Treating Ecuadorian patients with Project Change: Bermuda reminded anaesthetist Dr. Alistair McCrirrick of what medicine was all about.

?You go into medicine thinking that you are going to do great things, but it?s like any other job,? said the anaesthetist of 20 years.

?But this experience was actually like what you thought medicine was going to be about, because firstly you were really making a big difference in a short period of time to people who were really, really grateful.

?Overall it was an amazing experience and much better than I thought it would have been.?

Dr. Alistair McCrirrick went to Salcedo, Ecuador last month with the Project Change: Bermuda team. The other members who helped to complete the 92 operations were operating room nurse Lesley Fife, intensive care unit and recovery nurses, Oddrun Farestad, Rosie Gilbert and Regina Todd, and plastic surgeon and chairman of the Road Safety Council Dr. Christopher L. Johnson. Also in attendance were administrators Ianthia Simmons-Wade and Oliver Lewis.

The main operations that they carried out were cleft palate/cleft lip reconstruction, burn reconstruction, microtia repair or reconstruction of children born without ears and congenital hand abnormalities.

Dr. McCrirrick said the majority of operations were done on children, but he found that the children?s attitudes differed from the young people here.

?The six- to 12-year-olds who knew what was going on were so nice and so brave compared with children here and or in the UK,? he said.

?They did not cry and want their moms, but these kids they just laid out and got on with it. We had one little kid who had one little tear coming out, but he remained as stoic as anything. He didn?t cry. He didn?t make a fuss.?

The level of appreciation amongst the young people was also noticeable, said the anaesthetist.

?One of the nurses, Oddrun, brought a pair of football boots that her husband had given her to bring out, and she put these football boots on this little boy and when he woke up and saw a brand new pair of Nike football boots, he couldn?t believe it. Apparently he wore them for the rest of the week.?

In order to make it possible, there were numerous donations made in support of the Project Change: Bermuda team before they headed to Ecuador for a second time. As with the general public they also received donations from the Elan Clinic, the XL Foundation, King Edward VII Memorial Hospital and Sir John Swan amongst others.

?It was an expensive operation to run for over 90 operations,? he said, ?And I think that we have been very lucky that people have been very generous. KEMH gave us time expired disposable equipment and it made a big difference. Everything that we didn?t use we left there, either for next year or for the Ecuadorians to use if they need it.

?The cost of each operation is approximately $250, which is $23,000 for the entire mission, although this did not include flights, accommodation and transportation for the volunteers.

?Project Change: Bermuda is a wonderful example of the generosity of Bermuda and its medical community. In order to continue this worthy mission, cash donations are gratefully accepted.

?In addition to funding this very successful mission to Ecuador, Project Change: Bermuda, will also be travelling to Tanzania in August 2006 to provide care to needy African children.

?Donations are essential to providing this essential service to children who would otherwise suffer. To make a contribution please contact: Mrs. Simmons-Wade at 535-2388 or Dr. Johnson at 296-7439 or

e-mail: infointernationalplasticsurgery.org.?

This was the first time that the hospital allowed two staff members, nurse Rosemary Gilbert and Dr. McCrirrick, to go on paid study leave.

?I think it is the first time that the hospital has been involved to that extent,? he said.

?I think in the past if people wanted to go they had to take their own leave and we?d like to express our gratitude to them for allowing us to go and I hope that they are going to continue to allow a couple of members of staff to go each year and I think they may well do, because I think they understand what a worthwhile thing it was.?

The anaesthetist, who has worked in both the UK and Bermuda, had never seen so many people with deformities before.

?I think they came from quite a large area,? he said, ?But there may well be an hereditary component and people in those areas or villages may be prone to those abnormalities.

?The main abnormalities are cleft lips/cleft palettes and also malformed ears.?

The surgical skills that Dr. The surgical skills that Dr. McCrirrick saw, especially on the ear reconstruction, was like nothing he had seen before.

?It was fantastic. They took a little section of rib and they carved it into an ear, then they made a little incision into the skin and they put the carved bone under the skin.

?The next year they go back and lift it up from behind and away from the head so you have the proper shape of the ear. It sounds awful, but in fact some of the results were remarkable and some of them looked really, really good.?

These operations to repair the birth defects are so important as many of the children are stigmatised in their villages.

When asked how does one reconstruct a cleft lip, he explained that it was usually more complicated than just stitching it up.

?This is because it is usually associated with another abnormality called a cleft palette.

?The bit that you see is the deformity in the lip, but the real problem is a large hole in the palette. This normally forms or the two halves fuse when the embryo is maybe 20 weeks, so it is a failure of fusion and these children have great difficulty in eating.

?It is actually the repairing of the palette that makes a tremendous difference to these children from a point of view of eating and leading normal lives and the lip gives them the cosmetic appearance.?

The condition of the hospital was also something that he had not experienced before.

?It was very difficult conditions working there because we have very little of the equipment that we?d normally have, like the anaesthetic machines,? Dr. McCrirrick said.

?We obviously took drugs from Bermuda, but we had a fraction of the equipment and the support that we?d normally have had, but you very much had to make due and it was a ?can do? attitude.

?It was how can we solve this problem and what can we use instead of this. It was a great environment.

Here we have much more modern anaesthetic machines and state of the art monitoring devices, which is fantastic.

?The anaesthetic machines that we have make delivering anaesthetic very easy, but over there we had to make due with the bits and pieces and give anaesthetic perhaps a different way than we were used to.

?The monitoring machines that we have here allows us to monitor all of the vital signs, but without that we had to use our clinical skills and be much less reliant on technology to make sure that the patient was okay.

?Also you were working without the same constraints of paperwork, formalities, you were just getting the job done without the bureaucracy that normally goes along with it.?

He added that there was an ?all hands on deck? attitude amongst the volunteers.

?Of course working in a hospital everyone has their own jobs, but there was a tremendous camaraderie and everybody helped set everything up and at the end of the day the surgeons, the anaesthetists, the nurses all washed the walls, everybody worked flat out until the job was done. It was a great atmosphere.?

And for any medical staff who are thinking to take the plunge, he said: ?I think they will find it a very rewarding experience and also they would learn a lot in a very different environment that we are not used to working in.

?Limited equipment makes you certainly go back to basics and it makes sure that you are doing the basic things right or properly, and going back to your basic skills, as opposed to being quite so reliant on the technology that we have.?

For Dr. McCrirrick it was more rewarding than he could have possibly imagined.

?I think part of the main reason for that was because of the warmth of the Ecuadorian people and the gratitude of the patients.

?To be honest with you, it is not something that we see in our practice in the Western world.

?I think perhaps patients in the Western world have very high expectations and they are perhaps not as grateful as you might have imagined they would be. But there we were their only opportunity to have this sort of surgery and the patients and their families were incredibly grateful. It was extremely rewarding and if given the opportunity, I would love to go again.?