Pucallpa, Peru 2010

Jerzee

Jerzee
Originally uploaded by interplast

Dr. Joyce Chen, Interplast Webster Fellow.

Running into our surgical consultation room was a rambunctious and adorable little girl named Jerzee. She is 14 months old and has an unrepaired cleft palate. After an appropriate examination and counseling to Jerzee’s mother regarding her daughter’s cleft palate, Jerzee was scheduled for surgery the next day. Just as she came into our lives, Jerzee left, running out of the room after her mother.

Surgical Team Evaluation

Surgical Team Evaluation
Originally uploaded by interplast

Dr. Joyce Chen, Interplast Webster Fellow.

Pictured here is Dr. Kristen Stueber examining a patient with a repaired cleft palate, alongside Dr. Gary Fudem (pictured wearing glasses on the right) and I (pictured middle in blue). The patient’s palatal repair appeared intact but with his hypernasality caused by a shortened palate, the surgical team decided to schedule this patient for a palatal lengthening procedure to improve his speech. Amy Laden (pictured far right) helped us with the Spanish translation during this and other consultations throughout the day.

Rickshaw Racing

Rickshaw Racing
Originally uploaded by interplast

Dr. Joyce Chen, Interplast Webster Fellow.

At the end of our clinic day in Pucallpa, our tired but jovial team joined our hosts from EsSalud Hospital at a local restaurant. Transportation was quickly solved when we saw a line of motorized rickshaws waiting outside the hospital. After evaluating patients and/or setting up our operating rooms, everyone was hungry and eager to reach our culinary destination. We all shared rickshaw rides, racing and blending with the other motorists on the streets towards the promise of savory Peruvian cuisine.

Clinic Day

Clinic Day
Originally uploaded by interplast

Dr. Joyce Chen, Interplast Webster Fellow.

Our patients waited patiently to be seen in clinic. In the meantime, the adults passed the time conversing with one another, while the children enjoyed coloring with crayons. Fans overhead in conjunction with a slight breeze through the open windows helped cool everyone in the tropical Amazon climate of Pucallpa.

Meeting Our Hosts

Meeting Our Hosts
Originally uploaded by interplast

Dr. Joyce Chen, Interplast Webster Fellow.

After arriving at our hospital, our team was introduced to some of the surgeons and nurses with whom we will be working closely at EsSalud Hospital. They were introduced by Dr. Esly Vicente Anderson Motta, a pediatrician and medical director of the hospital (pictured left). He’s also been our main liaison and has been instrumental in preparing for our team’s arrival at this new site. Sitting next to him is Amy Laden, Interplast’s director of international services, who flew out to Pucallpa ahead of time to help with the preparations. Special kudos need to be given to Amy as she was able to make this inaugural team trip a reality with only two weeks notice, as our original intended Peruvian site was cancelled due to a dengue fever epidemic.

The Inaugural Pucallpa Team

The Inaugural Pucallpa Team
Originally uploaded by interplast

Dr. Joyce Chen, Interplast Webster Fellow.

In front of a banner announcing our arrival, the inaugural Interplast team to Pucallpa, Peru, posed for a group picture, already appearing to be a cohesive group, less than two hours after our bay area team members joined the rest of the team. As typical of Interplast team trips, the master itinerary had everyone arriving together in Peru. However, due to mechanical problems of their original plane, the bay area team members missed their connection in Miami and arrived in Pucallpa 8.5 hours after the rest of the team. Despite the travel delays, everyone was excited to see and evaluate patients on clinic day at our new site near the Peruvian Amazon.

Is there a doctor on the plane?

Is there a doctor on the plane?

Dr. Joyce Chen, Interplast Webster Fellow.

An hour into our red-eye flight from Miami to Lima, on Interplast’s inaugural team trip to Pucallpa, Peru, a flight attendant announced over the loudspeaker that they needed medical help at the front of the cabin. I, along with two Argentinean physicians, a cardiologist and a critical care physician, responded.

The flight attendant had watched a passenger collapse in front of the bathroom. She was immediately laid down on the floor with her legs propped up above her heart to facilitate blood flow to her head (this is called the Trendelenburg position). The patient was diaphoretic (perspiring heavily) and pale but had a nice, steady pulse. My years of general surgery and trauma training suddenly rushed back to me, and my examination and assessment of her were very second nature. With diabetes, cardiac disease, and head injury ruled out, we learned that this passenger had high blood pressure and had last taken her blood pressure medication during her layover in Miami. The Argentinean cardiologist checked her blood pressure which turned out to be low. In order to increase the amount of fluid circulating in her system and thus increase her blood pressure, we asked her to sip orange juice from a straw. After two full glasses, she pinked up, looked and felt much better. Her blood pressure had already improved!

As we were watching our patient recover, I was able to enjoy a conversation with my two new Argentinean friends. They had attended an international meeting of cardiac-lung transplantation in Chicago and were heading back home to Argentina. They had missed their Dallas, TX connection and were rerouted via Miami, FL and Lima, Peru to Argentina.

Before we left our patient and headed back to our seats, I asked her to see a doctor the next day at home in Lima to have her blood pressure checked and to make sure she was OK. She agreed and then graciously told us “grazie mille” with a genuine smile. Both she and the Argentinean cardiologist were of Italian descent, and I had mentioned to them that in college, I had taken some Italian and studied in Florence, Italy. My last thoughts as I drifted off to sleep…tiramisu, Michelangelo, Vivaldi, BUONA NOTTE!