March 17-20, 2011 Medical Team Visits From The USA and Performs Surgeries In Choluteca

This weekend was a busy weekend.

To start the weekend off right 3 of the 4 team members were coming out of Michigan and their plane didn't fly out so they missed their connection to Tegucigalpa.  Those things rarely happen, but when they do it can wreck havoc with good plans.  

So I breathed deeply and went to the airport 3 hours early because of an immanent teachers strike. Also not on my agenda, by the way... Since the hospital is over a two hour drive from Tegucigalpa, in Choluteca... That means that between Thursday morning at 7:30 am and 9:00 am I had to rearrange all land travel arrangements... Whew, but I got that done... then I had to get to the airport before the teachers which are on strike did...

But did I tell you that the air-conditioning on the Ford F-350 decided to start blowing a musty smell on Monday afternoon when I was going to get it washed, so I took it to the shop and they said 3 days to fix it... Which obviously was too late for my Thursday team... 

So I scrambled and found someone else to fix it for a mere $500 and some change... and it was supposed to be ready Wednesday afternoon, but wasn't because the part didn't arrive from San Pedro Sula on Wednesday morning like it was supposed to arrive.  The part arrived Thursday morning as I was fixing everything else which went wrong...

I went to the airport, the coast was clear, no rioting teachers near the airport... 

Remaining in contact with the air-conditioning people by cell telephone, I left the airport, to pick up the truck which was now supposed to be ready at 12:00.  Remember the flight of my medical team of four, which now consisted of the one lonely doctor, was set to arrive at 12:10... Several blocks and several traffic jams away from the air-conditioning place.  

Things were not looking good.  But remember it is only 9:10 because I had to go to the airport really early because of the teacher's strike.  Remember also that I have had to make arrangements for another car and driver for Friday for the people who missed their flight.  What a mess.  Jose has agreed to take the people south on Friday, but when he was driving his car through the mountains the other day, the hood flew up, nailed the windshield and broke it all the way up and down and across.  So I needed to help him with the logistics for a new windshield.  After all we don't want gringos in a car with a totally fractured windshield.  So, off we go to get a new windshield put in... They say 45 minutes, so by now it is 10:30ish and 45 minutes puts us at 11:15 which is not cutting it too close.  That gives us an hour to pick up the Ford and get to the airport, right? WRONG! 

see the rest of the story below...

 

Dr. Margaret Lee on the left

Dr. Lee, who came all the way from Hawaii, of course was on time and now due to the problems with the plane in Michigan she would have to surgery without English speaking nurses to help.  Not an ideal situation, because that means I have to stay pretty much tied down in the OR translating.

The first patient is ready to go, but the hospital is a little short on staff, since we had planned to bring our own nurses...

Another patient ready to go...

This time we did varicose vein surgery on several patients.

See the tumor on his head?

Now you see it but later we took it off... 

I am not sure I would be smiling so big going into surgery, but he was happy!

Another vein patient, patiently waiting her turn...

Another vein patient... She had big wads of veins on her legs... 

I know they must have hurt her...

Dr. Lee performing vein surgery

These make me think they hurt just to look at them.

I think she does this to make them not bleed so much...

The room filled up with student nurses...

We ended up having plenty of help in spite of the fact that our nurses arrived a day late.

Another patient..

Friday was "Fix a Hernia" day...

All these patients patiently waited their turn...

Things were slower with me interpreting, so they had to wait a while...

She was really happy about her exam...

Finally, Friday afternoon Dr. Adam Nofziger who is an ER doc and the two nurses arrived. Remember, they are the ones who got stuck in Michigan!

He worked in the ER.  I sure hope he will be back... I think he liked it, maybe! 

Left Danielle Dymora, Center Jamie Schwartz, Right Dr. Adam Nofziger

Having a cup of coffee before leaving for the hospital.

So the guys which are fixing the windshield now have it almost out and the 45 minutes have passed... I am panicking by now... So I ask... when?  "Oh, it takes 1 hour 45 minutes or maybe 2 hours."

By now, I am about to flip my top, but I smile and I call Jose...

He comes to where I am to pick up the money for the truck air-conditioner and goes and pays them and they are ready early... if you don't consider the fact that the car was supposed to be ready yesterday.  

So by now it is 11:30...  He then comes and gives me the Ford and I leave for the airport and he stays with the car which is getting the 45 minute windshield job...

So to make a long story short, I am at the airport and see the plane land...

The lines at immigration were backed up so Dr. Lee didn't walk out to meet me until 12:50...

Whew, what a day!

But everything was great from there on.

Great team, great patients, great Honduran volunteers at the hospital, great spiritual weekend...

Oh, by the way about 30 minutes out of town the air-conditioner started blowing REALLY hot air...  So next week it goes to the shop again...

When you think about it, pray for your friends who are missionaries in third world countries.  We have to wade through tons of problems to get anything done... Every day is a challenge, but the up side is there are lots of blessings along the way.

May 13-17, 2010 General Surgery Team In Choluteca, Honduras

Local nurses who always help us!

The lights went out.

And then they went out again!

This little girl received a glove balloon., the local nurses meanwhile were surprised that we did this.

It turned out to be a fatty mass.

Our table for the cautery machine has four broken legs.

In a hospital when you have a broken leg, you fix it.

A new use for casting material.

One of our patients with David the anesthetist which helps our teams.

Dr. Yeu-Tsu Margaret Lee (left)and Melba Manuel (right)

13 PEOPLE RECEIVE MUCH NEEDED HERNIA SURGERY

Dr. Lee arrived at the airport in Tegucigalpa after spending the night in the airport in Miami after she flew all the way from Hawaii to help Hondurans in need of hernia surgery. When her plane landed, I was waiting for her inside the area where arriving passengers go through immigration. When she came down the escalator she looked refreshed and ready to start surgeries. She curls up in a ball and sleeps anywhere. She never gets excited about anything and she is a picture of peace.

I had deliberately notified only 25 of the hernia patients which I have on my list, knowing that more would show up unannounced and knowing that the local doctors from Choluteca would have even more waiting for her when she arrived.

When we arrived at the hospital, the exam room was not open, so she had to start seeing patients on the front porch. Before long the keys arrived to open the exam room and things became less complicated. By the time she finished interviewing the patients, it was time to start surgeries, or was it? We arrived at the surgical operating rooms to be met with the news that:

1. There are NO clean patient gowns
2. There are 3 emergency cesarean sections, one in progress (twins)
3. There are 2 emergency appendicitis surgeries
4. There are not enough nurses to help Dr. Lee
5. There are not enough operating rooms because of all the emergencies so we have to wait

And wait we did and WE WAITED AND WAITED AND WAITED SOME MORE! By 7:00 PM the first surgery room finally opened up, but we had to “punt” in order to complete the first two surgeries. We used hospital instruments, since the “lady” who sterilizes the instruments was no where to be found. Somehow we made it through the first 2 surgeries before more emergencies came in. We called it a night at about 10:00 PM and went to the hotel. We figured bright and early the next morning we would start again. BUT…. It was not to be! When we arrived there were yet another two cesarean sections and several other emergency type surgeries, including a woman who had just had a baby and was bleeding to death. She was sent from another hospital about 30 minutes up the road, after they ran out of blood. So there we were, in the middle of all this, already 5 patients behind schedule and what does Dr. Lee do? She lays down, puts her feet in the air and sleeps.

Dr. Lee is efficient, meticulous, a teacher and has over 50 years of surgical experience. In the less than perfect conditions she thrives. She has a philosophy that everything will work out and it does.

Lights went on and off several times, helpers in the operating room changed more than several times, there were so many emergencies that there was no operating room several times, it was hot, the food arrived late, the recovery room was full, there were no patient gowns at times, there were no doctor surgery gowns at times, the instruments were NOT sterilized on time, just about anything that could go wrong, tried to present itself during this weekend. BUT all turned out well and 13 patients received hernia surgery. Thank you Dr. Lee!

Sometimes I feel really challenged working in a third world hospital, sometimes, I want to throw in the towel, but always I warn my team participants that there is only one thing which you can count on in Honduras and that is, “NOTHING EVER GOES AS PLANNED IN HONDURAS!”

Macadamia Nut Cheesecake and .......

Several weeks or was it months ago, September 24th to be exact, I promised to post my Macadamia Cheesecake Recipe. Well here it is. Thanks to Dr. Yeu-Tsu Margaret Lee a General Surgeon Volunteer from Hawaii, I had the incredible blessing of owning Macadamia Nuts for the first time in four or five years!

Photo is not mine it was borrowed from: http://www.mainmainmasakmasak.wordpress.com/

When Dr. Yeu-Tsu Margaret Lee arrived for the Medical Missions trip in September she brought with her a HUGE bag of Macadamia nuts. I was so excited, I wanted to cancel the medical team and go home to bake, but alas it was not to be.

The team was full of adventure and was well worth the effort, but after I dropped her off at the airport, I went home to make Macadamia Cheesecake.

White Chocolate Macadamia Nut Cheese Cake

White chocolate adds to the creamy texture and rich flavor of this cheesecake. I have no idea where I found the recipe, it was cut out of a magazine years ago and I just cut around the recipe and didn't save the magazine name.

1 ½ cups of chocolate wafer crumbs (since I can’t get those in Honduras I use graham cracker crumbs)
1 ½ cups chopped Macadamia Nuts, divided use
¾ cup real butter, divided use
¼ teaspoon ground cinnamon
4 packages of cream cheese (8 ounces each)
¼ cup firmly packed brown sugar
4 large eggs
¾ pound white chocolate melted
1 tablespoon liqueur (I use Grand Marnier)
2 teaspoons almond extract (the recipe calls for vanilla, but I like almond better)
2 tablespoons semi sweet chocolate chips melted (I skip this as I like the white chocolate flavor alone)

Combine chocolate wafer crumbs, ½ cup of Macadamia Nuts, ¼ cup of melted butter, and cinnamon and mix well. Press into the bottom of a 9” springform pan. Bake 10 minutes and then cool.

Beat softened cream cheese until it is fluffy. Add eggs one at a time. Mix after each addition. Stir in ½ cup of softened but not melted butter. Add melted white chocolate, liqueur and almond flavoring. Mix well. Fold in remaining Macadamia Nuts. Pour into the cooled crust.

Bake for 1 ½ hours at 300 degrees or until the center is set. Turn the oven off, open the oven door and let the cheesecake cool while in the oven. Cover and place in the refrigerator for at least 3 hours. This is the hardest part! Serve with melted chocolate poured over the top.

Dr. Chung's Letter To His Friends About the Medical Team Trip to Honduras

Dear Friends:

I just came back from a Honduras Mission. This is the summary of my trip.

On 9-24-08, I left DFW at 6:30 a.m. to Houston and to Tegucigalpa. I arrived there around noon. We, a general surgeon from Honolulu, Dr. Lee, retired Nurse Val Miller, and myself were met by Teresa, local missionary coordinator from Kansas City. We arrived at the Hotel around 4 p.m.

We got to the Hospital around 4:30 p.m. At the clinic, a Honduran Doctor was screening patients for possible surgery. Teresa told me that the surgical team was waiting at the operating room. I looked at a few patients and decided to do 2 thyroidectomies that night. I went to the operating room and asked them where I could change my clothes. They told me to go to the bathroom. It was wet and dirty. I had a very hard time changing to the surgical scrub suit.

At 6 p.m., we started the surgery and finished around 10 p.m. Dr. Barahona, a Honduran general surgeon, helped me. After surgery, we went to the hotel, had dinner and rested.

On 9-25-08, at 7 a.m., I went to the hospital to make rounds. I started surgery at 7:55 a.m. Had 3 thyroidectomies, one septoplasty, one nasal polyps, 2 cases of facial lesions and saw 12 clinic patients. I had one ENT Doctor and 3 general surgeons that came in turns and helped me. Lunch was brought in. At 9 P.M., the hospital told me that unless it is an emergency, I would have to stop. So went to the hotel, had dinner and rested.

On 9-26-08, I went to the Hospital to make rounds and went to the operating room. They didn't have gowns to work with. The laundry finally came around 8:45. We started surgery at 9 a.m. The first case had such a large thyroid, it took us ( Dr. Barahona & me) 3 hours. It was as big as a tennis ball. Another General Surgeon helped on the next 2 thyroids. Then I did one Septal surgery. At 6 p.m., there was only one anesthesiologist. Dr. Lee needed to do several hernias and I couldn't operate, so I went to the Hotel at 6 p.m.

On 9-27-08, I went to the hospital at 7 a.m., made rounds and went to the operating room. They didn't have gowns again. We had to wait until after 10 a.m. when gowns came. We started surgery at 11 a.m. I finished one thyroid and was just finishing septal surgery at 5:30 p.m., a thunderstorm came and the operating room was flooded. We all pitched in to sweep out the water. Then we went to the hotel to eat dinner. Came back to hospital and started another thyroid surgery at 8 p.m. It was so large, like a tennis ball. I finished at 11 p.m. and went to the hotel to rest.

On 9-28-08, I went to the hospital to make rounds and left Choluteca at 8:30 a..m. to go to the Airport. After I checked in, I had only 30 minutes to spare to board the plane. I arrived at DFW at 6:30 p.m.

The problems we faced at the hospital were these: I had only one head cover and one mask for all 4 days of surgeries. No shoe covers. I used one cautery pad for all these cases. No extra EKG pads and we had to use 3 pads for all of those patients. We had to put gel on them and tape them to the patients. Cautery machine didn't have a foot pedal and I couldn't do T&As. We had only one oxymeter sensor for the patient's finger and had to use the same one for all of those patients. The bathroom does not have any towels or tissue to wash your hands. Suction machines are barely acceptable.

The most amazing thing is that 2 anesthetists handled all these cases with no problems. I really appreciated them. There is no pre-op room. Patients are waiting outside of the operating room building in lawn chairs, with an IV and just sitting there.

Dr. Charles Chung

From the above letter, you can see a few of the problems which we face working in the public hospitals in Honduras. Some of the things he failed to mention are: Cats and dogs run freely through the halls of the hospitals, dead patients are placed in the hallways, there is no equipment or supplies, the patients have trouble with transportation, there are constant strikes with the nurses and doctors, just to name a few...

Just Another Uneventful Day In Honduras!

Valeria Miller, RN & Dr. Yeu-Tsu Margaret Lee were still sound asleep in their beds after working until 3:15 AM Saturday morning with the one team of local, Choluteca, dedicated nurses and CRNAs who stayed to help.


Dr. Margaret Lee is on the left (the short one) and Val Miller is on the right. (the tall one)

Everything seemed to be going well, at least in my dream, when all the niceness was interrupted by a call from a frustrated Dr. Chung. "No one speaks English here and I want to get started and there are no sterile gowns and, and, and ....." I immediately knew that it was to be one more uneventful day of surgery in Honduras. Dr. Chung was at the hospital chomping at the bit to start surgeries at 7:00 AM but it was not to be. The surgical gowns (photo above) didn't arrive clean and sterile until almost 11:00 AM. Dr. Chung was alert and ready to go, because he had returned to the hotel at 7:00 PM where the other surgeon could take her turn in the OR.



Due to one uncooperative local CRNA we were relegated to one surgery room and one team of surgeons the afternoon and evening on Thursday and Friday and it looked like Saturday was shaping up to be similar.



We were able to accomplish one surgery before lunch break on Friday, at which time the CRNA announced that she was taking a one hour lunch. I pleaded with Albertina Cruz to help, but she flatly refused. With no patience left and ready for a fight, instead of fighting, I did the next best thing and called the hospital director and reported her. The head nurse was sent to make a written report and the war was on. Albertina had refused to help the day before and we were way behind on the surgeries which we had promised to perform. Patients were losing patience! ... and so were we.



When the head nurse came and Doña Albertina realized that I was making a written report of her actions, or lack thereof, she walked out of the hospital NEVER to return. She left her post. She didn't talk to anyone, she just left. This is a HUMAN RIGHTS violation in Honduras, because she was the CRNA on duty for emergencies.



Evidently Albertina had been a bit of a problem since the beginning of her time at the hospital, but no one was willing to face the wrath of Albertina so they all walked around on eggshells and no one said anything. As I was writing my report with the head nurse, several of the nurses walked by and gave me the thumbs up sign and I was instantly a hero among her co-workers. All of the sudden, nurses and CRNAs who were NOT on duty began to show up to help. Albertina stuck her head out the door and I pointed to her with my finger and said, "She is the one."



Anyway, back to Saturday, when the telephone rang, it was almost 10:00 AM. I jumped out of bed, quickly ate my cold breakfast which I am sure was wonderful at the time when it was ready to eat at 7:00 AM. By the time I woke the other team members, the ones that had worked late, we were on schedule to arrive at the hospital a little before 11:00 AM. When we arrived the surgery gowns were STILL not clean and sterile from the night before. But, they arrived shortly thereafter and a frustrated Dr. Chung was able to get to work.



Everything went well after that until about 5:30 PM when we had a torrential rainfall and the entire OR flooded. Dr. Chung was a "trooper" and in the midst of all the water, he finished the surgery and then we unplugged all of the electrical cords in the OR. Dr. Chung worked perched on top of a wooded box as he used the cautery machine and finished the thyroid surgery.



Val and a local nurse then moved the patient to the flooded recovery room, photo on the left and then we all started cleaning up the mess.


Dr. Chung grabbed a broom and started working. For almost an hour we all cleaned and took photos of course.

When all of the water was finally out, I called a supper break and we left for the hotel to eat, while the floors were sanitized where we could start work again after supper.


We all arrived at the hotel, soaked to the bone, shoes wet, socks wet, pants bottoms wet and we were all tired, but exhilarated from all the excitement.


Dr. Charles Chung below, showing his broom expertise!

Sometimes I laugh when think about the differences in Mike and I. Mike would not have done very well in this particular situation. There were too many variables. Mike is Mr. Schedule, so the late surgical gowns would have driven him crazy. Mike is Mr. Plan Ahead, so the lack of having a backup plan in case of a flood would have driven him to drink. But the chances of a flood were so slim, who would have thought that you would need a backup plan.

Meanwhile, I laughed and waded through the situation along with my adventurous friends.


God makes each one of us different and I know that I am called to be here in Honduras living adventure after adventure, because I thrive on making sense out of the chaos.


When there is a crisis, I seem to be at my best. Many years ago I learned NOT to pray for patience, because the Bible says that tribulation makes us learn patience. I am not a fan of tribulation, so I don't pray for patience. However, I have learned through the tribulation which has passed my way unexpectedly that we can be happy and make the best of bad situations or we can grumble and complain and lose our chance to be blessed.



Dr. Yeu-Tsu Margaret Lee and Val Miller, RN smiling in the midst of our trial. Booties wet and no longer sterile, shoes wet, socks wet and still smiling!


I was taking the photo! SMILING of course!

Romans 5:3 but we glory in tribulations also: knowing that tribulation worketh patience;

Planned Chaos!!!!!

We arrived at the hospital a little late, but all was well. The flights came in on time and almost all went well at the airport as I picked up this week's 3 team members. Dr. Yeu-Tsu Margaret Lee came all the way from Hawaii on American Airlines and Valeria Miller and Dr. Charles Chung came in on Continental from Texas.

As usual CUSTOMS decided that they would confiscate or make me pay tax for the car parts for the FORD F-350 ministry truck, which Val brought down in her luggage. After a couple of minutes of wrangling and a firm look, they decided that in fact I did have a dispensa, as one of the guys remembered me from before and knew that it was useless to try to wait me out for a bribe. Finally the last few parts for the transmission arrived.

Then as we were closing up her bag, they discovered the Brianna's Poppy Seed Dressing. It was fun to try to explain why she was bringing poppy seed dressing to Honduras. I had sent Val a wish list and asked for my favorite dressing and for some really special vinegar which I use to cook with. She was wonderful and brought those things plus the car parts! Thank you Val!!!!

It has been years since I have been to Hawaii and Dr. Margaret brought me Macadamia Nuts. I have plans for those! A cheesecake with Macadamia Nut Crust! Maybe I will give you all the recipe the day I make it and dig it out of my archives. I still have recipes from Home Economics class in the early 1970s at Hall High School in Little Rock, Arkansas. I had a Home Ec teacher that was a wonderful cook. The thought of her makes me hungry for Mexican Wedding Cookies made from her recipe.

After finally getting cut loose by customs, we headed to a friend's Italian Restaurant to eat. While we ate, Jose went to downtown Tegucigalpa with the transmission parts to deliver them to the transmission guy. I had called him a few days earlier to have him meet me at the airport and then I called and reminded him at 10:00 am, but he never arrived. When I called him as we were leaving the airport he had a million excuses why he didn't make it to his scheduled appointment. So Jose had to leave the team and go to deliver the parts.

Upon his arrival, he wolfed down a few pieces of pizza and some lasagna and we were on our way to Choluteca.

When we arrived, it was the usual CHAOS at the hospital. There were lines of hungry patients and all were very impatient. Sandra from Caimito had arrived with several patients and was furious when I refused to see her patients first. The Hospital papers have a time sheet on them and so I go by the time the patient arrives and do not "play favorites". She demanded that I see her patients first and each time I politely refused until the last time, I said to her, "We are seeing the patients according to time of arrival." She then lied and stated that they had arrived at 6:30 am. I showed her the paperwork saying that they had arrived at 10:36 and 10:37 and she got mad and stormed out. She was obviously unaware that the paperwork was time stamped and that I would find out that she was lying.

Finally we had all the patients arranged and ready for surgery. Dr. Chung was already operating by the time we finished reviewing the general surgery patients. So we then went to start the General Surgeries, but they were doing an emergency c-section, so we played the waiting game, while Dr. Chung did his 2 thyroidectomies. A few hernia cases later and we were off to the Hotel Flamingo to rest for the night!