Hospital Loma de Luz in Honduras

Brigid and I began working at Hospital Loma de Luz in February, 2014.  Hospital Loma de Luz is the centerpiece of Cornerstone Foundation.  We were placed at Loma de Luz by World Medical Mission of Samaritan’s Purse.  We plan to provide urology services and surgery at Hospital Loma de Luz for 1 week periods 3-4 times yearly.

The medical staff is composed of missionary physicians and volunteers.  Charting is modern and the overall care is excellent.  Many of the resources are limited, and supplies are difficult to obtain.  The hospital is supported by donations to the Cornerstone Foundation (http://www.crstone.org/).  This is me with Dr. Ben, a Family Practice resident from Texas on a mission rotation.

I’m performing a complicated open kidney surgery assisted by Dr. Jeff McKinney, a general surgeon and the President of the Cornerstone Foundation.  Jeff began this project about 20 years ago.  We were able to perform very complex operations in this modern operating room.  Our “bloodbank” consisted of the entire staff of the hospital.  Blood, if needed, was obtained fresh from walking donors.  We did not need blood fortunately.

To get to Hospital Loma de Luz, it’s best to fly to the island of Roatan.  A ferry goes to La Ceiba on the mainland twice daily.  The drive from the ferry to the Hospital is 1-2 hours.

The site is located in the jungle on a hill overlooking the Caribbean coast.

Hospital Loma de Luz is located in the jungle of Honduras overlooking the Caribbean coast about 1-2 hours from La Ceiba.  The infrastructure and capabilities are modern although the surrounding area is primitive.

Brigid is here with Dr. Vance, our Ob/Gyn.

I’m removing a large bladder cancer with a resectoscope.  Before I arrived, there was no urologist here for many years.  The Hospital does not own any cystoscopy instruments, so I took instruments that were donated to me for mission use.  My set is limited, so I’m slowly purchasing more.  The need for urology surgery is great in this country.

Guest housing on the grounds is safe and comfortable.

Cornerstone Foundation also supports an orphanage and a bilingual school on the site.  Pictured is Scott with his first grade class.

Photos from May, 2014

We now have everything that is required to perform transurethral resection of the prostate at Hospital Loma de Luz.  During this Project, I was able to perform several of these procedures on patients who had previously required longstanding urethral catheters.  All patients were voiding normally without a urethral catheter on the day following their procedure.

Rosanne McKinney RN and Steve, our anesthesiologist, are inducing anesthesia for surgery.  Steve donated some of the excellent anesthesia equipment.

Brigid is preparing instruments for surgery.  Brigid managed the cystoscopy operating room, maintained the instruments, and participated in patient evaluations.  The "disposable" tubes that are hanging are used repeatedly and function quite well.

Right to left: Steve, our anesthesiologist, Edwin, a family physician, and two children.  Many of the missionaries bring their families to Loma de Luz.

A representative home that we passed along the dirt road to the hospital.  This part of Honduras is undeveloped and resource-poor.

Dr. Jeff McKinney is assisting me with and open ureterolithotomy.  This operation is rarely performed anymore in the USA, but it is lifesaving in areas with limited resources.  The patient recovered uneventfully.

Raymond helped me with translation and logistics.

Photos from October, 2014

We arrived in Honduras during a tropical storm.  The plane had difficulty landing, the ferry was not running, and the roads were closed by high rivers.  After a 2 day delay we arrived at the hospital in time to see a full schedule of patients on Monday.

We performed some open surgery, but the most common operation was transurethral prostatectomy.  Although we used boiled distilled water rather than using expensive prepared solutions and although our technology was primitive by USA standards, our results were as good as or better than the best results in any medical center in the USA.  With no complications, our patients began burdened by indwelling urethral catheters and consistently left the following day voiding without difficulty.  Patients had better results than we had a right to expect.

The nursing staff has become experienced in managing urology patients. Because transportation is limited, most of our nurses have gotten their training here at Loma de Luz.

This is one of my patients on the day following his prostate surgery.  Immediately following this photo, he smiled, picked up his urinal, and showed me his beautiful clear stream.  I considered it appropriate not to add that photo.

Photos from February, 2015

Dr. Judy is caring for a premature baby.  Judy seemed to carry the newborn everywhere that she went.

Isaac Hotz is a Samaritan’s Purse post residency fellow.  Isaac and his wife, An, are both family practice physicians.  They have 2 young children with them at Hospital Loma de Luz.

Dr. McKenzie and Dr. Isaac are working in the nurses’ station.

Drs. Pedro and Dave are seen in the hospital.

This is a staghorn calculus that I removed.  The stone was almost 4 cm by 2 cm in size.  I removed part of the 12th rib (shown) to get to the stone.  The surgery was an extended pyelolithotomy.  While almost obsolete today in the USA, the surgery is still effective where no advanced technology is available.

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Brigid donated a unit of blood for a patient who arrived at the hospital almost dead with a hemoglobin of 3.7.  He had been bleeding in his urine for about 3 years.  The patient has uncommon O negative blood, but 4 donors were found within minutes.  Hospital Loma de Luz has a “walking blood-bank” of volunteer donors.  All blood transfusions are fresh.  The patient was seen later that day up and eating in the hospital cafeteria.  Unfortunately, he will require major surgery for an aggressive bladder cancer.

The urologic surgery team is becoming very experienced.  We are able to efficiently provide a high quality of care.

They are constructing a bridge over the deep ravine that is located between the Hospital and the guest housing.

Photos from July, 2015

The bridge from Staff Housing to the Hospital has been completed.  For those without fear of heights, the travel is much easier.

Ariel, a second year medical student, shadowed Isaac Hotz, a Samaritan’s Purse post graduate missionary fellow, on his daily clinic.

We continue to perform open kidney surgery that would be considered obsolete in the USA.  Patients who are unable to pay for expensive modern resources have no alternatives, and the surgical procedures are life-saving.  Sam McKenzie, the high school son of one of our long-term missionaries provided excellent assistance for my surgical procedures.

Brigid prepared a patient education manual for urology patients.  Peter Stockton, our emergency room physician is reviewing the material with Brigid.  We are continuously working to improve the quality of care for our urology patients.

Photos from November, 2015

It is always a privilege to meet and work with the other mission physicians who volunteer at the hospital.  Drew and Christy Rideout worked with us on this mission.  Drew is a pediatric surgeon in Tampa.

The white area is a staghorn calculus (large kidney stone) that fills the diseased kidney.  In the USA, the stone could be removed and the kidney might be saved.  In Honduras, removal of the kidney is the patient’s only chance for a comfortable life.

This patient had an obstructed section of his urethra as shown on the x-ray.  Drew and I removed the diseased segment of and reconstructed the urethra.  Prior to this surgery, the patient had a tube through his abdomen into his bladder to drain his urine.  He will void normally following this surgery.

Drew and Christy brought Ana from Tampa.  Ana is a native Honduran and a USA citizen.  Ana is an outstanding scrub tech and a wonderful person.  Working with Ana made every day better.

Dr.  Rick Reichert and his wife came to Loma de Luz to help this week.  Rick is an eye surgeon, so he was very busy all week.  The need for help always exceeds our resources.

These are a few of the problems that we left for later.  There are always more patients in need than there are hours to provide that needed surgery.

Photos from February, 2016

Brigid is heading into the hospital to prepare for our 7th urology project at Hospital Loma de Luz.  Her ability to get the operating room up and running has become very efficient.

Dave Fields kept everything running.  With inconsistent electricity, Dave provided a generator for some of the procedures.  Also, Dave helped develop an organized urology equipment system.

Dr. Joe Lucero Has come for the week to provide anesthesia for our procedures.

Dr. Paul Fredette (surgeon)  came for a 2 week project at Hospital Loma de Luz.

Although TURP was the most common procedure, we also removed ureteral stones, performed a urethroplasty, and removed a kidney cancer.  While resources are limited, we are able to provide a comprehensive range of urology surgery.

Brigid with Rene Fredette.  Rene is a medical physician, but she also assisted me in surgery.

The girls enjoyed the heavy rainfall.  Hospital Loma de Luz is very child friendly.

Photos from January, 2017

We're back for our 8th urology mission at Hospital Loma de Luz.

Christine was our designated sponsor for this project.  Christine runs the lab and is seen with her team.  They do a great job with limited resources.

Bruce David was the anesthetist for our surgeries.  His wife Sandy, RN, assisted him.  They live in western Kentucky.

 Dr. Jeff McKinney  and Mike Yost built this device to deliver water for prostate resections. 5 gallons is enough for a large prostate without changing the bottle.

 This is the machine that we used to develop our x-rays.  They could use an upgrade.

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 We removed this giant kidney stone with an old fashion pyelolithotomy.  Modern lithotripsy technology is not available to these patients.

 These casitas are under construction at the hospital.  They will be used for long-term patients and their families.

Photos from May, 2017

Brigid and I returned in May, 2017.  The urology capability at hospital Loma de Luz is now efficient and well organized.

Joel interpreted for us.  At 18 years old, Joel has impressive world insight and he was tremendously helpful.  Joel has spent his life as the son of international missionaries, and he will soon be starting college in Indiana.

Sutured flank incisions and penrose drains are not commonly seen in the USA anymore.

Drs. Isaac and Ann are family physician missionaries at Hospital Loma de Luz.  Dr. Isaac takes care of routine medical problems, performs deliveries including Cesarean sections, administers anesthesia for surgery, and takes care of critically ill infants in the ICU.  It is extraordinary for one physician to be this proficient at so many complicated tasks.

Brigid with Liz.  Liz is returning to Scotland after many years at Loma de Luz.  We will all miss her.

Doris (center) runs the operating area.  They are preparing instruments for tomorrows surgeries.

Dr. Dan (left) was our anesthesiologist for the week, and Dr. Ryan (right) was our project sponsor.

Dr. Dave and I are removing a large kidney stone.  This is a complex pyelolithotomy that I learned how to perform in the 1970s.  The operation has been obsolete in the USA for about 25 years, so neither newly trained urologists nor their instructors have experience with this surgery.  In resource poor countries, this is the only alternative.  The surgery was performed in about 1 hour, and the patient was discharged home in 2 days with her problem resolved.

Transurethral resection of the prostate continues to be the most common operation.  My patients mostly had complete urinary retention and had been wearing a urethral catheter for an average of over a year.  Almost all patients are discharged on the following day voiding without problems and with no incision, no significant discomfort, and no medications. This is our only instrument set, and I have used even the disposable parts many times.  We hope for more instruments that will allow us to expand our capabilities.  It is amazing how much people can be helped with so little effort.

Dr. Peter is our ER physician.  He manages everything from major head trauma to Iguana bites.

Dr. Judy, our pediatrician, is seen with Iaian.  Dr. Judy is usually seen with one of the many abandoned babies.  Iaian is returning to Scotland after many years working at Loma de Luz.

These casitas are under construction.  They will be available for families and patients who travel from a distance for care.  Hospital Loma de Luz is the only capable medical facility for a large area.  There are always several new construction projects at Loma de Luz.

Photos from July, 2018

Urology at Hospital Loma de Luz is now a turnkey system for us.  The regular staff has arranged a clinic schedule of patients who need surgery, mostly TURP.  The operating staff has the knowledge and resources to begin operating soon after our arrival.

This donated flexible cystoscope greatly simplifies the evaluation of our patients.

Transurethral resection of the prostate continues to be my most common surgical procedure.  The surgical staff is increasingly comfortable performing open urology surgical procedures.  Although this setup appears to be primitive by USA standards, our results have been consistently satisfying.  Almost all patients have been using indwelling catheters before these procedures, and all have been able to void following the surgery.

I am assisting Jason, a family practice physician.  We're removing an infected bullet from this patient's penis.

As always, one of our greatest pleasures is getting to know and working with the other missionaries and staff at Loma de Luz.  On the left is Dr. Brian, a family practice physician that has been coming to Hospital Loma de Luz for 2 weeks yearly for about 10 years.  In the center is Dr. Jason.  Jason is genetically from Columbia but adopted and raised in Minnesota.  He is a full-time family practice missionary at Hospital Loma de Luz.  On the right, sitting with Brigid, is Grace.  Grace is a college student and a daughter of missionaries to Mexico.  Grace is spending her summer helping with a variety of functions at the Hospital.  She helped me with translation.

Loma de Luz currently has several building projects.  On the left, the main hospital is expanding.  On the right, more casitas are being built to accommodate patients and families who travel a distance to the hospital  Additionally, the Children's Center is expanding.  During our visit, a construction group from Minnesota was working on the expansion of the Children's Center.

As we departed on our last day, we are gratified to know that another urologist will be coming to Hospital Loma de Luz next month.  Many patients in this part of Honduras urgently need urology procedures and no other resources are available.

Since our last urology mission at Hospital Loma de Luz, 3 other urologists have provided care at this hospital.  It appears that our long-term goal of a continuing urology capability will be achieved.

Our other goal is improving the urology resources by adding more instruments and by advancing the available technology.

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