Mission to Honduras

I will be the first person to admit that there have been times during my association with the Army that have been supremely frustrating. Health care is not the primary mission of the military, and sometimes the differing expectations clash with what I expect as a physician. That being said, there are times when I feel fortunate for the opportunities that the Army provides.

A view of part of Hospital Escuela, the indigent hospital in Tegucigalpa, Honduras

For the past two weeks, I have been part of a medical mission to Honduras. Our team of 14 people (all active-duty military) includes everyone you would need to run two operating rooms—nurses, techs, orthopedic surgeons and residents and, of course, an anesthesiologist and some anesthesiology residents. During our time here we were able to provide care for 35 people, many of whom would never have been able to afford the surgical hardware we were able to donate. Patients at Hospital Escuela don't have to pay their doctors, but they do have to buy their own implants for surgical procedures. That can be a difficult task considering the amount of poverty here.

Waiting in the hospital with one of my residents, Mike Patzkowski, for another case to finish

Part of the challenge of providing anesthesia in Honduras is the fact that we can't bring all of our equipment with us. We can borrow some things from the Hondurans, but we try to be as self-sufficient as possible. To make this possible, we go about providing anesthesia a little differently than we would at home. Instead of using general anesthesia and keeping patients asleep with inhaled anesthetics, we relied on regional sedation using nerve blocks and then provided intravenous sedation. Of all our 35 cases, not a single patient received a general anesthetic or required ventilator support. That's a big deal for us because there isn't much monitoring in the recovery area. If the patient has been breathing continuously on his own, we know it is safe to leave him in the recovery area and hurry back to our next case. If the patient just barely came off a ventilator, he needs to be watched closely, at least for a little while.

One of the residents places a nerve block under ultrasound guidance

And nerve blocks like those allowed our orthopedic surgeons to place hardware like this on our patients

In addition to all of the operative cases, we also had the opportunity to interact with the Honduran attending physicians and their residents. I was impressed with how hard they work and what they do without.

Resident Mike Dimeola describes the popliteal nerve block to Juan and Alejandra, Honduran anesthesiology residents, while Mike Patzkowski acts as the ultrasound guinea pig

I'm glad that I've been able to put my medical knowledge to good use for some people who really needed the help. I hope that I can continue to find ways to participate in this kind of medical mission, whether military or civilian. I know I will be going home with a renewed appreciation for all of the amenities and comforts we have at home.

Might want to think again

Spencer: I don't like Scottish people.

Dad: That's ironic considering your last name.

Spencer: You mean Scott comes from Scotland?




-- Post From My iPhone

Small engine repair

This would be the intake manifold—or what's left of it

The last time I used our lawnmower, it unexpectedly shut off, but since I had just finished mowing the lawn, I didn't think much of it. When I tried to start it up this week and it wouldn't work, then I started putting some thought into things. It appeared that the engine wasn't getting fuel. The fuel line was looking pretty bad, so I replaced that. That didn't fix the problem so I pulled off the carburetor. No problems there, either. I started pulling off even more parts. it didn't take long before I found my problem—a broken intake manifold (pictured above).

As I was digging around on this engine, I had a flashback to a childhood memory. My father taught a small engine repair class at South Bonneville Junior High. This was back when North and South Bonneville were sharing a school so I wasn't any older than Mason. Anyway, the kids in Dad's class were pretty good about tearing these engines apart, but not so good at putting them back together. At the end of the school year, Dad would have boxes of engine parts, and he conscripted me and sometimes my younger brother to help put them back together. I guess that exercise ended up being rather useful after all.