I know I am back in Guatemala when, as I look out from the open window of the bus, a cute little toddler balanced on the front of a motorcycle waves at me as she goes by. The helmeted rider keeps hold of the child with one hand while weaving through the snarl of traffic. It’s no surprise that so many of the trauma cases we see here are the result of motor vehicle accidents. It takes us an hour or so to cover the 25 miles to the Old City—Antigua–that Spanish colonists built to rival any city of 16th century Europe. The hospital where we are to work, the Obras Sociales del Santo Hermano Pedro was commissioned for the medical care of religious orders in 1653. Since then the building has been damaged by earthquakes and rebuilt many times. In 1983 it was entrusted to the Franciscans, and in 1991 Brother Guillermo met Todd Collier of Memorial Drive Presbyterian Church, Houston. Todd transmitted Br. Guillermo’s call for help to Joe and Vera Wiatt, and Faith In Practice was conceived.
The Obras building is much the same as last year, although there has been one improvement: Jose the in-house physical therapist got his wish of a larger area in which to work with patients. He is happy to show us where some walls have been removed to remodel the space. He has a treadmill, a stationary bike and some other basic equipment, as well as more open floor space than before. The Obras still has no ice machine to ice patients’ surgical sites post-op. The co-ed bathrooms are still difficult to enter and exit for patients carrying their toilet paper as they push their walkers.
Unforgettable sights this week include the 84 year-old woman carried into the mobility clinic with her one leg dangling. A tall teenager with long, dangling legs is also almost dragged in by a volunteer who is barely taller than the boy he carries. There is a pretty three year-old girl whose four limbs are all malformed. She is very active and has no cognitive impairment. She is delighted with her new, child-sized wheelchair and climbs up into it by herself.
Without any assistive equipment, these patients of all ages and sizes until now were relying on their caregivers to pick them up and carry them anywhere they needed to go. The remarkable thing, according to Dr. Adam Schindler, a hospitalist on his first mission trip with FIP is that these people do not present with bed sores (pressure ulcers), which are common in the U.S. for patients in similar condition. Dr. Schindler concludes that the families are caring for their disabled relatives assiduously, making sure to move them constantly. When these people receive a wheelchair or a walker, not only their lives but the lives of their caretakers are transformed. Dr. Schindler and Dr. Michael Bubis covered the mobility clinic intake assessments this week, with PT Jill Crary. This week they assessed and helped 155 patients.
In order for this to be possible, ten times that number of patients were previously evaluated in farflung districts of Guatemala by local volunteers, most of whom were once FIP patients themselves. One, a cancer survivor whose face was reconstructed by a FIP plastics team has been volunteering for the past 18 years. He says that he is now grateful to God for his cancer, because without it he would not have had the opportunity to help the thousands of people he has since brought to the Obras. Another patient-turned-volunteer arrives at the Obras on a three-wheeled motorcycle, with her folding wheelchair mounted on the back. She works every day, all week, helping assemble new wheelchairs that are shipped disassembled in boxes direct from the manufacturer, along with U.S. volunteer assemblers Stephanie McSpadden, David Seeley and Valerie Zakarevicz.
Later in the week, outside the mobility clinic, a lady is talking excitedly, hugging and kissing all of us. We get first-time volunteer Margarita Ortiz to translate, and we find that the lady is saying how grateful she is for the FIP team that operated on her eye two years ago. This week she is back at the Obras with her husband, who is in line for a wheelchair.
On the surgical side of the mission, during triage on Sunday in Dr. Jack Dawson’s room, we recognize Carlos, whom Dr. Dawson operated on last year. Carlos injured his femur and knee in a motorcycle accident in 2017. He is presenting for follow-up and becomes emotional as he relates how much better his life has been this past year, compared to the half dozen years he spent as a cripple. He goes to each of us to shake our hands before leaving the room. So many trauma cases here are, like Carlos, young men who can no longer work to support their families if they are not able to use their arms or legs. Regaining the use of their limbs means being able to put food on the table for their children.
Another patient we see on Sunday has warped hardware from a previous surgery pushing out from under her skin like a scene from the movie Alien, grotesquely deforming her shoulder. She has been living with that condition for two years. But by Wednesday her shoulder is fixed, and she is discharged to go home.
Jessi Ivie, the veteran volunteer from Dallas is back this week to do post-op physical therapy, and she has recruited her colleague Esmeralda Moore to join the team. Esme is impressed by the willingness of her Guatemalan patients to attempt all the movements she asks them to try, on their first post-op day. One lady in her seventies feels faint, probably due to dehydration, and she must lie down again, but she too does her best to comply with the effort requested. Jessi mentions that some patients need assitive equipment post-op to use at home while they recover, but the policy of the Obras is to have them buy their own wheelchairs and walkers. So, on the other side of the building, Jose, the in-house physical therapist talks to Jocelyn, the in-house mobility clinic coordinator, to make sure that FIP patients are able to sign up for FIP-donated equipment.
Conversely, some patients referred from the outlying villages for wheelchairs turn out upon examination to be candidates for surgery. We are able to tell them that yes, they can have a free wheelchair, but, even better, we can fix their problem so that they won’t need the wheelchair anymore.
Some conditions, however, are more difficult to take care of. In the small isolation room with the crucifix next to the paper towel dispenser, a man whose infected leg needed debridement waits post-op to see if his cultures will come back negative. When Esme gets him up and walking, he heads for the painting of Jesus in the alcove by the unloading dock and pauses to bow his head and pray. Then he tells us he is grateful for the support FIP has provided as he has battled this recurring infection for the past seven years. Most of the trauma patients seen by Dr. Dawson do present originally with at least one prior surgical intervention that was done at the time of their accident, in a public hospital. If an infection sets in, it can be very difficult to eradicate completely. This week, Dr. Dawson and his Resident, Dr. Okpara did 14 trauma surgeries, with RN Janelly Banda and scrub tech Jose Torres.
Many of the joint replacement cases, on the other hand, are for similar issues as seen in the U.S., although they become more complex the longer patients continue to live without the necessary intervention. This week, Drs. Justin Dunn, Brock Howell (with RN J.P. Pemberton), Joshua McSpadden and Matthew Nies (RN Asmahan Daood) performed 31 knee replacements.
One type of case that is no longer seen in first world countries is adult hip dysplasia, which is still common here. In the U.S., babies are routinely screened for this condition. If detected in infancy, it can be treated by fitting the baby with a corrective sling, and no surgery will ever be needed. But, untreated, children grow up with a crippling malformation that ends up requiring a hip replacement. This week Dr. Kate Cahill, her Fellow Dr. Todd Pierce, P.A. Devin Zakarevicz and scrub tech Sean Fink did 14 hip replacements.
Dr. Michael Johnson did 13 foot and ankle surgeries, with RNs Joanne Fowler and Nancy Rove.
Dr. Mark Woolf, veteran of more FIP mission trips than he can count, retired from practice in the U.S. last year. FIP requires surgeons to be currently practicing in their home country. Post-retirement they can continue for only one year to volunteer as lead surgeons, although afterwards they can return to assist. Dr. Woolf on Thursday performed his last total knee replacement here at the Obras.
Shout out to the three other RNs: Ashley Bartholomew, Kristi Ditmarson and Robin Rogers, and scrub tech Jessica Lieffort.
Dr. Tony Kim headed up the anesthesia team, alongside Drs. Jaime Ortiz and Joe Fowler, and first-time volunteers Dr. Ed Yang and Baylor Resident Dr. Navid Darayan, with CRNAs Becky Stevens and Wendy Vences.
Post-surgery care in the PACU was provided by RNs Danielle Nies, Bailee Potts, Ruth Potts and Kyle Thurman. Our pharmacist was first-timer Michael Newman.
Many thanks to Zimmer Biomed and engineers Melinda Coleman, Timothy Hostetler and David Stafford. And extra special thanks to our Team Administrator, Ryan Richardson, of Stryker, who organized this trip for us.
-Courtney Kim
