Day 7: More Complex Surgeries - 'Necessity is the mother of invention'

On Friday, October 26, Niloo Edwards, MD, head of the division of cardiothoracic surgery at UW Hospital and Clinics, joined a Wisconsin delegation that journeyed to the Dominican Republic, there to spend a week providing free cardiac surgery to indigent residents in Santiago.
During his stay, Dr. Edwards and other surgeons operated on 11 patients, survived hurricane conditions and gained a greater perspective on health care in Latin America. The following is Day 7 of Dr. Edwards' blog of his experience. Return to Dr. Edwards' Blog: Day 1
Day 7: November 1, 2007
I give teaching rounds for the surgical and cardiology residents. Sara, one of the residents, translates. She has been helping the mission with since she was a medical student. She and Ivonne, another resident, are invaluable to the mission. They translate, help set up, find equipment, people and just about everything else to let us operate on the patients.
Bob presents the results of the Heart-to-Heart mission. In the 5 years he's been doing this, his teams have done 150 patients with only a 2.6 percent mortality rate. That is staggering, given how sick the patients are and how primitive the conditions are.
Bob Pascotto puts the rest of us to shame. We are occasional volunteers, but he established this program and brings groups to the Dominican Republic 3 times a year to continue his dream, even though he is unable to operate because of a back injury – a surgeon's work hazard.
Dr. Robert Pascotto presenting the Heart-to-Heart outcomes
PHOTO (above): Dr. Robert Pascotto presenting the Heart-to-Heart outcomes
Fritz has to tell his patient that her surgery has been cancelled because her white cell count has gone up even higher. She is distraught. Fritz is clearly upset too, but it is the best medical decision, no matter how we feel emotionally.

My patient for today also needs a mitral valve. Her valve is so scarred that I cannot get the smallest valve we have to fit. I have a sinking feeling: The patient's heart is open and I have no clear way to fix it. In desperation, I cut away all the valve attachments and part of the heart. This lets me fit the smallest valve in the patient. Necessity is the mother of invention.

The Wausau team winds up with another tough operation. The patient was to have an aortic valve replacement, but on closer examination in the operating room she also needs her mitral valve replaced. Despite the unexpected increased complexity the patient does beautifully, and we all get to leave early for the first time since we arrived.

Fritz graciously agrees to do Friday's operation, the 36 year-old man who needs a bypass. I am very grateful, since our team did not come with the necessary equipment to do bypass operations and we would have to go through the "garage" to find everything that we need.
The "garage" is the Heart-to-Heart storage area on the second floor of the hospital. Each team brings most of the disposable equipment they need to do the operations any left over equipment is placed in the "garage" for future use. This is clearly the world of misfit toys, and finding equipment let alone compatible equipment would take hours.

Non-disposable equipment like anesthesia machines, cardio-pulmonary bypass machines and the like are donated and used by all the teams. The most expensive component of the operation is the valves. This mission alone we have used over $75,000 worth of valves. We are fortunate that St. Jude Medical donated all the valves. Without that level of corporate support we would not be able to provide this service.
Go to Dr. Edwards' Blog: Day 8