Last fall, I attended my fourth medical mission to Mexicali, Mexico with the organization Interface. Interface was established in 1977 and provides cleft lip and palate and other plastic reconstruction surgeries to the children and adults of Mexico. Interface serves five different sites in Mexico, once or twice each year. Attendees spend two to five days each trip performing between 10 and 75 surgeries.
My team consisted of over fifty volunteers, including surgeons, anesthesiologists, nurse anesthetists, pediatricians, nurses, scrub technicians, and interpreters. We stationed ourselves at the Red Cross clinic, converting three patient clinic rooms into five operating beds. We also established a pre-screening room and a post-anesthesia care unit.
Patients were screened by a pediatrician, surgeon and an anesthesia provider. The clinic supplied us only with space and oxygen cylinders. We brought our own anesthesia airway equipment, supplies and medications. We did not have anesthesia machines, but used Bain circuits to deliver oxygen and anesthesia gases. We also made sure the environment had the necessary safety measures needed in an operating room.
Thao Hoang and young patient in Mexicali.
In two days, we performed over 50 surgeries, on patients two to 40-years-old. We performed cleft lip and or palate repair, syndactly excisions, scar revisions, microtia repairs and septoplasties. Each patient was escorted into the operating room, placed on monitors and mask-induced with sevoflurane and oxygen. After a peripheral IV was established, intubation was performed without the use of muscle relaxants, and spontaneous ventilations were resumed. Fentanyl and clonidine were administered for pain and sedation judiciously. At the end of surgery, the patient was extubated and transported to the recovery room. Most patients were discharged the same day, while those that had cleft palate surgery or needed more monitoring stayed the night.
It is always challenging to provide anesthesia in unfamiliar surroundings with limited resources. On the trip, I became more comfortable using the Bain circuit and honed my skills in managing the pediatric airway. The use of clonidine intraoperatively provided great analgesia and sedation in the patients. An intravenous dose of 0.5mcg/kg provided very satisfactory sedation and pain control.
This trip was rewarding and humbling. I felt a sense of accomplishment seeing the patients do well after receiving their anesthestic and surgery. It is always a pleasure serving a population in need of medical services. The patients were grateful, and I know that we made a positive impact on their lives. Also, I was truly impressed by the skill and work ethic of the volunteer team. I look forward to continuing many more medical missions with Interface, an amazing and hard-working organization.
