Notes from San Pedro Sula, Honduras
For over a 100 years, Luskin Orthopaedic Institute for Children, the pediatric orthopaedic provider at UCLA/Mattel Children’s Hospital, has been committed to serving children from around the world. Last week, we sent a team (Dr. Anthony Scaduto, Dr. Richard Bowen, Dr. Rachel Thompson, Fellow Dr. Enda Kelly, and NP Dana Connolly) to San Pedro Sula, Honduras, a city that has been ravaged by the pandemic and 2 hurricanes over the last year. We were the first pediatric orthopaedic surgeons to go into Honduras in the last 18 months. Please enjoy first-hand accounts directly from our team.
Our team, consisting of Tony Scaduto, Rick Bowen, Enda Kelly, Dana Connolly and me, arrived safely in San Pedro Sula, Honduras, on Saturday afternoon. We met the rest of the group, which includes anesthesiologists, nurses, neurophysiatrists and implant experts from across the United States, at the airport in a flurry of collecting bags of medical supplies and surgical instruments. In many ways, the start of this brigade felt like the other 5 missions that I have participated in with the World Pediatric Project – the joy in reconnecting with colleagues, the excitement about the workweek ahead and the fear that we will not be able to do “enough” in our short brigade were all the same. However, much had changed since our last trip to Honduras in February of 2020.
Since we last worked at the Ruth Paz Foundation (our home for the next week), Honduras had been hit not only by COVID-19, but also by Hurricanes Eta and Iota, all of which left an already-struggling nation battered. Moreover, the only pediatric orthopaedic surgeon in San Pedro Sula (and a dear friend and colleague), Dr. Gustavo Vasquez, had passed away, leaving many children without any pediatric orthopaedic care for months. Needless to say, this trip was even more daunting than previous trips, and we all felt a great sense of responsibility as we arrived at the Ruth Paz Foundation to organize for the week ahead. But despite how vast the challenge, we were confident that our partnership with the World Pediatric Project would allow our team to successfully treat the children of San Pedro Sula and train the new pediatric orthopaedic surgeon that recently moved to the region.
I have been traveling to San Pedro Sula with the World Pediatric Project for the past 6 years. WPP is a non-profit organization whose mission is to heal critically ill children and to build healthcare capacity throughout the world by sending medical and surgical teams to developing nations to evaluate and treat children and to train local providers in advanced medical and surgical techniques. I am proud to partner with the WPP and even prouder to help facilitate OIC’s relationship with the WPP, as our missions so closely align. I am grateful to be joined this year by two of my partners, our pediatric orthopaedic fellow and one of our nurse practitioners. I hope that we can continue to build our relationship with WPP to expand OIC’s global impact even further.
But for now, we operate. We evaluated over 50 children yesterday, many of whom traveled from around Honduras, in the hopes that we would be able to “cure” their deformities and alleviate their pain. Today, we will start operating on the 25 children that we selected for surgery on this trip. The upcoming days will be long and certainly trying, but I’m grateful for the ability to begin the rebuilding process in this hard-hit community.
The OIC team and our colleagues from the US and Honduras had a great second day in the OR. The staff at Ruth Paz Hospital are exceptionally hard working and grateful for our help. We had several long and intricate surgeries to do and finished late into the night. Despite the late hour, many of the the staff volunteered to stay as late as need be to help those children and their families. The resiliency of the staff and families of Honduras inspire us every day. Some of our patients came from as far as 8 hours away.
The team works amazingly well together- everyone pitching in to do what is required. It’s hard to believe there are 6 new team members of the 14 member team- seems like we have been together for far longer.
I’m grateful the OIC mission places a priority on helping children from around the world and this “Brigade” is a perfect example of that commitment. We couldn’t be here without the support of our donors back home. With every examination, every surgery, every smile from a weary staffer or relieved mother, you are here too!
Dana Connolly, Nurse Practitioner
As I write this blog, I am working an overnight shift at Ruth Paz Hospital in San Pedro Sula, Honduras, taking care of patients as they recover from spine and orthopaedic surgery. My work “day” started around 7pm when I arrived at the hospital and met the patients who are on the ward after surgery that day. Overnight, we closely monitor their clinical status and help manage their pain postoperatively.
Tonight, we have several new patients who underwent surgery the previous day. Fortunately, our night has been going smoothly. Our patients are doing very well postoperatively, only requiring occasional pain medications and routine fluids and antibiotics.
One of my favorite patients tonight is a sweet 19 month old girl who underwent surgery to put a dislocated hip back into the socket. She was born with her hip out of place and walked with a limp due to the dislocation. The surgery will help her walk better, as well prevent pain and early arthritis. It’s normal for any child to be scared after surgery, but she is doing great and should be able to go home tomorrow. I hope that I get to follow up with her on a future trip and see how well she is walking and running!
As a nurse practitioner, I have training and experience as both a direct care nurse taking care of patients in the hospital as well as experience being a provider who can diagnose and treat different pediatric orthopaedic conditions with collaboration from a physician. Having both skill sets has been helpful, since providing surgical care in a resource-limited setting requires flexibility and the ability to shift roles when needed. Many of the key components of caring for patients are the same regardless of the location of surgery- ensuring patient safety, mobility, adequate pain management, monitoring for complications. However, the details can become very different when working in a different country. For example, not all of our typical post operative medications are available here, so we have to find alternate options. Families travel from long distances and it can be unsafe to travel at night, so patients will stay in the hospital the night before to ensure they don’t have to deal with a long trip immediately before surgery.
Throughout my career as a nurse practitioner, I’ve been on several medical mission trips, but this trip with OIC stands out among them. This was my first time joining OIC’s work with the World Pediatric Project Honduras Brigade. I was so excited to be able to join and be a part of this amazing team of surgeons, anesthesiologists, nurses and staff who have been coming to take care of pediatric orthopaedic patients needing specialized surgery at Ruth Paz Hospital for the past several years. So far, I’ve been amazed at what this team can accomplish in a short week and I’ve loved being a part of the team!
DR. Enda Kelly
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…