Hospital del Nino Dr. Francisco de Icaza Bustamante, Guayaquil, Ecuador
A CardioStart mission team made an inaugural visit to the Hospital del Nino Dr. Francisco de Icaza Bustamante in Guayaquil, Ecuador on invitation by the hospital and the Fundacion El Cielo Para Los Ninos de Ecuador.
The Children’s Hospital Dr. Francisco de Icaza Bustamante received gold level accreditation by Accreditation Canada International (ACI) on November 20, 2014, after meeting international health care standards of quality. This is the first hospital in Ecuador and Latin America to receive international accreditation; it was recognized as one of the first medical units to meet international standards of quality care and services provided to its citizens. The hospital has 442 beds, modern equipment, as well as several clinical and surgical subspecialties. Services provided by the hospital include cardiology, endocrinology, genetics, dermatology, gastroenterology, nutrition, hematology, oncology, infectious diseases, nephrology, neurology, pulmonology, neonatal intensive care, intensive care unit, pediatric outpatient palliative care unit, pediatric gynecology, and emergency medicine.
Despite this quality facility the hospital has historically lacked the manpower and funding to support a heart surgery program for children with congenital heart disease and depend on visiting teams to receive the support for helping heart patients in need.
Pediatric Cardiology
The department led by Dr. Antonio Fernandez is well organized and offers a high standard of clinical and echo evaluation. This department has been supported previously by several visits by Dr. Tom DiSessa (CardioStart, USA), while representing other mission groups, and on his own initiative. His support of the department has led to the efficient admission, evaluation and preparation of patients who can be managed medically and those who are screened for surgery. Other facilities are still lacking and need better financial investment for this department to reach its fullest potential. The hospital’s aspiration to become a regional national referral center is realistic and well thought out. Full financial commitment to staff levels, equipment development is clearly needed.
Cardiac Surgery, Perfusion and Anesthesia
The surgeons, led by Dr. Montero, provide an excellent standard surgery, a similar standard in peri-operative care; they accomplish this despite several shortcomings in equipment and regular shortages in vital disposables. Regular staff support during the operative day and night cover to permit more complex cases be taken on, are simply not available. These surgeons, anesthesiologists and perfusion staff come from another hospital location to support this developing program. The anesthetic and perfusionist specialists do support the surgical procedures but are generally committed to another hospital. This must be changed with salaried support for caseload numbers and complexity to be taken on in increasing numbers. During the mission the following cases were carried out, in which the local surgeons (Dr. Montero’s team) undertook the role of primary surgeons throughout.
The nurses assigned to cardiac surgery were excellent and will need strong support from their OR department to continue their specialist skill knowledge and efficiency. The development of safer sponge counting was introduced, separating those used for IVs, cleaning, preparing the patient from those for use on the operative field. Additional educational advances were in ensuring sterile procedures prior to patient transfer at the end of the cases.
SURGICAL CASES ACCOMPLISHED
M/F
PROCEDURE
F
VENTRICULAR SEPTAL DEFECT CLOSURE, PDA LIGATION
F
TOTAL ANOMALOUS VENOUS CONNECTION REPAIR
F
ATRIAL SEPTAL DEFECT CLOSURE
F
ATRIAL AND VENTRICULAR SEPTAL DEFECT REPAIR
M
ATRIAL SEPTAL DEFECT CLOSURE
F
TETRALOGY OF FALLOT REPAIR
F
TETRALOGY OF FALLOT REPAIR
M
TETRALOGY OF FALLOT REPAIR
M
DEXTROCARDIA – SEVERE LV HYPERTROPHY-BOVINE HEART/MYOPATHY; AORTIC VALVE STENOSIS-REPLACEMENT
ICU
The nursing staff in the Cardiovascular ICU at the Hospital del Nino Francisco de Icaza Bustamante were knowledgeable, friendly and eager to learn. Their previous knowledge and eagerness to learn enabled them to develop great assessment and critical thinking skills to care for the very ill postoperative cardiac surgical patients during the course of the mission.
The major limitation we observed was the continual shortage of nursing staff and the unsafe workload placed on the few nurses within the unit. At times a single nurse was expected to care for and assess 3 critically ill children. This is a ratio that prevents the provision of safe and effective care and is something that should be changed to ensure that post-surgical children receive the care they require.
Education
All cardiology echo evaluations were teaching opportunities and all intra-operative teaching by the CardioStart volunteers were conducted entirely as teaching cases. Formal rounding and bedside teaching took place each day and by the end of the mission all ICU rounds were led by the local nursing team, supported by the local surgeon, cardiologist, and respiratory therapist.
CardioStart Team:
CANADA
Kate Earley RN, PICU Lee Malcolm RN, PICU Lynanne Mason RN, PICU
ECUADOR
Dra. Zorayda Figueroa M. Psych Ecuador (Executive Director, Fundacion El Cielo Para Los Ninos de Ecuador)
Dr. Renzo CiFluentes MD, Mission Coordination (Medical Director, Fundacion El Cielo Para Los Ninos de Ecuador)
SPAIN
Alberto Martinez Telluria MD, Anesthesia Elena Serrano MD, Anesthesia
United Methodist Church, Lake Oswego, OR, USA) (Children’s doll gifts)
Robb Wilson, Wilson Medical Specialties – suture equipment donation
Dan Woodward (OHSU) Medication procurement at cost.
Countries represented in this photo: Spain, Canada, Ecuador, Venezuela.
SUPPLEMENT: Additional Observations and Recommendations, regarding specific clinical areas of importance to develop or change are available on request.
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