Aaron-Make A Change International

This blog post will be a little different than prior ones. I wasn't able to upload anything while in the DR this time around, and we were really quite busy, so I didn't blog as much while in the DR as I would have liked. So I'm compiling this back in Detroit. I've decided to keep it a little shorter and throw in some more pictures this time around, and update you with just some of the stats from the trip. I'll get a breakdown of the surgeries later and post that separately once I do have it.

I left on Saturday, November 7th from Detroit, and really lucked out with the flight times really. There was a flight from Detroit to Boston to Santo Domingo that left at 7pm and arrived at 4am. The rest of the group traveled from Chicago, and arrived Saturday evening. Kelvin (one of the drivers) picked me up from the airport and drove me into Santo Domingo to meet with the group. We set off for Peralta in Azua on Sunday morning from there, which takes a couple hours. Overall everything went pretty smooth, other than the usual hiccups of flying internationally.

It was awesome to regroup with some of the doctors I worked alongside last year in general and orthopedic surgery, as well as meeting some new people. Everyone on the trip has fantastic skill-sets and the surgeons are all top of their fields. It was really an honor to work with them and serve the people of Peralta. Once we got into Peralta, we had a quick lunch that the local pastor's wife prepared for us, and then headed to the clinic to start the pre-screenings. I took a group up to the hospital to prep the OR and the pre-op area, since I had been there a couple times and knew the drill. Everything went great, and we had quite a few cases for the week. ENT/plastics had quite a few tonsillectomy/adenoidectomies scheduled, as well as some cleft lip and palate repair/revisions, along with a few other cases. General surgery was the usual - hernias, masses, etc. Ortho....pretty much anything you can imagine. I'll post some pics in a bit. Being that motor vehicle accidents (MVAs) are the number one cause of death in countries like this in the caribbean, you can imagine the ortho stuff we see. After we finished up with everything we headed to the house to chill out for the night and refresh before we got moving.

Oscar (anesthesia), Segun (anesthesia nurse), Ramon (ENT PA), and AJ (ENT)

Amna (internal medicine resident)

Melody (medical student in the DR) and Joe (PA student)

First day of surgeries in Peralta was a little different because we had so many surgeons and the different specialities on this trip. The ENT guys took over the main OR, and most of the anesthesia for the morning, so some of the general surgery cases were delayed a bit as we needed the anesthesia folks to do the spinals as that's how we numb most of the patients. It's a bit different than how we would do cases in the US, but it works well. We had two groups of ENT guys, A.J. and Ramon did a whole bunch of tonsillectomy/adenoidectomies, and Jay did a pretty complex cleft lip repair on the first day as well as some plastic surgery on a guy's face who had been shot in the head. That was crazy. He somehow was shot and the bullet seemed to ricochet through the sinus and out the frontal sinus. Pretty amazing that we got that fixed up. I did a post op check on him later that night and it looked great.

Anesthesia team prepping patients

AJ working on some tonsillectomies

Tom Komar (general surgeon from Cook County Hospital) and I on the first day did two umbilical hernia repairs, an inguinal hernia, and a cyst removal. Beyond that I spent most of my time in the pre-op area placing a bunch of IVs on the adults and kids. It was great for me to get some practice as it's been a while that I've placed so many IVs, and aside from one or two that I couldn't get, I was able to get even some complex IVs that I did just by touch.....so shout out to Christina Creel for teaching me when we were in med school. It definitely helped to speed things up as the nurses who help us out aren't always there as early in the morning so we were able to get things moving pretty quickly when I had all the IVs set and ready. Other than that, it was a bunch of running around, problem solving, finding equipment we needed, premixing antibiotics, and helping out here and there. I suppose my favorite part about these trips -- figuring out ways to make things work when something goes awry. When I think about what I want to do in the future and hopefully be more involved with the logistics aspect of trips, it's good to realize all the little things that need planning and equipment that we need to be more successful. For instance, Komar and I did two of our cases on the first day without a needle driver because the kit didn't have it. So we made it work....but it's definitely not something we would ever have to deal with in the states. I know it sounds simple, but you don't really realize how different it is until you're in that position.

Stephanie, Komar and I went down in the evening to do some post-op checks, and everything looked great. The patients as always are amazing and survive with not much more than tylenol for pain management. Definitely in the states all these post-op patients would be hopped up on narcotics.....but here it's a lot harder to get and they don't complain of pain.

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we didn't have a whole lot of cases and Komar and I had a bit of time to hike up the mountain and check out some of the area we haven't before. Usually it's too dark to go as far as we were able to go, so it was nice to see some of the area. We definitely got owned by a local when we were getting tired and panting on our way down and this dude came trekking by us with a huge bag of fruit on top of his head. I guess he hikes up the mountain like every day, so he's pretty much half billy goat.
I spent a couple days in Azua with David Garras and Dennis Gates (orthopedic guys) doing some pretty awesome and complex orthopedic surgeries. Dennis was a surgeon who had to stop operating because of an injury, what has been doing this forever and knew his stuff. I first-assisted with Garras on several procedures, and then Gates would scrub in to help close up the procedures. Gates and I also did a couple surgeries ourselves. One, a kid, 16 or 18 I think, had some hardware placed in his knee (plate, screws) that was bothering him and causing a lot of pain. His femur was now healed and so we were going to take the hardware out. It was a lot of fun. You basically cut open the leg, and start hacking away with a hammer and chisel. The plate had been completely grown over by bone. We eventually found it and just chiseled it out. Nothing quite like using a hammer and chisel on a guy's leg! We also had another case where the guy was in a motorcycle accident, broke his femur, had a titanium rod placed, had another accident, rebroke his femur and bent the titanium rod. Couple hours later of me chopping away at his bone, using a broken saw and bolt cutters to get out the rod, and a drill to put in the new rod, he was as good as new.

I can see the appeal for orthopedic surgery for sure. It's basically construction work on a human body. They were long hours though. Our longest day we worked 7am to 1:30am....but it was worth it.

Overall we did 92 surgeries on this trip. Orthopedic surgeries, general surgeries, ENT and plastics, all for people who otherwise never would have received them. Inguinal and umbilical hernias, cleft lip and palate repairs, tonsillectomies, gun shot repairs, femur/tibial/radius ulna repairs with rods/plates/screws -- pretty incredible stuff.

Some things I learned and thought about on the trip:

I need to learn to do spinals. It would really be a useful skillset to have in these countries for operations. The actual placement isn't difficult, it's really a lot like doing a lumbar puncture. However, I need to learn about the side effects, what to do when something goes wrong, how to troubleshoot, etc. But in the long run, something that would be useful. I had Oscar (anesthesiologist) teach me a bit today, and hopefully when I do my anesthesia rotation in my residency I get some more exposure.
No matter how hard you try to prepare on these trips and bring supplies you need, you always forget something. However, there are some basics that we really need that we don't always have that in the long run I need to think about and plan for better.
As it usually does, working in these environments confirms for me that this is what I am supposed to do. I'm not ever going to be the smartest or most skilled doctor in the room, and that's cool, but we play our strengths right? I know I can be a pretty great ER doctor, but my public health background and problem solving skills are probably more useful with what I want to do in global health longterm.
I've been considering doing some training at the Liverpool public health program in England. It's a 12 week program that teaches MDs just about everything in tropical medicine, and though this trip doesn't focus on it, I know it will be useful for me. Who knows when that will be an option, but it's something to look forward to and plan for in the future anyway.
As much as I can, I really want to continue to work with the Rush group. Everyone here is top of their fields in general surgery, ENT, orthopedics, medicine, etc. Everyone I've ever worked with overseas from Rush has been completely amazing and really skilled. The things they're able to accomplish is really mind blowing, and the fact that they all give up their time to do this really very cool. It's truly an honor to be able to work alongside them and learn from them. As an ER doctor, gaining experience in fields outside my scope of normal practice, it's really something very special. I'll for sure be back.