The team: Dan, Angeline, Constancio, Renata & David
This summer, I traveled to South America for the first time to attend Operation Hernia’s mission Ecuador. In your position about 9 months ago, looking through this website, my mind was a hodgepodge of questions. Will I actually be able to help? Can what I learn be useful to me at my level of training? Is it worth flying to a whole new continent for this?
The answer to all the above questions is simple. Yes.
I heard about Operation Hernia (OH) at a conference in Cardiff University, where one of the surgeons who had recently attended a mission in Africa gave his account of what they had done. The concept of OH attracted me for several reasons.
1) I have a keen interest in surgery, particularly gastrointestinal surgery, and I enjoy volunteer work and traveling. The mission sounded like a great way to combine my three great passions.
2) OH is a very transparent organisation, the aim was clear and there appeared to be much more of a personal touch in their work than other organizations that I was also considering. (My gut instincts were accurate – not once was I made to feel like another cog in a huge machine. My contribution was always valued by all the team, and the doctors treated me like an equal during pre-operative discussions and planning.)
3) I had never been to South America!
Knot tying practice
A whirlwind few months of preparation later, I found myself in a four wheel drive with some amazing surgeons, with our luggage in the back, driving down the steep but beautiful mountains of central Ecuador on our way to La Concordia, a small town in northern Ecuador, to start our project.
Almost 80 patients were waiting for us to arrive the Sunday afternoon before the operations began. We were working in a public health centre as well as a mobile unit graciously loaned to us by the local ministry of public health. We delegated quickly, and the surgeons each began to see patients with the help of the local bilingual junior doctors. I helped unpack all the items we had brought with us and made a list of everything we had. An hour and a half later, we discovered that we had brought 23 different types and sizes of sutures, and had about 60 patients listed for the rest of the week.
7am the next morning, I was running from one unit to the other, making sure each of the tables had adequate equipment, photocopying operating lists to be put up in front of each table, searching for more gauze and several other miscellaneous tasks. The surgeons were also working on rearranging the tables to suit our needs. By 8.30am we had made ourselves a makeshift theatre that felt familiar despite the fact that none of us had ever worked with such limited equipment or in Ecuador before.
Our first patients were anaesthetized, and the operations began.
We operated on 78 patients throughout the week, with our youngest a little 8 month old boy and our oldest an 83 year old great-grandfather. It was one patient after another, with more coming to see us between cases. There were some very complicated cases, with large defects, or rare hernias, including several femoral hernias in men and a lumbar hernia.
We realised very quickly that while hernias are hernias wherever you are, we would have to do things very differently from what we were used to. We had a large volume of patients to operate on in a short period of time, and a language barrier with the locals, who spoke only Spanish. It was imperative that we adapt our methods quickly in order to perform safe surgeries as best we could with what we had.
Despite the challenges we faced in terms of logistics, the unspoken language of the world is universal. With each patient we led into our operating room, we understood the message conveyed by the look they gave us as we helped them lie down on the table.
“I trust you.”
Many of them had waited years to be able to have their surgeries. Many experienced pain or discomfort from their hernias. Most suffered in silence. Without any knowledge of who we were or what our qualifications were, they allowed us to operate on them, and were more than grateful for our help. Even though hernia repairs are relatively simple procedures, I felt like we really made a difference in the quality of life for some of our patients, especially those who were breadwinners in their families and whose work had been impeded somewhat by their large defects.
I found new mentors in the surgeons and anaesthetist on the mission with me, all of whom gave me excellent advice and teaching about everything from the history of surgery to how to behave in a new environment amongst new colleagues. I learned surgical anatomy, knot-tying, assisted in 24 cases! I also got to learn how to handle different items of equipment, types of sutures and meshes (including mosquito net mesh!) as well as their uses. They were patient with my ignorance and very keen to teach me, and I don’t have to tell you that this opportunity was invaluable for a young medical student with an interest in surgery.
The local staff were more than helpful to us throughout the project, demonstrating dedication and patience in working with us and our language problems. Many stayed back after we finished for the day to make sure our operating room was cleaned and our patients reassured, despite the fact that they wouldn’t be paid for their time. Where we were unable to calm some of our younger patients down, they stepped in and soothed them for us. They opened hundreds of sterile packs for us, tied up our gowns, ran up and down with equipment, rounded up our patients, and greeted us with big smiles every morning. They really took teamwork to the next level.
Ecuador itself is one of the most diverse places in the world, with scenery and landscapes that I have never seen before, splashed with colour from the strong cultural heritage that they still keep. If you haven’t already gathered as much from what I’ve already told you, the local Ecuadorians were some of the nicest people I have ever met, and I had a great time getting to learn about their culture and heritage, as well as the fantastic geography and biodiversity of their country.
As I left Quito airport to return home, the immigration officer asked if I had enjoyed my stay in Ecuador. ‘It was the trip of a lifetime,’ I told her. It really was.
Angeline Hwee Yin Lee
Third-year medical student,
University of Bristol,