Belated update from Keith

Hi All,

Thanks for following along with us while we return to Uganda with our dear friends from DC Children's and UF Jacksonville. A special thanks to our former UNC colleague, Dr Gene Fried, now at UF Jacksonville, who jumped in at the last moment to provide cardiac anesthesia to the Ugandan children. Our trip over here was uneventful (mostly) but tiring (as usual). We had a wonderful rest at a Hotel on Lake Victoria Sunday night before getting on two buses Monday morning at 7 am for the trip in to Kampala. Despite having most of our supplies shipped over ahead of time by Samaritan's Purse (THANKS CYNDI AND JIM), we still accumulated 26 bags/boxes of luggage and supplies. The bus was packed. We had an interesting "off road" experience getting to the hospital since the main thoroughfare was blocked.

We arrived at the Mulago Guest House again (THANKS SO MUCH KATE and JOSEPHINE), where we are all staying. Such comfortable modest housing (except for the lack of hot water each morning...a terrible way I start each day). I continue to be amazed by our team. We so quickly converted the Cardiac ICU and Cardiac Intermediate Care units into fully functional (well mostly) units. we still have some work to do but it's OK...We have already operated on 4 children and each day presents itself with a new suprise. Day 1, was suppose to be a warm up for our first timers (Dr Mike Mill, CT Surgeon, Dr Gene Freid, Cardiac Anesthesia, Jenn Ditto (OR Scrub RN), PICU RN's Bren Sparling and Sandi Hawkins, and our loveable fellow, Dr Benny Joyner. But of course this changed. The first case, a PDA developed pneumonia and was canceled so we proceeded with another PDA ligation and added on a cardiopulmonary bypass (PUMP) case.

The team jumped right in and did a fabulous job. But we're always gerry rigging something or moving onto PLAN B (or as Spongebob's nemesis would say, PLAN Z). It's great to work with such resourceful, "CAN DO", "NO IS NOT AN OPTION", types....The second suprise came today when we added on a Coarcation repair that was seen at Tuesday's Clinic by Dr Sable. For some reason, they don't "see' coarctations here in Uganda, so we decided to show them.....AND the super suprise was a baby seen on monday with Transposition (and PS/SUB PS) who had O2 sats of 40...we put together the necessary equipment to bring him into the CICU, intubate, line him, and Dr Sable performed a life saving balloon Septostomy. While this buys him some time, surgery is the only long term survival option. Unfortunately, this is NOT something that can be done at this stage of the program here in Uganda. We're still working on options.

I'm here on call, swatting the mosquitos away thinking about my two beautiful children, Kyra and Connor, who I miss so much. Well the team will keep you up to date with events as the week proceeds. Tomorrow is independence day here in Uganda (YEP...they broke free from Britain too, sans the tea in the Harbour). So we will try to just operate on one child (and be half way done with our planned 10 cases.....), but who knows what tomorrow will bring.

Miss you all much.
Keith

We're here!

It is my great privilege, pleasure, and honor, to be traveling with the team this year. I listened to reports of the previous missions and hoped that one day I might be able to journey there with the team. That day came Saturday and we arrived in Uganda late Sunday evening and we've been non-stop busy ever since.

Monday was spent unpacking boxes and boxes and boxes of supplies and then setting up the OR and the ICU. The cardiologists screened and echoed the potential patients and chose two for surgery today. When we got here this morning though one of the kid's Xray indicated he had pneumonia and his surgery has been postponed until later this week. He's been started on antibiotics and another patient has been chosen.

Nursing lectures are about to start and with good fortune one of us will be able to get back on to blog some more later today.

Diane Yorke PhD RN
Clinical Assistant Professor
UNC Chapel Hill School of Nursing

Jennifer Ditto, RN MSN

My name is Jennifer Ditto and I am the scrub nurse going with the team to Uganda this year.I have been a nurse for 10 years, working in the operating room at UNC for 9 of those. I love to scrub pediatric heart procedures because of the challenge they present, but seeing such a small piece of what these kids go through wasn’t enough for me at one point though. I wanted to expand my view of the journey these kids take, so in 2005 I decided to further my education, going back to school to get a pediatric nurse practitioner degree. While I learned an incredible amount that I carry with me everyday caring for these children, I haven’t been able to get myself to give up being a part of the surgical aspect of their care.

As the hours dwindle away, and the fury of preparation for the trip is coming to a close, I find myself a little overwhelmed with the thought that tomorrow I will be in Uganda. Never having been out of the country before, I feel blessed to have the opportunity to be a part of this year’s trip to Uganda. I hope to teach the operating room staff there, about the congenital defects, as well as the procedure that we will use to repair them. Being a part of this team has been amazing so far, as we have been meeting together to plan the trip and gather supplies and equipment. Before even getting there, I am realizing how fortunate we are for the technology that we have accessible to us, and the people we work with that come together for a cause as big as this. I can’t imagine how this is going to change my life in a few days.While I am grateful for the wonderful colleagues that are also taking this journey, none of this would be possible for me without the support of my family and friends. A special thanks to my son, and my parents who are staying with him, while I head off for an adventure around the world. And as a humorous aside, to those of you who have offered up some of your most prized possessions, should I need them to get home safely, I’ll miss you while I’m gone!

Jennifer Ditto, RN MSN - Uganda Mission 2008

Bren Sparling , PICU RN

On the eve of this mission trip, I find myself nervous, excited and in somewhat disbelief that I am headed to Uganda in the morning. I have been a PICU nurse since 1991 and have been at UNC for the last 5 years. This will be my first mission trip. I feel so honored to be part of this caring team of people and realize that my life will be forever changed.

While in Uganda I will be caring for post-op patients in the ICU. I also plan to give lectures and precept the Ugandan nursing staff. I am grateful for this opportunity to share my PICU knowledge and experiences so that perhaps these nurses will grow to love being a PICU nurse as much as I do.

I am so thankful for all of the support and encouragement from my family and friends. I am especially grateful for this opportunity to be a role model for my three wonderful daughters.

Bren Sparling, RN, BSN

Benny Joyner, MD, MPH

My name is Benny Joyner and I am a 3rd year pediatric critical care fellow at UNC. I, like others on this mission, have always held a deep desire to reach out beyond our geographic and national borders to help children in need. In fact, my entire professional career has been focused on children-starting out as a high school teacher, until circumstances dictated that I change tack. As a result, a pediatrician was born.

After attending obtaining both my medical degree and my master's in public health degree from UNC Chapel Hill, I left the comforts of home and went to the bright lights of New York City where I completed my internship, residency and Chief Residency at the Children's Hospital at Montefiore in the Bronx. While I have always had a love of international travel for recreational purposes, it was during my chief year that I first got a taste of international travel with an altruistic aim. Working with the cardiac surgeon at Montefiore I was invited to accompany his team to El Salvador to participate in the care of post operative cardiac surgery patients. While this trip was by far the most exhausting experience of my life, it was also one of the top 5 experiences of my life and, quite honestly, the most rewarding experience of my professional career.

Seeing the impact that I could have on the lives of the children for whom I cared was a gift but, by far, the biggest gift that I received was the renewal of my spirit and belief in my decision to go into medicine. In a time of increasing responsibilities and pressures of trainees in the US medical system, the opportunity to go abroad and apply what I have learned thus far, to realize just truly how blessed I am to have the life I have, to work in the US medical system and to have the opportunity to support and partner with other medical staff around the globe could not have come at a more perfect time. I returned from that trip physically exhausted but more alive spiritually and emotionally and ready to tackle my fellowship.

How fortunate that this opportunity to work abroad-supporting others as they build their programs and to make the difference in another child's life half a world away-comes at a time as I make my next transition from fellow to attending. It is for these reasons that, when asked if I was interested, I leaped at the opportunity to go. I look forward to working with all of the staff in Uganda and acquiring experiences and memories that will last a lifetime.

Tiffany Mabe, RRT

My name is Tiffany Mabe. I am the Pediatric Manager for UNC's Women's and Children's Hospital. I am a respiratory care practitioner and a neonatal pediatric specialist. I have worked at UNC Hospitals since April of 1996. I came to UNC to specialize in pediatrics. When I began at UNC I worked in both the neonatal ICU and the pediatric ICU. I then trained, and worked full time, and continue to work as a pediatric flight therapist with Carolina Air Care. I also trained and continue to work as an ECMO specialist

Pediatrics has always been near and dear to my heart. My big interest has always been pediatric cardiac patients. I am very grateful to be able to go over on this trip to help with these cardiac patients.

I was with the first group from UNC to go to the Mulago Hospital in 2005 to set up the PICU. It was a wonderful experience that I will never forget. The people are absolutely wonderful and it truly makes you want to go back and help as much as you can.

When we visited the first time, we were allowed the opportunity to spend time in all of the areas of the hospital, including the Burn ICU, Neonatal ICU, and the cardiac clinic. This really allowed us to see where we needed to focus efforts to help out at the Mulago Hospital. The cardiac clinic really caught our attention. The physician would see many patients in clinic and truly make a diagnosis and treatment plan by looking at the patient, listening with a stethescope and follow-up appointments with medications. It was amazing to see how they were working with these children, who were in dire need of cardiac surgery, and managing them as best as they could to help them to have a somewhat "normal" life.

This in turn led to Dr. Kocis taking on the challenge of "beefing up" our efforts to help the children of the Mulago Hospital, and Africa on a much bigger level. Teaching, training, and gathering supplies for the first trip over to begin pediatric cardiac surgery. This first trip was a huge success in 2007, and the efforts have continued since the return of the team.

I am very thankful for the opportunity to go on this trip to help the children in need of pediatric cardiac surgery. I feel the need to give as much as I can to others, since I have been given a huge blessing. That blessing is having both of my parents alive and well. My father had a major heart attack in March of 2006, underwent the placement of a Jarvick Left Ventricular Assist Device, and now has been given a second chance at life with a new HEART! God has blessed my family over the past couple of years.

I hope and pray that I can give some of the knowledge that I have to the staff of the Mulago Hospital in order to enable them to grow, and take care of these wonderful children that are in need of cardiac surgery.

Tiffany Mabe, RRT

Uganda Fall 2008

Well, it is that time of year again. The UNC group has been preparing for this Uganda trip since early Spring by acquiring donations of equipment from many vendors, establishing personnel, and discussing the general preparations needed for such a huge endeavor. I am excited to see the Ugandan staff again, especially the nursing staff who were so eager last year to learn. I still think about that trip, and find myself amazed at how much they learned and so desperately wanted to soak up more. This year has been a bit more organized on our part. The unknown is not as prominent in our thoughts as we are now building on what we did last year. We are going armed with multiple lectures, hands on opportunities, and will be able to leave them with the ability to reinforce what we have taught with CDs, jumpdrives, and handouts full of information. We have books donated to start a little "library" for the nursing staff thanks to Diane Yorke, our nurse educator who made it all happen. While I currently work as a Pediatric Cardiothoracic Surgery PNP, I quickly return to my bedside PICU nursing role that I had done so many years prior. I like the ability to combine the two roles in this environment. I can go back to my "roots" and yet have it enhanced with my PNP skills. I hope to impact not only the postoperative patients, but also the nursing staff through lectures and precepting. And like Lupe, I have found this to be such a rewarding experience in so many ways. I hope one day, the nurses will be able to come to the US to further their education and be able to take that back to Uganda to "pay it forward" to the rest of their community.

Karla Brown, PNP
UNC Pediatric Cardiothoracic Surgery

Lupe Haynes, RRT RCP

I've been a respiratory therapist for 12 years now and I've been employed with UNC Hospitals for twelve years as well. I initially worked primarily with adults and didn't have much interest in the pediatric population. In fact, sick children terrified me! However, over time I felt I needed to challenge myself further in my career and I knew I would obtain further growth and exposure to new things in the pediatric realm. And boy was I challenged! I have come to love what I do and my role in helping children on their way to recovery. Every story doesn't end on a happy note but when they do, it motivates me to continue to strive to deliver the best respiratory care possible. I pray that God give me the wisdom to make the right decisions involving my management of my patients.

Over time, I have learned so much and was so blessed to be involved in the first heart medical mission in Uganda October 2007. When I was invited to attend the mission , I was so honored but at the same time terrified because this was another crossroad decision for me. This would be a great opportunity to give to those that were less fortunate than me. That alone was the best reason to go but the difficult part was would I be able to perform my job to the fullest? Would the experience and exposure I've had in the PICU be enough to help guide my decisions in the management of the patients in Uganda?

The trip was a great success and every health care professional that volunteered their time and compassion for the patients in Uganda left as better human beings. I've learned to be so grateful for what we have available here in the US and that it is so much better to give than receive. Because in giving you get out of your selfish mode and realize that it could be me on the other end and that alone makes me so grateful for what I do have.

I've been invited to go again this year and I"m so excited and can't wait to see my Uganda family again. My goal this year is to be able to educate the staff on ventilator management and the role of the respiratory therapist. My hopes are that I can build on the knowledge the nurses and doctors obtained last year and get them a step closer to being more self-sufficient in the respiratory management of pediactric heart patients. I will not only be performing patient care but aiding in establishing the role of respiratory care within the Uganda Heart Institute.

Lupe Haynes, RRT RCP

Our third medical mission to Mulago Hospital, October 4-16 2008

The UNC team returns next month along with our partners from Children's National Medical Center and University of Florida, to continue to advance the Pediatric Cardiac Surgery Program at Mulago Hospital with the near term goal of self sufficient, sustainable care for Ugandan children with heart disease.

UNC Team
Keith Kocis, MD - team leader and cardiac intensivist
Michael Mill, MD - cardiac surgeon
Benny Joyner, MD - intensive care fellow
Karla Brown, RN, PNP - surgical nurse practitioner
Katherine Desrochers, RN - ICU nurse
Bren Sparling, RN - ICU nurse
Sandra Hawkins, RN - ICU nurse
Jennifer Ditto, RN - OR nurse
Diane Yorke, RN, PhD - clinical education leader
Tiffany Mabe, RRT - respiratory therapist
Guadalupe Haynes, RRT - respiratory therapist
Ruben Bocanegra - cardiac surgery physician assistant
Bill Nicotra - cardiopulmonary perfusionist
Helen Snow, MBA - patient and donor delations

CNMC Team
Craig Sable, MD - team leader and cardiologist
Lowell Frank, MD - cardiology fellow
Laura Olivieri, MD - cardiology fellow
Justine Nalubega, RN - cardiology nurse
Ozzie Rivera - biomedical engineer
Lynda Dattilio, RN - ICU nurse
Christa Cato, RN - ICU nurse

UF-J
Stephanie Lacey, MD - team leader and cardiologist
Eugene Freid, MD - cardiac anesthesiology

Also
Cathy Partyka, MD - neonatologist

Alisha: 3 months post-op