The day a medical team from Cook Children's Medical Center arrived at a hospital in Ethiopia, more than 30 children and young adults were waiting -- all with heart problems.
Without whining or crying, they patiently waited their turns as the team worked late into the night, repairing one heart after another.
Five days, 12 open-heart surgeries and 14 cardiac catheterizations later, 32 young patients had healthier hearts and a much better chance at life, something that would not have been possible without the procedures.
As one young patient told the doctors after her surgery: "My skin hurts, but my heart is strong."
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In late January, the 22-member team from Cook Children's Heart Center headed for the Children's Heart Fund of Ethiopia Cardiac Center in Addis Ababa with two goals in mind. The team wanted to perform 20 to 30 open-heart surgeries and interventional cardiac catheterizations within five days. But members also wanted to provide hands-on training for the physicians, nurses and other professionals there.
In recent years, the University of Ethiopia and the government have recognized the need for training in pediatric cardiac care and have sought physicians to come to the country.
The doctors there lack expertise in using the equipment donated from other countries and are not trained to perform some of the more complex procedures. Without enough doctors, it's extremely difficult to meet needs in Ethiopia, said Scott Brown, executive vice president of the Gladney Center for Adoption. Brown led a medical mission to Ethiopia last year and served as the nonmedical liaison for the Cook Children's team.
The Ethiopian government trains physicians, but once they are overseas, they don't come back, he said. In Ethiopia, they make far less money.
"There are more Ethiopian physicians living in Washington, D.C., than in all of Ethiopia," Brown said. "And the docs who do stay over there are so taxed they're on call 365 days of the year."
Through medical missions such as this one, Gladney is trying to make a difference in the lives of many Ethiopian children, Brown said. Only a tiny fraction are placed for adoption.
"We're trying to make them have a better life by giving these children hope and medical care," he said.
The team worked to teach as much as it could in five days. But in the end members took away more personal lessons than they could have ever learned at home.
"As much as we taught them, they taught us," said Dr. Vincent Tam, a critical-care and thoracic surgeon from Cook Children's.
Going to a Third World country on a complex medical mission is no easy task. Cook Children's is believed to be the first major heart center from the United States to participate in such a comprehensive mission program and educational symposium, according to Dr. Ben Siu, a pediatric cardiologist with Cook Children's who went ahead of the group and presented lectures to physicians.
Once the team arrived at the hospital, they discovered that the patients' heart problems were made more complicated because they had gone so long without treatment.
The patients, ranging in age from 3 months to 22 years, had various congenital defects such as holes in their hearts and lesions that interrupted blood flow.
While many of the conditions are routinely corrected during infancy in the United States, the children in Ethiopia had never been treated. In fact, because their heart defects had been left uncorrected for such a long time, they were experiencing side effects such as high blood pressure and bleeding in the lungs that made their post-surgery care especially difficult.
The oldest patient, a 22-year-old woman, was in such poor health before surgery that she could not take more than four or five steps before becoming winded, Siu said.
Without surgery, most of the patients would have died.
The team's airfare and lodging was paid by the Ethiopian government. Private foundations, device manufacturers and other organizations donated equipment, medicine and supplies. The medical team donated its services.
When the team arrived, the Ethiopian physicians and nurses only wanted to observe, Tam said.
"We had to push them to become participants in the care," he said. "But at the end of the week, they were the ones doing the care."
While the equipment in Ethiopia wasn't the same quality as in Fort Worth, it never compromised the patients' care, Tam said.
"We certainly did not have the luxury of state-of-the-art tools," he said. "But everything was adequate -- different and maybe scaled-down models -- but very adequate."
For example, in the catheterization lab, the equipment could only record one image of the heart, from one angle at a time. Back in Fort Worth, the front and side of the heart can be imaged at once, said Dr. Deborah Schutte, a pediatric cardiologist with Cook Children's.
"We're used to taking pictures and getting everything we need," she said. "But there, if you wanted to see the front and side of the heart, you had to take two pictures."
Intensive care monitoring devices were not available in Ethiopia, said Dr. Jay Duncan, an intensivist with Cook Children's.
"Sometimes you just have to trust yourself and your staff and what you're seeing," he said.
Although the equipment did slow things down, all of the patients did remarkably well, Siu said.
The rewards of seeing such a difference in both the patients and the staff in Ethiopian were so satisfying that the team plans to return this year.
"The nights were long, but it felt so good just to be a doctor," Schutte said.
JAN JARVIS, 817-390-7664