from Traci Fortney, OR Nurse

What another rewarding year for me!  This was my third year in Ayacucho, and despite being exhausted from so many long, grueling days in the OR, I left once again with an immense feeling of satisfaction of being able to help so many people.  The most meaningful part of my week was being a part of the operations for our kiddos that came from so far away to have their cleft lips repaired.  I was able to meet the kids from Puno Sunday morning as they arrived at the hotel just as our plastic surgeons walked in for the airport.  Seeing the looks of desperation on the parents' faces as the surgeons put down their bags and sat in the courtyard to examine their new patients was saddening.  But as I met the surgeons, I knew the adorable children were going to be in good hands.

Monday morning rolled around and the OR got off to the normal slow start as we tried to relearn where everything was and what supplies we had available.  But as soon as the first cleft patient rolled in, we got down to business.  It was amazing to watch how Dr. J and Dr. Liu marked out their incisions on the lip and figured out how they could move tissue around to turn the cleft into a natural looking lip.  As we put the final sutures in, I had such a sense of accomplishment as I knew we just helped to change this child's life forever.  That feeling continued as the workday moved into the "worknight".  Yes, we had late nights in the OR all week, but we were able to touch so many families' lives that the missed sleep was worth it.

I am already counting down the days until I can return to Ayacucho and be back among the people of the Andes that I have grown to love so very much over the past few years.  As I was able to tell the director of the hospital at our farewell dinner when he asked who in the group was Peruvian- ¡soy peruana en mi corazón!

from Irit Barak, Recovery Room Nurse

I am back in Los Angeles still speaking Spanish, and my friends can't understand me. When went to eat lunch with friends, I still tried to pay with Peruvian money (Nuevo Soles).  I feel like I am still there.   I had great time and I am very impressed with how Loretta (the Nursing Director) worked with each one of us. Today, I'm spreading the word in Kaiser and I already have 3 nurses that would like to join us.

from David Daar, medical student

The cool thing about ultrasound is that it doesn't need translation.  What you see on the screen is what you get, and for the patients in Ayacucho that haven't seen technology like this before, being ultrasounded is both useful as a diagnostic and a psychological therapeutic.  While seeing patients with Dr. Cesar Aranguri, mission director and cardiologist, we performed a cardiac ultrasound exam on nearly every patient that came in. There was one rare case in which we used ultrasound to diagnose a patient with rheumatic fever - matching the clinical signs with the valve defects identifiable on ultrasound helped Dr. Aranguri effectively care for his patient.

But for the most part, our patients presented with muscular chest pain, in which no significant therapy was needed.  So Dr. Aranguri performed what he called "therapeutic ultrasound" on these patients.  Examining their heart and telling them it looked healthy and strong gave them a piece of mind they didn't seem to get in any other way.  This is one of the powers of medical technology, especially in areas like Ayacucho, and by helping lower the anxiety level of these patients, ultrasound proves to be a powerful tool for mission trips like these.  Hopefully next year, we can find a way to bring another machine or two!

from Susana Gutierrez and David Chen, volunteers

Our experience in Ayacucho has been unforgettable and truly wonderful. We specifically remember a mom who came to our clinic because her daughter had a foot infection. The mom had walked two days from the jungle with the daughter who had an infection and her younger daughter on her back. Amazingly, they had not eaten for two days. It was an extraordinary case of strength and perseverence. Thankfully, everything went well and the mission was able to finance their stay in Ayacucho, as well as their return to the jungle. What we have learned here in Ayacucho will forever change our lives. 

from David Daar, medical student

Today I worked in the gynecology dept., and it was a very positive experience.  Week 2 began today, and we had two new OB/GYN docs leading the clinic, Dr. Aliyah Khan and Dr. Frank Goicoechea.


I always had an impression of GYN that it wouldn't be for me, but my experience today really opened my eyes to the field.  It is a great mixture of clinic and procedures - and if I want to go on mission trips like PAMS in the future, it is a highly requested and needed specialty.  I really got my money's worth today.  We saw over 45 patients and scheduled several operations for later in the week that will significantly improve our patients' health, including 2 hysterectomies to prevent continued excessive bleeding and possible endometrial cancer in the future.

Another aspect that I learned a lot about today was the dedication to patient comfort and modesty - something especially pertinent to GYN.  Moreover, in general there is a high level of modesty amongst the Peruvian community, and being able to respect that while still effectively examining a patient was a task that takes both finesse and compassion.  Our docs today were phenomenal role models, and I appreciated how much time and energy they spent teaching us.

Another solid day in Ayacucho, can't wait for tomorrow!

from Julio Mendoza, translator

Day 1:  From the start, I anticipated that I would be busy all day helping to interpret for scores of patients, so the long hours came to no surprise.  I was also aware that people had traveled tremendous distances and would have endured hunger and thirst to have the opportunity to see a physician for the first time, so I was sympathetic to their physical status when they met with the doctor.  However, what shocked me the most were the tears shed by several of the mothers (in Pediatrics) when they received reassurance from the doctor that their babies would be okay and that they need not to worry.  It was at that point that I realized the importance my "grain of sand" played in the overall success of the Mission.  Those mothers would finally be at peace because she had done everything she could to ensure the best for her child -- and to be honest, I would have done the same if I had a child of my own and didn't have the many fortunes I have available to me.


Day 2: Today I worked as a floating interpreter.  I wondered if patients were scared of enduring surgery.  I know that if it was me, I'd be frightened, but I suppose that at some point having less pain is better than the alternative.

A mother who had limited resources gifted a lipstick to the pediatrician who went out of her way to refer her to an autism specialist.

I noted that is is becoming more and more difficult to turn down surgery patients due to high demand and limited resources.  As I walk around the hallway, patients crowd around me to ask if their surgery appointments will be honored, and all I can tell them is that surgery is no longer available because the spaces are filled.  Despite this, they beg me to intervine for them to the higher authorities, and all I can do is ask one of the directors to reconfirm what I had already told the patients.

Whether coming from a doctor or non doctor, there is no worse feeling then telling someone that they cannot receive surgical treatment because they are not sick enough to receive it (although I will add that doctors can probably handle it much better than I ever could).

Day 3: Despite all precautionary measures, I managed to come down with a mild case of diarrhea.  Fortunately, the pediatrician whom I was working with gave me some medication that quickly took care of the problem.

Most of the day went smoothly.  (I was even able to take some pictures of staff and consenting patients).  During lunch, I was able to get to know the pediatrician at a personal level, and it amazed me how similar our past experiences are.  The lesson that we learned from each other is that "that which doesn't kill you makes you stronger'.

On our way home from the clinic, my wife and our mutual friend (both of whom are doctors at the Mission) came across a young girl on the sidewalk experiencing an epilepsy attack.  We were quick to rush over and provide assistance, but the girl's two friends informed us that she would be fine.  Not being a doctor, I stood on the side and observed the scene with a sense of pride in that we were positively representing our program.  Our pediatrician's information was provided to the girl, and we expect her to show up to clinic tomorrow.


Day 4:  I hadn't even arrived to the door of the clinic, when I get flagged down by a familiar face.  I can¨t quite remember the details, but the distraught lady immediately starts telling me that her family showed up to surgery for the mother-in-law at 7am as instructed by the surgeon, but the surgeon wasn't there. I suddenly remember the case.  What can I tell her?  My guess is that the surgeon got wrapped up with another urgent matter and could not meet her appointment.  I rush to the program coordinator, who also remembers the case, and he immediately calls the surgeon via cell phone -- a surgery spot has been reserved to remove the tumor, but the surgeon needs to re-confirm the possible complications with the family before the procedure can be done, so she will meet with them one last time when the surgeon is done rounding on her patients. Whew!!!

I wasn't assigned to a specific clinic today, so I played the role of floating interpreter.  I wasn't as busy as days past, but I did feel privileged to be called on for the more complicated cases, when detailed communication was essential.  I did have some time to chat with the nursing staff and some of the patients, and they look forward to our return next year!

The day is done, and I¨m looking forward to visiting the orphanage tomorrow afternoon!

from Michele Torosis, medical student

Friday was one of those milestones all medical students (not so) patiently anticipate, the first time scrubbing in on a surgery.  After spending Thursday with one of the general surgeons, Dr. Sharp, seeing the far less glamorous clinic side of surgery, I was able to scrub in for the first time in the glamorous OR of Ayacucho.

The morning started with the anesthesiologist, Dr. Rinehart, guiding me through starting an IV on the patient.  After that I learned the sterile procedure for scrubbing in.  Finally my hands were inside the patients abdominal cavity.   The surgery was a palliative gastrectomy on a 80 year old lady with a large gastric tumor which had most likely metastasized.  Due to the high cost of a CT scan, the surgeon had decided to proceed with the surgery without one, deciding that a CT would not change the treatment of the patient.  Having done the fore, mid, and hindgut dissections in anatomy class, I felt confident knowing exactly where and what I should find in this region.  However, with blood actually coursing through all the arteries and veins, I learned I couldn’t even identify for certain the middle colic artery.  The two general surgeons verbally guided me through what they were doing.  My job was to retract, cut sutures, and suction.

Freeing the stomach from the greater omentum and the transverse mesocolon was the most tedious part of the surgery, not having the same tools as in the US.  After the tumor had been isolated and the stomach freed, it was time to remove it.  The tumor had taken over the entire greater curvature of the stomach and the majority of the stomach had to be removed.

Four hours later, my back started hurting, my hands were cramping and I was seriously starting to question my stamina.  Surgery has always been something I am interested in, but what if I am not strong enough to make it through back to back to back 5 hour surgeries?

After the patient was closed and bandaged up, I put in a foley catheter and helped the anesthesiologist transfer her to the recovery room.  Watching the patient quietly rest in post-op, surgery a success, I felt for the first time in Ayacucho that I had helped significantly improved the life of someone.  I had been a part of seeing the patient in clinic, taking her history, examining her, scheduling her surgery, and removing her tumor.  This experience was a nice finale to a diverse week of experiences and has excited me for our second week in Ayacucho.