More from October 2012 - Vol. 31 No. 10
Melissa A. Scholes, MD
On January 23, Meredith N. Merz, MD, led a humanitarian mission from Nationwide Children’s Hospital to Managua, Nicaragua, sponsored by Assemblies of God. I accompanied Dr. Merz as the pediatric otolaryngology fellow, joined by pediatric anesthesiologist Iwona Bielaska, MD, and family physician Brian D. Williams, MD.
Our team, “La Brigada,” volunteered at Managua’s Hospital Lenin Fonseca, a public hospital and training center for otolaryngology residents. Our focus was to perform otologic surgeries in children, as there are no pediatric otolaryngologists in Nicaragua and few otolaryngologists who perform any type of ear surgery. Nicaragua is the poorest country in Central America and second poorest in the Western Hemisphere. Supplies were tight, but the doctors at Lenin Fonseca do an amazing job with what they have. Nothing goes to waste, and what we consider disposable is reused for as long as possible.
Our first day was spent meeting potential surgical candidates in the clinic. We worked among the attendings and residents where there was a whirlwind of teaching and pathology. Noemi Callazo, the missionary for Assemblies of God in Nicaragua, was helpful in translating and facilitating communication. She has a working relationship with the doctors at the hospital, and helps facilitate care for those with the greatest need. The residents screen patients throughout the year for visiting teams and they did an excellent job performing pre-operative work-up.
Our next three days were spent in the operating room. As with most equipment, there is a desperate need for operating microscopes in Nicaragua. We brought a microscope head and light source to attach to an existing stand and ear instruments and supplies that were generously donated through Medtronic. The majority of surgeries were otologic. The residents enjoyed learning more detail about ear anatomy and surgery. An urgent tracheostomy was performed on a newborn and a bronchoscopy on a child with a strangulation injury. Dr. Bielaska also had the opportunity to teach the anesthesiology residents about pediatric anesthesia. Dr. Williams saw patients and served as a liaison for the Nationwide Children’s Hospital team and the doctors from Lenin Fonseca.
This was the first humanitarian trip for Dr. Merz, Dr. Bielaska, and me. It is difficult to express the total of our experience—we were challenged, humbled, and stimulated at every turn. Thank you to the AAO-HNSF Humanitarian Efforts Committee and Alcon Foundation for their support. Eugene N. Myers, MD, FRCS, Edin (Hon)
With 362 participants from more than 40 countries, the VIII Balkan Congress of Otorhinolaryngology–Head and Neck Surgery took place June 10-12, at the President Hotel, Tirgu Mures, Romania. Professor Gheorghe Muhlfay, MD, University of Medicine and Pharmacy, organized and presided over the meeting. An elegant opening ceremony took place on Sunday, June 10, in the Culture Palace’s Great Chamber with a delightful organ concert, offered by Ms. Molnar Tunde, followed by a cocktail party and the President’s Faculty Dinner. As the Congress’ Honorary President, I gave an invited lecture.
The well-organized program featured outstanding guest faculty from the Balkans, other European countries, and the United States. The program content was broad enough to appeal to everyone in otolaryngology with lectures on hearing loss, balance disorders, rhinology, and cancer of the head and neck. Featured panels on cochlear implants included one with Piotr Henryk Skarzynski, MD, and audiologists Margaret Price and T. J. George, and an excellent companion piece, the MED-EL Symposium. Other scientific sessions covered obstructive sleep apnea, laryngeal neoplasia, cancer of the head and neck, and rhinology, cervical endocrine, and plastic facial surgery. There was also a poster session.
The Gala Dinner at the President Hotel featured an outstanding group of young Romanian dancers in costumes typical of the ethnicities in Transylvania. The day after the closing ceremony on June 12, the guests took a trip to the Cheile Turzii salt mines followed by dinner at Sighisoara’s medieval castle. Overall, the meeting was outstanding, enjoyable, and was done at a very high level. Melynda A. Barnes, MD
Resident, Stanford University Hospital and Clinics
From February 19-26, I traveled to Mazatenango, Guatemala, as part of the Children’s Rehabilitation Institute and Surgical Program (CRISP) Foundation, with founder Ronald Strahan, MD; Jesse E. Smith, MD; Jeffrey Hall, MD; and Robert Kang, MD. Our mission was to provide free surgical repair of cleft lip and palate to all children in need. We also performed several reconstructive and cosmetic surgeries.
I was fortunate to accompany the group, which travels to Guatemala every August and February, by receiving one of the AAO-HNSF Humanitarian Efforts Committee Travel Grants.
The CRISP Foundation has traveled to Guatemala since the organization was established in 1997, and currently partners with Hospital Privado Shalom. With the help of local physicians who work at the hospital, missionaries, and local advertising, children come from all over with unrepaired cleft lip and palate, scar division, and other surgical needs.
When we arrived on Monday morning, there were at least 60 people in the waiting room. We didn’t have translators that day, so my Spanish came in handy. We saw patients until 4:00 pm and then operated until 11:00 pm. Our team consisted of three fellowship-trained facial plastic surgeons, two general plastic surgeons, a nurse anesthetist, a facial plastics fellow, two volunteers (scrub techs and OR circulator) and myself, a fourth-year OHNS resident.
With one large operating room consisting of three OR tables and two anesthesia machines, cleft lip, palate, and reconstructive surgeries were performed under general anesthetic. Mole removal, scar revision, blepharoplasty, and other minor procedures were performed on the third table under local anesthesia. About 15 cases were performed each day, with more than half being cleft palate repair.
Other cases included sinus surgery on a young girl with severe polyps (without endoscopes and navigation) and a paramedian forehead flap on a young woman who needed nasal ala and tip reconstruction. We brought anesthetic agents and surgical trays and instruments, and suitcases full of sutures, needles, syringes, gauze, tape, skin adhesives, and pain medication. Since the patients and their families were from remote villages, many of them camped out in the hospital during the week.
This trip was amazing and I highly recommend participation in a surgical mission trip. My passion for medicine was re-energized and I look forward to incorporating annual surgical missions into my career.