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Building a Partnership Model for Surgical Care in Guatemala

  • July 12, 2022
  • Access to Medicine, Medical Outreach
  • Guatemala
“I always joke that I feel a little guilty doing what I do, because I get almost as much out of this mission work as my patients do. It gives me more energy to continue wanting to be a better person and to help other people. It truly recharges my soul.”

Mike Oswald, CRNA.

A mission to provide critical surgeries for Guatemalan patients in need started Mike Oswald, a Certified Nurse Anesthetist, on a journey. This all began in 2009 when he started to visit Guatemala once or twice a year as part of surgical mission teams. Over time this developed into something more permanent, namely an ongoing communication and collaboration between local medical experts and the visiting mission teams.

It all came about because Mike and his wife Teresa decided to create a more sustainable model for health care access provided by the surgical mission trips. He knew that the teams were doing important work, but he wanted more. Health care is an ongoing process and in the case of surgeries, follow-up care is important after even the most successful surgery. He had encountered local professionals in Guatemala who had the skills and knowledge needed to change the way medical missions were done in Solola, Guatemala and he wanted to partner with them.

The New Beginning

In 2018 Mike and Teresa started a non-profit called ALMA which stands for “A love for missions abroad”. The first thing he did was team up with Dr. Vicky Loza, a local ophthalmologist. He then formed a partnership with local surgeon, Dr. Julio Estrada, who repairs hernias, removes gallbladders, etc., serious problems that are often ignored because the people in the communities served do not have the time or money to see a doctor. Mike then added social workers to the team. The social workers are tasked with visiting patients at their homes to address their immediate needs, but they also visit patients after their surgery which he knew was critical. The in-country team continued to grow with OR technicians, a secretary and nursing students.

When the ALMA teams traveled to Solola, they brought much needed resources including Americares donated medicines and supplies. Mike has been a valued Americares Medical Outreach partner since 2017 and has received product support for 10 surgical trips. Cumulatively, Mike and his teams have seen a total of 1030 patients and performed 294 surgeries with Americares donated product. During these weeklong trips, the local and American teams work together to help those in need. The ALMA teams don’t just take product, use it during their short-term trips and depart until their next trip. Mike created a system wherein there is lasting sustainable impact because of the partnerships he established in Solola.

Then Came COVID-19

When Covid-19 hit, the ALMA team could not visit Solola. What made things even worse was that due to shutdowns the local people could not make money. They couldn’t sell their goods and their crops rotted. Thus, even if they could get to a hospital for care, they could not pay for the needed surgeries.

Mike knew he had to do something so he kept in touch with his colleagues in Solola and shipped them resources when he could. The problem was the surgeries. He wanted to be sure the patients were able to get the surgeries they needed while he remained at home in Idaho. Mike came up with a great idea. He was able to get surgeons in Solola to donate their time and donors in the U.S. to financially sponsor the cost of the surgery.

The year-round sponsorships, which allow for more surgeries per year, continue and remain a complement to the ALMA team’s in-person trips.

The Return to Guatemala and a Young Patient

On November 4, 2021, Mike and his ALMA team traveled back to Solola, their second trip since travel restrictions were lifted. During the trip, the team saw 101 patients and performed 20 surgeries. One of those lucky patients was two-year-old Luisa*. When screened by the ALMA team, she was diagnosed with dacryocystitis, a blockage in the tear duct which causes the back up of tears in the tear sac. This can cause the tear sac to become inflamed and swollen.

Two weeks after Luisa was born, her mother, Vilma realized that her daughter’s eye was turning red and as the days went by, a white ball was formed near her tear duct which continued to grow over time. Vilma and her husband took Luisa to the hospital, however the surgery was costly. Due to the pandemic, the family’s economic resources were limited which made paying for the surgery impossible. Vilma was taught how to drain Luisa’s eye, but she saw no improvement and feared her daughter would go blind.

Vilma’s cousin told her about the ALMA medical day and provided her with information.

The Surgery

From left to right, Americares Medical Outreach Partner Mike Oswald, CRNA, Dr. Vicky Loza, local ophthalmologist, Dr. Thomas DeTar, U.S. surgeon, and in the back, Maggie McPaul, RN.

The procedure involved using an endoscope that went through Luisa’s nose to avoid an incision on her face. They were able to reconstruct the passage of her tears so that they would drain directly into the nasal cavity and bypass the duct obstruction. If you look closely, you can see the tiny tube that was implanted.

closeup view of young patient's eye after surgery with a tiny tube visible after insertion.
A young patient, Luisa, after eye surgery by a surgical team in Guatemala

The team used the Americares donated Precedex, basic and cataract surgical packs and Harley N95 masks when operating on Luisa. Mike stated that the Precedex was a “dream” to have in Guatemala. Because he was able to provide opioid free anesthetics, the result was a safer and superior outcome to the patients. In addition, he said that the basic and cataract surgical packs provided the team with an efficient and sterile solution to prep the patients for surgery.

The Outcome

Vilma considers the surgery a great blessing. She had feared that her daughter might have lost her sight during the time it would have taken to come up with the funds for the surgery. Vilma stated that ALMA is a great blessing to the Guatemalan families as they provide quality services and treat each patient with love and dedication. She stated that, as a parent, she was able to feel the interest of the team in the children before, during and after the operations.

Luisa playing at home after her successful eye surgery

Americares Medical Outreach donates medicines, medical products and educational resources to U.S. licensed medical volunteers who travel abroad to provide primary care, perform surgeries, respond to emergencies and strengthen local healthcare capacity. Americares has supported this work for over three decades in more than 80 countries.

*Name changed

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