May Surgeries

From May 21 to 28, the Daly group was here for what would be the final surgical brigade during my time in Honduras. Their goal was to expand upon the successful inaugural operations that took place in March. To do this, a number of projects needed to be completed, foremost of which were installing a backup generator in the event of a power outage and installing a water filtration system for the autoclave.

The generator and filtration system, along with many medical supplies, were to arrive two weeks before the Daly group came with technicians to install the equipment. With unsurprising Honduran reliability, the container was delayed at customs in Puerto Cortes by a broken computer system, and its ETA was completely unknown. However, to unload the generator inside the container, we needed to rent a mobile crane mounted on a flatbed truck and have it at the ranch when the container arrived. At this stage that I actually benefited by Hondurans’ aversion to schedules. I could not tell the rental company when we needed the truck, but they were content to wait until we called. When the container finally showed up on our doorstep a week late and without warning, we called the company, and they arrived within about a half an hour.

Everything came intact and was unloaded without a hitch. We even succeeded in enlarging the generator house to accommodate a larger than anticipated generator in the span of a week, no small feat for the ranch construction workers. I regret not having a camera handy to document the proceedings, especially the generator being lifted by the crane, which was impressive. Everything was in place for Dr. Daly and his team of technicians.

Dave Helgeson and Keith Hines installed the generator, Brad Weaver put together the water filtration system, and Becky Hines RN organized all the medical supplies. The generator was equipped with an automatic transfer switch to maintain a nearly constant power supply, keeping anesthesia machines and other life saving equipment running during surgery. The four orthopedic surgeons were now able to operate.

After screening patients in the external clinic, the surgeons selected a number of feasible operations. At final count, twelve operations were performed during two full days of surgery, ten orthopedic cases done by the U.S. surgeons and two elective, general procedures that Dr. Cerna completed on Pequeños. The Pequeños had needed their respective surgeries for some time. Of note was the most complicated procedure, removal of dead bone from a middle-aged woman’s wrist that had become infected after being operated upon by public hospital doctors. After taking out an unexpectedly large amount of dead tissue, she will need further surgery in August or November to finally correct the problem. None of the 10 patients from the community paid a cent for the operations they received.

All in all the week was a success, in large part because, with the invaluable help of Dave, Keith, and Brad, the final major components were installed to equip the building for function on a full scale. With these pieces in place, the Daly’s are ready to scale up operations in August to treat more needy persons. It was great to see a wide array of talented individuals give their time and work together to make large strides for the surgery center and the health of our community here.

Weblinks

Hello Readers. Just wanted to direct the attention of those interested to a few pages about the Surgery Center and my work as a volunteer. There is now a website for the Holy Family Surgery Center, http://holyfamilysurgerycenter.org/. It has news updates and some short biographies and testimonials from people involved with the project. The short piece I have written about my volunteer experience is basically the same one that is posted on the NPH International website: http://www.nph.org/ (put your cursor over "volunteers" on the left and click on "testimonials").

Not much else to report: I am gearing up for a visit this week by Dr. Daly's family and a slew of other visitors, including three other orthopedic surgeons, nurses, students, and experts who will help with some equipment installation at the SC. A container of supplies including a 100kW backup generator, water softener system, and seemingly endless boxes of medical supplies arrived last friday, and the goal this week is for the mechanics and technicians arriving with Daly to install these items to be able to operate again early next week. We will be having an all-day clinic Saturday to triage for possible procedures should everything be in place. Will keep you posted...

Inaugurating the Holy Family Surgery Center

The customary overdue Hello, and an update on the recent events at the Surgery Center. Though progress has often inched along, both during my time here and in the 5-year history of the project, March 6-11 we crossed a milestone of sorts, blessing and inaugurating the new Holy Family Surgery Center as “complete” and performing the first surgeries with U.S. medical personnel. It was the fruition of years of hard work and dedication on the part of St. Paul orthopedic surgeon Dr. Peter Daly, his wife Lulu and family, NPH International Director of Family Services Reinhart Koehler, and a sea of other invaluable colleagues, benefactors, Ranch employees, and friends of NPH.

Dr. Daly and colleague Dr. Mike Forseth performed the first surgeries on two patients who came to the external clinic looking for medical assistance in the weeks leading up to their visit. One patient, an elderly woman, was in serious need of help. Last November, she fell out of a tree and broke both wrists (why a woman in her sixties was climbing a tree to cut wood in the first place is a question we did not get into, and likely would’ve led to a larger discussion on Honduran cultural norms and living conditions). The public hospital in Tegus, her only form of assistance, asked for somewhere in the neighborhood of US$10,000 to operate on her. She hasn’t seen that kind of money in all the years of her life, so she walked away untreated and continued to care for her children as best as she could despite her comprimised condition.

On triaging this woman and other candidates at the beginning of the week, hand surgeon Dr. Forseth determined that hers was a case that, while complicated, they could reasonably undertake. Along with the other patient (needing a minor cyst removal in her hand, lingering from a previously botched attempt at a health center in nearby Talanga) the two became the Surgery Center’s first patients to receive US trained surgical care.

The surgeries were successful, and both women expressed gratitude and dignified satisfaction with the care they received. A humbling and rather striking sentiment I realized was the pride and joy felt by the community that such a center has been constructed for them. The goal is to make the center of U.S. quality, and this is a level of care far and beyond what these people have experienced. It really does affect one’s psyche when the quality of the facilities and services available to you are in poor condition and third rate. For these Hondurans to be told that they deserve (and will receive) sound care in clean facilities uplifts their dignity and sense of worth, and it is an additional benefit that really can’t be quantified. To see the surprised smiles of these two patients as they received careful attention from dedicated providers, who listened to and answered their questions, was a terrific thing to behold. Thinking of the many future patients that are soon to come, it certainly solidified my faith in the project.

All in all the week was a success, and I think everyone involved left with a feeling of satisfaction and gratitude, including the patients. For now, we will continue to treat patients once weekly at the surgery center for minor procedures (with Dr. Cerna from Tegucigalpa), progress with details in building construction, and gather more patients as we look forward to a May visit by the Daly group, with goals of augmenting the services provided and numbers of patients treated at that time.

The medical team that came with the Daly's.



My 15 seconds of fame scrubbed in and sitting at the surgical table.

Long Overdue Update: Christmas, David, Work

I'd bet that the countless loyal followers out there (if there are any left) are all but certain the blog has retired to greener pastures, but on a chilly February Sunday in Honduras I've managed to zap some life back in it. With so much to report, I’ll limit myself to give a hasty run-down of as much as I can remember from the last 7, 8 weeks (cringe)…

Well, Christmas was nice (a belated Merry Christmas to all and a Happy New Year). All the volunteers took a two week break from work and watched over the kids while the employees vacationed over the holidays with their families. It was something of a one-species Zoo. On Christmas eve and New Year’s we made gigantic bonfires, the kind of which could easily start a forest fire, for which the Discipulos Hogar, Finn, and I had to cut and haul about two dozen trees from the forest in which we live. Not fun. The kids roasted marshmallows as close as they dared, until the falling ash made such endeavors doubly dangerous and amidst their complaints we pushed them back for their own safety. No one was burned.

On Christmas day, all the kids went walked to various nearby villages to give away some of their clothes to residents. It was really quite heartwarming. Above are pictures in La Venta, a small town just up the highway. In the first, some Pequenos have stopped to bring clothing to the red house.

After two weeks of Christmas/babysitting chaos, my fellow volunteers and I were ready for a break. I was fortunate to then have the visit of my brother David from Jan 3 – 17. We spent a week on the Ranch and I did my best to show him around and give him the full experience. He weeded in the Hortaliza, swam at the dam, watched Dr. Cerna operate, and played with the kids during vacation courses. Then we escaped to travel Guatemala, which was a terrific time. We hit up a plethora of touristy but breathtaking sites, highlighted by a large clear lake nestled between three volcanoes, hiking an active volcano, and seeing the Mayan ruins in Copan. It was especially amazing to see multitudes of indigenous Guatemalans speaking their various local, indecipherable tongues as they conducted business in crowded marketplaces, wearing colorful woven cloths traditional of their still-vibrant native culture. The NPH Guatemala home also welcomed us for a night and showed us around their complex. It was a great week.

After seeing David head back to the U.S. to find a job, I’ve been focusing on work. Currently we are making final preparations to try to organize a surgical brigade from the States sometime this spring. My most important tasks are to install an automatic transfer system to turn our backup generator in the inevitable situation of a power outage during surgery, and get our license from the Honduran Ministry of Health. This is a tedious process involving applications, building plans, environment codes, and inspections. We also have the usual mix of nagging, minor construction projects (closet shelving, curtains, door installations, floor sealing, and other facile tasks made more difficult by a lack of dedicated, qualified workers).

That about wraps up the basics, for brevity I’ll leave it at that and spare more boring details. One last thing of note is that we are in the transition time for the January volunteers. We have six more here from the U.S., Spain, and Germany, and we are losing the old group (about 10, including my buddy Finn). Next weekend we will say goodbye to this incredible group of people, who will go their separate ways to travel Central America before heading back to the States, Spain, and Germany. They will be missed.

Soon to come will be information about how readers can donate to NPH and the Catholic Medical Mission Board. Stay tuned

CMMB MVP's for Change

Hi Readers,

Recently I have created a fund with the Catholic Medical Mission Board to support my volunteer work here in Honduras. If you'd like to read about the fund, the Catholic Medical Mission Board, or make a donation, please visit the following link:

http://support.cmmb.org/site/TR/Events/General?pg=fund&fr_id=1010&px=1109422

Thanks very much for your support! Below I have included the piece I wrote for the Catholic Medical Mission Board summing up the bulk of what I have been doing on the Ranch since my arrival. I include this because other than the “typical week” I related months back, I really have not described my job in any detail.

My primary responsibility on the NPH Ranch has been to manage the construction and operation of a brand new surgery center. Begun in 2004, the center is the vision of Dr. Peter Daly, an orthopedic surgeon from the U.S., and longtime NPH director Reinhart Koehler, whose goals are to provide a vehicle for bettering the health and medical care of underserved populations in this area through improved access to surgical services, which are in desperate need. My job is to communicate with project leadership to organize and execute construction tasks, as well as facilitate activities at the surgery center in construction, maintenance, and medical service provision. The center is nearly finished, having installed anesthesia gases and suction piping this past week, and we are currently planning final modifications to prepare the facility for licensure and certification by the Honduran Ministry of Health. Our leadership is also looking at long-term business and operational plans, which must cover the building’s expenses and upkeep while allowing access for poor and underserved Hondurans at prices they can afford. The center hopes to partner the expertise of U.S. and European medical brigades with Honduran care providers to exchange medical knowledge and elevate the country’s level of care while providing high-quality, affordable surgical services. Primary care for surgery center patients, including triage and follow-up, will occur at NPH’s external clinic, which is staffed by volunteer and Honduran medical staff and serves roughly 40 patients daily. Currently, the surgery center is being used once per week by a Honduran surgeon for small surgical procedures (e.g. removal of cysts, in-grown toenails, and benign tumors), and these patients are triaged at our clinic. They pay a symbolic nominal fee.

A second project of mine was to provide all needy children on the ranch with glasses. This project was begun last January by a volunteer ophthalmologist who examined almost all the children, fitted those in need with a supply of frames, and negotiated with the public hospital optometrist to make the lenses. Upon her departure in August, I finished her work by bringing the remaining children she did not examine to Tegucigalpa for eye exams, helping those who need glasses choose their frames, and taking prescriptions and frames to the optometrist. We just received our final group of glasses from the optometrist last week, so now the vast majority of children who need glasses, excepting those new to the ranch, have received them. Future work in this area would include keeping up to date with new arrivals, changing prescriptions, and repairing frames, and as we must pay for these services in Tegucigalpa this likely will be continued by other clinic staff.

My other duties include helping the Honduran surgeon to provide medical services at the surgery center. I call the patients to come for surgery, act as an assistant during the procedures, and clean up afterwards. For one weekend, I also helped the NPH International medical team to check on water filters brought to rural Olancho by a Virginian medical brigade, and I will likely help the brigade again when they return in the spring (see “La Hicaca”). Future ideas include making a public health presentation about diet, exercise, and common illnesses to children in our school during their science classes when they begin next February, and possibly working with our IT volunteer to try to implement in the clinic some rudimentary form of an electronic medical records database.

That about sums it up right now. Please consider making a contribution to the CMMB fund, or to NPH Honduras. Also coming soon will be a recap of a productive visit by Dr. Daly and his medical team that really whipped the surgery center into shape, and pictures of my surfing trip to El Salvador. Stay tuned.