Hernia Repair for the Underserved worked with Dr..Juan Carlos Alvarenga Ibanez and the Paraguayan Ministry of Health on a hernia repair mission in August 2014 with the dual purpose of providing care to the underserved and fostering sustainability through training and collaboration with local Paraguayan surgeons. This was our second trip to the Luque District hospital near Asuncion Archidona. While there is modest poverty in this location, these patients have limited access to care due to socioeconomic, cultural, and geographic factors.
Our surgical team included Dr. Campanelli and Dr. Marta Capalli from Milan Italy, Dr. Jim and Pat Manion from Creighton University, Dr. Cynthia Ferris and Tonya Daniels from Childrens’ hospital in Omaha, Dr. Rob Weinsheimer a Pediatric surgeon from Seattle and nurses and surgical technicians from Southern California (Debbie Edibiri, Sandy Highberg, her husband Greg and Carlos Zevallos) and Michigan (Dawn Porrit and Deb Bordine) – a truly diverse and outstanding group. Dr. Ibanez arranged in-country logistic support, identified potential patients with the help of Dr. Victor Lurashi and partnered with local surgeons and the government to facilitate training.
The team was on site for 6 days with 5 operating days. Fifty two hernia operations were performed by HRFU personnel and 3 Paraguayan surgeons were trained. In addition, Dr. Campanelli gave a lecture on hernia repair that was attended by 150 surgeons and nurses. There have been no patient complications reported after 4 week follow-up. We were unable to perform Pediatric hernia operations because the Paraguayan Pediatric Hernia Society objected to HRFU personnel training general surgeons to perform a pediatric operation.
After the trip most of the team journeyed to Iguazu Falls, one of the true wonders of the world. Below they are pictured with the Falls in the background. What a great picture!
The Lichtenstein mesh hernia repair was taught using the HRFU protocol to 3 surgeons by Dr. Campanelli. A standard rating form was utilized and all surgeons passed and were given 20 pieces of donated mesh for operations on poor patients. Later the surgeons will be videotaped using a GoPro camera and HRFU will send the videos to experts to review and determine if the training has been effective.
Providing mesh to our affiliated surgeons is helpful and allows them to continue operating and teaching with optimal materials. All 3 surgeons practice in systems that care for the poor and after further review of their operative abilities may be encouraged to teach others. Thus the impact of the trip increases exponentially. The C. R. Bard Foundation provided donated mesh and we thank them for their important contribution.
We greatly appreciate the team’s willingness to give back and provide the highest quality of care. This was an outstanding team with high quality people. And thank you to Dr. Ibanez who facilitated all governmental, customs, and local logistics. and the staff at Luque District hospital including Dr. Luraschi who generously extended their hospitality to our team.
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
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