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Ellen Johansen was one of the first nurses to volunteer for the trips from East Jefferson General Hospital in Metairie, La., where most of the Heart of the Americas team members work.

METAIRIE, La.-Ellen Johansen has a cherished memento from her first trip to Nicaragua, and it didn't come from a tourist souvenir venue.

The Kenner, La., ICU nurse was handed a beautifully carved, handmade wooden box by a young Nicaraguan woman in October 1999. The woman, in her early 20s, crafted the box, painting the Spanish words for "Memories from Nicaragua" on top, in gratitude for what was given to her 10 months earlier: a future.

The woman, "Eliana," received lifesaving, open-heart surgery the preceding January to correct an atrial septal defect, in an operation conducted through a nonprofit humanitarian mission that included Johansen.

"Without the surgery, she would have had a very hard life," Johansen said. "She might not have survived past her 20s."

Eliana was Johansen's first patient through Heart of the Americas [www.heartoftheamericas.com], a Metairie-based organization responsible for seven missions in four years to aid the cardiovascular health of the poverty-stricken population of Nicaragua. Teams of doctors, nurses and anesthesiologists have performed surgeries, angiograms, valvuloplasties, pacemaker implants and stent placements on roughly 750 patients, all free of charge and performed at two hospitals in the capital city of Managua.

Johansen was one of the first nurses to volunteer for the trips from East Jefferson General Hospital in Metairie, where most of the team members work (the hospital is not affiliated with the Heart of the Americas group). She jokes-only half-kiddingly-that she was asked to go because her clinical experience dating to the early '70s gave her the optimum experience working with outdated-or nonexistent-medical equipment. "I knew how to do things before they invented IV pumps," Johansen said, with a laugh.

Still, upon her arrival at Dr. Robert Calderon Gutierrez Hospital, she was shocked at the conditions she found. "The ICU was empty and had only two beds in it," Johansen said. "There were cabinets with a broken lock, no sink and eight oxygen tanks [cylinders] standing up against the wall.

"They actually had a portable X-ray machine. I had never seen one that old," Johansen said. "The X-rays they brought me back were still dripping wet because they don't have a dry developer. And they reused [cath] lab tubes."

Worse yet, many of the Nicaraguan nurses' training was not adequate. Patients were not turned, ventilation was poor, vital signs were not taken and many of the nurses did not know how to monitor IVs or use charts.

Sandy Levine, RN, CCRN, another Heart of the Americas volunteer, was surprised at some of the patient comforts that were missing.

"They didn't have any pillows," Levine said. "One of the things [the nurses] did was buy our patients pillows. And they are very expensive down there."

Levine said she discovered many of the professional difficulties confronting Nicaraguan nurses. Besides lacking equipment, they deal with patients who won't discuss their pain or symptoms, and work alone during the night shifts when no doctors are on hand.

"When I work there over a period of seven to nine days, I always feel rejuvenated," Levine said. "We take so much for granted back in the U.S. The people down there are so joyful that you're coming down there, and they're so grateful."

Nicaraguans are especially thankful for the surgery services of Heart of the Americas. The organization has performed 64 open-heart operations, which are all but unheard of in a country where health options are so limited, the rich travel overseas for major surgery and the poor have no means or access to treatment. Reports from international relief organizations note that open-heart surgery was not even practiced in the country until the mid-'90s.

It's that paucity of treatment that inspired an East Jefferson cardiovascular perfusionist to lay the groundwork for Heart of the Americas. Francisco Gutierrez is a native Nicaraguan whose father passed away a decade ago in that country from a heart condition that would have been easily treated in the United States.

"For me, it was something to give back to Nicaragua," said Gutierrez, who has made all seven trips and performs the perfusionist duties of operating circulation and transfusion equipment during open-heart procedures.

Even with the fiscal limitations, the hospitals working with Heart of the Americas have made tremendous strides over the course of the seven missions. "They have two or three monitors for patients now, and they have the knowledge on how to take care of patients on ventilators," Levine said.

Quoting one of the doctors on the mission, Levine said the purpose was "not bringing fish to the people, but teaching the people how to fish."

Heart of the Americas, which completed its last mission in October, plans on its eighth trip in the spring.

Contact Glen Fest at glenf@nurseweek.com

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