By: Jim Ross, MD
Secret of the Andes, by Ann Nolan Clark, was a book that I stumbled upon as a child. It is a story of cultural mystery and personal identity. The main character is a modern-day Native American boy who along with his guardian tend a herd of prized llamas in an isolated valley in the Andes Mountains in Peru. The boy is unaware that he is a direct descendant of the ruler of the ancient Incas. Throughout the book, he is instructed by his guardian in the religion and history of his ancient people, and goes in search of his true identity. Growing up in Minnesota I was fascinated to learn of a different type of culture such as was presented in this book. The descriptions of the culture, nature, and history were fascinating to me. I had visited my girlfriend’s family in Peru prior to this opportunity, but had little interaction with the health care system nor understood the difficulties of treating patients in this poverty–stricken environment. I have always had an interest in over-seas volunteer work, and have always wanted to create contacts in order to volunteer on an annual basis. This was the perfect opportunity for me to visit one of the hospitals in Peru, establish contacts so that I can continue to assist the health care and also provide education to the Orthopaedic department.
After my first trip to the hospital, I instantly realized why the hospital sees the vast array of trauma. There are essentially no stop signs or traffic lights at the intersections, and each car is fighting for its space in the street. Amongst the many cars, there are also many people riding scooters, motorcycles, and “moto-taxis” which is essentially a dirt bike with a carriage attached to the back. All of these vehicles are in addition to the many people who are walking across the streets or standing in the center of intersections selling various items and food. Taxis are very inexpensive as a trip to return to my hotel which was approximately a 20-minute ride was usually 15 nuevo sol (~$6) and would fluctuate depending on my bargaining skills.
My Monday afternoons, in addition to the remaining week days would all consist scrubbing in all the cases. There were a vast array of fractures including multiple tibial plateau, ankle, hip, long bone, and pelvic fractures. There was a gunshot to the proximal tibia, which the staff found very interesting as they see about 3 to 5 fractures sustained from gunshots per year. They were astonished when I mentioned that our trauma service sees that amount usually within 2 weeks. The highlight of my operative experience was teaching the staff various techniques that they had not used and teaching the residents simple techniques such as interfragmentary lag screws and reduction techniques. I was also fortunate to show the staff percutaneous sacroiliac screw fixation. This had to be planned well in advance, as there is only 1 fluoroscopy machine for the entire operating rooms, so more than 90 percent of the cases were done without fluoroscopy. Intra-operative decision-making is also very different in that one has to be quite creative given the limited availability of supplies.
Given that many patients have delayed operative fixation of their fractures, it is not uncommon for external fixators to be placed in the emergency room. There is a procedure room in the ER where small cases are performed, including ex-fix applications. Some of the patients that have ex-fix’s placed end up having this as their definitive treatment if their wait for surgery is long enough. Despite being a hospital with limited resources, it is still difficult for a patient to be admitted. The patients that are allowed admission are those that have priviledges similar to the U.S. Medicare/Medicaid system. Spanish serves as the primary language amongst the patients and the staff. The staff knows little, if any English, which put my Spanish to the test and made some discussions difficult especially since medical language is different in itself.
Overall, the patients have immense gratitude to the physicians, quite frankly more than I have ever witnessed before. They are constantly thanking the physicians and family members will seek out the physicians to thank them for their caring for their family members. It is quite remarkable and humbling, and I cannot wait to visit again. Viva Peru!!