Lunes en Loma de Luz

Today was our first day at in the hospital. We arrived to the clinic at 7:45 AM to a full waiting room. We quickly oriented to the new EMR on site and started to see our full patient schedule for the day. Many of the patients were surgical candidates, and we even operated on 3 of them today!  We took turns seeing patients, setting up the OR, and operating, with just enough time to find a lunch plate in between.

We were able to use our new audiometry application Shoebox Audiology in a quiet room. We haven't had the ability to perform audiometry here before, so we were excited to embark on this new clinical adventure. We had to find a makeshift sound proof room, aka La Bodega, and were successfully able to perform an air conduction hearing test.

The theme of the day of thyroids and cleft lip and palates. We saw everyone from a 2.5 year old girl with a thyroglossal duct cyst to a 50 year old with 10 year history of growing thyroid nodules that now happen to be the size of multiple baseballs.

After a quick return to the dorms for dinner, we checked on our first surgical patients today. Our little 7 month old cleft lip repair was chugging away at his milk bottle. He looked mighty cute.

We are thankful for another successful day and hope for positive outcomes for all of our patients!

Arrival to Hospital Loma de Luz

After an early departure from Seattle on Saturday morning, we reached Roatan, Honduras. We loaded our carts and luggage this morning before sunrise early (a stack nearly as tall at Kaalan). We traveled via large van, then a high speed ferry to La Ceiba followed by a two hour ride through pothole-ridden dirt roads to reach the Hospital Loma de Luz in Balfate.



We settled into the staff housing and oriented our newest team members to the area and the wild creatures that we might encounter (snakes, scorpions, spiders, oh my!). We took our crates replete with donated supplies to the hospital and unpacked. We readied equipment, set up the OR and clinic, and sorted through the 250 lbs of American donations. Sapna's biceps are sore from the heavy lifting and activity of the day.

A Tall Order

After several years of surgery here at Loma de Luz for advanced stage parotid disease and several facial nerves sacrificed, our teams have been very fortunate to only have one patient in the nine years we have been coming here who has required a facial nerve rehabilitation procedure.  Maritza had parotid cancer resected last year and continued to have trouble with her right eye closing all the way, so ideally needed a gold weight placed in her eyelid (not cheap!), and a tarsal strip procedure to raise up her lower eyelid.




These procedures are often performed by facial plastic surgeons, and this year is also the first year we have had a facial plastic surgeon on the trip.  Sapna Patel helped perform these procedures with a gold weight donated by Wayne Larabee, with a great result and happy patient!

This elderly gentleman has struggled for years with enlargement of the skin glands in his nose called rhinophyma, but his larger-than-life personality was never dampened (he told us he was Pinocchio's brother!). 

We were able to provide him a new nasal contour as shown in this post-operative photograph with dressing in place.  His daughter was so pleased she told him he was "guapisimo" - very cute/handsome - and ready to go find a girlfriend!

This trip was rich in with amazing preparation and assistances by Joshua Kennedy.

During the many thyroidectomies "Andre the Scrub Tech" easily managed his back table while catering to the needs of the surgical team.






As expected, equipment can often require a bit of a creative mind to make up for pieces we do not have.  Note the IV pole used to secure the laryngoscope in the suspension arm as fashioned Dr. Johnson and Joshua! In the end, the urgent pediatric airway turned out to be less than so, but we were sure happy to be prepared.









St. Patrick's Day was not forgotten! The team found everything green a posed for a quick photo at the beginning of clinic.

Hit the Ground Running

Day 2 at Hospital Loma de Luz was exciting and busy. We started off in clinic meeting our first two surgical patients for the day- a large parotid mass and complex thyroid. Once we got them triaged, the operations began! Meanwhile in the clinic, Malika Atmakuri and Ben Rubinstein held down the fort, from purulent ears to hemorrhagic vocal cords to pediatric midface lipomas. We treated some new patients and followed up with some previous surgical cases completed by the team in the past. A young man s/p anterior craniofacial resection + ALT flap for a right maxillary fibrous chondromyxoma returned to clinic to see us. He had healed remarkably well and was excited to be starting university soon. We were so pleased to see his progress.

The OR cases proved to be challenging as well with a right parotid mass coming originating from the deep lobe and extending into the parapharyngeal space and a very obvious malignant thyroid with palpable central nodes. Without nerve monitoring, things were tricky, but we persevered. While Dr. Bohannon was covering the head and neck cases, Dr. Johnson was putting a large cleft palate back together, while also staffing clinic, and keeping everyone at ease- now that’s multi-tasking.

Long after the sun had set, we wheeled our thyroidectomy patient into the ward and checked on our other patients. Despite our long day, we walked home home with smiles on our faces- only one last challenge remained- crossing the suspension bridges in the pitch black.  The best part was coming home to an amazing dinner- guacamole, homemade salsa, jamon, chicken, and Honduran beans & rice with cold juicy watermelon for dessert. I bet you are hungry now.

Broken Bones and Birthdays in Balfate

Today marks our first day in clinic and the operating room.  Clinic began by setting up our "electronic work station" to organize patient care and interact with the hospital's own electronic health record.  Through modern technology and wifi access our team can keep patient records and operating room schedule whether in clinic or the OR.  Our team in full is below: Isaac Bohannon, MD (Head and Neck Surgeon), Ben Rubinstein, MD (Resident), Kaalan Johnson, MD (Pediatric Otolaryngology), Malika Atmakuri, MD (Resident), Sapna Patel, MD (Facial Plastics Fellow), Joshua Kennedy (Scrub Tech), Angelique Berens, MD (Resident - not pictured, photographer).

First case of the day was management of a three month old mandibular fracture.  Through generous donations the hospital had enough equipment to assemble a respectable mandibular fracture instrument tray as pictured with Joshua and Angelique in the hospital instrument room.









The case was obviously very challenging to achieve adequate occlusion, but at the end we were ultimately very happy with the outcome as shown below, as Dr. Moe would say - that's PDG (Pretty Darn Good).  We decided that the ideal approach would be to use wires for 2 weeks and then to switch over to rubber bands, but an exhaustive search of the hospital left us empty-handed! Imagine our surprise, or lack thereof (for veteran volunteers), to learn that a team of dentists were planning to arrive in 2 1/2 weeks and would bring dental rubber bands!

At the end of a successful day we had time for a quick run to the beach.  Lucky for us the beach is just a short walk away in the sweltering heat, making a quick jump in the warm waters of the Caribbean a perfect end to a perfect first day.

  

We were also able to help Ben welcome his thirties in style.  Josh, our scrub tech, singer (skills TBD), pastry chef, and human selfie stick, made delightful "Buckeyes"- sugary peanut butter balls coated in the finest 72% dark chocolate that Honduras had to offer. Although someone liked them a little splotchy (cough cough, Dr. Johnson) and we forgot matches- the celebration was a success!

Arrival 2016!

Our Team left Seattle without a hitch and arrived in Roatan!

As we moved into our spacious accommodations at the Fosters Resort, we caught the last view of the sun as it sank below the horizon. It was obvious- we're not in Seattle anymore. We enjoyed a long walk at the beach before deciding on the premiere cuisine at Bananarama. While we dined on the snapper filet in lime sauce with coconut rice and beans, we listened to the tourists attempt to karaoke to familiar tunes including our beloved Hotel California by The Eagles.

After an overnight stay on Roatan we packed our bags yet again to take the ferry to the mainland.

Notice the giant cart of luggage in the background (All Ours!)

The temperature climbed ten degrees as we traveled from La Cieba to Hospital Loma de Luz. At the hospital, the familiar OR case board displays a glimpse of the patients we will help this week. We unpacked, readied our surgical equipment, organized our new cache of supplies, all in time to catch the high tide at the beach just across the road. Stay tuned for out first day of care tomorrow!

Please visit our Instagram at #UWOTOHONDURAS 

Planning for March 2016!

For a tax deductible donation: Cornerstone Donations

For proper routing to our team, email Angelique Berens