Page 45 - CASA Bulletin of Anesthesiology 2019 Issue 1

by local military personnel at all times. This has been their common safety practice during the past missions. We would not go on our own to “explore” San Pedro Sula. Our hotel was one of the nice hotels located in downtown San Pedro Sula. We would rest, dine and party within the hotel. I also spoke to my colleagues, who have gone to worse places than Honduras, and their experience was always phenomenal. The biggest reward they had was “makes them realize their original goal why they wanted to be a doctor”. With this in mind, I made up my mind.
On the evening of March 16, 2017, the mission team finally gathered at JFK. Most of us met for the first time. We would be working very closely during the next 7 days. Avianca airline took us on a redeye flight directly to San Pedro Sula, Honduras. All of the team members only had carry-ons with personal belongings, saving the checking luggage for our surgical equipment. Upon arriving in the morning of March 17, 2017, San Pedro Sula was like any Central American cities, beautiful and quiet. After picking up all the suitcases, the bus was escorted by the local military, and taking us directly to the hotel that we lodged.
Even though we were all tired from the long flight, all the team members gathered for
the briefing after some simple breakfast. All members introduced themselves to the group. Quickly, we were divided into two groups: GYN and orthopedic team. The teams were taken to two different hospitals. Physicians, PAs, nurses and surgical techs made up the main frame of the two teams. Other staff including us six anesthesia providers would rotate between two services to maximize the experience. It was even a first time for Blanca’s House to divide and conquer like this.
Day 1
Our job was to unload all the equipment, set up our workstations and evaluate all the patients. I joined the orthopedic team, heading to a tertiary care hospital, while the GYN
team was heading to a different hospital, which was less modernized. There were 23 patients who were selected by Dr. Juan Carlos, a local orthopedic doctor (one whom was planned for bilateral knee replacement). The selection criteria were based on their age, severity of the arthritis, and medical comorbidities, etc. Dr. Fracchia evaluated all of the patients, reviewed their x-rays while I evaluated all the patients for the anesthesia care. The anesthesia plan for the knee replacement is spinal anesthesia. Post -operative pain management was both regional, ultrasound guided adductor canal block (we had a loaner ultrasound from Sonosite) and oral/ IV pain medication. Most of these patients had never taken any kind of opiate based pain medication in their life; therefore, we have to be extremely cautious giving out pain meds.
Being in a third world country, the operating rooms are definitely under par comparing to what we have in the US. It will be a challenge for us to perform all the surgeries efficiently and
Vol.6, No.1,2019
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