Educational Outreach Program
Thao Hoang, CRNA, Provides Anesthesia on International Medical Missions
As a nurse anesthetist, one of my professional goals has been to provide anesthesia for volunteer medical missions to foreign countries. I have been especially interested in medical mission work aiding children. I find it extra rewarding and fulfilling to take care of pediatric patients. I have participated in two medical missions thus far. These were very challenging and rewarding experiences.
In November 2009, I served on a medical mission to Punta Gorda, Belize with a non-profit organization called Healing the Children Northeast. Healing the Children provides donated medical, surgical and dental services for children in the United States and abroad since its founding in 1985. The purpose is to help children throughout the world receive medical care unavailable to them due to a lack of medical and financial resources or health insurance. To date, more than 33,000 patients have been helped through Healing the Children’s efforts.
Our medical mission took place in Punta Gorda, Belize which is the capital of the Toledo District. This city is located in southern Belize and has a population of 6,000 people. This was the first time Healing the Children attempted a medical mission to this remote city. The main focus was to provide cleft lip/palate and other plastic reconstructive surgeries to the under-served children in the region. Our team consisted of nineteen volunteers, including four surgeons, one pediatrician, one anesthesiologist, two nurse anesthetists, along with a staff of nurses and scrub technicians. Punta Gorda Hospital is a local general hospital housing 115 patient beds that serves the district with general medicine, pediatric, and maternity care. We converted their small operating room into a two bed operating room. We also established a post anesthesia care unit and a screening clinic where the patients were screened by a pediatrician, surgeon and an anesthesia provider.
The hospital, due to lack of funding, was unable to assist beyond providing space and some oxygen cylinders. We brought our own anesthesia supplies including anesthesia machines, airway equipment, monitors and medications. For two days I provided anesthesia for a wide variety of plastic surgery cases including cleft lip and palate surgeries as well as scar revision procedures on patients between the ages of twenty two months to seven years old. These patients were relatively healthy and very well prescreened by our team.
Each patient was escorted into the operating room, placed on monitors and mask induced with sevoflurane and oxygen. After a peripheral IV was established, intubation was performed without the use of muscle relaxants and spontaneous ventilations were resumed. Morphine was administered for pain judiciously. At the end of surgery, the patient was extubated and transported to the recovery room. Most of the patients stayed overnight for nursing care and went home the following day, while a few were discharged the same day.
All of the children were special, but one in particular will always remain in my memory because of the way we were introduced to her. The team had heard, through the local villagers, that there was a twenty two month old girl who lived very far away who was born with a cleft lip and palate. The family was so poor that they were unable to travel to our clinic. Upon news of this, the surgeon, program director and I drove to this village. We found the child’s home, met her parents, consented and screened her. Then we brought them back to a hotel near the hospital where we performed her surgery the very next day. Her surgery went well and the family was very grateful.
This trip was very rewarding and a great educational experience for me. It was my first medical mission to a foreign country. There were many technical challenges such as working in unfamiliar surroundings and having limited resources. I really enjoyed working with a dedicated medical team, meeting and taking care of the children of Belize and being a part of a great humanitarian effort.
My second medical mission brought me to Mexicali, Mexico in April 2011. This trip was sponsored by the organization, Interface. Interface was established in 1977 and serves the children of Mexico with cleft lip and palate surgeries and other plastic reconstruction surgeries. Interface serves five different sites in Mexico,- one to two times per year. They spend two to five days each trip performing between 10-75 surgeries. The healthcare team consists of a volunteer group of plastic surgeons, anesthesia providers, nurses, pediatricians, psychosocial workers, and many volunteers. This particular team that I worked with in Mexicali consisted of twenty volunteers, including four surgeons, one anesthesiologist, four nurse anesthetists, one pediatrician, and many nurses, scrub technicians, and volunteers. On our first day, we stationed ourselves at the Red Cross clinic converting two patient clinic rooms into operating rooms. We also established a designated post-anesthesia care unit and a pre-screening room. All patients were screened by a pediatrician, surgeon and an anesthesia provider. The clinic only supplied us with space and oxygen cylinders. This mission did not have an anesthesia machine but only Bain circuits. We brought our own anesthesia airway equipment, supplies and medications. We also made sure the environment had the necessary safety measures needed in an operating room.
Over the next two days, we worked 14 hour days and performed 40 successful surgeries. I administered anesthesia to ten patients ranging in age from 12 months to 16 years for cleft lip and palate surgeries. The children were very well screened and relatively healthy. Again, I worked with an incredibly dedicated and experienced team. The local Mexican people showed their gratitude by preparing lunch and bringing it to the clinic each day. After each day of giving care, we would clean up, reorganize, and debrief.
Once again it was very challenging to provide anesthesia in an unfamiliar surrounding with limited resources. I learned to administer anesthesia through a Bain circuit, and honed my clinical skills in managing pediatric airway cases. I administered anesthesia safely in its most basic form with a Bain circuit, oxygen, and anesthesia gases without an anesthesia machine. I also learned that administering the drug clonidine slowly intraoperatively, with caution to avoid bradycardia and hypotension, yet provide great analgesia and sedation in these patients. An intravenous dose of clonidine at 0.2mcg/kg given in the operating room as well as in recovery provided very satisfactory sedation and pain control.
Overall, the missions to Belize and Mexicali were a success to help children who were otherwise unable to receive care, and I am proud to have worked with both of these missions. I found both medical foundations to be very well organized and dedicated, and their efforts to assist the under-served children were achieved and appreciated by the patients and their families. I have experienced tremendous personal and professional growth by taking part of this humanitarian work. Both medical missions were very rewarding for me and I definitely encourage those that are interested in mission work to volunteer with these groups. For more information, please contact me directly or visit their websites ( www.htcne.org and www.interfacekids.org).
Thao Hoang, CRNA, MS, Senior Nurse Anesthetist