UHMLA discovers an Oasis in the Peruvian Amazonian Jungle

Our first mission to Perú is finally accomplished with complete success.  The UHMLA group flew to Lima, then to Tarapoto and then rode a bus to Moyobamba where we checked in a hotel for the week of June 23rd through the 30th.  Another bus drove us to Yantaló every day back and forth.  Yantaló is a very small town in the Peruvian Amazon. The word “Yantaló” in Quechua means carrier of firewood on back.   Dr. Luis Vazquez, a retired cardiologist from Chicago, built a hospital complex in this remote place where his mother was born.  This is a state-of-the-art building designed by students of architecture of the University of San Diego and completed in 2015.  The physical plant is very spacious and immaculate.  It includes a large operating room with two columns of ceiling booms, three operating tables, three anesthesia machines and one laparoscopy tower.   Prior to our mission several other missions used the operating room for pediatric, plastic, general and gynecological surgery.   UHMLA was the first group that used all three tables simultaneously for an entire week. 

The members of the team were Rolando Rolandelli and Zubin Bamboat for general surgery, Michael Kuchera for gynecology and Deowall Chattar for plastic surgery. The anesthesia team was made up by Gerald Lefever, Walter Lewis and Cyrus Kapadia.  The nursing team was led by Christina Jimenez and included Carol Santana, Monica Grzelak, Ruben Milan and Lindsay Lefever in the Operating Room with Paula Lefever, Valentina Salvador, and Kathleen Kuchera in the recovery room.   We were very fortunate to also have with us Maria Kapadia and Erin McDonnell assisting us with the intake and discharge of patients and Charles Lewis managing the administrative aspects of the mission.

On Sunday we screened approximately 85 patients and selected 70 for surgery.   During the week we had three cancellations and some additional candidates screened. Ultimately we performed 67 operations in 63 patients between Monday and Friday.  Among the 63 patients six were children under the age of 10 (two 2 y.o., one each ages 3, 5, 7 and 9).  A total of 32 operations were done for general surgery conditions: 19 hernias, 11 cholecystectomies, 1 colectomy and 1 sphincterotomy for anal fistula.  Two ladies who underwent laparoscopic cholecystectomies stayed overnight with drains to be removed the next day. One of them had a gallbladder very suspicious for gallbladder cancer.  The colectomy was performed on a 35 year old man who presented with a nearly obstructing cancer of the colon.  His family history included a brother, only two years older, who already had surgery for an obstructing tumor of the colon requiring a temporary colostomy and his mother also with an obstructing colon cancer.  Although he had health insurance through his employer the process for him to get to see a surgeon was estimated to take several months.  After much debate we obtained the support of a surgeon from Moyobamba and proceeded with the surgery. We intended to do the operation laparoscopically and to that effect we mobilized the left colon and the splenic flexure. As we dissected around the tumor we realized that it was quite large, approximately 8 cm. in diameter, and firmly attached to the stomach. We had another debate including multiple family members and decided to open the abdomen and do an extended right colectomy with en-bloc partial gastrectomy.  The operation was uneventful and he recovered well without the need for any analgesics. He was started on a liquid diet on the 2nd postoperative day, which was the day of our departure.   Fourteen patients underwent surgery for gynecological pathology: 5 pelvicovaginal reconstructions including 3 cystocele repairs, one colpocleisis and one colporrhaphy, 4 hysterectomy (3 vaginal and 1 abdominal), 3 ovarian cysts, 1 D&C and one hymenal ring.   The D&C was performed to obtain endometrial tissue for biopsy in a lady with postmenopausal bleeding, the specimen was highly suspicious for endometrial cancer.  The ladies who underwent cystocele repairs stayed overnight with a urinary catheter to be removed the next day.  In the field of plastic surgery 21 patients underwent surgery: 10 for subcutaneous masses, 6 for scar revisions including flap reconstructions, 2 hand deformities, one eye lid deformity, one circumcision and one removal of subcutaneous foreign body. 

The support staff in the Yantaló clinic were excellent; especially Mery Padilla, the overall coordinator, Nino Ocampo the operating room nurse coordinator and Alberto Rivera the chef.  Wullman and Aljaz were also extremely helpful.  During our stay in Yantaló we met three first year medical students from the University of Rochester doing research on access to water in the Yantaló community.  We added to their summer curriculum a quick immersion to missionary surgery.  Overall the mission was a great success and we decided that Yantaló will become an additional destination for the annual UHMLA trips.

We were very saddened for not being able to meet Dr. Luis Vazquez who had planned on being there but was recovering from a medical emergency in Chicago. We wish he has a speedy recovery and is present in Yantaló  when we return next year.