Colette and Almotasim are walking

Almotasim’s cousin told us that the patient was an active boy. Colette, the Canadian ICU nurse, assured him that the 12 year old was about to be a lot more active.

At about eight thirty the previous evening, Almotasim had come up to the ICU from surgery with the usual array of kit and tubing snaking out of his chest and throat and was extubated in short order by the night shift. This was followed by a thankfully uneventful night.

A crucial part of the training the ICHF provides its hosts goes beyond immediate issues like, Exactly how does one repair an ASD? And Just what does extubate mean and how or why is it done? Other, less obvious details – like how to manage patient lists to keep the required number of beds in the ICU open – are also important, even crucial. To perform four complex surgeries that will likely require long post-op stays in the ICU, will create a bottleneck with the limited beds available for the next day’s patients. These are the sorts of management details that can often make the difference in a successful program.

Nine days into the Benghazi mission, after a few surprises and a one-day break from surgery, the ICU was very full. So it was with great relief, both to the ICHF staff and, presumably to Almotasim, that he was ready to leave for the pediatric ward after 20 hours. Which is the goal for ICHF pioneered Fast-Track Recovery program. It is a hard and fast rule of Fast Track that no patient who could walk into the hospital leaves the ICU under anything but his own steam. If a child needs to be carried out, he isn’t ready.

The boy was still dazed from his ordeal, granted, but he got out of bed and wasn’t particularly interested in getting back in. He and Colette took a walk down the long hallway and back, at which point he picked up that he was being transferred out of the ICU. Which in and of itself was welcome news, but he grew concerned about the modest amount of swag he’d accumulated. Could he take it with him?

The ICHF nurses traditionally pack small treats for the children: coloring books, blow-ticklers, small toys for their charges. Lindy, a South African born perfusionist working in Holland, brought a bag of stuffed animals with her. Almotasim had grown attached to his lion, and who can blame him? Once he’d cleared up the matter of taking his animal up to the ward, and facing the prospect of getting back into bed, the boy opted for another walk. Then he said goodbye to the other 12 year old in the ICU, with whom he’d made friends.

He went up about mid afternoon, where his cousin walked with us up to the pediatric ward – decorated with Disney characters and other American cartoons – where his parents and little brother were waiting. Almotasim was pleased to be getting out of the ICU, and a little less pleased to be getting plopped into another bed – but if it had to happen, at least he was going to have a decent roommate. He asked about getting his friend sent up to the neighboring bed. Colette said she talk to someone about it.

So what does the future hold for our friend Almotasim? He’s an active kid with a strong heart; he’s loyal to his friends – even the stuffed ones – and has the good sense stay in bed even when he doesn’t feel like it. He seems to ask for what he wants in life, and is a hair stubborn about it. Well, apart from aggravating his parents for the next few years, he’s going to be just fine.

Richard Murff

Benghazi, Libya

Victoryia and May sorting things out.

Performing better than twenty heart surgeries in two weeks, producing rich world outcomes under emerging world conditions, the ICHF has never been an organization to waste a lot of time. This was vividly illustrated on November 26^th, day one of the foundation’s second trip to Benghazi, Libya.

Dr. Kathleen Fenton, who has overseen Operation Babyheart in Managua, Nicaragua for the last five years, and Dr. Cameron Greydon of Australia both arrived in Benghazi a day ahead of the mission to assess patients. The rest of the mission was greeted with an ambitious schedule the first day: three procedures in two theaters, with herself and ICHF volunteer surgeon Dr. Ali Dodge Khatami from Switzerland to perform the two VSDs and a PDA.

Most of the team arrived in Benghazi at 8:30 am on Monday morning, but didn’t leave the airport when the donated medical supplies we were carrying were inexplicably impounded. This was as problematic as it sounds. Sorting through the donated supplies needs to be done before the first patient arrives in the PICU. After a lot of bad noise at the airport, the team arrived at the Benghazi Medical Center at two in the afternoon, roughly the same time the first patient, Asmaa, was coming out of the operating theater.

Janine Evans, the team coordinator for the Libya mission, called the charge and the nurses scrambled to change into their scrubs to care for little Asmaa – as well as sort the supplies and set up a modern ICU. The impounded bags arrived at the hospital about an hour later.

These sort of minor fiascos are simply part of the experience on a babyheart mission: pulling order out of chaos is what they do. Asmaa, thankfully, is a brave patient who appears to be able to face anything as long as her hair is in proper pigtails. A lady needs her hairdo, and who can blame her?

With two operating theaters going, at the end of the day shift two more patients arrived in a neatly ordered PICU. So day one ended the way a lot of babyheart missions do: from a morass of strange problems being hammer out in a foreign language to – somehow – a safe and ordered haven for recovering children.