22. Blogging at 9,000 feet

In Ecuador for my 7th overseas medical trip, some words about the previous six (nb, dates are approximate):
#1 Montalvo, Ecuador 2004. Blankets hung over ropes for exam rooms, major gyn surgery in an OR previously used only for cesarean deliveries, real questions about risks and limits of overseas surgery. An evangelical group (mmint.org) with three goals: medical care, support for the local church, and a spiritual experience for the participants, many of whom came with no medical skills or background. These goals were at times in conflict, but don’t be mislead by my habitual second-guessing; a tremendous experience.
#2 Accra, Ghana 2005. The organizer could not deliver on his promises so no real medical work, but whoa, what an amazing place. We stayed with a local family, met with government and church health system administrators. African art came alive.
#3 Chengdu China 2006. A first hand view of modern Chinese medicine (at least as practiced in large cities) . Should Western medicine feel complimented as China hurtles towards a Western health care system? Yes and no.
#4 Vietnam 2007: A medical exchange; I lectured with a bust of Uncle Ho looking over my shoulder; tried to assist with a hysterectomy, only to have language prove to be an unsurmountable barrier; listened to medical students explain why thy chose medicine, a mixture of filial duty and personal, usually negative, experiences with the medical system.
#5 Mozambique 2007: Sounded like a perfect setting: a rural Methodist-funded hospital with two ORs a couple of anesthesiologist, and no local gynecologist. Ii even knew some Portughuese! Though hindered by the absense of any prior screening, I helped with some deliveries and confronted the most difficult hystectomy I have ever done. And an unanticipated bottleneck: the small autoclave (sterilizer) couldn’t keep up, so some cases cancelled simply because there were no sterile drapes/gowns. But also an opportunity to appreciate the perspective of local chronically overworked operating room staff: I came wanting to do lots of surgery; but for them, I just represented extra and uncompensated work.
#6 Guayaquil Ecuador 2008: A group from Phoenix with a local connection to provide access to military hospitals and almost completely self-sufficient (no want of sterile drapes/gowns). In 8 days I saw 50 outpatients and performed 12 major surgeries and a couple of minors. My fingers were literally sore from tying so much suture. Finally.