Children’s Hospital International Services

Maria Jose de Gallardo, the program director for Guatemala at The Shalom Foundation got to catch up with Joseline, the cherubic toddler who had a massive growth removed from her neck here last summer.

When de Gallardo first met Joseline during a medical mission trip, she learned Joseline had the growth since birth. Sacs filled with lymph fluid grew steadily over the years until the growth was so large it began to affect her ability to eat, play, and sometimes even breathe normally.

“It had become so heavy that when she played, she tilted toward that side, and she stopped turning her head so much,” de Gallardo recalled.

Steve Goudy, M.D., assistant professor of Pediatric Otolaryngology at the Monroe Carell Jr. Children’s Hospital at Vanderbilt, agreed to do surgery since all other efforts to reduce the growth’s size had failed. The Children’s Hospital agreed to donate almost all the costs involved, with the Shalom Foundation picking up the rest, and arranging for Joseline’s transportation to the U.S., and her accommodations with volunteers while she and her mother, Veronica, were here.

The last time Goudy saw her was in September just before Joseline and Veronica headed back home. de Gallardo returned to Guatemala City as well. She lives there with her family, working with the Shalom Foundation long distance most of the time.

This past week, de Gallardo decided to meet with Veronica and Joseline for a shopping trip.

Joseline, her mother Veronica and Sofia, de Gallardo’s daughter

“My daughter, Sofia, needed supplies for her pre-school class and so we arranged to meet a mall close to where Veronica lives,” de Gallardo said. “Joseline was shy at first, as she always is, but I was struck by how much she has grown. She is now starting to say more words and communicate easier than before. She has gained weight; her cheeks have filled out, even her hair looks better. She just looked so healthy.”

de Gallardo invited Veronica and Joseline, who will turn 3 in May, to come home with them for doughnuts.

“She went on a ride on Sofia’s scooter.  I got her on it and pushed her slowly because she is still tiny, we have a wide street so she was very happy to play,” de Gallardo said.

And de Gallardo’s involvement through the Shalom Foundation will continue. Goudy had told the family that says if they want more cosmetic surgery in future, they could do a follow up procedure. For now, she is being seen by local physicians, and Veronica has just asked for a summary of her case from Goudy. Once de Gallardo receives it, she will go over what it contains with Veronica so she can share it with Joseline’s local physician.

“Joseline’s whole family is doing much better. Veronica feels more confident that Joseline will be ok, so that she is now looking for a job to help her family’s income. It was a life changing experience for their entire family and an amazing life story that I was blessed to be part of.  We are grateful to God and to the combined efforts of the Children’s Hospital and The Shalom Foundation,” de Gallardo said.

Added Goudy, ”The whole medical team that cared for Joseline here at Children’s Hospital is thrilled that she is doing so well. It is a testament to the resilience of children and shows how much can be accomplished by a community effort.  We are hopeful that she will be able to integrate easily into the age appropriate activities, with school not too far off. On future missions we hope that we can monitor Joseline’s progress. We are all very proud of how far Joseline has come.”  

Today’s schedule for the mission team was very busy.  Eight surgeries were performed and there were no cancellations for the first time this week.  There were two cleft palate surgeries, three cleft lip surgeries, one scar revision, one frenulectomy (tongue tie release) and an excision (removal) of a cyst.  All patients recovered successfully and discharged to the inpatient unit.  Dr. Goudy was also able to see Josie today.  Josie’s family brought her to the hospital so that Dr. Goudy could see her before he left Guatemala.  Josie’s condition continues to improve and her family is very pleased and thankful for the care she received from Children’s Hospital physicians and nurses.  The team will visit El Nino Jesus one more time tomorrow morning to ensure that all patients are doing well and can be under the care of the local pediatricians. 

The last thing on our agenda at the hospital was to pack up the supplies for transportation back to Children’s Hospital.  Many hands made work light and we were able to secure all instrumentation, etc. for the plane ride back to the United States. 

Every team member was proud of their contribution to the work that was done at El Nino Jesus this week.  27 cases were completed successfully.  Good relationships were formed with the pediatricians as well as the nursing staff.  Several El Nino Jesus staff members requested that Children’s Hospital mission groups come back to Guatemala and hopefully very soon.  All of us will never forget the beautiful children that we were allowed to participate in the care of.  The staff who didn’t necessarily know each other very well were able to come together as a team under some very difficult conditions.  They were able to many surgeries and even perform a successful resuscitation.  Congratulations to everyone who participated and many thanks.  Many thanks also to the administrative staff who arranged this blog on the Children’s Hospital website.  I am hopeful that this blog helped every staff member’s family.  One picture says a thousand words!  Adios amigos and hasta la vista…baby!

The ENT mission team started the day with good news.  Baby Maria, who had been transferred to the government hospital the day before, had a good night.  She was to be discharged from the hospital later today.  The news lifted the team’s spirits as they prepared for the upcoming surgeries. More illness caused a cancellation of one of the cases, two patients never arrived at the hospital and one patient had an NPO violation (the patient ate or drank before surgery). It sounds like a typical day back in our home operating room, doesn’t it? 

We were able to complete six surgeries. Three surgeries involved repairing cleft lips, and the other three were oronasal and plate fistulas.  All patients were discharged successfully to the nursing unit on the third floor. 

The team was finished a little early today and decided to get some R and R.  Some members of the team (all of the girls) decided to walk a couple of blocks from the hotel to explore a Guatemalan shopping mall.  They were surprised at the sheer size of the facility.  It was four stories and had lots of American type stores.  There was even a McDonald’s at the mall!  It struck the team as odd that there was such a modern facility in the midst of the extreme poverty that we have seen around the rest of the city.

There are eight cases scheduled for tomorrow.  We are hoping that the illness that seems to be prevalent among some of the children doesn’t affect any more patients.  Stay tuned….

The ENT mission team started the second day of surgeries without one of the surgeons.  Dr. Cofer developed a viral illness and had to stay in bed for the day.  Drs. Goudy and Wittkopf stepped up to this challenge and worked with Dr. LeMelle to coordinate a schedule that would accomodate all of the patients who had been originally scheduled.  As the team began preparing the O.R. we were informed by the El Nino Jesus staff that two of the patients would not be coming that day because they had fever.  Later in the day two more patients failed to show- also because of fever.  Another patient showed up at the hospital and we were able to operate on him.  In total, five cases were done- three cleft lips and two cleft palates.  One of the cleft lip patients had been discharged from the PACU to the floor and developed a complication requiring emergency resuscitation by the team.  The Guatemalan physicians ran with the baby from the floor to the PACU where the baby was successfully resuscitated.  The hospital physicians were uncomfortable leaving the baby on an unmonitored bed for the night, so they transferred the baby to a government hospital by ambulance.  There are nine cases scheduled for Wednesday.  The team hopes to be able to complete all of these surgeries without as many changes to the schedule!  Stay tuned….

filed by Lori Graves, R.N.

The surgeons on the ENT team performed eight surgeries today.  Three palate surgeries, two cleft lip surgeries, one hemangioma (benign blood vessel tumor) removal and two frenulectomies (releasing “tongue tie”) were completed.  One surgery was cancelled because the patient had fever. 

The team was able to function smoothly and really didn’t encounter any major obstacles.  Two of the patients were able to go home the same day, with the rest of the kids spending the night in the hospital.  The children are monitored very carefully by the mission staff as well as the hospital staff when they are transferred to the floors for care. 

The Guatemalan pediatricians are very careful not to discharge patients prematurely as the family could encounter great difficulty when attempting to return to the hospital.  Most of the patients come to the hospital by city bus and that is not always the safest and most reliable transportation. 

    
Postop patients

After the final hospital rounds were made by the surgeons and the anesthesiologists the ENT mission team were given a special dinner sponsored by the Pediatric Foundation of Guatemala at Los Cebellos.  The team was greeted by the Shalom Foundation Medical Director and two physicians employed by the Shalom Foundation.  The food was very good and included the best guacamole that we have had yet on our trip.  

One of our team members was surprised by the restaurant staff singing Happy Birthday to him and placing a large sombrero on his head.  The only problem was that it wasn’t his birthday and therefore he was quite surprised.  The restaurant staff are very enthusiastic about birthdays and gave Dr. Watkins a very nice photo of this event.  Maria Jose (Shalom Foundation staff member and interpreter) explained to Dr. Watkins that this was his welcome to Guatemala!  Tomorrow there are eight scheduled surgeries.  These will be similar to the cases done today.  The team will continue to work with the El Nino Hospital staff to continue to ensure the success of the mission.

 
A very tired crew!

Filed by Lori Graves, R.N.

The ENT Guatemalan mission team split up today.  Surgeons and anesthesiologists along with the PACU staff went to work at the clinic offices of the Pediatric Foundation of Guatemala.  Many patients were screened today for several types of surgery.  32 patients were found to have problems that could be repaired surgically.  The surgeries for the upcoming week will include cleft palate repairs, cleft lip repairs, frenulectomies, and scar revisions.  The O.R. staff along with the CRNA’s worked at El Nino Jesus today.  They worked with the staff of the hospital to organize 3 O.R.’s.  They located and arranged the necessary supplies so that surgery can start promptly Monday morning. 

After work was completed for the day, the team was taken to the Shalom School and Church complex.  This facility is located in a section of Guatemala City known as Zona 18.  This is a very impoverished area of Guatemala.  The team was impressed at the great ongoing work that the Shalom Foundation has undertaken at the school and church.  There have been several improvements to the facility that were noted by team members who had previously visited the church/school.  After the tour of Shalom the team headed back for a little R and R.  We anticipate a busy work day tomorrow and plan to “keep it a go!” no matter what situations come up throughout the week. Stayed tuned throughout the week for more updates!

To see more photos from the team’s first day, click here or on the photo below.

Filed by Lori Graves, R.N.

The ENT team wasted no time in getting to work after their arrival in Guatemala City.  Our first stop was to visit the hospital where we will be working for the next week.  The team took a quick tour of El Nino Jesus Hospital and made an assessment of the necessary equipment and supplies.  We put together a plan for throughput that will help maximize our efficiency as a team.  After the hospital visit, the team was taken to the new Shalom Surgery Center that is currently being remodeled.  The team agreed that the new hospital has a great potential but needs some more renovation work before a surgical team can be sent to work there.  We will be watching the ongoing work there with great anticipation!  Speaking of great anticipation…

The team is excited about tomorrow’s work.  We will send several team members to clinic to screen patients for surgery.  The operating room nursing staff and CRNA’s will be working at the hospital to ensure that all equipment is ready for business on Monday morning.  The team plans to work in 3 O.R.’s in order to maximize the number of patients that they are able to treat.  Stay tuned for more updates!

 (filed by Lori Graves, R.N.)  

The Monroe Carell Jr. Children’s Children’s Hospital at Vanderbilt Operating Room staff has packed up once again for another surgical mission trip to Guatemala City, Guatemala.  The team will leave on Saturday, September 27 and perform mostly cleft lip and palate surgeries at El Nino Jesus hospital during the week of September 29.  The team will be led by Drs. LeMelle and Goudy.  Other participating team members include: Dr. Shelagh Cofer, Dr. Maria Wittkopf, Dr. Scott Watkins, Dr. Rachel Cambray, Jill Moore CRNA, Roni Nylander CRNA, Brenda Sandlin, Lori Graves, Jacque Lee, Glenda Sullivan, Kate Rafferty, LaDonna Reyka, Sandra Tidwell, Allison Newton, Tommy Sanders and Cindy Bhavsar.  The team plans to run a very busy clinic on Sunday, September 28 and screen children for surgery.  Hopefully we will be very busy during the week, helping as many children as possible.  Also on the itinerary are plans to visit the new Shalom hospital that Vanderbilt is partnering with for future trips.  Wish us luck!

After three months of procedures and scans and one marathon surgery, Joseline is finally ready to return home to Guatemala.

This Saturday, she and her mother Veronica will be flying with volunteers who will be leaving for the next surgical mission to Guatemala coordinated by the Monroe Carell Children’s Hospital at Vanderbilt and The Shalom Foundation, a Nashville-based group that organizes international medical missions.

“It’s like a homecoming,” said Steven Goudy, M.D. “I’m excited for her to get to home. It’s been an overall success, and we’re sending home a happy child and mom to Guatemala.”

Joseline was at Children’s Hospital Sept. 19 for a procedure much like the one she had Sept. 2. Radiologist Mark Bittles, M.D., injected medicine to treat a few more places on her neck that were ballooning up. She also had more plastic drains placed under her skin.

“What Dr. Bittles did will continue to improve things, and she can always come back, depending on her family and finances,” Goudy said. “I’m satisfied. We improved her function and cosmetics. We met the major goals, but we can address things again down the road.”

The Shalom Foundation, which has been integral in providing this opportunity for Joseline, has organized a send-off celebration for her tomorrow evening.

“Joseline is doing very well following her surgery. Over the last few weeks, she has proven to be a real fighter. She is playing, laughing and smiling again,” said Steve Moore, chairman of The Shalom Foundation. “We are so pleased with the good outcome for her future and her health.”

Saturday will mark the fourth time that Children’s Hospital and The Shalom Foundation have teamed up to take top-notch medical care to the children of Guatemala. On this trip, they will also be announcing funding to support a campaign to renovate a Guatemalan hospital into a state-of-the-art surgery center to serve the community more permanently.

Stayed tuned as Lori Graves, R.N., takes over the International Blog to chronicle the team’s efforts to bring more life-changing head, neck and facial surgeries to the children of Guatemala City, Guatemala.

In the evenings as I exit Children’s Hospital for the day, there is usually a child playing on the Grand Staircase, giddily climbing up or sliding down. Yesterday, there was a toddler in jeans and a red t-shirt holding on to the railing and jumping lightly down each step. As I passed, I turned to smile at her and saw the tell-tale shy smile of Joseline.

With a new bob haircut, Joseline looked as cute as ever as she ran back and forth between her mother and me, smiling at both of us. It was wonderful to see Joseline playing so enthusiastically, but I was a little worried when I noticed her neck — she looked like she had swallowed a baseball.

An MRI revealed that fluid was collecting in cysts in Joseline’s neck. Wednesday morning, Mark Bittles, M.D., an interventional radiologist, installed more drains and injected medicine to shrink the cysts. The hope is to allow the skin in her neck to heal together so that fluid will not be able to collect there in the future.

Joseline is expected to stay in the hospital overnight. The drains will stay in for a week or two, and then doctors will monitor her to see if fluid returns.

“We’re all very happy she’s done so well and responded to the treatments,” Steven Goudy, M.D., said. “We hope that this is the last leg of her journey in Nashville and that we can send her home to her family in Guatemala.”