We are excited to share a resident's experience of serving on a medical mission trip in Honduras for a week this October. Dr. Aaron Brandt is a chief orthopedic surgery resident at Atrium Health in Charlotte, North Carolina. He was given the opportunity to train and provide complex limb reconstruction services at Hospital Escuela in Honduras, through the RESTORE program alongside Dr. Joseph Hsu, founder of RESTORE. The mission of Reconstructive Surgery and Transmission of Operative Resources and Education to Central America (RESTORE) is to build sustainable surgical capabilities in resource-limited hospitals in Central America through a combination of education and volunteer efforts. Dr. Hsu founded this organization eight years ago through humanitarian work done as part of medical readiness missions in the US Army.
To put the work the Atrium Health surgeons are doing in context, our busiest trauma centers in the United States see about seven to 8,000 trauma admissions a year. At Hospital Escuela in Honduras, they see about 15,000 trauma admissions a year. That's almost two times busier than the busiest US trauma center. So you can imagine the impact they make on a medical mission trip is quite profound.
Dr. Brandt is serving with the RESTORE team, which stands for Reconstructive Surgery and Transmission of Operative Resources and Education. Dr. Brandt is the second resident civilian to have the opportunity to travel with Dr. Hsu to Honduras through this program and learn from the local surgeons there.
Check out the video below for a short clip of Dr. Hsu talking on the Prosperous Doc podcast about "Mission Obsolescence," the vision he began with when he started RESTORE. Before his trip in 2018, Dr. Hsu said in an interview (06:05)
"As I started the RESTORE program in 2011, my plan was to be obsolete within 10 years, so the Honduran hospital could operate without us. After seven years of one to two trips per year, I feel that I’m getting close to my goal of being obsolete. To my surprise, the Honduran surgeons have become so good at their practice that they teach the US residents, which has been an interesting evolution."
Now that you have some background on Dr. Hsu's brain child, you can have a glimpse into their week in Honduras. The two surgeons used social media to share thorough daily updates on their progress and cases they treated throughout the trip. Here is Dr. Aaron Brandt's day by day account of their week.
Not even one day in and we have already seen enough to get my head spinning. Fly in Tegucigalpa, go straight to hospital for a 30 patient pre-operative clinic, then have meeting of the minds to figure out a schedule for the week and then up to the equipment room to try to pull together case carts for each patient.
I'm blown away by the number of staff who were there on a Sunday night until 9pm. The 30 patients who sat in the waiting room from noon until the surgical schedule was made (waiting hours more due to our delays); the complexity of every single case, and the appreciation these people had just to be evaluated and discussed.
Next up, 5 full days of surgery, learning from this group of talented surgeons and being a member of their team. This is a special thing Dr. Joseph Hsu has created down here and I am thankful he pulled me along.
Well day two didn’t disappoint. Probably my favorite “short cut” (see video in Dr. Hsu's tweet below) to an operating room ever, with some exercise built in.
Perhaps we complain too much at home when we run into "obstacles." Video of the walk to the OR from the area where we change and store equipment. Surgeons here amazingly upbeat despite true barriers to care. On the brigher side, the rain scared the pigeons away! #resilience pic.twitter.com/9zTffxgFcj
— Joseph R. Hsu, MD (@JosephHsuMD) October 22, 2019
Then start the week with 2 big deformity cases. Some pics to get an idea of the crazy stuff they deal with down here. Nothing helps you learn better than stripping all the excess and working with people who have to make it work with whatever they have.
And as usual, I’m just a little too big for most things.
Day 1: we operated on two cases...Day 2: 5 cases (no less complex) and all much like the one in my Instagram post. This gentleman unfortunately had a bad injury with an open fracture, flap and now with chronic osteomyelitis. Dr. Ochoa, the head surgeon of the limb reconstruction division in Honduras (mentioned in the video clip above), took us through a flap elevation, bone resection, frame and bone transport...just a typical case for these surgeons. I'm very lucky to be learning from these surgeons.
There is a different level of respect for this job when you have to spend time after a long day putting together your own case carts piece by piece and figure out if you even have the tools you need. I'm also grateful to Dr. Joseph Hsu, traum an important teacher and mentor to me, who asked me to join him for this trip. It is truly amazing to see what these surgeons can do when you give them the skills and some resources and let them fly. I will definitely use these skills in my career moving forward and really appreciate the guidance and inclusion. So many tips and tricks from Dr. Ochoa that can only come with experience.
The third day was so busy, I didn't have time to post, but luckily Dr. Hsu is the designated social media manager and photographer now, since he has trained the local surgeons so well over the past 8 years. The patient in Dr. Hsu's tweet below was an afternoon case where we performed stage 2 of shortening & angulation for primary closure severe open tibia fracture. Best thing was him tapping me after the picture and saying “tag me”. Dr. Hsu also shared, "Hopefully x-rays tomorrow. Hospital full, so emergency x-rays only."
Long but good day today of organizing equipment and making rounds.@AaronBrandt42 with one of his patients from Monday with @MirnaOchoa13, Guillermo Ramos, and Daniel Vallecillo. Patient went home today. Finished up with a late case and a great dinner with the whole team. pic.twitter.com/BgyP04t10p
— Joseph R. Hsu, MD (@JosephHsuMD) October 24, 2019
We unfortunately had very sweet lady with lengthening over nail from a year ago develop late infection. I was part of providing nail removal, saucerization, debridement, irrigation, reaming, and antibiotic coated locked nail. Dr. Hsu pictures tweeted pictures of pictures and videos showing the whole process. He summed it all up by saying "using grips from pick-ups to file end of nail smooth. Nail insertion smooth. Interlocking was a bit tricky." You can see my blisters in the tweet below. This was more than tricky for me...this was pretty crazy performing such a tough case with instruments that were just a little too small for me.
So, maybe putting interlocking screws through an antibiotic coated with a screwdriver handle (modular) from a mini-fragment set puts some stress on the fingers... @AaronBrandt42
— Joseph R. Hsu, MD (@JosephHsuMD) October 24, 2019
Still another full day of limb reconstruction tomorrow pic.twitter.com/KXonHbycco
Dr. Hsu went to local the local Orthopaedic supplies store to buy enough half pins & wires to last a year. He said Guillermo Ramos is not only a Master Surgeon, he's a shrewd negotiator! Great value for RESTORE, because implants here are 1/10th of the cost in US, plus we are proud to support local.
We treated our last case of the trip, treating an IIIB distal tibia non-union with deformity. The plan: fibula osteotomy, orthogonal rings first mount to match deformity, gradual closed distraction and deformity correction. No bone graft. You can find Dr. Hsu's full "Twittorial" here: Tweet thread.
Final meal last night with team. #notroughingit#RESTORE@MirnaOchoa13 @AaronBrandt42 @G3RSONV
— Joseph R. Hsu, MD (@JosephHsuMD) October 26, 2019
Daniel Vallecillo
Guillermo Ramos pic.twitter.com/nn4CbY6Wk0
Back to the grind but still reflecting from last week. I was lucky enough to be a part of this program started by my attending, Dr. Hsu, to help the local surgeons manage severe/challenging injuries/deformities with limited resources. His goal was not to do the surgeries, but to teach them so they would be able to manage these cases without him. 9 years later, I am lucky enough to learn from the surgeons he trained.
We went down as a team of only two. I was able to scrub and work with these surgeons, in their ORs, with their staff, with their resources, and I learned a whole other side of surgery, as Dr. Hsu just watched. I'm sure there were a lot of proud papa moments for him.
For those who know me, you know how excited I am about things😏. I went into the week feeling guilty about leaving my team and a service I was responsible for, and I was unsure of myself and what to expect. Day 1, that picture changed. Years of schooling and buying time, with this vague goal in my mind of working in undeserved areas. This vague goal of living a life that impacted others, like I saw from my parents and role model, Jackie Robinson, dictated many of my decisions. I saw medicine as my medium, but it’s easy to get caught up in the day to day and lose perspective. No time, no money, no clue. For me, this last week in Honduras was the first time in a long time where I truly felt like I was moving in the direction I had set out to go. That little voice that causes us to doubt was silent...finally!
As I get back into the flow here in Charlotte, I feel so fortunate to be where I’m at. I return to a busy week as Chief Resident , but these experiences help prove to me that the ups and downs, the randomness, and the decisions are setting the stage I had hoped to be on.
Thanks to Dr. Hsu for challenging me to be better, think bigger, and believe in myself, even when I wavered. Finally, thanks Spaugh Dameron Tenny for helping make last week possible!
Spaugh Dameron Tenny's (SDT) scholarship program, GOtoGROW, was established in 2018 to give doctors the opportunity to take their skills to impoverished countries and provide care to local patients. Dr. Brandt is the second orthopedic surgeon in training to be sponsored through Dr. Hsu's selective training program. SDT is thrilled to support Dr. Brandt on his medical mission trip and to be a small part of the impact these surgeons have on the Honduran community.
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Molly was the marketing director at SDT from October 2017 through November 2020. She is passionate about connecting with people, digital marketing, and serving her community.
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