ICSF Serves All Hemispheres October - December to Round Out 2010
First Team Mission to Kenya
In addition to surgical missions to Bolivia, Peru, and Mexico, ICSF served its first team mission to Kenya in the fourth quarter of 2010. An ICSF team composed of American, Filipino, and Kenyan doctors and nurses treated children who had a variety of conditions, including cleft lips and palates, acute burns, and congenital webbing of the arms, during ICSF’s first team mission to the poorest region of Kenya, western Kenya.
The scene was Kakamega City General Hospital. “The conditions were stark,” begins Dr. Williams. “The operating room windows were out of repair, the anesthesia machine did not work, requiring us to find a replacement, and the operating lights were burned out and had to be fixed.”
The most critical case that came to the bare-bones hospital was seven-month-old Esther. Esther had suffered a severe scald burn to her entire face and right side of her head six weeks prior to the team’s arrival.
"Esther’s eyelids were fused in the open position, and her mouth was fused in the closed position as a result of the third-degree burns that had been completely untreated. In addition, she had suffered an acute attack of malaria the month before, although she had been treated, and her blood count was now acceptable, " explains Dr. Williams.
"Esther’s mouth condition presented a severe anesthesia risk, and her age posed a severe risk both from a blood loss and a heat loss point of view. The little girl would require a major surgical mouth release prior to deep anesthesia, followed by rapid placement of a breathing tube. We considered sending her to a larger hospital in Nairobi, but based on my previous experience, I was concerned that in Kenya, there was not sufficient expertise for these rapid-sequence surgical and anesthesia maneuvers involving the airway, " Dr. Williams adds.
It soon became apparent that unless ICSF performed the surgery, Esther likely would not receive the needed surgery, which would result in the loss of her eyes, severe scarring and distortion of her head and neck — and likely her death. ICSF was indeed Esther’s only hope.
After much discussion and weighing the options, Dr. Mario Mahjong, ICSF’s experienced children’s anesthesiologist from the Philippines, and Dr. Williams, an experienced children’s burn surgeon who once taught at the Shriner’s Children’s Burn Center in Galveston, Texas, decided to go ahead with the surgery.
After special equipment was obtained from Nairobi, eight hours away, the team began its lifesaving — and technically challenging — work for little Esther. The nerve-wracking initial surgical mouth release and placement of the breathing tube could have resulted in blockage of Esther’s airway and sudden death. Instead, it proceeded flawlessly. The entire ICSF team, all present and performing crucial tasks, breathed one large sigh of relief and congratulated one another. But the surgery was far from over. Another five hours of careful skin grafting to the tiny eyelids, face, head, and neck lay ahead.
"One of the main challenges during this phase was keeping Esther's body temperature at a level compatible with life," Dr. Williams explains. "Fortunately, we had come prepared with a state-of-theart constant temperature probe, and we were able to round up a device sort of like a hair dryer with which our nurses could warm the baby during the operation. It was a battle to keep the baby’s core temperature high enough to avoid cardiovascular collapse, but our team rose to the occasion. They were great, each one of them," he adds. "The surgery itself couldn’t have gone better, except for when the IV, which was in one of Esther’s scalp veins, went bad, and we had to do a surgical insertion of the IV in her leg," he explains.