Guatemala, September 2015

2015 HRFU Guatemala Trip Summary

This was HRFU’s first mission in Guatemala. We were fortunate enough to work in collaboration with the Hospital Niño Jesús, Fundación Pediátrica.  This facility is a five story, narrow, high-rise in downtown Guatemala.  Our local host was Ariel Marroquín, Director of Operations of Partners for Surgery and Asociación Compañero Para Cirugía.  Ariel is a young man, fluent in English who attended the University of Alabama.  He functioned as our guide and safeguarded all of our transportation in Guatemala.  Liset Olivet, Executive Director of Partners for Surgery and Asociación Compañero Para Cirugía, was a gracious host and on our last day she gave us all Guatemala purses, even the men.

Our first day at the hospital was Sunday, where the anesthesiologists pre-oped all the patients for surgery that week.  Meanwhile, the rest of the team set up two surgery rooms.  This facility is completely modernized as we were met by a biomed engineer, Joe.  He made sure all the equipment and electronics were functioning for our surgeries. This hospital also had nurses, Irma and Maria Elena, who sterilized all of our instruments.

Our team was very small, consisting of members from Colorado, New York City and Omaha:

Dr. Mark Reiner – Adult Surgeon

Dr. David Partrick – Pediatric Surgeon

Dr. Daniel Rowen – Adult Anesthesiologist

Dr. Cynthia Ferris – Pediatric Anesthesiologist

Barb Haines, RN – Post Op

Sonya Cap, RN – Adult Circulator

Sarah Targoff, RN – Pediatric Circulator

Jamie Genre, CST – Pediatric Scrub

Amy Vinton, CST – Adult Scrub

Barb Elliott, RN – Coordinator

Mike Elliott – Admissions & Discharge Coordinator

I think what impressed us most about the trip was that Partners for Surgery took complete care of all patients.  They have a beautiful facility that provided room and board for all patients through the week.  They transported the patients to and from the facility for surgery.  An ambulance was on standby outside of the hospital – available for emergencies.  They had a fully staffed post-operative floor where patients stayed the night.  There were many full-time physicians and nurses to care for these patients post-operatively and overnight.

Dr. Mynor Alvarez, a local family practitioner, examined the patients and took care of all the patients from post-op to admission to the floor.  He took care of any medical problems that arose and would administer pain medications as needed.  We repaired 24 pediatric hernias and 39 adult hernias, with one very complicated scrotal hernia.  There were no complications during or after surgery.

We were provided lunch every day by Partners for Surgery.  There were many volunteers from Partners for Surgery who helped transport patients up steep ramps and assisted with the discharge of patients.

Our team stayed at a beautiful historical hotel called the Posada Belin, only five blocks from the hospital.  As we were there during the rainy season, it poured daily, about 2-4 inches per day.  There are many historical sites in Zone 1, where we were located.  However, due to the rain we were unable to see much.

We want to thank everyone from Partners for Surgery, especially Ariel and Liset, for a wonderful safe mission.

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Salcedo, Dominican Republic, May 2015

2015 HRFU Dominican Republic Salcedo Trip Summary

The week of May 24th, 2015 was the first HRFU trip to Salcedo, DR.  A team of 16 volunteers from the USA, 3 volunteers from the Peace Corps, and Dr. Lesly Manigat our on-site coordinator, descended upon Hospital Regional Dr. Pascasio Toribio Piantini.  This trip would not have been possible without the interpreter and logistic support provided by the regional branch of the Lions Club, and by generous supply donations from Direct Relief and Fundacion Solidaria.  With this help, the team was able to operate on 42 patients despite disruptions related to an unexpected regional physicians strike – a tremendous success.  Surgery was provided completely free of charge to all patients, with small and large hernias of the abdomen and groin repaired.  All operations were successful, and there were no complications.

The team was incredibly well received by the community and the hospital and its staff.  Many fond memories and new friendships created, with the community and the team looking forward to an even more successful mission next year.

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The team. From L to R: Mike Elliot, Barb Elliot, Nathanial Misra, Katie Clampitt, Krista Hinman, Dwijen Misra, Chris Hanson, Jessica Porritt, Rebecca Paskiet, Lesly Manigat, Tommy Lee, Amy Vinton, Julia Field, Victoria Conforte, Lisa Lugo, Dawn Porritt, Anna Disque, Fritz Disque, Jeanie Fry, Ron Oconer

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This trip would not have been possible without supplies from our generous donors.

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Many new friends were made. Here, Victoria Conforte, Barb Elliot, and Dr. Lesly Manigat pose with some the local nurses and technicians.

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Patients in the pre-op area.

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Jeanie Fry and Katie Clampitt working the recovery room.  There were no complications.

 

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Drs. Misra, Dr. Manigat with Dr. Pedro Hildalgo hospital chief of surgery

Surgery on Sunday: Omaha, NE, February 2015

University of Nebraska HRFU Hernia Mission 2015

Through the auspices of the University of Nebraska Medical Center (UNMC) and with the help of Dr. Filipi 3 surgeons, Dr. Sammy Cemaj the team leader, Dr. Keely Buesing and Dr. Vishal Kothari and Dr. Allyson Hascal chief of Anesthesia performed free hernia surgery on 13 in need patients.  The patients had no Medicare, Medicaide, private insurance and all lived at or below 200% of the poverty level.  Dr. Hans Dethlefs, a family practice physician at the One World clinic, coordinated recruitment of patients from area free clinics and performed all pre-operative history and physicals.  Mrs. Penny Johnson RN, coordinated patient care at the medical center and communication between patients and physician offices.  Multiple administrative meetings were conducted which included Mr. William Dinsmore the CEO of the UNMC system.  The surgeons saw the patients pre-operatively in their clinic, confirmed the diagnosis and obtained informed consent.

On February 27 at the Bellevue Medical Center all patients with family members arrived early for admission and then throughout the day surgery was performed in three operating rooms.  Third year medical students participated and first assisting in the ORs.  All surgery was completed by 2:30 PM and no intra-operative or early post-operative complications occurred.

Patients will be followed in the surgeons offices, in 7 -10 days and at one year.  Below are pictures of the students and surgeons.

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UNMC medical students that participated

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Dr. Sammy Cemaj the team leader

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Dr. Keely Buesing on the left

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Dr. Vishal Kothari on the far left

 

The initiative went smoothly and the patients and families were well pleased.  A number of team said when are we going to do this again.

Dominican Republic, November 2014

HRFU Dominican Republic Trip Summary

The most recent HRFU Dominican Republic was a huge success!  A team of 50 US volunteers plus 7 Institute of Latin American Concerns health care providers (cooperadores) and 2 Peace Corp volunteers provided care for over 250 patients and two potential HRFU team leaders, Dr. Mark Reiner and Dr. Antoine Lofti were trained – see below about team leader training.  One hundred three hernia operations were performed without complication and numerous other patients were examined and treated medically. As always the team members were grateful for the experience.  The patients and their families touch your heart in ways unanticipated.

Pictures below show Dr. Guy Giroux of Anesthesia and our Pediatric surgeon Dr. Robert Cusick on the right, a child patient in her mothers’ arms – another beautiful child patient, and Dr. Jim Manion our chief of Anesthesia sitting with one of his adult patients.

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HRFU Team Leader Training:  We use a team leading manual and Dr. Reiner and Dr. Lofti were given a copy by e-mail prior to their arrival with the understanding that they were coming to learn about but not necessarily volunteer to be a team leader.   The manual includes the HRFU mission statement and goals, our code of conduct, the way HRFU supports teams, our surgical policies, team leader qualifications, how to plan a trip, assemble a team, fund raise, the expected OR routine, surgical complication local physician backup, in kind donation procurement, a description of our surgeon training model, the responsibilities of specific team members, information about liability and sterility practices, a sample equipment and medication list for a  80 patient trip, information about the Peace Corp and attachments of a variety of HRFU policies and chart forms.

After reviewing the manual materials with the surgeons they performed hernia operations and Dr. Filipi assisted/observed and explained the Lichtenstein repair as we train it.  Dr. Lofti and Reiner will then decide about their further involvement.  Yearly team leader training will continue to build the reach of our program.

Mao, Dominican Republic, November 2014

2014 HRFU Dominican Republic Mao Trip Summary

The trip to Mao as a new site for HRFU in the Dominican Republic trip was truly a success.  From November 17th-21st; 66 hernia operations were performed and numerous other patients were examined and referred for additional medical and cardiac workups pre-operatively. As always the team members were grateful for the experience. We had team members from Centrastate , Jersey Shore , Lankenau and CHOP Hospitals.

Drs. Jarrod Kaufman, Giampero Campanelli, Robert Fitzgibbons were the surgeons. Dr. Kaufman led the team and brought many new first time physicians. Dr. Sandra Abramson a Cardiologist facilitated the pre-op and post op evaluations. The anesthesia team consisted of Drs. Charles Farrell, Anthony Fugaro, and Nancy Moyer CRNA.  There were no operative complications during the mission and none reported postoperatively to date.

The entire team performed well under less than predictable conditions, as this was our first time at the site.  There is continued enthusiasm on the part of the team members and local hospital staff members to continue our work at the Mao hospital. The Timmy Foundation and Banelino and HRFU Local staff truly helped round out the team for a successful mission.

There were many good moments and below are but a few.

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                              Below two of our post operative patients are ready to go home.

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 Surgeon Training:  One fully trained local surgeon, Dr. Fausto Rodriguez-Perez, a Mao surgeon was trained by Drs. Campanelli and Fitgibbons on the Lichtenstein repair.  Dr. Fausto did very well and was awarded pieces of donated mesh for future Lichtenstein repairs on poor patients.  Below are pictures showing the beginning of training with Drs. Campanelli and Fitzgibbons . After operating and after completion of 5 other groin hernia operations performed by Dr. Fausto  with Drs. Campanelli  and  Fitzbibbons first assisting him.  After each of the 5 operations a written rating form was used to assess surgical performance by Dr. Fausto.

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Training has become an important part of the HRFU mission.  Many hernia repairs need to be performed but surgeon training and eventually if protocols are followed, training of those surgeons to be trainers will occur.

Surgery on Sunday: Omaha, NE, October 2014

Background:

                Inguinal hernia is one of the most common ailments known to mankind. When symptomatic it can severely affect the patient’s quality of life. Nevertheless, the vast majority of inguinal herniorrhaphies are elective and, therefore, not available to uninsured patients who do not have the financial wherewithal to pay for the operation. Using the Surgery on Sunday model developed in Kentucky, Hernia Repair for the Underserved (HRFU) developed a free clinic for hernia surgery at Creighton University Medical Center (CUMC) two years ago, based on institutional commitment to the poor as well as the volunteer efforts of medical students and hospital personnel at CUMC and Bergan Mercy Hospital in Omaha.

                Hernia Repair for the Underserved consulted with a local free clinic physician, Dr. Hans Dethlefs at the One World clinic in Omaha and the Federal Tort Claims Act (FTCA) medical legal protection application was submitted and accepted. Under this law, all hospital credentialed volunteer professionals are medico-legally protected if the surgery is performed in an associated free clinic. Committee meetings to work out logistics of the pre-op clinic, the follow-up clinic, enlistment of other volunteers such as transporters, translators, housekeeping for the ORs, a pharmacist, registration personnel were completed. A memorandum of understanding with the hospital system was co-signed.  The organizing committee was chaired by Matt Kayl RN and director of the CUMC and Bergan Mercy operating rooms.

 

                                                   Mission Report

Fifteen patients were seen in the pre-operative clinic by Dr. Dethlefs.   Patients were operated upon using 3 operating rooms and a volunteer staff of 4 surgeons, 4 anesthesia personnel, 15 nurses, 3 surgical technicians, two translators, one instrument cleaner, a logistics coordinator, a housecleaner, a pharmacist and 7 medical students.  Three umbilical hernias were repaired, and 13 inguinal hernias were repaired including two chronically incarcerated hernias.

                The average OR turn over time was 31 minutes and there were no intraoperative or early postoperative complications.   All patients were discharged home by 6:00 PM.  Below are pictures of personnel and OR teams.

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        Margie from Housecleaning                Renee our instrument cleaner

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PACU team with Pharmacist        

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       Our translators Isis and Samantha                Four of the medical students

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                                           The room 7 team

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                                                            The room 8 team

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                                                                The room 9 team

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                                            The Pre-Op Post-Op Team

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        Janese Gerhardt with a well-deserved thanks from one of the patient families

Special Thanks:

            Hospital administration is complicated in modern times but finding the time and finances to assist the poor has always been a priority at Creighton University.  Mr. Kevin Nokels, the CUMC hospital CEO, Matt Kayl and Pat Townley are thanked for their support and work.  Janese Gerhardt RN contributed over 40 hours of time to prepare the patients and paper work plus work during all clinics and the operative day – Janese thank you!  Sharon Cyr RN contributed over 20 hours and was essential to the success of this initiative.  Dr. Hans Dethlefs worked all the patients up and coordinated care beautifully.   Thank you to Dr. James Manion and Theresa Keefe CRNA from the anesthesia department who have been intimately involved in over 20 humanitarian surgical activities and provide compassionate very high quality care that makes continued programs possible, and to Dr. Robert Fitzgibbons who has headed the surgical team and provided hernia surgical expertise that is almost impossible to match.  Finally to the many other devoted volunteers who have repeatedly assisted the poor and to the new volunteers who in fact made this initiative possible.

THANK YOU