One World Surgery: My Week in Honduras on a Medical Mission

You’ve also got to get yourself to Tegucigalpa, Honduras. When I looked for round-trip flights, they were over $800 apiece. Anticipating an eventual trip to Central or South America, we had accumulated enough American Airlines Aadvantage points from the welcome bonuses offered by a pair of Citi credit cards to cover the entire cost for our family of four, saving more than $3,000 on these flights.

About One World Surgery

Currently, One World Surgery operates in one site — the Holy Family Surgical Center at NPH Honduras, but there are plans for a second site at NPH Dominican Republic and there is a vision to help as many people as possible with additional sites in the future. It started with a trailer. Simple surgeries performed at NPH Honduras in a converted semi-trailer. Don’t ask me how. The people to ask would be Dr. Peter Daly, an orthopedic surgeon from St. Paul, Minnesota who started coming to NPH when he was about my age, and his wife LuLu, who shared his vision. Together, they found a way to build a modern clinic, a three-OR surgical center complete with “overnight” bays that provide around the clock care for more patients, and an amazing center to house all the people who come by the dozens every other week throughout much of the year.

We were fortunate to join a brigade attended by the Dalys. That’s not remotely unusual, since they make the commute from Minnesota most months, but the fact that we were also joined by their extended family did make this particular week rather special. Their son, Father Michael Daly, delivered the optional Saturday evening mass to a couple hundred Pequeños and us, and our son was able to take his first communion from him (his older brother took his at Notre Dame in Paris last year). LuLu’s 86-year old mother came for the first time ever and was joined by three of her children, including Dr. Rocky Romano who also happens to be an orthopedic surgeon.

The Romanos are an Italian family from Chicago and much to our delight, they were intimately involved in the planning and preparation of our evening dinners. We feasted on fantastic Honduran Italian meals throughout the week. I don’t think I failed to come back for seconds a single night. Our accommodations were in a recently built complex that housed all of the participants. Our room had four beds, a desk and chair, a bathroom with dual sinks, a walk-in shower, and a small “water closet.” With screened windows in both the front and back, the rooms are well-ventilated. The vaulted ceilings, complete with a ceiling fan, are extraordinarily tall. The brick, tile, and woodwork were clearly the work of skilled craftsman.

It almost felt like we were living a little too well in this impoverished country, but we learned that hospitality is an important part of gaining repeat visitors. We may have been “robbed” of an authentic Honduran experience, although the four of us each took cold showers until we figured out how to work the handle to get hot water, but I’ll admit it really was nice to come back to a comfortable, well-appointed place after a busy day on the ranch.

My Week in a Honduran Surgical Center

Claire, the friendly One World Surgery volunteer coordinator, met us at the airport with boxes of pizza and helped ensure we all made it safely to the ranch. We arrived at NPH Honduras Saturday afternoon after a one-hour bus ride in which we got to know a handful of people sitting near us. While the volunteers came from around the U.S., most seemed to have ties to either California or Minnesota. Most of our orthopedic surgeons (I believe we had 9) came from the Sacramento area, and Dr. Daly’s influence explains the high prevalence of those of us from the Land of 10,000 Lakes, including a nursing student who has a family cabin on the same lake where my parents live. Small world. On Sunday, Dr. Daly led a group of us on a five-mile jog around the hilly compound. That was my first clue that we might be working hard, not that I expected anything different. That afternoon, we made the 10-minute walk to the surgical center for a group orientation. We sat down with the surgeons and learned a little more about the types of cases we could expect. We had one pediatric general surgeon (not coincidentally, the mother of our volunteer coordinator, Claire) and a whole bunch of orthopedic surgeons. With a knowledge of the cases ahead of us, we were then let loose to explore the operating rooms and gather our supplies. We found everything we would need to provide high-quality anesthesia care, including a Glidescope, small Sonosite ultrasound, Datex-Ohmeda anesthesia machines, and all the drugs and needles of every gauge and length we could want. Of the three anesthesiologists on the trip, I had more recent and frequent experience with pediatrics, so I offered to do the first peds room, but Monday would be all ortho. None of us were chomping at the bit to be in the complex ortho trauma room, so that assignment went to the loser of a high stakes round of paper-rock-scissors.

We worked with two Honduran anesthesia providers, which was interesting due to the language barrier and not knowing their skillsets, but apparently, they work independently when we’re not around. Their presence was a blessing, as it gave us the freedom to leave the room at times to see our next patients, perform peripheral nerve blocks, and check on our colleague in Room 3, the complex ortho trauma room. I think I spent as much time in that room as my own room on Monday morning. We weren’t dealing with fresh trauma. These were mostly patients with a long history of numerous operations on femurs shattered by bullets or motorcycle mishaps who now had infected hardware requiring removal, replacement, and extensive debridement. But they were trauma cases nonetheless. We learned this as our first patient was well into his second liter of blood loss, laying on his side in a lateral position, with veins scarred down from dozens of prior surgeries and only one 18-gauge IV through which we could fluid-resuscitate him. With one of our surgeons pulling back the shoulder, me holding the ultrasound probe just over the collapsing left internal jugular vein, the paper-rock-scissors-losing anesthesiologist managed to place a central line through which we were able to transfuse blood, IV fluids, and medications to support his blood pressure while we got caught up. I knew there would be challenges on this trip. I expected them to come in the form of a lack of drugs or equipment or perhaps patients with chronic illnesses who don’t see doctors and have blood pressures or blood sugars completely out of control. Neither of those issues surfaced; the challenge came from the complexity of the ortho trauma cases, but once we know what to expect, we were better equipped to handle them. Each day, the room had two cases. I took my turn in there on Wednesday and things went pretty well. I volunteered to cover the room again Friday when we brought back two of the more complex patients from earlier in the week for repeat procedures. The patients we cared for had nowhere else to turn. In Honduras, if you can’t afford to pay for your supplies, including suture, implants, and medications, you can’t have surgery. The facility now has a waiting list of patients thousands deep who have been seen in clinic and would benefit from surgery. I spoke with one of the surgeons who saw dozens of hip fractures one day in clinic. The patients were non-weight-bearing and the patients had been injured, on average, 13 months ago. In America, many will get their fractured hips repaired within 13 hours. Let that sink in. In the pediatric room, we performed a number of orchipexies for undescended testicles in boys 7 to 9 years old. When caught earlier in life, as they would be back home, the chance for a fully functional testis is significantly higher. If left untreated (and undescended), the risk of testicular cancer goes up substantially. Although earlier intervention would be ideal, we were giving these boys a better hope of becoming a father some day and a lower risk of becoming a cancer victim. These surgeries are life-changing.

A Typical Day with One World Surgery

I woke up at 0530 on a bed with no blanket (a sheet is all you need), took a quick shower, and made the ten-minute walk past the grazing cows to arrive at the surgery center by 0600. I would gather the necessary supplies for the day’s cases, prepare my room, and see my first patient.

We worked with excellent interpreters, a couple of whom were Honduran physicians who were unable to find adequate employment as doctors. In Honduras, you can either work for the government or go into private practice. To do the latter in a safe way, a security guard is a requirement, and few Honduran doctors will earn enough to pay themselves a fair wage and afford private security. Peripheral nerve blocks were usually done in the recovery room prior to surgery. I performed quite a few ultrasound-guided interscalene, fascia iliaca, adductor canal, and femoral nerve blocks for the predominantly orthopedic patient population. One of my blocks was performed with me crouched down next to my patient’s bed, which was a mattress on the floor.

The first patient was to be in the operating room by 0700, and we usually hit that mark or were very close to it. The trauma room typically had two patients per day. The sports room (mostly repairs of old rotator cuff tears and ACL or multiple ligament tears) would have four or five scheduled cases, and the pediatric room would care for six to eight patients each day. Breakfast and lunch were served in the break room downstairs, and when I was able to sneak down there, I was often greeted by my wife and kids who were volunteering. That was a fun interlude in my day.

Most days were roughly 12-hour days for the anesthesia crew, give or take an hour or two. Wednesday is a scheduled “half-day,” which is a bit of a misnomer as it was a 10.5 hour day for me, but they do make an effort to get everyone out earlier to interact with the kids in the afternoon before dinner. Normally, there is a Wednesday soccer match featuring the volunteers versus the hermanos (children), but we were treated to a special celebration that day honoring Stefan Feuerstein — a man who made Oprah’s Supersoul 100 list — it was his 10th anniversary working as director with the Ranch. Our boys had fun playing with the local children, running from them, running after them, and taking part in the same games, one of which included a machete. Fortunately, the children are well supervised by volunteers. One of the local girls spent most of the afternoon in my wife’s lap, occasionally chased after our boys, and ended up being “adopted” by us as her American Godparents. We sponsor her by sending money monthly to support her and the ranch. Like our family’s $2,000 admission fee, this money comes directly from our donor advised fund.

In the evenings, all of the American volunteers on the brigade, along with some of the international volunteers on extended stays, and the more permanent staff would gather to share a hearty communal dinner. After dinner, we would get our boys to bed and return to the conference center hall for a presentation on the history and mission of the center or fun group activity. Carlos started us off with a great rendition of Frank Sinatra’s My Way on karaoke night. Beer and wine is available with dinner and there’s enough for the grownups to have one or two beverages a night. On Friday night, when our work was done, we felt we had earned the right to an extra ration or two and we were graciously accommodated.