A BMET travels to exotic lands with Project Open Hearts to provide training for biomeds who service and support cardiac surgery equipment.

“Opportunities don’t happen…you have to look for them." These are the words of Chuck Rudolph, a fellow Project Open Hearts (POH) volunteer.

Because you are reading this article and not just looking at the pictures, there must be a part of you that finds biomed volunteer work overseas intriguing. I felt the same way a few years ago when I joined POH, a charitable medical team that teaches cardiac surgery to physicians in developing countries.

Making an Opportunity
In the mid 1990s, I noticed and admired people like the late Bob Morris, Ismael Cordero of Orbis International (whose story was published in 24x7 in October 2003), and several local biomeds volunteering with Operation Smile here in the Philadelphia area, all of whom traveled overseas and used their biomed skills to help others.

Shastin Medical Center, Ulaanbaatar, Mongolia

PO-6 Series Russian ventilator

Author Lou Shonder, perfusionist Gankhuyag, and surgeon Dr. Bat-Undral

Lou Schonder poses on the observation deck of Zayzan Hill overlooking the city of Ulaanbaatar

Family members of a POH surgery patient with Lou Schonder

We did it! POH volunteers Jim Burris and Lou Schoner pose with Dr. Bat-Undral and Shastin engineers after installing the oxygen maniford system donated by Denver’s Mile-High Rottary Club.

I became inspired to join a volunteer medical team and got a lead very quickly, thanks to Scott Leshner of Carelift International. Project Open Hearts, a small volunteer medical team in Denver, needed a biomed for its trip to Kyrgyzstan. After a few phone interviews, I joined the POH team.

Since then, I have had the good fortune to travel with POH to Bishkek, Kyrgyzstan (1998); Karaganda, Kazakhstan (1999); and Ulaanbaatar, Mongolia (annually, 2001 through 2003). Having the opportunity to meet all of the wonderful people of POH (our team and the local people where we have traveled) has been a blessing.

Time Travel
Frequently, I am asked, "What are the hospitals like? What is it like working in that environment?" Simply put, it is like stepping back to American health care in 1955.

The hospitals have an architectural style reminiscent of 1940 to1960. Twenty years ago, I worked in older US hospitals that had not been recently renovated, and the appearance was very similar. Other than some recent donations, the medical equipment in use is typically Soviet-made. It is reminiscent of American appliances from the 1950s: basic construction, strong, and built to last. Unfortunately, time has taken its toll on the equipment over the years, and the hospitals do not have adequate funding for replacement. Arranging for donations of medical equipment and devices and providing training on their use and maintenance are important parts of our program.

The main focus of the POH program is clinical education, however. The success of our program, like any educational program, depends on hard work by both the teachers and the students. Our host at the Shastin Medical Center in Ulaanbaatar, Mongolia, Dr. Baseenjav, is well respected in Mongolia and was named last year as the top surgeon in Asia. He is dedicated to improving health care in Mongolia, and his staff shares his enthusiasm.

Ready to Learn
The staff members’ dedication is something I will never stop admiring. They do not have the salaries that their counterparts enjoy here in the United States. Their motivation to work long hours and advance their skills is frequently not rewarded with money—only with the knowledge that they are providing service to their community. They are also very eager to learn, and they work very hard to take full advantage of the educational opportunities offered by the POH team. In the next year, Dr. Baseenjav will require the staff to learn English. It is a wise move, because most of the information on the Internet is in English, as are most textbooks and journals on cardiac care.

An important aspect of the education program of POH is to recognize the extent of local resources and capabilities; we try not to implement technologies and procedures that the local staff will not be able to support on its own after we leave. For instance, we do not encourage a dependence on disposable items that a facility may not be able to afford or easily acquire.

The ultimate goal is to enable the local program to support itself. If this goal is achieved at Shastin, the impact will change cardiac care for the whole country, because Ulaanbaatar is the only place in Mongolia offering cardiac surgery.

For the local program to be complete, it will need to include biomedical equipment support. To this end, a university in Ulaanbaatar is about to start a biomed program. As in many places around the world, some equipment cannot be used because parts are unavailable, the expertise to repair broken equipment is lacking, and/or the staff has not been trained in how to use the devices. The hospital engineers and technicians now are focusing on the plant engineering end of things, so when a biomed shows up with tools and biomed test equipment, it is a great service to the hospital.

Don’t Forget Your Toothbrush
I have had field service positions here at home, but until I had to pack for a POH trip, I did not really know how to assemble the perfect “traveling biomed shop." The initial instinct is to try to prepare for anything, especially because finding spare parts locally is very unlikely. As I learned the hard way on my first POH trip, though, one has to prioritize carefully. Personal items needed for a week or two take up quite a bit of luggage space and weight, even before tools, test equipment, and spare parts are packed.

Regardless of how well prepared, one is still in an environment that has few service manuals and spare parts. The manufacturers’ technical support resources that are common here are not available; for the most part, it is just the biomeds and their tools.

Biomeds who are considering volunteer service but get stressed easily in STAT situations at their US facilities need to keep in mind that conditions can be much worse in hospitals overseas. Things like oxygen and electricity, which we take for granted at home, are not guaranteed commodities. “The submarine is going down!" was a favorite phrase of Jim Burris, my assistant this year, during the occasional crisis.

Biomeds, of course, need to stay even-keeled during a crisis, but it is even more important to be able to think quickly in an unfamiliar environment.

See the World—Meet Wonderful People
While traveling with POH, I have toured Beijing, China; Budapest, Hungary; Vienna, Austria; Frankfurt, Germany; and Bratislava, Slovakia. Such travel is a wonderful perk and reward for work well done. It is easy to stop over someplace on the way home, because the trips require making flight connections. This year I decided to stay in Mongolia for my “after trip" rather than spend time elsewhere. Having been to Ulaanbaatar three times (with a fourth trip planned in 2004), I feel as if it is a second home. I have fallen in love with not just this city but with all of Mongolia.

Although Ulaanbaatar is a typical metropolitan city, the people who live in the countryside of Mongolia have not yet lost their traditional nomadic lifestyle, although it is struggling to survive. Mongolians are friendly, peace-loving people, and it is common to see families in traditional garb moving about the city and in the hospital. Because it is the custom for the entire family (and I mean entire family) to visit the hospital after a family member’s surgery to thank the surgical staff with a home-cooked meal, we have been able to meet and enjoy the company of many interesting people.

Although our program has helped improve surgical success, patients who are fortunate enough to have surgery while our team is working with the local staff have a better chance for a successful outcome. For them, it is like winning the lottery, and they show their gratitude with all their hearts.

Project Open Hearts Project Open Hearts (POH), a nonprofit organization based in Denver, works with foreign medical staffs to provide first-hand surgical training, assistance with diagnostic procedures and consultations, support for orphaned children and needy families, and an ongoing exchange of knowledge to continue the education process. The goal is self-sufficiency for all medical programs initiated. POH was founded in 1993 by Rita Lenz, who still serves as POH director. Over the years, POH cardiac surgery teams have traveled to Kazakhstan, Kyrgyzstan, Uzbekistan, the Palestinian Territory, and most recently, Mongolia. A program is now being developed in Tanzania for possible initiation in 2004, when POH will be celebrating its 10th anniversary. POH is always in need of donations of medical equipment and supplies as well as money. For information, please e-mail info@poh.org and visit the program’s Web site at www.poh.org.

You Can Too
My experience with POH has been incredible. There is nothing more rewarding than bringing lifesaving medicine to people who so desperately need it. The sacrifice each team member makes to ensure the success of the team is inspiring and indescribable. I have never been so appreciated as a member of a health care team as I have been in this group, and the appreciation shown by our hosts, the patients, and the patients’ family members is overwhelming.

Working with POH has offered me the chance to witness and take part in the behind-the-scenes planning and decision-making of the clinical team—an educational opportunity that rarely presents itself at home. The opportunity goes the other way: The clinical team is able to see biomeds function behind the scenes, too.

Our biomed talents are desperately needed around the world. If you have been considering getting involved and performing charitable biomed work overseas, take the next step and find a way to make your dream come true.

Lou Schonder can be contacted at lschonder@poh.org.