From an anesthesia standpoint, the people of Ecuador were very naïve in regards to narcotics and sedatives. It was also common to encounter patients with reactive airways, despite not having a smoking history, which was most likely due to poor air quality. Some of the common patient conditions we experienced that were unique to Ecuador were cleft palates and polydactyly.
Although it’s impossible and unrealistic to believe that one person, group, organization, or entity can “save the world,” this mission trip helped me to recognize the importance and impact of individuals and groups taking the initiative to utilize skills, education, knowledge, resources, and talent to serve communities around the world to enhance global health with smaller scale projects. As a future Advanced Practice Nurse and CRNA, I realize that I have the ability to improve healthcare outcomes, and look forward to volunteering locally and globally after graduation.
As a [nurse anesthesia student], it was empowering to work with other CRNAs practicing independently to deliver safe, high-quality anesthesia services to patients in another country.
It was emotionally challenging to learn about some of the stories of some of the patients who underwent surgical procedures. Parents and children came to the Loja hospital from other cities, traveling over 12 hours on a bus, and some babies and children would be kept NPO [nil per os, or “nothing by mouth] all day long in hopes of being able to have surgery. One child was abandoned by his mother and left at an orphanage.
The inpatient ward where the patients recovered was crowded and hectic. There would be up to six pediatric patients in one small room, and each patient had a parent or guardian who stayed with the child 24 hours a day. The patients and families were responsible for providing their own linens, food, water, and other supplies for the patient throughout their inpatient stay. It’s fascinating to discover things we take for granted in the United States, such as convenience of scheduling surgical procedures quickly, short commutes to surgical centers, private patient rooms, and availability of medications and diagnostic testing.
At times, the English-Spanish language barrier was also a challenge, especially during sedation cases. Luckily there were always translators close by to assist. We also had very long 12-16 hour days in the OR. At first I was not looking forward to the long work days, but staying late meant that we were able to help as many people as possible. The thought of making a positive change in someone’s life kept me energetic and determined.
One of the most rewarding aspects of this mission trip was providing anesthesia for pediatric patients undergoing life-changing surgical procedures, like cleft palate repair, that would not have been possible for the families and patients both logistically and financially.
It was also rewarding to work alongside so many outstanding multidisciplinary health care professionals. We were constantly collaborating with other CRNAs, surgeons, nurses, surgical techs, nurse practitioners, volunteers, students, and translators to ensure efficient workflow and to provide the highest quality of care for our patients.
It was very surprising to see a significant amount of funding had been obtained to revamp the surgery department at the hospital in Loja. The OR suites all looked brand new and even more sleek and updated than some of the surgical suites in the United States. However, the rest of the hospital seemed dated, cramped, dingy, and rough in comparison to hospitals in the United States.
I learned so much from the CRNAs that I worked with on this mission trip. These CRNAs introduced us to new ultrasound technology, and helped guide the SRNAs to perform regional anesthesia blocks for some of our patients. It was remarkable to see how well the blocks worked, and how patients woke up more comfortable from their procedures. I also was exposed to new anesthesia methods and techniques that I was not exposed to previously. In addition, the CRNAs allowed for us to practice autonomously as SRNAS, but were always present if we needed assistance.
While on the mission trip, I was able to provide anesthesia for complex pediatric cleft palate and other ENT procedures that I was not previously exposed to during my pediatric clinical rotation. I feel as though this experience has been invaluable, and I feel more prepared to provide anesthesia for these types of cases in the future.
I’ve also been inspired to enhance my Spanish language skills, especially as a health care provider.
This mission trip has been life-changing, and my practice will never be the same. I realize there is so much we take for granted here in the United States, and I feel inspired to give back to communities around the globe after graduation.
What was astonishing to me personally is that I was easily able to put aside my own needs (being tired, hungry, thirsty, having incredibly sore feet, etc.) whenever there was an opportunity to help someone else. While it would have been relaxing to go back to the hotel at 4 PM every day, I was willing to stay as late as possible to ensure patients received high-quality anesthesia during their surgical procedures.