Pediatric Heart Patients a World Apart

The Dominican Republic is a small Latin American country in the Greater Antilles archipelago, due west of Puerto Rico and east of Cuba and Jamaica, on the Caribbean island of Hispaniola. It was there that Christopher Columbus landed when he "discovered" America in 1492. But, even though it is only a little more than 3,000 miles from San Francisco, for children in the Dominican Republic suffering from congenital heart defects, the country is a world apart from American heart care, said UCSF Children's Hospital pediatric cardiothoracic surgeon Tom Karl, MD. In November, Karl returned from a volunteer mission to perform cardiac surgery on children of the island nation of about 10 million people, where "congenital heart problems are diagnosed late, not at all or are neglected." He and his team spent two weeks repairing tiny hearts in the Dominican Republic through the sponsorship of the International Children's Heart Foundation (ICHF). The ICHF takes lifesaving cardiothoracic surgery to 22 underserved and developing countries throughout the world, where heart defects are often not treated because of a lack of expertise and equipment, because they are considered too risky or because they are too expensive for families to afford. Without this care, most of the children would otherwise die or have a very poor quality of life, Karl said. "In terms of sophistication, treatment in the Dominican Republic is probably at the same level as cardiothoracic surgery was in the United States in the 1970s, when the concept of infant heart repair was not developed," said Karl. Karl was accompanied by UCSF pediatric respiratory therapist Soledad Carias and operating room nurse Letecia Misterio, both veterans of numerous missions with Karl's ICHF team. The surgeries took place at the Hospital Infantil Arturo Grullón in Santiago. The procedures Karl conducts include the repair of such conditions as tetralogy of Fallot, which in the United States is one of the most common congenital heart defects, occurring in an estimated six per 10,000 births, and representing 5 percent to 7 percent of all congenital heart defects. Other operations include repair of heart valves, closure of septal defects, correction of anomalous venous connections and palliation of single-ventricle hearts. Many of the children Karl treats abroad are older and would have been operated on at birth or very early in life in the United States, he said. Parents often travel from throughout the country to reach the medical teams put in place by ICHF, Karl said. He recalled one mother on a past trip who traveled by bus for hours from a remote part of Nicaragua to reach the hospital in the hopes of receiving lifesaving treatment for her child, only to arrive cradling her dead infant in her arms. Karl described the Dominican Republic visit as an intense, but extremely rewarding experience, where he and his team performed 20 cardiac surgeries, or "10 days - two cases a day." Traveling with him on missions in Central America and elsewhere are teams of between five and 15 nurses, anesthesiologists and others required to perform the delicate operations. An added bonus, he said, is that the donated medical supplies that remain in-country can mean a dramatic leap forward in terms of long-term medical care. "We have to take ventilators and monitors with us, and we leave them there afterward. There are truckloads of supplies that have been donated to our various mission hospitals," Karl said. "Open heart surgery alone makes little impact on the health of a developing nation, but the side benefits for treatment of more prevalent health problems, such as provision of equipment, transfer of technology, team building, etc., are very real for the local program, and last well beyond the time we spend there."