Source: Blog Post

Today was our final day of operating here at La Providencia.  We began our morning by rounding on patients who stayed overnight from yesterday’s operating schedule.  One of our patients from yesterday was a 5 year-old male boy who underwent reconstruction of a Flatt-Wassel type III thumb duplication.  He was all smiles this morning in recovery.  His pain was well-controlled and he was ready to travel home.  He will follow-up in the clinic with assistance from local orthopaedic surgeon Dr. Silvio Gonzalez.


Today’s cases included: bilateral wrist extensor tenosynovectomy in a 4-year-old girl with uncontrolled juvenile rheumatoid arthritis, ring metacarpal lengthening with iliac crest autograft for symptomatic brachymetacarpia, curettage and bone grafting for a distal radius giant cell tumor, excision of a ganglion cyst, treatment of a neglected elbow fracture-distraction with a entrapped medial epicondyle fragment, and corrective osteotomy of a malunited both bone forearm fracture.


The 8-year-old boy with a malunited right forearm fracture is a “frequent flyer” at La Providence.  Two years ago, our team performed a corrective osteotomy on a malunited forearm fracture on his left side.  This case was particularly challenging as there was a rotational component and the osteotomy was performed without fluoroscopy.  Last year, he underwent hardware removal on the left side.  This year he returned with normal forearm rotation of the left side, but with a malunion on the right side.  Despite the need for a repeat procedure, this energetic 8-year-old enthusiastically signed up for surgery and let us know his preferred cast color.  His favorite color is blue!  Fortunately, our resources at La Providencia have improved.  With intraoperative imaging, the osteotomy was performed expediently.  Prophylactic forearm fasciotomies were performed to minimize risk of compartment syndrome. 


For surgeons operating in a foreign country, our challenges center around equipment issues and care of patients with poor access to treatment.  For our anesthesia providers, the issues are more complicated.   Returning to the anesthesia team this year are Melinda Seering, MD and Laura Covalli, CRNA and newcomer, Maria Gordan, MD, 4th year resident from the University of Iowa Hospitals and Clinics.


Some thoughts and reflections from our anesthesia team:


“Every day in Honduras was a fun day of caring for these wonderful patients.  We had some machine issues initially with the scavenging system that we were able to successfully fix.  Each year we perform larger operations and we are always grateful that we can care for these patients in a way that makes it look easy.  This year we provided care to older patients than in years past.  This provided a new set of concerns.  Health concerns were larger in some patients, we started IV’s before surgery in some and had to worry about pregnancy tests.  This year we were able to do a regional blocks and a bier block.  It is always stressful to think about how to do common procedures in developing country.  The bier block was utilized as the primary anesthesia for the operation.  We would also like to thank 3M for their donation of the Bair Huggers.  We were able to keep our patients nice and warm in the ORs this year with the air conditioners running.  We would also like to thank the wonderful interpreters: Julie, Dr. Iveth and Sofia for their help with “happy” mask inductions and pre-op IV starts.” 


The team is happy to see the week end safely.  The mission has been a great success.  We are proud of our group’s culture and ability to function like a team that has been together for years although some of us just met at the beginning of the week.


“A kind gesture can reach a wound that only compassion can heal” Steven Maraboli, author