We were already in the airport, it was 8 p.m. on 19th November and five of us (3 surgeons: T Butrón, JA Pascual, MA Vaquero and 2 anesthesiologists: O Aramburu, ML Vizcayno) as the other two members of the group (S Alonso, M Donat) had left in the morning.

Spanish Team in Ecuador
Spanish Team in Ecuador

We had left behind the whole preparatory work carried out since at the end of July Prof. Kingsnorth, president of Operation Hernia Foundation, confirmed to us the mission, which was the starting gun for us to begin with the project and allowed us to ask several institutions for financial help and medical companies for medical material. We received financial cooperation from Obra Social Caja Madrid, Covidien, Gore SA, Smith&Nephew and Ricardo Viera (as a personal contribution), and medical and pharmaceutical material from Braun Surgical SA, sutures division and pharmaceutical division, Covidien sutures division and electro-scalpels division, Prim, Smith&Mephew, Menarini, Dr. P Castillo (Hospital Universitario Santa Cristina), Hospital Universitario Santa Cristina and Hospital Universitario 12 de Octubre, for whose help we want to thank them from here as it allowed us to carry out our mission to a happy end. We also thank our work companions in our several hospitals as they took care of our work while we were in Ecuador. We wrapped in plastic coverings the five great bags of medical material we had prepared and we marked them with red crosses to facilitate customs in Quito.

After a flight that took fifteen hours, we arrived at Quito airport at 8:35 of the 20th, six hours ahead of Spain time. Haydee, an Ecuatorian young girl who had already collaborated actively with the first mission in Ecuador, was waiting for us with a van and its driver. We proceeded to La Independencia with a stop at the Museo de la Mitad del Mundo. After several hours we arrived at the Corporación de Salud Padre Damián, a small health complex in that small place, made up by several simple one-storey structures, one of them with an operation theatre preceded by a hall with a washing stand and lockers room, a maternity room, several rooms with 2-3 beds each for the admitted patients, infirmary control, sterilisation room, and storeroom; another house with 4-5 consulting rooms and a third facility with a small laboratory and the administration area. There we unloaded our medical material, and Nidia, the administrative head, showed us the operation theatre with an old surgical table and lamp, where they were putting up an auxiliary lamp with four halogenous bulbs, she showed as several stretchers for us to choose the table we would use as a second operation table and the cloth screen that would divide the operation theatre into two spaces in order to be able to operate on two patients at a time. We finally went to La Concordia, a city four kilometres distant, where we were taken to the Atos Hotel, our small but friendly lodgings situated at the crossing of the two main streets of the city, with a heavy traffic of lorries, cars, autotaxis, and motorcycles. After a quick look at our rooms, we came down to meet doctor Kathia Tinizaray, the head of health services in the area, who would be our help the next days, as well as doctor Miguel Bunces, in charge of CSPD, who combined that work with his job in public health since a short time before. We finished our first day with a supper at a grill on the main street.

On Sunday at 7 in the morning we were ready to go to the CSPD, we bought some fruits in a stall in front of the hotel (pitahajas, bananas, mangoes, ananas, ) and we breakfasted on our way to the CSPD. Santiago and Miguel went with Dr Bunces to the local radio station to be interviewed so that people would know of our arrival and our beginning with examinations and operations that same day; the rest of us finally began our work: we unloaded all the material, shifted some shelves inside the operation theatre, Olatz and later Miguel too placed all the anaesthetic material at the back, and the rest of us put in place the sutures, meshes and all the other things, among them the toys (which had been given to us by Dr Martínez Montiel and nurses from the Department of Digestive Medicine of the Hospital 12 de Octubre), leaving the operation theatre ready for operations. We then came to the consulting room to examine the patients that came to the CSPD. We did it in three rooms, dividing the work between us. We confirmed those who had hernias and incisional hernias, etc, and identified those who needed laboratory tests. We worked in a chain. Haydee would take their data, we examined the patients and filled up the data sheets, then we ordered them and lastly we wrote the surgical patients lists for every day. By then it was time for the midday lunch and we had finished; so we decided to begin operating that same day, Sunday, after lunch. We operated upon four patients, we tested the stretcher and the auxiliary halogenous lamp, what a heat! There was one diathermy which, together with the one brought by us, provided one for each table. Everything went without any special incident and with much joy. We had gone far beyond what we had planned beforehand. At the end of the day, and after checking most of the patients on the list, we realised that some of them had no pathology, so that maybe the number of patients could be insufficient to occupy us the second week. We had to think what to do! Speaking at table during dinner we thought we could perhaps make some publicity on the local TV stations.

The following days we kept our routine, we bought fruit at 7 in the morning, took the bus to La Independencia, sat down for twenty minutes to take our fruit and our coffee and we started with the operations. On Monday we operated upon 13 patients, one of them a difficult case which took almost 4 hours, so that we finished almost at 7 in the evening with only 35 minutes break to eat in the bar-shop by the side of the CSPD. We realised that could not happen again as we came to know that the water supply was cut at 6 pm. Jovita told us about it, a very efficient and charming nurse who helped us most of the time and told us she had a daughter in Spain. On Tuesday and Wednesday we finished earlier, which allowed us to take supper one day with the chief of police, Mayor Luna, Kathia, and Sandra Ocampo, the owner of the hotel, whom we met that night and who from that moment helped us in all our needs. On Wednesday we were called from the Efe Agency while we were operating, and we spread the news of our work thinking that we could attract more patients that way. We had already operated upon some children between 4 and 11 years. We could not include smaller patients because the respirator was not working and the anaesthetists told us it was not possible to operate without them. All the children were happy as we gave them toys which we also distributed among the children of the workers in the centre. On that day at 7 pm we went to the local TV station whose owner was Sandra s brother and on whom we operated a few days later. Haydee and doctor Bunces accompanied us. They interviewed us in the news programme and they gave us the opportunity to announce our work, so that the following days more patients came to our consult.

We daily increased our work: consultation, operation theatre, incoming register in sheets specially prepared by us which Haydee wrote out and printed in her computer. In that way, all the patients had ready a sheet with their data with information about their clinical situation and about the cost; besides, we filled in a database with all the information of each patient, and we completed the report we gave the patient together with a prescription for the medication they had to take. Thus the first week passed fast; a few days at night we went to a cyber centre to look at our e-mail in Internet, and we planned what to do on the weekend. How to make the announcements that would bring us more patients. Haydee got printed a thousand copies of an informative sheet in a printing press with details about our presence and our activity and where could those interested come. During the weekend we split into two groups and we went through different places giving out the information sheets and sticking up posters in pharmacies and other establishments. Sunday 28 was census day in Ecuador, which means that the whole country was paralysed as everybody had to remain at home since the previous midnight so that the officials could come and collect the data. How well we slept that night! No lorries or street noises to disturb us.

We too were censed, but as we were foreigners we were allowed on the streets. It was surprising to see La Concordia turned into a ghost city without any bustle, traffic, people as it would have been unthinkable a few hours before. That morning some of us went with Mayor Luna in a police car to patrol through the area and we saw how the people remained in their houses or at their doors with many children playing, all that after a brief visit to CSPD to see a patient who had been operated and had informed us he had fever; we verified he had a slight inflammation of the wound. He had been prescribed antibiotics, was now without fever and he returned home. We all had lunch together at Haydee s house. Some of the group remained there singing in a kind of home Karaoke, and others went back to the hotel.

The next day we began our second week. We operated upon 14 patients. In the evening, while the last patients were being attended to, Teresa went with Sandra to Quinindé, city 30 minutes by car where they had two interviews in local radios and two in local TV stations, and they visit the public hospital, and its directors through Sandra accepted that the next Operation Hernia mission would be carried out in their two operation theatres which are very well furnished. On the next days we had many new patients as a result of the announcements. Stitches and staplers were removed for the patients operated upon the previous week, and we saw three patients with seroma, and one with hematoma, while the others were doing fine. Pepe Pascual taught two lady doctors how to remove staplers, one of the health centre in La Concordia and the other of the CSPD, who were to do the follow up of the patients to be operated on the second week. Every day we operated on more patients, 16 on Wednesday with 20 procedures, which is our record.

We finally reached out last day on CSPD. We operated upon 10 patients, folded down the operation theatre, and we placed all the remaining material in bags. The farewell meal took place with all the workers of the centre who had helped us all the time. We eat fish with peanuts and coco sauce, accompanied by white rice. We all were very happy. Jovita cried at the farewell. We had one day free before returning to Spain. Sandra and Kathia took us in two cars to Quito. We slept in Sandra s apartment and the next day we went on a tourist visit to Otavalo, an indigenous village which is UNESCO Historical Heritage, with a high cultural level and a handicraft market which we liked very much. Now only our return flight was left. We had not imagined we would have to face the problem of the air traffic controllers strike in Spain which put our flight 24 hours later so that we reached Spain one day later than planned. We used that time to sum up our work: we had operated upon 106 patients, with 121 procedures in all. We had achieved our mission well beyond expectations.

Teresa Butro