Wednesday, September 14, 2011

El Salvador, part 1

I'm back! I'm exhausted. I tried to write this post the other day but I came down with a weird post-traveling illness (?) of flu-like symptoms and dizziness which forced me to listlessly lay around my apartment and wish for waffles.
But I'm better now. Just tired, still.

And I have much to tell!
The trip was amazing and wonderful overall and also of course parts of it were rather sad and thought provoking.

But perhaps I should start at the beginning.

I've told you a bit about my dad, but have I mentioned that he is a bone surgeon by trade? He is. And he's really good.

He's also really good. As in, he uses his vacation time to fly to places like Tanzania and Nicaragua and perform surgeries for free there. He signed up for a trip to El Salvador with this organization, Operati0n Rainb0w (you can find them, I just don't want people googling them and getting this blog), and invited me to go with him and work as a nurse. And of course I said yes.

So off we went!

We met up with our group at the airport on Friday night at about 9:30 pm. We all had our various carry on bags and we had to check in as a group since our checked luggage was giant duffel bags loaded with medical supplies-- surgical instruments, medications, bandages, drills, saws, etc. Our flight left at midnight and arrived in San Salvador only two hours after its scheduled arrival because one of the passengers got sick and we had to emergency land in Mexico City and then take off again. Because, of course.
But! We arrived in San Salvador! We had made it!
Except apparently it is very difficult to enter a country with 30 duffel bags full of knives and drugs and we were missing one of the documents we needed. Operati0n Rainb0w is very experienced and organized-- they had been working with the El Salvadorian government for months, but apparently a new rule had just been enacted so we needed some extra document, which we didn't have. Which meant we couldn't leave. So we hung out at the airport for a couple hours.
We finally made it through, had a quick lunch at a nearby hotel (and picked up a couple more members of our team), and then took a two hour bus ride to San Miguel. I was very, very happy to arrive in San Miguel.

We had a late dinner that night and got to know each other a little bit. The team included 26 people. There were 6 surgeons, plus anesthesiologists, operating room nurses, recovery room nurses, a physical therapist, several translators, and a few volunteers without a specific job who were eager to learn (me). Everyone on the trip was incredibly nice, as you might imagine, given that they were all using their vacation time and spending their own money to journey to a foreign land and work for free.

This was the first mission in 5 years to El Salvador (apparently the government wouldn't let Operati0n Rainb0w go there until now because it was too dangerous) and the team planned to spend the week as follows:
Sunday- Clinic. See all the potential patients and decide which ones they could help with surgery and what the rest of the week's schedule would be.
Monday, Tuesday, Wednesday, Thursday- Surgeries
Friday- Rounds. Visit all the patients and discuss with the local doctors the plan of care for all of them after we left (when to take the casts off, etc).

Sounds relatively simple, right? WRONG.
Before we arrived we had basically no information about the types of patients they would be seeing, which meant that the people that packed had to pretty much make educated guesses regarding what kind of equipment to bring. They brought a variety of stuff-- saws, drills, wires, screws, pins, plates-- but it was all in a limited amount, of course. Throughout the week I kept hearing stories about how the surgeons had to MacGyver together their equipment in creative ways to make it work. ALSO, we had six surgeons and 3 operating rooms, but there were certain things (like the drill and the saw) that could only be used in one room at a time. This meant that all of the surgeries of the day had to be scheduled so that the room that needed the drill had the drill and the other two rooms didn't need it. It was all sort of a logistical nightmare.

We were up bright and early on Sunday morning to hold our clinic day. This meant that the doctors saw hundreds of patients and had to assess them and decide which ones they could help with surgery and which ones didn't need surgery, or needed some other kind of surgery that they couldn't perform that week, or needed surgery but it would be too dangerous because of potential for infection.
Then, the doctors had a big discussion with the information from all of the potential surgery patients and came up with a schedule for the week.
This took a very long time and of course there were changes to it throughout the week.

Patients came from far and wide to see our team. There were children with bone deformities and club feet, people with growth problems, little old ladies with crippling arthritis, people in home made wheelchairs or hobbling in on the sides of their feet with their joints sticking out this way and that.
People traveled for hours and waited patiently, quietly, all day long just to see if their children might be able to have surgery.
Monday was our first surgery day. This was probably the day I felt most uncomfortable because I really didn't have a role yet. I put on my scrubs but then I just had to kind of wait around a lot of the morning while nurses ran around fetching supplies and the doctors prepped for surgery. I did a couple little paperworkey tasks and then in the afternoon I was able to help out (a little) and observe (mostly) in the OR.
Check out the X Rays above us-- those were the feetsies that were about to be operated on.

Tuesday I was asked to go on rounds with the doctors in the morning (to see the patients they had operated on the previous day) and to try and keep all the patients organized. I ended up mostly doing this for the rest of the week because there was actually a lot that needed to happen-- patients needed to know their care plans, some were in severe pain and needed stronger meds than the hospital had, the PT had to go see some of them and teach them range of motion exercises or how to use crutches, we needed blood tests or X rays for some patients, we needed traction for one, we needed a bed for another and on and on and on. I felt like I was kind of inventing my role at times and I wondered if I was being helpful but it really seemed like it should be somebody's job to coordinate all of these things and keeping all the post op patient care organized, especially since most of our team was in the OR all day. So I had my own little mini-team and we would go on a series of rounds all day long, checking on the (42 total) post op patients and tying up the various ends that came loose. It felt very nurse practitioney and I loved it.
Do you see those beautiful smiles? Totally worth the trip.

Part 2 forthcoming.