Nicaragua Day 5

Okay. If I wasn't so far behind on blogging, I'd come up with more imaginative titles.


Our fifth day here was also our last day at the hospital. Steve and Michael, both college students considering medical school, have been our comic relief. When they weren't assisting in the OR, they distributed toys to the waiting children. Today, they broke out the sticker books, and no one was left out of the action!


The first surgery of the day was pretty usual for us by day 5: a painful hemangioma on a little girl's back. The demeanor of many of these children when they were wheeled into the OR truly amazed me. This patient was very docile, completely nonplussed despite the number of people working on her: taping tubes, adjusting IV's, covering her face with a mask, not to mention the horrible taste/smell of the anesthetic.


With the more than adept OR staff, you would think it was surgery as usual. However, there were some telltale signs that this wasn't a state-of-the-art facility! At one point, I was asked to photograph the rusting OR tables and a white piece of rusted, dilapidated equipment which La Merced is hoping to replace for them. And while (unlike the clinic) it was an air conditioned envrionment, at one point we caught the AC unit spitting out water right on top of the sterile area (in the foreground below). The affected pieces had to be replaced, and the table relocated until the unit finally 'thawed out.'


Our last two surgeries of the day both involved hands that were badly scarred, and consequently, the scar tissue was interfering with the proper growth of the fingers. The first was a small boy who had grasped the tailpipe of a motorcycle with both hands when he was a year and a half old.


The second, was of a girl who, when she was two, was being pushed in a hammock when it caught on fire over a nearby open flame. They couldn't get her out in time, and her face and hands were badly scarred. It took them two hours to get her to a hospital. Following the accident, her mother left her, she never had any corrective surgeries, and the woman who brought her in to see Dr. Perrotta claimed to be her aunt to be authorized to allow her surgery, even though she and her husband had taken the child in when no one else in the family stepped up to take care of her.


Since she had never had surgery, and there was so much scarring everywhere, Dr. Perrotta had to make a hard decision as to what was the most critical need at the moment. Like the previous patient, the scarring on her hand had inhibited proper growth of her fingers, yet on a much more severe scale. Three-fourths of her right thumb was entrapped inside the burn scar. The x-rays show four fingers, but only a nubbin of a thumb. Its bones are overlapped inside the soft tissue of the hand. Her other four fingers are inhibited by flexion deformities from scar contractures, rending the hand pretty useless. So the goal for the day was to release the thumb, reconstruct it, and give her pinching ability with that thumb and the index finger.

I think this may have been the messiest surgery I witnessed. He had wanted to do it with as little blood as possible, so he had the anesthesiologists drop her blood pressure down to keep the open wounds from bleeding. However, they were unable to locate a standard pediatric bp cuff with a manual dial, and the one they finally rigged up didn't hold. Blood was everywhere. I was amazed the docs could even see to continue operating. Once they were able to release the thumb, the question became, how to get the thumb to stay in the proper position during the healing process.

What they felt was the obvious answer, put in a pin, wouldn't work because the hospital had no pins. So after much debate, they put in a few well-placed stitches with a heavy material, and after grafting the skin over the newly created thumb, bandaged it with a splint. (Ha ha, I'm sure if you have a medical background you are astounded with my use of medical terminology! ;-)



I think today was by far the most stressful in terms of challenges. Personally, I would love to see this brave little girl brought to the States for state-of-the-art hand reconstruction, as well as the surgeries necessary on her face to give her some chance at a normal life without the points and stares of strangers.