Thursday update

Hello all, we are still with very limited (and slow) email access. Hopefully this will improve today. The team finished in the OR at 8:30 pm last night and we had a pizza party to relax. The infirm members of the team are getting better each day, hopefully to return back to work in the next 24-48 hrs. Sleep is improving, though still erratic. Luckily the Ugandan coffee is STRONG.

The four patients done so far are doing extremely well. Two will transfer to step down status today. Two more patients to OR today with the first case having just gone back. The teams are working well together. The knowledge transfer continues. We are expecting a VIP tomorrow

More later.

Wednesday Update

So far the cardiac surgeries have gone fairly smoothly. The first two patients had correction of their surgical defects without any difficulty and both are eating and recovering in the ICU. In fact, we left the OR at 9 p.m. last night, which is awfully good for the first day. The first patient for day two is in the ICU recovering, while the surgical team is in the OR with the second patient. It will be another 9 p.m. evening for the team.

The team has been fatigued by jet lag and varying illnesses (flu, GI upset, dehydration, etc.), but we have rallied around each other to support our sick colleagues and pick up the necessary work loads. We will continue to monitor our team's ability to complete the 10 scheduled surgeries. Thankfully, we came well prepared with a wide spectrum of medications to treat every possible ailment. IV fluids have been given without problems. We hope all of us will soon return to our healthy state and that no one else becomes ill.

Sorry for the lack of communication

We have had no internet access for the last 2 days. We have brief power outages, particularly during rain storms and late at night. Fortunately Greg Griffin, our perfusionist, had prepared the bypass machine for battery operation, so the surgery could continue without complication. Access to our hospital email web accounts has also been sporadic. SORRY!

Dr. Dorostkar from Univ. of Minnesota joins Team UNC

Dr. Parvin Dorostkar, a pediatric cardiac intensivist from the University of Minnesota, joined our team for this mission. She will be assisting Dr. Kocis with final cardiac evaluations and care of the post operative patients.

Travel Directions: RDU to Entebbe

TEAM UNC Arrives in Kampala Uganda

17 team members boarded an airplane @ RDU Saturday at noon carrying 900 lbs of additional medical equipment and supplies. Sunday evening at 8pm (local) (1 pm EST) we arrived anxious to begin our mission. We stayed at a hotel outside Entebbe airport due to safety concerns of traveling at night and more importantly the recent riots in Kampala sparked by a disagreement between the the president of the country and a tribal king. We drove into the city early this morning, spending 1.5 hrs on the main road from Entebbe, then veering off to back roads for the final miles into the Capital due to gridlock. We have checked into our modest housing on the perimeter of the Mulago hospital complex. It will be our home for the next 10 days.

Our heavy/large equipment, which was shipped in August, has finally entered the country last night in the belly of our plane, but is still in the process of clearing customs. We need that equipment to proceed with our planned surgeries. We are hopeful the shipment will arrive by 5pm today. It will be a late night unpacking that shipment. We are all scurrying about reorganizing the pediatric cardiac ICU (4 beds) and stepdown unit (4 beds). Much of our organization system from previous missions remains intact. The OR team is unable to enter the OR now due to an adult esophageal surgery that is underway. We expect that operation to end soon and the OR to be transformed into a Pediatric Cardiac OR. Drs. Lwabi, Dorostkar, and I will begin the final screening of patients now. We have narrowed the potential pool to 12 to fill the 10 planned surgeries. Patients vary in age from 11 months to 14 years. Our new team members are quickly orienting to their new environment though jet lag is present in all.

We are still planning on having our joint cardiac surgery case conference this afternoon to review the patients. There's a lot to fit in today.

Repairing the Ugandan Children's Hearts

Our colleague, Dr. Craig Sable from Children's National Medical Center, has screened hundreds of children in the previous years. We have identified 17 patients for consideration for surgical repair, although we only have space for 10 operations on this mission. The cardiac lesions we will be repairing this year are ASD (atrial septal defect), a hole in the upper chambers of the heart, and VSD (ventricular septal defect), a hole in the lower chambers of the heart).

1 Mary N
2 Peter K
3 Oliver N
4 Asasire M
5 Joachum D
6 Atwib S
7 Anna Grace
8 Jovita K
9 Regan T
10 Hellen B

With Alternates:
A1 Joan O
A2 Faith K
A3 Fahad M
A4 Matovu Hussein
A5 Ethan K
A6 Jesse W
A7 Pheona A

Final determination will be made at the time of our last preoperative evaluation on Monday and Tuesday September 28-29.

A prayer card has been created by Samaritan's Purse (attached) for those interested in praying for the successful repair of these children's heart defects and our team's safety.

UNC Project Uganda Sept. 2009 mission

16 members from UNC will travel on Sept 26, 2009 to Kampala Uganda for the next Pediatric Cardiac Surgery Mission. We will continue our ongoing efforts to train Ugandan Health Care Providers (MD, RN, RT, perfusion, biomedical engineering) in treating children with complex congenital heart defects. Since our last mission in Oct 2008, our partners from Children's National Medical Center have returned in April 2009 and operated on an additional 10 children while advancing the Uganda Heart Program. The Ugandan team in-country has successfully repaired 3 additional children. We plan to operate on 10 children with increasingly complex heart disease while preparing the Ugandan Team to continue this work after our departure. We are again blessed by the generous support of Samaritan's Purse and UNC Institute for Global Health & Infectious Diseases.

Team Leader: Keith Kocis, MD
Pediatric Cardiac Surgeon: Michael Mill, MD
Pediatric Cardiac Anesthesiology: Gene Freid, MD
Pediatric Intensivists: Stacey Peterson Carmichael, MD, Parvin Dorostkar, MD
OR Nurse: Jenn Ditto, RN, PNP
Physician's Assist: Ruben Bocanegra, PA
Perfusionist: Greg Griffin
Cardiac ICU Nurses: Karla Brown, RN, PNP; Katherine Desrocher, RN; Diane Yorke, RN, PhD; Susan VanFleet, RN; John Bryson, RN; Julie Fields, RN; Jeannie Koo, RN, PNP.
Respiratory Therapists: Lupe Haynes, RRT; Sheila White, RRT.
Biomedical Engineering: Elizabeth Smith

A big day for Patrick

Our colleagues over at UNC Health Care have a new post with an update on Patrick's condition, as well as links to local media coverage of the heart repair procedure. Read it here.

Repairing the heart of an 18 year-old Ugandan here in North Carolina

Cross-posted on the UNC Institute for Global Health blog.

The institute’s UNC Project-Uganda has brought an 18-year-old young man, Patrick Kahuma, to UNC Hospitals to repair a narrow heart valve. They are inserting a balloon into the vProalve to widen it. In the U.S. and other developed countries, this procedure would have been done before Patrick turned 2. Patrick has lived with this heart defect for 18 years. He had to drop out of school because he couldn’t make the 6K walk from his village to the school.

He traveled to Chapel Hill with his aunt (he is an orphan) and an interpreter. The procedure is taking place now, and IGHID is live on Twitter during the procedure.

Read more about the story here.