La Paz, Bolivia 2010

Dadelin

Dadelin
Originally uploaded by interplast

Dr. Joyce Chen, Interplast Webster Fellow.

Prior to our arrival in La Paz, our team was aware of Dadelin, an angelic one-month-old baby girl who had congenital amniotic bands in her left leg that were causing intermittent compromise of blood flow to her foot. These constriction bands are formed in utero and have the potential to act like tourniquets, cutting off the blood supply to the arm or leg.

After Dr. Terrazas had initially evaluated her in one of the more remote areas in Bolivia and had recommended that surgery be postponed until she was older, her pediatrician called to tell him that the blood flow to her foot was getting worse. Routinely, our team does not operate on patients less than three months old, but we knew that we would likely need to make an exception to save her foot. We were fortunate to have several pediatric trained anesthesiologists on our team that were comfortable and competent administering anesthesia to neonates and infants. We operated and partially released the amniotic constriction bands and restored blood flow to her foot. Dadelin’s recovery was uneventful and after surgery, just like any other baby her age, she spent most of her day peacefully sleeping. Her tiny toes remained pink and warm.

Crossing Lake Titicaca

Crossing Lake Titicaca
Originally uploaded by interplast

Dr. Joyce Chen, Interplast Webster Fellow.

On the border of both Bolivia and Peru, Lake Titicaca is the highest lake in the world at 12,500 feet and the largest lake in South America. Without any bridges to allow cars and other vehicles passage across this sizable lake, local ferry operators are kept busy transporting vehicles and passengers alike. The ferry boats are not huge and can only accommodate a couple of cars and at times just one gigantic bus. With the winds’ permission, multiple ferries can transport vehicles simultaneously, providing safe passage for all aboard. What a sight it was to see the brightly colored buses and trucks bobbing up and down against the breathtaking backdrop of Lake Titicaca!

Boats Anyone?

Boats Anyone?
Originally uploaded by interplast

Dr. Joyce Chen, Interplast Webster Fellow.

After a week of hard work operating and taking care of patients in La Paz, part of the team visited Copacabana, a quaint town on the shores of Lake Titicaca. Among the street vendors and markets, we discovered a delightful, elderly Bolivian woman crafting and selling reed boats of various sizes and character. She graciously allowed us to observe her deft hands at work, carefully and intricately designing the charming miniature boats that could actually float.

Sharing a Smile!

Sharing a Smile!
Originally uploaded by interplast

Dr. Joyce Chen, Interplast Webster Fellow.

In this picture two of our PACU nurses, Colleen and Kim, pose with two of the ward nurses of the Miraflores Central Military Hospital, where our patients recovered post-operatively. The joint efforts of our teams through open communication and great rapport led to excellent care and recovery of all the patients.

Are We Done Yet?

Are We Done Yet?
Originally uploaded by interplast

Dr. Joyce Chen, Interplast Webster Fellow.

In pigtails and donning one of her favorite hats, Mirabella concentrated on holding her hands still while hand surgeon Dr. David Kim took pre-operative photos during clinic. She was an especially sweet, patient girl and we all enjoyed taking care of her.

The Condoris

The Condoris
Originally uploaded by interplast

Dr. Joyce Chen, Interplast Webster Fellow.

Among the 140 patients evaluated in clinic, siblings Brittany and Joshua came with their parents to be evaluated by our team. They shared the congenital deformity syndactyly, a condition where developing fingers do not separate normally and thus affected babies are born with conjoined fingers. Fortunately, both of them were selected as appropriate surgical candidates and were scheduled for surgery on the same day. After separation of their fingers, Brittany and Joshua will be able to use their hands more normally.

Dr. Jorge Terrazas

Dr. Jorge Terrazas
Originally uploaded by interplast

Dr. Joyce Chen, Interplast Webster Fellow.

At the Miraflores Central Military Hospital in La Paz, Bolivia, our host surgeon Dr. Jorge Terrazas enthusiastically pointed to one of the many brightly colored posters he posted over the past month, advertising the free reconstructive hand surgery that our Interplast team will provide to both pediatric and adult patients. In preparation for this trip, Dr. Terrazas, who is an orthopedic trained hand surgeon, tirelessly screened over 700 patients prior to our arrival and selected more than 100 patients to be seen by our team. Interplast has successfully partnered with Dr. Terrazas for the past eight years in La Paz; together we have operated and taken care of hundreds of patients.

Clinic Day

Clinic Day
Originally uploaded by interplast

Michael Galvez, Interplast volunteer coordinator/ translator.

Today we set up shop at el Hospital Militar Central. Our host, Dr. Jorge Terrazas, is great. He not only prescreened 700 patients prior to our arrival, but he also facilitated setting up our operating site and getting local nurses, residents, and other hospital workers to help out. The clinic itself was captivating; there were so many people in need of correction of hand problems including congenital defects, burns, work-related injuries and accidents. Dr. Kyle Bickel, Dr. David Kim, and Dr. Joyce Chen along with Dr. Jorge Terrazas helped evaluate all patients to determine if an operation could improve function and form of their hands. Witnessing their collaboration with decision making was phenomenal. Everyone on the team was working hard. The pediatricians and anesthesiologists were thoroughly evaluating patients and the team nurses were setting up the quirófanos (ORs) and seeing patients as well. Given that we were starting up quirófanos from scratch, the anesthesiologists worked closely with the local physicians and nurses to ensure that we had everything we needed. Amazing day really, many patients in true need of help and great people working together to make it happen.

Arriving in La Paz

Arriving in La Paz
Originally uploaded by interplast

Michael Galvez, Interplast volunteer coordinator/ translator.

We arrived a day before beginning clinic day in La Paz, Bolivia. This place is breathtaking (literally at times); it has blue skies over a huge valley with amazing Mt. Illimani in the background. Everyone on the team feels well today. Besides the slight time change, most team members are worried about "soroche" or altitude sickness, considering last year’s team was significantly affected by it. Most of us are on Diamox (altitude medication) and some have tried “mate de coca” or coca tea, a local alternative. We walked around today to acclimate and went to see our operating site to evaluate and deliver our crates of equipment. Tomorrow is clinic day, where we evaluate potential patients and determine if we can help them during our trip and/or offer physical therapy.