The Charities: Nuestros Pequenos Hermanos NPHUS.org OneWorldSurgery.org
While in bed on Wednesday night I felt a slight tickle in the back of my throat which is usually the first symptom I experience when I get a cold.
On the day we arrived I vaguely heard that a woman had felt sick on arrival with significant URI symptoms but then had tested negative for Covid. The next day another woman was ill and they got to room together. I never heard any details but certainly, they could have caught the flu just before leaving home, or a random non-Covid cold or RSV. On Thursday I heard that it had been considered to send one of them home to the USA early in case they got worse but I think that wasn’t done. After we returned home, it was a few days later that one of them posted she finally was all better.
I assumed that as it had been 3 or 4 days since exposure on the bus ride I probably had whatever they did. But at work on Thursday I felt fine and forgot about it until Thursday night when I started coughing quite a bit and had a sore throat. I took some Cepachol lozenges and then some Afrin spray when I got a little congested. Friday I coughed a bit in the OR (I left my mask on as much as possible, even when not in the OR) and felt fatigued during the day. On my walk home from work I felt a little breathless from the 1/2 mile uphill walk in the heat and noticed my running pace was a little less than expected (of course I still RAN!).
Friday morning I made this post to Instagram. I had moved FaceBook into a hidden spot on my iPhone and turned off News notifications so I wouldn’t be subjected to the virtual or real insanity of modern life while traveling but I did post a photo or two to Instagram each day which would also show up on my FB feed.
As I walked the path (wet still from the overnight rain) to work for the last time I felt like 5 days was not enough and I could easily work a few more (despite my schedule at home being only 1 or 2 days per week). In Fiji where the remote hospital only was able to run its one operating room for the 6 weeks per year that the charity brought in surgeons and staff I REALLY felt like more could be done. At NPH/OWS though they not only ran the operating rooms with volunteer staff 30 weeks per year but also did orthopedics and ophthalmology with local surgeons the other weeks.
The Evolution of One World Surgery from just Dr. and Mrs. Daly bringing back the one child for surgeries in MN to a state-of-the-art 3 OR surgery center and medical clinic and a huge conference center with modern housing for 60 people in one of the poorest nations in the world is amazing.
Having read this before the trip I assumed that as this was an orthopedics trip it was going to be surgeons from Summit in Minneapolis. The blurb at the website does not mention that several years ago SCA was acquired by United HealthCare (the large insurance company trying to more vertically integrate its business). At the same time, United HealthCares physician employment arm (Optum Health) employs 10% of the physicians in the USA now. Buffalo has almost zero patients covered by United Healthcare insurance and no SCA-owned surgery centers here that I am aware of. I don’t know if any local groups have been acquired by Optum but I read the local newspaper and business news fairly carefully and haven’t seen anything. When the local competing hospital systems had problems a few years ago I was sure that UPMC or The Cleveland Clinic would move in and take over but neither did.
It was not until several days into the trip and discussions with various people that I learned that anyone who works for Optum or SCA had their $1000 donation (to cover room and board and supplies) paid by United HealthCare. They were also paid their salaries for the week. They just had to cover airfare (and it seemed some were able to use CME funds for this). But it is only for One World Surgery that United Healthcare does this. So it was very lucky that the head of SCA became so dedicated to OWS. It also explained to me where the money for the huge conference center came from as it seemed like just regular donations would be enough to run the surgery center but not such a huge construction project.
United Healthcare (headquartered and founded in MN) had $350 Billion in revenue last year so it is a tiny amount (and a tax write-off) for them to provide a lot of support to OWS. So no wonder all of the SCA/Optum folks keep coming back and want to in the future. For me though I felt slightly like a sucker for having given up a week’s income and $1000 that most of the people I was working with had not.
I feel there are probably other medical missions that need my time more than this one which is so financially well backed. Also, I really would liked to have been able to see some of Honduras other than the airport and the NPH property. Just a bus ride tour through the capital would have been nice even if couldn’t get out for security reasons.
Next year OWS is opening a new surgery center at the NPH campus in the Dominican Republic that has to date only had a primary care clinic. Since next year is sooooo busy for me (lots of travel plus Alex graduating college in May and me doing Ironman Florida in November) a super organized OWS mission to the DR in December might work out perfectly though and for 2026 I can find some other places to go with non-OWS groups. The gynecologists in Buffalo are going on a mission soon and I need to find out their future plans.
I didn’t save a photo of Friday’s schedule I guess but I remember having a short elbow case first and then a long interesting repair of a 10-year-old rotator cuff injury that required the surgeons to harvest a tendon graft from the hamstring (like is often done for an ACL repair) to use in the shoulder. I think on the first case of the day I did the infraclavicular block and on the second one Theresa and Marcia did a modified supraclavicular. At one point Dr. Sigman floated around the room creating “content”.
Someone gave me a breakfast break in the morning. I had no appetite really but wanted some coffee to perk me up. There was a big birthday cake extravaganza in the kitchen. I didn’t think singing would help my sinus headache so I took my coffee upstairs. But there is a nice video of them celebrating Dr. Peter Daly’s birthday!
I had gone back to the OWS page to see Dr. Daly’s bio. He attended Notre Dame undergrad and then the Mayo Clinic for both Medical School and Orthopedics residency. He has received the Alumni Association Humanitarian awards from both ND and Mayo! He and his wife were both very friendly and energetic. They both said Thank You over and over to everyone on the mission.
I don’t have a photo but I had made a note that my lunch was meager vegetarian (I am thinking just rice and some carrots) which was fine as not that hungry anyway. At lunch, I got to speak with one of the translators. There was always a translator in the pre-operative area and they always had one or two in the clinic areas. Some of the staff spoke decent English but most just a little. The translator I ate with I learned was a schoolteacher in the capital (for elementary school) and was volunteering a week at OWS as it was the kids’ “summer/Xmas” break from Dec. 1 to Feb. 1.
I asked her about education in Honduras and she said that sadly the rural children often had to walk an hour or two to get to the nearest school and that was only IF it was staffed. Many still have no schooling and a significant portion of the population is illiterate. Teachers were paid so little that not many people could afford to choose it as a career. A website I checked said from $250 to $600 per month.
After the walk back to the Moscati center (having left behind as donations my OR shoes and my stethoscope) I went for a long run. I took lots of photos because I wanted to make a Relive video. Here it is.
Everywhere I ran on Friday afternoon I saw boys out with machetes clipping the long grass along the paths and in front of the buildings. I guess Friday is “mowing” day. I stopped and talked a little to the kids on the porch of one of the houses for special needs kids.
I kept a little distance from the kids because of my coughing though. After running I did a while of stretching until cooled off enough to shower and then rested in the hammock and created the Relive video to share with the group.
For dinner, we had the amazing Italian food that Lulu had cooked with help from local staff and volunteers. It was a little strange as the night before had been hamburgers and fries and we were all craving some more traditional Honduran food with our departure imminent. But the food was very delicious and we did have a Mariachi band. They were very loud though and I still had a sinus headache so I went outside and washed dishes for a while. At that distance, I could hear them at a pleasant volume.
Someone had made a short video of photos from the week that was shown on the screen and then we also watched a short TedX lecture by Dr. Sigman about the opiate epidemic and giving less for surgeries. It was good but a little dated as almost all docs now give out a lot fewer opiates (or none) but sadly opiate deaths from fentanyl are rising anyway.