Project Shunt
In 1997 the University of Michigan was approached by Healing the Children to help with a project they had in Guatemala. Guatemala is a country in which the incidence of spina bifida and myelomeningocele is quite high. They were looking for assistance with pediatric neurosurgery to deal with some of these problems. Healing the Children was working with a voluntary organization in Guatemala, The Pediatric Foundation of Guatemala, to provide such care and sought the assistance of neurosurgeons that might be willing to travel to Guatemala to help with treating these children.
Guatemala is located in Central America and was in active civil war until 1996. Once a treaty had been signed between the local insurgents and the military, some measure of political stability ensued. Thus, Healing the Children felt that an opportunity had arisen for possible medical missions to Guatemala. The Department of Neurosurgery at the University of Michigan undertook an exploratory trip in 1997 in which several faculty and residents traveled to Guatemala to assess the conditions and circumstances under which such a neurosurgical medical mission might take place.
For the past twelve years, members of the University of Michigan Department of Neurosurgery, Anesthesiology, Pediatrics, and Operating Rooms have organized an annual trip to Guatemala to perform neurosurgical procedures for indigent children. This outreach mission is called Project Shunt. Working with Healing the Children and The Pediatric Foundation of Guatemala, the group provides much needed neurosurgical care to indigent children in Guatemala. A large proportion of these children are descendents of the native Mayan population.
Guatemala is a country with an emerging middle class but there is still a significant disparity with respect to health care. The majority of the population (52%) is under eighteen years of age, and of Guatemala’s 5.4 million children, 80 to 85% live in severe poverty. In addition, Guatemala has one of the highest incidences of spina bifida because of a variety of factors including dietary issues, genetic predisposition and poor prenatal health care.
Our most recent mission occurred in September 2008. We performed 26 operations during the week-long mission at El Nino Jesus Hospital in Guatemala City. We operated on children to repair complex spinal dysraphisms including diastematomyelia, myelomeningocele, terminal myelocystoceles and lipomyelomeningoceles. In addition, we performed a series of procedures for hydrocephalus including third ventriculostomies and placements of ventriculoperitoneal shunts.
The rhythm of a medical mission has now been well established within the Department of Neurosurgery. The project is led each year by one of the neurosurgical residents who has been a previous member of the medical mission and who now takes the responsibility to be “in charge” of the present mission. He or she is assisted in their role by a future medical mission leader and a past medical mission leader. Thus, the neurosurgical residents who participate in this process will have spent three consecutive years participating in the mission. They are guided and supported by neurosurgical faculty, specifically Dr. Karin Muraszko and Dr. Suresh Ramnath, who are founding members of Project Shunt. Dr. Nicholas Boulis began his participation as a resident back in 1997 and continues his association as an attending neurosurgeon, currently practicing at Emory. In addition, there is strong help and support from Anesthesiology, specifically working with Dr. Brian Woodcock and Dr. Judy Negele of St. Joseph Mercy Hospital. Finally, there is also leadership on the part of Dr. Gail Annich from the Pediatric Intensive Care group. The Departments of Neurosurgery, Anesthesiology and the Pediatric Intensive Care Unit have members of their residency and fellowship group participate. The nurses of the Mott and Main Operating Room also participate making certain that supplies and equipment for the operating rooms are well organized.
In the weeks leading up to a mission we ship some eight pallets of equipment to Guatemala, and each team member brings a foot locker of medical equipment including sterilization units. In the past, all of this equipment was brought to and from Guatemala on a yearly basis. The group has recently rented a storage facility in Guatemala to maintain some of the larger equipment. Preparation for each trip begins as soon as the last trip has been completed. Fund raising is ongoing throughout the year and includes a sale at UMHS each December of various handmade Guatemalan goods that the group brings back with them, specifically for the purposes of fund raising.
In addition to performing operations, the group provides teaching to other surgeons, nurses and parents. An important educational objective for Project Shunt was to improve the quality of life for children with spina bifida. We therefore use a variety of resources to help train health care professionals in Guatemala in state-of-the-art management techniques. For example, by developing an intermittent catheterization program and providing catheters to patients and their families, there has been a dramatic decrease in urosepsis and renal death among these spina bifida patients.
Industry support has been important and has allowed us to bring a variety of pieces of surgical equipment as well as shunts to Guatemala. In addition, medical supplies are both purchased and contributed by the University of Michigan and various vendors. Significant contributions are also made by various friends of Project Shunt to assure that all expenses are met. Some 25 health care professionals travel to Guatemala each year to provide this week-long medical mission.
It was the goal of the group to provide identical care to the children of Guatemala as that which would be received stateside in Mott Children’s Hospital at the University of Michigan. With each trip we create three operating rooms. Included in this are supplies for both pre-operative and post-operative care, as well as all necessary medicines and surgical supplies. Aligning with The Pediatric Foundation of Guatemala has been important and assures that each patient gets adequate pre-operative screening and post-operative care.
The complexity of the cases has increased over the years and it is now routine for us to do some of the most challenging spina bifida cases such as diastematomyelia and complex lipomas. By working with The Pediatric Foundation we have been able to train some of the general surgeons in Guatemala in some basic neurosurgical techniques. By assembling such a complete team, we have been fortunate to have few complications and some very rewarding successes. This is truly a team effort. We work diligently to create a pediatric neurosurgical hospital for the week we are there. This includes the pre-operative clinic, the OR, the post-operative care unit and the subsequent inpatient care unit. For each of the medical participants, it is very apparent that the experience reaffirms why they became health care professionals. The smiles on the children’s faces and the look of hope in their parent’s eyes help us understand the impact of this work and gives us inspiration to return yet again.
