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CRNA in Honduras
CRNA in Honduras
Posted on: Wednesday, May 25, 2016

I agreed to serve for a week with a Kentucky surgical team traveling to Honduras. To serve was my only expectation. Once I returned however, it felt as if I had taken a very restoring vacation instead. I will go again, and I highly recommend it to all my healthcare colleagues. The following is a summary of my week.

The surgical team consisted of 2 general surgeons and 1 GYN surgeon, 3 CRNA’s, 2 CRNA students, scrub techs, and nurses of various backgrounds. All others provided non­medical services, perhaps doing the most important work of the trip.

All­star CRNA Jennifer Boils (Campbellsville, KY) masterfully coordinated the entire trip stateside. Lemuel and Tammy Baker (Kentucky RN’s serving as missionaries in Honduras) coordinated the trip once we arrived in Honduras. Through Jennifer’s direction, all 45 team members arrived together in Tegucigalpa, Honduras with an enthusiastic team and a shipping crate full of every necessary supply. Through Tammy and Lemuel’s direction, all 45 members had safe transportation, good food, and a flawlessly operating hospital.

Work on the first day involved unpacking the supplies from the shipping crate, and assessing all the patients for the week. I quickly gained a new respect for those who organize back home ­ the many supplies required just for anesthesia! We unpacked hundreds of donated items, then organized them so that future teams could function more easily.

Assessing patients was interesting. It was necessary to transition our thinking from “what acuity can we personally manage” to “what acuity can we manage HERE.” The nearest hospital was 2 hours away. The mission would have to pay cash for any complications or extra care required. There was no blood bank and limited medication.

Teamwork began from the start when the surgeons and CRNA’s collaborated while evaluating patients. We worked together to determine the most appropriate patients for the week. Common comorbidities included hypertension, diabetes II and heartburn. Assessing cardiac function began with “How far did you walk to get here?” ­ as most walked or biked several miles. We were vigilant with our stethoscopes and actually palpated the neck, abdomen, and ankles of most patients. The biggest struggle was translating the Spanish pharmaceutical nomenclature.

 

There were 4 operating rooms which were surprisingly modern. The gas machines were several-­generations old Narkomed 2B’s and functioned adequately with Sevo and Iso. The only limitation was oxygen supply. We elected to hand-­ventilate rather than use the ventilators in order to assure our oxygen tanks would last the entire week.

The monitors were the ubiquitous HP/Philips modules, with separate “etch-­a-­sketch” gas analyzers. I felt very fortunate! Two of the rooms had old Bluebell carts, while the other 2 simply used a table for anesthesia supplies. The beds were older Amsco 2080’s, which used hand cranks and foot pedals. They grew on me because they worked every time. Our supplies were more than sufficient. We even had Bair Huggers, LMA’s, and a bronchoscope. A backup generator automatically started several times a day in order to maintain consistent power. All of this had been donated from the states!

Each OR day began with breakfast together. Someone usually shared a story or word of encouragement while we ate. We would break for lunch as a team and eat together (surgeons and all)­ which facilitated unique bonding. When the CRNA students didn’t need help, I stayed busy giving breaks, mopping floors and washing instruments.

Once the cases were completed, we usually joined one of the non­surgical teams. We helped locals carry water buckets, visited a church and an orphanage, and gave candy to the kids. While our surgical setting was mostly familiar, these visits into the community were nothing like home. The poverty was real ­ as most homes were maybe 15’x15’, with dirt floors, and walls which were penetrable by the elements. Having realized this, I noticed my most meaningful observation of the entire trip: the people were happy. They were smiling and joking. The kids ran, played and laughed. I was compelled to reevaluate my concept of happiness and analyze the things which I felt contribute to my joy.

The cases went very smoothly, and there were no complications. Nearly every patient thanked us with a smile and warm embrace. By post-op day 2, all patients were discharged with acetaminophen and ibuprofen for pain control. And they seemed to manage very well!

After the final case, we restocked our unused supplies and prepared the facility for the next surgical team ­ which was due in several weeks. It was a life­-changing trip, and my desire would be for each CRNA reading this to be able to experience something similar to enhance personal growth, as well as enhancing the lives of those less fortunate than us.


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