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Boston Children's global health: a medical mission to Grozny

  • Tripp Underwood
  • 10/24/2011 12:00:00 AM
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This September a team from Boston Children's Hospital went on a medical and educational mission to the war-torn city of Grozny, Chechnya. As representatives of Boston Children's Global Surgery Program, Boston Children's Plastic-Surgeon-in-Chief John Meara, MD, DMD, BMA, pediatric anesthesiologist Craig McClain, MD, MPH, nurse anesthetist Nelson Aquino, CRNA, MS and staff nurse II Jay Hartford, RNews You Can Use, BSNews You Can Use, SNI spent a week treating Chechen children and training local doctors to improve their delivery of pediatric perioperative healthcare at the recently constructed Gronzny Children's Hospital.

While in Chechnya the team was joined by Russian plastic surgeon Dr. Elena Karpova and hosted by Chechan surgeon Dr. Khassan Baiev, who also serves as director of the International Committee for the Children of Chechnya.

(Slide show images by David Coventry, www.davidcoventry.com)

The mission begins

Traveling from America to Chechnya is no easy task. The trip takes three days and involves several flight transfers. It was a grueling travel schedule, but the team says the excitement of landing in Grozny quickly alleviated their fatigue.

[caption id="attachment_4556" align="alignleft" width="225" caption="Nelson Aquino, CRNA, MS"][/caption]

Nelson: 'Having seen many pictures of the destruction caused by Chechnya's two wars, I was expecting Grozny to look like a battle zone with destroyed tanks littered among the ruble of burned out homes and buildings. Turns out the Grozny airport was very modern, much different than the makeshift airport I had flown into when I worked in Haiti after the earthquake.'

Craig: 'When we arrived there was some commotion outside the plane, with rows of people lined up in traditional Chechen garb. We didn't know what was happening, but some of the flight attendants kept saying 'doctors, doctors,' so we thought the spectacle might have something to do with us. When we de-boarded we were greeted by rows of people cheering and waving the American flag while children danced. It was the most memorable welcome anyone could hope for.'

Down to work

[caption id="attachment_14574" align="alignleft" width="300" caption="A team of medical professionals from Children's (back row) recently visited Grozny Children's Hospital to treat patients and teach Chechen medical students"][/caption]

Over the course of a week the team screened over 150 children and treated everything from congenital defects to burn injuries from the Russian and Chechen wars. When not treating patients, the team interacted closely with their Chechen medical hosts, helping them install new equipment and teaching them new anesthetic and surgical techniques, which they could then apply to their own practices.

Craig: 'On our initial assessment of their ORs, it became apparent, like many ORs in the developing world, that there was no piped in oxygen. Instead, the anesthesiologists were using oxygen concentrators. The problem with an oxygen concentrator is that it doesn't have the power to drive a modern anesthesia machine. We also found out that there were 7 new anesthesia machines that had been donated to the hospital that were functioning as very nice, unused ornaments in a closet, because they didn't have the proper oxygen source to drive them. There was a pipe source of oxygen in the hospital (in the ICUs and recovery areas) but the lines did not extend into the ORs because the hospital had run out of money. They literally just came to a dead end in the middle of the hall leading to the ORs. I casually asked if there were plans to extend the lines to the OR and they told me, 'If you think it should be done, then we can do it this afternoon.' So that's exactly what happened. They purchased high pressure hosing at the local market and extended the lines into the ORs. We then showed the local anesthesiologists how to use the new machines that they thought were superior to the older technology ventilators they had been using.'

Jay: 'The Chechen surgical team and medical staff were very eager to learn and most appreciative of our efforts. They asked many questions ranging from specific techniques to how they could generally improve different areas. They listened intently often with follow up questions. It was clear that this was an extremely valuable opportunity for them, which was very flattering. We were provided with several excellent interpreters, who were also very gracious and eager to help in anyway, so there was practically no disruption in dialogue, which made the experience more rewarding for everyone.'

Meeting of the minds

[caption id="attachment_11104" align="alignright" width="120" caption="John Mera, MD"][/caption]

The Grozny trip was the brainchild of doctors Meara and Baiev. The two met in 2008, during Meara's first medical mission to Chechnya. The two doctors hit it off very well and kept up correspondence after Meara returned to the states. Their mutual dedication to pediatric health and the well-being of children everywhere was the foundation on which the mission was built.

John- 'Khassan is an amazing doctor. The medical work he did during the wars is beyond reproach. Working along side him was a true honor and I hope to have the chance to doing it again in the future.' [To read more about Dr. Baiev's medical heroics during wartime, get his book 'The Oath: A Surgeon Under Fire' by clicking here.]

Nelson: I read 'The Oath' on the way over to Chechnya. When we visited Khassan's home, it was surreal to go into the basement where he operated on so many war victims. Being in that room and seeing it with my own eyes really gave me a better appreciation for all he'd been through.'


Gracious hosts

As with any medical mission, the team's hours were long and many of the surgical quarters were cramped. After a long day of teaching and seeing patients, rest and relaxation was a must. Azool, a friend of Dr. Baiev, housed the team and showed them the true extent of Chechen hospitality.

Jay: 'Our accommodations were exceptional to the point of being overwhelming. From the time we showed up at Azool's guesthouse it was like the prodigal children had returned. Each night there was enough food prepared for 12 or more people, twice as much as we needed. We were waited on hand and foot. If we even started to clear our own plates, our hosts, including the armed guards would rush over and insist we sit and they would clear. They would constantly ask if there was 'anything else?' or if we'd had enough. They treated us like visiting royalty. On our second to last night Azool presented us with several gifts, mostly books and picture albums of Chechnya. It was all very humbling.'

[caption id="attachment_14582" align="alignleft" width="120" caption="Craig McClain, MD, MPH"][/caption]

Craig: 'At one point we left Azool's and visited Khassan's home village of Alkhan Kala, where we dined in Khassan's house and met his sister. She cooked us an unforgettable, traditional Chechen meal. Being so welcomed in to the homes and lives of would-be strangers really proved to me the power medicine has as a form of diplomacy. Endeavors like this send a very powerful message to others. Boston Children's is in a unique position to be world leader in supporting such relations, and I for one would love to be involved in building those bridges.'

An experience that stays with you

It's been nearly three weeks since the team returned to the States, but the mission remains fresh in their minds. Readjusting to life at Boston Children's has been relatively smooth, but team members say a trip like theirs can forever change a person's views on caretaking. The Boston Children's Global Surgery Program hopes to develop the relationships fostered by this trip with the Chechan caregivers. This was a fantastic start, but there is still much to do to improve the health of children in Chechnya.

John- 'This trip made me realize that we at Boston Children's have so much to offer developing countries in the area of pediatric surgical care delivery and education. Our small team was able to teach people things that will change the way they deliver care to thousands of children in Chechnya.'

Nelson: 'Working alongside Chechen anesthesiologists and seeing how they worked was very eye opening. I learned about their practices and medicines, and marveled at how much they did with so little. It really made me appreciate the variety of medication, technology and experts we have here in America.'

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