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James Hammel, M.D., left, works with Sergio Hernandez, M.D., in repairing a patient with a serious heart defect known as Tetralogy of Fallot. |
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One of the Nicaraguan patients who underwent cardiac surgery was Maria Jose Miranda Perez, right. She is seen here with her mother shortly after her surgery. Maria had her aortic valve and mitral valve destroyed by rheumatic fever. Dr. Hammel repaired her valves using her own tissue. This was a special technique Dr. Hammel learned during his fellowship in congenital cardiac surgery at the Hospital for Sick Children in Toronto. |
The child’s only chance for a normal life is to have surgery to correct the defect. However, your country doesn’t have the resources or the expertise to perform open heart surgery in children.
It sounds hopeless, but wait — an American foundation wants children in all countries to have access to lifesaving cardiac operations — your child’s heart will be fixed.
That was the situation earlier this spring when a medical team of 12 people left Omaha and went to Managua, Nicaragua, from April 26 to May 10 to provide assistance to Nicaraguan children in need of heart surgery.
The team — headed by James Hammel, M.D., a UNMC pediatric cardiac surgeon — included pediatric intensivists, a pediatric cardiac anesthesiologist, a pediatric clinical perfusionist, five intensive care unit nurses and a respiratory therapist.
Except for Dr. Hammel, the other team members were from Children’s Hospital, UNMC’s pediatric affiliate here in Omaha. They all took personal vacation time to make the nearly 2,100-mile trip from Omaha to Managua, the capital of Nicaragua with a population of more than 1.6 million people.
The trip was coordinated through the International Children’s Heart Foundation (ICHF), an organization that aims to care for children with congenital heart disease in developing countries.
Dr. Hammel’s group went to a private hospital called Hospital Salud Integral. Over the first two days, they saw 80 children with heart conditions. From this patient list, they identified 14 children who were considered most critically in need of heart surgery.
The 100-bed hospital had three operating rooms.
“They gave us an empty room, and we turned it into an ICU,” Dr. Hammel said.
Children’s Hospital and several other companies donated more than $100,000 in surgical and intensive care supplies and drugs. All the care was provided at no charge.
“The impact we had in this two-week experience was incredible,” Dr. Hammel said. “It was truly a transformational event for these families. These are families that are suffering because they are raising a child they know will die, and they don’t have any hope of surgery being done. It’s a tremendous burden both financially and emotionally.”
Dr. Hammel said about 500 children are born in Nicaragua each year with congenital heart defects requiring surgery.
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One mother left a lasting impression on Dr. Hammel.
“Her son’s oxygen level was extremely low. She told us that her boy would ask her, ‘When is this going to stop?’ He couldn’t run and play. He didn’t even have energy to eat.”
The 14 children who underwent surgery are all doing well, Dr. Hammel said. Some even went home within two to three days after surgery.
“Several children came in with their lips and fingertips really blue,” he said, “and they went home nice and pink.”
Dr. Hammel earned his undergraduate and medical degrees from the University of Michigan. He completed his general surgery residency at UNMC and his cardiothoracic surgery residency at the University of Iowa Hospitals and Clinics in Iowa City. He then completed a fellowship in congenital cardiac surgery at the Hospital for Sick Children in Toronto. He also accomplished research fellowships in neonatal cardiac surgery and transplant surgery. He joined the UNMC faculty in 2005.
Dr. Hammel, who speaks medical Spanish, worked closely with Dr. Sergio Hernandez, a heart surgeon at Hospital Salud Integral.
“It was a growing experience for me,” Dr. Hammel said. “My comfort zone got a lot wider. I wanted to teach Sergio how to do the various procedures. It was big leap for both of us, as we were both in new roles. Although Sergio had taken pediatric cardiac surgery training in Mexico City, he had not been able to operate much after returning to his home in Nicaragua. For me, it was the first time I played the role of teaching pediatric cardiac surgery.”
The surgical cases varied from simple to complex.
“We did some complicated cases for children we knew would never survive otherwise,” Dr. Hammel said, “and some easier cases that were just a little beyond the local team’s capability, so that they could progress.
“This was a total team effort. Each of our people worked closely with a Nicaraguan counterpart, teaching the role he or she played in taking care of the kids. It was an experience I will never forget. It’s something I will likely do again.”
Dr. Hammel recognized his boss at UNMC, Kim Duncan, M.D., for allowing him to go on the trip and for covering all the cardiovascular and thoracic surgery cases while Dr. Hammel was gone.
Other team members included:
- Pediatric cardiac perfusionist — Joseph Deptula, who served as trip coordinator;
- Pediatric intensivists — Jeff DeMare, M.D., Mohan Mysore, M.D., and Swati Agarwal, M.D. (from Virginia);
- Pediatric cardiac anesthesiologist — Kim Hanson, M.D., Ph.D.;
- Intensive care unit nurses — Kim Schuettner, Julie Newill, Kristen Keller, Ashley Bare and Cheryl Dick;
- Operating room nurses — Diana Dye, Denett Carpenter (from Kansas City); and
- Pediatric respiratory therapist — Kelley Clark.