PRMC Surgeons Take Skills to Nicaragua

Several orthopedic surgeons performed hip and knee replacements at Nicaraguan hospital

by Phil Davis, Delaware Online
Peninsular Regional Medical Center orthopedic surgeons and staff work on a patient at a hospital in Nicaragua in early June.
Peninsular Regional Medical Center orthopedic surgeons and staff work on a patient at a hospital in Nicaragua in early June.

For one week in a 6 million-person city in Nicaragua, a team of 33 medical professionals from America with specialties in orthopedics took to one hospital with $2 million worth of medical equipment and prosthetics. They were greeted with an employee bathroom with a toilet without a seat. And no paper towels. On June 6, the team led by several Peninsula Regional Medical Center orthopedic surgeons paid their way to fly to Manolo Morales Hospital in Managua as part La Merced’s efforts in the region. La Merced is a nonprofit organization that provides specialized medical care to the impoverished, with a focus on facilities in Nicaragua. They took on about eight cases a day at the hospital, but according to orthopedic surgeon Pasquale Petrera, it could have been much more. “We were limited by time and how much we could work,” said Petrera. “We were operating nonstop.”

All the cultural and practical differences between the small Hispanic country and the United States when it came to practicing medicine were on display. Surgical equipment was sterilized in the same small sink filled with green liquid, similar to what you would expect at a barber shop. Records were kept on typewriters. The air conditioning would only work in the operating room, and only some of the time. According to fellow orthopedic surgeon James Trauger, they reused medical supplies, scrubs and wardrobes that would never see the outside of a garbage can after their first use in America. It was Trauger’s third trip to the region, having first gone in July 2011.
During his time at the hospital, he noticed equipment and supplies he brought down during his first trip were still in use by doctors at the hospital. “I took several tourniquets down three years ago. [One] tourniquet they had down there had been used on a lot of patients, and it was the same tourniquet from three years ago,” Trauger said. On the plus side, Trauger added that some instances of materials being used again would actually help cut down on the waste hospitals typically produce here in the states, specifically when it comes to washing up before going into surgery. “Here when we scrub, every single surgeon gets an individual peel pack and plastic is wasted. You scrub your hands with a sponge on one side and scrubbing bristles on the other, and it goes in the trash. So you do eight cases a day. That’s eight sponges, eight things of plastic that go into a landfill,” said Trauger. “There, there’s a huge bucket of stuff that probably lasts four months, and every surgeon comes up and they hit it with their elbow, put some soap in their hands, wash their hands. There’s no scrub brush, no plastic thrown out. You wash your hands off with water and you go into the room,” he added.

But while he and several other surgeons squeezed into the hospital’s small operating room to perform around eight hip and knee replacements a day, he and Petrera started to notice a difference in the level of excitement and involvement in medicine from younger resident doctors. “Here in the United States, they can’t get the kind of experience they got there,” said Petrera. “[They] all sewed, all assisted in surgery, all scrubbed in. And we watched them. It’s not a free-for-all.” “They were intimately involved in the surgery, which gives them a leg up over kids here in this country who think they want to be doctors but have never been in on a case,” added Petrera. “You do not have that opportunity here.” Trauger went on to describe how doctors in the country are chosen by their academic ability by the end of high school, with the top 1 percent going on to medical school immediately after graduating. In combination with the open nature of the hospital, with students in training as young as 18 years old sitting in on surgeries, it further illuminated for Trauger how regulated teaching medicine and surgery is in the United States. “The roadblocks, there are no roadblocks there. You can bring someone into your operating room, you can teach them what you do and information can be disseminated,” Trauger said. “For a surgeon to learn how to do something, he cannot look at it and know how to do it. They have to see it and feel it.” He said he envied how a program like this can exist and have surgeons freely teach other surgeons new techniques, something that’s not nearly as easy here in the states. “If reason could stand, medicine would be so much better. Every surgeon would be able to learn from every other surgeons and there wouldn’t be such a disparity in the care you get, I don’t think,” added Trauger.

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