from Jay Crary, orthopedic surgeon

Dr. Jay Crary, orthopedic surgeon

From my first experience in Ayacucho in 2012, I learned that  the city of Ayacucho has skilled orthopedic surgeons, but lacked the necessary equipment to handle common types of leg and thigh fractures in an ideal manner.  As a result, injured patients had to endure much more difficult, painful and less successful treatments that often resulted in long-term problems and disability.   

On this, my second mission, we decided to do something to make a lasting impact in this area.  Thanks to generous contributions of our supporters, Ayacucho Mission and the Peruvian American Medical Society partnered with SIGN Fracture Care International, an orthopedic non-profit, to provide the necessary equipment to enable the Ayacucho surgeons to offer their patients the best options for treatment of leg and thigh fractures.  

The initial phase of the program was the introduction of the equipment and instruction in the appropriate technique.  Alongside Dr. Cesar Aranguri, Director of the Mission, I led an instructional course for the orthopedic surgeons in Ayacucho.  Over the following week, I assisted two Ayacucho surgeons, Dr. Prado and Dr. Romero, on two cases.  The first was a 10 year old girl who had had a femur fracture 6 months earlier that had failed to heal despite previous surgery.  The second was an open tibia fracture in a young man who fell off a horse. Both cases were quite successful.  

During the first month after the Mission concluded, Dr. Prado and Dr. Romero did two more surgeries completely independently.  Both cases went very well, which is a testament to their skills as surgeons and the equipment and training provided by the Mission.  We believe this will be a very valuable program for the people of Ayacucho and the local medical community.  It will allow local surgeons to treat severely injured patients so that they can mobilize and return to their work and their families more quickly, with easier and more predictable recoveries and less short and long-term disability.  

Pre-operative x-ray of an 18 year-old man who fell off a horse and sustained open fractures of the tibia and fibula.  Local Ayacucho surgeons Dr. Prado and Dr. Romero worked alongside Mission surgeon Dr. Crary to apply the techniques and equipment introduced by the Mission to intervene on the patient.

Post-operative x-ray from the same patient showing the successful placement of a SIGN intramedullary nail to stabilize the tibia.  This patient was able to walk with crutches immediately after surgery and will begin weight-bearing on the leg after about 6 weeks.

A Circus, a Loudspeaker and El Gobernador: Our First Day in Quinua

Our first day found us in Quinua, Peru--an important historic and cultural site famous for its ceramic figurines, battle site memorial and rich Quechua heritage.  At nearly 11,000 feet above sea level, the city and its surrounding communities have very limited health infrastructure for its 6,000 residents.  It was a perfect place to start.

Working closely with the Quinua-based community health center, Asociacion VIDAS, our small mobile team treated nearly 100 medical and dental patients, and identified a number of surgical cases to bring to Ayacucho Regional Hospital to treat the following week.

Realizing that the patients requiring orthopedic surgery may not be able to travel to the clinic, we turned to Braulio Huaman, the town's Gobernador for ideas to reach the people.  He offered to drive around town in a mototaxi (imagine a rickshaw fused with a scooter) inviting individuals with fractures and other injuries to contact our group through the loudspeaker attached to the roof.    We loved the plan, but were disappointed to find out the town's loudspeaker was broken.  Never discouraged, the Gobernador came up with his second great idea:  Let's walk across the way to the traveling circus that had just come to town and ask to borrow theirs.

To our pleasant surprise, not only were the circus folk (a very nice family) happy to carry their speaker down from the big top and mount it to a mototaxi, but we found our first orthopedic surgery case--a trapeeze artist who had broken her leg in a recent show.  In no time, the Gobernador was rolling through town, getting the word out about the available services.  It never fails to amaze how many new ways we learn to work together.

Patricia of Circo Galax, traveling from the jungle through Quinua into Ayacucho and beyond

Raquel Yupanqui, Director of Asociacion VIDAS testing the loudspeaker atop the mototaxi

John Billimek and Braulio Huaman, El Gobenador de Quinua

from Teresa and Scott Fisher, volunteers

Day 5

Though we have only spent 5 days at the hospital, it feels like we’ve been there for much longer, and it will seem so strange to not walk down the now familiar streets tomorrow morning. The stories you’ve read from me so far are just a fracture of all the stories everyone here has experienced. Every day when we would see each other, either eating dinner together, walking in the town square, or hanging out in the courtyard of our hotel, we all had something special to share. The surgeons spoke of interesting surgeries they had performed that day, the nurses of the patients they had cared for, and us volunteers, who are not use to the medical world, of the unique situations we experienced, but most of all, of the truly sincere kindness, warmth, and appreciation these people showed. The affection that they were not afraid to show was a surprise to me, especially with people who they had trouble communicating with. 

Our last day was a shorter day, which is how they have it set up. We saw patients who had any complications from surgery, any children who still needed surgery and came from far away, and did lots of following up and closure. 

I had 2 memories from Friday that touched especially. One was the young girl, who we called “Roxy,” whom I wrote about in my last post. She came back to the hospital on Friday, found Scott, as she knew where he would be, and then the 2 of them came to find me because she had a present for me. She brought me a bag of these traditional rolls from Ayacucho that her mom had made, and another bag of corn, that you fry to make a sort of pop corn, and then wrapped in newspaper, a clay decoration that is to bring you plentiful food and wealth. She was so excited to watch me open it, and just kept giggling. I took off my small heart necklace that I’ve had for several years and put it on her, so that she would remember me as well. I hope I see her again if we can come back next year. 

The other memory that was special was when an older woman, who I had seen when I worked with the general surgeon on Thursday, came and found me, holding in her arms her 2-day old grandson. She asked me if I would name her grandson!! So, naturally I start going through all my brothers’ names, and she keeps saying no, we already have one with that name in our family. So, I start going through all my dad’s brothers’ names, and still not getting anywhere. Then, out of the blue, she says “I think I’d like something really different for him, like in Japanese or Chinese! Seriously?? Now, that one really threw me for a loop, so I start scrambling, until I think of Yao Ming, the basketball player. So I tell her that name, and how maybe if she names her grandson Yao Ming he’ll grow big and strong. Not so wild about it…. ! By this time, I have no idea of other names, so I see one of our Asian volunteers, Ray, walking toward me, and begged him to throw out some names. He came through, we wrote down 4 names, including Yao Ming, and she said she would choose one of those! Phew!!

The day ended with an appreciation lunch at 2:00, put on by the hospital, which was a nice way to all come together, though 3 of our surgeons were still in the OR. From there we went back to the hotel, packed and just hung out visiting, exchanging emails, etc…, until the big double decker came at 7:00 to take us back to Lima. We arrived in Lima at 6:00am and then waited for our different flights. Scott and mine took off at 10:00 , so that wasn’t too bad. We are now in Cusco, and I will wait until tomorrow to write about this next part of our trip. Love to all of you!

from Susanita Richman, translator

I'm an ESL teaching from New Jersey who volunteered as a translator this July in Ayacucho.  I am a "civilian"- that is, not of the medical world at all.  For me, it was a great honor to be asked to volunteer and to be  part of your world for two weeks.  Not that I want to part of the medical  world- can't even look at blood or needles! I  was very impressed with the team leadership and the organization of such a large group!  I  thoroughly enjoyed serving with different doctors as they were wonderful teachers too, explaining each case to the medical students and me.  What a magnificent learning experience it was.  At times, I had to ask the doctors to put some of the medical terms into plain English.  One doctor said that the patient has a "blah, blah" to which I replied "...and that would be?" "a swelling", "oh!,  that word I know!" 

At times, dealing with medical language felt like a third language!  When I worked in the pharmacy, as a civilian, I had to ask the pharmacist (at least 40 times!) "with or without food".  She was extremely patient with me, but I was mortified that I couldn't remember!!  Next year, I'll make myself a cheat sheet so everyone will think that I finally got it!  I never cease to be amazed at the magnificent work of the medical teams.  The hours are long, but that's why we came!  The patients are so grateful!  

What's important in life is "not what you have, but what you give".  Ayacucho mission gave me the opportunity to "give" and I am truly grateful! 

From Jessica Gimbel, Nursing Staff

The most memorable patient I had was a teenage girl who came in for a scar revision; her upper torso was so badly burned that she had lost most of the range of motion in her neck. It was somewhat difficult for me to communicate with our patients since they spoke Spanish and my only background in the language dated back to high school. Because of this, there was frustration on both sides and I couldn't tell whether or not she trusted me as her nurse. She was even more unhappy when she had to stay overnight because we had so many surgeries scheduled. 


However, when her name was called the next day, she was overjoyed; I put on her cap and booties and wheeled her to the OR. Right before I left, I was surprised to hear from one of our translators that she was asking if I would be there to take care of her after surgery- I was surprised and flattered, but also felt an even stronger sense of responsibility to make sure that her recovery would progress as smoothly as possible. When she came into the recovery room, she was unconscious and shivering. Ten minutes and five blankets later, she woke up and looked me right in the eye. "Is it over?" "Yes."

The next day (after a few rounds of pain meds and deep breathing), I showed her how to take care of the surgical site and gave her discharge instructions. After paying close attention to the teaching and getting dressed, she was ready to leave. With a big smile on her face, she gave us the customary hug and kiss on the cheek, then squeezed our hands with a sincere "Gracias!"

This girl reminded me of my reasons for coming on the Ayacucho medical mission- to help treat those in need, and to do so with a sense of compassion and mutual respect. This was my first medical mission, and it helped open my eyes to the world while simultaneously showing me the avenues through which a single person can make a difference.

Anonymous entry from a General Volunteer

I came, I saw, I…..learned. As a general volunteer who spoke little to no Spanish, I had expected to be set aside as some extra, called upon only for menial labor. However, it turns out that each and every member is an integral part of the system. On the first day, I was placed in the pharmacy, where I was part of the team that dispensed the medication. Throughout the week, I was placed in various other services including OR, where I observed the surgeons perform dozens of miracles, family medicine, where I learned about the basic examination techniques, and "crowd control", where I helped other volunteers keep order in the waiting area as dozens of patients wait their turn. I learned so much from this trip and I met so many amazing people. Hopefully I’ll have a chance to come back next year. 

from Candy Sopp, Licensed Clinical Social Worker

Mark De Antonio, Mission Psychiatrist, and I were asked to see a 20 year old female  patient who initially came to the mission for medical care regarding a broken nose.  The mission surgical team decided that the patient did not need surgical intervention at this time, but referred them to us to address her immediate mental health needs.  


We initially met with the patient and her father.  After talking with them both together and getting some family history and learning how she broke her nose, we asked to meet with the patient alone.  This was a challenging case to deal with due to the family dynamics and family violence which led to the patient having a broken nose.  We were finally able to work only with the patient without her father in the room to provide crisis intervention to her regarding her current home situation.  


We were also able to refer her to the mission mental health clinic, COSMA for ongoing mental health services including continued medication management and counseling.   The father of the patient was adamant that she needed surgery regarding her broken nose due to the potential negative psychological effects of not doing surgery.  However, he then reported if the mission does not perform surgery on his daughter, she will hound him for the money to have the surgery, $2,000.   In talking directly with the patient, she told us she was fine with not having surgery, but was extremely distraught about the home situation and not feeling safe in her own home.  We provided her with a information for a domestic violence shelter in the community as an additional safety resource.   She was open to the resources we provided and  willing to follow up.  It became very important to speak to her alone as her father was not ultimately a support to her in achieving safety and psychological support.  


This was a rewarding experience for us to be able to help this  patient.  We also realized in working with this  patient that surgery is not always the answer.  In cases like this, the mental health interventions we can provide are of primary importance.