After setting up and picking our cases on Sunday, we began performing surgeries bright and early Monday morning. Two of our patients, Manuel (top) and Vargas are shown here awaiting their surgery. Manuel had surgery on his spine and Vargas had a knee replacement. Again, I must remind the viewer that we had permission to take these photos as privacy laws are very different in Ecuador.

I’ll start this post by showing some of the preparations for the knee replacement surgeries and a view of those patients as they prepare for surgery and await their turn. The holding area for pre-operation was small.

Dr. Estrada reviews x-rays with his next patient in the pre-operation area.

Meanwhile, it was the responsibility of the nurses to set up the surgical rooms, scrub in, and prepare the sterile equipment for use.

The following photo is of Kaitlin and me scrubbed in before a surgery, and the one after that is Kaitlin and Lance. I figured I’d make a cameo on the blog to show I did do nursing while I was there too. Thanks to Alexis Brown for snapping this photo. None of us had OR experience. I work in the ER, along with Kala who is pictured later, and Kaitlin and Lance both work in ICU. The local staff, Dr. Estrada and the physician assistant with us, Kentucky Skinner, were all very patient with us. I think we all learned a lot.

Once the room was ready for the patient, he or she was moved from Pre-Operation to the surgical suite.

The Ecuadorian nursing and surgical staff placed an IV and catheter while we finished setting up the surgical equipment and either our anesthesiologist or theirs prepared the patient. Here, a nursing student named Junior places the IV for our next case. He often scrubbed in with me for surgeries. He became a rather vital part of our orthopedic team. It was rewarding getting to know the local staff. We learned a great deal from them and we taught them our techniques. It was a wonderful cross-cultural learning experience for everyone. Junior spoke Portuguese primarily with some English and some Spanish. We were able to communicate on about the same level in Spanish.

Kala, Junior and I.

Below, our anesthesiologist, Man Frost, prepares the patient and teaches a local student his technique while Ecuadorian nurses support the patients physically and emotionally. Man Frost put patients under general anesthesia, but the local staff just performed spinal blocks. This meant patients were awake for their surgeries but just couldn’t feel from the waist down. They could hear everything. Personally I wouldn’t want to hear people drilling and sawing my knee.

Now the patient is ready for surgery.

I wasn’t on the neurosurgery team, but I did get to observe a few of their surgeries and meet some of the amazing people they operated on. They did far fewer cases than we did, though a few of the ones they performed were much longer surgeries.

Here Dr. Edison Valle and Dr. Gabriel Vidal review x-rays of a potential neurosurgery candidate with local doctors.

Dr. Edison Valle reviews Manuel’s x-rays the day before his surgery. I was informed he was staying in the private part of the hospital, where patients have semi-private rooms and refrigerators in their rooms. This is because Manuel has insurance. He was very happy every time I encountered him and never had a single complaint.

Here is a 27-year-old women with a tumor on her spine. I was drawn to her when we were taking a tour of the hospital. I asked her if I could take her photo and then I later found out she was one of the neurosurgery patients.

And here Kaitlin is comforting her right before surgery as Lisa helps to pull her over onto the stretcher.

The next post will provide a unique, inside look at surgeries in action. It might be a little more graphic for those who are sensitive to that.