Quirofano Movil

Thursday was our first mobile surgery experience, and with Dr. R out of town it was predicted to be busy.
We had 9 cases scheduled, and although none were complicated, it would be a full day.
The area we were visiting was a common health center located less than an hour outside of Cuenca, in a pueblo called Quingeo. It was part of Health Area #3, a common location for Cinterandes family practice docs and medical students to follow patients in, given its proximity to the city.
We met at the Foundation office and piled into Isuzu-Chevys with Cinterandes logos that sped up winding roads from the city into the surrounding hills, leaving the pavement and bouncing over packed dirt caminos, passing campesinos in their white hats hauling bundles of sticks, wares, and babies, tending cattle, and washing clothes. Women in traditional garb weilding scythes mowed grass and weeds that were later bundled, dried and burned.

Staff members were well ahead of us, readying the truck and pre-oping the patients who were waiting in the health center to be called. Family members were waiting with them, highlighting the advantage that this unit has over the hospital setting which places many barriers between the patient and the process.

Patients changed into a gown and were called into the truck for booties and hats. Behind where the patient is seated in this photo are the parts of the truck outfitted to support the OR that is housed in the rear of the truck. There is a small bathroom/changing room/scrub closet, a dual well sink for cleaning and sanitizing instruments and scrubbing, floor to ceiling shelving that holds supplies ranging from surgical instruments to refreshments, and an autoclave for sterilization. One interesting visual for the day was the counter space occupied on one side by clean instruments and the other side by a waffle iron that we were using to make grilled cheese.
Once the surgery was completed, the patient's cart was rolled out the rear of the quirofano and lowered on a hydraulic ramp so they could be transferred to post-op to recover from anesthesia. Once the patient feels able they are allowed to return home. For some of the larger procedures, including lap-choles, they may stay the night with a nurse.

All of the cases are elective procedures and patients are screened very effectively to ensure good outcomes that do not require the services of a larger health facility. So, compared to a hospital, the patients are healthier in general and complications are nearly zero. Problems are identified by local health care providers - sometimes students and then verified by their attendings- and then referred to Cinterandes to confirm and perform a thorough history and physical to verify the need and suitability of each surgical candidate.
Our cases were mostly minor skin lesion removals, with some larger and more complicated masses, as well as two more involved laparoscopic procedures.

 A surgeon who had recently completed his residency was performing most of the operations with a resident assisting most procedures and the seven of us students took turns as first assist, second assist or scrub tech.
It was a bit crowded, but everybody got a taste for it, since it was a different experience from the typical OR. Dr. V was the anesthesiologist, so was occupied in the OR nearly the entire day, while Freddy, one of the drivers, ran back and forth full time as the circulator. Dr. B worked as the scrub tech or assisted, depending where the students were, and it was obvious that this was a very capable, if skeleton, crew.
We finished late and missed Spanish class. I had my last day at VCM the next morning, and there was an emergency abdominal aortic aneurysm that kept me busy from the morning up to our afternoon planning meeting. Dr. R was back in town and had a recent birthday that we all celebrated. The next week J2 and I would be heading out into el campo with another doc to see how that program worked, a mobile surgery day was scheduled on University of Cuenca's campus on Tuesday and Thursday was post-op follow up leading into a holiday weekend.
With the celebration, our meeting ran late, so by the time we got home M and J2 were planning to head to a small southern mountain town for the weekend, and at the last minute I joined them.