October 2008

The October trip was cancelled, in large part because of Hurricane Norbert, which crossed the southern Baja Peninsula the weekend of our trip. Fortunately, Mulege escaped any significant rain.

Prior to the October trip, during the week of September 10-14, Aeromedicos was involved in a very rewarding case of a young boy, Brandon, from San Juanico, Baja California. Dr. Vallee had seen Brandon and his mom Elisabeth in the clinic about three years earlier, when it was learned that Brandon was born with an imperforate anus. That is a birth defect where the end of the colon does not make the final connection to the exterior of the anus. At birth the child was given a colostomy and tests were later done to see if it was possible to surgically attach the colon and achieve a functional system. During this process, the father left, the mother lost her job, and consequently lost the medical benefits that could have helped Brandon.

Because we had not seen or heard any more about Brandon, it was assumed that the young boy had been helped somewhere. However, this August, one of our volunteers, Mike Nizec, found out that nothing had been done and that the colostomy was in need of repair. Pictures taken by Mike showed the hyperplastic tissue around the colostomy to be in need of some aid.

Dr. Vallee agreed to go down on a special trip to evaluate Brandon. Meanwhile, contacts were made to try and find a suitable place where some sort of surgery could be performed. Since passports and visas were not available and would take too long to obtain, it was decided that a Mexican hospital would be the best opportunity to fix the colostomy.

One of our contacts, Liga, a flying group that does great work in Sinaloa and whom we have assisted in the past, emailed us that they were having a clinic in Tijuana on Sept 13 at a Catholic hospital and had the anesthesiologist and OR time but needed a surgeon. Brandon was evaluated by Dr. Vallee on the weekend of August 29, at which time Dr. Vallee saw a normal, healthy young kid, ready for a new directions. Meanwhile, Dr. Gayou asked Dr. Tamir Keshen, a pediatric surgeon, if he would be interested in helping. Fortunately for all concerned, the answer was, “ yes”!

The next step was to insure that the mother and child were in Tijuana prior to the date of the surgery. To that end, several of our pilots volunteered to make the trip. It was finally decided that Craig Arcuri would be the first pilot with Peter Lewis as back up. As the date grew near, a tropical storm, with a predicted landfall close to the Cadeje landing strip, threatened to wreck our plans. By contacting Dave Steibel in San Juanico, we were able to get the mother and Brandon to Guerrero Negro for pickup on Thursday before the surgery.

One last glitch, a leak in a fuel tank on Craig’s plane, meant that he could not use his plane. After a quick conference with Craig I found out that he had sufficient C210 time so I agreed to loan him my plane to make the trip. We met at the hanger to go over the plane where I found to my chagrin that the master switch had been left on and the battery needed charging. That problem, fortunately, was an easy fix and Craig was off the next morning early with Bob Nussbaum, whose job was to arrange accommodations and chaperone Elizabeth and Brandon while in TJ.

Friday afternoon Dr. Keshen, Dr. McFarland, and I met at the plane and flew to Tijuana. At the hotel, Dr. Keshen got his first look at the young boy’s situation. As the discovery process progressed, it started to appear that maybe, instead of just a colostomy repair, the pass thru of the colon to the anus could be undertaken if an x-ray showed favorable positioning of the colon and the anus. The next step was to meet at the hospital to evaluate the OR and find needed instruments. A phone call to Mike Nizec in San Diego was made to have him stand by to run down any essential surgical tools and deliver them, if needed, to the hospital. To everyone’s relief, the hospital was well equipped with both the needed surgical supplies and the x-ray capabilities.

Brandon was admitted to the hospital, with mother spending the night by his side, and the surgery was scheduled, conditional on the outcome of the x-ray.

The next morning the x-ray showed that the colon was indeed in a favorable position and the pass thru surgery was begun at about 9:30 am. After almost 5 hours in surgery by Dr. Keshen, with Dr. McFarland assisting and a great OR team, the first step was complete. The colon had been connected to the anus!

There was a follow-up appointment at the hospital 2 weeks after the surgery and mom was been given instructions and dilators the help the muscles recover. If all goes well, the closure of the original colostomy will be done at the same hospital in January.

This has been a great experience and there has been fantastic support and teamwork by a number of individuals, all working hard toward the same goal. The following is a list of all involved.

Thanks and great job, everyone! John Grube DDS Director Aeromedicos of Santa Barbara

Team Brandon

Pediatric Surgeon: Tamir Keshen

MDs: Eric McFarland ; John Vallee , Bob Gayou , Irlanda Diaz

Anesthesiologist: Mahfous el-Tawil (Tawil)

OR nurse: Donna O'Connor

Interpreter: Lala Gutierrez

Pilots: Craig Arcuri, John Grube

Ground Crew: Mike Nizec ; Dave Steibel ; Bob Nussbaum ; Frank Mora (Tijuana interpreter)

Clinic Coordinator: Jacki Hansen

The Entire Staff of Hospital Sagrado Corazon Tijuana Mexico: A competent well run facility with a great staff and even a sense of humor that comes with a smile.

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