Going Home

I'm writing this from the airport as I wait for my flight. Tuesday and Wednesday were long days but yesterday was a bit shorter. We finished all the surgeries that we scheduled so that was a good thing. We had our farewell dinner last night with the staff from Obras Sociales de Hermano Pedro. Dr. Jack of course regaled us with a song he had written accompanied by his guitar. Dr. Charlie then read some poetry to us, but we could not convince Lila to sing for us. Maybe next year?

The nurses, scrubs, surgeons, anesthesiologists and the other nurse anesthetist made this a very memorable trip. Until next time everybody!!!

The four surgeons: Jack Graber, Charlie Haislet, Omer Sanan, Alisa Wright

Old equipment but it still (mostly) works!

Suction......from 1945??? Yes, the plastic canister got cleaned and reused. And we shared it with the surgeons.

Marilyn, Mark and I---the three main anesthesia providers

Cool fireplace in the restaurant last night.

Pix from day 2

In the OR with a hysterectomy

What I see from the head of the bed: one resident from Spain, one surgical tech, and two surgeons.

Surgery: Day Two

Wow, what a busy busy day today! Not only did we complete all of our scheduled cases, but we had to clean up a mess of a patient left over by a Spanish team from four weeks ago. She had gone home but returned today due to her infection. The Spanish docs performed a hernia repair with mesh and then extended their procedure by also performing a panniculectomy (removal of the pannus, all the skin and fat from the abdomen). The panniculectomy became infected and since she has mesh, the mesh is also a source of infection. We took her on and two of the surgeons opened her up and cleaned out all kinds of smelly nonsense. It's a wonder she's alive. I felt like I was at home doing an add-on case at 4:00 in the afternoon on a sick patient who was infected! The Spanish doc who originally performed her surgery will probably not be allowed to return to Hermano Pedro. Teams are supposed to only perform simple surgeries. Many of these patients do not have clean homes to return to so a major surgery never should have been performed. I'll get off my soapbox now!

I'll upload a few pix here in a minute, then I'm off to dinner and bed!

Surgery: Day One

We had a fantastic, busy day today in the OR at Hermano Pedro! We ran three ORs and were able to complete 16 cases by 4 pm. Our anesthesia staffing is a bit tight this week so each anesthesia provider is running their own room; we have a retired anesthesiologist available to give breaks and to give us a hand as needed for pediatric cases, etc. Usually we have four anesthesia providers and we juggle all the cases and rooms so each provider gets significant chunks of time to lollygag. I prefer it the way we did it today as I get into a routine with the circulator, scrub, hospital staff and surgeon.

I worked with Omar Sanan today, a general surgeon from Minneapolis. He is a very low-key guy who is also a skilled surgeon. He regaled all the ladies in the room with funny stories in English and all the muchachos (the hired guys who work full-time at the hospital) with different funny stories in Spanish. At one point he nicked a vein on a laparoscopic case and tried to put a staple on the vein to stop the bleeding. Only he quickly found out we were out of staples! He calmly removed the stapler from the tiny trocar hole and placed a grasper into the same hole, pinched off the vessel, and waited until more staples could be located. Ah, the world of anesthesia in a third world country!

This evening I had dinner with five other women in our group at a great French restaurant about a block from our hotel. We were done by 7 and all looking forward to coming back to our hotel and reading good books and going to sleep!

We have 16 more cases on the schedule for tomorrow--gallbladders, hernias, and hysterectomies. I'll try to remember to take some pictures while we're in the OR so I can upload them tomorrow.

The hospital/social work organization, Hermano Pedro

Chilling between seeing patients in the "Anestesia" room

Marilyn (another CRNA) and I

Happy hour at the Sky Bar--love the view!

Pre-Op Clinic

Today the entire team converged on Obras Sociales del Hermano Pedro and unpacked all the surgical and anesthesia supplies. We then operated a surgical pre-op clinic to determine who was best suited for the surgeries we are capable of performing (gynecologic and general this week). Most patients spoke Spanish so one interpreter was sufficient. In several cases, however, the patients spoke a native dialect. So a conversation went something like this:

Me: Have you ever had surgery or anesthesia before?

Spanish interpreter: (in Spanish, to the native dialect interpreter) Have you ever had surgery or anesthesia before?

Native dialect interpreter: (in Kaqchikel or K’iche; I can't tell the two apart; to the patient) Have you ever had surgery or anesthesia before?

Patient: Usually responds with a long-winded account.

Native dialect interpreter: (in Spanish to the Spanish interpreter) She has had two children in the past.

Spanish interpreter: (in English to me) She has had two children in the past.

Me: So have you ever had surgery or anesthesia before?

Spanish interpreter: (in Spanish, to the native dialect interpreter) Ask her if she's ever had surgery or anesthesia before

Native dialect interpreter: (in Kaqchikel or K’iche; to the patient) Have you ever had surgery or anesthesia before?

Patient: Might respond with yes or no. Might give another account.

Native dialect interpreter: (in Spanish to the Spanish interpreter) no.

Spanish interpreter: (in English, to me) No.

And that is just one question. Needless to say it was a painstaking process to elicit a history with the language barrier and even more difficult to describe their anesthetic options to them. You have to wonder how much of what I said was interpreted in a way the patient could understand!

We have a very packed OR schedule this week and it will surprise me if we get through all the cases that have been scheduled. We have several pediatric cases, mostly hernia repairs. Then we have a bunch of hysterectomies, gallbladders, and a few lipoma resections.

I will post a few shots from our happy hour this afternoon in another post. And then I'm off to bed to rest for a busy day tomorrow!

A few Pix

This one's for you, Mike....

Yes, it's a volcano. No, I don't know when it erupted last!

Here are a few shots from my hotel's courtyard (the flowers are beautiful here, mom!) and from cruising around......

Arrived in Antigua

As I write this I am sipping a cup of Guatemalan coffee and enjoying the sound of a fountain in the colonial courtyard of our hotel. I flew in to Guatemala City last evening and promptly met up with my taxi driver, Julio outside the customs area. It is a short 45 km up to Antigua where we will be based for the next week. The rest of the medical team arrives this afternoon and I look forward to catching up with many surgeons, anesthesia providers, nurses, and scrub techs from Abbott Northwestern Hospital in Minneapolis.

I am here in Guatemala with a group called Common Hope, based out of Minneapolis. Each year they send three consecutive teams over three weeks to operate at a Catholic-based hospital in Antigua, Hermano Pedro. Patients pay for their services based on their means and income and the hospital/this medical group supplement the rest. Most of our procedures this week will be general surgery, gynecologic and podiatry surgeries. Last week they performed large numbers of tonsillectomies so we hope to not have any rebleeds this week!!

Well I'm off to cruise around Antigua and try out my new camera. Pix to follow....