Hearts and Minds: Dr. James Hammel Leads Omaha Children’s Hospital Team Beyond Borders to Repair Heart Defects in Young Patients in La Paz, Mexico
It seeems as though every year or so now I get an assignment to write about a medical mission team from Omaha that travels beyond borders to deliver care. In this Journeys story for Metro Magazine I write about the trips led by Dr. James Hammel and his team to the peninsula Mexican state of Baja Sur California and the city of La Paz, where life saving operations are done on infants and toddlers.
Visit the digital edition of the magazine, including my story, at–
Hearts and Minds: Dr. James Hammel Leads Omaha Childrens Hospital Team Beyond Borders to Repair Heart Defects in Young Patients in La Paz, Mexico
©by Leo Adam Biga
Appearing in the May-June-July 2016 issue of Metro Magazine (http://www.spiritofomaha.com/Metro-Magazine/The-Magazine/)
The peninsula Mexican state of Baja Sur California is a tourist draw for its ocean-front beaches and vistas. But isolation from the Mexican mainland makes it hard for residents to access specialized medical care. Poor residents lack the means to travel, much less afford treatment. A lack of pediatric heart services results in many congenital defects going unevaluated and undiagnosed. Consequently, many children die before getting an opportunity to be treated.
To bridge that care gap Cardiothoracic Surgeon Dr. James Hammel twice a year leads a medical mission trip to the southern city of La Paz in that Mexican state. He and his all Children’s Hospital & Medical Center team were there in November and they’re back again this April.
Before starting the La Paz trips four years ago, Hammel was a veteran of medical missions to Honduras and Nicaragua. His work in Mexico grew out of a collaborative with a Sioux Falls, S.D. health center that received children cancer patients from Big Sur through the Los Cabos Children’s Foundation based on the peninsula. Foundation founder Tom Walsh is from South Dakota. Children sent to Sioux Falls who presented heart problems then came to Omaha for treatment.
When a boy named Mario died before ever making it to a Chidlren’s operating room, Hammel resolved to provide care in Southern Baja in order to circumvent the delays that result in such needless tragedy.
“Before we went down for our first trip there was no pediatric cardiologist in that state of Mexico, there was no cardiac surgeon, adult or pediatric. There had never been an open heart operation performed there historically. There was no intensive care unit team either, And there obviously was no familiarity with doing heart surgery, so we were really pioneering something there.” – Dr. James Hammel
“It was obvious to me he’d been turned away again and again and again,” Hammel says. “His mother was very sweet and she had taken him repeatedly across to the mainland and sort of begged for surgery from one of the centers there. But they just couldn’t get it. That case firmly cemented my commitment to this charitable foundation and when the opportunity did arise to work down there that seemed like a lot better option than bringing people up.
“Bringing kids up is very expensive, cumbersome, difficult. It takes a long time and it’s only possible to do in very small numbers. I thought. Well, for the same amount of money we could treat a dozen children there by bringing our team down.”
Hammel leads some 20 medical professionals, most specializing in critical care, on each 10-day trip. They’ve instituted many firsts there.
“Before we went down for our first trip there was no pediatric cardiologist in that state of Mexico, there was no cardiac surgeon, adult or pediatric. There had never been an open heart operation performed there historically. There was no intensive care unit team either, And there obviously was no familiarity with doing heart surgery, so we were really pioneering something there.”
He brings intensive care doctors, children’s pediatric intensive care nurses, a perfusionist to run the heart-lung bypass pump, cardiac anesthesiologists, operating room nurses and a surgical assistant. Everyone volunteers their time. Their care is entirely free to families.
“What we do is a calling, a passion, it’s what we love to do, but it is a job and you don’t always appreciate and grasp the enormity of what you’re able to do until you give it to somebody for free. What we give down there is something nobody in the United States will ever appreciate the way the people in La Paz do. I cannot over-stress the amazing feeling you get when you save the life of a child whose family has tried every avenue and lost hope and then you do that for them and they are so grateful. I can’t imagine not doing this work. I’m in it for the long haul.” – Dr. Bridget Norton
It’s taken awhile to build trust with local leaders but a permanent program is now in the works.
“Little by little the administration of the hospital we’re working in and the government health ministry and the state government began to take an interest in the possibility of making an ongoing program. That’s when my goals took their last maturational step,” Hammel says. “We’ve been back every six months for a total of six missions and we’ve operated on 68 children – some with simple diseases but some with very complicated heart defects. Mostly they’ve done fine.”
Some children require multiple surgeries.
“My goal is to establish a new cardiac treatment program to be a permanent part of that state’s health care system. In all of Mexico there are about 11 pediatric cardiac surgery programs and eight are located in Mexico City itself, thus the distribution of this resource is really poor and access is really limited. There are probably 18,000 children born in Mexico with heart defects every year and probably only about 3,600 corrective operations and catheter procedures performed. So, nearly 80 percent of the children with heart defects likely die, It’s a really big unmet need in the country.”
His goal is to help the Mexicans “build a viable, self-sustaining program that goes on treating these children when we’re not there and even after we stop coming.” He adds, “We have recruited to the state two pediatric cardiologists, a pediatric intensive care doctor and the first cardiac surgeon in the state. We have trained a group of pediatric intensive care nurses in special techniques for cardiac intensive care nursing. We trained the operating room staff.”
Before it can be self-sustaining, he says a “critical mass of manpower” is needed. Progress to get there is being made.
“It’s a gradual thing. This last summer the program performed its first open heart operation without us being there. They have performed a larger number of non-open heart cardiac cases, simpler cases, so they’re beginning to get going.”
He expects the program to reach a major milestone in 2016.
“When we get the program fully accredited by the Mexican federal government the hospital system can begin to receive some reimbursement for each case they do. It amounts to about $6,000 or $7,000 per case, but we can do it for that. It’s going to take a little more investment for needed supplies before we get to that point.
“In the meantime, we go and we do a dozen cases twice a year and that’s wonderful. It’s a great thing for the children we treat and their families, but it’s not enough. I would estimate there are about 60 children born in this state of Southern Baja a year with critical heart defects who need an operation, so we’re not reaching all of them.”
“The trip has evolved and the camaraderie has become much more important and never more so than last trip when the kids were much sicker.” – Shannon Hoy
He’s created a nonprofit, Abriendo Corazones – Opening Hearts, to coordinate the medical care and logistics of the trips. It partners with the Los Cabos foundation. Children’s may soon be formally involved.
“Our hospital administration has seen the positive effect this kind of work has on our staff as far as their resourcefulness, their creativity, their career satisfaction. It’s something that really brings us together
and that has real tangible benefits in terms of our ability to do our job with excellence. I think Children’s is coming to see this work as a two-way street with great benefit to the people there and to our patients and staff here.”
Dr. Bridget Norton, a Specialist in Pediatric Critical Care Medicine, has been on all but one La Paz mission. She says it’s a “team-building” experience for both her and her fellow professionals who go.
“We make relationships and connections and friendships with colleagues we wouldn’t necessarily make without that experience.”
Many things Children’s does in Omaha, such as blood conservation and comfort med administration, have come out of what the team’s learned to improvise with in resource-poor La Paz.
Norton says the trips put in perspective the gifts she and her mates have to give.
“What we do is a calling, a passion, it’s what we love to do, but it is a job and you don’t always appreciate and grasp the enormity of what you’re able to do until you give it to somebody for free. What we give down there is something nobody in the United States will ever appreciate the way the people in La Paz do. I cannot over-stress the amazing feeling you get when you save the life of a child whose family has tried every avenue and lost hope and then you do that for them and they are so grateful.
“I can’t imagine not doing this work. I’m in it for the long haul.”
Perfusionist Joe Deptula, who’s made multiple Central American mission trips with Hammel, says the work is about “being able to give back.”
Shannon Hoy, a Certified Registered Nurse Anesthetist (CRNA), has made many mission trips herself. She sums up the La Paz mission as “a great experience,” adding, “The trip has evolved and the camaraderie has become much more important and never more so than last trip when the kids were much sicker.”
The team can’t forget a patient named Oscar.
“Oscar came to us with a very serious congenital heart defect, which was previously operated on during a different trip,” Hammel says. “Due to his age and heart defects, his heart had sustained a lot of wear and tear and we were unsure how well he would do despite the repair.”
When the team left for home his vitals looked good. Then a fire in the unit forced a patient evacuation. His lines were cut and he expired off the meds. News of his death hit the team hard as he’d twice beat the odds only to lose his life anyway.
Most operations are scheduled in advance but families often show up unexpectedly with a sick child. The parents of a 6-month-old named Derek drove hours to reach La Paz, where the team found the baby so fragile they simply admitted him for observation without a single line or anything started lest the trauma prove too much. The boy’s surgery the next morning went well and today he’s totally repaired and healthy.
The life-and-death surgeries and the intense emotions take their toll.
“You are exhausted and not just physically,” Norton says. “It’s hard work and we work long hours. We do overnights in the hospital. But it’s also emotionally draining. You just have a lot of feelings and emotions you work through.”
Once back home, some decompression is necessary. Thoughts of La Paz, however, are never far from Children’s team members’ minds. Not only do patients and families leave an imprint, but so do staff.
“We’re like family,” Norton says of her team and the Mexican team they work alongside. Collaboration is vital to the program’s success. “They’ve been amazing and are on-board with the mission. We really couldn’t do anything we do without them – all the support services they provide, the hoops they jump through, taking care of the equipment we leave down there. Any blip that comes up, they handle it.”
Los Cabos foundation former executive director Greg Edwards now heads Abriendo Corazones – Opening Hearts with Dr. Hammel. He says building the program has inherently high stakes and complexities because it’s critical care. Since that care is largely delivered by Omaha specialists, much coordination and navigation is required. These specialists not only practice their healing arts in La Paz but impart expertise there. Locals also travel to Omaha for training.
“The support of Dr. Hammel’s team and friendships that exist at Children’s has been essential for this to happen,” Edwards says. “You cannot have a cardiac program without intensive care. Building a pediatric cardiac care program is no small task. It has meant creating relationships with Mexican officials. recruiting qualified staff, turning the surgeries into not only life-saving operations but a training theater for the local Mexican medical staff, creating a pipeline for medical supplies needed for the surgeries and intensive care from Omaha to Baja.
“It really is a huge undertaking.”
Abriendo Corazones accepts donations to support its efforts at strengthening hearts. Contact Dr. Hammel at 402-955-4360.
For more on the trips, visit http://www.loscaboschildren.org/donate/.