Beyond Borders: Pediatric Care Goes Overseas

May-June 2011


CHRISTUS Santa Rosa Children's Hospital in San Antonio has been providing comprehensive pediatric services since 1959 and treats children from more than 65 counties in Texas, more than 20 different states and many foreign countries. The hospital, like many other Catholic hospitals, works to extend the healing ministry of Jesus Christ abroad.

At CHRISTUS Santa Rosa Children's Hospital, we try to be purposeful and strategic about creating medical outreach programs as part of our healing ministry, while realizing that an unexpected call may come from across the world. When, through strong physician and community relationships, the Children's Hospital is asked to help children beyond our borders, we answer the call when we believe our participation will truly make a difference in a program or the clinical outcomes of the patients. Examples are our efforts in Mexico, in several countries with a group called HeartGift and in Haiti.

The town of Muzquiz is a small mining community in the mountains of Coahuila, a state in northeastern Mexico. Muzquiz is home to a school called CAM 18 where children with significant disabilities receive an education and treatment. Most of their medical issues include severe orthopedic problems that require surgical intervention and extensive physical rehabilitation.

A San Antonio physician approached the Santa Rosa Children's Hospital about getting involved in the small Mexican community to assist in improving the health of its children. In 2000, thanks to a generous donor, the CHRISTUS Santa Rosa Children's Hospital Foundation set up the Muzquiz Fund, dedicating financial resources to support the children and the school. The funds were to be used to address the immediate medical and surgical needs of these children and to help the school become self-sufficient with its rehabilitation program.

The project initially focused on training the CAM 18 staff in Muzquiz to care for the children. The children's hospital sent its pediatric rehabilitation program leader to establish rehabilitation treatment plans for the children and to train the school staff in the latest therapy techniques relevant to the physical disabilities of the students. Over time, we also provided wheelchairs, braces and adaptive equipment for the 45 children receiving care at the school. In addition, the hospital sent multidisciplinary teams of surgeons, residents, nurses and even dentists to set up clinics and treat children at the school and in the surrounding areas. Children who could not be treated in Muzquiz because of the complexity or severity of their medical conditions were flown to San Antonio for services.

The CAM 18 staff came to San Antonio for a six-week training session at CHRISTUS Santa Rosa. We gave them training on proper follow-up care and long-term therapy, thus were able to help them become self-sufficient in providing the right type of care for their students.

From an administrative perspective, the paperwork process of bringing children from Muzquiz to the U.S. was long and difficult. It was especially hard on the children and their families to be separated from their homes for an extended time. To alleviate the strain of bringing children across the U.S. border for surgical treatment, and to serve any new children needing intervention, CHRISTUS Santa Rosa physicians joined forces with the surgeons at CHRISTUS Muguerza, an affiliated hospital in Monterrey, Mexico, which is much closer to Muzquiz. The surgeons from CHRISTUS Santa Rosa trained the Monterrey physicians on orthopedic treatment techniques and follow-up care for these children.

At each step of the way, we have worked to empower people in the Muzquiz area and give them the resources to take care of their own children as close to home as possible. Now many of the students at the school can receive their surgical intervention in Monterrey, rather than traveling to our hospital in San Antonio. On the rare occasion a child with complicated medical needs must come to San Antonio for surgery, the Muzquiz Fund still works to make that happen.

The Muzquiz Project has evolved to take on new endeavors. As a dynamic and ever-evolving program, the goals and purpose have been modified and adapted to meet the changing needs of this community. One of those newly identified needs is preventive health care. The high rate of spinal-cord deformities in the Muzquiz area became the catalyst for educating the residents about including folic acid in their diets. Through a local church-sponsored organization, the Muzquiz Project now supports distribution of folic acid to all women of childbearing age in that region. The goal is to reduce the number of children born with birth defects like spinal cord deformities who might need the services of a school like CAM 18.

Local liaisons have been instrumental in navigating the community's culture. Initially it was very difficult to convince the citizens of Muzquiz of folic acid's value. "Las Caritas," the organization we work with to distribute the folic acid, has a positive reputation in the community for its work distributing meals and medicine to the homeless. This community good will provided the trust needed to successfully launch the program.

In the U.S., when an expectant mother learns her baby has a congenital heart defect, she knows the baby has access to state-of-the-art care and will receive treatment at the child's birth. In other parts of the world, a new mom may not have the choices or opportunities to seek treatment and interventions that can make the difference between her baby's life and death.

CHRISTUS Santa Rosa has partnered with HeartGift, a non-profit group that brings children from around the world to receive life-saving heart surgeries. Our partnership has treated eight children from such faraway places as China, Mongolia and Iraq. These patients and their families pay nothing to travel to the U.S. for the surgery. Community volunteers serve as hosts to these children and their families and open their homes and their hearts to them. CHRISTUS Santa Rosa donates its facilities at a reduced rate, and physicians from our Children's Heart Program donate their services.

Through our partnership, physicians also go to these countries to hold clinics and treat the children locally. Children are then identified who will need more extensive surgical intervention in San Antonio. HeartGift handles the process of getting the child and one family member to the United States, saving our hospital resources for the actual treatment of the child. The hospital arranges for the child to receive pre-operative care, surgery and post-operative follow-up, generally over the course of one month. Most heart defects can be treated with one invasive procedure and then require no further intervention.

We have found pairing with another like-minded non-profit group has allowed both parties to leverage outside relationships and create a better program. Members of our community have a way to specifically donate to international medical outreach. Each member of the partnership has a different group of supporters, and by working together we can pool those resources. Of course, we have common links as well. Some of our physicians sit on the HeartGift board.

Strategy aside, there are always opportunities for spontaneous action. As a children's hospital, we have to be ready to quickly answer a call for help.

When the massive January 2010 earthquake devastated Haiti, none of us could escape the tragic images coming across the television screens. The medical needs in the impoverished country were great, especially when it came to caring for the Haitian children.

We received a call from Healing the Children, a national relief organization dedicated to providing medical care for children in need. They were looking for help for two 10-year-old girls with severe orthopedic injuries.

CHRISTUS Santa Rosa quickly agreed to care for the girls, and they were brought to us in March 2010. They arrived with extensive leg injuries and subsequent infections from those injuries. Both girls received dozens of surgeries during the two months they were inpatients at the hospital. The bones in the girls' legs were so badly damaged by infection that portions of dead bone had to be removed. They then underwent wound debridement and orthopedic surgeries to reset the bones.

The girls' care has been managed on an outpatient basis ever since, and they live with host families here in San Antonio. Both girls required an external fixator on the injured leg. Due to the raging infection in the bone, they both ended up with one leg shorter than the other. They have undergone a bone-lengthening process and have regained the five centimeters they each lost. There is still quite a bit of rehabilitation ahead for these girls. Their bones are healing, but more therapy and rest are required due to the risk of re-injury.

This type of international medical outreach brings in resources from all areas of our hospital, including risk management and other behind-the-scenes departments. When these girls came to San Antonio, they essentially were wards of the U.S. government and we had to follow many rules and regulations in their plan-of-care.

Caring for these Haitian girls has led to a ripple effect in the San Antonio community. The girls' two host families got together to create a non-profit group to build structurally sound houses in Haiti. The San Antonio community has rallied around these girls and their families back in Haiti, holding fundraisers to make their hosts' non-profit group a success. An unintended result of extending our healing ministry is that it often inspires others to do the same.

Whether we embark on a mission with a strategic medical outreach program or answer the call at a moment's notice, as a Catholic health care provider, we have to weigh this enormous responsibility with fiscal consciousness as well.

In this day of reduced reimbursement and economic turmoil, it is important that we set limits. We cannot provide all care for free. Deciding where to draw the line is a tough decision, and one not treated lightly. At CHRISTUS Santa Rosa, we involve a multidisciplinary team representing social work, patient financial services, administration and, where possible, the physician to determine if a request for international charity care will be accepted. We assess our current charitable commitments with our available clinical resources and, keeping our mission and values in the center of the conversation, weigh each case independently.

Our answer is not always yes, but we are confident that our decision-making process assists us in reaching the best conclusion, allowing us to care for as many children as possible.

MARCY DODERER is vice president and administrator, CHRISTUS Santa Rosa Children's Hospital, San Antonio.

The CHRISTUS Santa Rosa Children's Hospital is part of the CHRISTUS Santa Rosa Health System and is one of five hospitals in the system that serve Central and South Texas.

Treating more than 150,000 children each year, the 200-plus-bed hospital is the only academic children's hospital in San Antonio. Partnering with the department of pediatrics at The University of Texas Health Science Center at San Antonio and private pediatricians, the hospital has been providing comprehensive pediatric services since 1959. The hospital treats children from over 65 counties in Texas, more than 20 different states and many foreign countries. CHRISTUS Santa Rosa serves as an advocate in the public policy arena and is committed to clinical research.


Copyright © 2011 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.

Beyond Borders - Pediatric Care Goes Overseas

Copyright © 2011 by the Catholic Health Association of the United States

For reprint permission, contact Betty Crosby or call (314) 253-3490.