BY JIM HOWE
A career spent caring for very sick children, plus some mechanical ingenuity, helped I. Federico Fernández Nievas, MD, when he accompanied a medical charity team to Peru.
He joined about two dozen other medical professionals from around the United States to treat poor children with congenital heart problems. The nonprofit humanitarian Hearts with Hope Foundation, which sponsored the trip, needed a specialist in pediatric intensive care.
Fernández, who works in the pediatric intensive care unit at the Upstate Golisano Children’s Hospital, heard about the trip through a former colleague and volunteered to go.
The mission took place in a city hospital in a poor, dangerous area of the capital, Lima. Vans carrying the volunteers had to pass through various security checkpoints and fences to get into or out of the hospital.
“It was like a jail, with police, security and so much poverty,” he says.
“Children have very little access to heart surgery there, especially the farther they live from Lima,” he says. “I was told that people with money will go to Mexico or Chile for pediatric cardiac surgery.”
Cardiac specialists in Lima preselected patients, then, together with the American team, chose the 10 children to be operated on. Some of the work done was corrective, some palliative. “We tried to choose surgeries that are meaningful for the patients, what is possible and sustainable to improve the quality “of life, at least, if not correct it,” Fernández explains.
In addition, several other children underwent cardiac catheterization, where a thin tube is threaded through a blood vessel to diagnose a heart problem or plug a small hole in the heart without surgery. The doctors also held a clinic to examine additional children.
“We did about 10 complex cardiac surgeries in five days,” Fernández says. The team arrived at 5 a.m. on a Saturday, was in the hospital discussing cases through that evening and got the equipment ready on Sunday. On Monday they started performing two surgeries a day. By Friday night, they removed the breathing tube that the last child had needed. They left the next day.
The patients, ranging in age from infants to midteens, all came through well and have received follow-up care from the local doctors in Lima.
Because certain supplies were not always available, the team had to improvise. Fernández cobbled together an elaborate life-support apparatus for one child that included a ventilator, monitors, pumps, a maze of tubes and electrical cords and an inflated rubber glove to support some of it. He also rigged up breathing devices for some patients.
This was his first such trip. It was humbling. It reminded him why he chose medicine for a career.
“It was very intense, the emotions, and the people were so grateful. There was a sense of special connection,” he says.
“When I was young and idealistic, people asked, ‘Why do you want to be a doctor?’ This is the answer.”
What’s a pediatric intensivist?
Pediatric intensivists are doctors who specialize in the care of infants and children and who usually work in a pediatric intensive care unit, or PICU. They see children who have long-term illnesses as well as those temporarily in need after surgery, serious injury, septic shock, seizures or various heart and lung problems. Monitoring children’s breathing and setting up machines to help them breathe is a major concern.
I. Federico Fernández Nievas, MD, the son of a pediatrician, has a lifelong interest in using technology to help the sickest patients, which led him to decades of work in pediatric intensive care, life support and pulmonary medicine. He came to Upstate in 2015, where he is medical director of respiratory therapy and of the ECMO program, which uses a life-support machine to keep the heart and lungs going.
He has worked in major hospitals around the United States and Canada, and before that in his native Argentina — from the capital, Buenos Aires, to remote Tierra del Fuego, at the tip of South America, where he set up a training program for pediatric intensivists.
This article appears in the summer 2019 issue of Upstate Health magazine.