Read in Matthew 4 about the temptations of Christ. Struck by how He resisted the temptation to take the path of least resistance, refusing to turn stones into bread. He fully embraced his humanity, part of which was a reliance upon God as his father to provide for him as he started his time of ministry. We certainly have not chosen the path of least resistance in coming here - I know today will be a challenge as first days always are.
We have breakfast at la Tapera, then head to the hospital. We are unable to get cases started right away - a myriad of small delays and trying to find supplies we had failed to locate last night. Then, the mayor has an opening ceremony of sorts in the hospital courtyard, a smattering of around 50 locals show up to welcome us and enjoy the free cheese empanadas - I had a few myself. Chances are I will need my own gallbladder removed before this project is over. We finally get rolling clinically around 10:00am.
First case is a reoperation on a lady who has already had a cholecystectomy, but apparently still has a remnant gallbladder remaining that has managed to re-accumulate stones - I have no idea how this happens - but we struggle through a tough dissection (much scar tissue) in dangerous territory. Case went well and the anesthesia machine worked well (as did Jean, our capable anesthetist). Next, Bill does the vaginal hysterectomy, complete with the. patient's son watching and asking a lot of questions (not sure I can do that to you, mom). The case takes a long time to get started for myriad reasons, then it takes a long time as the language barrier and lack of familiar instrumentation start to take their toll. Everyone is meeting everyone for the first time and roles are still being defined.
As the day drags on, my frustration starts to build. We have promised to fix a hernia and take off a large lipoma as well, but the consults keep coming and it becomes exhausting just confirming that we have adequate sterile instrumentation for the next procedure. I feel like I'm doing everything (but so is everyone else), yet nothing seems to get done, and the patients wait patiently, dutifully fasting as told. Stan winds up excising the lipoma on a table in the recovery room while I see consults and bird-dog the supply prep. We then manage to fix a hernia under local anesthetic on the secondary table in the OR while Bill finishes up the Hysterectomy. We see a few more consults (actually, Bill sees TONS of them - they are really hurting for good gynecologic care here and he is in much demand). Then, make rounds on our postops. The gallbladder patient is having a lot of pain and a low grade fever (we later find that lowland Bolivia IS a low-grade fever for most of the year). This has me nervous - we don't really have the capability of doing bile-duct reconstruction down here and I'm not in the mood to improvise. We check back one more time after dinner and she is doing better. We get to dinner around 8pm and debrief on what we feel is a successful day - pulling off four cases in the first day at a place where they haven't done any surgery since this time last year. We talk about ways to improve the process tomorrow - everyone has productive insight. Our clinic team (entirely Bolivian) saw about 100 patients as well.
Wendy says the girls were still travel-weary much of the day, and with the heat they spent a good part of the day back at the hotel. Thank God the AC was repaired. They have looked out for our safety too as our shower knob is now wrapped with an insulating layer of electrical tape. I enjoy a cold shower before hitting the sack.
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Location:Somewhere northeast of Yapacani
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