Anthony M. DiGioia III, MD: August 2009 Archives

Our trip to Guatemala is coming to a close.  Tonight we had a goodbye dinner for the staff at the Santo Hermano Pedro Hospital.  Padre gave each of us a certificate to commemorate our stay here.

Santo Hermano Pedro hospital staff

 

Although we could not help everyone, we have accomplished much this week.  We would like to leave you with a patient's story.

Julio's Story

Julio was diagnosed with leukemia at age 14.  He had a bone marrow transplant and was treated with high doses of steroids.  He is now 24 and cancer-free.  The side effects of his cancer treatment affected his knee joints as the steroids destroyed the cartilage between his knee bones. He has been in pain for the last eight years with increasing limits in his activity.

Julio told us that his family could not afford the joint replacement operation and that even if they could, he thought he would die in the hospital.  His neighbor had a knee replacement at Santo Hermano Pedro Hospital.  She showed Julio's family her new knee and told them about "the best doctors in the world" who have come here to operate.

Julio told us his story in the hospital:

I was so scared the day of surgery.  My heart just went beat, beat, beat, beat.  Dr. Tony talked to me that morning and made me calm, and my heart started to beat normally again.  I told the anesthesia doctor to give me something so I would not have to see the surgery, and the next thing I knew, I was awake with my new knee.

Because I can speak English and most of the others here cannot, I would like to thank all of you for helping me and my people.  I'm sorry, this makes me cry, but I have so much thanks in my heart for all of you.

Soon I will be able to play soccer with my friends and dance with the girls.

Gracias!!!!

  

And as you can see from the photo of Julio, he is quite the ladies' man!

Today was the first non-surgical day since arriving in Guatemala.  After three and a half days of operating, the team was able to replace 63 hip and knee joints!  The operating room staff took great pride in the long hours worked and the number of Guatemalan people they helped.  However, there was no rest for the weary as they had to re-pack all of the surgical equipment and implants to ship back to be used by another Operation Walk team on a future trip.

With the surgeries completed, the primary task became focusing on the post-operative care of the patients.  The surgeons made rounds on all the patients they had operated on over the last few days.

Dr. Mike Weiss and Duane Chess check on a patient.

Many hugs and handshakes were exchanged because the patients were so grateful and appreciative time that the doctors and other team members gave to help them.

Dr. Tony DiGioia greets a patient.

Incisions were checked...

Tracy Brnusak and Janice Harmon check an incision.

...and all dressings were replaced with clean bandages.

Tom Maidens changes a dressing. 

This afternoon team members were finally able to explore the quaint town of Antigua and its many unique shops and picturesque views.

Antigua, Guatemala

 

Although the hours have been long, there isn't a single team member who hasn't been touched by the kindness and gratitude shown by the people here (and more than a few team members have also been touched by a bit of "upset stomach" associated with travel to foreign countries!).

Tomorrow will be another busy day of post-operative care, along with multiple physical therapy sessions, in preparation of sending patients home to begin a new life free of hip and knee pain.

Each one of the Operation Walk Pittsburgh team members extends thoughts to friends and loved ones back home.  They can't wait to see all of everyone in a few days and to give a firsthand account of all the wonderful things that were seen and done here.

But for now... we say Adios! from Antigua, Guatemala.

Antigua, Guatemala

Today has been another busy day at the Santo Hermano Pedro Hospital.  Today we'd like to share some interesting differences between health care here and health care in the United States.

The Santo Hermano Pedro Hospital is run by the order of Franciscan Monks.  While the patients are not required to pay for surgery during our Operation Walk mission, most make a donation to the hospital.  These donations are used to fund the orphanage that is part of the hospital.  Many patients come from far distances, and their families will stay in the city at Casa de Fe (which is similar to our Ronald McDonald House).  The difference is that if we run out of patient beds in the ward at the hospital, the patients who had surgery in the beginning of the week and are doing very well will be transferred to the Casa de Fe where their families will take care of them.   The staff will visit to make rounds to assess the patients and give physical therapy, but there is no staff staying at Casa de Fe.

The surgical procedure is similar.  The patient is taken to the pre-op area to be prepared for surgery.  The patient has surgery and then is transferred to the PACU to recover for several hours before going to the Post-op Ward.  When the patient is ready to be transferred to the ward, the nurse opens the door to the PACU and yells "patient" loudly across the hall.  That is the signal for the staff to prepare for a new patient.

Barb admitting Clara to the PACU

On the post-op nursing units, there are no private rooms, but wards that hold three to ten beds.  In one ward, beds line the walls with the foot of one bed touching the head of the next bed.  In another ward, the beds are next to each other with about three feet of space between beds.  There is very little privacy and (surprisingly) the patients don't seem to mind.  

We made rounds this morning to change post-operative dressings.  If a patient's ace bandage becomes soiled with drainage, the ace bandage is changed.  The soiled bandage is placed in a bag and given to the family to take home, launder and bring back for the next morning's dressing change.

Tori and Tracy with a patient

The family also brings toilet paper (which is always in short supply) and toiletries to the patient.  Patients' gowns and bedding are changed only as needed.  A daily bath is not part of the nursing routine here.  Operation Walk brought all the medications needed for the joint replacement surgeries.  The family must bring in any medications the patient was taking prior to surgery (such as diabetic or cardiac medication).

Physical therapy is done at the patient's bedside and in the halls and gardens surrounding the wards.  One patient who had surgery today required a walker before surgery.  Because he could not afford to buy one, his family made him a walker out of lumber and nails.

Physical therapy with Frank

Visiting hours begin at 2 p.m. daily, and it seems that the patient's entire family comes to visit.  The wards get really crowded, but it's almost like a celebration every day.  We have heard no complaints from any of our patients or their families, only thanks and blessings for our being here.

Visiting hours

Another cultural note:  When using the bathroom, used toilet paper is not flushed down the toilet, but thrown into a waste basket next to the toilet. 

The Santo Hermano Pedro Hospital was a busy place today.  The OR staff and surgeons started performing surgery at 6:30 a.m. and completed 22 joint surgeries today.

The patients who had surgery on Saturday and Sunday are recovering on the hospital wards.  Patients are taken for X-rays of the new hip or knee and have blood work done the day after surgery.   Each patient then has a physical therapy session in the morning and another in the afternoon.  The Operation Walk physical therapists were joined by 10 physical therapy students from Guatemala City who are in their final year of studies.

We were able to talk to many of the patients today between physical therapy sessions. We asked each patient how long he or she suffered with pain prior to coming here for surgery.  Answers ranged from 3-20 years.

We also asked what each patient's hope was for the future.  Most patients answered that they would like to be able to work again. Here are several other responses:

"I feel absolutely great today.  In the future I'm going to do everything!"  Rosalvina, right hip replacement

Some of the patients also wanted us to express their thanks to all involved in Operation Walk.  A few comments to share:

"I want to thank all of you, especially the doctors that come from far away with their good hands."  

Lidia, left knee replacement

"I want to thank all of you for leaving your houses to come here and help us walk again."                                                                                                       

Victor, bilateral knee replacements

 

On a cultural note, it was the feast of Our Lady of La Merced.  A procession went past the hospital and thru the town of Antigua.  The photo below is of a float honoring Our Lady of Merced.  The float weighs over one ton and is carried by the women through town.

Today was the first full day of surgery for the Operation Walk team in Antigua, Guatemala.

A view inside one of the four operating rooms being used

The team started operating at 7:30 a.m. and didn't finish the last case until 6 p.m.  Although it was a long day in the operating room, much was accomplished.  The team was able to complete 18 total joint replacements on 12 different patients (6 patients received bilateral replacements).

Dr. Tony DiGioia and Physician Assistant Mike Hallahan work on a total knee replacement.

Dr. Mike Weiss, Dr. Anton Plakseychuk and Physician Assistant Duane Chess operate on a patient.

Following surgery the patients were transferred to the nursing unit where they will rest overnight and then begin physical therapy in the morning.

 

The patients and their families have been very appreciative and grateful for the Operation Walk team's work in Guatemala.  One patient said that it was "a miracle from heaven" that the Operation Walk team came to Antigua.  Another patient's family approached a team member with tears in her eyes then hugged and thanked them for giving her loved one a chance to walk again!  It is moments like these that reaffirm the work being done and the tremendous impact the team is making in the lives of the Guatemalan people.

To see additional photos of the team's trip, please visit http://www.operationwalkpgh.org/trip_photos.htm

The screening process lasted most of the morning and then the selection process began to determine which patients would qualify for surgery.  After the patients were selected, the surgeries were scheduled for the week.  The patients and their families were informed of their selection for surgery.