Meet one of our newest Bolivian partners

Dr. Fernando Nogales, colorectal surgeon, reflects on his personal and professional journey to becoming a surgical partner of our General Surgery Program  

Solidarity Bridge and Puente de Solidaridad celebrated an exciting “first” in September, organizing simultaneous surgical campaigns in two cities, Cochabamba and Santa Cruz. Many factors came together to make this possible. Solidarity Bridge container shipments in 2020 and 2021 delivered enough surgical instruments and updated equipment to assemble two full mobile laparoscopic surgery units. At the same time, new Bolivian surgical partners helped staff the two campaigns. One of these newer partners is a young colorectal surgeon named Fernando Nogales. The head of Puente de Solidaridad’s Santa Cruz office, Patty Paz Estenssorro, sat down with Dr. Nogales in the days after the September campaign in that city to talk about how he came to join our mission. His path illustrates some of the challenges faced by Bolivian doctors to fulfill their vocations, and how our surgical programs help overcome some of the barriers.

Dr. Nogales went to medical school in Santa Cruz, specializing in colorectal surgery, also known as coloproctology. It is an uncommon specialty in Bolivia, and the San Juan de Dios public hospital in Santa Cruz was quick to hire him once he completed his training. As the highest-level general public hospital in the city, patients are referred to the San Juan de Dios from throughout eastern Bolivia for conditions such as megacolon, diverticulitis, and colon cancer, which are Fernando’s area of expertise.

Despite his training and the need for his services, Dr. Nogales soon discovered he was rarely able to operate, especially laparoscopically, because the hospital did not have the equipment and instruments required. Then in October 2016, the hospital announced the arrival of a Solidarity Bridge/ Puente de Solidaridad mission team with a guest surgeon, Dr. Magued Khouzam. The team brought the needed equipment and instruments to train the hospital’s general surgeons in laparoscopic gallbladder surgeries while operating alongside them to treat patients. Fernando introduced himself to Magued, who quickly discerned that Fernando was well trained in colon surgery but was facing persistent systemic barriers to performing it for his patients. 

In 2017, the mission team returned to San Juan de Dios, this time focused on esophageal and colon surgeries. Magued and Fernando partnered on several very complex procedures, but at the end of the week they ran out of time to operate one scheduled patient. Magued and Fernando discussed the case, and Magued suggested to Fernando that he—Fernando—was likely better skilled to manage the case than Magued would have been. It was a colon surgery for a Chagas disease patient, and Fernando was more experienced than Magued in manipulating the particularly fragile tissue of Chagas patients. As Fernando told the story to Patty Paz, he recalled that moment as a lightbulb flashing on in his head. Limited opportunities to practice his skills until that point had made him lose confidence in his own abilities, but Magued’s words encouraged him to have faith in himself. The mission team left equipment and supplies at the Puente de Solidaridad office for Fernando to perform the pending surgery—which was a success—and several more over the following months.

Over the next couple of years, Dr. Nogales stayed busy with his growing family and expanding career. In addition to his staff position at the San Juan de Dios, he started operating at private clinics so that he could apply his skills as much as possible. But he was troubled by the number of patients he saw at the San Juan de Dios Hospital and their persistent barriers to care. Solidarity Bridge and Puente de Solidaridad returned for a mission visit in 2019, but the capacity to operate on those week-long missions was insufficient to meet the tremendous patient need. 

And then the COVID-19 pandemic hit. The San Juan de Dios Hospital was overwhelmed with COVID patients throughout 2020. All but emergency surgeries were halted for most of the year. Puente de Solidaridad had already been reaching out to Fernando to expand his partnership with them to operate more low-income patients. Fernando then helped establish an agreement with Clinica Viara, a private surgical center that was designated as a “COVID-free” site, to perform low-cost surgeries there. He started with three patients operated in November 2020. Dr. Nogales received an almost “symbolic” honorarium of $72 dollars from Puente de Solidaridad for each of the three surgeries, which included one open and one laparoscopic gallbladder extraction, and an umbilical hernia repair. For Fernando, the ability to be back in the O.R. amid the pandemic, and the gratitude of the patients who otherwise could not have afforded care in a private clinic, made it worth it. 

Dr. Nogales (center) is assisted by Dr. Ugarteche (right), while Dr. Herrera (second from right) mentors both surgeons during the September 2021 laparoscopic surgery campaign at the Buena Salud Clinic. The team performed 17 gallbladder and two hernia surgeries over the course of three days (one patient required both procedures).

Dr. Nogales performed an additional eight low-cost surgeries for our patients in the first eight months of 2021, and then helped organize a surgical campaign at another private surgery center in Santa Cruz, Clínica Buena Salud. Over the course of just three days in September, ten doctors* collaborated to treat 18 patients at the Clinic. The surgeries were performed laparoscopically, thanks to instruments and supplies loaned or donated by Solidarity Bridge/ Puente de Solidaridad. That campaign was headed by long-time partner surgeon Dr. Luis “Lucho” Herrera, who together with Puente de Solidaridad medical supplies coordinator Jose Choque, traveled from Cochabamba with one of the mobile laparoscopic towers to supplement the surgical facilities at Clinica Buena Salud.

At the end of Patty’s conversation with Fernando, she asked what motivated him to become an active partner of Puente de Solidaridad. Fernando recalled the closing ceremony of one of the mission trips at San Juan de Dios. Several of the patients spoke of their immense gratitude to both the visiting team and the San Juan de Dios staff. “It reminded me of why I went into medicine,” and that collaborating with Puente de Solidaridad makes it possible to continue to fulfill that vocation to treat patients who desperately need him.  

In late October, Dr. Nogales will serve as lead surgeon on a campaign to the town of El Torno located 35 miles southwest of the city of Santa Cruz. In addition to providing complex laparoscopic surgeries for over a dozen patients, Fernando will mentor his counterparts at El Torno’s municipal hospital, thereby continuing the chain of training and expansion of Bolivia’s surgical workforce. Thank you Dr. Nogales for your invaluable contributions to our mission to increase access to surgery for all who need it in Bolivia.

Thank you also to Patty Paz for sharing their conversation with us. 

*In addition to Dr. Herrera and Dr. Nogales, the surgeons who collaborated on the September 15-17, 2021, campaign at Clinica Buena Salud include: Dr. Ugarteche, Dr. Calvimontes, Dr. Fernandez, Dr. Perez, Dr. Chavez, Dr. Rendon, Dr. Soleto and Dr. Torrez.