Meet Me in Santa Cruz

Written by Jodi Grahl

Eighteen hours after taking off from Chicago, Judy, Pancho and I landed in the city of Santa Cruz on Saturday morning. A few hours later we were joined by Enrique, Magued and Gustavo, fresh off 10 days in the central Bolivian town of Punata with the Multi-Specialty Mission Trip.

It is the first Solidarity Bridge mission trip for Pancho (gastroenterologist), the fifth for each Judy (surgical nurse), Magued (general surgeon) and Gustavo (interpreter and Benezet Intern), and the 14th for me as SB staff member. Enrique (anesthesiologist), one of the founders of Solidarity Bridge, claims to have lost track of his tally a while ago, but the records report 20 mission trips completed. We’re welcomed by Patty, Regional Coordinator of Puente de Solidaridad (PdS), and the rest of the Santa Cruz staff.  Jose, PdS Medical Supplies Coordinator, and Patricia, PdS Executive Director, have also joined us from Cochabamba. 

Bright and early on Sunday, we arrived at the San Juan de Dios Hospital to meet with our local hosts, headed by Bolivian general surgeon Dr. Boris Urna. Magued and Boris had forged a fast friendship 18 months earlier on our first General Surgery Mission Trip here. This year, Boris has organized an entire Course on Minimally Invasive Surgery around our visit. An enthusiastic team of residents gave up their Sunday to come present the pre-selected surgical cases for the week. Then, finally, we began to meet the patients. 

A few relatively simple cases would include gall bladder extractions for Elvidia, Carolina and Ruben. Every case is different, and there is no guarantee that any of these cases won’t include special challenges. 

We also met Salomon, Juan, and Faustino, each in need of hernia repair. The hospital does not currently perform the procedure laparoscopically, so the mission trip and training course will allow us to serve these three men, while at the same time demonstrating the technique to those present in the OR and dozens of students and doctors who will watch the surgery via monitor in the adjacent auditorium. 

Elvira, Yenny, and other patients with increasingly challenging cases will also benefit from our mission this week. Their cases include several diseases of the colon and the esophagus caused by Chagas, the devastating parasitic disease endemic in Bolivia. 

As I look back on those first hours, it is already Tuesday. We are exhausted but excited to report that seven patients are already on the road to recovery! We started on Monday with some of the so-called simpler cases. By the end of the day, the missioners and local staff had integrated as one team, and were ready to move on to bigger challenges. Some of the cases facing us included patients waiting years for help, while doctors debated if they were even operable. Forty-two year-old Walter -- father of three, farmer, Chagas patient -- would essentially need his esophagus split and reconstructed. His surgery was first on the schedule, and ended up stretching four and a half hours. And that was just the first of three surgeries today!

But as I try to clear my head and get some rest before another long day in the OR tomorrow, it’s Elena who is on my mind.

Elena is a delightful 22-year-old woman from Punata. That’s where Drs. Magued and Enrique met her last week. She had come to the hospital on the last day of the Multi-Specialty Mission to share her story, which involves a devastating accident when she was just 14 years old. Much of her abdomen had been crushed under a vehicle and she was left with a colostomy. With her family at her side, Elena was desperate to know if her intestinal tract could be restored. At first, Dr. Magued wasn’t sure it was possible, and it certainly could not be done the day before his departure from Punata. Quickly, he consulted with his colleagues in the U.S. who helped him develop an appropriate treatment plan. Meanwhile, the family took an overnight bus to meet our team in Santa Cruz. Everyone pulled together to get Elena’s labs and images ready. Her operation needed to commence as early in the week as possible to allow time to address any possible complications.

Elena was understandably anxious as she waited to be wheeled into surgery. To distract her, I asked her to tell me about her life and her plans. She had finished middle school, but her treatments and the management of her colostomy made it too difficult to continue her studies. Her last words to me as the nurses came for her broke my heart. “I haven’t been able to do anything interesting with my life.” I just had time to respond: “you’ll have plenty of time after this to do many interesting things!” before the OR doors shut behind her.

Dr. Magued did not know what he would find when he inserted the scopes to begin the colostomy reversal. The extensive internal damage she had suffered and the scarring left behind by various surgeries made the images difficult to decipher. Elena knows that there is no guarantee that the surgery will turn out as hoped. As always, Dr. Magued began surgery with a prayer, and we all continued to pray as he inserted the scopes and began to explore.     

Three hours later, Jose and I were in the recovery room as Elena opened her eyes. The nurses explained that surgery was a success. The colostomy is gone.

Elena began to repeat, in a somewhat comical loop as the anesthesia slowly wore off: “My tummy doesn’t have anything? Just scars now? That doesn’t matter. Now I can wear any clothes I want? My tummy doesn’t have anything? My tummy doesn’t have anything anymore?” 

Once she was a little more awake, the loop changed to another topic. “I want to do something with my life. I want to help people who have the same thing I have.”

And you will, sweet Elena!
To quote Dr. Magued: Life is good!


Jodi Grahl is the Director of Gynecology, General Surgery, and Pacemaker Programs at Solidarity Bridge. She is currently serving on her 14th mission in Bolivia.