Target New Jersey; Mission from the Heart

<v Speaker>Major funding for a mission from the heart is made possible by U.S. <v Speaker>health care, dedicated to providing over one million members with quality <v Speaker>care. U.S. <v Speaker>health care. The health plan for living. <v Speaker>Additional funding provided by Siemens, a diversified leader in medical electronics, <v Speaker>providing technology and caring hands nationwide, worldwide <v Speaker>for more than 100 years. <v Speaker>And the Medical Society of New Jersey, the oldest state medical society in <v Speaker>the nation, serving New Jersey with 10000 dedicated physicians. <v Speaker>The Medical Society of New Jersey caring for your health. <v Speaker>Since 1766. <v Speaker>You're a part of a very, very special team going to Tbilisi in Soviet Georgia.

<v Speaker>Gotta work harder than you ever worked your entire life. <v Speaker>But it's going to be very, very, very satisfying to you when you've finished it. <v Speaker>We've gotten records of the number of children from Armenia. <v Speaker>Ukraine and from soviet Georgia. <v Speaker>We've reviewed those medical records. <v Speaker>And from those we've picked the patients that we think are reasonable to operate on. <v Speaker>I think we should put this on a list of potential cases. <v Speaker>This is an undertaking that has never been tried before. <v Speaker>It rested on our ability to bring essentially

<v Speaker>a full operating room team. <v Speaker>I see your team post-operative recovery room team to a foreign <v Speaker>country with different electrical supplies, different water, different <v Speaker>philosophies of life, and try in that environment to <v Speaker>pull off somewhere between fifteen and 30 open heart operations. <v Speaker>Deborah Heart and Lung Center in Browns Mills, New Jersey, had a plan, <v Speaker>a mission from the heart to do pediatric open heart surgery <v Speaker>in a Soviet republic where medicine is 25 years behind American <v Speaker>standards. The idea was to help free small Soviet republics, <v Speaker>Georgia, Armenia and the Ukraine to help their children.

<v Speaker>To provide some modern equipment and to train their doctors. <v Speaker>Tbilisi, the capital of Soviet Georgia, is located in the eastern part <v Speaker>of the Georgian Republic, just north of Turkey and between the Caspian <v Speaker>and the Black Sea. It was chosen as the site for the mission because of its <v Speaker>location near Armenia and the Ukraine and chosen <v Speaker>because it was the smallest republic, thus had potentially the least bureocracy <v Speaker>to overcome. <v Speaker>[singing]. <v Speaker>Tbilisi, a Georgian for Warm Springs, warm, aptly <v Speaker>described the city not only because of its mild climate, but also <v Speaker>because of its people the most hospitable of places. <v Speaker>City with old world charm, a place where locals

<v Speaker>strive to keep traditions alive. <v Speaker>Tbilisi, like many other parts of the Soviet Union, is economically <v Speaker>hard pressed, government store shelves are bare. <v Speaker>Gasoline hard to come by and lines for cigarets are long. <v Speaker>The ruble is looked at as practically worthless. <v Speaker>There's no money for modern medical equipment and much of the equipment there breaks <v Speaker>down and either can't be or isn't being fixed. <v Speaker>With such economic problems, routine medical care is

<v Speaker>lacking. But we found out that 80 percent of the patients who are coming into the clinic <v Speaker>for evaluation of their congenital heart disease had never had any immunizations, <v Speaker>for example. So the pillars upon which all of your health care stand <v Speaker>are absent. <v Speaker>Cardiac surgery is one of the most expensive fields in medicine. <v Speaker>And the whole problem is very much linked up with economic problems, with the whole <v Speaker>republic. Pediatric open heart surgery is performed in Moscow, <v Speaker>Leningrad and Kiev. <v Speaker>The waiting line in Moscow and Leningrad is long and the mortality rate in Kiev, <v Speaker>capital of the Ukrainian republic high. <v Speaker>Deborah does heart surgery free of charge. <v Speaker>Since 1973. <v Speaker>Children from all over the world come to Deborah to be operated on. <v Speaker>In 1988, Deborah did open heart surgery on its first child <v Speaker>from the Soviet Union.

<v Speaker>Her name was Maya Sragow. <v Speaker>She was destined to die. <v Speaker>And that's what it was. she never walked in their life. She had to be carried by her <v Speaker>mother all the time. If she'd walk, she'd make two steps and go into <v Speaker>a crouch so she could breathe, because that's that's a physical part of this particular <v Speaker>sickness. Her lips were blue. <v Speaker>Her fingernails were blue. <v Speaker>And when she returned to Odessa in the Ukraine, the Soviet Ukraine, <v Speaker>it hit her all the newspapers throughout the entire country. <v Speaker>And we were flooded with requests by parents asking us to help them because they could <v Speaker>not get any help in Russia. Who would bring the children to Deborah? <v Speaker>Those case could run. The cost of those cases could run anywhere between 25000 <v Speaker>to 40000 or even sixty thousand dollars per child. <v Speaker>And there is a number of associated costs, the use of the bed, equipment, On-Call <v Speaker>time staff and so forth. <v Speaker>What we were able to do this time, of course, was to get all of the equipment donated, <v Speaker>put absolutely no pressure on Deborah's equipment. <v Speaker>Number of foundations and corporations donated supplies and loaned equipment

<v Speaker>to make the trip possible. <v Speaker>A mean, medical outreach arranged for a cargo plane to bring it all to <v Speaker>Tbilisi. <v Speaker>So instead of bringing the children to Deborah, Deborah came to the children. <v Speaker>Deborah asked the health ministries in Georgia, Armenia <v Speaker>and the Ukraine to send the medical records of children needing open heart <v Speaker>surgery. <v Lynn B. McGrath, M.D.>To carry out complex congenital heart surgery. <v Lynn B. McGrath, M.D.>Risk is involved to do that. And when you're going into it in a situation where there are <v Lynn B. McGrath, M.D.>a lot of unknowns, a lot of imponderables about which you're not confident. <v Lynn B. McGrath, M.D.>Then to try to reproduce what we do here. <v Lynn B. McGrath, M.D.>Make we may not be 100 percent successful in doing that. <v Lynn B. McGrath, M.D.>So I'm I'm a little reticent to go ahead and do too many complex operations for that <v Lynn B. McGrath, M.D.>reason. And also because taking care of those patients after the operation <v Lynn B. McGrath, M.D.>is also an important part of their success, especially in complex forms of congenital

<v Lynn B. McGrath, M.D.>heart disease. We'll be going over there for seven or 10 days and then we'll all be <v Lynn B. McGrath, M.D.>leaving. So I don't want to leave a whole bunch of patients who survive their operation <v Lynn B. McGrath, M.D.>of com- complex congenital heart disease and just leave them there isolated. <v Lynn B. McGrath, M.D.>And the people who are left behind to take care of them not really know how to manage <v Lynn B. McGrath, M.D.>that. <v Edward Rourke>When they start studying kids with more complex congenital defects. <v Edward Rourke>They're not going to get them on that system. <v Edward Rourke>They'll have to be redone elsewhere. So there's no sense kidding ourselves. <v Speaker>At least give us an idea whether or not this kid is even operable or not. <v Speaker>Give us some idea- some idea. <v Speaker>Medical records were slow in coming from Armenia. <v Speaker>And once staffers looked at sophisticated x rays of the heart. <v Speaker>They realized they needed to be redone. <v Speaker>Diagnostically, they were useless. <v Speaker>Yes. So a team of four left Deborah and went to Armenia <v Speaker>to get the medical information necessary for surgery. <v Speaker>John Ludwig, chief technician in Deborah's pediatric cardiac catheterization

<v Speaker>lab, was in Armenia. <v John Ludwig>The workup that they did with the children, the x ray and any kind of history physical <v John Ludwig>was not adequate for our physician to risk this, these children's <v John Ludwig>lives in order to correct their heart disease. <v John Ludwig>We had two days in which to prepare an entire cath lab and three days in which to study <v John Ludwig>fifteen children. And so we roughly worked, I guess, a good 12, <v John Ludwig>15 hours a day to get that done. <v Speaker>When the Deborah team reached Tbilisi, they found the Georgian cath lab also <v Speaker>troubling. <v Speaker>I need a part. I would usually get that part within the day or certainly the <v Speaker>next day. It takes them the better part of six months to a year to get that same <v Speaker>part. <v Speaker>What I saw was fifteen hundred boxes piled up in the same room, <v Speaker>which had to be moved out before we could do anything. <v Speaker>

<v Speaker>We start now, I want to store all this stuff somewhere else. <v Speaker>My be to set up two over there and two over here. <v Speaker>Wow. OK. <v Speaker>Lucy Palmer is intensive care unit charge nurse who speaks fluent Russian. <v Speaker>She was sent ahead to set up the ICU on the sixth floor of Children's <v Speaker>Hospital. My first impression when I arrived here was shock, <v Speaker>absolute shock to the amount of work that had to be done to set up the unit. <v Speaker>The room was bare. So we realize now that we had to negotiate for <v Speaker>curtains, beds, mattresses, tables for our monitors,. <v Speaker>And getting the operating room up to American sterilization standards was even <v Speaker>tougher.

<v Chizuko Williams, R.N.>I don't know how those people do cleaning, but <v Chizuko Williams, R.N.>I have to scrub down all the wall and not once. <v Chizuko Williams, R.N.>We have to do it every day. Three or four times. <v Chizuko Williams, R.N.>We have to demonstrate. How to do cleaning. <v Chizuko Williams, R.N.>Used to clean. Yes. <v Chizuko Williams, R.N.>How can I explain to her? <v Chizuko Williams, R.N.>We showed them how we do it because they don't even have a mop, <v Chizuko Williams, R.N.>don't even have the cleaning right. <v Chizuko Williams, R.N.>So we go through one step at a time. <v Chizuko Williams, R.N.>We cannot speak Georgia. <v Chizuko Williams, R.N.>And they cannot speak English but the body language, <v Chizuko Williams, R.N.>we communicate. <v Speaker>Communicate well enough that in a week's time, the sixth floor of Children's <v Speaker>Hospital was transformed into a working pediatric, cardiac, medical <v Speaker>and surgical unit. <v Speaker>I have tunnel vision when I'm operating. So what I'm saying is what I see in the <v Speaker>operating room is what I see when I'm operating at the Deborah, doesn't change much.

<v Speaker>My responsibility is is really not much different than it is <v Speaker>back home. The difficulty in doing it, however, is <v Speaker>all of the other people, all of the other backup systems that we need to have in place <v Speaker>are perfect. <v Lucy Palmer, M.S.N.>When I hear all the noise, the familiar sounds, the beats, the bubbling. <v Lucy Palmer, M.S.N.>You can close your eyes and feel you're back at home. <v Lucy Palmer, M.S.N.>But when you open 'em, you realize you're not. <v Maria Colombi, M.D.>As soon as the people of Tbilisi heard that there was <v Maria Colombi, M.D.>an American team coming down. <v Maria Colombi, M.D.>There have been many requests to be seen by us. <v Maria Colombi, M.D.>And since the first day that I was here. <v Maria Colombi, M.D.>I saw many patients, about 10, 12 a day and they continued to come <v Maria Colombi, M.D.>to be seen. <v Maria Colombi, M.D.>They are hoping, all of them, they are hoping to that we offer to come <v Maria Colombi, M.D.>to the United States.

<v Maria Colombi, M.D.>Unfortunately, we cannot do this because we have already many children. <v Maria Colombi, M.D.>Their children had relatively complex heart disease, but stable, <v Maria Colombi, M.D.>and they can wait for one or two years. <v Maria Colombi, M.D.>So these are the children that I select and I <v Maria Colombi, M.D.>offer to come to United States. I would say so far six or seven <v Maria Colombi, M.D.>out of seventy or 80 that I saw. <v Maria Colombi, M.D.>So we'll see. <v Speaker>And then there are the others. <v Maria Colombi, M.D.>It is very sad, especially for the very sick children. <v Maria Colombi, M.D.>But I quite agree with what they told you in Moscow. <v Maria Colombi, M.D.>That there is a hole. But the main problem is a very <v Maria Colombi, M.D.>high pressure in the lungs that at this point that will do only <v Maria Colombi, M.D.>harm to close the hole and much better to leave alone and not doing <v Maria Colombi, M.D.>anything. They probably think, yes, it's too risky and <v Maria Colombi, M.D.>the heart will not work well.

<v translator> is there any chance that if she gets well? <v Maria Colombi, M.D.>Is very difficult in generally, these is a progressive disease of the lungs. <v Maria Colombi, M.D.>The only possible treatment will be to consider heart and lung transplant, <v Maria Colombi, M.D.>which is done very rarely even in the United States. <v Maria Colombi, M.D.>So let's just say theoretical question then than anything <v Maria Colombi, M.D.>else. I do not know if they are doing it in Russia. <v Maria Colombi, M.D.>I review in the last six months about 150 medical records <v Maria Colombi, M.D.>of children from Russia and wind up to pick about 19 <v Maria Colombi, M.D.>20. They find it formularies, the noses and later symptoms <v Maria Colombi, M.D.>defects. <v Maria Colombi, M.D.>This is Chichinade, this is the challenge now, a six year old <v Maria Colombi, M.D.>and the current catheterisation was then two years ago in Moscow. <v Lynn B. McGrath, M.D.>I'm just not so sure if the study is two years old that we should proceed

<v Lynn B. McGrath, M.D.>because, you know, we wouldn't proceed with that if we were back home. <v Lynn B. McGrath, M.D.>I know we would restudy that our hands. <v Lynn B. McGrath, M.D.>So I think we have to reconsider that. <v Maria Colombi, M.D.>OK, I see you being protected. <v Maria Colombi, M.D.>If you speak to the mother of these children because they have a high <v Maria Colombi, M.D.>expectation for surgery. So you better you explain. <v Maria Colombi, M.D.>I have always been telling them that you were the guy making the final decision. <v Maria Colombi, M.D.>That was clear with me. But-. <v Lynn B. McGrath, M.D.>Never. Please. I'm Dr. McGrath. I'm a surgeon. <v Lynn B. McGrath, M.D.>I want to discuss her son's case with her. <v Lynn B. McGrath, M.D.>Her son has the trology of fillow which means there are two problems inside the heart. <v Lynn B. McGrath, M.D.>There's a hole inside the heart and also a narrowing in the lung artery. <v Lynn B. McGrath, M.D.>This needs to be repaired. <v Lynn B. McGrath, M.D.>However, the catheterization of the heart, the X-ray of the heart that the child had <v Lynn B. McGrath, M.D.>was too old, two years ago and needs to be repeated before he can have an operation.

<v Lynn B. McGrath, M.D.>So what we'd like to do is bring him up to the United States and catheterize him there <v Lynn B. McGrath, M.D.>and operate on him over there and tell her that we don't know now when <v Lynn B. McGrath, M.D.>he's going to come, but we will let her know when that will bring him over. <v narrator>Dr. McGrath also met with the parents of children scheduled for surgery. <v Lynn B. McGrath, M.D.>I'm Dr. McGrath. I'm the surgeon who will be operating on your child tomorrow. <v Lynn B. McGrath, M.D.>She has a problem. It's just outside the heart called the patent ductus arteriosus, <v Lynn B. McGrath, M.D.>its a big word means that there's an abnormal artery present. <v Lynn B. McGrath, M.D.>All children have this at birth, but it closes after about one or two <v Lynn B. McGrath, M.D.>weeks, normally in her case, this has stayed open <v Lynn B. McGrath, M.D.>and it's causing too much blood flow into her lungs, although she's <v Lynn B. McGrath, M.D.>getting along well at this time. <v Lynn B. McGrath, M.D.>Eventually, this will cause damage to her lung arteries, significantly reduced life <v Lynn B. McGrath, M.D.>expectancy. And this is why we're recommending that this be closed at this time. <v Lynn B. McGrath, M.D.>There's risk involved to her life to have this done, but the risk is low.

<v Lynn B. McGrath, M.D.>Like one percent means ninety nine percent chance. <v Lynn B. McGrath, M.D.>If she wants- [mother: one percent?] one percent risk, means ninety nine percent chance <v Lynn B. McGrath, M.D.>that she would survive and be well after. <v Lynn B. McGrath, M.D.>So I really believe it's the right thing to do for her at this time. <v Lynn B. McGrath, M.D.>You understand? [mother: Yeah.] Do you have any questions? <v Lynn B. McGrath, M.D.>Everybody's frightened to have their child to have surgery. <v Lynn B. McGrath, M.D.>But it's it's in her best interest to have this one. <v Lynn B. McGrath, M.D.>OK? <v narrator>Although the risk was small, Viollette Maisuradze was scared, mostly <v narrator>because her child, Mariem, didn't appear sick. <v narrator> <v narrator>Mariem would have undergone surgery even without the Deborah team. <v narrator>But the question was when. <v Lynn B. McGrath, M.D.>The amount of surgery that takes place in this institution when we're not here is very

<v Lynn B. McGrath, M.D.>limited. And so just because you have a patent ductus arteriosus that they <v Lynn B. McGrath, M.D.>have the ability to close here does not mean that it's going to get done. <v Lynn B. McGrath, M.D.>So we think that we'll do some of those too while we're here and maybe that will <v Lynn B. McGrath, M.D.>stimulate them to in the future, do more of those cases. <v Violette Maisuradze>So this operation isn't connected to his heart. <v Violette Maisuradze>And those advantages. It is operational? <v Lynn B. McGrath, M.D.>Yes. Because you have to get to the heart. <v Violette Maisuradze>Don't stop the heart? <v Lynn B. McGrath, M.D.>Very quick. It's a procedure that's been done tens of thousands <v Lynn B. McGrath, M.D.>of times, don't worry. <v Lynn B. McGrath, M.D.>I know. Don't worry is easy for me to say, although I worry too. <v Speaker>[Mariam singing].

<v Speaker>All is good and everything went fine. <v Speaker>Mariam is back in the surgical intensive care unit and seems to be doing OK. <v Speaker>[chatter] You want your mom. Ok.

<v nurse>Everything went very well. <v nurse>[chatter] Hi, are you ok? <v nurse>yes. You want to go to this side? Come on over here. <v nurse>She's fine! <v nurse>She's awake too she's doing fine. <v Violette Maisuradze>She's well? <v nurse>She's fine. <v nurse>She's sleepy but she's awake. <v Violette Maisuradze> Now, I'm very happy <v Violette Maisuradze>because my child is better I think.

<v narrator>The majority of the 19 surgical procedures scheduled were open heart <v narrator>surgeries, procedures that Georgian and Armenian doctors perform <v narrator>on adults, but not on children. <v narrator>He has a problem with a hole inside the heart. <v narrator>The hole is between the two filling chambers of the heart. <v narrator>This problem causes there to be increased blood flowing into his lungs arteries. <v narrator>And although he's getting along well now, this problem will significantly reduce <v narrator>his life expectancy. <v narrator>Many children who have this problem will die in their 30s or 40s <v narrator>because of that. And this is why we're recommending that the hole be closed at this time. <v Speaker>Nine year old Dakia Vepkhvadze, an avid soccer player, came <v Speaker>to Tbilisi from an outlying village. <v Liana Vepkhvadze>From my eyes my son is pretty healthy.

<v Liana Vepkhvadze>I don't see anything. I'm afraid Doctor could cut him and it may be worse for <v Liana Vepkhvadze>him. I don't know. <v Liana Vepkhvadze>He doesn't worry about the operation. <v Liana Vepkhvadze>He tells me, don't worry, I'm happy. <v Liana Vepkhvadze>Don't worry. I'm not afraid. <v Speaker>Tell your momma goodbye.

<v Speaker>There's an endless stream of children with congenital heart disease in this country who <v Speaker>are going to die if they're surgically untreated. <v Speaker>And many of them are going to die soon. That we've seen in the clinic even this week that <v Speaker>we just can't help. At this time. <v Speaker>Colleagues of mine, for example, have set up congenital cardiac surgical units <v Speaker>in Arkansas. <v Speaker>And he took six month period of time setting up his congenital cardiac surgical unit <v Speaker>before he was willing to proceed into his first case.

<v Speaker>So we were going into a situation in a foreign country, in a hospital that had never <v Speaker>done any kind of congenital cardiac surgery. <v Speaker>And we were planning to do this in six days. <v Speaker>We did four cases today. We were done by 1:30. <v Speaker>If we were back at the Deborah. Probably we would have done one or 1:30. <v Speaker>So we're able to accomplish that very efficiently, just like we would have if we'd been <v Speaker>back home. <v Speaker>All right. <v Speaker>All right. How about four fifty? <v Speaker>Right at Fifty. Hundred percent of people charity. <v Speaker>This one's got a leak so you're gonna lose some of your title volume. <v Speaker>Can you ask him to move, move.

<v Speaker>Twenty nine. <v Speaker>Twenty nine point thirty, no twenty nine. <v Speaker>[speaks Georgian]. <v Speaker>Ask him to move his hand. <v Speaker>There's risk involved in his life to have this done, the risk is about two percent means <v Speaker>98 percent chance that he could survive and be well after. <v Speaker> I trust you completely. <v Speaker>Does she have any questions? <v Speaker>Seven year old Behance Sarkisian came to Tbilisi from Yerevan, <v Speaker>the capital of Armenia. <v Speaker> I'm pretty calm before the operation.

<v Speaker>Because my older son had an operation in the United States and everything went <v Speaker>well. So I'm pretty confident. <v Speaker>Yea he remember me too. <v Speaker>Lucy, can you talk to him. He's waking up. <v Speaker> Here's mama. <v Speaker>. <v Speaker>The children were all extremely stoic. <v Speaker>There is only of the 19 children we did, perhaps only two that had <v Speaker>major periods of crying and trying to get out <v Speaker>from the situation.

<v Speaker>Most of them just simply allowed what had to be done to be done <v Speaker>to them. And and because of that, sailed right through the operations <v Speaker>or sailed right through the intensive care unit. <v Speaker>My daughter's name is Salome. <v Speaker>She's two years old. She could not play for our loved time, play <v Speaker>got her tired. And she often had the cold or flu. <v Speaker>How would you feel if the child feels well? <v Speaker>Mother feels well too. <v Speaker> That's fine. <v Speaker>All together. Together. <v narrator>This nine year old boy, Niaz Tsindiliani came to Tbilisi

<v narrator>from a nearby village. <v Nunu Tsindiliani>He's extremely weak. <v Nunu Tsindiliani>He doesn't grow. He hardly eats. <v Nunu Tsindiliani>And I'm hoping this will give him a new view on life. <v Nunu Tsindiliani>Everything is in your hands to let him play like the other kids <v Nunu Tsindiliani>to grow and run. He cannot run. <v Nunu Tsindiliani>He walks slowly. <v narrator>There was an electrical problem and perfusionist. <v narrator>Jeff Luckenbach had to hand crank the heart lung machine, something <v narrator>that normally doesn't happen. <v Jeff Luckenbach>I've been in this racket 14 years and I've hand cranked twice previous. <v Jeff Luckenbach>I was concerned at first because I didn't know the nature of the product if it had been <v Jeff Luckenbach>what had been a similar the problems we had last week, we <v Jeff Luckenbach>could have been out of power for an hour. An hour and a half. <v Jeff Luckenbach>Was the first case we've had electrical problems the previous week.

<v Jeff Luckenbach>Power failures. <v Jeff Luckenbach>Electricians in the hospital have been turning power out without telling us. <v Jeff Luckenbach>So we went in expecting to have problems, as it turned <v Jeff Luckenbach>out. We've blew a circuit breaker in one of our power lines. <v Jeff Luckenbach>So we switched to the alternate power source. <v Jeff Luckenbach>As You saw we had hand cranked, for about 30 to 40 seconds. <v Jeff Luckenbach>The alternate power source provided us with electricity and we went back on bypass. <v narrator>When they open Neaz's chest, doctors found his case was more complicated

<v narrator>than they anticipated. <v Speaker>The diagnoses on this patient is not as clear as it would be from back home. <v Speaker>These children are not worked up diagnostically as thoroughly as we <v Speaker>would probably do back home. <v Speaker>We thought the problem was a simple hole inside the heart. <v Speaker>Between the two filling chambers in the heart. <v Speaker>And in fact, the child had a more complicated problem in that all of the veins that were <v Speaker>draining the blood from the right lung back into the heart were connected to the wrong <v Speaker>chamber. So what requiring more complicated repair with what we call a patch <v Speaker>or a baffle in order to redirect those anomalously connected veins <v Speaker>back into the left side of the chamber, which is where they should be. <v Speaker>If a child with a simple hole inside the heart were to develop damage to the lung <v Speaker>arteries, that might reduce the life expectancy for 30s or 40s. <v Speaker>But if you compound that by adding an increased amount of flow to the lungs, by having <v Speaker>all the veins connected to the wrong place, that development of damage to the lung <v Speaker>arteries might occur more rapidly in the 20s.

<v narrator>But despite these complications, Neaz did fine and was moved to the <v narrator>intensive care unit. <v Speaker>We'll talk to you about... Needs off in P1. <v Speaker>Tell me, can you believe it? <v Speaker>you want to go up? <v narrator>After the operation dr. Douglas Joyce went to find Neaz's mother to let <v narrator>her know how the surgery progressed. <v narrator>First he looked on the second floor. <v Douglas H. Joyce, D.O>She's upstairs. <v Douglas H. Joyce, D.O>We're done. And one of the surgeons we didn't find her, no. <v Douglas H. Joyce, D.O>Tell her that we're all done with the operation and everything is fine. <v Douglas H. Joyce, D.O> We closed, we closed this hole

<v Douglas H. Joyce, D.O>that was between the two filling chambers in the heart. <v Douglas H. Joyce, D.O> And her child is in the intensive care unit. <v Douglas H. Joyce, D.O>Her child is in the intensive care unit now. <v Nunu Tsindiliani> How is the result of the operation?

<v Nunu Tsindiliani>I would like to see my child. <v Douglas H. Joyce, D.O>They were under the impression, I think, that there was going to be no risk from the <v Douglas H. Joyce, D.O>surgery. And it's our practice to produce a low risk for certain procedures. <v Douglas H. Joyce, D.O>We convinced her that the risk was low and that she should let the child have the chance <v Douglas H. Joyce, D.O>to have surgery. And after the case, when I went to speak with her, I think that she was <v Douglas H. Joyce, D.O>concentrating on the fact that there was a possible mortality because of the low risk <v Douglas H. Joyce, D.O>that we put it, which to her was much higher than she respected. <v Douglas H. Joyce, D.O>So as soon as I spoke with her. She passed out right to the floor and it took several of <v Douglas H. Joyce, D.O>the cases to be done successfully before the parents got the feeling <v Douglas H. Joyce, D.O>that we actually were going to come out with good news rather than bad news. <v Nunu Tsindiliani>Thank you. Thank you.

<v Nunu Tsindiliani>I was afraid yesterday before the operation. <v Nunu Tsindiliani>Nobody gave me a 100 percent warranty that the child is going to <v Nunu Tsindiliani>do well. <v Nunu Tsindiliani>We are from pillory a little town, <v Nunu Tsindiliani>Nietselise. We are not Georgians. We are as elby jangling My <v Nunu Tsindiliani>son Gangaji Pirif is a six years old. <v Nunu Tsindiliani>He's a nervous boy. His heart gets him very tired. <v narrator> <v narrator>This type of outpouring of emotion from Georgian and Armenian parents

<v narrator>was the rule rather than the exception. <v Speaker>We have 300, 400, 1 3, 400 is fine. <v Speaker>415, fifteen was fine, 20. <v Speaker>Half-. <v Speaker>Did in the operation, we just closed the hole in the heart. <v Speaker>And your son is doing very well. <v Speaker>To be like. <v Speaker>Go, go watch. I'll be here all day.

<v Speaker>Watch them then. <v Speaker>[chatter]. <v Valerie Siegeldorf>I'm sure the parents in the United States are just as relieved when their children come <v Valerie Siegeldorf>out of surgery. But I've never seen anything like it here that fathers were <v Valerie Siegeldorf>crying. The mothers were kissing the surgeon's hands. <v Valerie Siegeldorf>You know, it's grabs your heart. <v Valerie Siegeldorf>It was very emotional for everyone here, I think, to see it. <v David Meier-Levi, D.O.>Did surgery on their son. And he has done very. <v David Meier-Levi, D.O.>You will be able to see him every two hours and you will <v David Meier-Levi, D.O.>be able to talk to him and also lay down during the day we'll be able to bring him some <v David Meier-Levi, D.O.>food. <v David Meier-Levi, D.O.>It was nice to see the appreciation of what we've what we did <v David Meier-Levi, D.O.>for them. But it embarrassed me a little bit because I did not <v David Meier-Levi, D.O.>really feel that we deserved such an adoration. <v David Meier-Levi, D.O.>I think that was their way of showing their appreciation for that.

<v David Meier-Levi, D.O.>And it may be their custom of doing that in this particular way. <v David Meier-Levi, D.O.>But I felt a little bit embarrassed about that because, first of all, I'm not used to <v David Meier-Levi, D.O.>that. Number two, I just-. <v David Meier-Levi, D.O.>I just felt I was doing my job and I was just very happy that the children were doing <v David Meier-Levi, D.O.>well. So that was my biggest. <v David Meier-Levi, D.O.>Thanks for me. <v narrator>Valerie Siegeldorf is a perfusionist someone who works at the heart lung <v narrator>machine, which keeps the rest of the body alive. <v narrator>As the surgeon stopped the heart to work on it. <v narrator>Two months before the trip, she gave birth to her first child. <v narrator>While she couldn't pass up the Deborah trip, she found her own heart torn <v narrator>between job and family. <v Valerie Siegeldorf>It was hard, very hard leaving. But it's quite an opportunity just to come here <v Valerie Siegeldorf>and to visit the Soviet Union is an opportunity in itself and to help take <v Valerie Siegeldorf>care of these children who obviously wouldn't have gotten any help at all.

<v Valerie Siegeldorf>I heard her cry yesterday. <v Valerie Siegeldorf>It's hard. I miss her a lot, but getting <v Valerie Siegeldorf>over it. And I think it gets worse every day. <v Valerie Siegeldorf>But there's a lot of nice people here and there's all kinds of babies <v Valerie Siegeldorf>downstairs. I can go down and visit home. <v Valerie Siegeldorf>It helps. <v Lynn B. McGrath, M.D.>It's <v Lynn B. McGrath, M.D.>extremely important in cardiac surgery in order to have success, to do a very <v Lynn B. McGrath, M.D.>efficient operation. <v Lynn B. McGrath, M.D.>And so you have to have people with you who are very familiar with your technique. <v Lynn B. McGrath, M.D.>So there's not a lot of talking back and forth and discussing the perfect <v Lynn B. McGrath, M.D.>cardiac surgical operation from the point of view of the surgeon is one where there's no <v Lynn B. McGrath, M.D.>talking. The operation is just done.

<v Lynn B. McGrath, M.D.>Everybody knows their place. It's like playing chess in the library. <v Lynn B. McGrath, M.D.>You have to be able to think and concentrate and have everybody working <v Lynn B. McGrath, M.D.>like a clock. <v narrator>But it isn't always easy for doctors to admit they need help from their peers <v narrator>or to admit that doctors from another country can do things they themselves <v narrator>are unable to do. <v Speaker>Unfortunately, the level of frustration of the physicians significantly increased <v Speaker>as a result of our visit because they saw that we came in and in the 10 day <v Speaker>period came in and set up an ICU, an operating room, <v Speaker>cart the heart lung machine, and carried out con, you know, congenital heart surgery and <v Speaker>that it's possible to do that. And so I think their level of frustration is is even <v Speaker>more enhanced. <v Dr. Teimuraz Chachanashvili>Now, let's see that your surgery. <v Dr. Teimuraz Chachanashvili>Not every problem can be decided or made <v Dr. Teimuraz Chachanashvili>by surgeons hands. <v Dr. Teimuraz Chachanashvili>The one of the point is the equipments and medication <v Dr. Teimuraz Chachanashvili>won't surgeon have, and what team he have, or training

<v Dr. Teimuraz Chachanashvili>the team he have. <v narrator>The mission gave the Deborah team a different kind of training. <v Valerie Siegeldorf>We sent blood to the lab, you know, one sample and got three results back <v Valerie Siegeldorf>and things like that. <v Valerie Siegeldorf>My patient had the wrong blood type on his chart. <v Valerie Siegeldorf>Luckily, we didn't need to give blood for that patient. <v Valerie Siegeldorf>If blood were needed and the wrong blood transfused, that patient might have <v Valerie Siegeldorf>become seriously ill or even die. <v Roger Moore, M.D.>Their laboratory would take an hour to an hour and a half to get a blood gas back to us <v Roger Moore, M.D.>when things are happening very quickly in an open heart operation, you can't wait <v Roger Moore, M.D.>that long. So many of us ended up relying on our clinical judgment, <v Roger Moore, M.D.>having done this type of surgery for 10 years or so before and <v Roger Moore, M.D.>treated in manners that we thought were appropriate for the clinical <v Roger Moore, M.D.>situations rather than basing it totally on laboratory data. <v narrator>While doctors were often not satisfied with the quality of Georgeann lab work,

<v narrator>they did find the Georgian people ready to help whenever they could. <v Speaker>We had chatted with four families. <v Speaker>We'd planned to go ahead on Monday with their operations. <v Speaker>And then we were told sort of offhandedly that there was no blood available for two of <v Speaker>those children. On further investigation, we found that of the 19 children that we <v Speaker>had planned to operate on. <v Speaker>There was no blood available on eight of them, which is really an incredible setback. <v Speaker>At that time. And so we spoke to the Ministry of Health about this, and <v Speaker>the health minister went on the television and made a plea for blood. <v Speaker>And by that evening, by Sunday evening, we had the place was inundated with donations <v Speaker>of blood. <v Speaker>Starting off with 450. <v Speaker>Although people worry about complications during surgery, the time children <v Speaker>spend in the intensive care unit is also critical. <v Speaker>

<v Speaker>Can you cough? <v narrator> doctors <v narrator>gave the children medication to reverse the anesthesia quickly after surgery. <v narrator>Yet some took longer than others to come around.

<v narrator>Have her mom come in. <v Speaker>[people talking to the child]. Look at your bear. <v Speaker>Every few minutes... <v Speaker>She's appropriate, but she just isn't responding to pain the way she should. <v Speaker>I think her pre med is just taking effect. <v narrator>They all were removed from ventilators and needed to practice breathing on their own. <v John Hill>More and more and more after we remove the breathing tube.

<v John Hill>We did a lot of post surgical care. <v John Hill>Deep breathing, exercise, chest percussion, breathing techniques were important to <v John Hill>prevent the patient from getting either pneumonia or collapse a segment of <v John Hill>their lungs. <v Nunu Tsindiliani>Four, five, six, seven. <v narrator>Mothers helped coach their children in proper breathing. <v narrator>They also prepared their food and took care of their clothing. <v Speaker>

<v Speaker>Leave me alone is what he's saying. Yes. <v Speaker>Usually they say Coca-Cola. <v Speaker>Who's this? <v Speaker>Real tough case. <v Speaker>We've been lucky. <v Speaker>No strokes, no reentry, no infection. <v Speaker>The bottom line has been all along the patients themselves, the children. <v Speaker>Our responsibility is really to those children who we shouldn't have taken it upon <v Speaker>ourselves unless we were confident we could do it. <v Speaker>The children spent one day in intensive care. <v Speaker>The next in the step down unit there, the children got stronger and <v Speaker>took their first steps. <v Speaker>You ready? <v Pam Dey, R.N.>The first time that they get up, they are in a lot of pain.

<v Pam Dey, R.N.>They're still weak from the surgery and everything that's happened to them. <v Pam Dey, R.N.>We take it easy. You know, we have them sit on the end of the bed first, make sure that <v Pam Dey, R.N.>they're not dizzy and they're not going to have any problems. <v Pam Dey, R.N.>And then mom and dad or whoever accompanies them or guardians them <v Pam Dey, R.N.>and the nurses help them take their first walk, once they get up, then <v Pam Dey, R.N.>they're not as stiff. And then they feel more comfortable. <v Speaker>The next day, they were moved to the floor, trying to be steadier on their feet. <v Speaker>Deborah's team did remarkably well with the 19 surgical procedures. <v Speaker>Doctors and nurses found working with their Georgian counterparts a challenge.

<v Diana Barker, R.N.>Yeah, I know that the systolic is good. <v Diana Barker, R.N.>Okay, let me do the pressure and then they can do the pressure. <v Diana Barker, R.N.>Who first? <v Diana Barker, R.N.>They knew how to do it. Unfortunately, here in the Soviet Union, <v Diana Barker, R.N.>they are not allowed to be autonomous and practice <v Diana Barker, R.N.>nursing. They work directly for the physician and not as a colleague, <v Diana Barker, R.N.>as we do in the States. <v narrator>By the end of Deborah's time at Children's Hospital, the nurses were functioning much

<v narrator>as American nurses do. <v narrator>Deborah attending anesthesiologist Konstantin Dateshidze is Georgian <v narrator>and went to medical school with the Georgian minister of health. <v narrator>Dateshidze grew up in Tbilisi, but left the Soviet Union in 1981. <v narrator>This mission allowed him to go back home. <v narrator>A bit of a hero. <v Konstantin Dateshidze, M.D.>I grew up in this town and everybody was waiting for for <v Konstantin Dateshidze, M.D.>us. Everybody was waiting for me. And now, of course, everybody was proud.

<v Konstantin Dateshidze, M.D.>And I was getting enormous amounts of phone calls. <v Konstantin Dateshidze, M.D.>My phone wouldn't stop ringing. <v Konstantin Dateshidze, M.D.>I was just incredible amount of <v Konstantin Dateshidze, M.D.>people who were wishing us luck, wishing me a lot personally <v Konstantin Dateshidze, M.D.>and proud. <v Erakle Menagarishvili> We all think this is the greatest event in Georgia, which cannot be over <v Erakle Menagarishvili>expressed. I want you to understand me correctly. <v Erakle Menagarishvili>We are not talking about the 19 lives only, although it is <v Erakle Menagarishvili>by itself very important. <v Erakle Menagarishvili>We are mostly talking about the big endeavor that Deborah center started <v Erakle Menagarishvili>along with the Georgian doctors. <v Speaker>So you have one, two, three, four boxes. <v Speaker>All right. So let's what do you want to label those? <v Speaker>Armenian Americans had raised money to buy much of the medical equipment and transported <v Speaker>from Tbilisi to Armenia.

<v Speaker>Without modern medical equipment. <v Speaker>Many questioned what Georgian doctors would be able to do once the Deborah <v Speaker>team left. <v Jeff Luckenbach>We left them with enough equipment for about eight open-Heart procedures. <v Jeff Luckenbach>Beyond that, the rubles aren't going to buy oxygen. <v Jeff Luckenbach>ADAS and the other about two thousand dollars worth of disposables per procedure. <v Jeff Luckenbach>Their hospital is being renovated and the people <v Jeff Luckenbach>that do the work we do haven't done a case in a year and a half. <v Jeff Luckenbach>Their surgeons who who rely on muscle memory, their <v Jeff Luckenbach>hands don't have that. <v Jeff Luckenbach>And I don't see how they can possibly perform open <v Jeff Luckenbach>heart surgery. I think we've given them maybe the initiative to try to use our equipment <v Jeff Luckenbach>and hopefully the children that they operate on will also benefit. <v Jeff Luckenbach>I keep my fingers crossed. <v Lynn B. McGrath, M.D.>If they're going to be successful, they can't continue with their usual mechanism, and <v Lynn B. McGrath, M.D.>that is everything, they reuse it because what happens after two or three uses, <v Lynn B. McGrath, M.D.>it breaks down and you have a disaster on your hand.

<v Lynn B. McGrath, M.D.>So they have to accept the fact that this would be a very costly program. <v Lynn B. McGrath, M.D.>It will all depend not on the interest of the medical personnel here who are extremely <v Lynn B. McGrath, M.D.>interested. All depend on their political will. <v Lynn B. McGrath, M.D.>And I'm sure of financial ability to support this kind of a program. <v Lynn B. McGrath, M.D.>We, of course, will do everything we can to try to support them, but they will ultimately <v Lynn B. McGrath, M.D.>will have to come up with a fair amount of money if they're going to support this type of <v Lynn B. McGrath, M.D.>ongoing endeavor. <v narrator>The Georgian minister of health wasn't really concerned. <v narrator>He felt that his republic would be able to find some hard currency to purchase <v narrator>equipment in the future. And he was happy that Georgian doctors would be the <v narrator>first to begin a three month study rotation at Deborah. <v Speaker>With this one visit, all the problems cannot be solved. <v Speaker>But once again, may I point out this was a very good, successful <v Speaker>beginning and I wish to continue like that in the future. <v narrator>But for now, 19 children benefited from an unusual cooperative <v narrator>effort. A true mission from the heart.

<v Speaker>Thank you very much for coming here and saving my daughter and the other children. <v Speaker>The memories will stay with us and the warmth in our hearts will stay forever. <v narrator>A few days after surgery, the children looked well. <v narrator>And only a week after surgery, Niaz Tsindiliani looked like <v narrator>he was well on his way to a full recovery. <v Speaker>Major funding for a mission from the heart was made possible by U.S.

<v Speaker>health care dedicated to providing over one million members with quality <v Speaker>care. U.S. <v Speaker>health care. The health plan for living. <v Speaker>Additional funding provided by Siemens, a diversified leader in medical electronics, <v Speaker>providing technology and caring hands nationwide, worldwide <v Speaker>for more than 100 years. <v Speaker>And the Medical Society of New Jersey, the oldest state medical society in <v Speaker>the nation, serving New Jersey with ten thousand dedicated physicians, <v Speaker>the Medical Society of New Jersey caring for your health. <v Speaker>Since 1766.