global health initiatives 

Dakar, Senegal, 2007

For the first and second trips, in March of 2005 and of 2006, the Dr. Jonathan Chen and his teams traveled to Cambodia. This year, they set their sights on the African continent, traveling to the Fann Cardiovascular Hospital in Dakar, Senegal. There they operated on seven children between March 12 and 16, 2007.

In addition to Dr. Chen, the team included Dr. Alejandro Torres, a pediatric cardiac catheterization specialist; Dr. Patrick Flynn, a pediatric echocardiography specialist; Kevin Charette, a pediatric perfusionist; Dr. Johanna Schwarzenberger, a pediatric cardiac anesthesiologist; Dr. Ralph Slepian, a pediatric cardiac anesthesiologist; Jillian Kirkpatrick, a pediatric ICU nurse; Dr. H. Michael Ushay, a pediatric intensivist; and Ellen Moquette, a pediatric catheterization nurse.

Tiny patients, complex problems

The children in Dakar were much smaller and had slightly more complex problems than in Cambodia, where most were teenagers, says Dr. Chen. In Dakar, most were toddlers; the tiniest patient was an eight-pound, two-year-old girl, the largest a 22-pound teenager. The trip was sponsored by the Surgeons of Hope Foundation, Inc., a non-profit organization whose goal is to bring lifesaving surgeries to children in developing nations while helping build surgical expertise in these countries. In all of sub-Saharan Africa (south of Morocco), says Dr. Chen, there are just 10 cardiac surgeons, five of whom are in South Africa.

As grim as the statistics are, the benefit a pediatric cardiac surgery trip offers is potentially exponential, explains Dr. Chen. "If even one of the operations we conducted enabled one of the surgeons to secure his skills in pediatric cardiac surgery," he says, "that surgeon could go on to operate on 100 sick children on his own." The New York team worked alongside two Senegalese surgeons, including cardiac surgeon Dr. Mouhamadou N'Diaye, Fann Cardiovascular Hospital's director. Dr. Chen reports that both surgeons caught on quickly to the pediatric cardiac surgery techniques their New York colleagues taught them.

Duct tape and wine cork to the rescue

On this occasion, even more so than the previous trips, the team faced major shortcomings in the hospital facility. "We had some huge obstacles on this trip," says Dr. Chen. Before the first operation could even take place, the team had to spend the better part of two days repairing broken equipment, using a hefty dose of ingenuity.

In repairing the anesthesiology equipment, they found themselves using duct tape and wine cork. Determining that the catheterization lab was too small to carry out the necessary procedures, the team constructed a new one in an operating room with the diagnostic equipment they brought from New York, including arterial blood gas analysis machines, a portable echocardiogram machine, and an echocardiography probe. As the surgeries commenced, the team was compelled to scrub with IV fluid from saline bags, having discovered the sinks were clogged by calcium deposits.

The greatest gifts

The doctors wanted to ensure the operations they conducted during their visit were safe. While the rest of the surgical team spent the first 48 hours in Dakar preparing the ICU and operating rooms, Drs. Chen and Flynn examined the children and selected seven whose disease was so advanced that they would be inoperable within a year, when the next surgical team was expected to visit. "Thankfully, we don't encounter patients in the U.S. who are this advanced in their congenital heart disease," says Dr. Chen. "The problem in Senegal is there are no doctors to operate on these children."

A highlight of the trip was a dinner with the President of Senegal, Abdoulaye Wade and his wife Vivanne at their official residence, where the team urged investment in medical supplies. "They were very grateful. We're the first American group to go and do congenital heart surgery there," he says.

All of the members of Dr. Chen's team donate their time and use vacation days to pursue these trips. While the children recovered from surgery, emotions of parents ran high as they expressed their gratitude. Many had been told their children were inoperable. "The greatest gifts we get," says Dr. Chen, "are the photographs that the parents send us when their kids are back home."

(Written in conjunction with the Office of External Affairs, Columbia University Department of Surgery.)

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