This year Physicians for Peace was fortunate to have Dr. Duffy Casey of Global Brigades working with us in his last year at Eastern Virginia Medical School. Having extensive medical mission experience, Duffy was an excellent correspondent and brought back great stories and videos of his Honduras medical mission with Physicians for Peace. The following is an excerpt from his travel journal:
Duffy Casey
Trip Diary
Tegucigalpa, Honduras
Plastic Surgery Mission
Monday Jan 19th, 2009
I arrived in Honduras a couple of days ago. It’s been almost a year since my last trip down here, and more than three years since I left after living here. This is my first medical mission trip with Physicians for Peace, and I’m looking forward to working with Dr. Brody and the plastic surgeons at La Hospital Escuela. During my third year of medical school I spent several months in the operating room rotating with general, vascular, and pediatric surgeons, but I’ve never had the opportunity to work with plastics so this week is sure to be filled with new experiences and learning opportunities.
Dr. Brody’s plane touched down at noon and I was waiting for him at the airport with a sign but the arrival area is so packed these days we missed each other. After calling the in-country host and director of the plastic surgery residency program, Dr. Luis Gonzales, I arrived at La Hospital Escuela and met with Dr. Brody in the doctor’s lounge outside of the OR. After spending only a few minutes with the man I can tell his wealth of knowledge is only matched by his caring and generous nature. This is his second trip here in the last year. In the doctor’s lounge he introduces me to the 2 plastic surgery residents who insist on being called by their first names, Oscar and Carlos. We spend about 15 minutes together talking about our trips and sharing stories of international medical adventures around the globe before heading off to the floor to meet our patients for the week. Dr. Brody’s been awake for nearly two days straight getting here but is just as bright and anxious to get to work as I am.
Our group consists of three medical students, Carlos and Oscar, Dr. Brody and myself. We move from bed to bed and the residents and medical students take turns introducing each patient to us. The floor is divided into two sides, one for the men and one for the women. We start on the men’s side and find that of our 15 patients, 2 of them have facial cancers, 2 have broken jaws from gun-shot wounds, many have severed tendons from machete wounds, a teenager lost his arm in a coffee processing machine, several have burns on various parts of their bodies, and still others have broken facial bones from trauma. At the end of the men’s hall lies an elderly man, now 79 years old, missing half of his nose. He gets excited when he sees Dr. Brody, and when Dr. Brody comes to his bedside he greets him with a warm hug; his name is Don Filepe. They met in September of last year when Dr. Brody removed a very large Basal Cell Carcinoma from the man’s cheek and grafted the affected area. He knew the man would need follow-up surgery and Physicians for Peace and the Honduran physicians arranged appropriately. Dr. Brody is happy with the results of the first surgery and assures Don Filepe the follow-up surgery will yield even better results. On the women’s side most suffer from burns, some from cooking, others from fires, and one who had an accident with battery acid. After each patient is introduced, Dr. Brody asks us several questions about the diagnosis and treatment options. He’s patient when we don’t know the appropriate answers and encouraging throughout.
After talking with a few of the patients on both sides of the floor it becomes obvious that they all share one thing in common, they’ve been waiting for days or weeks for surgery. The residents explain that there just aren’t enough plastic surgeons for all the patients who need their help. They also explain that the X-ray machine in the hospital has been broken for some time now and that any images the patients have at their bedside were taken at a private facility outside of the hospital, paid for by the patient out of pocket. For the ones who need X-ray images prior to surgery but lack the funds for the private facility, they sit and wait in limbo while their friends and/or family search for a way to get the money together.
After a few hours on the floor Dr. Brody asks which patient we’re going to start on. It’s already starting to get late but you can see he wants to waste no time while he’s here. He understands the value of his time here just as much as the residents and wants to make sure he’s done all he could with the time he’s had. We head to the operating room together and begin working on the long list of surgery patients. When we get out, the sky is dark, we are all tired but happy knowing that this was just the beginning of what is sure to be a good week.
Tuesday January 20th, 2009
It’s 6am and I’m trying to build up enough courage to douse myself with another bucket of cold water. I’m staying in the same house I used to live in between 2003 and 2005. There is only running water a few hours of the day and I use a trash can to collect as much of it as I can, then in the mornings I dip a small bucket into it and toss it over my head as my make-shift shower. The water is colder then I remember it being and I transition from my state of still waking up to an adrenaline rush the moment it hits my back. By the time I’m through I’m wide awake and ready for another day at the hospital. I catch a taxi and arrive at the hospital at 7am. Dr. Brody has just arrived and is ready to get back to the OR.
Our first patient today is a 25 year old man who was shot in the face several days ago. His jaw is fractured in several places. Dr. Brody motions for the resident to stand close to him as he examines the panorex X-ray of the man’s jaw. They each go through pointing out where the injury is, which parts of the bone are most affected, and suggest ways to approach the repair. We continue the conversation as we scrub in together. Dr. Carlos acts as the primary surgeon and Dr. Brody carries the conversation throughout the surgery. He asks a range of questions from possible complications, anatomical structures, and post operative care. Dr. Carlos’s knowledge is extensive and he doesn’t miss a single question.
During the lunch break Dr. Brody and I pause to watch Obama be sworn in as the next president of the United States. It’s a historic moment in our country’s history and we’re celebrating in Honduras. The physicians coming in and out of the lounge each cheer or share words of support and encouragement as CNN broadcast continues.
The day continues and we are able to repair another patient’s broken jaw and place a much needed skin graft on a woman’s burnt leg. Each patient we work with is so grateful for the help we are trying to bring it makes the work fly by and encourages us to continue to strive to do more. After operating for 4 hours on a man who severed several tendons of his arm, we finish the day and leave the hospital around 8:30pm. The sun went down a long time ago, and Dr. Brody is still operating on a minimal amount of sleep, but you’d never know it by looking at him. He looks just as energized, excited, and happy as he did this morning.
Wed, Jan 21nd, 2009
I toss the first bucket of cold water over my shoulder at 6am and am instantly 100% awake. A triple shot of espresso couldn’t have done a better job of washing away any feeling of still being tired. I want to get to the hospital a little earlier today, so I scarf down my breakfast of fried plantains, beans, and tortillas and quickly hail a cab in front of my house in La Colonia Kennedy.
I head straight for the lockers and jump into my scrubs then walk over to the check-out counter where we get our face masks, hair nets, and shoe covers necessary to enter the area outside the operating room. After getting everything on I walk into our assigned OR for the day and get ready for a long list of patients.
Our first patient is a 22 year old male who was beaten in the face with a rock. The gang problem in Tegucigalpa has increased with the global economic collapse and with it injuries like this one are becoming more and more common amongst the hospital’s patient population. Dr. Brody goes through the educational process of question and answer, and brainstorms the options for repair with the residents, then begins with the surgery. The case is difficult and takes several hours to complete. By the end, however, the team seems satisfied with the results and Dr. Brody congratulates the residents on a job well done. As we head out to the hallway for a few minutes break, we see Don Filepe sitting patiently at a desk. Dr. Brody quickly makes his way over and greets him with a warm smile and hand shake. Don Filepe smiles as best he can when he sees Dr. Brody and me walk over. He’s been waiting since 7am and is anxious for surgery. Dr. Brody comforts him and lets him know he’ll be next.
Don Filepe’s surgery lasts the majority of the afternoon. His condition is unusual and the approach to repair his nose and lip is difficult. With the guidance of Dr. Brody, both Dr. Carlos and Dr. Oscar move from one step of the surgery to the next without much difficulty. It’s difficult to imagine how much this man has had to endure in his life and what would happen to him without the help of these dedicated physicians and organizations like Physicians for Peace. After hours of surgery everyone is pleased with the outcomes, and Don Filepe moves to the post operative care ward. We discuss the case as a group for another hour before each heading home. It’s past 8pm, and we’re all tired after another long day in the OR.
Thursday Jan 22rd, 2009
I arrive at the hospital at 7am and meet the team of medical students, residents, and attending physicians in the lecture hall. Dr. Brody has prepared several lectures for the group, and everyone sits with notepads ready, listening attentively and taking notes. They ask questions throughout, and Dr. Brody does his best to explain the intricacies of plastic surgery technique.
When the lecture ends, we head together as a group to the operating room. The first patient suffered from a burn to her leg more than a week ago. She’s been waiting for a skin graft and smiles as we enter the room. She thanks us before the surgery begins then again as she is wheeled out to the post operative care ward.
Today, Dr. Brody and I are surprised when Dr. Carlos and Dr. Oscar take us out for lunch. Dr. Carlos drives us in his car to a new restaurant in town and treats us to a wonderful Honduran meal. We sit around the table sharing stories from our experiences with patients in operating rooms around the world, and they tell us about patients who have stood out in their mind here in Honduras. We’ve all gotten closer during our hours together as a group in the operating room, and it’s nice to sit together and talk like friends outside of work.
After lunch we quickly return to the hospital and the operating room. Patients are waiting, and although we all needed the short break, everyone is ready to get back to work. Our next two patients are both men in their late 20’s with broken jaws. The surgeries are complex but Dr. Carlos and Dr. Oscar get better with each repair they do. It’s late by the time we’ve finished the second repair but the group isn’t ready to call it a day yet, so another patient is brought back and we do a quick skin graft before leaving for the day.
Friday Jan 23th, 2009
Today is Dr. Brody’s last day. His flight leaves around 1pm so we start operating early. Today we have one patient. The man in his 30’s is another patient Dr. Brody operated on in September. Apparently, he was kicked in the face by a horse 2 years ago and has received several surgeries since. Much of his tissue has been replaced by scar tissue which is currently preventing him from closing his mouth. We take him back to the OR, and after a couple hours of surgery Dr. Brody is convinced he will no longer have to suffer from this problem. He still has a little bit of time before he needs to be at the airport and schedules a meeting with two of the directors of the pediatric burn unit across the street. It’s amazing to see that he is always willing to do more, to see one more patient, to try and help one more person, regardless of how late it is, how little he’s slept, or if his plane is leaving shortly. This is the attitude I’ve found is at the heart of Physicians for Peace, and one of the elements of the organization that makes them so successful. It has been an amazing experience working with the talented and dedicated people at PFP, and I look forward to working with them more in the future as a medical doctor.
You can contribute the work of Dr. Brody and others who are making a difference in international health care by donating to our Specialized Surgery Program today!
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