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2017 Mission Trip - Dominican Republic - The Heart Hospital Deaconess

The Heart Hospital Mission Blog

Dr. Lee Wagmeister of The Heart Group, joined by colleagues from The Heart Hospital, will journey to the Dominican Republic to spend a week performing heart valve surgeries to indigent residents in Santiago. The
trip, scheduled for April 21-30, is with the Heart-To-Heart Mission organization. The following is the journal of his experience.
 


Healing Hearts Around the World 2017

Deaconess Gateway Conference Center - Rooms A, B, & C

Tuesday, June 20, 2017 @ 6:30 PM

Join us for a Community Forum as Dr. Lee Wagmeister and our Heart Hospital Team share clinical and life experiences from their recent mission trip to the Dominican Republic. Brad Byrd, Anchor for WEHT TV will be the emcee for the evening. 
 



Wrap-Up

A Beach Trip, Traveling, and No Good Deed Goes Unpunished

As quickly as it all began, just as quickly it has come to an end. Overall we did 7 complicated surgeries but changed many more lives both at home and abroad. I do wish we could have done even more but it is what it is.
 
In those first few days I wondered about the future of Dr. Bob's Heart to Heart Mission, with the hiring of several heart surgeons in the city. After talking with some of the physicians there, I came to have a better understanding of the medical system in the Dominican. Then seeing the extensive poverty in the city, and even more in the countryside, I believe the need will remain great and that these mission trips have a role for years to come. Time will tell. 
 
Team building among our team and between the two surgical teams was evident our last day. The friendships made are sure to last for a long time. In prompting a final adventure together, Cindy, the surgical scrub for Dr. Harville, commented to Dr. Bob: Sometimes when you work hard occasionally you can play hard.

 

 
We traveled 2.5 hours one way to have a day at the beach, going through areas where our last patient is probably from. There were tin-roofed huts with no electricity nor comfort amenities that we take for granted. I know that this is true in many parts of the world but I see why the need will still be present for years to come for the Heart To Heart Mission. 

 

 
Sunday was a day of travel home. This was the most difficult day of our trip. Unfortunately, one of our members had their passport probably stolen at the last minute causing much angst and concern. This team member is fortunately back in the U.S. and will be home late Monday morning. The rest of us had another flight canceled again from Dallas. We flew to Louisville arriving at midnight and drove home. No good deed goes unpunished. Fortunately we made it home with everlasting memories. 
 
The work done in the Dominican was so important that when life events at home occurred, team members were able to remember why they were there. Things missed included a kindergarten graduation, a loved one being hospitalized, a birthday, children’s illnesses, a family vacation, and other events planned or unplanned. So on that note, I want to thank the families of my team. They also gave up much for each member of the team to go. The support at home to encourage each member allowed them to participate and focus on their role in this rewarding mission. 
 
Again, our community has the right spirit--understanding that we all have so much, and to give a little goes a very long way. I'm proud to be a physician at The Heart Hospital at Deaconess, and proud of this team that wants to give from the heart also. Thank you to my team and their families. Lastly, thanks to all of you for indulging my thoughts and observations over this past week. 


Friday, April 28, 2017

Tears of Joy and Goodbye

Today is the last day that we will see our patients, and all are doing well. Yesterday's patient started to cry as soon as we came into the room. Kelly was in there first to say good morning and the tears that followed from both the patient and Kelly were genuine.  

 


As others entered the room, more tears followed. It was hard to get a picture with the patient without anyone welling up just a little bit—or a lot. We then go see the next 3 patients and the same scenario keeps repeating itself.

 


The true gratefulness of what we as a team have done here has not and will not go unappreciated. Patients are overwhelmed by their experience and the new futures they have to look forward to.

This affection we have for our patients and the love and faith they have in us goes beyond anything one could imagine and it keeps happening for every patient. Their lives have changed! Just as important, our lives have changed!

It should be noted that it wasn’t just tears creating all that water--we had a river of water pouring from a ruptured pipe down the back stairwell of the hospital as we left the conference earlier. The hospital was even crying about us leaving! Then, back at the hotel, the skies opened up and a short monsoon of a rainfall came upon us and flooded the lobby of the hotel. The skies of the Dominican were also crying with us.

I had the privilege of being an honored speaker for a short talk in front of several of the medical staff. Most were cardiology residents, surgical residents, internal medicine residents and medical students. I thank Dr. Bob for asking me to talk. Of course, I had to do it a little different than anyone else in the past. Usually, it's a slide presentation and talk; I decided to make it into a didactic discussion with audience participation without slides, with Rommel translating. I think it went over well, as we talked about how to reach patients by explaining aortic valve disease in terms that they would understand. Even when the patient goes home, I want them to be able to explain and repeat what the doctor told them in non-medical speak. By explaining things in simpler terms and not book terms, patients are more likely to connect with the physician and follow the recommendations. That was my true message and I hope that I was able to convey it. The talk seemed to go over well.

 


I learned the next mission trip is in the fall, with teams coming from New York City and Boston. As I understand it, the teams are coming without as much equipment and materials; also (again, as I understand it) we were the first and only team to be essentially self-sufficient for every aspect of this mission except the lodging. (If anyone reading this blog knows otherwise, please let me/us know.) Before leaving, we donated our ample extra supplies so the next mission trip will have plenty to work with even if they bring nothing. We gathered and donated everything from operating room materials, to medications and home/hospital support. This has never happened before to this extent. Throw on top of that the superior job of showing what a small community can do both in terms of support and medical competence compared to bigger metropolitan locations is impressive. To say it simply, The Heart Hospital at Deaconess ROCKS!

Lastly, the hospital and supporting staff gave us a going away reception. It was nice to say goodbye with a little Dominican dancing and again much food. End to a perfect day.

Ultimately, it's worth repeating: Their lives have changed! Our lives have changed!
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Note:  Saturday and Sunday are travel home days, so a final wrap-up blog will be published on Monday.

 


Thursday, April 27, 2017

Team Unity

For Thursday’s surgery, our last one for this trip, we operated on a gentleman with a wide open aortic valve and impaired ventricle. Since the other team’s operation got canceled, today was a unity building day for the two groups. Dr. Harville and I did the final operation together and were supported by both teams. I learned much from him and will be bringing home some new ideas which we will probably implement at The Heart Hospital. He may try some surgical techniques that I use for my valves when he returns to his home hospital. It's nice to learn from others, especially in a real life setting, and goes to show that you can always improve.

  


After finishing this case, our surgeries were complete. With our remaining time in Santiago, we will provide post-operative care for our patients and continue to work with the medical staff at the hospital. I have realized that the medical staff here has a long way to go. They have unity but lack experience and direction. They have great motivation but need to focus more on attention to detail. Maximizing patient outcomes is not just a successful surgery but what happens afterward in the ICU and on the patient floors. Many times a missed detail goes unnoticed but it only takes one small detail missed to have a catastrophic result. Our job here is to teach, educate, and reinforce. It’s difficult to change processes with a visit every six months but hopefully with time, the surgeons here will take the reins of the ship and use the knowledge and skills we’ve shown them to enhance the care they provide. That will be the turning point for excellent results.

 

 


Wednesday, April 26, 2017

"Wow! That Worked!"

It seemed that everything we did today went right. When you are dealing with patients this sick, being able to say that is, in itself, amazing. Our Wednesday patient was a nice young lady who told us that the most she could walk was 10 feet before she became winded. She wanted to feel better. As we began surgery, it became clear why she ran out of breath so easily. Two of her heart valves leaked like the worst kitchen faucet you’ve ever seen. At least two of my fingers could fit through the spaces in this one. Additionally, her mitral valve was very tight. In essence, it was a small blow hole not opening or closing like it should. Thanks to the great work by our team, we were able to address these issues and I know that by tomorrow, this lady will be breathing better than she has in years.

 

 
After the case, our team ventured to the atrium/lobby for ice cream. A stranger approached us when he heard us speaking English. It turned out he is from Los Angeles and is here to help care for his father who is scheduled for kidney surgery. We spoke with the gentleman about our mission program and the surgeries we are doing at the hospital. He does not know us but expressed genuine thanks and gratitude for our dedication to come from Indiana and do what we are doing. While we were still in the atrium, the family of our second team's patient from yesterday recognized the group and made it a point to come over and greet us. They thanked us many times over, even though it was the other group who did the operation. They were just happy that we all came here from afar and that we care.

 

 

 
One of the many lessons I have learned and continue to learn is that while we may only be doing a few operations, the impact we have on these patients and their families is enormous and cannot be overstated.


Tuesday, April 25, 2017

Making A Difference Day

Today was day 2 of surgery, with 2 surgeries! Our team repaired an ascending aneurysm and replaced an atrial valve.  

Our mitral valve patient from yesterday is doing fantastic. She’s the woman shown with the heart shaped sternal pillow. She and her daughter requested help with a note on her sternal pillow and with translation to communicate with everyone to tell us how she is doing. She was also getting ready to get up for some walks in the halls. 

Here’s a note from Jessica: I ended up crying today after visiting our patient from yesterday. We can’t communicate verbally, but she was rubbing my hand and then kissed it and pulled me in for a hug.  I couldn’t contain my emotions from how grateful she was.

Isn't this what it's all about?
 

 

Our second patient is a young gentleman with nearly a 6 cm aneurysm and a bad valve. We repaired and replaced everything. The patient’s aneurysm took up more than half of the pericardial space. Shown in one of the photos below is our team showing the patient his before/after photos of his aneurysm.

Ricardo, the local cardiac surgeon, assisted for a good portion of the surgery again having limited experience with all of these various surgeries. He continues to be a pleasure to work with.

 

 

Yesterday, Jessica came up with a team saying… every time something was a little different: "I have not seen this before." Today's saying was, "That did not go as planned." Fortunately the surgery itself went without a hitch with only minor variations in the plan as we went along. While each day is becoming a little smoother, each day the surgery gets more complicated.
 
Amazingly, each operation today was done without swan (an intensive monitoring device), minimal post-op pain meds, and each patient was extubated minutes upon arrival to the ICU. Our ICU nurses took these changes in normal routine in stride.
 
Ashley and Tammy have used compassion and skill to penetrate the language barrier and care for the patients while educating staff and family. Despite all of our modern medicine, there is something to be said about simplicity with identical results.
 
In just a few days, I learned something I already knew but has been reinforced each day. We have a great team at Deaconess Heart Hospital and I am proud to be part of it. For the difficulty we face, the other team here from Knoxville has expressed many times how super prepared our team is from day 1. The skill set is obvious, with organizational skills that I would put up against any surgical team in the country. Deaconess Heart Hospital and I are blessed with these individuals’ skills, and devotion of time and effort to this endeavor.  Selfless and skilled.....a great combination.

 


Monday, April 24, 2017

Get-To-Work Day

Today is get to work day. While the weekend was busy getting the OR and other areas ready for surgery, today we begin operating.

We may only have one case per day but each day it will get progressively harder. In many ways, it would very difficult to do 2 per day. We have to start from scratch each morning in prepping the patient--there are no IV's already started, for example. There are many reasons to delay the incision but it is what it is.

While it looks like an operation at home, from the start little things that are NOT typical at home seem to happen here, like the sternal saw falling apart mid-incision and before that, not even having a motor to power the saw. It was gone. As you can see in a photo Jessica, our perfusionist, had to place part of her bypass machine on the floor as the tubing would not reach—we adjust, modify and deal with whatever comes our way.

We also don’t have any computers for charting—it’s a throw-back to see staff holding clipboards and paper.

The temperature control device for the patient while on bypass failed so we had to cool the lines by running through an ice bucket and then heat water in a microwave and run the tubing through the hot water to warm the patient. Overall, no real catastrophes, just good old ingenuity. 

   

The patient was a 56 year old woman with mitral stenosis. We retrieved a golf ball worth of clot from her atrium. The valve was so tight only one of my fingers would fit through the valve. All of this are the effects of long-term rheumatic valvular disease. How someone lives like this I cannot fathom.

There is a young new cardiac surgeon, Ricardo, hired at the hospital. He is only doing a few cases per month and only coronary surgeries at the present time. He actually assisted me for the majority of the operation to learn more about how to do mitral valve surgery--especially the different techniques he has only seen infrequently in the past. He seems very capable and with time and experience, he will be a very good addition to this community.

In the ICU, the patient was almost immediately extubated upon arrival. Pain medication consists of ibuprofen and Tylenol only. A half-hour after arrival in the ICU she is awake enough to ask for water and say thank you to everyone. Her family is shown below, relieved that all went well.

Finally—Dr. Fish’s “touchdown” below summarizes how we all felt at the end of the surgery:  Victory!  Successful surgery, and no complications.  

  


Sunday, April 23, 2017

Meet the Patients Day

Today is “Selection Sunday.” It’s the day we find out how many patients we will have during our visit and the details of each case. We learned that the number of patients ready for surgery is 1/2 of what is normally available. Instead of doing 14 to 16 patients, we are only going to do 8. That’s because the Dominican Republic recently changed their policy on heart care and will now pay for heart surgery, including physician and hospital expenses. Due to this change, several heart surgeons have been hired and the straightforward CABG and valve surgeries have been done prior to our arrival. Only the sickest, most complicated and high risk patients were saved for us. This is good for the people of Santiago, but limits the number of surgeries for us to do.
 

We spent most of the morning going over the patient list in a group setting. The cardiology residents from the local hospital for the less-fortunate presented the list of patients. They did an excellent job of giving the information about each patient. The patients range in age from 28 to 70 and all have rheumatic valvular disease. Many have had valve disease for so long their heart muscle is weakened. There are several double valve procedures and one case is a redo operation from a different mission trip several years ago of a double valve where one of the valves is leaking. None of these operations will be easy, but they are desperately needed.

 

After learning about the patients and their cases, we had the opportunity to actually meet each patient and one of their family members. We were able to ask questions and have them ask us anything. It didn’t take long for our team to realize just how much we could change these patients’ lives… for the better.

The rest of the day was spent deciding on the order for surgery and what team members would handle which cases.

A couple of interesting things to mention include the amazing view of the city from our operating room. No one can seem to get over having an actual window inside an operating room. We are also excited to have a young cardiac surgeon from the D.R. observing our surgeries and maybe scrubbing in. He recently completed training in Brazil and wants to practice in his own country. If we can help train more young doctors during our trips, the need for international assistance should decrease. 

 


First day in the D.R.

Saturday, April 22, 2017

Here we go! The team arrived at the hospital on Saturday. Our goal for the day was to take an empty operating room and ICU and transform both into a cardiac operating room and ICU recovery room. There were 49 boxes of supplies to move from the 7th floor to the 12th floor where the operating room and ICU are located. All of the boxes and much of the cardiac equipment were stuffed into one room and piled from floor to ceiling. We had to tear down and rebuild the heart-lung machine.  We set up instrument trays in a mostly dark room. We discovered that the monitoring lines we brought from Evansville will not communicate with the monitors in the room. We placed a high value on the few screwdrivers available and used them to fix or adjust equipment. Dr. Fish made necessary adjustments to the anesthesia machine through non-conventional methods and may now be called Dr. MacGyver. 

The people we’ve met are wonderful and helpful and the hospital treats us like members of their staff. They even feed us lunch! Today it was chicken and rice with a salad. We really needed that fuel to finish our transformation task! By the end of the day, our team and the others who joined us in the Dominican Republic successfully created a fully functioning cardiac surgical suite! We couldn’t have asked for a better first day and are now ready to handle whatever is thrown at us!


This evening, after setting up our suite, we went to a private home for dinner. Dr. Bob Pascotto and his wife, Joan, are the leaders of our larger group and have been involved in this mission work for 15 years. During that time, Dr. Bob became friends with a lady known as “Mama Sarah.”  Mama Sarah worked with the first mission team years ago. She assisted the hospital with facilitating the things needed by the visiting teams. It didn’t take long for Dr. Bob and his group to discover that she also has a local catering service. Thanks to her delicious cooking and friendship with the team, it has become a ritual to enjoy Mama Sarah’s hospitality during each visit. We were also excited to learn that Mama Sarah’s daughter, also named Sarah, is now a neuro-radiologist in Florida. Sarah was a medical student when we first met her!

 


Pre-Trip Post:

Dr. Lee Wagmeister, cardiothoracic surgeon with The Heart Group, will be traveling to Santiago, Dominican Republic, April 21-30, 2017 as part of the Heart To Heart Mission  http://heartmission.com/   
 
Dr. Wagmeister will be joined by the following colleagues from The Heart Hospital on this life-saving mission trip:

Dr. David Fish

Anesthesia

Jessica Edwards

Perfusionist

Kelly Talbott   

OR Team Leader

Rebecca Wonning

OR Lead Certified Surgical Technologist

Melissa Bradley  

OR Certified Surgical Technologist

Tammy Hildebrandt  

THH ADON/ Staff Nurse RN

Ashley Mellott   

THH Staff Nurse RN


The operations will take place at Hospital Meropolitano de Santiago.  This 400 bed public hospital cares for indigent patients and serves a population of 4.2 million people.  There is no cardiac surgery in the region for private or non-paying patients. 
 
The team is prepared to perform heart valve replacement surgeries on 10 patients in 5 days.  When not treated with antibiotics, rheumatic fever can result in rheumatic heart disease, which is almost non-existent in the US but very common in less developed countries.  These patients are typically young adults in their 20s or 30s with very poor quality of life, as they’re unable to work or provide for their families.
 
A trip of this scope requires months of planning and many thousands of dollars in funding.  The Heart Hospital at Deaconess Gateway and Deaconess have provided medical supplies and approved absences for clinical staff.   Abbott Vascular has provided the needed heart valves for the operations.


Preparing for a medical mission trip starts months in advance.  Dr. Wagmeister’s house/basement was the initial staging and sorting area for the medical supplies that have been sent ahead.