Our short time in Puno has been slow-paced but interesting.  It is very sunny and clear, a much needed break from the smog and chaos of Lima.  We took a boat ride on the great Lago Titicaca.  Later, we toured some Incan ruins.  We are now heading back to Lima, where we’ll take a midnight flight to Miami…and then  home to Dallas.  This week has been a great experience for us, both professionally and personally.  See you when we get back. 

floating islands of Lake Titicaca

We woke up at3:00AM this morning to catch an early flight out of Lima.  After two planes and a bus ride, we arrived in Puno, on the shore of Lake Titicaca.  The city and lake sit at over 12,000 feet.  We difinitely felt the effects of the altitude after being at sea level on the coast in Lima.  This is a beautiful city with vistas of the Andes and the blue Titicaca.  The people of Peru are very friendly in general, but the locals here are especially engaging.  Most descend from the Aymara tribe, which is slighly different from the Quechuans from Cusco.  The Spanish colonization was less extensive here, allowing the Aymarans to preserve more of their native culture.  The atmosphere is festive with musicians and dancers performing on the streets.

view of the Andes from the plane

                                                               map of Lake Titicaca

    making a friend in Puno

After a long day of surgery, we headed across Lima to Loayza hospital where all of the post-operative patients were kept.  Loayza is the free hospital for the poor.  The patients could not afford to stay at the private hospital where we were operating.  We were surprised to find that the patients were loaded into the ambulances as soon as 20 minutes after the surgery for the harrowing trip through Lima rush hour back to Loayza.  Jeremy and I were anxious to see the skull base tumor patient as well as the two aneurysm cases, all very high acuity patients.

We were happy to find all the patients in good condition.  Julian, the tumor patient, had been weaned from the ventilator and was moving his left side.  The UCI (Spanish for ICU) was staffed effectively by a senior critical care resident.  It is clear to us that the patients here are a resilient bunch.

Jeremy with Mrs. Ochoa, a lumbar fusion from Monday.  With essentially only Tylenol, “I’m having no pain.”

Dr. Jaime Lopez and Dr. Victor Torres, Neurosurgeons on staff at Loayza.

We are tired after a long four days of work.  The experience here is extremely rewarding to us personally.  It is obvious to us how fortunate we are to operate under such ideal conditions in Dallas.  We will certainly be more grateful for what we have when we return.  Undoubtedly, our office and OR staff will be glad to hear this.  We would like to thank all the hospitals in Dallas that donated supplies for our trip.  This is particularly true for Pat Galvan and Mark Loftus at Presbyterian. 

Tomorrow morning, Jeremy and I will be heading south to Lake Titicaca near the border of Bolivia for a day and a half of exploring before our midnight return on Friday.  Stay posted for a few more entries on the blog.

Headlight rigged to microscope for added illumination.

Final thoracic spinal instrumentation construct.

Good news from Peru.  They found our luggage!  It was nice to put on clean clothes today.  The team is tired from the heavy workload and travel.  Another full day of surgery awaits us today.  We are operating at Maison de Sante, a private clinic that has allowed us to use their operating rooms and staff.  Loayza, the hospital for the poor, is just not equipped for this type of surgery.  The patients have been shuttled back and forth by taxi and ambulance across Lima, including fresh post-ops.  We have seen the chief of staff of the private hospital, a cardiologist, as a patient.  This has helped things run smoother for the team. 

                 Local OR Nurses

The Peruvian  surgeons we’re working with have been collecting difficult cases for the last few weeks, anticipating our arrival.  They do not have the expertise or equipment to tackle these surgeries effectively.  It is amazing to see how much good they do with what they have.  A trip like this can certainly make you appreciate how easy we have it at home.

Today, Jeremy and I are clipping another aneurysm.  The microscope they have here is quite primitive, making the case much harder than it needs to be.  Yesterday, we tackled a difficult skull base tumor without the microscope at all.  We’re planning on tweaking the scope today in an attempt to improve the optics.  One of our two excellent battery operated headlights we brought has stopped working.  We’re counting on the second one lasting one more day.  Our second case is a young man with a severe thoracic spine fracture.  He was initially partially paralyzed, but has improved over the last 3 weeks.  He has not been able to afford the cost of the instruments needed for the surgery.  (In the bottom tier of the Peruvian medical system, the hospital and doctors are free, but the patients pay for the meds and equipment.  The expedition has brought all the supplies he’ll need.  Hopefully, he’ll be able to get out bed tomorrow for the first time in almost a month.

These are videos of our Monday surgery day.

Dr. Denning and I took a long, crowded flight to Lima with a tight connection through Miami.  We arrived at 1:00 AM; our luggage and surgical supplies did not.  Our surgical team was met with a warm welcome by the local neurosurgeons.  We examined patients all day today at the two hospitals, Loayza and Maison de Sante.  We tentatively scheduled multiple surgeries for the next several days.  We were fortunate to find a Starbucks, which proved quite helpful.  Check out our video and pics from rounds at Hospital Loayza.

DNS surgeons, Dr. Mike Desaloms and Dr. Jeremy Denning, will be returning to Peru tomorrow, September 11 for a medical mission.  They will be joining Eagle-Condor Humanitarian and Innovasis, Inc. for the one week surgery-focused trip to Lima, Peru.  The expedition will focus on examining and treating impoverished patients who do not have access to state-of –the-art medical care.  The group will bring an abundance of donated medical supplies.

Dr. Desaloms and Dr. Denning will be reporting their experience with a daily Blog found on the Dallas Neurosurgical and Spine website.