By William R. Wilson, Jr., MD, FACS, FAAP
After a year of preparation, a team of sixteen including cardiovascular surgeons, nurses, and medical technicians came together, January 20-29, to reinitiate the Cardiac Surgical program at Hôpital Sacré Coeur. The volunteer professionals travelled from their homes in Massachusetts, New Hampshire, Connecticut, Florida, and California. Team members were led and selected by Dr. Thomas Pezzella for their particular areas of expertise and clinical interests. Included were Cardiac surgeons (three), a cardiac anesthesiologist, perfusionists (two), Cardiac ICU nurses (four), cardiac PA, an OR nurse and technician, a respiratory therapist, a biomedical engineer, and an echocardiography technician.
The team assembled on Friday and Saturday and began orientation and planning for the week ahead. Many of the team participated in the daily communion services conducted by Sister Ann in the CRUDEM Chapel. The services and Gospel readings set the spiritual tone, provided insight and meaning for the mission.
Mark 3:20-21: “He came home. Again (the) crowd gathered, making it impossible for them to even eat. When his relatives heard of this they set out to seize him, for they said, “He is out of his mind.”
Asked to reflect on the Gospel’s meaning, Tim Traynor from CRUDEM Facilities Management and Maintenance replied, “Cardiac Surgery in Haiti, are we crazy?”
On Friday, Saturday and Sunday work began in multiple areas. Drs. Tom Pezzella, Andreas Kamlot, William Wilson, echo tech Sophia Rodrigues, and PA Tia Phillips began seeing prospective patients for evaluation and surgical repair. Patients that had previously been identified and screened were examined. A total of 33 echocardiography studies were performed. Approximately 20 had various forms of congenital heart disease, 10 acquired valvular heart disease and 3 normal studies. Three patients were selected and prepared for surgery.
Simultaneously, the CVICU team made up of nurses Cathy Phelan, Patricia Caruso, John Laszlo, Kathleen Gannon and respiratory therapist Wanda Reynolds set up the ICU, adjacent store room, stocked medications, supplies, tested equipment, ventilators and medical gases in preparation to receiving and recovering the open heart patients.
Acts 22:3:11: …I asked, “What am I to do, Lord?” The Lord told me “Get up and go to Damascus, there you will be told everything that has been assigned to you to do.”
Preparation of the operating room supplies, surgical instruments, and collection of anesthesia supplies was directed by Nurse Jackie Butler, technician Raymond Rogers and Nader Zaidi, MD. Perfusionists Bob Picotte, Alejandro Duenas and William Griffiths biomedical engineer reassembled the cardiopulmonary bypass machine, located all necessary equipment and supplies, and made sure all OR equipment was in safe working order.
Sunday morning final materials acquisition, medication identification, and a dry run through in the CVICU and OR were performed with all the team members present.
Monday morning at 3 am, thoracic surgeons, Drs. Kamlot and Wilson, were called to the hospital to consult with Dr. Bernard, the Sacré Coeur Staff General Surgeon, for a patient with a sucking chest wound. The patient had suffered a stab wound to his left chest. An emergency FAST Echo of the pericardium was performed to exclude a cardiac injury, the chest tube was repositioned, and Dr. Bernard later performed an abdominal exploration to rule out diaphragmatic and intra-abdominal injuries.
After last minute details were checked, the first open heart procedure was performed on Monday morning.
The patient was a 22 year old woman with symptoms of mild shortness of breath, palpitations and fatigue due to a large secundum Atrial septal defect. On physical exam she had a loud pulmonary flow murmur and right ventricular heave.
She underwent pericardial patch closure of a 5×3 cm defect by Drs. Wilson, Pezzella and Bernard on cardiopulmonary bypass. Within an hour of the procedure she was extubated and continues to do well.
On Monday afternoon, while the cardiac team was recovering the first patient, reviewing echocardiograms, and making plans for subsequent cases, a major trauma occurred on the road just outside the hospital.
“Awah,” a loud cry of collective voices erupted from the crowd outside the hospital, a mournful sound which was heard as far away as the CRUDEM compound.
A 65 year old woman pedestrian had been struck by a Tap-Tap, suffering an open femur fracture, popliteal artery avulsion, severe hemorrhage, and shock. Tina Greco, RN, Trauma Nurse and visiting CRUDEM volunteer, immediately recognized the severity of the patient’s injuries and need for immediate intervention. The victim was placed on a stretcher and wheeled across the street to the PICU. “Can anybody help?” A team rapidly assembled in a defacto “Trauma Code” led by Dr. Bernard, the hospital nurses, and visiting team.
The patient was successfully resuscitated. Due to the severity of her neurovascular, soft tissue and boney injuries she required an amputation to her mangled lower extremity later that evening. Within 24 hours she was extubated, with stable hemodynamics and taking oral nourishment.
Tuesday morning the second open heart procedure was performed by Drs. Kamlot and Wilson. The patient was a 42 year old woman with dyspnea on exertion, fatigue, chronic atrial fibrillation and Class III congestive heart failure. On physical exam she had a loud murmur of mitral insufficiency. Echocardiography demonstrated severe mitral regurgitation and moderate stenosis due to a restrictive rheumatic valve.
On cardiopulmonary bypass and cardioplegic arrest a large left atrial thrombus was removed, the left atrial appendage ligated and mitral valve replaced with a SJM prosthetic valve using posterior leaflet preservation technique. Within 24 hours she was extubated and her anticoagulation restarted. She had a smooth postoperative recovery over the ensuing week.
The third cardiac case scheduled for Wednesday, an 18 month old boy with a small patent ductus arteriosus, was cancelled due to a skin infection. Plans are to perform ductus closure during a subsequent mission.
Wednesday and Thursday time was spent performing patient care, rounding on recovering patients, inpatient consultations, making plans for follow-up care, and in teaching sessions with the patients, families, Haitian Doctors and nurses. The OR equipment, disposables and supplies specific to cardiac surgery were transported back to the CRUDEM compound and sequestered in the Sprung storage area for future cardiac surgical missions. Detailed lists of supplies were compiled during this time. On Friday, a group travelled to the Hôpital Universitaire Justien in Cap Haitian.
Mark 4:31-35: He said to them, “Is a lamp brought to be put under a bushel basket, or under the bed, and not on a lampstand? For there is nothing hidden, except to be disclosed; nor is anything secret, except to come to light. Let anyone with ears to hear listen!” And he said to them, “Pay attention to what you hear; the measure you give will be the measure you get, and still more will be given you. For those who have, more will be given; and from those who have nothing’ even what they have will be taken away.”
The cardiac surgery week was a success and has provided a sound foundation for future missions. A number of potential surgical patients have been identified. Necessary equipment and supplies have been collected and stored. The operated patients have done well and the mission has demonstrated that Hôpital Sacré Coeur can support cardiac surgical procedures. A number of areas for improvement have also been identified. The participants placed their ‘light on the lampstand’ and used talents and gifts in Christ’ name.
