A story of surgical compassion

BASED ON AN INTERVIEW WITH PROFESSOR EDGAR RODAS, former minister ofB health in Cuenca, Ecuador. Of the country of Ecuador. Professor of Surgery, Meritus, University of Oswai. From South America. With experience of doing mobile surgery.

I am a very religious person when it comes to the purpose of life. I believe in God and I deeply believe that God has created us for a reason. I believe that we have to fulfill a mission that he has given to each one of us. Everybody must have a mission and I think we should always try to figure out what our mission in life is. Why we were created. I struggled with this question all the time when I was young. Then, for different reasons, I came to the conclusion that I was created to serve others and to relieve the pain of others. I have to act consequently to that belief. I feel very deep in my heart that I was created to do that. I try to orient all of my life around this purpose.

I think there are several reasons and several experiences that I had in my life that led to the organization of Cinterandes and the mobile surgery program. Going back, I think the main one that moved me, really, was my experience in the town of Mallatauro. Mallatauro is a small town lost in the slopes of the Andes Mountains. It lies on the western range of the Andean Mountains. We used to go there with the medical students to give medical care to the people because it was a very remote region. At the time, the only way to get there was by horseback ride that took over 12 hours going along the mountains and lots of narrow roads and precipices. A very difficult journey.

One day, the priest of Mallatauro called me and told me that, “one of my friends in the town needs help.” She was a 22 year old lady in the 8th month of a pregnancy that had been normal, but all of the sudden, she developed abdominal pain, and distention. These are all of the symptoms of an acute abdominal infection.

I didn’t know what to do there. I was thinking that maybe it’s appendicitis. I could just do it under local anesthesia, make the incision, put the tray in, bring her back to the city. If she was pregnant, maybe we had to do an emergency c-section under local anesthesia.

I took all the equipment I could, and with two medical students, started the road to Mallatauro around 5 o’clock in the afternoon. We drove all night. I remember so clearly it was very chilling, the moon was a full, everything bright, just the noise of the mules and the horses on the roads. I remember the rocks that rolled over as they passed by; the wind blowing; the cold wind blowing on our faces. And I was thinking, “What shall I do?” Will I be able to deal with the problem I was going to find?

Finally, when it was clearing up at 6 o’clock in the morning, we got to the small hut, smoke was coming out of the roof. And we got with the father that went to meet us. The little, young lady was dead. She was still warm, but she was dead. I listened to the womb, and the baby was dead also. There were no signs of life.

The only thing that the Priest put on was a black poncho, a funeral mask, and we returned to the city with our hearts full of sadness. I realized then how helpless the people in the mountains were. It didn’t matter that we had modern hospitals in the cities, they didn’t have access to that. I realized that access was the problem.

It was difficult to take surgery to those remote regions, so I started to think about what to do. Then, I had many experiences with the foreign missions. I had already had some experience with Project Hope. I saw the Project Hope, the ship Hope, going to Guayaquil. I was just graduated from the medical school and I went to do my internship in the boat. I saw 1st world medicine for the first time; surgery done in a different way than we used to do. And most of all, I saw the compassion of those doctors with the patients, and the way they treated the patients. I realized that many of them were sacrificing their vacation time. I realized that they went from a country full of commodities to live in a difficult way. And that they did it for our people. So I thought, we should do the same for our own people. Then I met Interplast. I met Donald Laub, 1976. After many times trying to meet in San Francisco and Cuenca, finally we met in Cuenca. We decided to take the program to the University of Cuenca and to the city of Cuenca.

Organizing the program was a success. I was again impressed by the care that people put in the patients, the long hours, the sacrifice that that implies. I was impressed very much by Dr. Laub because he taught me that in order to serve others, you have to be an excellent professional. You cannot serve others if you are not well prepared to do so.

The first task of anybody is to prepare themselves to serve others. The pursuit of excellence became one of my obsessions too. Another thing that impressed me was the humanitarianism, his concept of humanitarianism. The service of others that, at the end, makes you happy, because you get the psychic income. A friend of Ecuador had this expression, the Silario Sicorico, a friend that’s not a doctor, but he tells me and Claudio Marlo,the Minister of Education in Ecuador, and says, “You don’t get money, that you get salario psicologico, psychological salary, psychic income. This concept was said in different languages and in different places. It’s the same concept that you get some satisfaction of serving others which is much better than money. Dr. Laub explained many times that it was a result of our genes.

I found an opposite concept of Francis Collins, one of the people on the human genome team. I think he was the leader of the human genome project. He thinks it’s not in the genes, he thinks that it’s in the moral law. That’s one of his proofs that God exists. He believed that because we all have the feeling of what’s good and what’s wrong and that something’s wrong when we don’t follow our conscience. So, the altruism that he calls this feeling, it’s ingrained in our human soul from outside, from a supreme being, and that’s why we find happiness in serving others.

There are many reasons. Every major religion has this concept of serving others. This agrees with my distant past, my education, and my upbringing in a home that my parents always taught me that serving others is the best you can do in your life. So my parents,my family, and my friends had the same concepts.

At this time my city was isolated from the rest of Ecuador. There were no roads in Cuenca. There was a Spanish and Native culture, with very, very valuable principles. They say, “Don’t lie. Don’t steal. Don’t be lazy.” Those are the three principles of the native philosophy. So, the city had those values. My friends, my education, high school, the university, the example of my teachers at my university, all doctors at that time who just decided to be doctors to serve others, to cure disease, to alleviate pain, that was the purpose of being doctors. That was just understood.

aaFinally, I thought about how technology creates a gap. The most you accomplish in technology, does not access that part of the world. So the gap widens all the time. I thought that I should find a way to apply our knowledge to the benefit of the masses and not in benefit of the people who can access this already, people who have the possibilities, the money and the geographical location and everything.

Then I thought, why not? Let’s put an operating room in a truck. Ambulatory surgery was started at that time. When I was a medical student in Ecuador, you had to take the stitches out to discharge a patient. They were at least 8, 10 days at the hospital. You never sent a patient with stitches home. The ambulatory surgery was starting to increase. The progress in anesthesia, made surgery recovery faster. An operating room is a limited space, that you can have equal to almost any hospital.

I got lots of criticism about that from my colleagues because they thought my patients would have more infections. They thought that the patients were going to be subject to a major risk. I decided to do it. It took me 15 years to get an operating room. We started the program 19 years ago, the 26th of May, 1994.  We just celebrated our 19th birthday.
Compassion comes from latin compatissere, which means suffer with. I understand the capacity that we have as human beings to suffer with the suffering of others.  This is the reaction that most of us have to some extent. I think every human being feels something when he sees another human being suffering. The reaction is different. Some people just go away and don’t want to even see. Some others can just sit and cry with the other person. And some others feel like doing something to alleviate this pain. I think, we surgeons are this type: we have to do something. So we want to act, we can’t a

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