Week 1 - Viedma

It was an in-depth introductory week at Viedma, both as to the manner in which medicine is delivered and as to Latin American culture.  After meeting critical personnel on Monday, we arrived at the clinic ready for surgery at 8am Tuesday and discovered a mariachi band setting up for Dr. Romero's 70th birthday party.  It was explained to us that Bolivian culture values relationships above all else, and the clinic's head surgeon was being honored for his lifetime of service to Viedma and paternal relationship to all of it's patients.  After speeches and cake, surgeries resumed as usual.  We took the day to learn about the children present, and the way of Bolivian medical education. 

Nicole: My lack of any prior Spanish has hindered me significantly in building relationships with the nursing staff and Bolivian medical residents.  Any efforts on my part are met with encouragement, but the language barrier does prevent the transmission of specific details of burn care.

Will: Having been to Honduras on two prior medical trips before starting medical school, I had an exposure to medical Spanish that has helped both inside and outside the clinic.

In the rest of the week we've observed between 6 and 7 procedures every day, ranging from mild wound redressings to skin grafts and reconstructive surgery, in addition to the constant physical therapy and nutrition administration of the recovering patients.  It is not uncommon for the two surgeons on hand to be called out of long procedures, such as wound debridement, for simple redressings and initial evaluations of new patients.  The juggling of such responsibilities are facilitated by an experienced nursing staff and a simpler procedure room.

One of the more impressive procedures we witnessed was a reconstruction of an adolescent patient's left neck and ear.  Will was present for the Z-plasty of her neck to remove fibrotic scar tissue which lasted 2.5 hours, and Nicole was present for the reconstruction of her ear from the mass of remaining tissue, which was an additional 2 hours.  The procedure not only restored her range of motion, but was a day-to-night difference in the young girl's cosmetic appearance.  Physical therapy was observed over the next two days. 

Startling information for both of us was the fact that sedation for these incredibly painful burn injuries is only provided by the clinic for children under 5.  Older patients must have medicine provided by the parents, at an extreme cost for these patient families.