Editor: When I decided to become a physician, the main reason I chose to do so was to take part in mission work. It was also one of the reasons that I chose to become an anesthesiologist as we had more anesthesiologists in my department at Wake than some entire countries in Africa. This led to me doing some mission work in Ghana during residency.
To this day, I still have plans to engage in more mission work after my kids are a little bit older and I have the financial freedom to pay for these trips on my own without raising. In this WCI Saturday Selection, Dr. Dahleen describes his own experience with mission work while working for One World Surgery. This post was originally written by and published on Physician on FIRE.
Take it away, Leif!
For the last fifteen years or so, I’ve thought I ought to participate in a medical mission. “Someday, I’ll do that,” I figured.
In recent years, as I’ve contemplated taking an extended sabbatical that could become permanent, I realized I could be running out of time to take my skills to a part of the world where they’re more sorely needed.
I started researching options and reaching out to organizations, looking for an opportunity that would both allow me to offer my services as an anesthesiologist and allow my family to accompany me and volunteer in some other capacity. After all, one big reason I’ve decided to work less and perhaps not at all is to spend more time with my family before our boys are grown and on their own.
Finding the right opportunity took longer than I expected. Many of my e-mails went unanswered, and most groups that did get back to me were not interested in having my wife and children tag along.
My parents knew of our desires and learned that the daughter of a family friend had been on a trip to Honduras and nothing but good things to say about her trip, and families were welcome to join. I found the One World Surgery website and quickly realized that this was the place for us.
One World Surgery: My Week in Honduras on a Medical Mission
I was drawn to this particular organization because it is all about family. They not only allow medical personnel to bring their families, but actively encourage it and incentivize it in their fee structure. The surgeries are performed in a modern facility dubbed the Holy Family Surgical Center. By the end of the week, the 50 or so people in your brigade almost feel like family. You work together, dine together, and stay together in the Moscati Center in suites housing four or five people apiece.
Additionally, the surgical center, which could be more accurately described as a surgical hospital, is on the grounds of a 2,100 acre ranch called NPH Honduras. The NPH stands for Nuestros Pequeños Hermanos, Spanish for “our little brothers and sisters.”
Several hundred Honduran children and young adults who were previously without a safe place to call home live on the ranch. They are cared for by local staff and international volunteers and the children grow up together as one big family.
I loved the family focus of both the NPH site and the surgical mission, and the fact that it was in a Spanish speaking nation was an added bonus. We found a mission week that lined up well with our schedule, filled out a quick online application, and were approved to join the mission within a matter of hours.
Funding the Medical Mission Trip
To join a brigade, the term they use to describe the 20 or so week-long missions they have each year, the cost is $1,000 for the first person, $500 for an additional family member over 18, and $250 for additional family members under 18.
This is a tax-deductible donation that makes the brigades self-funded to cover the cost of local transportation, meals (and those were some tasty meals!), housing, etc…
Since I planned to take the standard deduction of $24,000 in 2018, the cost would not have been tax-deductible for us. Fortunately, I’ve been proactive and have already taken a deduction on the money I’ve donated to our donor advised fund, and we’ve put more than enough there to fund a trip like this a hundred times over.
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.
My Family’s Week with One World Surgery
While I was busy in the O.R., my wife and kids did their part around the ranch as general volunteers. The options for kids under 10 are limited, and child volunteers must remain with a parent, so they weren’t able to help with meals, the on-site tortilleria, or perform some of the other options available to older kids and adults.
They did, however, stay busy. At the surgery center kitchen, they would cheerfully bus and wash dishes, empty the garbage, and haul it up the hill to the incinerator. They spent two days cleaning out a sweltering storage room that was full of spiderwebs. They washed walls, scrubbed floors, and sweated like never before.
Other days, they played with the younger kids on the ranch, tiring them out before nap time, and there was an opportunity to rock babies to sleep, but they somehow missed out on that one. There were other little tasks at the surgery center, like putting tape over names on folders.Their favorite assignment was entertaining kids outside the clinic waiting room on the pediatric clinic day. They had some toys we had brought from home, and they played with Honduran kids of all ages.
We do a fair amount of family traveling (see our other travel posts), and we do have schoolwork to keep up with. Our boys are enrolled in public school, but we do some “roadschooling” when away, and with a sometimes halfway-decent wifi connection, they were able to log in and do their Khan Academy, Duolingo, and other computer work on their Chromebooks.
There were a handful of other kids about our boys’ ages and a little bit older, so they got to play with them in the evenings and make some new friends. At the end of the week, our sons wanted to know if we could come back again next year. That’s the sign of a successful trip.
Although they actually worked pretty hard, they really enjoyed their experience that week, which is exactly what we were hoping for. We also hope that spending a week among disadvantaged children in an impoverished country gives them a little perspective as to just how good their lot in life is, and that not everyone is so lucky.
The Amazing People of NPH Honduras
We met and got to know so many incredible people that week. It starts with Dr. Peter Daly and his wife LuLu. They first visited the ranch about fifteen years ago. There was a nine-year old girl with an orthopedic deformity of the legs that could only be fixed with a series of surgeries over the course of many months. They arranged to have the girl join them in Minnesota for the better part of a year, where she had each of the required operations and therapy, before returning to the home in Honduras.
When the Dalys returned to Honduras, they learned of a greater need for Hondurans both on and off the ranch who desperately needed surgical procedures. For seven or eight years, they made regular trips to perform procedures in a trailer which had been converted into a makeshift O.R. In 2009, the modern three O.R. facility was opened as a result of the impressive fundraising efforts of the Dalys, Reinhart Koehler (who helped found NPH Honduras in 1986 and has remained ever since), and others close to NPH.
Now, the Dalys make the commute to and from Honduras roughly ten times per year and remain very much involved in fundraising activities in Minnesota and throughout the United States. Dr. Daly has performed hundreds of surgeries at the center in Honduras and has helped recruit thousands of volunteers to join him in caring for those in need.
His wife LuLu joins the brigades, too, and works tirelessly to ensure the volunteers are well cared for. She, along with family and friends who joined her, prepared those scrumptious dinners every day, and regularly asked both my wife and I how things were going and if anything more could be done to keep us happy. Her energy and enthusiasm was infectious. You can get a sense of that in this youtube video in which she (in pink scrubs) and the surgical center staff have a lot of fun.
Before our trip, I heard we would have the chance to meet Dr. Merlin Antúnez, the orthopedic surgeon who grew up on the ranch with his siblings and now serves as the medical director of the surgical center. He operates most weeks, whether or not there is a volunteer brigade onsite, and he does the vast majority of the follow-up clinical care for patients who have had operations from all types of surgeons.
We not only got to meet Dr. Merlin, but I got to work with him in the O.R., dine with him in the conference center, and see him give a presentation after dinner. He and Dr. Daly expressed their gratitude to us personally every single day, and I don’t believe I’ve ever felt so appreciated for the work that I do. The U.S. mantra of “blame anesthesia” became “praise anesthesia” in Honduras, and I’ll admit it was an awfully good feeling.
Dr. Merlin came from humble beginnings; as a child, his mother was unable to care for him and his siblings. NPH took them in, raised them, educated them not only through high school, but also continued to pay for his tuition as far as he wanted to go, as they do for all of their former residents. In Dr. Merlin’s case, he went through medical school and an orthopedic surgerical residency, and returned to give back to the ranch.
His education continues as he gets to work with skilled surgeons from around the U.S. Before his arrival at NPH, he had no familiarity with arthroscopic surgery. Now, he is likely the most skilled arthroscopic surgeon in Honduras.There were so many other great people that I could continue this article indefinitely (but I won’t). I will say I was impressed by the volunteer staff who work with the kids for a minimum of 13 months at a time.
There was the orthopedic fellow who once ran a sub-fifteen-minute 5k. The orthopedic surgeon five years my senior who could easily retire based on his lucrative non-clinical business, but decided by the end of the week that he’d keep his license active to continue doing humanitarian work.
The surgeons who were returning for the third or fourth time. The PACU staff that worked long days and had no trouble keeping patients warm in an 85 to 90 degree recovery room (a temporary issue). The volunteer and local clinical staff, and the general volunteers on the brigade. So many generous and inspiring people.
If you’re not inspired yet, watch Kevin’s story, starring the young man, Drs. Daly and Merlin, Miriam and others, of surviving gun violence and getting the help he desperately needed from One World Surgery (see additional videos here). His story is one of hundreds just like it.
My family and I returned to Honduras on a second brigade from May 11th to May 18th, 2019. The Doc of All Tradez joined us, and wrote about his experience in 9 Reasons to Go On a Medical Mission and 1 Reason to Not Go.
The good people at One World Surgery are always looking for volunteers in the following areas:
- O.R. circulating nurses
- Scrub nurses and/or scrub techs
- Preop nurses
- PACU nurses
- Sterile Processing
- General volunteers (typically spouses or children of clinical support)
If you are at all interested, please express your interest in an email to medicalmissions(at) oneworldsurgery (dot) org.