This was our second trip within a year to Yantalo, Peru. The group this year comprised of surgeons, nurses and anesthesiologists combined with some volunteers who were embarking on their first medical mission. The trip got off to an inauspicious start. We departed from Newark on 4/5/19 and arrived in Lima that night. After an overnight stay in Lima, we boarded two domestic flights to Tarapoto that were scheduled to depart 8 minutes apart. One flight took off, and the later flight was canceled at the last second due to poor visibility and bad weather in Tarapoto. The group that took off circled around Tarapoto airspace for about two hours before the flight had to be diverted to Chiclaya airport due to bad weather. We remained on the airplane in Chiclaya for an additional hour and a half when the pilot decided to fly back to Lima as the weather in Tarapoto failed to improve. We met up with the rest of group in Lima airport and scrambled to find another flight later that evening to Tarapoto. All 20 of us finally arrived in Tarapoto 32 hours after leaving Newark. The bus ride to our final destination of Moyobamba was smooth and we all crashed that night as soon as we reached the Alta Vista Hotel.
The team was led by Zubin Bamboat from General Surgery. Rick Nitzberg and Igor Elyash were the other two general surgeons. The Gyn contingent comprised of Drs. Mike Kuchera and Mike Ingber whose urogynecology experience proved to be invaluable. Jim Mattie from anesthesia made his first mission trip accompanied by Gerry Lefever and Daniel Chung who are both experienced UHMLA anesthesiologists. The nursing team was led by Imelda Jimenez and Arlin Fidelaga; they were accompanied by Alex Fidelaga, Carol Debiasse and Lisa Kilian. Hilda and Paula Lefever along with Kathy Kuchera made up the pre-op and PACU team and there was a solid contingent of support and admin staff led by our IT expert, Chris Kuchera.
On Sunday, all the team diligently screened a large contingent of general surgery and gynecology patients in the clinic. The nursing and admin team set-up equipment, organized the ORs, and created a patient database and the OR schedule for the week. Approximately 80 patients were evaluated for surgery and 55 were deemed appropriate candidates for surgery. A total of 52 surgeries were performed from Monday to Friday of which 27 were general surgery and 25 were gynecology. Patient ages ranged from 15 to 81. In similar fashion to last year, we hosted a Peruvian medical student who was on an elective rotation from her med school in Lima and a local general surgeon from Lima who came to observe and assist with some surgeries.
There was no shortage of interesting and challenging cases this year. A young 34 year old man with Lynch syndrome whom we operated on the previous year came to see us for a one year follow up. Last year Drs. Rolandelli and Bamboat performed an extended right colectomy with en bloc partial gastrectomy for a T4, N0 transverse colon cancer that was growing into his stomach. He recovered very well and remains cancer free. This year he brought his mother and older brother to be evaluated by our surgeons. His mother who is 64, underwent a partial left colectomy in Lima 5 years earlier for cancer and now had an 8cm right sided colon cancer. She was fortunate enough to have a CT scan with her that showed no metastatic disease. Her older son had a partial colectomy with colostomy 6 months ago for an obstructing colon cancer. His pathology report confirmed very aggressive disease and despite this he was unable to receive any postoperative chemotherapy rendering him very high risk for recurrent disease. We therefore did not recommend any additional surgery for him, but did perform surgery on his mother. Drs. Bamboat and Nitzberg performed a completion total colectomy with ileorectal anastomosis. Her recovery was better than any of us could have hoped for and she was discharged on the evening of post op day 3. The local surgeon who assisted us with the surgery will serve as our contact to ensure that these patients continue to recover well and receive appropriate follow up treatment such as chemotherapy if needed.
We also saw a 15 year old boy with profound unilateral gynecomastia. He was accompanied by his mother who explained to us that he was afraid to play sports and mingle with other kids his age out of fear of being made fun of. He would refuse to go to school and had only a handful of friends whom he called his “true friends” that he felt comfortable around. We performed a nipple sparing mastectomy on him that he tolerated very well. Seeing his reaction to the cosmetic outcome and his mother’s gratitude was priceless.
The gyn team were challenged with difficult cases all 5 days. Having two experienced gyn surgeons allowed us to serve a truly unmet need for complex urogynecologic surgery in Peru. Drs. Kuchera and Ingber performed hystecterctomies in two young women for massive uterine fibroids measuring over 40 cm. They also performed several urogynecology procedures including cystocele repairs, uretheral diverticulectomy, vaginal hysterectomies, Laforte procedures, anterior pelvic slings, and vaginal vault suspensions. They also performed laparoscopic ovarian cystectomies, LEEPs, and removal of a large bladder stone in an older woman that was causing incontinence. Their patients did well and were truly grateful to receive these life changing operations.
The staff at Yantalo were so accommodating and professional. Mery Padilla the medical director of the clinic was an invaluable resource for us and continues to update us on the status of the patients. Nino Ocampo continued his excellence as the operating room coordinator and master trouble shooter. He was able to replace the laparoscopic tv screen that broke down on our first day, with a 55 inch flat screen Samsung tv that enabled us to perform laparoscopic surgeries the rest of the week. We are grateful to the clinic staff for making our trip successful. The group spent half a day sightseeing in Lima on our way back to NJ and some members went on to Machu Pichu. We expect Yantalo to be a permanent venue for future UHMLA missions.