Beginning in 1997, members of the University of Michigan Departments of Neurosurgery, Anesthesia, and Operating Rooms organized annual trips to Guatemala to perform neurosurgical procedures for indigent children with neural tube defects. Team trips took place annually from 1997-2014 and another trip – the most recent – was taken in 2016. This outreach program was termed Project Shunt. Working with Healing the Children as well as the Pediatric Foundation of Guatemala, Project Shunt has provided much needed neurosurgical care to children in Guatemala over the past 20 years. The Project Shunt team hopes to return to Guatemala in the near future to evaluate other important outreach opportunities.
Located in the heart of Central America, Guatemala is home to an estimated 14 million people, half of which are children. Guatemala is the poorest country in Latin America with more than half of the population living on less than $1.25 per day. As primary health care for children in the country has continued to improve, more children are surviving infancy and early childhood with debilitating congenital or acquired conditions requiring advanced pediatric specialty care. For example, Guatemala has among the highest rates of neural tube defects in the world. Neural tube defects are birth defects of the brain or spinal cord, most known by conditions such as spina bifida or nasal encephalocele. As a result of this high incidence, the need for neurosurgery and craniofacial surgery in Guatemala is significant (www.worldpediatricproject.org).
During the most recent medical mission in 2016, 16 neurosurgical procedures were performed, including the repair of myelomeningoceles, untethering of spinal cords and surgical management of hydrocephalus. The teams who have gone on these missions have included neurosurgeons, anesthesiology faculty, pediatricians, pediatric intensivists, neurosurgical residents, anesthesia residents, pediatric ICU fellows, nurses and ancillary personnel/translators.
In addition to performing operations, the group has provided teaching to other surgeons, nurses, and parents. An important educational objective has been to improve the quality of life for children with spinal bifida and train the health care professionals in state-of-the-art management techniques. Through the development of an intermittent catheterization program and the provision of catheters to patients and their families, a dramatic decrease in urosepsis and death among these patients has been experienced as a result of this program.
In addition to ongoing fundraising in the past, industry support has played an important role, allowing the team to bring shunts to Guatemala. Medical supplies have been both purchased and contributed by the University of Michigan and various vendors. Significant contributions have also been made by a variety of individuals and friends of Project Shunt to assure that all expenses have been met.
It has always been the goal of the Project Shunt group to provide identical care to the children of Guatemala as that received stateside at C.S. Mott Children’s Hospital at the University of Michigan. With each trip taken, three operating rooms were created, almost from the ground up, and supplies for both preoperative and post-operative care were provided. Aligning with the Pediatric Foundation of Guatemala has played an important role in the success of this program, helping to ensure that each patient has received adequate pre-operative screening and post-operative care.
Since the first Project Shunt trip took place and over the years of medical mission trips, the complexity of the cases steadily increased. On more recent trips, the team performed some of the most challenging spina bifida cases such as diastomatomyelia or complex lipomas. By assembling such a complete team, there have been very few complications and, more importantly, many very rewarding successes.
Project Shunt has been a team effort – one that has essentially led the team to create an entire pediatric neurosurgical hospital for the weeklong duration of each trip, including the pre-operative clinic, the OR, the post-operative care unit, a pharmacy, and subsequent inpatient care.
For each clinical participant on the care team, Project Shunt has continuously reaffirmed why they once chose to become health care professionals. The smiles on the children’s faces and the look of hope in the parents’ eyes witnessed during each Project Shunt medical mission trip have helped team members to understand the vital impact of their work, providing inspiration to return in the future.