Trans­plant sur­geons save kid’s lives in Venezuela

The China Post - - LIFE - BY JOSHUA GOOD­MAN

Clutch­ing a tiny Bi­ble, Gilda Ve­lasquez leans over her son as he falls asleep with the help of a pow­er­ful seda­tive and a catchy car­toon jin­gle play­ing on a hand-held TV.

“Re­mem­ber, you’re a Chris­tian, you’re a Chris­tian,” she re­peats amid her tears to Yin Car­los as or­der­lies wheel the 6-year-old into the op­er­at­ing room where he will get a new liver.

For any fam­ily touched by liver dis­ease, an or­gan trans­plant can be a sec­ond chance at life. But the pro­ce­dure is prac­ti­cally a mir­a­cle in Venezuela, where an eco­nomic cri­sis makes even nee­dles and ac­etaminophen scarce.

Yin is ben­e­fit­ing from the ef­forts of a U.S.-based sur­geon and his coun­ter­part in Cara­cas who have helped save dozens of Venezue­lan chil­dren with fail­ing liv­ers. The doc­tors now hope to repli­cate their suc­cess in such a chal­leng­ing en­vi­ron­ment as Venezuela and as­sist hun­dreds of boys and girls from other parts of Latin Amer­ica and the Caribbean where pe­di­atric trans­plants are un­avail­able.

Dr. To­moaki Kato of New York’s Columbia Uni­ver­sity Med­i­cal Cen­ter be­gan per­form­ing the trans­plants in Venezuela a decade ago af­ter he was con­tacted by Dr. Pe­dro Ri­vas Ve­ten­court, a sur­geon at Cara­cas’ Poli­clin­ica Metropoli­tana.

The Ja­panese-born physi­cian says that back then he couldn’t even lo­cate Venezuela on a map. But he and Ri­vas Ve­ten­court have now per­formed 50 pe­di­atric trans­plants with living donors in the South Amer­i­can coun­try, grad­u­ally build­ing a large team of med­i­cal pro­fes­sion­als.

With live-donor trans­plants, sur­geons re­move a re­cip­i­ent’s dis­eased liver and re­place it with part of the donor’s healthy or­gan. Both the donor’s liver and the do­nated sec­tion of or­gan sub­se­quently grow to full size.

Kato and Ri­vas Ve­ten­court say they have a one-year sur­vival rate of over 90 per­cent for the pro­ce­dure they per­form at Poli­clin­ica Metropoli­tana, which is sim­i­lar to out­comes in the U.S. Af­ter that, the risk of in­fec­tion or com­pli­ca­tions falls dramatically and most re­cip­i­ents go on to lead healthy, long lives.

The so­cial­ist gov­ern­ment pro­vides 30 per­cent of the fund­ing for the trans­plant pro­gram that aims to help poor fam­i­lies like Yin’s. Phi­lan­thropy, med­i­cal in­sur­ance and the pa­tient’s fam­ily pay for the rest of the pro­ce­dure that costs roughly US$20,000 at the weak­est of Venezuela’s three of­fi­cial ex­change rates, in­clud­ing a steep dis­count by the sur­geons. Yin’s fam­ily didn’t have to pay a cent be­cause the fa­ther’s em­ployer picked up the re­main­der of the bill.

Hours be­fore check­ing into the hos­pi­tal last month to do­nate part of his liver to his son, Jean Car­los Fer­nan­dez re­counted the last two hellish years. Yin made mul­ti­ple vis­its to the emer­gency room, fre­quently missed school and the fam­ily had to sell their home in the eastern city of Ma­turin to pay for overnight bus trips to the cap­i­tal for ex­ams to in­ves­ti­gate why the boy’s liver was scar­ring.

“The doc­tors told me that if we don’t find a donor, the boy will never reach the age to have a girl­friend,” Fer­nan­dez, a con­struc­tion worker, said while rest­ing at a rel­a­tive’s apart­ment on the out­skirts of Cara­cas where a photo of the late Pres­i­dent Hugo Chavez fea­tured promi­nently on the wall.

Yin, his stom­ach bloated and skin jaun­diced from liver dis­ease, seemed obliv­i­ous to the pending 12-hour op­er­a­tion. The shy, soft­spo­ken boy prac­ticed writ­ing the al­pha­bet in a note­book and said he wanted a pinata for his July birth­day.

Once the surgery was un­der­way, about a dozen med­i­cal pro­fes­sion­als led by Ri­vas Ve­ten­court ex­tracted the child’s mot­tled liver while Kato, head­ing a sim­i­lar team, spliced a 400-gram (al­most 1 pound) por­tion of his fa­ther’s healthy or­gan.

The World Health Or­ga­ni­za­tion says that only about 150 pe­di­atric liver trans­plants are per­formed each year in Latin Amer­ica and the Caribbean, mostly in Ar­gentina and Brazil, com­pared with about 600 in the U.S.

“A lot of chil­dren die each year in Latin Amer­ica be­cause they do not have all treat­ment op­tions lo­cally for end-stage liver dis­ease,” said Dr. Juan Car­los Caicedo, a Colom­bian­born doc­tor who over­sees a trans­plant pro­gram geared to His­panic chil­dren and adults at North­west­ern Me­mo­rial Hos­pi­tal in Chicago. “A lot more pe­di­atric trans­plant pro­grams are needed in the re­gion.”

The pay­off can be huge in terms of lives and money saved. An or­gan trans­plant in the U.S. costs up­ward of US$500,000, but it’s just a frac­tion of that in Latin Amer­ica. Suc­cess­ful trans­plants can also save money by sparing years of costly dial­y­sis and other pal­lia­tive treat­ments.

With the back­ing of Venezue­lan fash­ion designer Carolina Her­rera, who met Kato when he per­formed a life-sav­ing op­er­a­tion on her cousin, the two doc­tors have cre­ated a foun­da­tion, Fun­daHi­gado Amer­ica, to raise funds to train med­i­cal teams in Latin Amer­ica and the Caribbean. They hope to launch the project in the Do­mini­can Repub­lic later this year.

For hos­pi­tals across the re­gion, re­cruit­ing and re­tain­ing tal­ent is a ma­jor chal­lenge. Many Latin Amer­i­cans who study in the U.S. are eas­ily en­ticed into stay­ing, as Ri­vas Ve­ten­court says he al­most did af­ter com­plet­ing his fel­low­ship at the Uni­ver­sity of Illi­nois-Chicago. If they do re­turn home, fa­cil­i­ties and nurs­ing staff aren’t as ad­vanced, mak­ing it more dif­fi­cult to pro­vide the same qual­ity of care.

In Venezuela, cur­rently known more for a health care cri­sis rather than state- of- the- art medicine, the dif­fi­cul­ties are even more pro­nounced. Venezuela’s Med­i­cal Fed­er­a­tion says more than 10,000 doc­tors have left the coun­try in re­cent years as salaries — es­pe­cially at public hos­pi­tals — have tum­bled with a cur­rency that has lost more than half its value on the black mar­ket this year alone. A few of the doc­tors who Kato and Ri­vas Ve­ten­court spent years train­ing were among those doc­tors leav­ing.

As Venezuela’s eco­nomic cri­sis has deep­ened, the gov­ern­ment has been al­lo­cat­ing fewer dol­lars to the pri­vate sec­tor, lead­ing to wide­spread short­ages of med­i­cal sup­plies and equip­ment.

“This is like a storm and it’s my job to make sure peo­ple don’t get wet,” Ri­vas Ve­ten­court said.

Some hos­pi­tals, in­clud­ing the once-pres­ti­gious public Uni­ver­sity Hos­pi­tal in Cara­cas, have had to sus­pend all surg­eries. Kato says on oc­ca­sions he has had to ferry vas­cu­lar clips and other hard-to-find sup­plies in his lug­gage.

But the two sur­geons said the sac­ri­fices are worth it.

Yin, who was dis­charged from the hos­pi­tal this week, is ex­pected to make a full re­cov­ery. He’ll spend the next three months con­va­lesc­ing with his fam­ily in Cara­cas, wear­ing a sur­gi­cal mask to guard against in­fec­tion. While shy as ever — his fam­ily jokes he should’ve had a tongue trans­plant — he’s smil­ing more and the whites of his eyes have re­turned to their nat­u­ral color, a sign of a healthy liver.

Kato and Ri­vas Ve­ten­court are also thrilled, be­cause with ev­ery life saved a le­gacy of knowl­edge is be­ing left be­hind in a coun­try long ac­cus­tomed to los­ing its best doc­tors.

“If you go do surgery and go back (home), there’s noth­ing left when the sur­gi­cal team leaves,” said Kato. “This is a dif­fer­ent ap­proach.”

(Right) In this May 9, photo, Venezue­lan Dr. Pe­dro Ri­vas Ve­ten­court, left and Dr. To­moaki Kato of New York’s Columbia Uni­ver­sity Med­i­cal Cen­ter, stand out­side of the surgery room min­utes be­fore they start a liver trans­plant surgery on Yin Car­los Fer­nan­dez at Cara­cas’ Poli­clin­ica Metropoli­tana in Venezuela.

AP

(Left) In this May 8, photo, Yin Car­los and his fa­ther Jean Car­los Fer­nan­dez, who do­nated part of his liver to save his son’s life, share a quiet mo­ment be­fore they de­part for Cara­cas’ Poli­clin­ica Metropoli­tana for a liver trans­plant in Cara­cas, Venezuela.

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