The Logistics of Surgery & Health Care: Timmy’s 1st Surgical Trip

The Logistics of Surgery & Health Care: Timmy’s 1st Surgical Trip
December 12, 2012 Callie Daniels-Howell

by Andrew Morrow

“It’s easy to play any musical instrument: all you have to do is touch the right key at the right time and the instrument will play itself.” – Johann Sebastian Bach

Two weeks ago, Christmas came early for 68 Timmy patients in the Amazon Basin of Ecuador. Each of these patients, ranging from 10 months to 67 years old, received a critical hernia surgery—a relatively simple operation that will improve their health and enhance their quality of life. Months of preparation finally concluded in this 6-day medical trip, and Timmy’s first ever-surgical team. In this blog I’d like to highlight the behind-the-scene efforts that led to providing these life-changing surgeries.

Part of my responsibility as the Timmy Fellow this year helping to coordinate logistics for Timmy’s medical teams – i.e. booking flights, arranging transportation, purchasing hotel rooms, shipping supplies, creating itineraries, etc. When I started in this position in August, the first assignment passed to my desk was Timmy’s inaugural surgical trip, slated to perform hernia surgeries at our partner hospital Stadler Richer. Planning began immediately, and I worked with Timmy’s Ecuadorian staff to create a budget, design an itinerary (although this was difficult because it was the first Timmy trip of its kind), and organize pre-trip meetings with our medical professional volunteers. I also worked closely with Timmy’s medical supply warehouse volunteers and Medicine Women to solicit and pack nearly 500 pounds of donated surgical equipment. These supplies, crammed into jumbo-size hockey equipment bags, were transported to Ecuador sequentially over a two-month period. While there was much to be done at headquarters in Indianapolis, it quickly became evident that my role was only a small piece of a vast logistical web.

Backing up…approximately one year ago, Timmy partnered with an Omaha based non-profit called Hernia Repair for the Underserved, who agreed to co-sponsor our November surgical service trip to Stadler-Richter hospital in Archidona, Ecuador. In the year leading up to our surgical trip, medical professionals volunteers on Timmy trips to Tena, Ecuador screened patients and kept detailed records for those in need of hernia repairs. One such patient was Christina, a 50-year-old woman with a small umbilical hernia. Although not life-threatening, the hernia was discomforting and disfiguring. The promise of a surgery ensured that she would maintain a robust lifestyle while working and caring for her children and grandchildren.

Fast-forward eleven months…throughout which the behind-the-scenes work continued. In October, Timmy’s staff in Ecuador promoted the soon-to-arrive surgical team, working with an Archidona radio station to advertise the team and hanging fliers throughout the province, in Internet cafes, on community bulletin boards, and in schools. Local doctors also referred patients. All of this was done in close coordination with the Napo provincial government and Ecuador’s Ministry of Health, two of Timmy’s partners in the region who are assisting our efforts to expand Timmy’s medical services to include surgery.

Just before Thanksgiving, Timmy’s surgical team rendezvoused in Ecuador. The team consisted of three general surgeons – one from Italy, one from Calgary, and one from New Jersey – a pediatric surgeon, an anesthesiologist and six nurses. We spent the first day at Stadler Richter Hospital, unpacking equipment, organizing anesthesia medicine, preparing the OR, and designing a system for patient flow. We also spent the afternoon screening patients that had formed a line outside of the hospital. Unplanned, we decided our “organization day” was ahead of schedule, presenting the perfect opportunity to get the week started. That afternoon, our Italian surgeon performed the week’s first hernia repair. Three hours later, our first patient safely walked out of the hospital.

For the next 5 mornings, patients formed a line in the hospital’s hallways to be screened for surgery. Some of these patients had been referred months before by Timmy’s physicians and others had heard our radio advertisements or seen a flier. Each day—two surgeons operated, while the other two physicians screened patients and created the next day’s schedule. In this manner, there was a rotation, a rhythm that picked up speed and precision as the week progressed. In total, 50 adults and 18 children received surgeries, ranging from inguinal to epigastric hernia repairs. Additionly, our medical professionals volunteered to tackle a few non-hernia procedures including a foreign body removal and an excision. Our anesthesiologist also stepped up to assist on an emergency caesarian section in the absence of the hospital’s anesthesiologist (who underwent a hernia surgery that morning!). As of today, there have been no known complications and Timmy’s on-the-ground staff in Archidona will continue to monitor the conditions of our patients.

After witnessing nearly 70 surgeries, two pediatric cases stick out vividly in my mind. Matie and Fabian, siblings from a community three hours outside of Archidona, were slated for surgery early on Thursday morning, providing them and their parents enough time to travel home during the afternoon. The brother and sister each had small umbilical hernias. It was a joy helping to prep them in the pre-operative room and to watch the nurses, as they did for each pediatric patient, blow air into a latex glove to make a balloon and hand one to each. I escorted Matie, two years old and the younger of the two, to the operating room first. Fabian soon followed. Today, both are thriving.

While cases like Matie’s and Fabian’s stand out as great success stories, others, unfortunately, illuminate the limitations of surgical work in the developing world. We had one such case on this trip—an elderly man who was discharged from the pre-operative room by our anesthesiologist after she determined that his vitals and condition were unfit for surgery. I watched as our anesthesiologist discussed the situation with local staff and a translator in the hospital hallway. She reasoned that the patient – who had a prosthetic right leg and a discolored left leg – could not handle anesthesia and would potentially require ICU services, medical luxuries only available four hours away in Quito. She instructed the translator to relay to the family that surgery, unfortunately, wasn’t an option.

At the end of the week, our surgical team joined the Stadler-Richter hospital staff for dinner. This group of local physicians, technicians and administrators had worked incredibly hard throughout the week – cleaning surgical instruments, facilitating patient flow, running lab tests and pulling necessary anesthesia medicine from the pharmacy. This dinner was a chance to exchange thanks and to experience the culture and cuisine of the region. It was also a nice way to bring closure to a long week.

This whole process has taught me that the logistics of expanding access to healthcare and providing health services to developing countries is extremely complex and easily overlooked by short term volunteers. Planes, buses, cars, trucks…boats have to be arranged to get medical professionals and student volunteers to Timmy’s international partners, while efforts of equal or greater magnitude must also be undertaken to get patients to those health care providers at the right time. Over the years, Timmy has worked hard to perfect its logistical system for primary care delivery. As surgery becomes a fundamental component of our healthcare provision, I feel confident in saying Timmy is strategically positioned to expand its medical programming to include surgical services. Hernia repair was the first of many steps!



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