I forgot to mention in yesterday’s entry that when I wrote the date on the first patient’s chart (no EMR) 6-Dec-23 (Honduran way) I realized that it was my late father’s birthday. It was always easy to remember as it was the day before Pearl Harbor day (and my mom’s the day before Valentine’s Day).
Charities Info: Nuestros Pequenos Hermanos: NPHUS.org OneWorldSurgery.org
Surprisingly I took no photos before getting to the hospital on Thursday morning but here is a video from my walk to work a few days earlier.
I was scheduled to work in OR 2 again, and as the first scheduled case was a forearm tendon transfer I came in early so I could get all set up and still get to do the infraclavicular block. However, the schedule had changed and my first case was instead just a knee arthroscopy (no block necessary). Dr. Merlin was a little late so it was more like America where I routinely rush to get ready on time just to wait.
The knee scope was on someone who had a total knee replacement at OWS earlier in the year but had persistent pain. There was a small loose piece of tissue that they removed. The next case was the repair of a tibia fracture. The patient was an agricultural laborer who was knocked over by a cow, he was taken to the city hospital but had no way to pay the $800 they wanted for the needed “hardware”. Earning only $50 per week all his money went to feeding, clothing, and housing; nothing left for savings or medical care. I was told by someone else that a housekeeper or nanny in Honduras only earned $2/day. It was obvious that Honduras was poor but only when I researched the numbers was it clear HOW poor. The poorest nation in Central America … and only above Cuba in all of Western Hemisphere.
Luckily for the Tibia patient, his injury was only 10 days old so it would be a “normal” repair as opposed to if it had healed improperly and gotten attention only months or years later.
Dr. Merlin had to leave early as the official graduation of the Orthopedic Surgery Fellows was that night at his home so Dr. Michael Forseth supervised the tendon transfer case for a patient with an old untreated laceration that left their hand crippled. Dr. Forseth had flown down from Minneapolis on Wednesday with Dr. and Mrs. Daly, the couple who had founded One World Surgery. Dr. Forseth is with Summit Orthopedics, where Dr. Daly worked before retiring and concentrating on the charity. Below he shows how multitalented he is by cooking our dinner (Italian!) with Lulu Daly and then working in the OR with Juan Carlos.
Earlier in the trip during our tour, it was mentioned that Dr. Daly and his wife would be coming down during the week but it wasn’t mentioned why to us. Obviously, the surgeons who had been here before were aware of the graduation. Maybe that is why Dr. Sigman came this week even though he had no cases scheduled.
Dr. Forseth had a special “mission music” list on his phone and I enjoyed it when Warren Zevon’s “Lawyers, guns and money” came on. I didn’t realize that it had the Honduras line in it, a few verses after the Havana one; “I was gambling in Havana, I took a little risk, …). If anything Honduras is probably less safe now than 45 years ago when he wrote the song.
Here is a nice video of some of the volunteers visiting with the orphans.
I only saw the outside of it but there was a medical clinic just for the orphans (300 total, 80 with special needs). Some of the mission volunteers were there each day helping out it was not nearly as modern or well-maintained as the surgery center/medical clinic. It had a staff of one MD and two RNs every day and one stayed there overnight in case a child had a medical emergency. They also had specialists from the city come in regularly to see the kids rather than having to transport the kids to the city.
The last case on Thursday went quite late (in theory all cases were supposed to be done by 3:30 or 4:00). It also seemed poor planning to have the deaf patient for the last case (but I just give anesthesia). When his family came into phase 2 recovery and helped him change clothes I asked “Tiene hielo en su casa?” Luckily the answer was yes as the surgeons had given orders that the arm should be kept iced and elevated above the heart as much as possible to decrease swelling.
It was 6:30pm by the time he was wheeled out to his family’s car and I hurried home as dinner was at 6:30 usually. I decided to take the main dirt road instead of the narrow path through the forest as it seemed like it would be less creepy.
It was PITCH black. There was no moon and finally, the sky was clear (it had been a little overcast every evening, Jupiter was always visible but few or no stars) so I was happy I would get a good star photo with the iPhone 10-second night mode exposure.
I had a penlight in my backpack but it was pretty dim, the iPhone flashlight was much better. I was walking along and looking at the stars when I looked down and saw this beauty.
She had her head lifted pretty high and kept an eye on me. She was about 6 feet long and quite thick. After I shared the photo on WhatsApp several people asked what I “did” when I saw the snake. Obviously, the most important thing was to get a good photo! Then I backed away a little and walked on, looking back once or twice to make sure she wasn’t following.
I was excited to see the snake actually as I hadn’t seen a reptile or amphibians on the trip. In Costa Rica, they had such a variety of lizards, frogs, etc. I asked one of the staff and they said that in the wet season, they have a lot more wildlife including big iguanas. I guess in the dry season they head down to lower coastal areas that are rainforests year round.
I’m not sure what we had for dinner that night but luckily it was Xia’s (PACU RN) birthday so we got CAKE.
The graduation ceremony at Dr. Merlin’s home was attended by some of the surgeons.
As a consolation prize, they had a bonfire after dinner for the rest of us. I had realized the day before leaving home that I would be in Honduras for the first 2 nights of Hanukah. I still light the candles even though an atheist so I slipped a few into my luggage.
The marshmallows were REALLY good. Perhaps they were freshly made. Someone else got this good video of leaf-cutter ants working at night.