HOSPITAL DEL NINOS
Lima, Peru
May 20-28th 2017
In May, 2017 a CardioStart pediatric cardiac team returned to the Instituto Nacional de Salud del Niño (Children’s) Hospital, Lima, where we had assisted previously OVERA PERIOD SPANNING 20 YEARS, to continue development of the Pediatric Cardiac Development Programs.
There remain a large number of children needing evaluation; for several regions, particularly in the interior, tertiary evaluation is still not possible at the moment. The healthcare need continues to be a pressing requirement. Around 50% of the people of Peru live in poverty; preventive healthcare is limited, as is also, the pre- and post-natal care available for expectant mothers. Those with cardiac problems, therefore, may not survive long. Those who do survive may not necessarily be diagnosed and successfully placed on a waiting list. The families and the healthcare ministry often do not have enough funds available to provide full care for the indigent and this group is often only able to provide assistance with the help of occasional international visiting teams.
This mission, the 13th to Peru spanning 20 years, focused on advancing surgical, anesthetic and nursing care practices to improve outcomes for children currently being operated there.
Most of the features of general cardiac care were in place in the hospital, and in some areas, excellent care was available. The frustration of the local team is in taking on more complex cases. They continue to struggle with a lack of some equipment and disposables. A team of 12 volunteers joining from 5 countries arrived together at the Hospital to assist with diagnosis and management of patients being presented for surgery.
CardioStart volunteers brought some very valuable donations to support the OR, PICU and Interventional Cardiology programs.
SURGICAL CASES ACCOMPLISHED
| NAME | AGE | PROCEDURE | OUTCOME |
| A.S.S. | Closure of VSD & Repair of Stenotic pulmonary valve | Satisfactory | |
| A.T. | Aortic Stenosis – resection of sub-aortic membrane | Satisfactory | |
| C.A.F. | 2yrs | Re-closure of residual VSD; repair of tricuspid valve | Satisfactory |
| E.G.R. | 14mths | Repair of secundum ASD with PAPVD of the right pulmonary vein | Satisfactory |
| A.C.C. | 6yrs | Repair of aortic and mitral valve disease (initially, satisfactory, but died after MV repair sutures separated requiring emergency 2nd op | Died |
| J.E. | 11yrs | Closure of sinus venosus ASD with re-direction of PAPVD | Satisfactory |
EDUCATION
Surgical teaching in the Operating room took place each day, supporting the surgery itself and OR management. No anesthetic or perfusion teaching was necessary as the local perfusionist is already expertly qualified, and the anesthesiologists were experienced and well organized in pediatric cardiac case management.
In the ICU, The team volunteers applied Cardiostart’s mission of side-by-side education in every area assisted. Education sessions included: hands-on Basic Life Support/CPR, Alarm Fatigue in Critical Care, and Arterial Blood Gas Analysis.
2017 CardioStart Team Members
Rick Burian RN: Nursing (Portland, OR, USA)
Nicole Burnham RN: Nursing (Vancouver, BC, Canada)
Renata Cassar MD: Cardiology (San Paolo, Brazil)
Andrew Cochrane MD: Surgery (Melbourne, Australia)
Matthew Fondriest: Nursing, OR (Denver, CO, USA)
Eliana Morla Chiong Kongfook: Coordinator (Lima, Peru)
Lynn Leslie RT: Respiratory Therapy (Phoenix, AZ, USA)
Aubyn Marath MD: Surgery, (Portland, Oregon, USA) Mission Director
Jessica Ribar: (Database) Sarasota, Fl, USA)
Kaelin Schickedanz: Nursing (San Diego, CA, USA)
Sarika Steinhaus Nursing (Seattle, WA, USA)
Jennifer Timberlake: Nursing (Salt Lake City, UT, USA)
Acknowledgements: A number of individuals and corporations made generous in-kind and financial donations. CardioStart gratefully acknowledges the specified support of the following:
- Amy Lauth Foundation – support for hand-carried suitcase packages.
- Oregon Health & Sciences University Pharmacy Department, (Portland, OR, USA) – discounted medications.
- All Children’s Hospital (FL, USA) in-kind donations.
- Peace Health Hospital, Springfield, OR – in kind donations.
- CorMatrix Cardiovascular Incorporated, pericardial membrane material donations.
A full summary of educational activity, observations and PICU management recommendations is available, on request.
Aubyn Marath MBBS MS FRCSEd ATLS
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