104. San Lucas: Anesthesia

No problem with having anesthesia able to cancel any surgery any time.  Surgeons, with their "chance to cut, chance to cure" mind-set may schedule surgery for someone with a concurrent illness (upper respiratory illness, uncontrolled diabetes, heart disease, anemia, etc.) that increases surgical risks to unacceptable levels.  So put a hold on, let the patient recover, stabilize, benefit from further evaluation.

So when anesthesia asks to talk about my planned San Lucas surgery, it seemed routine.
"Do you have access to blood if a transfusion is needed?
"Do you have a specific (i.e., name and phone number) back-up for delayed postop complications?
"Do the sponsoring organizations know what you're doing?

These are valid issues for overseas medical missions and always play a role in patient selection, but I felt that I might as well have been asked, "Do you have a silver stake for the vampire?"

Bottom line: no gyn surgery.  I think the real issue was not wanting a gyn patient to bump a podiatry patient.  After all, this was podiatry mission, with four podiatrists and a team organized to support them; I was just an self-invited guest.  I'm okay with that. Just be open about it.

103. San Lucas: Fibroids

Fibroids, or leiomyomas, a common subject here.  Benign muscular tumors of the uterus. Ana, 36, Aura, 47, and Irma, 43, all have symptomatic fibroids.  Symptomatic means pain or abnormal bleeding.  No medical treatment for fibroids, just surgery, usually hysterectomy, which is usually not difficult but does have increased risk of bleeding (see previous post).  Ana and Aura have low blood count, so probably would do best taking iron supplements for a few months before any surgery.  But that leaves Irma (whose fibroid seems to be a pain issue), and Leticia, who has abnormal bleeding and an enlarged though non-fibroid uterus, as surgical candidates.  Two out of five, not bad, all things considered.

Enter anesthesia.

102. San Lucas: the Logistics of Care

Dr Tun had five San Lucas patients screened for possible gyn surgery:

Valeria, 67 has apparent cervical cancer with zero chance of getting the type of radiation, chemo and/or surgical treatment that would be standard in first world countries.  Would a "debunking" (i.e. removing as much of the cancer as possible, knowing that microscopic remnants would probably remain?) hysterectomy help?

But malignancy makes surgery more risky: life-threatening bleeding, pulmonary embolism, and injury to the urinary system, and so on. So I said I could not offer surgery, though the government hospital about 2 hours away by public transportation, might help her.  That would require multiple trips and blood donors.

Surgical patients at the government hospital are supposed to bring two blood donors (of the same blood type) in case they need a blood transfusion. Even if the surgery is unlikely to be associated with heavy blood loss--therefore the blood not needed--these donors will help replenish the hospital's blood bank. Apparently there are local biases against blood donation, such that many prospective surgical patients have to pay donors.

Chances are that the logistics of care away from San Lucas will prevent Valeria finding any care, unless symptoms such as bleeding increase, at which point any therapy would be less likely to help.