Hurricane Mitch was the most powerful hurricane of the 1998 Atlantic hurricane season, with sustained winds of 180 miles per hour. Mitch formed in the western Caribbean Sea, and with favourable conditions rapidly grew to peak as a Category Five Status, which is the highest rating on the Saffir–Simpson Hurricane Scale. When it came ashore on October 29th, this slow moving storm dropped historic amounts of rain on the Central American country of Honduras. Unofficial reports of up 75 inches of rain resulted in catastrophic flooding throughout central America, and brought the death toll to nearly 11,000, another 11,000 people missing, and roughly 2.7 million left homeless.
Teams from across the globe, including a family physician from outside of London, Ontario who was born in Honduras, rush in to offer assistance. Amongst the survivors a young child, who was thought to have a congenital heart defect. They were brought back to London for further assessment and possible surgery, however, the child is deemed medically unfit for surgery at the time, and is returned to Honduras.
Touched by the situation, a team from Victoria Hospital, in London Ontario was formed to carry out a mission of general and plastic surgery in the storm–ravaged country of Honduras. Coming from an NICU and Operating Room nursing background, I was excited to join the team; which would soon become the first of many medical missions for me.
Shortly after returning from the mission in Honduras, I was attending a conference and, as luck would have it, I met a perfusionist from the Children’s Hospital of Philadelphia who had just returned from a pediatric cardiac surgery mission. I made the remark, one that I went on to hear from a number of my allied health professional colleagues back home as I recanted my mission experiences, “If there was ever a chance to do a cardiac surgery mission, I would love the opportunity to get involved.” He asked for my contact information and told me he would keep me in mind if he heard something.
Six weeks later, serendipity. Duke University contacted my new friend at the Children’s Hospital of Philadelphia wondering if they have someone who could join them on a mission to do pediatric cardiac surgery. They reply “We don’t have anyone at the moment, but we know someone” and I get the call to go on what becomes the first of two missions I do with Duke University in Nicaragua. This was a purely a pediatric mission. The team brought all of the disposables they needed to do the cases they were planning to do. They had established, in concert with the Texas Heart, a fleet of heart lung machines to be used at the centre.
Through conferences and networking, I quickly come to learn that there are many more groups who are doing pediatrics, versus adults on these missions, and some do combinations of both. It was at yet another conference that I met Dr. Thomas Pezzela, a cardiac surgeon, who was also a field surgeon in the Vietnam War. After seeing the plight of people in developing nations, he dedicated his career to advancing cardiac surgery in these developing nations. Dr. Pezzela put me in touch with an American Non–Governmental Organization (NGO) known as Project Open Heart who was looking for a perfusionist. I had the fortune of travelling a number of times with them to Mongolia and Tanzania to do adult cardiac surgery. Shipping containers of disposables were sent along which we unloaded upon our arrival to the hospital.
Funding and administrative shortfalls ended the work of Project Open Heart. This lead to the cancelation of a planned third return mission, as well as all future missions and the team disbanded.
Disappointed over the cancelation of the mission, I could not help but wonder if perhaps a team could be assembled from my hospital. Certainly, I have had a number of people I work with say “If there was ever a chance to go on mission, I would love to go!” Knowing the contacts in Mongolia, I asked them “Would you be interested in a team from Canada come to Mongolia to carry out this mission?”
A team of medical professionals from the London Health Science Centre, loosely known as The London Cardiac Outreach Team, is born. Through Serendipity and networking, the London Cardiac Outreach Team has gone on a total of 10 missions to Mongolia, Peru, and to China for almost exclusively adult cardiac surgery.
Volunteer’s pay their way to the destination and take from their vacation time to attend the mission. When you are returning a number of times to the same location, understandably, it becomes difficult for people from one hospital to continue to devote their time year after year. This has resulted in the team from London to invite volunteers from across Canada to join their mission, and this has been a wonderful opportunity to be able to share with the perfusion community.
Through networking I have been associating and volunteering with other NGO’s, including CardioStart International, and The VOOM Foundation, both from the USA, and the Australia Open Heart International.
From what I have seen, the missions fall into one of about three categories. The first is a scout mission where a small group will go to the centre that is inviting the them. The objectives are to go and look at their facilities and program to see if they can support what might be required for the program. This could mean a shipping container of items being sent in to help facilitate the mission happening.
The second type of mission I refer to as the satellite mission. Here a team returns on a fixed schedule. The local team will carry out the selection of patients, and their long term follow–up care. The mission team comes in to carry out the surgical procedure and their immediate post–operative care.
Then there is the “teach them to fish” missions. A group will enter an agreement with the host hospital with a long–range plan to expand the experience of the local team so that they can provide the service locally, thus creating a long range impact on the region. These missions can range from a simple come to assess what they are doing, provide in servicing and mentoring, to building a program from the ground up.
There are pros and cons to various mission groups. Larger groups, such as Cardio Start and Open Heart International, have the ability to send shipping containers full of items required to carry out a mission. They do have a large network of people to draw upon, and often they are reaching across boarders and often across oceans to find the staffing they require to carry out a mission. This means those attending frequently have to get to know everyone’s strengths and abilities while in the trenches.
Smaller teams, such as the London Cardiac Outreach Team, can only bring items that fit in their luggage. We have adopted what I refer to as the “wagon train” method for bringing in supplies. We send the host hospital a list of items we need to perform the case, they will look at the stock they have, and let us know what they are missing. We in turn will then make up a pack for each individual case from the needs of anesthesia straight through to the ICU. One kit is then made up which has all of those supplies. We make up kits for aortic valves, mitral valves, bypass surgery, and will have a couple of additional kits made up. By doing this, in the event someone’s luggage goes missing, we do not lose all of the cannulas or all of the valves, which would bring the mission to a quick stop.
The advantage for a smaller local team is that the team members know each other’s strengths, and can hit the ground running when they arrive. We have seen, especially if we return to the same hospital for a number of years in a row, recruitment tends to fall off a bit. This is understandable as people have limited vacation time, thus the need to widen our net from only members The London Health Science Centre to other hospitals from both within the province and throughout the country. We have had the opportunity to experience the mission with a number of our colleague’s from within Canada. This in itself, has created a Canadian core, or as I will often refer to us as, Team Canada.
Occasionally there is a role for non–medical personnel. Some teams such as CardioStart and The London Cardiac Outreach Team, will in addition to the cardiac surgical program, have a community outreach program that provides the opportunity for non–medical volunteers to join the surgical team. Often these volunteers find themselves assisting at orphanages who have a long list of projects, including sweat equity construction, making sunscreens, drapes, general maintenance, and mural painting and programs for the children.
These opportunities open the doors for people back home to also make a difference by donating the needs of these children. In addition to some cash donations for projects at the orphanage in Peru, The London Cardiac Outreach Team has received backpacks embroidered with the children’s names, sporting goods donated by colleges, quilts made by seniors, and sweaters made by church groups. Thus, people who might not be able to travel with the team can also make a difference in the lives of those less fortunate, which in itself is a dividend making a difference in the lives of people back home who know their efforts are going to a good cause.
On occasion, disaster relief has spurned clinics for these teams who have had scheduled mission trips planned for the region. For example, the London Cardiac Outreach Team after a surgical mission, went on to open a clinic which supplied medical assessment and free prescriptions to a small town outside of Cuzco, Peru, where torrential rains washed away homes made of mud brick. The residents of the town were evacuated to a tent city. Armed with physician travel packs that provide, for a nominal rate of about $500 which covers paperwork for customs, shipping and handling, a pharmacy worth of over $5,000 of in–date, location relevant, drugs which would cover the 10 top ailments in the local area.
More recently, CardioStart International had people on the ground when the earthquake hit Nepal. With more staff arriving, the mission changed from a cardiac surgical mission to an emergency aid mission for those in need in the face of this disaster.
The numbers I have been told that we need to remember, is that 90% of the world’s population does not have access to cardiac surgery. Thus, be it a young child born without access to have a congenital heart defect corrected, to a mother or father who has been affected by rheumatic heart disease because they had no access to antibiotics when they were younger, and now who now find themselves in need of valve surgery, are the things that we take for granted back home.
As health care providers, there are opportunities for us to give a child a full and happy life, to return a parent to their family to help raise the children, or to return them to the work place to contribute to the family’s over all wellbeing, all by simply volunteering a week or two of our time. If the opportunity ever presents itself I would encourage you to do it. You will be challenged, and will have to break out your McGyver skills. You will see things that you only read about in text books, and you to will often learn a skill or two from them.
You get to see and experience some far off sometimes exotic lands that are developing. While you are there, you will change the lives of individuals and their families. Impart new knowledge to our counterparts which will assist them on their journey in healthcare, build new friends, and experience some “how did I ever get here?” once in a life time moments.