In the News
Antigua, GuatemalaSeptember 10th, 2013
Mahatma Gandhi once said, “The best way to find yourself is to lose yourself in the service of others.” I have found this to be indisputably true. I was raised as one of twelve children, by parents that lead by an example of lifelong service. As a result, I am fortunate to be surrounded by family, friends, and many UCLA colleagues that consistently pursue opportunities to help those less fortunate. This influence led me to seek out medical work in developing countries early on in my career, training during clinical rotations in Mexico and later volunteering in Peru as a registered nurse. After speaking with my father and other surgeons that take part in medical mission work, it became clear that often the number of surgeries that can be performed is directly related to the number of anesthesia providers that accompany the group. This became my motivation to pursue a career in anesthesia. Once completing training as a nurse anesthetist I began to research medical mission teams in need of anesthesia providers.
Faith in Practice is a Christian organization that sends over 1,100 medical professionals and support staff each year to provide healthcare services to over 22,300 people of Guatemala. The surgical services provided include ENT, general surgery, gynecology, orthopedics, plastic, and urology procedures. In addition to providing necessary surgery, they also implement healthcare programs to benefit Guatemalans on an ongoing basis. These include cervical cancer screening, training of local healthcare personnel, and restorative and preventative dental services. Perhaps one of biggest impacts of this organization is that it seeks not only to solve an immediate need, but also to leave behind structure and training that lasts long after volunteers have returned home.
I joined a team of 43 volunteers from Oregon, Washington, and California in need of anesthesia personnel and we embarked for Antigua, Guatemala in May 2013 for a weeklong medical mission. After a day of orientation to the city and the hospital facilities, the anesthesia team set up the four operating rooms; two designated for pediatric ENT procedures, one for general surgery, and the fourth for gynecological procedures. Las Obras Hospital was well equipped in terms of equipment and supplies. The hospital is run almost entirely by volunteers throughout the year, many of the teams bring the supplies they require and leave whatever is not used. The result is a random yet comprehensive assortment of endotracheal tubes, laryngeal mask airways, oral airways, etc. In addition, each OR had modern anesthesia machines (Draeger Narkomed), end-tidal CO2 monitoring devices, and standard cardiac monitors.
Our anesthesia team was comprised of three anesthesiologists and two CRNA’s, allowing us to staff the four OR’s and have one rotating float provider each day. We spent Sunday performing preoperative anesthesia evaluations for all patients scheduled for surgery that week. This was an interesting experience because many of the patients had never seen a doctor in their lives. Some needed internal medicine consults, and others had echocardiogram and EKG results written and interpreted only in Spanish. Monday through Thursday we worked 10 to 13-hour days in the OR. Since we had already seen the patients, turnover time was usually 10-15 minutes, including transport to the PACU, giving report to the nurse, then quickly verifying NPO status and any last-minute questions with the next patient before beginning again.
Our team performed a total of 72 anesthetics: 22 pediatric cleft lip and palate repairs, 27 general surgery cases that included hernia repairs, laparoscopic cholecystectomies, and a laparotomy for tumor removal. There were also 23 gynecological cases, including abdominal and vaginal hysterectomies and vaginal sling placements. Fortunately, we had sufficient quantities of inhaled anesthetics as well as succinylcholine, rocuronium, antibiotics, ephedrine, phenylephrine, anti-emetics, and reversal agents.
In general, the co-morbidities that were most prevalent in the Guatemalan patients were diabetes, hypertension, and obesity. We found that although few of the patients smoked tobacco, the lungs of both the pediatric and adult patients were very prone to bronchospasm and/or wheezing in the PACU. After speaking with local physicians, we were educated that this was due to cooking over wood-burning stoves in homes that were not well ventilated. The need for nebulized albuterol treatments in the PACU was occurring so frequently that we began to prophylactically administer albuterol via the ETT prior to extubation. This noticeably decreased the need for nebulizer treatments and oxygen in the recovery room for the remainder of the week.
In speaking with my anesthesia colleagues that have also taken part in medical missions, it seems that the conditions under which I performed anesthesia are not the norm. I was fortunate to have newer anesthesia machines, working monitors, etCO2, and adequate supplies of medications and equipment. The main challenges were the need to be adaptable, since each operating room was equipped differently, and the need to be creative when performing preoperative assessments or constructing equipment. In assessing activity tolerance, we would ask, “How many terraces do you climb to carry your laundry outside to hang?” We also constructed a device compatible with the breathing circuits in order to administer albuterol, a circuit with which to provide positive-pressure ventilation to patients in the recovery room, and a custom-made “LTA kit”. Both the greatest challenges and learning came from practicing flexibility, adaptability, and ingenuity when necessary.
Gordon B. Hinckley said, “One of the great ironies in life is this: “He or she who serves almost always benefits more than he or she who is served.” I am sure that we made a difference in the lives of the patients we cared for during this trip, just as I am equally sure that this experience and the people of Guatemala have changed me. For those who would like further information on volunteering with Faith in Practice, more information can be found on www.faithinpractice.org or feel free to contact me with any questions.
For additional international opportunities to volunteer, please contact Drs. Sopher, Keyes, Brill, Patel, and Scwarzenberger.
Rose Wechter, CRNA
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