Guayaquil, Ecuador

PEDIATRIC CARDIAC MISSION

Hospital del Nino Dr. Francisco de Icaza

Bustamante,Guayaquil, Ecuador

April 26th – May 3, 2025

SITUATION & MISSION OBJECTIVES:
On thisoccasion, CardioStarts International mission team made a return visit to the Hospital del Nino Dr. Francisco de Icaza Bustamante in Guayaquil, Ecuador on invitation by the hospital Administration, arranged by the Fundacion El Cielo Para Los Ninos del Ecuador. This was designated as a ONE-week mission, because the hospital administrative had suffered equipment and personnel shortages from the covid pandemic and their clinical situation in the hospital has only recently improved. A very large waiting list of congenital heart cases awaiting full evaluation and surgery had also developed making a further appeal for mission support necessary.
Among the equipment shortages was a complete lack of oxygenators and tubing packs used for the heart-lung machine to keep blood flowing during the heart procedure.The Children’s Hospital Dr. Francisco de Icaza Bustamante has had an illustrious history and years previously, had received gold level accreditation by Accreditation Canada International (ACI) on November 20, 2014, after meeting international health care standards of quality. It has struggled since to retain specialist services in some areas. The hospital has 442 beds, some modern equipment, as well as several clinical and surgical subspecialties. Services provided by the hospital include cardiology and surgery, 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 these facilities the hospital lacks the manpower and funding to support a full-time heart surgery program for children with congenital heart disease and often depends on visiting teams to receive the support for helping heart patients in need.

PEDIATRIC CARDIOLOGY:
The department is well organized and offers a high standard of clinical and echo evaluation, but there is no cardiac catheterization facility there. Patients have to be evaluated at another hospital which has a suitable Angio-catheter laboratory. The Echocardiographic department has been supported previously by several visits by Dr. Tom Di Sessa (representing CardioStart, and other humanitarian cardiac mission groups), and visits he has arranged on his own initiative. The hospital’s aspiration to remain a regional referral center is challenged by the severe budget constraints it is currently enduring which threaten patient safety and general operational standards of care. On this occasion, Dr. Tom Di Sessa led the evaluation of those patients who presented for cardiological assessment.
Cardiological, echocardiographic and general evaluations were provided for over 32 children drawn from the
community, arranged by Fundacion El Cielo.

SURGERY:
Inserting Tisgen pericardium, California, USA. Instruments donated by Scanlan Inc, Minnesota, USALocal surgeons, Dr. Montero and colleagues have been forced to recently reduce and almost completely stop doing surgeries because of major equipment shortcomings, including blood gas analyses, sterilizer units, insufficient ventilators and shortages in disposable products. Owing to these and other financially related constraints, some essential ICU nursing staff had been let go from the serviceThe local OR nurses previously assigned to cardiac surgery were also finding it very difficult to retain their specialty skill knowledge and proficiency due to the lack of cardiac surgical cases being scheduled. Those remaining were clinically supported by CardioStart nurses during the mission. Each CardioStart team member brought in ICU and OR disposables used during the mission. Patch membranes and Goretex tube grafts were donated to help suitable patients the operating list have the operation they needed. A dedicated local cardiac anesthesiologist had been appointed by the hospital and provided the essential cardiac care for the week’s operating schedule.

INTENSIVE CARE UNIT:
The Unit is supported by an excellent local Intensivist, who handled the admissions of all children requiring ICU support. The available ventilator status was limited – to one only, limited cases that could be completed. As previously found, the local ICU nursing staff were knowledgeable and their 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 this mission. The continual shortage of nursing staff and the unsafe workload placed on the few nurses within the unit remains a serious challenge to sustaining optimal results and has led to low morale. The available nursing and medical support at night was also substandard compared to previously.

EDUCATION:
All cardiology echocardiography evaluations were used as teaching opportunities and formal rounding and bedside teaching took place each day and during the mission. All ICU rounds were led by the local nursing team. Sessions were devoted to teaching nurses from ICU on principals of pediatric cardiac nursing care, and cardiopulmonary resuscitation techniques.

SURGICAL CASES ACCOMPLISHED:
Seven children underwent cardiac surgery utilizing cardiopulmonary bypass and despite the issues relating to supply availability, the procedures went well with no morbidity or death. Cases included Ventricular Septal defect, Atrial septal defect and Fallot’s Tetralogy.

PROGRAM DEVELOPMENT:
This mission is supported by 6 pallets of medical equipment including a heater-cooler (brand new) being sent and delivered by airfreight, including several medical equipment items of value for the heart program and items for the local clinic and outreach program.

CARDIOSTART VISITING TEAM:

ECUADOR
Dra. Zorayda Figueroa
(Executive Director, Fundacion El Cielo Para Los Ninos de Ecuador)
UNITED KINGDOM / USA
Aubyn Marath, Cardiothoracic Surgeon (CardioStart Mission Director)
UNITED STATES
Tom DiSessa, Pediatric Cardiologist
Barbara Ferdman, Intensivist
Rachel Debus, Senior Perfusionist
Sarah Ramadan, Perfusionist
Daniela Dinh, OR Nurse Instructor
Christine Lannon, Database coordination

ACKNOWLEDGMENTS
Several individuals and corporations supported our work on this mission and/or made generous in-kind and/or financial
donations:
Airlink Inc., Washington, DC, USA – assistance with logistical freight donations.
Americares Inc., Stamford, Connecticut, USA – donation of certain medications.
CardioStart Administration Team, Tampa, Florida, USA – management of mission administration & logistics.
CardioStart Resale Thrift, (Shari Maguire) Sisters, Oregon, USA. Database funding support.
Children’s Lifeline, Denver, Colorado, USA – funding support for specialist medications.
Dr. Farah Rahman, Horsham, Pennsylvania, USA. – Donation of hand-sewn surgical hats.
Dr. Dan Woodward MD (OHSU) – Assistance with certain specialist medications procured at cost
CSSD services, PeaceHealth Hospital, Riverbend, Springfield, Oregon, USA – re-sterilization of equipment.
J. Sanders. & J Crown, Sammamish, Washington, USA – financial donation in support of mission activity
Mr. Steven Yett. Provision of Warehouse storage facility, Eugene, Oregon, USA.
Mr. Mark Napoli, Perfusion Services, Mount Laurel New Jersey, USA. – – donation of perfusion supplies.
Ms. Carrie Ochocki, Perfusion Services, Brecksville, Ohio, USA. – donation of perfusion supplies.
Ms. Sarah Ramadan, Perfusion Services, Denville, New Jersey, USA – donation of perfusion supplies.
Pape Rental equipment, Eugene, Oregon, USA – assistance with container loading.
Scanlan Inc, St Paul, Minnesota – donation of exclusive surgical instruments
The Amy Lauth Foundation, Roanoke, Virginia, USA – support for freight logistical cost.
Tisgen Inc., California, USA. – donation of Pericardial membrane.
United Methodist Church, Lake Oswego, OR, USA. – donation of Children’s patch doll gifts.

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