Since 1997, members of the University of Michigan Departments of Neurosurgery, Anesthesia, and Operating Rooms have organized a trip to Guatemala to perform neurosurgical procedures for indigent children with neural tube defects. This outreach program is called Project Shunt. Working with Healing the Children as well as the Pediatric Foundation of Guatemala, the group provides much needed neurosurgical care to children in Guatemala. Guatemala is a country with an emerging middle class but with significant disparity between the classes. The majority (52%) of the population is under 18. Of Guatemala’s 5.4 million children, 83% live in severe poverty. Guatemala has one of the highest incidences of spinal bifida because of dietary issues, genetic predisposition and poor prenatal care.
During our latest medical mission we performed 16 neurosurgical procedures including repair of myelomeningoceles, untethering of spinal cords and surgical management of hydrocephalus. The team consists of neurosurgeons, anesthesiology faculty, pediatricians, pediatric intensivists, neurosurgical residents, anesthesia residents, pediatric ICU fellows, nurses and ancillary personnel/translators. In the weeks leading up to a mission, we ship several pallets of equipment and each team member brings a foot locker of medical equipment, including our sterilization units. Preparation for each trip begins as soon as the last trip has been completed. Fundraising is ongoing throughout the year and includes a sale of various handmade Guatemalan goods that are purchased each year.
In addition to performing operations, the group provides teaching to other surgeons, nurses and parents. An important educational objective was to improve the quality of life for children with spinal bifida and train the health care professionals in state-of-the-art management techniques. By developing an intermittent catheterization program and providing catheters to patients and their families, there has been a dramatic decrease in urosepsis and death among these patients. Working with local neurosurgeons, we have seen a shift to more complex cases as they take on the more routine cases.
Industry support has been important and has allowed us to bring 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 a variety of individuals and friends of Project Shunt to assure that all expenses are met.
It was the goal of the 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, we create three operating rooms, almost from the ground up. Included in this are supplies for both preoperative and post operative care. 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 and it is now routine for us do some of the most challenging spina bifida cases such as diastomatomyelia or complex lipomas. 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 create a pediatric neurosurgical hospital for the week we are there. This includes the pre-operative clinic, the OR, the post-operative care unit, a pharmacy and the subsequent inpatient care. 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 the parents’ eyes help us understand the impact of this work and gives us inspiration to return yet again.
Karin M. Muraszko, M.D.
Julian T. Hoff Professor of Neurosurgery
Chair, Neurosurgery Department
Medical Director Project Shunt