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, October 2013
/in Ecuador, Missions /by herniahelpadminArchidona, Ecuador
Background
Hernia Repair for the Underserved collaborated with Timmy Global Health on a hernia repair mission in October 2013 with the dual focus on providing care to the underserved and fostering sustainability through training and collaboration with local Ecuadorian surgeon partners. This was our second trip to this site in Archidona, a city of 4000 within Napo Province.
Access to quality healthcare in the Amazon Basin is extremely low. The public hospital in Tena, operated and funded by the Ecuadorian government, is consistently understaffed and over capacity. The Timmy Foundation has developed an organized, well-run network providing primary care services to the indigenous, Quichua patient population. Hospital based services are delivered at the private, non-profit Stadler Richter Hospital which provides high quality care and outreach to the poor. While there is modest poverty in this location, these patients have limited access to care due to socioeconomic, cultural, and geographic factors.
Participants
Our surgical team was a collaboration between UCLA, Denver Children’s Hospital, and the Timmy Foundation and consisted of three surgeons, three anesthesiologists, one internist and six nurses. Our local partners from the Timmy Foundation arranged in-country logistic support, identified potential patients, partnered with local surgeons and government, and facilitated training.
Trip Details
The team was on site for 6 days with 5 operating days. Over 80 patients were screened and evaluated. 55 operations were performed in Archidona and Dr. Partrick assisted on a complex pediatric case at Tena Hospital. Patients were between 1 and 78 years old and 11 pediatric cases were performed. 30 umbilical, 24 inguinal, 3 recurrent, 2 femoral, and 1 ventral hernias were repaired. There have been no complications reported after 2 months of follow-up with our local surgeon.
Training
Training in Lichtenstein technique and mesh based repairs in Ecuador is different from that in many of our other HRFU sites. The Ecuadorian surgeons are highly skilled, well-trained in tension free technique, and do have access to mesh. Limitations come from diminished availability and quality of mesh and the lack of capacity to care for the burden of disease in the public system. Our training with Dr. Patricio Moretta Suarez and Dr. Jose Llumuca focused on optimizing technique for challenging cases, performing surgery utilizing only local anesthesia, recurrences, and remediation of pain. Dr. Moretta from Quito and Dr. Llumuca from Tena participated in our training collaboration with 17 cases performed together over 2 days.
Fortuitously, the higher complexity of cases selected for our training was better tailored for this circumstance. Our Ecuadorian surgeons felt that it was not feasible to operate under local and were clearly convinced otherwise, doing both scrotal hernias and extraperitoneal ventral repairs under local. Three recurrent hernias all had prior mesh based repairs indicating the utilization of tension free techniques in country. Two large femoral hernia repairs were performed demonstrating modifications to standard Lichtenstein technique to address this anatomy. Two triple neurectomies were performed for coexistent inguinodynia. For both trained surgeons, it was more appropriate for them and helpful to deal with these advanced scenarios.
Providing mesh to our affiliated surgeons would be helpful and allow them to continue operating and teaching with optimal materials. Both surgeons practice in systems to care for the poor and have the ability and desire to train others. The Timmy Foundation’s local coordinators can help to ensure that our mutual goals are met by providing local contact and support to our affiliated surgeons. Both Ecuadorian surgeons “greatly enjoyed the collaboration between the teams and very much look forward to the opportunity to work with Hernia Repair for the Underserved in the future.”
Support and Acknowledgments
The local government of Napo Province and its local public health affiliate Patronato generously extended its hospitality to our team facilitating all governmental, customs, and local logistics. The Timmy Foundation is an incredibly valuable partner with similar goals and vision and was instrumental in ensuring the success of this mission. Covidien Hernia Solutions generously donated all mesh for this trip allowing us to train and operate with some of the highest quality products available. Americares generously provided material and logistic support donating over 1000 pounds of equipment, supplies, and medications making our operations possible. Hernia Repair for the Underserved is immensely grateful to the donors that support our mission to provide the highest quality care to the poor and train others to continue this work. The kindness and concern of all of those that support us made this trip and our other HRFU missions possible. They are without a doubt good for all involved.
Paraguay, September 2013
/in Missions, Paraguay /by herniahelpadminHernia 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
Guatemala, November 2012
/in Guatemala, Missions /by herniahelpadminLed 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.’”
Dominican Republic, November 2012
/in Dominican Republic, Missions /by herniahelpadminThe 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.
Ecuador, November 2012
/in Ecuador, Missions /by herniahelpadminOn 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!!
Haiti, September 2012
/in Haiti, Missions /by herniahelpadminOverview
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
Santiago Dominican Republic ILAC Trip, November 2010
/in Dominican Republic, Missions /by Corey Lawson