An update from Dr. Enda Kelly in San Pedro Sula, Honduras
I joined the OIC pediatric orthopaedic fellowship programme in August of 2020. About 9 months prior to this I had traveled from my native country of Ireland to LA and interviewed for the position. At that time the faculty enquired if I would like to travel outside of the United States to partake in a mission trip. I enthusiastically agreed as I had never taken part in any such activity in my years of training to date. Roll forward to January 2021 while sitting in a clinic Dr Thompson asked if I wanted to come to Honduras that a trip was in the planning stages…
Our first day in Honduras was a hive of activity. We travelled directly from the airport to the hospital and started to unpack our supplies. The hive of activity was immense. We brought a proverbial mountain of donated PPE with us that needed to be unpacked and sorted. Then the medical supplies that would allow us to perform surgeries while simultaneously checking the surgical implants that were required to complete these surgeries. An inventory of medical supplies that would take days to perform in a traditional medical setting was completed in 8 hours. We were set.
Our first day was a general orthopaedic clinic of 27 patients, the spine clinic also saw about 25 patients giving a total of just over 50 patients reviewed . (Other parents who have heard we are in town drop in to Ruth Paz Foundation with their children for review and they are never turned away). The ‘can do’ attitude is front and foremost at every level of the Ruth Paz Hospital and World Pediatric Project volunteers.
The orthopaedic conditions that one might see once a year in a practice in the United States or Europe walked in in multiples. The complexity of cases being immense.
I had the great pleasure of being teamed up with the only full time paediatric orthopaedic surgeon here in San Pedro Sula. He is newly appointed and just starting out in his career as an attending surgeon- much like myself- as a result we resonated quickly. We saw multiple complex cases together, had great discussions about the management of these cases and ultimately set surgical plans that we would then carry out of the coming week. I believe that the education and skill sharing component of any mission trip is key to its success.
With clinic day completed we settle into the working week with a full slate of surgeries scheduled. The routine is now set for the coming days; Breakfast at 6:30am, drive to the hospital at 7:00am, ward rounds at 7:05am, preoperative planning for the coming days cases, picking the equipment and supplies required for the cases, checking that instruments are sterilised and that the ensuring that we adapt the schedule to ensure we have instruments going through the sterilisation department efficiently so that they are processed quickly for their next case. This is followed swiftly by the first preoperative “time out procedure” of the day.
As a fellow nearing the end of training I am getting comfortable with operating skills on a more complex caseload. It seems like every case here is on the complex end of the spectrum.
The operating room experience has been wonderful. There is a common goal to achieve much in a very limited time; this can do approach makes for a very pleasant working environment. I am now learning the names of surgical instruments in Spanish, which has been comical, however the local scrub nurses have decided to teach me each instrument as we go through each case. I fear the Irish scrub nurses will be confused when I return home and ask for various instruments in Spanish.
I’m working with Dr Thompson and Dr Ardon today. We have a couple of very difficult dislocated hip cases to perform.
But first I need to fashion a heel for a cast that would offload the forefoot of a child after her operation. We don’t have an ‘off the shelf’ offloading shoe and crutches are also in short supply. I go to the floor and make an offloading wedge out of fibreglass/tongue depressors so that the patient can fully weight bear.
Back to the operating room.
Dr Thompson performs the hip surgeries while giving step by step instruction to both Dr Ardon and myself. This is the type of teaching case that is difficult to attain in many settings as the volume is generally very low however, we have 7 such cases to complete this week- we have completed three to date.
We finish off the day with some lower limb deformity correction surgery and then realigning an elbow that had healed in a poor position after the patient fell and broke it 5 years previously. I asked Dr Ardon if he had many such cases to look after. He has 4 in his clinic and after today has now learned a new technique for treating this condition. This sharing of information and techniques with this brigade is strong.
The hours speed-by in the operating room and suddenly it is 8:30pm. A postoperative round is performed and any potential issues are taken care of prior to the team leaving Ruth Paz. We say hello and goodbye to our night shift nursing colleagues.
We get back to the hotel by 10:30pm. It’s time for a team dinner and a quick debrief on the day. It’s now 11pm, everyone is drained. Soon it is 6:30am again…