Source: Blog Post

Today was our final day at La Providencia.   Per routine, we began our morning rounding on patients who stayed overnight from yesterday’s operating schedule.  The young child who underwent a corrective forearm osteotomy had significant swelling, but there was no concern for compartment syndrome.  One of our team’s safety protocols is to perform prophylactic fasciotomies for patients undergoing major reconstructive forearm procedures and to bivalve all upper extremity casts until discharge.  These principles have served us well over last 3 years.  We have performed 69 operations over this period of time and have not had any significant complications.


The success of our pediatric hand surgery missions over the last two years has been greatly enhanced by occupational therapist Meagan Pehnke’s tireless work.  We identified several patients this year that were not candidates for surgery including patients with cerebral palsy, congenital hand differences, and arthrogryposis.  Throughout the week, these patients were scheduled for intensive occupational therapy sessions during which they were instructed in home exercise programs and received custom-made splints.  The majority of these patients had never received therapy services and were eager to learn what they could to improve their function.  As one example, we evaluated a 7-year-old girl with bilateral ulnohumeral synostoses (elbow fusion) that had significant difficulty in completing simple self-care tasks independently.  Meagan was able to make her adaptive tools with splint materials including an extended handle for a tooth brush and utensils as well as a long handled reacher for toilet hygiene.  Over the course of the week, Meagan worked with 27 patients and made nearly 40 custom splints.


Since this was our final day at La Providencia, the team spent several hours this morning organizing supplies and equipment in preparation for a lower extremity orthopaedic team (led by Kenneth Noonan from the University of Wisconsin) to return in January 2018.  Over the years, we have accumulated enough donated equipment to create four well-stocked hand trays that includes equipment favored by our two pediatric hand surgeons: sharp tenotomy scissors, an assortment of skin hooks and small retractors (e.g. Ragnells), and our beloved 0.5 mm Castro-Viejo forceps. 


However, it would be an understatement to say that the team still lacks some equipment and implants (e.g. a sufficient number of bipolar forceps, 12 & 14 mm length small fragment screws, medium saw blades).  There are other daily challenges: power outages in the middle of surgery, lack of high quality fluoroscopy, a limited quantity of antibiotics and outdated anesthesia machines.  In each and every operation, creativity is required by our nursing team and surgeons to successfully overcome unexpected challenges.  Hand surgeons Ericka Lawler, MD and Apurva Shah, MD MBA have found that the flexibility and creativity required to perform surgery at a high level in Honduras has helped develop their basic understanding of the pediatric upper limb, and improved their technical acumen.      


One of the fundamental goals of each mission trip is to nurture young, talented physicians to develop a commitment to service of the underprivileged.  This year, our team included two house officers: hand surgery fellow Nicholas Beck, MD and anesthesia resident Maria Gordan, MD.  Nick and Maria have shared some thoughts about their week in Siguatepeque, Honduras:


“I’m happy that I was given the opportunity to travel to Honduras with the team.  I was excited for my first mission trip as it’s a mix of two of my favorite things – travel and operating.  It’s been a phenomenal trip, far better than I expected.  It was eye-opening to see the struggles of patients receiving medical care in a developing country with delayed and neglected treatment.  Those delays presented us with challenging cases due to the progression of the patient’s natural history, which we don’t commonly see in the United States.  As a trainee, it’s been one of the best weeks I’ve had for surgical education.  My favorite part of the trip was interacting with extremely grateful families and our brave patients.”

--Nicholas Beck, MD


“Being in my final year of training I felt this is the perfect time to apply my skills and knowledge on a mission trip.  Our anesthesia team functioned as a well-oiled machine despite limited supplies and equipment.  One of the challenges we faced was pain control in a 14-year-old boy after complex elbow surgery.  We were able to perform an image-guided infraclavicular block using a cardiac ultrasound probe.  I am returning home knowing that even if small, my contribution made a difference in these kids’ lives.”

--Maria Gordan, MD


The team is happy to see the week end safely.  The mission has been a success.  We think that we have meaningfully changed the lives of dozens of children, and their families.  But there is always a sense of sadness when leaving Siguatepeque.  Part of this feeling comes from the realization that we have received far more than we have given. 


On a final note, the team would like to thank and recognize our team leader, and Queen Bee – Mary Dowling, RN.  For Mary, this pediatric hand surgery mission to Honduras is the 65th mission in her career.  Over last few decades, she has been to Nicaragua, Guatemala, Peru, El Salvador, and Guinea West Africa.  During a year in which many Americans have questioned our national identity and world leadership, our team does not have to look far to see an everyday superhero.    


“The best way to not feel hopeless is to get up and do something.  Don’t wait for good things to happen to you.  If you go out and make some good things happen, you will fill the world with hope, you will fill yourself with hope.”  --Barack Obama