4th Generation of International Humanitarian Surgery

The Ann Oh blog

Prologue

One of the purposes of these blog stories is to assist the students are in the process of acquiring knowledge, skills and experience. In that we assist in their choosing their value system. I am so happy that this blog project has been successful. And there have been no complications. In fact success compels us to share a happy student, which is ongoing right at the present time. The Ann Oh story.

Thank you to Dr. Donald Laub

I want to begin by thanking Dr. Donald Laub for giving me this wonderful opportunity to visit Ecuador and learn from two wonderful doctors – Dr. Edgar Rodas and Dr. Jorge Palacios – who are both bringing crucial medical care to the rural poor in Ecuador. One early Saturday morning in June, Dr. Laub welcomed me to his home, and as we sat down in his living room he asked, “Why do you want to become a doctor?” I answered, “Because I want to help others.” It was a concise and straight-forward answer, but at the time I vaguely understood its meaning. However, Dr. Laub showed me how I can help others and with what mind and spirit. He is an amazing mentor who kindles the passion and furnishes with expert knowledge and guidance. And most of all, Dr. Laub is a tremendous role model who seeks to inspire students like me to pursue excellence in all endeavors, yet show compassion and serve those who are less fortunate. I am truly blessed to have met Dr. Laub and to go on this trip because I got to experience my first “peak experience” – the moment that reaffirmed my desire to become a doctor and help others. His own journeys around the world exemplify the compassionate doctor.

(Disclaimer: Dr. Laub is uncomfortable with him being mentioned in my post. But I insisted.)

Cuenca, Dr. Rodas

I arrived in Cuenca, Ecuador – a beautiful Spanish colonial town steeped in culture and art nestled in the Andes Mountains – where I met Dr. Edgar Rodas and his wife, Dolores. Dr. Rodas founded the Cinterandes Foundation, which operates a Mobile Surgery Unit (MSU) that is fully equipped for doctors to perform laparoscopic surgery in remote communities. My first trip with Dr. Rodas and Cinterandes surgical team and volunteer doctors was going to be a 12-hour ride winding through the majestic Andes Mountains; gaping at the snow-capped volcano, Cotopaxi; and finally arriving at a small town of San Jose de Las Minas, just north of Quito.

Standing in scrubs, I watched from a small TV monitor at the head of the OR table more than a dozen hernia repairs and tubal ligations. Coming out of a tubal ligation surgery, the husband of the patient called out “doctora” and asked how it went. I told him “muy bien” and we exchanged some “thumbs ups”. When I met the husband and wife again in the recovery room to do a questionnaire, they thanked me. Taken aback by their gratitude, I realized that the short white coat I had on conferred capability and knowledge that I didn’t have. I felt flattered that as a stranger in a foreign country I could be treated as a doctor who knew something. I had my first peak experience where I saw a vision of myself as a surgeon traveling around the world helping people.

I also got a chance to conduct a short post-op patient satisfaction survey for a research project that Dr. Laub suggested and Dr. Rodas fully supported. What I found confirmed that the Mobile Surgery Unit is an excellent model for rural surgical care in Ecuador because it meets the medical needs of the patient, and the social and cultural needs of the family and community. Overall, I found that the patients truly appreciate the care and attention that they receive from doctors and staff. Family members also find the atmosphere more comfortable than a hospital because they can visit the patient after surgery, and there are many opportunities for both the patient and family to talk to the doctor right after surgery. I saw that the patient-centered approach practiced by Cinterandes created a more positive environment and allowed patients to be invested in their medical care.

Dr. Rodas and Cinterandes Staff

Most of all, patients appreciated the Cinterandes doctors and staff for their heart. All the patients were receiving free surgeries at MSU – some that would cost at least $1500 at a hospital, which would be a great economic burden on these poor families. The patients and their families understood that the doctors were working voluntarily and were grateful for their dedication to help the rural poor. I felt the same as I stood in the surgical unit in multiple operations, watching the doctors and medical students work hard as a team to create the best results. Although this work was for gratis, I believe everyone on the trip gained something immensely more valuable than tangible or monetary goods – a gift that Dr. Laub calls “psychic income” – that is contentment and energy attained from helping others. I was amazed to see how a successful surgery brought alegria (happiness) to the entire family. Surgery truly has a multiplier effect because it not only changes the life of the patient by eliminating the disability, but also positively impacts the family and community. Dr. Rodas’ work with Cinterandes is proof because he has performed 6,200 life-enabling surgeries that have forever changed the futures of the patients’ families and strengthened their communities.

Guayaquil, Dr. Palacios

Descending from the Andes Mountains I arrived in the premier port city of Guayaquil, where the Rio de Guayaquil paves its way to the ocean, making islands in its wake that are lit up by little towns. I met Dr. Jorge Palacios, a plastic surgeon who spearheads Fundacion Rostros Felices (Happy Face), which operates a mobile surgery unit that provides free cleft lip and palate surgery in rural towns. Unfortunately due to time constraints, I was not able to go on this trip. But I was able to visit Dr. Palacios’ private clinic where I saw several very interesting operations – such as a breast implant, liposuction and auriculoplasty for portruding ears – and I also got to work at the centro de quemados (burn center) Dr. Palacios founded at the Luis Vernaza Hospital in Guayaquil.

At the burn center, I saw many patients who suffered third degree burns from construction work-related accidents, electrocution from poor wiring and gas explosions. Some patients had burns covering more than half their entire body, while some lost limbs. Maribel Ortega, the chief resident, showed me how to debride a burn wound and taught me all the supply names in Spanish. So when she asked for “pinsas” I would hand her the forceps; when she yelled “apositos,” I would grab the gauze, soak it in diluted chlorine then place it on top of the wound. I also got the opportunity to do a skin graft, where I saw the doctor use a dermatome to take epidermis and part of the dermal layer from a donor site and I stapled the skin on to the burn wound. A few days later, Maribel showed me the result of the skin graft I had done – it was free of infection, clean and healing well. She said, “You did a good job.” I was glad.

More memorable than the blood and gore, or the blades of the dermatome were the relationships I created with the patients. Third degree wounds and skin graft donor sites take about 10-15 days for the skin to grow back and repair itself so patients stay in the burn center for a long time and doctors really get to know them. It was difficult in the beginning just to see patients shivering on the OR table but I began to converse with them in my limited Spanish. Every morning I would enter the burn unit and see them waving from their beds, and I would give a big smile and wave back from outside their glass isolation rooms. Silently, I would pray that their wounds would heal quickly so they could be embraced by their family who stood vigil outside the burn center every day.

Dr. Palacios left me with words that sum up my trip and my renewed passion to become a surgeon. Showing me a wood model of his ship he said,

“Los Barcos, estan seguros en los puertos.

Pero, ellos no fueron hechos para esta alli!”

Translation:

The ships are safe at the harbors.

But they were not made to be there!

So we must travel! Whether it is by airplane, boat or a mobile surgery unit on wheels, we must go the distance to help families who lack access to care. I want to be a doctor who is fearless in embarking in uncharted territories, passionate to serve those in need, and eager to forge new relationships and build bridges between countries. This is an ideal I will strive for myself as I pursue a career in the medical field.

My primero trip to Ecuador has opened my eyes to different peoples and cultures, and has taught me that true medicine is about compassion and giving. Thank you Dr. Donald Laub for making this trip possible, and being the greatest mentor ever. I would like to thank Dr. Edgar Rodas for giving me this wonderful opportunity to join him and the Cinterandes staff on this trip. I would also like to thank all the doctors, medical students, Freddie, Gonzalo and Mrs. Dolores Rodas for such a warm welcome and making my first trip to Cuenca a wonderful experience. I want to thank Dr. Jorge Palacios, his mother, fiance and his family for making my time in Guayaquil truly memorable; and Maribel Ortega for teaching me so much in the burn center. And a most honorable mention to Solomon Lee, a friend who has been a bridge connecting me to so many wonderful people. Lastly, I hope to come back to Ecuador soon with better Spanish skills because I have absolutely fell in love with the people and the country. Muchisimas Gracias!

Epilogue

The coincidence is improbable. That is what makes such great interest in why success happens. Ann Oh is not one of my Stanford students; she is not a diplomate of my speakers 20 presentations in the “principles and practice of international humanitarian surgery” course for undergraduates. She has recently graduated from University of California, Berkeley. She had not been exposed to my teaching methodology, my theory of the need to brainwash regarding to the value of helping others with international surgery. But her appearance is not pure coincidence. When word of mouth spreads the idea rather than the force-feeding method, success is at hand and celebration is appropriate at this early time.

I therefore anticipate that the Ann Oh story is simply chapter one.

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2 thoughts on “4th Generation of International Humanitarian Surgery

  1. Wonderful blog, Ann. Your experience sets an example for all of us. It makes me happy to see that Dr. Laub’s blog is in such great hands.

  2. Ann Oh:
    I am very happy, because you understood your mission, and the essentials of Donald Laub philosophy!!!
    Donald, you are changing the world!!!. Thanks to you, many, many medical students will become humanitarian and will help to change the life to many children. DIOS SIEMPRE TE BENDIGA!!!!.
    Jorge Palacios

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