Honduras: Day 4

Source: Blog Post

We arrived back at the clinic at 8:15 am.  Per routine, the hand surgeons, physician assistant, nurses and occupational therapist made morning rounds.  The patients and families were deeply appreciative for the care our team has provided.  Exchanging hugs and taking photographs together is the norm for our patients and the medical team.  When reflecting on her experience making morning rounds, occupational therapist Meagan Pehnke noted, “all of these patients said “bien” when asked how they felt this morning after the difficult operations they underwent yesterday.  The spirit and gratitude of these patients and families fills my heart.”

“Hump Day” turned out to be another challenging day at La Providencia as we operated past 8 pm.  The team has pushed hard this week to deliver on the promise we have made to 33 children and their families.  There were a total of 8 cases on the operative schedule including a 9-year-old girl with a chronic Bado III Monteggia lesion (ulnar malunion with lateral radial head dislocation).  This injury occurred 4 years ago from a fall on the playground.  Ericka Lawler, MD and fellow Lucas Seiler, MD made an extensile lateral approach to the elbow.  After identifying and protecting the radial nerve, a lateral elbow arthrotomy was made.  A remnant of the annular ligament was identified and preserved.  A transverse osteotomy of the ulna was made.  The ulna was plated in apex medial alignment and the annular ligament was reconstructed using both its remnant and strip of triceps fascia.  Together, these maneuvers permitted anatomic reduction of the radiocapitellar joint – an excellent outcome given the chronicity of the injury and inherent challenges of operating with major equipment limitations. 

One of today’s other patients was a beautiful 2-year-old boy with Poland syndrome.  He has a mild chest wall deformity, absence of the sternal head of the pectoralis major and symbrachydactyly of the left hand.  He was a candidate for surgery one year ago but we deferred his reconstruction due to time constraints during last year’s mission.  Today, Apurva Shah, MD and Anju Thomas, PA-C performed syndactyly reconstruction of the 2nd and 4th webspaces utilizing a dorsal commissure flap and full-thickness skin grafting from the antecubital fossa.  We will complete his hand reconstruction next year by deepening the 1st and 3rd webspaces.

Other cases today included reconstruction of bilateral hand postaxial polydactyly, an acute lengthening osteotomy of the ring metacarpal for brachymetacarpia, reconstruction of a Flatt-Wassel type VII thumb duplication, excision of an elbow mass, a dorsal wrist soft tissue contracture release and full-thickness skin grafting for a burn injury, and a closing wedge osteotomy of the distal humerus with ulnar nerve transposition for cubitus valgus deformity with a tardy ulnar nerve palsy.  Not exactly the typical OR day for two hand surgeons in the United States!

The Sharing Resources Worldwide mission team always brings a senior orthopaedic surgery resident or a hand surgery fellow to Honduras.  The team is committed to inculcating the philosophy of charity and service to the next generation of hand surgeons.  University of Iowa Hand Surgery Fellow Lucas Seiler took some time out of his busy week (bouncing between two ORs) to share some thoughts on his experience in Siguatepeque:

“One has certain reservations when travelling to a foreign, developing country on a mission trip.  Will we be safe?  What is the lodging / clinic situation like?  Will we make a difference?  Shortly after our arrival all of these questions were answered, and this week has been truly incredible.  My time in Siguatepeque has presented a unique and wonderful opportunity to continue my medical training and advance my surgical skills.  More importantly though it’s given me a chance to give back to those truly in need.  Medical training is a lengthy and inherently selfish process, which my wife well knows.  I’ve spent countless hours away from her and the rest of my family.  The mental, emotional and physical demands of training can be grueling and it is easy to lose focus on why I started down this path in the first place.  Many of our patients this week have travelled from different corners of Honduras to receive care that they could not otherwise afford, or may not even be offered within the country.  Being here this week, being part of this team, and helping these fantastic children has helped renew my focus and provide prospective.  It required years upon years of instruction and direction on behalf of my teachers, counselors, and mentors to make me a surgeon.  Operating at La Providencia has helped to feel as though the time they’ve invested in me and the skills they’ve imparted are truly serving their intended purpose.” – Lucas Seiler, MD (Hand Surgery Fellow, University of Iowa)

The team departed at 9:30 pm from La Providencia.  We are once again very tired, but happy with an excellent day’s work.  We look forward to our final day of operating tomorrow.

“I slept and dreamt that life was joy.  I awoke and saw that life was service.  I acted and behold, service was joy.” – Rabindranath Tagore