Friday, November 27, 2009

"Hyster Sisters"

Another remarkable story from the mission with Project HANDS comes from two sisters who arrived together, both to have hysterectomies.  Partner for Surgery came across Silveria and María Concepción Gonzales in their cervical cancer screening in Salamá, Baja Verapaz.  Both were recommended to have hysterectomies due to ovarian cysts and the substantial amount of pain they were having.  Without knowing that these two were sisters, the surgical team coincidentally scheduled their operations on the same day.  It wasn't until they were already side-by-side in the recovery ward that their relationship was discovered and they were affectionately dubbed the "hyster sisters."

After speaking with María, age 29, about her situation at home and how this operation is going to help her, I was awed by what this woman has been through, apart from the 12 hour trip to the clinic.  She started working at age 12, helping in other people's homes and sewing in a factory.  At age 18 she got married and the following year had her first child.  She now has three kids, ages 6, 8 and 10.  Her husband has since left Guatemala to find work in the U.S. as an illegal immigrant.  He sends money back to her when he can, but there is little work for him at the moment in housing construction.  María talks to him every day, and expects him to come back within a couple of years.  Her husband sent money for her to pay a caretaker to take care of her kids and mind the house while María is recovering.  Upon returning to her villiage in Baja Verapaz, she is looking forward to a relaxing recovery and being able to work pain free.

Silveria came accompanied by her husband who showed immense concern for his wife during and post-operation.  He suffered for the pain his wife was having prior to the operation, so much so that he wanted to sell everything they owned in order to pay for an operation in Guatemala, which they told me would cost Q14,000 (about $1,700).  The couple has 5 kids at home from ages 3 to 13, who are being cared for by her brother.

Both María and Silveria were amazed by how well they were treated by the team of foreign doctors and nurses.  As María put it, "They see us as equals," which is apparently more than they have seen in their past experiences.  "They neglect us when they see the 'cortes'," the traditional skirts that indigenous Guatemalan women wear.  To them, the traditional dress means no money, and they often cannot receive treatment.  María and Silveria feel very fortunate to have had this opportunity and were eager to find out how they can help with our mission.  They are determined to return to their villages and show the others how their life has improved because of the operation they have had.  Hopefully this will help to alleviate the fear that other patients have had concerning surgery and assist us in reconfirming more patients that need operations.


Sunday, November 22, 2009

H.A.N.D.S. Recap and Mirsa's Story

Today marked the end of an extremely successful surgical mission with 72 surgeries completed.  On the first day of the mission, only 45 patients were scheduled of the 60 some originally confirmed.  Partner for Surgery had originally booked plenty of patients, but many did not show up on the day they were to travel to San Juan, Sacatepéquez for surgery.  Many of the no-shows don't come simply because of fear.  They do not understand the specifics of an operation and are unnerved by such invasive procedures.  Additionally, coming to San Juan for a week often means several hours of transportation to get here, and a week off of work (a week less of pay).  Many people just can't afford to give up that much work and still put food on the table.  Furthermore, who is going to take care of the 12 children at home?  Excuse my exaggeration, but I'm not exaggerating.  It is common to find women who have 8 or more children.  Therefore, with all this extra room in the schedule, we were able to find several patients in the area who were able to receive surgery.

One particular walk-in was a family that included a mother with two children, ages 2 and 4mo., and a grandmother.  They patiently waited for their turn to be evaluated, and after the surgeon was able to screen them, they left with two surgeries scheduled and antibiotics.  The grandmother was scheduled to have a lump removed from her breast.  Mirsa, the two-year-old girl was scheduled for a hernia operation.  Oscar, the four-month-old received antibiotics for a lung infection.  Good thing they decided to stop by.  Mirsa was scheduled to be operated on the next day.  She came in with her mother scared and hungry from not having eaten.  She quickly forgot about her woes while she was distracted with bubbles and crayons.  Everyone immediately fell in love with Mirsa and her family.  They were incredibly cooperative with all the photos being taken of them.

Mirsa's mother entered the O.R. with her when it was time for her surgery.  She was asked to be there to keep her calm until the anesthesia took effect.  I passed by her as she was taken out to the waiting area.  I can't imagine the stress on a mother when her child is in the operating room.  I was surprised to find out that her son received the same operation at age four.  I guess one can never really get used to such a thing.

The surgery started at 9am.  Initially, the surgeon could only find lymph nodes and the hernia was not obvious.  As he was pulling away at the lymph nodes and excising them, he accidentally cut a vein that connects to the main artery of Mirsa's leg.  The wound quickly filled with blood and the atmosphere in the room became tense, but the surgeon reacted with a calmness that only a veteran could display in this situation.  He asked for a smaller size suture that we didn't have at hand, so the circulating nurse and I ran into the next room to find the appropriate size stitch stashed away in one of the boxes while he managed the bleeding.  We found the suture, quickly ran it into the O.R. and the surgeon patched up with tear with ease.  Once this crisis was averted, the overall mood lightened to its usual pleasantness.  The hernia was repaired swiftly and Mirsa was out of there in no time.

While in post-op recovery, Mirsa started to feel panicked as the anesthesia started to wear off and she found herself in a strange place with foreigners.  Her mother was quickly called in to console her and she was soon comforted in her mother's arms, tears streaming down both their faces.

Mirsa recovered quite quickly, and the family was able to go home that afternoon.  It is amazing how quickly children are able to recover after an operation.  Within no time, she was smiling and playing in her bed, enjoying the oreos the nurses gave her.  Mirsa's mother was incredibly grateful that the surgical team was able to do away with her daughter's pain.

Sunday, November 15, 2009

Project Hands Surgical

Another surgical mission with a team of Canadians from the group, Project Hands started yesterday with pre-op triage and evaluation.  What a looong day.  The patients have all been pre-screened, so it should be a quick in and out consultation just to verify that they do need surgery.  Unfortunately, it hasn't gone as smoothly as we would like.  The ginecological patients seem to be very demanding of the surgeon's time, and some of them have been labeled as surgery unnecessary.  Kind of defeats the purpose of the initial triage...

The hardest patient we had to turn away was a 47-year-old woman with stage four uterine cancer.  Unfortunately, PfS has decided that we cannot help cancer patients.  We simply do not have the resources to be able to pay for aggressive series of treatements, and sadly, neither do the patients.  It is a shame that this woman, Marta, made it all the way to San Juan thinking she was going to be operated on.  It wasn't until further testing was done on the woman that her terminal illness was known.  So we sat down with the woman after her consultation with the doctor and explained to her that an operation would not fix her problem.  I only listened in on the conversation while my co-worker did the talking.  I wanted to get an idea of what to say in the even that I should have to have this same conversation with a patient some day.  It was painful even as a spectator.  My co-worker told me that she avoided completely the word "cancer" because people freak out when they hear that word, and we don't have biopsy results to say that with 100% confidence.  After thorough explanation to the woman that she had an "illness" that needed very aggressive treatment and an operation would not cure it, she seemed to understand.  She asked how much the treatment cost and we explained that we couldn't really guesstimate a price but it involved a series of trips to Guatemala City, which is about 5 hours from her municipality by bus.  We told her that we can help set up an initial appointment for a biopsy, but from there they are on their own.  There is no doubt that they do not have the money for chemotherapy, so the most she will be able to do is go home and enjoy the rest of her life.  The woman's daughter seemed to understand the situation a little better, for she welled up with tears, but the woman kept her composure and simply nodded.  All she wanted was an operation to help with the pain when she urinated.  As it turns out, her illness was a lot more involved than she thought.

On a lighter note, I observed an abdominal hysterectomy today, which was most excellent.  I have yet to see a surgery that I don't enjoy.  I've been keeping pretty busy translating here and there and haven't gotten quite as much OR time, but tomorrow we have a full day of cases, so I expect to see a lot more.

Sunday, November 8, 2009

Surgical Mission with Team ISHI

At the end of October I had the amazing opportunity to be part of a surgical mission in San Juan, Sacatepéquez.  The clinic there called Centro de Salud Bárbara (CSB) has recently installed two fully loaded operating rooms, complete with air conditioning! (A real luxury)  Partner for Surgery has helped to equip these ORs and find surgical teams to come and put them to good use.  This month's team was from New Jersey and goes by the title International Surgical Health Initiative (ISHI).  A team of 20 came down to Guatemala, including 6 surgeons, 2 anesthesiologists, 1 nurse anesthetist and 7 OR and recovery room nurses.  They even came with their own journalist, photographer, and two people to handle all the logists and plan making.  This was quite an organized bunch, to say the least, and I can't say enough about their efficiency.  We had a total of 60 patients scheduled to be operated on over the course of 5 days, but team ISHI finished in four.  Although they were very serious and extremely focused in the OR, team ISHI certainly knew how to have a good time when they were off the clock.

The patients came from a variety of areas within the departments of Alta and Baja Verapaz.  The majority spoke Q'eqchi', some spoke Spanish, and a few others spoke A'chi.  The language barrier would have posed quite a problem if it weren't for our collaborators from these areas.  Partner for Surgery contracts a few special local area managers who travel with the patients, stay with them at the patient shelter, and translate from Spanish to their native Mayan language.  We certainly kept these people busy as they were constantly on call; translating for the inital evaluation and often times entering the OR with the patient to keep them at ease.  Some of the patients really appreciated having someone there who spoke their language.  Others blindly followed whatever instructions the nurses were able to convey through body language and gestures.  I helped to interview some of the patients with ISHI's journalist, and most felt fine about the fact that the doctors didn't speak their language.  They said they were so happy to be able to have the surgery, an operation that they wouldn't be able to afford under normal circumstances, and they trusted this team of foreign surgeons to do a good job.

On a personal note, the whole week was incredible.  As someone who is interested in going into medicine, the experience couldn't get any better.  I was able to observe any surgery I chose throughout the week.  What was not a big deal to the doctors made my day, my week for that matter.  All of the doctors were incredibly nice and patient about explaining anatomical elements and answering all of my questions about the procedures.  I'm wondering if there is any possible way I would get experience like this in the States.    
(photos to come)

Friday, November 6, 2009

VIA-CRYO Cervical Cancer Program

In my second week with Partner for Surgery, I had the opportunity to participate in a course for Guatemalan nurses and doctors that teaches cervical cancer detection and treatment.  PfS teamed up with Faith in Practice to educated 20 or so medical professionals on this simple, easy technique taught by Dr. Peter Thompson.  VIA stands for Visual Inspection of the Cervix with Acetic Acid (vinegar) and CRYO is short for cryotherapy, the subsequent freezing of any pre-cancerous lesions on the cervix.

Acetic acid treatment serves to identify cells that are pre-cancerous or affected by the Human Papillomavirus. When a positive case is identified, the patient undergoes cryotherapy, in which the infected cells are frozen using nitrous oxide. Throughout the course of several months, the frozen cells are replaced by new, healthy cells. Women who receive cryotherapy are only required to return after one year for a follow-up.

The students followed a schedule of daily review and theory in the morning and clinical practice in the afternoon.  We were allowed to use a space at the National Hospital in Salamá, Baja Verapaz to set up 8 make-shift clinics separated by bedsheets.  PfS helped to gather patients that arrived every day to be screened, many of whom had never even had a pap smear before.  The patients were greatful to be educated on feminine health and cervical cancer prevention, a theme that is not widely discussed nor taught in the outlying regions of Guatemala.

The implementation of VIA-CRYO courses and screenings has been of great value to the Mayan cultures of Guatemala.  Studies have shown that this system of screening and same-day treatment is much more effective in developing countries.  That is not to say that it is better than the pap smear; rather, it eliminates the need to return for results and/or further treatment.  Many of these women travel hours by bus to be screened and leave their daily responsibilities behind.  Returning to the clinic for consecutive visits is simply not an option for the majority of them.  In this way, the women can be screened at the clinic with the acetic acid test, receive cryotherapy treatment if results show a positive lesion, and return home the same day.

Wednesday, November 4, 2009

October 2009 Medical Mission

With the help of Project Hands, Partner for Surgery had yet another successful medical mission to the department of El Quiché.  The team of Canadian medical professionals included: Drs. Tony Dunlop, Pat Connick, Dennis Saunier and Nurses Sandee Saunier and Jacquie Clayton - a laid back bunch that was ready to roll with whatever came at them (stomach flu included).

We visited the municipalities of Chiché, San Antonio Ilotenango, Cunén and Chajul for triage as well as the municipalities of Kumacaj and Acul for some cultural immersion.  At the end of the week, 379 patients were evaluated by the doctors, 145 of those being referred for surgery.  Among the referrals included patients with hernias, sebaceous cysts, cleft lip and/or pallet, and prolapsed uterus.

One of the most heartbreaking cases that stands vivid in my mind was a boy with an obvious limp due to a nagging foot ailment.  When he removed his shoe - without socks I must add - he revealed a deformed foot with toes that seemed to form one big open sore.  No wonder this kid was limping!  It was determined by the doctor that the boy had a problem with incontinence, perhaps due to nerve damage.  A conversation with the mother revealed that she had gotten tired of changing her son when he wet his pants, which apparently happened often, and left him to fend for himself in urine soaked pants and shoes.  In a hygiene discussion with the boy and his mother, we instructed her how to care for the child's poor, infected feet.  Additionally, we stressed the importance of putting on clean clothes and, more importantly, clean socks.  We suggested that she take him to the bathroom every two hours to prevent him from wetting himself, but it's hard to say whether she will follow up on that or not.

We returned to Antigua -some of us still suffering an unpleasant stomach flu- and met at Frank Peterson's house (the founder) for one last meal as a team.  Some of the team left the next day while other stayed to get their fill of Antigua.  Dennis and I decided to tackle the volcano Pacaya.  Our guide affectionately dubbed us team Puma and encouraged our ascent to the top of the volcano.  My impatience was getting the best of me during our hour or so ascent as I persistently asked our guide when we were going to get to see some lava.  It was certainly worth the wait to arrive at the top.  Seeing the flowing river of lava snake its way down the side of the volcano was like nothing I had seen before.  We sat at the top with our celebratory sack lunch and watched as other climbers roasted marshmallows over the lava.  I will definitely go there again.