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Shunt Donation Project – Ooooh, LOTS to tell!!

June 20, 2013

I’m knackered.  It’s hot (hottest day of the year apparently which, going by how low and below-average the temperatures have been so far this year, isn’t actually much of an achievement) and I’ve just returned from London.  I know I need to update you all on what’s been going on and I’m very aware that it’s been a while but so much has happened that it’s literally been a case of not being able to find the time to sit down and write a lengthy post on all that’s happened.  I am yet to master the art of the short-but-sweet post, as you will no doubt have noticed if you’ve been following this blog.  Since my last post, Four Fab Things have happened and all of them have enabled me to make great progress. And here they are:

Fab Thing Number One

The last time I posted I had just had the three Medtronic shunts donated for Vietnam and was waiting on forty Bactiseal shunts to come from Codman so I could send them to Kenya.  The Bactiseals are actually the ‘tubing-only’ bit of a shunt, without the valve bit which regulates pressure.  At first I wasn’t sure if they would be able to use ‘tubing only’ but as it turned out it was perfect, because in Kenya they are having specific problems with the tubing-only parts of the cheap shunts they have to use!  A shunt-match made in Heaven.  Since then there has been a lot of to-ing and fro-ing with Codman (not in a bad way; just establishing what quality measures they need to put in place and what I need to do to meet those measures) and this week we finalised that; they need a printed letter from the neurosurgeon which Mr Albright has written, signed and sent off to me.  So as soon as the letter arrives, I’m sending that (recorded delivery!!) to Codman who can then release the shunts to me – and off to Kenya they’ll finally go.  I knew when I started this that it would be a slow process once the formalities came into the picture but now we have a procedure established, I can request the letters from the shunt recipients earlier and get the whole process running a lot quicker when Codman next have shunts to donate.  So the letter is on its way, the shunts will soon be on their way and Codman and I have an quality procedure in place.  Codman box – tick!

Fab Thing Number Two

A couple of weeks ago I received an email response to a general ‘can you help me?’ email I’d sent out to a couple of neurosurgeons about six weeks earlier.  The reply was from Mr Lewis Thorne, consultant neurosurgeon at ‘my’ hospital (haha!), the National in Queen Square.  He also works at the Royal Free in London.  Lewis had actually operated on me about nine years ago when he was a registrar at that time for Mr Watkins.  He had clamped off my shunt to see if I could cope without it as I was overdraining badly at that time so Mr Watkins had thought that there might be an outside chance my hydrocephalus had resolved itself and my brain was draining the fluid as well as the shunt, hence the very low pressures I was experiencing.  Lewis was great, very kind, friendly and reassuring.  Unfortunately having my shunt clamped off turned out to be one of the most hideous experiences of my life as far as hydrocephalus goes (in case you’re wondering, the most hideous experience was shunt infection – both of them).  It wasn’t Lewis’ fault that it was so awful though, so I let him off.  A couple of days later Lewis came to my bedside and gave me the wondrous news that he’d be unclamping my shunt first thing in the morning as the pressures were going into the high thirties by this time – they should be a maximum of about fifteen.  No news has ever been as gratefully received in the history of the world; even Archangel Gabriel and his announcement of the birth of Jesus received a very muted response compared to my reaction to my upcoming shunt-unclamping.  After that I didn’t see Lewis at all and assumed he’d left the hospital for pastures new.  He had, initially, but returned recently.  I found him whilst Googling ‘information about shunts’ one evening.  I knew I needed to update myself on the different types of shunt available now so I knew which types would treat different cases of hydrocephalus – it’s not a ‘one-size-fits-all’ in the shunt world!  Amongst the results was a link to a lecture that had been given at a neurological institute entitled ‘Everything You Need To Know About Shunts!’.  Unfortunately it had been given in 2011 so I was more than a little late.  But I pounced on it and was amazed to see that the person who had given the lecture was Lewis Thorne.  If he knew everything there was to know about shunts, he was my man!  So I’d emailed him back in April and had almost forgotten about it what with everything else that was going on until he replied, with an apology for being late in doing so, saying that he was very interested in my project and would love to help if he could.  Result!  I arranged to meet with him at his office for a chat and that took place last Wednesday.   When I told Mum I’d be meeting with him, she said, ‘does he remember you, do you think?’.  I had wondered myself, until I noted that he had begun his email to me ‘Dear Mr Adams’.  Clearly he didn’t remember me.  I did actually (gently) correct him on that and informed him that I am in fact female, to avoid a bit of confusion – and possible embarrassment – when we did meet, which he was absolutely fine with.  I was surprised how nervous I was about the meeting; I had a neurosurgeon actively interested and offering help.  I didn’t want to screw it up so found myself swotting as though for an exam on what I’d done so far!  Needless to say, I shouldn’t have worried.  When I arrived, Lewis was finishing a meeting with some doctors but on seeing me he literally smacked his hand to his forehead and said ‘Jordan!  I should have known I’d recognise you as soon as I saw you!’ and asked me to wait in the strangest waiting room I’ve ever sat in.  It was full of, er….skulls.

I'm hoping these aren't previous patients from the National....

I’m hoping these aren’t previous patients from the National….

Not a magazine or a fish tank in sight.  I had to resist an overwhelming urge to play around with them all.  Luckily Lewis came in to get me before I had a chance to get my hands on them and rearrange them into the ‘conversations at a bus stop’ scenario I had in mind.
My meeting with Lewis was the most uplifting part of my work on this project so far.  I had honestly thought he might offer me some much-needed advice, or give me a couple of contacts but he went above and beyond this.  I was glad I’d swotted up though because everything was fresh in my mind and we were able to have a pretty lengthy and detailed discussion on options and plans.  He said that this is a cause close to his heart as he had been out to sub-Saharan Africa a few years ago, taking some medical equipment to donate to charities and due to charity politics hadn’t been able to give what he had taken out there.  He has ideas for reducing the costs of surgeries generally and also alternative uses of shunt treatments – I can’t go into everything now because a) it’s in the early stages and b) it’s too medical – he would have to explain it properly!  Having him on board is so fantastic and such a relief, I can’t begin to describe it.  I now have someone who seems as passionate about this as I am and who I can run all the questions I previously had no answers to by.  He inspected the donated shunts from Medtronic (as they’re expired) and pronounced them ‘absolutely perfect!’.  So we’re working together on producing a ‘business plan’ to present to the Vietnamese government and show them that the surgeries can be and are worth investing in both economically and – most importantly – to ease the suffering of the children.  The cost to the government for nursing these untreated children for years until they die is most likely way greater than the cost of cheap but effective shunt surgeries using effective equipment.  We are both aware that persuading a communist government who are currently heading down the US-based system of insurance health care is not going to be simple.  Lewis wants to get something published as that will carry a great deal more weight. Once we have that in place we can roll it out to more governments who may need persuasion that shunting children is a very worthwhile and very necessary exercise.   He also has access to spare shunts which he is sourcing this very moment.  I am starting to wonder what the heck I would have done without him now.  I had, as I said to him in our meeting, reached the limit of how far I could go alone.  All the research in the world won’t change the fact that I am a mere patient who has neither the expertise nor the contacts medically to make sure I’m making the correct shunt decisions.  I have expertise in how it feels to have hydrocephalus but that, and a lot of passion concerning the issue, is about as far as it goes!  The fact that Lewis is so busy as a surgeon and is still happy to help and give me his time, free of charge, with the support and encouragement that he’s already shown in just a couple of weeks, has made me feel for the first time that we can truly make a difference to untreated children with hydrocephalus across the world.  Power in numbers!

Fab Thing Number Three

The same day as my meeting with Lewis, I managed – quite by chance – to secure an impromptu meeting with the surgical manager at Medtronic, the very company who had kindly donated the three shunt systems for Vietnam.  Louise (the lady in question) just happened to be at a hospital I was visiting to discuss shunt donations with.  The person I was speaking with about their shunts suddenly broke off with a ‘Eureka!’ moment as she remembered that Louise just happened to be in the building that very day and would I like to meet with her?  Would I!!  Louise was in surgery, overseeing the use of a new surgical drill Medtronic had just produced so she came out to meet me, fully ‘scrubbed up’ in her blue theatre outfit.  She was very enthusiastic about the project, the fact that I already had three Medtronic shunts and even more about the fact that I myself have a shunt.  This is a detail that does seem to ‘wow’ the medical personnel I come into contact with.  To me it’s no great shakes; I have a shunt.  And yes, this is why I’m doing this project, because I know how hideous hydrocephalus can be.  But sometimes I think they half-expect people with shunts to be ill-looking or not as energetic maybe as I can come across sometimes.  I can sort of understand this, given that they are seeing people in hospital most of the time when they’re ill and either pre or post-surgery!  I feel like a shunt commercial; ‘Yes!  You too can look and act like this if your shunt works properly!  Because you’re worth it!’.   Anyway, Louise was fantastic and promised to look at the fundraising side of things as well as establishing some proper support from Medtronics overseas suppliers as they’ll have greater numbers of shunts to spare.  And she was as good as her word; a few days later I received an email from Louise saying that she’d loved meeting me and she was currently talking to Head Office to get some plans in place.  All from a chance five-minute meeting outside Theatre Two!

Fab Thing Number Four

Last but oh-so-not-least, I finally got to meet with Kim Nguyen Browne yesterday, from Go Vap Orphanage!

Kim looking happy with two of the shunts!

Kim looking happy with two of the shunts!

We met in London so I could hand over the Medtronic shunts so they can get back to Vietnam and be used.  Meeting Kim was like meeting a long-lost friend, although we’ve only ever spoken on the telephone up until now.  She, like all the others I have met and who are now involved in the project I only started in April, has an absolute heart of gold when it comes to helping others and I don’t give a toss how sappy that may sound.  The work she’s done to help these children already and the contacts she’s established with other charities and organizations helping her is impressive to say the least.  She was overjoyed to get the shunts and our meeting was far too brief for my liking but hopefully I may be able to meet her for a longer lunch when I next meet with Lewis or on another of my now-frequent trips to London.  She was so helpful in what we discussed and she said she will post pictures of the children who actually receive these shunts and allow me to follow their progress so of course when that happens I will share with you!  It will be so amazing to see the faces of the children who will (fingers crossed) soon be out of pain thanks to these shunts.  And I cannot stress enough how good it felt to hand the shunts over to her.  I thought that moment would take about six or seven months to come about, not two!  Kim uses the following as the motto for the Vietnam Volunteer Network she manages and the work they do at Go Vap and all the other orphanages they help; ‘Together we can make a difference’.  I’ve learned this lesson more than any other since I started.  There was always going to be a ceiling on how far I could get alone.  Now with Lewis, Kim, Louise, Mr Mallucci, Tim and Louisa at Codman and every single other person who has helped/shown an interest/given me a contact/urged me to keep going, I’m starting to see that this project now does have, and will continue to grow, LEGS!  My determination to get changes made in both our healthcare system (STOP throwing useable products into landfill sites and send them to where they can be used to save lives) and overseas (don’t brush hydrocephalus under the carpet any more when seventy-nine percent of new cases this year will be in developing countries) is absolutely renewed.  Not that it went anywhere; it was just wondering which path to take next.  Now I have a path.  With friends.

Shunt Donation Project – a big challenge ahead

April 5, 2013

If you’ve just jumped in and are wondering what this ‘F-List’ I keep banging on about is, you can read about that here.

You can read about how the project written about below is now developing here.

Number Six: Set up a shunt donation programme from the UK to aid countries where treatment is limited or non-existent.
Number six in my list is the most important one to me.  It’s also the reason that my list is rather short, compared to many Bucket Lists and Must-Do-Before-I-Change-My-Mind lists out there.  Number Six is going to be a long project and I don’t expect to have it fully completed and established by the time I’m forty.  I want it to be set-up and running but I expect there to still be some teething problems!  The fact that I intend to have another ‘F-List’ next decade (F for Fifty, natch) is the other reason for my F-List being short-ish; I’m doing my life goals in bursts, head-permitting (a little like the weather).  Back to Number Six – being able to help disadvantaged countries in their treatment of hydrocephalus is a goal that I’ve held since about four years after I was diagnosed.  I wish in a way I had wanted to do this before four years in but I was finding adjusting to life with hydrocephalus pretty hard at that time and was in a bit of a mess to be honest.  The hospital stays were intense and scary and pretty relentless.  But in retrospect I think it’s a good thing that I found it so hard to get through; if it had been a breeze, I probably wouldn’t have felt so compelled to get something done in countries which have limited or no treatment.  Knowing now what rising pressure in the brain feels like, the panic it creates, the horrible symptoms and completely alien feelings, the thought of children going through it with no option of treatment is simply incomprehensible to me.   So around 2005-2006 I started to make notes on what I wanted to do someday when I was well enough to really apply myself to the cause.  There was a lot of reading and research to be done and it would take a long time, I knew – but I never abandoned the idea.
The Go Vap Orphanage
I first came across the Go Vap Orphanage on YouTube; I was looking for videos of anything hydrocephalus-related.  I was having another relentless barrage of problems with the shunt; I was overdraining terribly (see more under the ‘Hydrocephalus’ category for overdraining symptoms and experiences) and was in hospital far more than I was out.

One of the volunteers at Go Vap Orphanage

One of the volunteers at Go Vap Orphanage

  Treatment was slow and cautious due to the complexities of my particular situation and so I was ill for a long time, unable to do much at all apart from lie flat on the floor for most of the day.  As I scrolled through the videos (many of them surgical ones aimed at medical students which wasn’t really what I was after; I wanted to watch people talking about their experiences of having the condition, to see if anyone had severe overdrainage so I could maybe get some advice), I saw an image which stopped me in my tracks.  It was of what looked like a hospital ward, but was obviously not one from this country.  I clicked on the image to watch the short video.  What I saw in that 90 seconds changed my life forever; I knew at that very point that I would not – and could not – ignore the issue and that even if it took years, I would do my utmost to get a shunt donation programme together. Go Vap Orphanage provides food, housing, and education to about 250 children in the outskirts of Ho Chi Minh City.  Many of the children are born disabled as a result of Agent Orange, a toxic defoliant containing dioxin which was sprayed by the U.S. over Vietnam as part of its herbicidal warfare programme called ‘Operation Ranch Hand’. The companies who manufactured Agent Orange, as well as the U.S. government actually knew about the cancers & adverse health effects but did not even warn the soldiers who sprayed the defoliant.  It entered the food chain and subsequently, hundreds of children are still being born today with birth defects and disabilities, hydrocephalus being one of the most prevalent.

Kim Nguyen Browne, founder of the Vietnam Volunteer Network, with one of the beautiful children she helps

Kim Nguyen Browne, founder of the Vietnam Volunteer Network, with one of the beautiful children she helps

Kim Nguyen Browne, the woman in the video, was herself adopted from Go Vap Orphanage and, wanting to give back to the place which had cared for her as a baby, set up the Vietnam Volunteer Network in 2008 to enable volunteers to help the children affected.  Today it is thriving, with regular donations, some support from medical companies and healthcare professionals and volunteers flying in from all over the world.  But it is still a desperate situation as far as hydrocephalus is concerned; the video I had watched had been the ‘terminal ward’ at the orphanage; as the video camera panned around the room, the scene was horribly bleak.  Countless iron cots with dying children.  ‘Too late’; the terrible words which are just unbearable to hear when faced with a picture like that.  Here is a link to the video I mentioned and which I watched; Kim is in it: The Terminal Ward At Go Vap Orphanage.

The first ‘Great Plan’ – which I’ve currently shelved!
My first plan was to see if it would be possible to set up a regular training scheme for UK-based neurosurgical trainees and/or registrars to assist in existing neurosurgery training programmes in countries such as Uganda and Haiti. The benefit of spending so much time in hospital is that you get to chat to all the medical staff at length about their backgrounds.  I quickly discovered after many stays at the National that neurosurgical training placements were difficult to get (I think there are only thirty-four neurosurgical units in the UK).  In developing countries there are often no trained neurosurgical staff to carry out pre-operative and post-operative assessments, initial assessments of potential patients and to assist in theatre.  Of course, the optimum goal is to have neurosurgeons trained in their own countries to add to and develop the existing health infrastructures which already exist.    However, training takes years, funding is short and facilities are in even shorter supply.  So I thought; well, why not try to get a regular rota of UK trainees to work six-month placements overseas before returning to the UK to continue their studies.  Once a group has returned, the next can fly out.  It sounds so simple, doesn’t it?  And if it were that simple, it would have been set up already.  However, I couldn’t find any evidence of established programmes like this; CURE Hydrocephalus in Uganda has medical volunteers flying out but it is on an  basis with no consistency.

Another inspirational individual; Benjamin Warf and some of his patients in Uganda.

Another inspirational individual; Benjamin Warf and some of his patients in Uganda.

I contacted Dr Benjamin Warf, who heads up the neurosurgeon training programme in Uganda and put my ideas to him.  He liked them, said they were good – but that logistically the situation was very difficult.  He suggested I find out first if registrars and trainees would want to do it and if their medical facilities would be prepared to let them go and then return.  I contacted another neurosurgeon, Mr Ellenborgen.  He said the same thing; great ideas, noble ideas; a logistical headache.   So following Mr Warf’s advice, I started lurking on medical student forums, became a member of various chat rooms and read and read and read….and it quickly became obvious that this was a biiiiiiiig job.  Too big to even know where to begin with it.  So many things needed to be addressed; funding, accommodation, training facilities, sufficient patient numbers to warrant the time and expense, willing participants and medical establishments – I literally didn’t know where to go first.  Every time I sat down to ‘have another go’, I’d end up with another banging headache, the way I always do after too much concentration.  I needed to start with smaller, simpler steps.  So the Overseas Training Programme is on hold until I feel stronger to address it again – or until I have a ‘Eureka!’ moment.  IT IS NOT SCRAPPED THOUGH.  I REPEAT, IT IS NOT SCRAPPED.  I don’t like quitting; it’s simply on hold as I have now to get on with the plan I am capable of doing: (Update: as of June 2013 this project idea was scrapped under the advice of the neurosurgeon I am now working with!  All for very good reasons.  The shunt donation project is now what we’re focusing on).

The second ‘Great Plan’ – not so ‘great’ in terms of scale but equally great if it means saving childrens’ lives
The second – more immediately ‘do-able’ plan is for shunt donation.  Shunts are often key to surviving hydrocephalus, yet the cost of buying them and implanting them means that for many infants and children, they are simply not accessible.  Children are left with no options.  In Vietnam, due to costs and difficulties in screening those who may need surgery, usually only the fittest are operated on; the rest are left to die naturally.  Kim had mentioned in her video about donated shunts; feeling that this may be a more realistic goal, I decided to pursue this option and see if I could a) find out just how many shunts are discarded and how many could actually be used and b) get my mitts on ’em.  Operation Shunt is on.

You can read about how this project is now developing here.