Loja, Ecuador Visiting Educator Workshop

Burn Assessment

  Burn Assesment 
  Originally uploaded by interplast.

Just next door to the fake patient, a real patient with a significant friction burn to his leg was being looked after.

Burn Practice

Burn Practice
Originally uploaded by interplast.

Times were recorded for how long various steps took, and this information will be used as part of the planning process. There was great enthusiasm displayed by everyone involved.

Mock Burn Victim Triage

Waiting for the Burn Victim
Originally uploaded by interplast.

Following this, the hospital officials staged a “mock burn victim” triage, during which a medical student covered with ketchup was brought into the emergency department by ambulance and was followed by us officials as he went upstairs to the burn unit.

Burn Lecture

Burn Lecture
Originally uploaded by interplast.

I then gave a lecture to doctors, nurses, and ambulance drivers about the acute management of burns.

Burn Unit Expalantion

Hospital Director Explaining the Burn Unit
Originally uploaded by interplast.

I started off by meeting with the various hospital officials that are involved with the burn unit. The unit is still under construction, and a detailed explanation of how the completed unit is expected to work was presented. Everyone seems to be interested in making the project successful, and they are looking to me to give some guidance in their planning, which is a very exciting prospect.

This is one of the hospital directors explaining the design of the burn unit.

Burned Mom and Nina

Burned Mom and Nina
Originally uploaded by interplast.

I was also shown a diagram for the further construction of the burn unit - which is ongoing right now, with mud, dust, hammering, open floors and ceilings, and general mayhem right next to the burn patients with minimal separations.

In the afternoon I gave a general lecture on burns and burn units, and why they are so useful and effective. After the lecture I met a surgeon and nurse from Piura, Peru, who had come all the way from their home city to see me. Hopefully I will be able to have more of an interaction with them before I leave.

I decided that I need to change my lectures - Cora is going help me translate some into Spanish for the Paramedics and Nurses tomorrow morning, and I have been asked to give another one to the doctors in the afternoon that covers a bunch of topics of concern to them. So, a lot of work!

Talking With Dr. Ludena

Talking With Dr. Ludena
Originally uploaded by interplast.

I’m back at my hotel after a full day. I started at 0800 with Cora and Nelson Samaniego taking me to the hospital to meet with the hospital director and several other medical people. An opening ceremony was also sprung on me, with speeches, etc, which was a little disconcerting but went off fine, I guess. Good thing I decided to wear my tie.
One of the R1’s who is working in the burn unit, Dr. Christian Ortega, had been asked by me through interpreters last night to come up with some numbers related to the burn unit functions, and he did a fantastic job, providing a several page document that he had partially translated into a form of English for my benefit (I am not one to talk about bad English: my Spanish is totally unintelligible!) The document was well received by everyone else at the meeting as well.

The plastic surgeon who is director of the burn is Dr. Rodrigo Ludena, and he apparently has been in Loja for years, but has never met with Interplast before. He spoke about his training in Columbia before he came to Loja, how he had noticed that burn care was suboptimal many years ago and had been trying to improve such care for a long time. He did state that he was glad for any help that could be provided by Interplast to the unit.

Another person who came to the meeting was the representative of the INNFA, a nonprofit organization that apparently is headed up by the first lady of Ecuador and which provides support to children in need. They have also agreed to help adults with burns in Loja.

After the meeting I did rounds in the burn unit, unfortunately without a translator, and got a better look at the severely burned child - a very sad case. According to Dr. Ludena, he has a 90 percent burn - and I think he would have great difficulty surviving in a premier North American unit. I was concerned about the management of his pain during dressings - they didn’t seem to be giving him anything, but because of the lack of effective communication I could not be sure. I was also asked to see a few pressure sore patients: two paraplegics and a diabetic. I advised the rounding group that I was not prepared to do major flap surgery on these patients - I don’t have the right equipment or the time - and also I am not hopeful that the underlying cause for these severe ulcers will be corrected. One of the paras had a big skin graft on his back from a previous Interplast team that had healed well.

Planning The Week...

Planning The Week...
Originally uploaded by interplast.

I really feel empowered to try to help these nurses do the best job they can to help care for these people. They seem enthusiastic about the concept of a burn unit, and since they seem to be in the middle of construction, maybe some real changes can be made.

I just finished having a meeting with the surgery residents of the hospital. We had it in the lobby of the hotel. There were about 15 of them, at various stages of training. All of them expressed enthusiasm for the concept of learning more about burn treatment, and also for the concept of a burn unit. I am apparently going to meet the burn unit director tomorrow. I signed on to do a fairly ambitious program over the next few days. I will go in tomorrow and assess the unit in depth, and then give a general lecture on burn care tomorrow afternoon. I have talked about doing some workshops as well, where I could propose scenarios to them that they would then have to puzzle through, and also a “pig lab” where I could teach them how to take a skin graft on the side of a pig carcass. I don’t know if I will get around to it all, but it will be fun trying.

Nelson, Cora and Nurses

Nelson, Cora, Nurses
Originally uploaded by interplast.

I’m in my hotel room at the Liberator here in Loja, Ecuador. The flight here was 2 hours late, but it really didn’t make any difference. Cora and Nelson Samaniego, Interplast’s hosts in Loja, were at the airport to pick me up and take me to the site. I experienced an absolutely hair-raising ride from the airport over a mountain pass with near misses of big slow moving buses and oncoming cars. The Samaneigos were completely unconcerned. They described their ambitious goals for my visit: to help promote the idea of a regional burn unit that could cover the entire district of Loja as well as Northern Peru; to teach; and to do some needed surgery if there was time.

Nelson and Cora (and their daughter Stephanie) then took me to a soccer game. The local Loja team was up against a more powerful rival from Guayaquil and trounced them 4-0. There was tremendous exuberance in the stadium, with many people wearing the local colors, including Nelson.

We followed this with dinner at the new KFC restaurant (been there for about 4 months- I guess a sign that Loja is advancing economically!) and then did a tour of the new burn unit, still under construction.

It was an eye-opener for sure. They had two nurses looking after seven patients; four children and three adults. Three of them are from one family and share one room. Among them is a severely burned young boy of about five-years old who is probably going to die soon (he has burns on over 80 percent of his body, including deep face burns). He is lying on a bed with a wood crate over top of him that is covered with blankets. There is a gooseneck lamp inside the crate to try to keep him a little warm. He is slathered with flamazine, and has a foley and an IV. He seems to be unconscious, which is probably a good thing.

How Mad I Would Be

My name is Tim Sproule, and I am a plastic surgeon from Toronto, Canada who specializes in burns.  I am going to Loja, Ecuador on an Interplast visiting educator workshop to teach Ecuadorian doctors and nurses about burn care.  I teach laser physics and surgery at the University of Toronto, and I feel very lucky that I have the opportunity to come to Ecuador with Interplast to help empower the local doctors.

Right now I am sitting in my hotel room in Quito, Ecuador. The trip down was uneventful except just as we were landing last night. Apparently there was too much fog over the airport and the pilot decided at the last minute to pull up and fly around again for another approach. Many people on the plane got terrified and were chanting prayers, etc. I was vaguely aware of how close the mountains are around Quito from the last time I was here, and how mad I would be if we hit one!

Anyways, it obviously didn’t happen and we landed without any problems at all.  My bags were X-rayed as we were going through immigration and an officer was interested in what I was bringing down, but passed me through without any problems.  The hotel had a bus at the airport to pick me up and whisk me here - I don’t feel like I am out of North America yet.