AM Meeting:
Dr. Powell describes Saturday as the ‘Best first day surgery in 9 yrs’ – everything went very well in the O.R.’s.
General volunteers report that they really appreciate veterans of the mission. They are patient and willing to teach the newcomers. Orthopedic fellows and orthopedic resident say the first day in surgery was an amazing experience: seeing cases they may only otherwise see in textbooks – excellent to be able to help these people.

Physiotherapy – in addition to the supply run to the store yesterday they got their first patient up – in fact – they couldn’t keep him down! You will see a photo of this patient, accompanied by Anne and Tanya, out on the terrace enjoying the view from the hospital. He is strong, happy, and anxious to recouperate – discussion turns to making sure this patient does not overexert himself and put the hip out. Interesting – J.D. also happens to be artistic – treating the nurses to caricature pictures of them – some not so accurate! Good material for a story and a few laughs at dinner. Manuel Avila is happy about how each member of True North Missions works – thank you and God Bless.

CPR is scheduled on the 5th floor of the hospital tomorrow at 6, Tues 6, Wed at 7. A few of the mission volunteers have offered to help Pam Railton. Local, Daniella Ledesma (daughter to Santa Ines hospital board executive, Bruno Ledesma) will help with translation. Pam has brought a CPR teaching video (in Spanish) and CPR mannequins for the students to use for practice.

Dr. David Fermor will be organizing teaching sessions at the med school for two sessions this week.

Surgeries planned for today:

A. P. – 53 yr old male – previously worked in construction- will receive left total hip. A.P’s femur head is migrating into the pelvis and the head is over contained into the socket – rarer to see this condition and it makes the patient’s hip very stiff.

R. V.- 57 yr old female- right hip pain since birth – groin pain – 4 cm leg length discrepancy – left hip has never been in place since birth – the head, femur, and hip did not develop normally. Correction will involve shortening the femur – new hip – new acetabular- technically challenging case.

T. B. – 48 yr old female – pelvic osteotomy 20 yrs ago – pain and sciatica became worse 3 yrs ago – will receive right total hip and hardware removal.

M. C. – 33 yr old-bilateral hip pain will receive right PAO – She has a great chance of success. PAO should preserve the cartilage and delay arthritis. Solid indication for recommending a PAO.

V. F. – 25 yr old female will receive left PAO – 25 yr old female – bilateral pain – subtle dysplasia – perfect time to correct.

H.S. -75 yr old female left hip pain progressively worse. Sitting is painful. Will receive a left total hip – she received a right total hip 1 1/2 yrs ago.

As it turns out, the first scheduled surgeries took a little longer today, there were challenges with obtaining appropriate x-rays, etc. Two surgeries were rescheduled to Monday and four completed today, Processing had challenges due to a broken down sterilizer as well – this is not an uncommon experience during mission.

There have been more than a few patients that have caught the hearts of all our volunteers. As mentioned the first day of the blog, it is very difficult to turn away any one person who comes to the clinic in search of surgical help. Sometimes, a hip condition may be too complicated, progressed and/or arthritic for surgery. In addition to having complex conditions, many of these people come from difficult situations, which can magnify, of course, the difficulty of their physical deformity/challenges. Each of our volunteers can relate moments when they have felt empathy for those we have seen this week: in pain and in search of help. As volunteers, in a foreign country, either, we are happy and hopeful to provide surgical assistance, or, we are sad and concerned for those we cannot. Three examples stand out over the past 3 days.

First, one nurse tells of a pretty lady in her 40’s with a son in grade 9. She has severely limited mobility and walks with a cane. This woman was abandoned on the streets when she was baby and eventually adopted – but grew up with nothing. She is a street merchant who makes and sells her own popcorn. She is doing her best to raise her son and is concerned that her challenges are limiting his ability to attend school. He is spending more and more time taking over the popcorn business and taking care of his mother. She has severe scoliosis of the spine and an old fusion of the hip which she received at a much younger age. The doctor’s evaluated her condition and the curvature of her spine is her main challenge and the fused hip could not be treated. . There is no solution we can offer at this time for this unfortunate lady. There is a distinct feeling of hopelessness for medical staff and volunteers as they to watch her leave the clinic: the only consolation being the opportunity to buy popcorn. Lots of popcorn in the clinic that day.

Another patient that was difficult to watch as he left our clinic was Carlos. This man is in his 40’s. He has had previous hip procedures but he suffers from a rarer condition that involves migration of the femoral head further into the socket than it should be. Carlos is quite limited in his mobility and he is in obvious pain. He has been unable to work. As he lay on the examining table, he is hopeful. However, when he receives the sad news that we cannot help him with surgery, it is hard for him to contain the tears. Finally, when he is alone at the end of the examination, he cannot contain his disappointment – one of our nurses is heartbroken to see him cry and she stands beside his bed holding his hand. Later, he makes his way out of the clinic and as you can imagine, it is quite emotional to watch him as he struggles to walk away.

Finally, another special patient from clinic day was asked to come in for further assessment – Sandra is a 27yr old female with hip dysplasia, cerebral palsy and reduced mental development (grade 2 level). She lives with her sister who looks after her – their parents left for the US, leaving the girls to fend for themselves. The sister is a street merchant selling wares and trying to make enough money for them to live: she must bring Sandra along each day, despite her limited mobility and mental capacity – there is no alternative. This patient has hip dysplasia but correction would not be a routine PAO – more x-ray’s and specialist consults are planned to see if this smiley young lady can be helped. The Rotary is very interested in helping her as well. If she becomes a surgery candidate, she will need approximately 8 weeks of 24 hr care. In fact, before the end of the day, Manuel Avila has explored the prospect of the Rotary covering her stay in a local cancer facility for her potential special rehabilitation. However, surgery for Sandra is not a predictable situation and recommendation for surgery must be carefully considered. By Monday, it is determined that the risks of any procedure the mission could do in Ecuador are too high for this young lady’s overall well-being and, sadly, we are in a situation where we would love to help but cannot offer Sandra a solution at this time. We may still be able to re-evaluate Sandra’s special circumstances in the years to come.
Comments about the day:

Today was a more organized and ‘cooler’ day…

Observed an osteotomy – awesome!!