Learning Compassion and Flexibility in Ecuador

The 8-year-old patient breathed evenly, unconscious on a makeshift operating table in Guayaquil’s military hospital. The volunteer surgeon made an incision into his groin to repair his hernia using a donated scalpel. The CRNA administered anesthesia using a rudimentary anesthesia machine composed of metal cylinders. A few feet away, another patient lie on another table, having another surgery.

Suddenly, the lights started to flicker. 

“Stay calm,” Assistant Professor Michael Greco instructed his two students.

He resumed administering anesthesia to the young boy.

Suddenly, darkness enveloped them. The electricity went out. The hospital had no generators.  The ventilator providing the boy’s oxygen shut off. Then, the monitors displaying his vital signs, oxygenation and cardiac rhythm went black. 

Greco grabbed a resuscitator bag and mask and began to manually deliver air into his patient’s lungs, with only the small battery operated light from his laryngoscope to guide him. For the next 10 minutes, Greco administered oxygen into the boy’s lungs with his right hand squeezing the ambu bag while monitoring his palpating pulse with his left hand from the boy’s carotid artery located on the side of his neck.

Suddenly, the electricity resumed, the ventilator began to pump automatically, the lights in the room shone brightly. Greco, together with his second year nurse anesthesia students Jessica VanderKwaak and Derrick Smith, and the rest of the health care team continued with the planned surgery.

The team was in Guayaquil, Ecuador for a week-long medical mission volunteering for Blanca’s House, a nonprofit organization that sends medical professionals to underserved communities in Latin America to provide free treatment. Joining the Columbia Nursing trio was Steve Gruendling ‘97 who coordinated the set up of anesthesia machines and other essential medical equipment prior to the surgeries.

The Columbia Nursing team provided anesthesia for 65 surgeries including gallbladder removals, hernia and cleft palate repairs, and skin grafts for burn victims. In addition, the team set up a satellite surgery center 10 miles away from the hospital in Vergeles, a rural town. They transformed a former primary care medical office into a functional surgery center with two operating rooms and a recovery area.

The need for volunteers is great in Ecuador. Thousands of Ecuadorians depend on health care provided by nonprofit organizations to fill the resource gap in the country.  For many, this is the only health care they receive. Volunteers on short term missions favor surgeries that require minimal follow-up care and carefully prescreen patients to help ensure against post-surgical complications.

 “It was an incredibly humbling experience,” said Greco, assistant director of Columbia Nursing’s Nurse Anesthesia program.  “Many of these patients travelled up to 12 hours to receive our care. Many of them brought homemade empanadas and other small gifts as a thank you. They were so grateful for our services."

The team worked 12-15 hour shifts in a single operating room with two operating room tables, one used for general surgical procedures and the other for plastic surgery. The hospital provided an antiquated but functioning anesthesia machine. Each participant brought a large bag of donated equipment including syringes, needles, and blankets. Nothing was wasted: Volunteers sterilized and reused all of the tubes and scalpels. They even covered the operating tables with cloth instrument coverings since the hospital had no sheets.

“We tend to throw away this type of equipment in the United States,” said Greco.

Although supplies were limited, learning opportunities were plentiful.

“Most hospitals in the United States have expensive anesthesia machines and monitors,” said VanderKwaak. “On the mission, we brought an anesthesia machine in a suitcase and screwed it together on a steel cart. We provided safe care to patients utilizing very basic monitors even when the power went out.”

VanderKwaak and the team came up with creative solutions to provide anesthesia with few resources.

“We had one large cylinder of oxygen for the week,” said VanderKwaak.  “If we ran out of oxygen, we couldn't do any more surgeries. It was illuminating to see that a simple resource like oxygen is a luxury to Ecuadorians."

Smith also applied his classroom and clinical rotation experience to real-world situations during the mission.

One evening, he heard high pitched gasps from a young boy emerging from sedation. He recognized the signs of laryngospasm—a common post-anesthesia condition when the vocal chords seize up and block air flow into the lungs. Smith knew how to treat the child from his classroom lessons and clinical experiences. With experienced CRNAs nearby, he delivered oxygen and positive pressure into the boy’s airway using a bag and mask until the spams broke and his breathing returned to normal.

 “The trip tested my ability,” said Smith.  “It also reminded me of why I came to Ecuador—to give care to people who have no other way to receive it .”

One day, walking by the waiting room in between operations, he was stunned by the number of people, many sitting on the floor, patiently waiting for surgeries.

“There were so many people waiting to be helped. It was a humanizing experience.”

The students say they have returned from Ecuador with a greater appreciation of the health care needs in underdeveloped countries and the importance of teamwork, particularly under challenging circumstances. 

“Both students did a wonderful job,” Greco said. “Despite the limited resources, they were able to provide safe and compassionate care. I’m proud that we provided them with such a wonderful opportunity to strengthen their nurse anesthesia education and broaden their perspectives on global health issues.”