Paraguay, September 2013

Hernia Mission to Paraguay

1st to 12 September 2013

Summary – compilation of all team member comments

Eight operation days: 6 in the Hospital Nacional and 2 in Luque Hospital.

A total of 76 patients were operated on.

Twenty operations in Luque hospital (mainly Lichtenstein repairs), Dr. Lurachi and Dr. Dubarry trained in Lichtenstein repair by Dr. Reinpold. Both surgeons passed.

Fiftysix operations in the Hospital Nacional de Itauguá. Dr. Carlos Pfingst passed training course in Lichtenstein repair. He was trained by Dr. Reinpold

The team:

Gabriele Behrend               Intensive care nurse

Janese Gerhard                   Nurse

Ingo Leiser                            Operating room technician

Dr. Wolfgang Reinpold      General and visceral surgeon specialized in hernia surgery

Alexander Schröder           Medical Student (final year)

Carsten Seebohm               Anaesthesiologist

Vera Sicking                         Anaethesiology nurse

Dr. Lutz Steinmüller           General and visceral surgeon specialized in hernia surgery

Initially the first hernia mission to Paraguay was designed for two teams with two hernia specialists in each team.


What went well

Very warm reception of Prof Cuenca and his residents at the airport in Asunción.

Very dedicated and professional team. The whole team highly skilled.

Five out of eight team members with experience in surgical missions in Africa and Latin America

The team was heartily received in both hospitals. Local people wonderful in both hospitals. Almost every evening social events organized by Prof Cuenca and his team: Dining out in Asunción, football match with barbecue (Asado), Visit of the National Football Stadium “Defensores del Chaco” for the Football World Cup qualifier Paraguay vs Argentina, etc.

Warm reception of Hospital Administration in Luque Hospital (local newspaper was present, report and team foto posted on the web!)

Very good patient selection in both hospitals. Most of the patients apparently poor.

Good patient preparation! Good medical chart! Good documentation of comorbidities, drugs, consent for operation.

OR hygiene and tidiness acceptable

Two ORs in both hospitals with very good light

Implementation of Team time out achieved!

Implementation of Operation schedule

Very good outcome after surgery: Except for some minor hematomas which did not need intervention no complications.

Very good team work within our team but also with the local staff despite different languages

Team transport from hotel to hospital well organized. Good food at both hospitals.

Dedicated documentation by Janese and Alexander

Breakfast Team meetings important

Good selection of materials which we brought to Paraguay: Instruments, mesh, suture material. Drapes, gowns gloves, etc supplied by local hospitals.

Very thankful patients

Very good travel and accommodation organization by Carsten Seebohm

Excellent patient outcome! No major complications. Outcome confirmed by Prof. Cuenca.

Very good support of the mission in Hamburg (charity event organized by Gross-Sand Hospital.


What we can improve upon:

Accomodation closer to hospital! Transfer at least 45 min was too long! Should be no longer than 10 to 15 min!

Language barrier was a problem! Fortunately at least one resident with reasonable German and/ or English knowledge in both hospitals.

Need of more translators, especially in recovery area.

Peace corps available in Paraguay?

Our anaesthesiology team was initially not well incorporated in both hospitals despite early information of Prof Cuenca and Dr Luraschi.

After first bumpy day very good cooperation between Paraguayan anaesthesiologists and Carsten Seebohm and Vera Sicking

Own anaesthesia team is crucial in future missions because local anaesthesia teams change very often which prevents standards from being implemented.

Coordinator between ward and OR unit especially in Hospital Nacianal de Itauguá necessary.

Local Instruments partly in deplorable conditions, especially scissors.

It was extremely important to bring own instruments!

Sterilization process was too long.

Hospital Nacional: Cleaning staff often slowly causing delays. Aparently due to conflict between administration and medical staff.



Very good first hernia mission to Paraguay

Prof Cuenca and Dr Luraschi are very interested to continue project

Dr. Wolfgang Reinpold