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Experience report 2015

"So good to see you again!" - A warm reunion with Juan, this time already a week before the planned second brigade for anorectal malformations in Honduras at the “Colorectal and pelvic reconstruction conference” in Columbus, Ohio in the USA.

This year we planned the medical mission of our association “Helping hands for anorectal malformations” so that we could still take part in the conference organized by Marc Levitt, one of the leading specialists in colorectal surgery in children. During the three-day event, current therapy trends and surgical methods for children with anorectal malformations or Hirschsprung's disease were discussed with well-known children's surgeons, including Luis de la Torre (Pittsburgh, USA) and Jacob Langer (Toronto, Canada). Numerous audience interactions in the sense of interactive multiple-choice questions, which were cleverly built into the lectures, quickly show how difficult it is to treat these rare clinical pictures - opinions regarding the interpretation of findings and the choice of the correct surgical method sometimes differ widely. However, most of the participants have the impression that they have benefited greatly from this event and will be able to benefit in the future treatment of the patients. After this intensive refresher course, we are off to Honduras in perfect tune with the topic. During the outward flight we talk to the organizer and founder of the “Fundacion MAR” (MAR stands for malformación ano-rectal). Juan Craniotis the planned weekly program. “I've scheduled 37 patients this year” - with the help of some donor friends, Juan was able to mobilize enough money this year to plan this number of children.

The health system in Honduras faces a problem with complex diseases such as anorectal malformations - on the one hand, the local pediatric surgeons lack the capacities and, on the one hand, the experience to deal with these problems in the same way as in the western world. In the care provided by the public hospital, the child's survival is paramount. The existence of a functioning anus is rather secondary, the costs are too high for the families in the Latin American country, who for the most part live well below the poverty line. If the families want a correction of this malformation, they would either have to raise the financial means themselves through the care in the private hospital, or they are lucky enough to be supported by the Fundacion MAR.

The last year was a complete success - the operated patients from the first brigade a year ago were all followed up by Juan himself and showed excellent results. The joy is written on the face of the parents we already know. For many of the patients now comes the finally redeeming step of closing the artificial anus after the surgical correction of the anus has been successful, it has healed well and the patients are no longer dependent on a stoma. Overall, we were able to complete the surgical treatment in twelve children and restore bowel continuity.

There is still a lot of catching up to do in the documentation of medical treatment. Juan repeatedly reports on manual records of medical interventions and planned therapies, which can often no longer be found a few days later. However, documentation is essential for consistent and urgently needed follow-up care for young patients. Everyone was very enthusiastic when we were able to present our colleagues on site with the medical documentation system “care01” for protected online documentation in the sense of a digital patient file. It was precisely for this mission that we received a free license from Amir Moussa, the developer of the system, as support and were able to train the pediatric surgeons as well as students and administrative staff in such a way that continuous documentation of the interventions as well as the postoperative course was also possible for the other brigades becomes possible.

During the very intensive week in which we are again working in the clinic from eight in the morning to sometimes eight in the evening, we can perform anorectoplasty on a total of 23 children - some with light, and some with more complex forms. All in all, our stay this year was even more cordial than the year before. The sisters and everyone else involved already knew how it would go and welcomed us again with open arms. The relaxed atmosphere in the operating room and between the procedures make it a real pleasure to be with the people on site.

In a country like Honduras, beliefs and legends still play a big role. You see diseases that are rare in the western world. Our disgust is great when we pull a roundworm over 20cm in length from the artificial anus of a 2-year-old child before the start of an ostomy. During the rounds we ask the local doctors why many of the children wear dry towels or washcloths wrapped around their heads - according to many patients, the brain should not receive oxygen after an operation in order to accelerate healing. Since this does not really affect the oxygen supply, we have nothing against it in this case. Juan, on the other hand, struggles with worse traditions which, as he says, are still consistently continued by the “ignorant people”. For example, many parents do not give their children the recommended diet after an appendix operation but put the child on a special diet on their own. The children then only receive tortillas and water for weeks, are no longer allowed to consume protein and finally come to the control after 1-2 months, completely emaciated and malnourished. "They believe their grandmother more than the doctors." tells us Dr. Mario Arista, the pediatrician who looks after the inpatients throughout the week.

In the evening after the long days in the clinic, there was still some time to eat with our host Juan and his family as well as some local doctors, to talk about the political situation and the problem of poverty in Honduras. It quickly becomes clear that the future prospects, especially for Juan's children in Honduras, are currently very limited. Although they attend private schools with lessons in English, their father fears that all doors can only be open to them outside the country. “I was born in Honduras, I lived my life in Honduras and if it's only me, I can die in Honduras. But I want my children to have a good future. " Juan and his family are also thinking about moving to a more peaceful country in his retirement.

After a short excursion to the state coast and a visit to some places outside of San Pedro Sula, we say goodbye at the airport for a long journey back to Vienna with a warm hug and the words: "Hasta proximo ano!" and return to our peaceful homeland with many experiences and impressions.


Donation account


IBAN: AT89 2011 1826 8970 0500
Institute: Erste Bank


2nd BRIGADE 2015



IBAN:   AT89 2011 1826 8970 0500
Institute: Erste Bank


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