Completeness of Care: Paediatricians & Paediatric Intensivists

Dr. Henry Issenberg (third from left), Operation Smile volunteer paediatric intensivist, works with a young patient during a medical mission in Jordan. Photo: Jasmin Shah.

Editor’s Note: With more than three decades of experience performing safe surgery in resource-limited environments, Operation Smile knows that a single surgical procedure is a small part of a larger, multi-tiered process that’s focussed on the entire well-being of the patient. Our “Completeness of Care” series highlights each of our volunteer medical specialties and the critical roles these dedicated, selfless volunteers play in our ability to uphold our Global Standards of Care*, which outlines procedures that allow us to provide our patients with outcomes that are consistent with the world’s finest hospitals, no matter where in the world our surgeries are performed.

Since the vast majority of Operation Smile patients are children, our volunteer paediatricians and paediatric intensivists are critical to providing medical evaluations and treatments for our young patients, whether at a medical mission site or at one of our care centres.

Before a child receives surgery from Operation Smile, paediatricians identify acute or chronic medical conditions during comprehensive health evaluations. Their findings are then shared and discussed with the medical mission’s clinical coordinator, paediatric intensivists and anaesthesiologists to determine if it’s safe for the patient to be put under anaesthesia – the aspect of surgery that presents the most risk in any environment, including the world’s most advanced hospitals.

Even after a child is deemed healthy enough for surgery, an additional evaluation is performed on the day of the procedure to provide the most current and complete picture of the child’s health. They continue to care for patients after surgery and ensure families are prepared to care for their children once they return home.

“While paediatricians don’t have the most complex role medically, I have always said that we have a critical logistics role because we have to communicate our patient’s cases with all of the different medical specialties,” said Dr. Geir Stangeland of Norway, who, before becoming Operation Smile’s Associate Chief Medical Officer, served as a volunteer paediatrician on 29 medical missions dating back to 2001. “That is why we are the first people in and the last people out every day.”

Dr. Geir Stangeland, Operation Smile Associate Chief Medical Officer, provides a comprehensive medical evaluation to a young Ethiopian patient in 2010 as a volunteer paediatrician. Photo: Margherita Mirabella.

During the time when patients are under anaesthesia – especially immediately after it has been administered and before the patient returns to consciousness – paediatric intensivists are at-the-ready to recognise and react to any medical complications with cardiopulmonary resuscitation, medication and other live-saving treatments. Paediatric intensivists also serve as the head doctor for the medical mission team itself, responding to any ailments or emergencies our staff and volunteers may experience in the field.

While their roles differ greatly both at their respective workplaces and in the medical mission setting, open communication between paediatricians and paediatric intensivists is crucial to Operation Smile’s ability to deliver the best possible patient outcomes.

“I have full confidence in all of the volunteers on a (medical) mission, but just like in our own workplaces, there are times when we want to discuss certain patients with other physicians,” said Dr. Bruce Banwart, a longtime Operation Smile volunteer paediatric intensivist from Kansas City, Missouri, U.S. “There have been many times when somebody has come in to the recovery room and said, ‘Bruce, they want you in the operating room.’ Then as a team, we have a discussion about the concerns of that patient, whether it be coarse breath sounds, oxygen saturations lower than normal, or a rash that was only discovered once the child’s clothes were exchanged for a hospital gown.

“I cherish the exchange of ideas that occurs on Operation Smile (medical) missions and the genuine respect that we show for others’ ideas.”

Dr. Bruce Banwart (right), Operation Smile volunteer paediatric intensivist, and recovery room nurse Alyssa Petersen tend to a child after her surgery during a medical mission in Madagascar. Photo: Zute Lightfoot.

Operation Smile paediatric intensivists and paediatricians continually face challenging cases. Due to the socio-economic conditions in many of the low- and middle-income countries where Operation Smile works, children often arrive in poor health due to the effects of malnutrition, including anaemia. Respiratory and cardiac issues are also commonly seen.

“These children have often had little to no access to medical care for much of their lives and may not even be aware of the seriousness or complexity of the underlying health problems that may have,” said Dr. Ben Gitterman, a longtime volunteer paediatrician from Washington, D.C., U.S. “We try to connect them to other health resources in the community they live in when possible.”

Dr. Henry Issenberg, one of Operation Smile’s leading volunteer paediatric intensivists from Larchmont, New York, U.S., recalled a situation when the work of a paediatric intensivist potentially saved a life at a medical mission.

“A small, developmentally-delayed child was seen at screening and scheduled for cleft palate surgery… On the morning of the proposed surgery during the routine pre-operative review and physical exam, the (paediatric) intensivist noticed subtle seizures and felt the anaesthesia and surgical risks did not warrant pursuing the proposed procedure within our (medical) mission setting,” Issenberg said. “(It was later discovered that) the child had an unrecognised genetic syndrome associated with structural neurologic disease and seizure disorder… Arrangements were made for the child to be referred to a large regional children’s hospital for further evaluation and care.”

Dr. Henry Issenberg (centre) tends to a patient during an Operation Smile medical mission in Brazil. Photo: Marc Ascher.

According to Stangeland, Gitterman’s and Issenberg’s stories underscore how critical the evaluations of paediatricians and paediatric intensivists are to the level of patient safety set forth by Operation Smile through its Global Standards of Care.

“The most important thing that they mentioned was, ‘Ok, we may not be able to provide the child with surgery at this time, but we try to refer them to whatever medical centre there may be in that country so that we can provide the child with basic care,’” Stangeland said. “Then ask the family to come back to a future medical mission for another chance at surgery.”

While every paediatrician and paediatric intensivist is driven by a passion to care for children, those who volunteer for Operation Smile said they feel a deeper connection to the service they provide to children and families around the world through the organisation’s life-changing – and often life-saving – work.

“There is a very high level of professionalism within the Operation Smile volunteer pool. Each team is united in one goal, focused like a laser to bring the best medical and surgical care into an underprivileged, disadvantaged community,” Issenberg said. “These children and families would never have the opportunity to receive amazing transformative reconstructive surgery, which we accept as a basic human right, for all people.”

Dr. Shadi Alsmadi, a volunteer paediatrician from Jordan, added: “I believe that all children, despite of their religion, race, social class, should receive the maximum attention and care. We help not only children, but also their families. We give them new faces, new lives and new hope. Operation Smile is the best in doing this.”

Dr. Shadi Alsmadi, an Operation Smile volunteer paediatrician from Jordan, comforts a young patient during a medical mission in his home country. Photo: Manuela Emmer.

*Global Standards of Care © 2006, 2015 Operation Smile, Inc. All Rights Reserved.