heart disease is a growing problem in Ecuador.
At the hospital, we spend our Sunday sorting out supplies in an unused operating room. While the facilities are old fashioned by American standards, the place is clean and brightly painted against the humidity that clings to everything in an equatorial port city.
Lynn Harness, a perfusionist from Tupelo, Mississippi, sums it up when he says, “You make do with what you’ve got.” He points to Heaven and adds, “There is a lot of upstairs work.” Which may be the only thing that could possibly inspire a bunch of hard working professionals to use their vacation time to fly across the world to do their day jobs, without pay, under less than ideal conditions including an undermanned language barrier, and still produce the same success rates as in the US, only faster.
The speed is due to what the chief PICU nurse, Frank Malloy, calls “Fast Track Recovery.” A program developed by the ICHF in response to trips where 20 some odd surgeries are performed over the course of two weeks, while only five or six PICU beds are available for recuperation. Breathing tubes are taken out quickly after surgery when possible, reducing the likelihood of infection. In addition, painkillers are limited somewhat to better assess the patient’s immediate needs. While the light use of drugs would frighten most North American parents, it is hard to argue with the results.
When the team arrives at Bustamante on Monday morning it is clear that on Sunday the waiting rooms were not running at full tilt. The halls are now filled with folks waiting to be seen by the hospital’s limited staff. It is loud and crowded and for the ICHF, the real work hasn’t even started yet.
While the first patient is being prepped for surgery, Frank delivers a presentation on Fast Track Recovery to the volunteer nurses. Then they wait. Which returning nurses will tell you is the most aggravating part: the meds and equipment have been sorted out and inventoried, and the beds are ready. Dora, a respiratory therapist and veteran of previous ICHF trips, checks the ventilators. “This is too easy,” she says, “Everything works.” But it will be the last time for about two weeks that they will be idle.
The first patient – eleven-year-old José – comes out of the OR after lunch. Within minutes of arrival in the PICU, the boy is breathing without the help of a ventilator and coming out of his stupor. Despite having just had open-heart surgery and still clouded by anesthesia, José is strong enough to deliver a Beckham-like kick to the head of volunteer Melissa. But he’s a charming kid and after a little water, changes his approach, he delivers a wet smooch to Amanda. In a few more hours, José is asking for wheelchair rides, and within a day, walks (or rather dances) himself out of the PICU with Melissa at his side. She’s very forgiving like that.
Every morning, the team meets for breakfast at the hotel with the conversation centering on yesterday’s traumas and the hopes of the coming day. The next three patents are infants, and while not the ham José turned out to be, are very squirmy. There are hiccups, there always are. Javier does need to be reintubated and the little ones don’t move off the floor as quickly as the older children do.
The worn parents – one at a time – are allowed in the PICU to sit with their babies. It is here that Lauren, a volunteer from Toronto on the first week’s night shift, says that the language barrier seems most insurmountable. “I’m pretty good with comforting the families. That’s an important part of my job. But here it’s harder, you can’t mime warm and fuzzy.”
It is fascinating to watch the surgeons and technicians in the OR work with machine-like precision on outdated equipment and to see the nurses, grinding out twelve-hour shifts on their vacations, caring for these poor children who otherwise would have fallen through the cracks of an overwhelmed system. They are, by necessity, unsentimental about what they do. And perhaps on an individual level, that is the only option. Still, given the circumstances of a team used to the latest whiz-bang technical equipment in the OR and PICU, the overall results of the team on this first week in Ecuador seem little short of miraculous.
Maybe there is something to the ambitious name Dra. Zorayda coined: ICHF is Heaven for these children.