SPA Newsletter

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Submitted by Alan Klein, MD, FAAP
a.s.klein@att.net

Many of us hit the road to volunteer our skills in underserved communities around the globe. Many more of us don't, and have no idea what it's all about. Starting this month I will present a series of stories or journal excerpts written by doctors like you. They will range from beginner experiences to the veteran traveler and missionary. Our first article was written by Elizabeth S. Yun, MD, Assistant Professor of Pediatric Anesthesiology at the University of Wisconsin. (Email: esyun@facstaff.wisc.edu).

When I applied to medical school, my goal was to use my training and education to help people in all circumstances. Then this past February, I joined the organization, Healing the Children, WI on their trip to Rivas, Nicaragua, a small town south of Managua. This group consisted of pediatric orthopedic and plastic surgeons, operating room nurses, anesthetists and anesthesia techs. I finally had a chance to use my skills to help children in desperate need of medical care.

I knew I had entered a new world when the bus taking the group from Managua to Rivas blew out a tire. As we waited at the side of the road for the tire change, I had my first real view of Nicaragua. I watched dogs and chickens wander through the trash littering the side of the road. I felt the smoke from the open fire of a one-room house burning my lungs. A horse-drawn cart slowly ambled past us filled with people staring at the gringos. Yet in the distance I could see a volcano rising majestically into the clouds. Nicaragua was a place of great beauty and great poverty.

I saw the challenges that we faced when we arrived at the hospital. We walked to the operating rooms accompanied by a stray dog. Laundry hung on trees in the courtyard. The operating rooms contained old Ohmeda machines with no monitors and scavenging system and only an ancient suction machine for the operating rooms. The equipment and supplies from the United States were piled up in the hallways. As I stared at the chaos, I wondered how we were going to practice anesthesia.

Yet in the next few hours we set up the anesthesia workroom in a storage closet and organized our equipment and drugs. We grabbed several carts to serve as anesthesia carts and small boxes to hold our drugs in the OR. We created a scavenging system by running tubing out of the OR into the hallway so everyone would stay awake during the surgeries. Our group of doctors, nurses and technicians, who had just met one day ago, meshed into a cohesive unit. I also enjoyed the challenges of providing anesthesia without the safety nets that I depended on in the United States and using the available equipment to give a safe anesthetic. At the end of a twelve-hour day of cases I was exhausted yet exhilarated.

But it wasn't always an easy time. I felt keenly that my lack of Spanish hampered communication especially during inductions. I couldn't use words to reassure patients as I usually did. Instead I could only comfort by holding them or touching their faces. I looked into eyes that held not only a normal fear of the OR that I see in children in the US, but also sadness and resignation. These children might be scared but they would follow and not resist. And there were several times when I wondered if certain people were taking advantage of the rich Americans. There would be demands for more donations, but we would find neglected equipment lying in a corner. One mother seemed all too eager to leave her daughter with us. I wondered if we were truly helping people improve their quality of life or enabling them to keep things the same.

I have now been home for a month and I have had more time to reflect on this experience. Did we help the children? I know we did, but I realize now that the business of helping others in other countries is a much more complicated task. Yet, despite my questions, I still would go back to Nicaragua. The need to provide good medical care to one child who might not otherwise have that chance is still great. And every time I care for that child, I move a step closer to reaching my goal of the ideal physician.

Elizabeth S. Yun, MD
Assistant Professor of Pediatric Anesthesiology
University of Wisconsin