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.

 

Conclusion:

Very good first hernia mission to Paraguay

Prof Cuenca and Dr Luraschi are very interested to continue project

Dr. Wolfgang Reinpold

Ecuador, November 2012

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On December 1, 2012, the HRFU team returned from Archidona and by all accounts the patients did well. Although it was the first surgery trip for the Timmy Foundation, lead by August Longino, they did an extraordinary job supporting the team.

Dr. Wexler, Dr. Campanelli, and Dr. David Partrick (a Pediatric surgeon) operated on 68 patients and there were no known complications. Dr. Cynthia Ferris, anesthesiologist extraordinaire, provided wonderful care. Flexibility, knowledge of underserved country conditions and competence are her hallmarks. Dr. Kevin Buckley examined patients pre-operatively and filling in where needed. Five nurses from Calgary, Canada ensured the standard of care was maintained and loving care was provided.

One important aspect of the trip was the welcoming and appreciation of the Ecuadorian people. They repainted the hospital for this trip and have expressed their appreciation in many ways.

Congratulations Team – Well Done!! 

eq3 eq4 eq5 eq6 eq8 eq9 eq21 eq71 operating-room

Dominican Republic, November 2012

The most recent HRFU Dominican Republic trip was a huge success! Forty two US volunteers and many Institute of Latin American Concerns health care providers (cooperadores) and 4 Peace Corp volunteers cared for more than 200 patients. Two Dominican surgeons were trained as described below. One hundred and fourteen hernia operations and 18 lumpectomies were performed without complication and numerous other patients were examined and treated medically.

Surgeon Training

Two fully trained Dominican Republic surgeons were chosen–a Pediatric surgeon for Pediatric hernia training, and a general surgeon for Lichtenstein hernia repair training. Dr. Robert Cusick trained the Pediatric surgeon and Dr. Wolfgang Reinpold trained the adult surgeon. Both trainers used a validated surgical technique rating form designed by the University of Southern Illinois surgical department education division (with input from Dr. Filipi, Dr. Cusick, and Dr. David Chen of the UCLA department of surgery). The rating form is now being implemented in the U.S. for surgical residency training. The hernia rating forms are available upon request.

The rating form was reviewed and then the trainer performed the first operation and the trainee assisted. The trainee and trainer reversed their roles with following operations. The trainer then filled out the rating form in privacy then immediately reviewed it with the trainee giving him a numerical score and explanation for all of the step ratings. This was repeated immediately for four subsequent operation. Both surgeons passed with flying colors and Dr. Ramirez was given free mesh on condition that he would use it only on poor patients and that he would monthly fill out a spreadsheet on the patients receiving the mesh and send the spreadsheet electronically to Dr Filipi. Photographs below show the process.

 

Guatemala, November 2012

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Led by Dr. Dwijen Misra and his head nurse Dawn Porrit, the HRFU team traveled in early November to the village of San Juan Sacatepeguez about 1-2 hours from the Guatemala City airport. The name of the facility was Salud de Barbara and it is run by Partners in Surgery. Dr. Manuel Torres, a Pediatric surgeon and Dr. Hinshaw a general surgeon along with Dr. Misra performed 52 hernia operations and removed several lumps and bumps. There were no surgical complications.

This was the first trip for this team and to this location.

Dr. Misra reported, “The team and excellent local staff adapted very quickly to a routine. The love I’ve come to feel for the Dominican patients during D.R. missions was replicated with the Guatemalan patients. I cannot imagine not coming back to help the brothers and sisters, aunts and uncles, and the children of those we were blessed to help. When we left San Juan Sacapeteguez, we said ‘hasta luego,’ not ‘adios.’”

baby er girl mother mtn team

Haiti, September 2012

Overview

Thirty six patients were operated upon and three Haitian general surgeons were trained to do Pediatric inguinal hernia repairs and the adult Lichtenstein repairs for inguinal hernias.

Team

Cynthia Ferris, MD; Rachel Dowd, RN; Theresa Alvarado, RN; Bob Cusick, MD; David Chen, MD; Lesly Manigat, MD

HRFU-Haiti2012 from Charles Filipi on Vimeo.

Summary

The team, in conjunction with Dr. Paul Severson of Promise for Haiti, did an outstanding job operating upon 36 patients and teaching 3 fully trained Haitian general surgeons to do Pediatric inguinal hernia repairs and the adult Lichtenstein repairs for inguinal hernias. Eight demonstration cases with the trainee as first assistant were followed by 28 cases performed by the trainee with the proctor assisting or supervising. There was a consensus that Dr. Jeudy and Dr. Devidson are satisfactorily trained and ready to perform the operations but studies should be completed and mesh needs to be provided for their future repairs. Dr. Jean Luis needs to be encouraged to do more hernia repairs in the Pignon hospital. It was agreed that the Lichtenstein repair is a good model for teaching.

Dr. Filipi, president of HRFU has spoken with SafeStitch Medical and Davol and both have promised free 3” x 6” flat pieces of packaged sterilized polypropylene mesh. SafeStitch has 35 pieces and Davol will give 200 pieces through Americares with a possibility of providing more in the future. These commitments come from high level officials in both companies.

Data was kept on the operations performed and scores were tabulated on a new surgical technique rating form.  This will be utilized for further analysis and publications.

Possible Studies

Dr. Cusick, Dr. Chen, Dr. Manigat and Dr. Jeudy are now in discussion about hernia studies. Eventual presentations are expected with the intent of publishing findings on prophylactic hernia repair antibiotics and the development of hernia centers of excellence. Hernia Repair for the Underserved will assist these projects. It appears to be the intent of all team members to return to Pignon to provide follow-up and training of other Haitian surgeons. The overall project appears to be a success if we can now facilitate the performance of the operations by the trained surgeons and keep records to document use of the training provided.

Site Attributes

  1. Pignon is the best place for a further course
  2. Port au Prince is still dangerous
  3. Sterilization is satisfactory
  4. The CRNA Maseline knows where everything is and is very helpful
  5. The road to Port au Prince when improved could change Pignon significantly