Tuesday, May 23, 2006

More about Honduras

Me with a tiny patient

These past few days I've been wrapping up all the paperwork for my trip to Honduras. There's lots of paperwork to be done: basically providing a list of all the procedures that we completed, and getting an estimated cost for all the services and supplies that were donated. During this process I discovered that the services of an administrator/translator (aka me) are worth approximately 4% of the services of a hand surgeon. Hmph.

I've posted some more photos from my trip. In this set, you'll see photos of people from the trip. There are no surgery photos in this batch, just photos of the group of doctors and nurses and some of a few people we treated. Even though we spent lots of time at the hospital (more than 80 hours in six days) we managed to find time to relax as well. We also went out to dinner most nights and had a big dinner Thursday night, inviting the hospital staff to join us.

I have also posted some >photos taken in the OR. [EDIT: I thought better of this, so this paragraph is purely theoretical.] along with descriptions of some of the things I learned and some of the procedures that the doctors did. Some of the photos might gross you out but I tried to keep the gore factor to a minimum. Unless you're extremely sensitive, you should be fine. Also, I labeled the most graphic photos with a * in the name, so if you roll your mouse over the small images on the photoset page, you'll know which ones to watch out for. In some ways, though, these are the most fascinating. For example, you might see a tumor being removed, or tendons being repaired, bones being attached together with metal plates or my favorite, a pollicization. This was an 11-month-old child who was born with only a tiny little boneless nub of a non-functioning thumb. The surgeons detached the index finger and turned it into a fully functional opposable thumb (that's what a pollicization is). It's so cool to see the photo of the little hand (you can tell its size by comparing it to the size of the surgeon's fingers) and to think about the tiny tendons and nerves that were attached to the finger to make it into a thumb. Amazing! It was also great to think that because of this group of doctors, the little boy will grow up with two working hands, and that would never have happened otherwise.

Luckily I didn't have to learn too much tricky vocabulary. I was able to get by with the words I knew and stuck mainly to layman's terms (didn't have to learn the Spanish for "tenolysis", "contracture" or "dorsal ganglion"--I'm not even sure what the English words mean!) But I did come back with a slightly enhanced vocabulary: I know how to say "stitches", "tendons", "cyst", "splint", "dizziness", "thumb", "wrist", "nerves", "chart" and a few others. Next time I go out for Mexican food, I'll try to slip one or two of those into conversation with the waiter...

Thursday, May 18, 2006

An Exhausting, and Exhilarating, Week

I returned on Tuesday after my volunteer program in Honduras. I had no idea what to expect before I left, but was absolutely and without a doubt thrilled with the whole experience. I learned so much about medicine, which was really interesting, and we really helped a lot of people, and we all felt really good about what we were able to do.

This was my group: 6 surgeons, 1 pediatrician, 4 anesthesia staff, 5 nurses, 1 scrub tech, 1 physical therapist, her 16-year-old daughter, a professional photographer and myself. Besides me, only one anesthesiologist and the pediatrician spoke Spanish, so I was very busy during the week translating for the patients and their families. Overall, we treated 80 patients in five days!

On our first day, Sunday the 7th, we went to the hospital around 8 AM, where we were greeted by around 100 patients, all with hand and arm problems, who had all been waiting since 6 AM to see us. We divided up and began screening the patients. I sat at one table to translate for two of the surgeons, and two other bilingual Hondurans sat at the other two tables. As each patient came in, the doctors diagnosed their problem, discussed what could be done to fix it, and if the patient wanted to go ahead, we scheduled them in for surgery that week. Before long I got into the rhythm of the questions to ask: what happened? when? can you move your hand? can you bend/straighten your fingers? what bothers you most about the problem (lack of movement/use/feeling)? have you already had surgery? And by the end of the day, I could recite the pre-surgery instructions in my sleep: be at the hospital by 6 AM day of surgery, and don't eat or drink anything after midnight the night before (not even water!) We saw patients of all ages with all kinds of problems. Here's one crazy one: a man had been hit in the elbow with a machete more than 20 years ago. The bones were broken and separated at the elbow and had never grown back together, so they just flopped around freely, unrestrained by the limits normally imposed by the elbow joint. However, his muscles and tendons were mostly intact, so he had movement and use of his arm, and even a very strong grip! He had wrapped a bandana around the elbow for support, but had been living and working this way for more than 20 years! Actually, that's one patient we didn't treat, because the only fix that could be done would involve fusing the bones together, which would mean he would lose all movement in the arm.

One of my first impressions was how patient the Hondurans were. The screening day stretched on throughout the day until around 4 or 5 PM, so by the end the people still waiting had been there for 10 or 11 hours, waiting in the 100-degree heat to see us. But there were no complaints or protests, no angry people demanding to be seen, indeed very little obvious irritation. The children were well-behaved and very few cried. I would see more evidence of this kind of patience and endurance of hardship throughout the week, in such stark contrast to what I can imagine would happen in the U.S. It was impressive and yet sad as well, because it shows that life is often hard for these folks, and they have had to learn to accept and deal with the discomfort and difficulty that life deals them.

In the next few days, I'll write more about some of the most interesting cases we saw and I'll have some photos to show of the hospital, the doctors I worked with and some of the cases we saw. And if you're interested in seeing what a cyst excision, spaghetti wrist reconstruction, Hunter rod implant, burn scar revision, PIP arthrodesis, or bilateral thumb partial duplication repair looks like, I'll have some photos up very soon. In the meantime, here's me in my scrubs.


Wednesday, May 10, 2006

In the OR

Just a quick report from the heart of the storm here in Honduras:

It´s been an incredibly busy few days. We have seen and will be treating approximately 80 or 90 patients this week and each day when we arrive there are more waiting to be seen, in the hopes that they can be squeezed in. The patients we are treating are here for hand and arm treatment. Sometimes this is a congenital defect, like a little boy we saw yesterday, who was born with polydactyly--extra fingers. In his case it was a thumb with two ends on one of his hands. Today we saw a boy with syndactyly--he was born with his ring and pinky fingers grown together; the doctors separated them. We´ve also seen deformations as a result of car accidents, falls out of trees or off of roofs, falls onto glass or rocks while playing soccer, and one snake bite. But by far the cases we see most often are machete wounds. The ones we see are self-defense wounds across the hands, from victims of an attempted robbery or attack. Some of the cases are heartbreaking.

I am busy! I spend my day translating with patients going into or out of the ER, talking to the nurses from the hospital which is hosting our group, or else working on paperwork for the upcoming patients. But in my free time, I get my mask on and go into the OR to watch the surgeons work. It´s so fascinating. I could spend all day describing the procedures I´ve been watching.

Internet time is limited so I won´t be able to write more until I get back, but then I´ll have lots of stories and lots of pictures. Some will be kind of gory, but I won´t post them here.