For the long update on the trip, I decided to just give you the play-by-play I typed to my family while I was there….
Date: Wednesday, October 26, 2005
Subject: Woohoo from Mongolia!!!
I am typing in a state of exhaustion and relief. We did the first pediatric cardiac bypass case in Mongolian history today!!! And the child is doing very, very well!! Praise the Lord! I cannot even come near to explaining how this week has gone. Our container of supplies, including the anesthesia machine and cardiac bypass machine and LOTS of other important stuff, did NOT arrive!!! We now see this has been totally in God’s providence. Our goal was to do 10 ASD (atrial septal defect–hole between the 2 collecting chambers of the heart) cases starting on Monday. Well, given that we didn’t have our equipment, the Mongolian physicians invited us to observe them doing two of their hypothermic cardiac arrest cases on Monday. This is when they literally wrap the child in ice, wait for the child to cool, stop the heart, and operate as fast as they can. I think all of us were completely nauseous watching the whole thing. It was a completely heartwrenching, frightening experience!!! One case, a 27-year-old, survived. The other, a 3-year-old, did not. That’s about their mortality rate: 50%.
Meanwhile, in the screening, Kirk had been coming across a lot of other kids who we could really help with different types of surgeries. So, we went back to the drawing board figuring out what we could do with their supplies and what we brought along with us. For the cases we watched on Monday, they used an antiquated Russian anesthesia machine with ether anesthesia. I’ve only read about ether anesthesia historicallly. It is no longer on our boards!! So, after we watched these horrible cases, their surgeon’s were really pushing us to do some other cases. Plus, we were considering some other cases we really wanted to do. We want to do cases where the benefit outweighs the risk, meaning they are likely to die if we don’t do the surgery…or they’ll die if the Mongolians do their version…or we can’t get them on the Children’s Heart Project list to get them accepted in the U.S. I admit I was completely freaked out Monday afternoon and thought there was no way I could safely proceed!!! I needed a little alone time and some good debrief and prayer time with some of the wonderful people on the team, including, of course, my wonderful husband. I figured out how I thought I could safely do things my way. I was so freaked out because I thought there was no way I could safely do things their way!!
So, we did two non-bypass cases on Tuesday. I told the team I would go set everything up and see what I had and would not proceed if I did not feel it was safe. I cannot tell you how nervous I was starting that first case!!!! Lots of prayer and tears (I kept getting all this amazing confirmation that all would be OK that made me cry) getting there!! But, hallelujah, both kids did really well. I was able to extubate (remove the breathing tube) both of them in the OR, which is a victory. So, I was feeling a lot of relief going into today. But, today we did our first bypass case. Our perfusionist (who runs the bypass machine) was feeling the stress I was feeling yesterday. He had the same criteria. He’d set it up and if he didn’t feel safe he would not proceed. Well…we did it!! And that child was extubated within a half-hour of arriving in the ICU…another victory. I cannot even tell you the relief!!!!! Kirk told the team way back in Feb. that we would plan and the Lord would likely blow all our plans and make us totally rely on Him. Well, that is what has happened!!!The director of Samaritan Purse’s World Medical Mission is here and his morning devotion before we did the first cases yesterday was about the Lord being personal, a provider (ohmygosh has He provided just exactly what we need…and no more!), a protector (He would keep us out of trouble), and powerful. From what I have witnessed in the past 2 days, I cannot tell you how true this is!!!
Date: Friday, October 28, 2005
The Lord continues to miraculously intervene. We successfully did 2 pump cases and one non-pump case yesterday. All 3 kids were extubated within an hour of arrival in the ICU. More woohoo! I think everybody sees it and feels it. Kirk said I feel like it’s a failure when they wake up crying (because I want them to be comfortable and not in pain!), but everyone else is so excited to hear them crying! Especially their parents. You should see their tears of joy and relief!
Today is a big day. We are going to do a baby that will absolutely die if we don’t do surgery…but who is so sick he might not survive the surgery. His father has been driving us around the whole time we have been here because he has wanted to serve us for what we are doing. He and his wife understand the risk of the surgery…but they understand the absolute risk if we don’t do it and want us to proceed. Please, please pray! Another child is 13. He is the son of the man who owns the 2 vehicles that they have been using to drive us around. He is at risk of sudden death if he doesn’t have surgery. The last is a little baby. Littler patient, bigger risk. Only one case is a pump case. We had just enough equipment to set up one more pump case and no more. It is truly amazing to see God direct our steps. We feel like it’s like the widow’s flour and oil…it lasted just as long as the famine lasted and then dried up. We keep opening suitcases and finding what we need. And I bet when we’re done, the supplies will be gone.
The Mongolian surgeons were going to do another hypothermic circulatory arrest case today. Kirk and Dave (Kirk’s partner) saw the patient…and said he doesn’t even need surgery!! Thankfully, they cancelled the case. That is another prayer of ours. The risk of their surgery is so, so great. It’s even more heartbreaking to think they are putting kids at risk who don’t even need it. Kirk and Dave and John (our surgeon) have been working valiantly to try to help them improve their diagnostic skills and figure out who really needs surgery. Kirk and John are meeting with the Minister of Health for Mongolia today to try to get them to start funding the supplies for the pumps for the children who need heart surgery in Mongolia. That’s the whole problem. They have pumps but no appropriate supplies for doing peds pump cases. And the doctors and hospital only get $5 per case. I honestly think they don’t want to hurt these kids. They’re doing the best they can with extremely limited resources. So, prayerfully, I’ll have a good report tonight!
Date: Saturday, October 29, 2005
Today’s is a mixed report. Bottom line is we did 8 successful surgeries this week and have 8 kids doing very well and 8 very happy families. I don’t know if I’ve ever been so tired! The director of the hospital and the surgeons hosted us for a nice dinner last night. I was so, so tired I had a hard time rallying to get there, but I’m glad I did. We were showered with presents from them…and 2 of the families of the kids we treated showed up with more presents. Truly, truly humbling. I came home and slept like the dead. First night since we got here that I didn’t wake up in the middle of the night thinking about what was before me. It’s a really good tired though. I get tears in my eyes just writing and thinking about it.
We’ve staffed the ICU every night this week. Kirk’s partner Dave and one of the nurses were there last night. So, Kirk, another nurse, and John the surgeon got up this a.m. to go relieve them…and hopefully send the kids from yesterday out of the ICU to the floor. They were both extubated early after surgery too and all the rest of the kids have been able to go to the floor post-op day 1. Then the surgeons want to take us to the countryside. So, its a nice day to relax a little and reflect before we get on the plane tomorrow.
I said it was a mixed report…we didn’t get to do the child who will most definitely die without the surgery. It has a lot to do with politics and circumstances that are not worth getting into, but what an incredibly hard decision! It’s a chance for a lot of us to see what Kirk has been seeing for 5 years. He’s had to tell countless families there’s nothing we can do. Sounds strange, but I’m happy for him that there are many more of us who are experiencing it and can share the emotional burden with him.So, anyway, much progress made. Much more to be made. Kirk said the meeting with the Minister of Health was just ceremony. No real progress on policy there. But, after 9 trips, it was at least a meeting with the Minister of Health. It’s easy to get discouraged with how far there is to go…but we’re trying to keep focused on how far we’ve come. There’s that parable in the Bible about the shepherd leaving the 99 sheep for the one. We came halfway around the world for eight. That’s pretty remarkable.
To God be the glory. Great things He has done.
Oh, yea, the container arrived today. I think that was God’s humorous exclamation point on the week. He wanted us to do all in His strength, not our own. Another oh yea: I can’t tell you how many things we used the last of on the last case! On the last case, the blood warmer on the pump failed. We were able to get the patient just barely warm enough. After he was off pump, the oxygen line to the pump broke. Truly amazing! We did so many creative things to get this all accomplished, I think my skills must have grown exponentially. I will be so appreciative to do my job in the U.S. now!!!
Thank you so much for praying and supporting us!
Dr. Kim Milhoan, President, For Hearts and Souls