 Good afternoon everybody. Nice to see you all again. Hope you've had a good conference so far. Today I'm just going to be going over my profusion without borders experience in Arshaia Lebanon. I'm a student here at THI and I have nothing to disclose. So a little bit about myself. I am a junior here at THI, a profusion student, but before that I was an anesthesia tech in Dallas, Texas, working at University of Texas, a Southwestern Medical Center, as well as the Methodist Medical Center in downtown Dallas. I've also done some research clinically and in the University for drug discovery. And one thing I like to think about myself, and I think many people strive to be, is a global citizen. In the sense of a global citizen is making home in any country, as well as respecting different cultures and embracing the differences that we all have while looking past the borders and having the idea of humanity being most important. One of the things about myself is that as a global citizen, I was born of overseas, have a parent from a different country and as well as an American parent, and I've traveled to many countries around the world, both alone with my family, as well as now with a lot of coworkers. Here are some pictures of me in different mission trips before in Guatemala. I've also had a picture of me and my mom on a mission trip together and making new friends in different countries, including Spain, Guatemala, India, as well as London, England. So when I heard about the Profusion Without Borders scholarship from my director, Ms. Deb, I immediately hopped on it and I was lucky enough to win the scholarship and have an opportunity to pick a organization to travel with and do a mission trip. The organization I chose was the Novik cardiac Alliance, also known as the NCA. Working along Dr. Novik, who has served in 35 countries or over 35 countries now and then over 9,000 operations in the time that he's been doing mission trips. The thing I liked about the Novik cardiac Alliance is what I've written in bold in his statement is, although we are trying to help children with congenital heart disorders, he says, regardless of gender, ethnicity, religion, genetic factors, economic means, he is here to help any child in any type of situation. Dr. Novik was also recently in Ukraine in Lviv, during, well still during this war, and trying to help many different children while being, while living in the hospital for two weeks with the sirens going as well as other people taking shelter in the hospital. So I do applaud him for going to Ukraine in this time because he knew he needed to save these children's lives. So why Allershai 11-on? I chose Allershai 11-on first and foremost because I was actually born in Jettison, Arabia, which is nearby and I've always had a tie with the Middle East and wanted to find my way back there. And this was the closest mission trip there. I also chose this trip because a former profusional outboarders recipient, Nick Starkey, he's a profusionist based in Wisconsin, offered me the opportunity to go with him and learn from him. So I definitely hopped on then. A few things about Allershai 11-on is that we worked at the Allershai government hospital. The population of Allershai is about 6,000 to 7,500 people, but the people that we're working on were not just children from the city itself. People walk hundreds of miles, trains, cars, and it wasn't just the Lebanese people, but the Syrian refugees that are right across the border. It's next to Beirut, about two hours drive on the southeast border. It's agricultural economy is the thing that powers it most. It's mostly olive oil pressing and great molasses. And in 2019, Lebanon had an economic crisis. This was before COVID-19 and with COVID-19 adding on top of their economic crisis, it is now based off the UN, 78% of the population is below the poverty line. Many, as you can see when you're there, they're rolling blackouts, times blackouts, even in the hospital, they were blackouts, including people not having basic food, basic clothes. So it was very prevalent that 78% is below the poverty line. They're still working to bounce back from their economic crisis and COVID. So a little bit of the team statistics. There's 21 of us total for the two weeks that we were there. People did one week and left, or some people stayed the entire two weeks. I stayed the entire two weeks. We had two main surgeons, Dr. Novik, as you can see, and Dr. Marcelo Cardiale. They were our cardiac surgeons and Dr. Willid Sehran is our Lebanese surgeon that was assisting all of the surgeries. He was also the one who was trying to bring a cardio program to Al-Rashaya, Lebanon, because there's only one in Beirut and they needed to expand somewhere else in Lebanon to help these people in need. I had two profusionists. I had Nick Starkey, as I was mentioning before for the first week, and Laza Aramina for the second week. He is originally from Serbia, but got his training at the gosh hospital in London, England. There are also many volunteers there, including coming from 10 plus different countries. We had people from Serbia, Croatia, Macedonia, London, Australia, etc. That was another thing I liked about the Novik cardiac alliance and most mission trips in general, in the sense of it's not just Americans going to help people in need in different countries. It's a global effort to bring these people the help that they need. We also have four ICU beds and one operating room. Also, in this picture, you can see in the top right next to my face is our wonderful scrub nurse and scrub circulator, Martina. She held down the fort the entire time. She ran everything and we just followed her orders, which I loved. And we had our amazing anesthesiologist who kept everything going in a sense of positivity. Singing and dancing for these 15 hour days. He was the one that kept us going the entire time. A couple of our case demographics. We did 13 cases in total in the 14 days that we were there. Ages range from 17 days old to all the way to 15 years old. We had a large guy, which I was very surprised. I've never done pediatrics before. And I always think of the neonates, smaller babies, but seeing other people need like 15 year olds, 13 year olds, I thought that was really cool to work on as well. The weights differed as you see 2.5 kgs all the way to 56 kgs with that 15 year olds. And we did about half males and females. Some of the procedures we did were repairing ACDs, VCDs, Heterology and Fallot. And we did start with a PDA ligation on the first stage just to make sure that the OR was working in a sense of we got everything handled and do like a simple sort of case. These are some of the wonderful children that we were able to help. I did get permission to use these photos. But these were some of the wonderful kids. They came out so much better on the other side and they were so brave to even let strangers like us work on them. So I was very grateful to do that. A little bit about our profusion equipment. We're using a Stockard-Chiley roller pump. As you can see in this picture, we did have to tape up half of our things. There was a little we I'm glad that we had a lot of zip ties to put everything together. Extra connectors. We had a duffel bag full of connectors, which I didn't understand why until we got there. We did Frankenstein a good amount of circuits, which was great. The circuit we're using was a little bit to our heater collo as a Cincinnati Sub-Zero Hema Therm, which gave us many problems throughout the two weeks that were there. Our ACT was our Metronic ACT Plus. And we were doing a modified Del Nito while we were there. We'd make the Del Nito either the night before or the morning of, keep it in the fridge and add autologous, not autologous blood, but donor blood to it and blood prime our pumps. So some of the problems that we face while we're there, there are many problems, but the other four that I want to that were the biggest and want to talk about today. First things first, the heater collo I was saying before our Hema Therm had troubles from the beginning. We had it pouring out the backside, which was great. Well, not great, but which was an experience. And the heating issues, it was never able to heat. It could pump water, but it was never able to heat. So we did the good old bucket trick. As you can see in these pictures, I don't know if I can move my stuff. As you see in these pictures, I was doing the bucket as well as Nick Starchy was also doing a bucket because I thought for the two weeks there, my biggest worry was I'm going to be hauling water 24 seven for 14 days. But it turns out I wasn't alone. Even Nick was there to help me out. It was a team as a team effort. And I was very grateful for that. Another thing about the hot water issue is there was no hot water in the hospital. So half the time, so we would use several kettles the entire time, we would take it from the ICU while they were making tea in the ICU, ask for our other kettle and rewarm these patients. By the last day, the heater cooler was completely out. No more pumping at all. And as I was watching Nick, or lasso pump his case, I was just wondering, how are we going to rewarm this patient? What are we going to do? In the end, as I was trying to problem solve, I found myself sitting on the ground next to anesthesia with a medical student constantly bringing me bags of microwave bags of saline. And I sat holding the AV loop, trying to keep the patient warm. It did work. It took a while and my hands were definitely very, very warm. But I was watching the temperatures to make sure I wasn't overheating the patient, but it was successful. And there's probably better ways to do that and less uncomfortable ways of keeping the patient. But that was the thought that I had first to do. Next, although this helped with not keeping the patient cold, but we had no AC in the OR, which came with a lot of problems with the ill medical students that were coming to help or coming to observe. Most of them had to tap out in about 30 minutes turning green, having to sit down. Also, Dr. Novick is very much not a fan of no AC. So many breaks were taken. Doors were open, compromising serility, which made Martina our circulating nurse, nurse, governor, very upset. You could hear many people clapping in the background, trying to keep flies out. And if we had any, we'd close the doors and say we're shut in shop for the day. So that was definitely an issue. Another issue was we had a limited supply of ACT cartridges. Our ACT, we were promised more cartridges throughout the week, but we're never given them. So we had to learn how to ration. As we heard Chris play talking yesterday of the method of keeping a test tube of blood and shaking it, keeping your armpit and going back and forth and counting the seconds. Our anesthesia anesthesiologist definitely was trying to show us that as well as using ACT cartridges. And as you can see in this picture of our ACT, we did have our favorite unlucky number on our ACT machine, which it kind of described the rest of the day. It was it was a very fun day in that sense. And lastly, which wasn't actually a problem, but we shared storage with the rest of the hospital. And we set up our shop. As you see in this picture, we were next to the resuscitair, which I've seen burst before, but this was very different as I was grabbing cannulas looking for the next equipment for the next case. I'd see a new buddy baby born right behind me and taken here to check to see all their vitals. And it was just amazing to see that as we were saving other babies lives that a new one was being born into the world and we were hoping and praying that we won't be working on the next and they're healthy. So that was really good to see in the midst of working with other children. And here's just some of my favorite moments throughout the trip. The first picture is just of this lovely mother who was with her child the entire time she was there 24 seven, we would leave at two in the morning and come back at six in the morning. And she was still there taking very good care of her baby. And to me, it reminded me of my own mother and how grateful I am that a mother's love is something that I will never take for granted. And now she really should let to me when I was overseas. We also have Boncho or anesthesiologists who like I said, we were playing the Queen playlist for 14 hours a and he danced through every song on repeat every time and kept us lively and in a good mood. I saw pictures of Nick, I have a candid picture of Nick looking at one of his patients after we were working after we worked on them. And this is one of the great things I thought about on mission trips is you're not just in the or you have the ability we we work with our ICU staff, we work rather in intervention as we work with everybody. So it was this idea of seeing your patient beforehand, seeing them after keeping track of them. And this I felt was one of the most gratifying parts of the trip was being able to see your patients after and know that they're safe, know they're doing better. Also, I was also seeing my patients after it was great. I love that as well. But seeing they do it himself without anyone coming through is very nice. Every morning we check up on our patients. I also saw lots of the nature deep valleys of different grapes and olives met a lot of nice people. A lot of great friends have kept in contact with some of the nurses. One of our nurses went to live with Dr. Novik. As well as talking to Martina our scrub nurse who ended up sending me different recipes for Croatian foods that because I told her I've been working on a garden she's like, you have tomatoes, I know how to use tomatoes. As well as I was able to see some of the nature and by that we had a hotel dog that was always there in the mornings. And that was something nice to see every morning, I suppose. And as some of the takeaways, first and first, it was the ability to give children another chance at life. These brave children were the best part of the entire trip. And I would never take that away from anything. It was the most priceless part of the trip. Just seeing blue babies turn red was something I've heard and we've seen in the movies, but seeing it in real life was definitely, I felt a different change in the steps that I was going when I saw that. Also, I'm very grateful to be in the United States, all of our resources, something that I take for rent every day, like air conditioning. I just forgot that sometimes you don't have things like air conditioning or the right size scrubs. And we complain about the cannula sizes and we complain about all of these things. But sometimes you have to make do what you have, be grateful for them. And that was a good reset coming back to the United States and saying, we're lucky to have all of these things, we should chill out just a little bit and keep moving forward. So that was one thing. And also, I gained so much information and education. I was at kind of the beginning of my stay here at THI. And I was worried that I wasn't going to be able to keep up. And Dr. Novik walked me through it every day. Every night, we had medical students that were coming through and learning about it. And I would sit in on the chat and learn all about different cardiac surgeries and the things that we should should be doing. And both Nick and Lazo from different sides of the world, are still profusionists and they still kept their three, you know, oxygenate the patient, keep the flow up, you know, things like that were definitely still in place in both sides. And another thing I need to mention is that this trip as lovely as I'm making it sound was very tough, very, very tough in many different senses. The long days, yes, that's, you know, it is tough, but that wasn't in the sense that I mean, we've all had our tough cases. And being away from the people that you love or going home to talk about it and kind of express the tough days that you've had was kind of difficult, seeing really hard cases or losing a patient that was very, very difficult. And the 14 days, you feel like you're drowning half the time. When you get out of it, you take that breath and you know that you've helped more people than that would have been helped before. And regardless of how tough it was, I promise you that I would do it again, and again and again. So I'm definitely grateful for this opportunity. And I'm not thinking about maybe doing international or pediatric profusion due to this trip. I think it was there's so many other ways to help people, different places, different people. So that's definitely something I'm thinking about now and considering. And as I was saying before, I've kept contact with a lot of the people that I met overseas, and as well as I was able to leave my scrubs there for a lot of the staff and the medical students, because they were 80 pound, 80 pound medical students wearing triple XL scrubs. And I was like, you can definitely have my, you know, I can always get some more. I also left some of my books over there, because a lot of some of the nursing stuff is very interested in profusion. And they just needed a grip of it. So I did leave a couple of my books there, which I was able to replace when I got back. But there's no need to, you know, I if I could share any information that I was happy to do so, as well as some of the supplies, when I first got back to the THI, we had a lot of near expiration things or things that no one was interested in anymore. And I was able to gather them up and send them back to the Novik cardiac alliance HQ in Memphis, Tennessee. And that's definitely something that I want to mention now is help however you can. And what I mean help however you can, if it means going on mission trips yourself, please do so. If you don't want to do that, there's so many other ways to help. This could be sending supplies that your surgeon doesn't find doesn't prefer anymore or things that are near expiration, as well as if it's monetary that also works as well. And if you don't want to donate anything at all, the other thing that you can do is just spread the word, spreading the word to someone else who might be interested in doing so can help change so many people's lives. So there's definitely definitely different ways to help people. Just a special thanks to people that got me on this journey coming there and back from our child up and on. I want to give a special shout out to Ms. Deb for even giving me this idea. Thank you so much for that. And I also want to thank the Lebanese country, Lebanese team and Dr. Walid Sinchran. They're very resilient people and love to go back one day. Thank you.