February 2018: LA ESPERANZA, HONDURAS

The decision to embark on the Honduras 2018 mission trip was delayed due to concerns of violence after the presidential election. The final decision was made on January 27th, 2018. We held two Thursday evening meetings, February 1st and 8th in preparation for our departure on February 10th. A team of attending surgeons and anesthesiologists with prior experience on UHMLA trips in La Esperanza was assembled. The team included Ted McLean, Rolando Rolandelli, Isaac Spiteri, and Dan Chung. We also had a third anesthesiologist already ticketed to travel, but unable to attend due to a family emergency. Since we were already planning to travel without recovery room nurses, this loss was devastating. Fortunately, Gerry Lefever, with less than 24 hours’ notice, boarded the plane with the rest of the team. Two chief residents also joined us on their first mission trip: Lyly Nguyen and Anand Shah. Operating room nurses included Kristyn Fabyanski (UHMLA Guatemala 2017), Lorene Caroleo, and Carolyn Neier. Furthermore, I was approached by Yuri Jaramillo and Dayanna Grau, two young nurse assistants who work in Surgical Access in the Main OR at Morristown Medical Center. Both had just obtained their degree in nursing but had never practiced. We welcomed them into the group, trained them in circulating functions at MMC, and planned on Baptism by fire. Four additional members completed the team: Susie Kaye, Maggie Claudio, Suki Dewey, and Mercedes Rolandelli; all four had prior experience in UHMLA missions.

The trip from Newark to La Esperanza was relatively uneventful, without any incident of violence in Tegucigalpa. On Sunday we made the usual transfer of duffle bags with supplies from the hotel to the Hospital Enrique Aguilar Cerrato (HEAC) and began setting up the equipment while we screened the patients scheduled to undergo surgery on Monday. Upon unpacking we realized that we had left behind the light source for the camera. Fortunately, we were able to replace it with one available at HEAC. Since we only had one tray of laparoscopic instruments, we had to interpose a smaller case in between cholecystectomies so we could sterilize the set of instruments.

The schedule Monday through Thursday consisted of three cholecystectomies along with two minor cases in room 1 and five open cases in room 2. By Friday, we were left with a number of cholecystectomies but no smaller cases to interpose, so I decided that we would only complete one cholecystectomy in room 1 and remain available for any special cases in which our team could offer a distinctive advantage over the local team (for example, cases involving pediatric anesthesia). We also participated in the care of an acute emergency on a physician colleague.

With two prior trips to La Esperanza under our belt, we had the advantage of knowing the hospital, the nurses, and some key physicians. We even had some returning patients. Every phase of the process went very smoothly. Patient selection, movement in and out of the operating room, surgery, and recovery were flawless. All physicians and nurses performed at their usual high level. The team members that stood out in this trip were Yuri, Dayanna, Maggie, Suki, and Mercedes. Yuri and Dayanna absorbed a lot and really began to connect the dots between nursing school and clinical practice. By the second day both looked as if they had been practicing nursing for many years. Maggie successfully filled her usual role of social worker and scheduling officer. Suki continued her charge of turning over instruments between cases with professional expediency. Finally, Mercedes has really become an effective troubleshooter between the UHMLA team and the hospital employees. Nurses, secretaries, sterilization technicians, and many others relied on her mediation.

All operations were accomplished as planned without any complications. We finished the week with the usual ceremonies: Shoulder to Shoulder expressed their appreciation for our work and we recognized the great effort they make to support us. Typically, at HEAC there is only one or two elective general surgery cases; during this particular visit we increased this amount to 10-12.

After all our hard work we even had the opportunity to enjoy some sightseeing on Friday afternoon. Luckily, on Saturday morning, we left Honduras just ahead of a snowstorm. No matter how many of these trips one makes, there is always a great deal of emotions to “unpack,” as well as luggage. Our next mission will take place in Yantaló, Perú June 23rd through June 30th, 2018.