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Middle Ground
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Hearts Afire

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Winter 1998
Hearts Afire
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For many, it is all they can do. In the short amount of time they have in Lima, the doctors cannot possibly address every case. "We have to say no to so many of them," Alejos laments.

Working in unfamiliar surroundings, with unfamiliar equipment (some of it more than 20 years old) and struggling to communicate in an unfamiliar language, improvisation becomes the key to survival. When a 13-year-old girl goes into full cardiac arrest on the operating table, surgeons Sadeghi and Meada are stunned to learn that the O.R. is not equipped with internal paddles -- slender prongs that would fit inside the open chest cavity -- for the defibrillator machine to jump-start her stopped heart. Given no other choice, the two fashion their own internal paddles, wrapping two pairs of forceps in saline-soaked gauze, placing them against the child's still, exposed heart and touching them with the broad, flat paddles of the defibrillator. The result is a loud ZAP! and a brief funnel of sparks. The girl returns to life.

Sometimes it is the doctors themselves who suffer the consequences of mechanical failures. In the middle of one operation, anesthesiologist Howard Chait reaches to adjust the setting on a monitor, lets out a sudden loud groan and staggers backward after receiving a strong jolt of electricity from a short circuit. Later in the O.R., someone smells something burning; it turns out to be an electrical cord in a wall socket. A nurse reaches down, pulls the cord from the wall, waves it in the air for a few moments to let it cool and then plugs it back into the same outlet. The American doctors just shake their heads and return to work.

The fact is, things have improved since Alejos' first visit in 1995 when a gowned and masked hospital mechanic, tools in hand, had to attend each surgery in case the aging heart bypass machine broke down. There is newer equipment now, much of it donated from abroad. Yet, one doctor observes that much of what he sees looks like it should be on display in a medical museum.

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