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Final Report

Dear Friends,

Our trip is over and I find the time and energy to write a final entry. A small group of us spent six intense days working together. Many of us did not know each other, but we came together, formed a tight knit group, and worked well as a team. All of our days were very long, leaving the hotel at 6:45 am and not returning until about 8:00 pm that evening. Who at home could work twelve to fourteen hour shifts six days straight? Not me 🙂Above is the line of patients waiting to be screened on our first day at the hospital. I do not have the actual numbers of patients screened but more showed then anticipated. The day was very hot and humid. People waited very patiently and the children were well behaved. No tears or misbehaving on their part, their need for treatment was very obvious and well appreciated.

As you can see above, our Honduras OR is very similar to our OR rooms at home. The equipment is a bit older, but so are the volunteers on this trip. Some of this equipment was used back in the good old days of our training. There was no problem figuring out how to use it!The electrical wiring was a bit questionable but worked just fine. No power outages this trip! As an OR nurse, it is my job to keep the room running smoothly and keeping all happy.Keeping in touch with your home base was another important part of this team. Here is a great image of our Catherine balancing home in Salt Lake with work in the OR on her Blackberry.

On the last night at dinner, each of us guessed the number of surgeries done on this trip. The official number is still unknown, as is the grand prize or the winner

In closing I would like to thank all the members of this team for a wonderful trip. I will miss you all. This team blended their talents together well and the final numbers should prove this statement.

My greatest respects to you all,

Annie

~Ann Spencer

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Honduras Workshop 2008

I always wax philosophical as we approach the end of an IVU-Med workshop. So many tragically deformed children treated but oh so many left who are in need. As is so often the case I find that I seem to learn as much as I teach and that the reward I receive personally far outweighs anything that I provide.

This trip is very exciting since our local peds surgeons/urologists continue to prove their interest, dedication and thirst for work. Other than lacking the materials, diagnostic aids and specialized colleagues and nurses their skills are impressive. It must be difficult for them to realize how challenging the lack of funds and hospital support stifles their efforts.

The other excitement is the presence of Founder Dr. C. Devries on the mission. I stand in awe of the woman´s brilliance as a physician and visionary who has accomplished great things in a short time. She provides the means for so many to obtain life altering and often life saving care which previously was only a dream. I thank her particularly for giving me and so many others the chance to give back. As one anesthesiologist said in response to the ubiquitous poverty “I wake every day and remind myself that I have won the lottery”. I have begun a campaign to have our founder canonized Saint Catherine of Salt Lake. Sadly me efforts have been unappreciated by the powers that be.

How has this trip been? Consider a great group of comrades all energized and tireless, incredible pathology and all day OR time, a tropical environment and the chance to help so many chilren needing our services. What’s not to like!?!? The real currency however comes from the smiling faces of the moms and kids being treated. They consider the presence of IVU a miracle. Thank you St. Catherine. Thanks also th our super Docs and nurses and to our Honduran hosts who always make me feel at home. Lily you are a wonderful childlife resource and have an unlimited potential to achieve greatness.

Adios,

John Gazak

~Ann Spencer

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Last Day in Honduras

Friday morning. It is the last work day here in San Pedro Sula for the team. I am Catherine deVries, founder of IVUmed. This has been a nostalgic trip for me, since this is the first place that I visited 16 years ago when Interplast’s founder, Don Laub, invited me on a surgical team trip. At that time, I was overwhelmed by everything. The poverty. The smells at the hospital. The long hours standing on our feet at the operating table. The long lines of patients who had traveled for days waiting to be seen.

Since then, much has changed here. The local nonprofit that we work with, the Ruth Paz Foundation, has become a highly efficient organization that runs everything from contacting the patients to long-term follow-up. They feed the team, arrange our transportation, and generally run the Honduran side of the show. We now have a team of Honduran surgeons that have developed excellent skills in pediatric urology. They just need a little tune-up on some specialized procedures, which is understandable, considering that in their practices, they cover the full range of pediatric surgical diseases and also practice general pediatrics. They are truly amazing. We have a group of volunteer anesthesiologists as well, and they help us to run the 3rd room.

Some things remain the same. The poverty. The exhaustion at the end of the day. And the wonderful sense comraderie between team members. The patients and their families are a great source of good spirit. They are doing well, even after some major operations. Lily keeps the kids entertained with games and art projects. We will be wrapping up the surgery this afternoon, but will stay in touch with the Honduran team by email throughout the year. It is sad to be leaving so soon. It feels like we just arrived and yet we can all feel the intensity of a week of 14 hour days in the OR in our knees and necks. It will be good to take a rest tomorrow.

~Ann Spencer

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Honduras

Hi, my name is Lily Morrison. I’m 14 years old, and I’ve never been on an IVUmed trip before. Neither have I ever written a blog. My job on the trip has basically been to keep the patients entertained, and help keep their minds off their surgeries. I’ve met tons amazing people over the last few days, kids who spend days in bed and are in so much pain but hardly complain. And parents who walked for miles in order to bring their kids to a bus to the hospital, and nurses and doctors who work so hard all day. Everyone seems so happy and grateful, despight everything. I brought along with me tons of paper, pens, play doh, crayons, coloring books (thanks to Becky and Virginia), and toy cars. The kids (and parents, too) seem to like everything so far, and can spend hours making things out of playdoh or playing tic-tac-toe.

Yesterday I watched a surgery for the first time ever, which was pretty cool. At first I thought I would get woozy or naucios, and Ann even had me sit down just in case. But I didn’t feel sick at all, I just thought it was pretty amazing. Its cool that they can cut you up and then sow you back together, and then you get better.

Well, over all Honduras has been an amazing and rewarding experience so far.

~Ann Spencer

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San Pedro, Honduras ’08 Day 4

I was given the opportunity today to enter the blog as a guest of IVU . My name is Carlos Angel, I am a pediatric urologist and practice in Knoxville, Tennessee. I was born and grew up in Colombia , so being back in a Latin American country is both familiar and reminiscent of my roots. As usual, upon our arrival, the team was inundated with many patients that needed care for severe congenital malformations of the urinary tract. It is now our foutrh day of operating and we have been able to perform most scheduled cases, fortunately, with few complications. As usual, on a trip like this, there are some glitches and this year´s was the resectoscope, which, no matter how much everyone tried, refused to cooperate. A special treat for me when I participate in a team trip with IVU is the chance to meet intresting people of quite diverse backgounds . We do have some things in common, however, curiosity about other peole and other cultures and the realization that we can do our part to help less fortunate human beings. To experience life vicariously through the eyes of the people we meet in these trips and the kids we care for is for me the greatest reward. We are working with three great local doctors, namely Drs. Tome, Gomez and Velez that are caring, extremely hard working and dedicated to the welfare of their patients. The staff in the OR wil do anything they can to make us feel welcome and to help the team, although for them it only means long days, extra work and none of them have a finacial incentive to do any of this. This is what I would call true altruism. Now, about Honduras, a small Central American country still plagued by many of the ills of the developing world such as violence, poor sanitary conditions, poverty and lack of education. What I have noticed is that, while all of the above may be true , as in many Latin American coutries life is experienced with joy and people( often complete strangers) tend to naturally come together and help each other. The children we operate are trusting, very calm, seem happy and do not experience as much separation anxiety as we are used to see in the US. Well, it is back to the OR now…

~Ann Spencer

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First Day

Good Morning Friends, April 19, 2008
I would like to introduce myself to you before plunging in to writing this blog report of IVUmed’s trip to San Pedro Sula, Honduras. My name is Ann Malcolm Spencer RN and work in a small rural hospital on the Oregon Coast. Our hospital is a 21 bed (not 21 OR suite) hospital that treats a wide variety of patients. Surgery is my love and has been my home for the last 18 years. Traveling with Medical Missions has become my second love, making this trip to Honduras my 11th in the past 6 years.

At the present time, 4 of us, Catherine, Lily, Becky and myself sit in the Houston Airport waiting for our 7pm flight to Honduras. I have time to reflect over my reasons of why anyone would want to spend hours in an airport waiting to work over their vacation. I have over heard what others on the plane are going to do on their vacations. Golf and drink tequila in Mexico. Another family is on their way to a cruise in the Caribbean. Basically my reasons are very selfish, my life as been blessed. Blessed with a safe and comfortable childhood. Blessed with good health, great friends, incredible son and a loving husband. I have much to give back in this life and what a better way that to help the children of world. Each trip I swear will be my last but only time will tell.

More to come in the following days.

~Ann Spencer

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Tim’s Daily Nigerian Times (Day 14)

March 6, 2008 – Day 14

After enjoying the last breakfast at the guesthouse (warm biscuits and jam) we set off to the hospital to perform a last minute cysto and tie up a lot of loose ends. The cysto patient was a no show and that allowed for us to split up all the jobs – paying multiple bills, picking up some finished sewing, giving out some donations and gifts, handing over the numerous patients that we had operated on over the last couple of weeks. On a personal note, it was interesting to see how our urethroplasty patient with buccal graft did over the 2 weeks. We never see those patients every day and I think it was interesting to see him each day and the course of his convalescence (the patients in Nigeria don’t believe they are getting their money’s worth if they are sent home “prematurely”) and he’ll stay until his foley comes out 3 weeks postop.

We then had enough time to dart out to the HIV widows quilting shop and got some last minute shopping. Many spent more than they planned when we saw the wares and it couldn’t go to a better cause. The beautiful fabrics of the region were on display in a traditional art form (apparently they do American style quilting….whatever that means) J…

We popped back to the VVF clinic and the OR for a final lunch of rice/pounded yam and the red stew. It was nice to have the time today to say a proper goodbye to all the new friends that we had made. Many nice and thoughtful words were shared on both sides. Lots of “Kodak moments”. With a tear in our eye we set off back to the guesthouse to pack up for Abuja.

After bringing out the baggage we realized that there was no way we were going to fit all the baggage in the back of the Peugeot station wagon. Fortunately Sunday and Chima arrived with the upgrade – Land Cruiser. Despite the upgrade we still ended up sitting four in the back seat…with Pauletta on the floor behind Tom’s seat. With knees and elbows everywhere, backs cramped and everyone hot (and most of us smelly), we set off. Another truly Nigerian experience. The trip was as harrowing as I remembered from the arrival, with multiple passing attempts being “white knuckle” moments, although Ezekil did an excellent job of avoiding other cars/potholes/bikes/motorbikes/people/goats/roosters thanks to his trusty car horn. With bags all around (and on top) of us we pulled into the Abuja airport….

The Abuja airport (aka Danté’s Inferno) was as hot as I remember. I was the only one in shorts and I was sweating buckets. The long lines and cramped quarters made me glad that we had come several hours early….After negotiating security, check-in, 2 surveys, and emigration we sat down for quick and well-deserved beer in front of the only (and small) air conditioner. The ice cold Heineken and Pringles were a very satisfying dinner. We then had to say goodbye to Tom and Susan as they were taking an earlier flight to Amsterdam. I am sure that we’ll sit down for a dinner/drink at the AUA. After seeing them off, we waited for our flight – basking in the glow of the icy cold A/C. We were called in a couple of hours prior to our departure into the preboarding lounge (after another security check). Even though I didn’t believe it, it was true….this room was even hotter.

Equipped with bright lights that were blinding if viewed from the proper angle in addition to the 110+ heat, I felt like I was in an interrogation room from the former Soviet Union. After an unending session in the hot box, I was ready to give up any of the classified information I was privy to…fortunately they called us to board just as I was about to break down. Realistically, how much information can you give up as a Canadian? The specs on the 6 helicopters we have available for military service? J

We got aboard and fell asleep quickly. Economy class seating seemed like first class when compared the car ride down….

Tim’s Lesson of the Day:
“Traffic rules aren’t a bad idea”

Tim “Blogman” Davies

~Catherine deVries

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Tim’s Daily Nigerian Times (Day 13)

March 5, 2008 – Day 13

As we wind down the last full day in Jos, I’m realizing a couple of things, one of which I will miss the breakfasts in the morning (French toast again this morning). Another epiphany was the fact that I have really grown comfortable here in Jos. It was a seamless transition from anxiety about going to and performing surgery in Nigeria, to now comfort in a new location/OR. It is amazing to see what these surgeons can do with very little in the way of instrumentation and equipment. The term general surgeon definitely means something here. It really tests what a new grad like me has learned about urology. I have learned much from the more senior urologists on the trip and from the local surgeons as well.

We set off to finish up the remaining cases. A couple of PV Slings, 2 more injections for bulking agents and we managed to fit in a couple of last minute cystos. As usual a lot of pathology was around. 2 obliterated bladder necks and a couple of bad strictures were seen on the cystos. But a failed catheterization from another hospital resulted in the worst urethral perforations Tom has seen in 32 years in practice(fat all around the membranous and bulbar urethra). Throughout the day in the OR a plethora of interesting cases rolled through the door – a fungating axillary carcinoma, myelomeningocele, open tibial fracture, flexor tendon repair, all in one day. Wow!

As we winding off the trip, the paperwork has really picked up and last minute consults have really come up today. We do the best we can in the short time that we have remaining. We returned to the guesthouse for a quick Sloppy Joe dinner and more paperwork. We were bid adieu with another sing along from the other group staying with us which thankfully stopped just before 10pm. We gratefully fell asleep in silence….

Tim’s Fact of the Day:
The city of Jos is actually the initials for “Jesus our Savior”

Tim “Blogman” Davies

~Catherine deVries

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Tim’s Daily Nigerian Times (Day 12)

March 4, 2008 – Day 12

Another All-American (or in my case – Canadian) breakfast of eggs and toast. We spied the “Quick and Easy Cookbook” in the kitchen this morning – one quick glance told us this was the secret to the meals we had been receiving.

We started off the day with a couple of cystocele repairs with PV Slings with fascia lata. We were able to harvest plenty of fascia with 2 pretty small incisions over the lateral thigh in the first case. In the second case, the fascia was harvested in 1 incision for both the sling and the cystocele repair. The second case was performed by Dr. Sunday Lengmang, with Susan assisting. They both went well. Tom chipped in with the general surgeons as they perfomed a suprapubic prostatectomy and a cysto that revealed a large stone in the proximal bulbar urethra. We looked at our limited options and decided that an open urethretomy was his best option. I certainly haven’t seen one of those in my residencies!

*During the day, I had the unexpected pleasure of having my wife call to see how we were making out. It was very sweet of her. I can’t believe she was able to get a call through to be honest. She reached the VVF ward office and Pauletta was right there, she checked to make sure that it was my wife and ran the 500m to the OR to get me. When she arrived she could only say 2 words breathlessly: “Wife” and “Phone”. She then collapsed to the ground unconscious….disaster was averted when Simon the local anaesthetist began to perform CPR. A few cracked ribs later we had her back performing urodynamics.and I was on the phone with my wife.

We finished off the day with a couple of PV slings, and all the procedures went well. We had another long day with our arrival back to the guesthouse at 830PM. A quick burger and fries (although not sure if it was hamburger), although not exactly like home, prior to sitting down to do some

Tim’s Lesson of the Day:
“Check with your physician before starting an exercise program (or run to give someone a message)”

Tim “Blogman” Davies

*Portions of this paragraph may have been fabricated/exaggerated for effect (Don’t worry Paul, Pauletta is just fine)

~Catherine deVries

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Tim’s Daily Nigerian Times (Day 11)

March 3, 2008 – Day 11

Awoke with the sweet smell of pancakes and syrup making its way through my Sahara sand filled nose to my smell receptors…..

After a lovely weekend we are back to the daily grind. We have really settled into a groove here. We have been splitting up rounds to be efficient prior to the OR getting started (although there is no rush as the 8AM start is Nigerian time). We have been reviewing the patients the night prior, with Susan cranking out the paperwork like a champ. The patients undergoing UDS have their results reviewed and plan outlined the day after the testing.

We performed 2 more PV Slings today and 2 bulking agent injections in the OR. Thankfully all were uncomplicated. We have started the transition from teaching the procedures to having the local surgeons performing the operations with our guidance. I feel (as a recent resident) that I can relate to their process pretty well.

These days have been pretty long as we return back to the guesthouse after dark every night, eat dinner and sit down to do paperwork/review patients until we are all pretty sleepy. This definitely isn’t a vacation…..

Tim’s Lesson of the Day:
“Monday’s come early in Nigeria too”

Tim “Blogman” Davies

~Catherine deVries

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