La Paz, Bolivia 2006 Surgical Trip

Singing Paula

 

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This is Paulina (whom you may remember from this post), serenading our team. She had quite a repertoire, but this was her favorite.

Baby Care Unnecessary

Baby Care Unnecessary
Originally uploaded by interplast.

This woman came into clinic with an open wound, which apparently heals and then re-opens. Dr. Huntsman was able to do a 10 minute procedure to solve the problem. Ana Maria and I were eager to do baby care (such a cutie!) while she had the short procedure, but she kept the baby with her. Fortunately, the baby slept, and didn't need Momma's attention for a little bit.

Planning With Post-Its

Planning With Post-Its
Originally uploaded by interplast.

This is our international partner, Dr. Jorge Terrazas, and Dr. Tom Huntsman, our team leader, planning the next day’s schedule. Notice the post-its system on the wall. Each color represents a different kind of operation, so Tom can switch patients around to maximize the team’s time.

Instructions For Post-Op Care

Instructions For Post-Op Care
Originally uploaded by interplast.

Dr. Huntsman, on the recommendation of our surgery committee, developed this sheet of instructions for families of children who have had surgery to refer to on the wards, so that they can help with the post-op care. Dr. Dora Rusin Gomez, of Interplast's international services department translated the instructions into Spanish.

Child With Crayons

Child With Crayons
Originally uploaded by interplast.

Interplast sends crayons and sheets from coloring books donated by the Ronald McDonald House Charities to keep the children busy while waiting for surgery, or recovering from it.

Heisman Trophy Winner Before Surgery

Heisman Trophy Winner Before Surgery
Originally uploaded by interplast.

Here is our little Heisman trophy winner before his hand reconstruction surgery. You may remember him from his famous pose after surgery.

Happy Birthday, Jim!

Jim's Birthday
Originally uploaded by interplast.

Seth Mazow, communications and technology coordinator: Happy Birthday, Jim! Today is Jim Dirck's birthday, so feel free to leave a comment wishing him a happy one.

ABC: Altitude, Boxes and Customs

La Paz, Bolivia - Jim Dirck, director of medical supplies: We started out for Bolivia 4 days early as Bolivian Customs has become more stringent with clearances due to people attempting to bypass import fees, etc....  We had been instructed that the only way to guarantee there will be enough time to have the boxes arrive at the hospital to begin clinic and the surgery program as scheduled is to allow 3 full working days for processing...  Cris and I flew out of San Francisco wondering what to expect on the other end - not only with getting our supplies and equipment to our host hospital; but what impact the altitude will have on us and the team...  Luckily, we received great treatment from American Airlines and the boxes were checked through to La Paz...

After a layover in Miami and the typical "try and get some sleep" red-eye, we landed in La Paz at approximately 5:45 AM...   We exited the plane and walked toward the little booths where Bolivian Customs' officials take our green colored forms completed on the plane prior to landing...  After a brief visit at the booth where our documents were verified we proceeded to the baggage carousel and waited for the boxes...

We were tired from the long flights (over 12 hours with lay overs) and the time change, but what hit the hardest was the heaviness in your body and how quickly you become short of breath even with minor exertion.  This is the altitude at work.   It is like moving about wearing weights while trying to breathe through a thick blanket...  With the help of some sky caps, we managed to locate all the boxes (I must have counted them three times to make sure we got them all, as my mental faculities were also dulled by being over 12,000 feet above sea level).  We seperated our equipment from the supplies as the inspector needed to see what is for temporal use (equipment) vs. the items for donation (supplies).  Once this is accomplished we were told that the equipment will be cleared on Thursday with the supplies to follow on Friday - hopefully.  Our host contact, Dr. Jorge Terrazas, arrived in time to help with this brief "back and forth" conversation to clarify the status of our boxes and nail down the remaining transport issues.  Our paperwork was in order, and while we felt confident that all the bases have been covered, there was a lingering concern.  If we did not get our equipment and supplies by the time the team arrived, there would be lost days, meaning less people receiving surgery.  We left with Jorge and without our boxes...

Thursday morning we attended a pre-screening clinic with Dr. Terrazas.  We saw people with terrible injuries and birth defects that have gone untreated for 3, 4 and 5 years and more due to their financial situation.  They have come from La Paz and other parts of Bolivia in the hope of having function restored in their hands, fingers and arms.  Mothers and fathers with babies born with defects, children, teenagers, men and women who want to be able to return to work all line up to see if there is hope... Many receive good news and for others, there is the disappointment of being told that their situation cannot be helped by surgery...  So many of these are because too much time has passed and their now fused joints, dead nerves and atrophied muscles will not respond to surgery or physical therapy.  They could not afford to pursue treatment when they could have been helped...  The bright side is that many can be treated and are slated for the screening clinic by Interplast volunteers the following Monday.  I should point out that Dr. Terrazas is the only hand specialist in Bolivia. 

Towards noon time a knock on the door brings news of our equipment - it has arrived.  Cris and I go to help with the unloading and place the monitors, surgical instruments and the rest in a storage room...  We are told once again that the supplies should arrive the next day, Friday, but there is a slight complication.  The person at the ministry office who must sign a document to officially regonize the donation is out of town.  Jorge begins making phone calls to find an available qualified official to sign off on our supplies. 

Friday is spent on phone calls and brief meetings to get our remaining boxes out of Customs...  Finally, I'm told that all is in order and a small processing fee is required to finalize the transport of our supplies to the hospital (a common event)...  I meet with the official liason who verifies payment and rushes off to the airport at about 4:30 PM...  The sun sets and we wonder if we need to go into plan "B" mode.  If we don't get the boxes today, nothing can happen until Tuesday at the earliest - Monday, May 1st is a holiday.  It is just after 8:00 PM when the phone rings and Jorge in a tired, but obviously happy voice says, "Jim,  I am at the hospital and they have just put the last of the boxes in the storage room".  Now, we can begin our work.    

Teaching Local Hand Therapists

  Teaching Local Hand Therapists 
  Originally uploaded by interplast.

One of the most important functions of any Interplast trip is the teaching. By teaching local doctors, nurses and therapists how to improve the quality of care that they provide to the local population, we can really make a long-term impact. Here I am teaching some local therapists from my computer.

Paula and Tupiza

  Paula and Tupiza 
  Originally uploaded by interplast.

This is 6 year-old Paula with her mother. They traveled from Tupiza - a day and a half from La Paz. Paula was burned at age 2 in a fire that started in the kitchen. Her mother, Feliza, heard about the team on TV. Paula loves to sing, and she has quite a repertoire. She sings for all of us when we make rounds. She and her mother will stay in the hospital until next week, when I will see her to remove her dressing and to make a splint, and to teach her mother how to do exercises that will increase her range of motion.

Heisman Trophy Winner

  Heisman Trophy Winner 
  Originally uploaded by interplast.

This little three year-old boy has just completed hand surgery. He is quite the merrymaker, and in this picture, he looks just like he's posing for the Heisman Trophy.

Matasuerga Fireworks Victim Brandon Steve

Matasuerga Fireworks Victim Brandon Steve
Originally uploaded by interplast.

Here is Brandon Steve, who was injured by the matasuerga (literally: kill your mother-in-law) fireworks. When I wrote this post, I promised I'd try to upload a picture of the little guy, so here it is.

Smooth Day of Surgeries

  Smooth Day of Surgeries 
  Originally uploaded by interplast.

La Paz, Bolivia - Martin Walsh, hand therapist: Here are a few pictures from clinic on Monday, we saw about 75 people and more this afternoon, so far we have filled up the first week with surgeries but want to screen more people this week before we make next weeks schedule. Today's first surgery day went smoothly and the surgeons performed about six surgeries total. The team appears to be working well together. Here a mother hopefully watches on as team members examine a baby who was being screened for a possible surgery.

Teresa

  Teresa 
  Originally uploaded by interplast.

La Paz, Bolivia - Martin Walsh, hand therapist: This is Teresa, a patient that we all fell in love with last year and who has come back for surgery on her other thumb. She was very pleased with the results of last year's surgery, and we are excited to see her back as well!

Very Supportive Hospital and Matasuegra

La Paz, Bolivia - Amy Laden, translator/coordinator: We are well underway now, and all seems to be going smoothly.  The hospital is very supportive, from administration to the floor to the OR staff.  Dr. Jorge Terrazas, an orthopedic surgeon and our international partner here in La Paz, Bolivia, has been with the team in clinic and today.  Residents are scrubbing in.  There is a small foundation called SOS Manos that was started over a year ago (pre last trip).  Rocio (Jorge's wife), his mother and several others are members.  Their purpose is to raise money so that hand patients can receive care, both with Jorge and therapy.  They provided breakfast and lunch yesterday for the patients and families.  Many came from far away and are being housed by the first lady´s office.

We saw a 7 year-old boy in clinic named Brandon Steve, with several fingers burned.  I have a photo which I will try to upload tonight.  When he was asked how he was injured, his parents told us it was a "matasuegra", which translates to kill your mother-in-law and is a type of fireworks.

More later.  BTW, the weather is actually sunny and warmer than expected.  Chilly, but not really really cold.  What a pleasant surprise.

Interplast Staff Ahoy!

La Paz, Bolivia - Amy Laden, translator/coordinator - Hello!  I'm Amy Laden, director of international services at Interplast.  I am being joined here in La Paz, Bolivia by Cris Davila and Jim Dirck, both Interplast staff members in the medical services department.  They are the guys who pack the 3/4 ton of medical equipment that goes on each trip, order and keep track of inventory, make sure all the equipment is working and make sure that we meet the customs guidelines for each country where we work.  That last one is no small task!

Anyway, we'll be blogging here from La Paz for the next two weeks, so stay tuned to see what's happening with the team.