Thursday, October 28, 2010

Epic trip - Surgical Elective to Cuenca Ecuador

It has been a while since I last posted an entry. Much has happened since my last dated entry, and this is why i am finally penning down some thoughts about my surgical elective.

On the 27th of August I left Melbourne for my big trip to South America - specifically to Buenos Aries in Argentina and to Ecuador.

Cuenca, Ecuador and the Fundacion Cinterandes. This is where I undertook my surgical elective from the 19th of September to the 30th of October. The foundation started a Mobile Surgical Unit in 1991 and to date, similar programs world wide such as in Honduras and New Zealand. To date, the foundation has performed some 5000+ surgical operations in various rural towns in Ecuador. Procedures range from typical general surgery procedures such as herniorrhafias and superficial tumour excisions to gynaecological, opthalmological and urological procedures. The mobile surgical unit is also capable of performing more complex procedures such as Cholecystectomies both conventional and laparoscopic.

Before elaborating further, I will divide this entry into separate components, 1. Medical/Surgical and 2. Culture and People

Medicine and Surgery

Being able to experience medicine in Ecuador has been a very very rewarding and unforgetable experience. I had the pleasure of being immersed in both rural medicine and surgery during this elective. For 3 weeks of this rotation, I was in at a regional clinic or 'sub-centro' as they call in here in Cumbe, a small town of about 4500 in population, 40mins from Cuenca. Over here, we got to work with doctors, do consults to practice and improve our medical spanish and above all, the opportunity to experience a new culture and their attitudes towards western medicine. Making diagnoses with the aid of convenient radiological exams or laboratory tests are almost impossible here. Much of the management of patients invovles astute clinical acumen i.e. deciding if a patient has infective or parasitic diarrhoea or a viral illness - and whether to send them home with anti-parasitic or anti-biotic agents or allow the illness to run itself out. The arsenal of medications available for any infection include, Penicillin, Ampicillin, Amoxicillin, Metronidazole and Tinidazole. Pain and fever medications available are Paracetamole and Ibuprofen. Salbutamol for any respiratory distress. In order to get these medications for free, patients have to visit a goverment run clinic - medications in Ecuador from a pharmacy are expensive, and for the poor people here, it sometimes can be almost impossible to afford.

The lack of resources here often forces one to come up with new ideas and innovations to help the community - and such a baptism of fire is an invaluable experience. Home-made spacers from used plastic bottles that I saw was perhaps one of the 'innovations' I got to see being given to patients. Even gloves and handwash are hard to come by. Visiting one of the 'big' public hospitals, none of the above resources that I often take for granted in Melbourne can be found. You can't find a single bottle of Avaguard in an entire floor, that normally permeates the hospitals of Melbourne, or even glove boxes. All these things we take for granted due to its abundance in a first world country, are a luxury. Interns and doctors bring their own gloves, masks, scrubs etc.

Being part of the Mobile Surgery Unit with the Fundacion Cinterandes has been the best experience to date. The ability to provide surgical treatment to communities that would otherwise suffer with pain and disability has never ceased to amaze me. Whats is more, the success rates of the surgeries and complications rates are comparable if not better than conventional operating theatres in city hospitals of the developing world.

During these trips, we served as assistants in surgery as well as instrumentors or scrub nurses. Main post-op care was also provided by the medical students under supervision by the surgeons and anaesthetist. Other than the medical and surgical experiences that I gained by participating in this elective, personal reflection has also allowed me to realize how far I have come since starting medical school. The local more junior medical students would look to us in times of doubt, and under the appropriate situations would be able to provide the correct advice confidently and accurately, whether it was general medical/surgical knowledge or details concerning post-operative patient care.

Satisfaction, is an indescribable feeling; the feeling of contentment, joy, being proud of one’s actions but not necessarily with excitement, all put together. People who know me, know of my passion for surgery, head and neck oncology as well as plastic surgery, yet here I was helping out in straightforward procedures, hernia repairs, excision of superficial tumours, cholecystectomies and tubal ligations etc, and yet I was enjoying it. This was not evident to me, until a friend and colleague whom I was relating my experiences to said to me, ‘Jeremy, you have tasted satisfaction’. This trip has changed my perspective of medicine, delivery of health care and perspective of life itself.

Being a doctor is great. Being able to do something to change the trajectory of a human beings medical outcome or life is an amazing skill to have. This has now come to be my personal encouragement to work in medicine. The money, the prestige and respect that comes from the job whether earned or by association are important things in anybody’s personal life, but now I strongly feel that it is the intangible rewards that really keeps me going when the going gets tough.

Vacation time

Travelling alone has opened my eyes to the world. Learning a new language has helped the experience so much I cannot imagine how much less of an experience I would have had, had I not picked up Spanish beforehand. Before this, I use to have the impression that people who lugged backpacks around for trips that seemed to have no end were simply escaping the realities of life, to prolong the inevitable meeting with what they had left behind in the first place.....nothing much to desire.

But now, having met so many different types of people from all over the world, Germany, Austria, Brazil, Argentina, Ecuador, Ireland, South Africa, Korea.. I am incredibly envious of people like that. Taking a long trip is a huge commitment. A commitment to put life, normality, comfort zones on hold while one decides to leave and sometimes be a totally different person for an uncertain amount of time. Could I ever put my life on hold to pursue such experiences? If you asked me this question before my trip, I would not even consider that question worth answering. put my life on hold?!?! What about surgical training? writing papers? research? decorating my CV with all sorts of prizes and accolades?? I was a fool back then.

Now, all I want is to plan for my next trip. Fulfill all the experiences that I want and should have as a young person before stepping onto a train which is my career which has no end station. We are young once, youth will leave us that is for sure, but jobs are always there no matter when you return. That said, is easier said than done. Now having completed medical school, a new 'title' added to my name and another academic degree, we shall see where life takes me.

My trip has also shown me that, there is so much to see around the world, so many cultures to experience, so many different people to meet and so many different lifestyles to appreciate. I want to see the world, I want to live my life, the way I see it fit.