More bugs and less bugs…

Everyone is trying to keep the bugs at bay!

​Greetings friends!  Wow, what a great day!  After our last couple of really late nights I am so happy to report to you all that every single team member was back in Hotel Rey by 8PM!  So good to take off the scrubs, put our feet up, and talk about our successes of the day and plan for tomorrow!  Surgery on our 20-year-old could not have gone better, the case went perfect and our old friend the guardian angel was on display as the implants impounded for him were exactly the ones he required!  Our guardian angel is great and never lets us down!  Our patient’s parents were so excited and happy for him, it was an amazing display of love and gratitude, the kind of gratitude that fills you with energy no matter how hard you work and how much you pour in!  Here in the DR it is normal procedure for the family to stay at the hospital with the patient and provide their care.  I hope to get to know these folks a bit better before we leave, they are super nice and full of a certain type of grounded humility that is such a refreshing perspective.  More to come as I learn more.

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We have had some challenges with health on this trip.  It is not unusual for a few on the team to get GI issues after a week or so here, yours truly not excluded.  Generally speaking I have been and continue to be pretty lucky though last year and 8 years ago I was not so fortunate.  Usually the afflicted get the trouble at home after we return.  This year however we have had 4 people catch the early bus to misery, 2 from Portland and 2 from St. Louis.  3 of them had to stay at the hotel today while one brave soul tried to tough it out only to wind up sleeping on a couch in the hallway for part of the day.  These folks seem to have caught a different sort of bug though as they have all rallied well and I expect them to be near normal tomorrow.  I am hopeful they are completely recovered in the morning and that everyone else escapes the trouble.

Some truly great news to share in sort of a good news bad news way.  The autoclave situation here has degraded this year.  The vintage machines are unable to produce enough pressure in about half the cycles to produce the required steam needed to sterilize.  We run our trays, take them into the OR and when we open them up the sterility indicators have not ‘turned’ positive and we are forced to deny them and start over.  This requires rewrapping and waiting 30-40 minutes for the autoclave to run and then we have to try all over again to see if this cycle was the lucky one to produce enough pressure to do its job.  If it does then great, we go get our patient and progress with the surgery.  If it does not we start the process all over again.  This problem was the major reason why we have been working until 11 – 11:30PM the last couple of nights.  We have tried various things to improve the problem and nothing was consistently working.  Today we spoke with the newly appointed administrator of the hospital Dr. Marte, a truly delightful and capable person.  Dr. Marte and his son (also a doctor that works through ILAC) jumped on the issue and within an hour had helped us come up with an successful short-term solution!  Excellent news to us tired OpWalkers!   Even better than that is the fact that all of this hullabaloo prompted a look into the real reason behind the state of the art autoclave I have written about in the past that is not in service.  Well, I shouldn’t say not in service because it does do a great job as a linen dryer as it usually has linen draped all over it. Anyway, the drilling into the million-dollar non-functioning autoclave problem actually uncovered two problems.  One is that the water supply here has to be augmented with a lot of chlorine to kill the buggies that caused the GI issues I discussed above.  The other is that there are some electrical elements that got damaged and haven’t been repaired.  A repair shop was called, new elements were discussed and (we think) ordered, and are hopefully on their way now!  They will be accompanied with a chlorine filter and with any luck this Cadillac autoclave could be up and running soon!  That my friends, would be AWESOME and save us a ton of time and effort, as well as dramatically reducing our frustration levels.  Best news ever is that these repairs will cost very little and everyone wins in the end.  In all the years we have been coming here we have had amazing outcomes and not a single complication!  We are VERY careful about doing everything in our power to avoid complications.  Because Juan Bosch has the Orthopedic Residency program along with the ILAC Cooperadore Program (which represents a permanent commitment to health care and education in the Dominican Republic) we are well aware of what happens to our patients after we depart.  Our mission is to provide the exact same standards and care that a patient at home in one of our hospitals would receive.  In other words, we never compromise.  Both Dr. Marte’s are as committed to excellence as we are and I am truly excited that we have them solving this challenge once and for all!   

Our team here in the Dominican Republic is truly great this year and has really jelled very quickly.  We are a highly sophisticated and well-oiled machine.  In room 1 we have an awesome and talented surgeon Dr. Mike Vessely, an amazing runner Madeline Vessely who learns faster than anyone I know, a hard charging and energetic circulating nurse Juan Rangel, a fantastic assistant Adele Smith who seems to have five hands holding so many retractors, a sleep causing whiz of an anesthesia provider Tim Kirby, and an incredible nurse Alisa Labatto who gave me some much-needed time to do other things, thanks Alisa!  Over in Room 2 we have the man with the midas touch Dr. Paul Duwelius, a terrific and caring circulating nurse Andrea Weber (Justin I hope to see you here next year!) the versatile and tireless nurse Vafa Talebi, the funniest anesthesiologist ever Dr. Brent Graham, a highly motivated runner Hanne Gehling, and the ever energetic and invaluable Lead Runner Connor Schwab.  Way down in Room 5 our new surgeon Dr. Hans Moller is large and in charge and doing a great job, Dr. Joe Mahoney is providing the anesthesia flawlessly and is truly a great guy, and the incredible circulating nurse, scrub nurse, and runner Debbie Larson is knocking it out of the park.  We also have many other members with Natalie Reed and Anette Gorrman doing PT and a million other things I don’t even know about, the amazing Caroline Swanson and Colleen Love doing a rock star job of preoperative and postoperative care, our videographers who are everywhere all the time Peter Dowell and Hugh Potter (say cheese!) our med students (and interpreters, schedule keepers, and two guys that get pulled in a million different directions) the excellent Stefano Byer and Felipe (the smartest guy in the room every time) Rosario, Shannon Coupens who is tireless, organized and a fountain of knowledge (thanks amigo), Miranda Kirby who is an amazing young woman who is helping OpWalk get organized in a way we never have been, and myself.  My hat is off to our team here with their feet on the ground.  This team has come together and done an amazing service for the people here in La Vega.  We miss all of our friends who have made the trip in past years and wish you were all here as well!
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Surgery count stands at 46 with a HUGE day coming up tomorrow as we have 5 rooms running.  Implants and supplies are thinning out but we think we have enough to get them all done.  Spared by Ramona today, God bless her.  Huevos and toast, no plantains!  Alarm bells in 4 ½ hours!
 
Buenas noches mis amigos!!

"Movement is life, freedom, and independence."
​-Dr. Paul Duwelius, Founder of Freedom to Move