On the road To Guayaquil



Starting upper left Dr Marilyn Ray driver to Boston.

upper right: Dr Wilton supervising equipment checking at Logan.

Middle left Dr Wilton talking with osteopathy students including his daughter Shannon.

Middle right: our black belt protector Harry Charashe

Lower middle left: Rostro de Christo group from Merrimack College helping at Damien House in Guayaquil

lower middle left: Valley Regional Hospital Alumni including Jen Martin

Bottom:our Translator David Gutierez

Touring and Final Patient Goodbye

We toured city yesterday and then returned to the Damien House for a final visit with our patients for a Goodbye Party with testimonials and gift giving. The patients’ families were present and added to the love. The event was both joyous and bittersweet as it was the last time we’ll see these very happy and gracious people for at least 2 years. There were songs and speeches and presents that the Hansen’s patients made for us. It was a non-clinical event and they were there as friends as well as patients. We had dinner and saw some more clinic workers as patients and left for a night flight home, very weary but grateful for such an opportunity as we received there. It is what it is all about.
Thank you to the American Society for Surgery of the Hand for their support!

No pictures for this party because of HIPPA compliance. All the patients were smiling and happy and the pictures were great but not appropriate for publication. We have been so lucky to be able to be here.

An Evening at Damien House

Saw postop patients and then had wonderful reflection and synopsis of the week at dinner.

Every one shared their thoughts and perspective of how the work affected them. We overall were awed at the unity and smoothness of the mission.It appeared that everyone met or exceeded their job description and the patients were happy and grateful that someone made the effort to care for them. There were overtones and outright statements about the spiritual aspect of the mission and how fortunate we were to be a part of it and be transformed into better and more grounded persons walking a spiritual path with practical feet. So great is the light of unity that it can transform the world.

Second to Last Day: Lectures, Shopping and Goodbye Dinner at Damien House

The day is only half over. Have a an enjoyable evening ahead at Damien House for a goodbye dinner with our patients and the staff at Damien House. Sister Annie who is in charge of the care of the Hansen’s patients has orchestrated the event.
The patients are staying at the foundation until they are healed postop.
We had 25 rather than 41 patients because the rains washout some mountainous roads. We are making daily postop rounds on the patients and doing some screening of the staff for various orthopaedic issues.

The Plastic Surgery Department has been dramatically helpful in facilitating patient care, particularly in the OR. We gave talks this AM to the residents and were presented with certificates of appreciation by the Hospital .
The Department has requested that wee return and continue the exchange of ideas and continue the teaching and patient care. We are exploring a return visit in 2 years for the Hansen patients and perhaps next year for a visiting teaching week.

This has been a particularly productive visit with the Hansen’s patients profoundly appreciative. The faculty and residents were most welcoming and a true delight to get to know and work with.

The spiritual component has been overwhelmingly gratifying. Following in Paul Brand’s foot steps in even such a small way has been one of the most profoundly moving experiences of our lives. I came across this in my reading yesterday.
“Oh, Son of Man!
Deny not My servant should he ask anything from thee, for his face is My face; be then abashed before Me.” Baha’u’llah
Doing this for even such short moment has made us feel as if we have been doing what we are meant to doing on this plain.

Some of the groups we have been working with have been the Junta de Benevolencia od Guayaquil, a large charity that runs schools, hospitals and nursing homes including Luis Vernaza Hospital and its Plastic Surgery Department where we did our surgeries, the Daimien Foundation which focuses on the long term care of patients with Hansen’s disease, the American Association of Periferal Nerve Surgeons, whose Dr Jim Wilton has organized this effort and invited some outstanding foot and ankle surgeons, as well as the American Society for Surgery of the Hand which is sponsoring this project with manpower and funding.

Will report back on tonight’s festivities .

Fourth and Last Surgical Day

Some of our patients couldn’t make it down from the mountains secondary to mud slides, therefore our surgery schedule ende a day early.Got a chance to work with another Plastic surgery resident who also was quite talented and the surgeries continued to go well. The remarkable aspect to the surgery has been the immediate postop consistent improvement in motor as well as sensory function. This has been particularly impressive in the soleal sling releases where the ability to heel raise has been dramatically improved one day postop.
The upper extremity postop surgical patients likewise comment on a sensation of increased strength and sensation but don’t have the equivelent immediate massive visible strength improvement seen in the tibial nerve release patients.
The gratitude of all the patients for the caring surgery they have received is moving and makes us all grateful that we have the skills to make such a difference in people’s lives.

Tomorrow is university lectures, rounds and perhaps some site seeing

Third Surgical Day

Another day spent in loving service. Getting to bond with both the patients and the hospital and Damien house staff as well as intervening in a difficult medical course for these patients has been rewarding beyond words. The ongoing
sharing of knowledge and expertise among the surgeons and support staff has been a source of growth. The sharing of life stories has brilliantly illuminated the reality that we are all one.

Second Surgical Day

We are falling into a rhythm with regard to delivering surgical services.The day was clinically productive as we were able ego work with podiatry and plastic surgery residents. Soleal sling release and median and ulnar nerve releases were performed by advanced residents under the die toon of the attending surgeons to the great benefit of the patients.

Morning post op rounds revealed a group of happy patients who had remarkable increase in muscle strength and little pain. In particular on of the soleal sling patients was able to stand on his toes one day postoperative. I haven’t seen such recovery of motor function before.

The progression disease was more advanced in today’s patients and the progress of nerve deterioration was visible.

One of the aspects which has made this mission work so well has been the tremendous support of the Damien Foudation staff and the hospital staff on so many levels. Some of these folks are pictured today. Sister Annie who is smiling with Dr Andes Rivadeneira has been caring for these Hansen Patints for 30 years. She has been one the rocks who have made the medical missions work. She has likened Dr Jim Wilton to Paul Brand in his dedication to the surgical rehabilitation of the Hansen’s patients.

The hospital where we are working is the oldest and largest in Equador and dates back to 1564. It has over 800 beds and is reminiscent of USC-LA County medical center with a private wing attached. The breadth and scope of the medical/surgical services offered is impressive. The standards of care and precautions taken are world-class.

What most impresses me the most so far is that the surgery we are doing is making a difference in the lives and health of our patients. It is hoped that we can ultimately teach ourselves out of a job as the neurolyses are learned by this competent cohort residents and fellows here.

First Day of Surgery at Hospital General Luis Vernaza

Our first day at the hospital was one of pure joy. The reception was loving. The patients were appreciative. There was a sense that this was where we were supposed to be at that moment and that our entire lives were a preparation for this day. We did nerve decompressive surgery on both the upper and lowere extremities in patients with Hansen’s disease. We worked simultaneously on opposite upper and lower extremities with the Hand society member performing neurolyses of the radial, median and ulnar nerves as needed (carpal tunnel, cubical tunnel and radial tunnel releases). The surgeons  of the Periferal Nerve Society performed soleal sling, common femoral nerve and tarsal tunnel releases. Surgeries were done to decompress inflamed Periferal nerves to prevent further deformity and to relive pain as well as increase both sensation and strength.

One of the joys was sharing ideas, techniques and perspectives in a collegial and mutually respectful attitude with the brilliant and well trained plastic surgery fellow,  hand surgery attending and the surgical resident participating in the surgeries today.

Dr. Andres Rivadineirva is a third year plastics fellow with a deep interest in nerve compressive surgery. He has published 10 year follow up on neurolyses in Hansen,s patients documenting impressive improvement in strength and sensation and prevention of ongoing deformities and tissue loss. He scrubbed in today Anne we shared aprroaches and surgical techniques. His attending hand surgeon Dr Lorena Escudero likewise scrubbed in and shared her expertise. Working with them was pure delight.

Our anesthesia teams came with us from the States and provided seem less safe surgery. Of note, turnover times were great and the hospital had the supplies we were unable to bring including absorbable suture. (The excess supplies of suture in the  State has gone to the relief areas of Syria.)

Support from Damien House and the Rostro de Cristo organization has provided material as well as loving moral support to our endeavors.

The days are full and sleep has been inadequate but the sense of happiness and peace is remarkable. Everyone is looking forward to the coming opportunities to both give and receive the bounties of this service.