Lima First Surgical Day

Our first surgical day in Lima started bright and early at 6am. We got up and got dressed and had a quick breakfast of tamales and yogurt while listing to Incan pan flute christmas music. Our bus arrived and we loaded up all of our equipment and set off for the hospital. In Peru there are two tyoes of hospitals, private and public. Private hospitals are for the wealthy or for the few who have insurance. Public hospitals are discounted and partly paid for with governmental funding but they are less clean, less private, pretty much less every thing. The hospital we were working out of was of the latter variety. There were armed gaurds at the front gates and we had to move through huge crouds of people in various states of distress and discomfort. You would see gaping wounds and festering infections all waiting outside for their turn to be seen. Each different specialty had its own set of buildings. We were working out of the gynecologic building. So we arived and were issued into a small "office" to change out of our street clothes and into our scrubs. We were told that we were not allowed to arrive already dressing in hospital attire but that we needed to dress once we arrived. After dressing we got all of the equipment that we had brought and went to the operating room. To get there we had to walk through the gynecologic inpatient unit where all kinds of women were crammed into one bed right after the other with no attempt at privacy. There was a shared bathroom if you were in a position to get up yourself, but the hospital provides no essential hygiene items, your family is responsible for bringing you everything, including toilet paper. Apparently our walking through the unit caused quite a stir because they never let us do that again after the first day. The OR was located right outside the bathroom and had a very strict dress code, you could not enter without the customary mask, booties and head cover if you ever tried to enter without any one of those items you were quickly and severely chastized. Dress code aside, the ORs were pretty creepy at first with the white tiled walls and really old beds and cracked tile floors. We were offered the largest of the ORs but had been given very strict rules as to when we could use it and how we could use it. Time restrictions really put a damper on the number of patients that we would be able to see. Anyway, we prepared for the first patient and if you think about it having to bring everything you could possibly need for a surgery is pretty tough and keeping track of it all is even harder. We were allowed to use the anesthesia machine and the bed with its various attachments and some tables but we had to buy anything else that we wanted to use or ran out of or discovered that we had forgotten. It was kind of crazy when you would be in a case and need a drug that you had not brought with you and you look over at the anesthesiologist, in this case Doctora Reyes or her resident Carlos, and ask if they had it and they would say, well did you buy it? And of course we had not so either we did without our sent a runner to the pharmacy to pick it up. Some of the drugs needed to be refrigerated and so they would come in a plastic sandwich bag accompanied by an ice cube, made with contaminated tape water I am sure. At first the nurse anesthetist and I were bugged that they kept an anesthesiologist with us at all times but we soon created a symbiotic relationship in which we learned from eachother. I will go into more detail about the procedures we did in a surgical blog entry when I can upload my pictures but for now let me tell you that I have never seen this kind of surgery in any of my training so far and to me it was facinating. Some of our pictures are quite graphic but I think that you will enjoy seeing them. After a full 11 hour day we packed all of our stuff back into bags and walked them to our office and locked them up. We were all dead tierd but soon were wide awake as we cluched on to our seats for a wild bus ride back to the hotel in Lima rush hour traffic. We went to a restraunt in a strip mall on the cliffs overlooking the ocean and then headed back to the hotel for some much needed rest.

First Day in Peru

Well after my first full day in Peru I am tierd but very excited for what the next 10 days will bring. I left Salt Lake International airport at 8:30am on March 19th. I sat on my buns for 5000 miles until I arrived in Peru just after 11pm. We did not get into our hotel until after 2:30am. Customs and all that jazz hung us up. This morning I had to be up at 6 so that we could be to the hospital by 7. We arrived at the hospital and as we began unloading our stuff it became very evident that we were no longer in Kansas or any where near there. The patient that we were going to be seeing were all lined up outside sitting on something like bleachers. Many had traveled for days to get here from their remote Andean villages. It was clear from looking into their faces that they were so excited to see us and that their needs for facial reconstruction were severe. We are traveling with three maxillofacial surgeons that have been coming down here for ten years. Some of their old patients were waiting with the other patients to once again lay eyes on these men who had so eased their burdens and improved the quality of their lives. The entire group stood up and clapped as we entered the building with our equipment. We spent the entire day seeing each one of the patients that had been brought in especially for us. Our group consists of 17 people, 3 surgeons, 2 residents, 4 medcial students, me, another CRNA, a scrub tech, and three support people. We all crammed into a small exam room and brought them in one by one. It cannot have been a comfortable feeling for these simple humble people to have so much attention. The first picture is one that I took of all of us in a room interviewing a patient.Never mind, it will not let me upload any pictures so I will just have to insert them after I get back. The crazy thing about Peru is that some things are so third world and primitive but others are absolutely state of the art. The imaging that the patient's received was absolutely amazing. The Idaho Condor group that I am with pays for everything for each of the patients that we treat. The imaging that they get cost $40 US dollars. The hospitalization, medication, surgery, imaging, lab work and everything else involved in the first three cases we did totaled $300 US dollars. Certainly seems like there is room to cut back on our outrageous medical expenses don't you think? Anyway, no political stuff right now. We interviewed about 39 people in about 6 hours and picked 18 that would be good cases for the equipment we had. We had to send the other 19 people home which was extremely sad. Many of those people, as I stated earlier, had travelled long distances just to be told that they needed to wait until next year. Those who were selected were immediately placed in the hospital for preoperative workups and to be monitored. They placed all of our patients in the same ward, not the church kind of ward but the hospital kind. Each morning we would walk past the ward and all of our patients would be hanging out of the windows waiting to see us and tell us how excited they were for their turn to have surgery. We made up a tentative schedule so each one knew when they were suppose to get to go to the OR but sometimes they had to be postponed because their lab work wasn't done or for some other concern and they always cried and were hard to be consoled. For those of you who have been to South America you know that the people can be brutally honest and pretty mean to each other. If you are fat everyone calls you Fatty, if you are skinny that is what you are called. So these kids and young adults, in most cases have been ridiculed and defined by their deformities so surgery is their only chance to feel like everyone else. I was told an incredible story that illustrates this point perfectly. A couple of years ago a 19 yeat old kid came to be seen by the group. He had been playing soccer and had fallen and been kicked in the face. His nose had been severely fractured and lay completely sideways on his face. The bones healed that way and he had been living with that and the shame that came with it for years. The years of teasing had taken their toll and the young man wore a hat all of the time and did not ever look anyone in the face. His eyes were always down cast and it was evident that he truly felt like he was worthless. He arrived with his mom and was examined by our doctors. He hung his head as his case was discussed and did not make a sound. The surgeons told him that they could easily fix his nose and could make it look just like it used to, one doctor went as far as to say "we will make you look beautiful". Upon hearing those words the young man looked up and with tears in his eyes said "you can?" That same day his nose was rebroken and set correctly and a splint was used to hold his nose in its proper orientation. When the young man looked at himself in the mirror he burst into tears as did his entire family. Every morning after his surgery the young man was waiting at the gates of the hospital and followed the team around asking what he could do to help. He would not leave. He carried bags and  washed instruments and the floors, he would not leave until the expidition was over. It reminded me of the story of the savior and the healing of the ten lepers.
   After we had met with all of the patients that we would be seeing we had some time to go and see a little bit of Lima. As a group we went to an very nice restaurant near so Incan ruins. Apparently lots of famous people go there. We ate to our hearts content and I even tried guinea pig. That pretty much sums up the first day. I am going to try to post this but I want you all to know that I have not yet proofread anything and the spell checker has not been working so  . . . be kind.