Honduras: Day 3

Source: Blog Post

After a long, difficult day of surgery yesterday, we hit our hotel tienda for some ice cream and sat outside in the courtyard sharing stories and laughter.  The team awoke with warm smiles, propelled by the excitement of the upcoming day.  After a quick breakfast, the team was well-caffeinated and ready for a second day of surgery at La Providencia. 

On this year’s mission team, we have 11 returning volunteers and 5 newbies.  Given the long working days, heat, humidity, expense, and time away from family, we asked some our returning team members about what keeps them coming back to Siguatepeque, Honduras.   Meagan Pehnke OT, Kelly Beard ORT, and Elisabeth Alonso-Hohman RN shared their thoughts.

“The gratitude and appreciation of these children and families is like nothing else I have experienced.  The smiles on their faces before and (always) following surgery is contagious and fills my heart.  These mission trips give me the opportunity to think creatively in ways that are significantly different from my work at home.  I also thoroughly enjoy the opportunity to learn about roles and support the entire operative team, especially as I rarely have the opportunity to interact with most of these colleagues during my typical work day.  Burnout is something we all experience in our various fields within healthcare.  Participating in this mission work has personally been one of the best means to prevent this and always acutely reminds me of why I love my career.” Meagan Pehnke, OT

Kelly Beard, ORT surgical tech from Iowa shares, “What keeps me coming back?  At home, even though we are helping people, it feels like a normal job -working for a paycheck to pay the bills.  In Honduras, we choose to come and work hard.  In some cases surgery is life-changing for the kids.  It is unbelievable to me that every time we arrive at the clinic on the first day of screening we see so many hopeful faces.  So many things we take for granted at home – it is hard to imagine not being able to get the healthcare you need and hearing the stories of people traveling for many hours to be here is humbling.  This is why I enjoy giving some time and sharing a wonderful experience.”

 “Everyone wears a hat – Walk into any operating room and you’ll see that everyone is dressed similarly.  There are scrubs, a face mask, and a hat.  Some people wear a disposable hat, others choose a personal cloth hat that can add some flair and personality to their otherwise bland attire.  We all wear different hats, and we hope they provide a look into our personality.  I was drawn to return to Honduras for a second year because of the many hats worn by all of the team members, both literally and figuratively.  One person may spend most of the day wearing the hat of an anesthesiologist but also transform into the circulating nurse, environmental services, or central processing.  There are hats of generosity, perseverance, and altruism.  It was the willingness of each team member to be flexible and humble that has impressed me the most.  Everyone has the same goal: to provide the highest quality care to the patients whose families have made sacrifices to help their children.  During last year’s mission trip I wore many hats for the first time and the challenges and reward that came along with those new roles are what encouraged me to return.”  – Elisabeth Alonso-Hohman, RN

“I love how our team members come from two different locations (The Children's Hospital of Philadelphia and the University of Iowa) and work as a cohesive team.  I enjoy getting to know the volunteers from other health care centers.  The biggest reason I return is knowing the impact we are making on the lives of the children we serve.  It is an honor for parents to trust us with their child’s care.” – Deb Fuhr, RN

Nine operations were scheduled for today.  The procedures included a 4-year-old girl with a brachial plexus birth injury who underwent pectoralis and subscapularis lengthening with latissimus dorsi and teres major transfer, excision of a periscapular mass, open reduction of a lateral condyle nonunion with ulnar nerve transposition, radial head excision for a post-traumatic elbow contracture, soft tissue releases and skin grafting in a family of three – who have returned from last year to continue the correction of their hand contractures, excision of bilateral post-axial polydactyly and correction of a Flatt-Wassel type II split thumb deformity. 

One especially challenging case of the day was a 10-year-old girl with a lateral condyle nonunion.  Her injury had occurred four years ago and she presented with symptoms of severe pain and ulnar neuropathy.  Her exam noted a cubitus varus deformity due effective insufficiency of the lateral collateral ligament.  Apurva Shah, MD and Iowa hand surgery fellow Lucas Seiler performed an ulnar nerve transposition, surgical fixation of the lateral condyle and repair of the collateral ligament with bone tunnels and a suture anchor.  As the fracture was four years old, the bony surfaces proved a challenge to prepare and achieve appropriate alignment. 

Hand surgeons Ericka Lawler and Apurva Shah took time out at the end of the day to reflect on the challenge of operating on children with neglected fractures and dislocations.  These operations are often extremely difficult, and require a high level of preparation in order to execute well.  As both physicians have been in practice for a number of years, these cases bring a renewed sense of excitement as they serve as a reminder of our days as trainees when the most routine cases required daily preparation.  This is a concept we should emphasize to our residents and fellows.  No matter what your years of experience, the demands of being a surgeon require that you continue to educate yourself and take time to prepare.  The responsibility of taking care of patients should never be taken lightly.  

One additional challenge we face in this developing country is unreliable electrical power.  Numerous power outages have occurred throughout our time here.  Although a generator typically provides backup power, this source is not completely reliable.  The use of headlights and flashlights allows us to continue to provide care for patients.  Being flexible and creative in unpredictable situations is an important part of mission work.

At the end of the day we round as a team to assess the comfort level of our patients and discuss post-operative plans.  Many of our patients stay overnight for observation and pain control.  A parent is required to stay by their bedside.  A nurse from La Providencia stays overnight at the clinic to administer medication.  She will call us with any concerns. 

We headed home at 8:45pm satisfied with a good day’s work.  We had some time to relax as a group and share some memories.  We are excited for another busy day tomorrow.

“The meaning of life is to find your gift.  The purpose of life is to give it away.” –Pablo Picasso