Surgery trip manual - Oct 2011


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Surgery trip manual - Oct 2011

  1. 1. Orthopedic Surgery Mission Trip Team Manual Guatemala City, Guatemala October 1 – 9, 2011 Monroe Carell Jr. Childrens Hospital at Vanderbilt
  2. 2. INTRODUCTIONThe Shalom Foundation“Shalom” is a Hebrew word meaning “peace, health, safety, completeness, wellness, hope” andmore. The Shalom Foundation is a 501(c)(3) non-profit organization dedicated to providingassistance to children and their families living in extreme poverty. Shalom provides services in fourkey areas: medical care, nutrition, education and housing and community development.Through Shalom’ s Education Program thousands of children receive the opportunity for a goodeducation and are prepared to graduate from elementary, middle and high school. OngoingEducational opportunities are also provided to medical and education leaders through cooperativeseminars, hands-on workshops, health clinics and surgical missions. Education is an importantcornerstone of The Shalom Foundation’s programing in Guatemala.Through the Nutrition Program a filling meal and clean water is provided to hundreds each day.Our Nutrition Program continues to grow with the addition of a clean water initiative with supportfrom Rotary and church partners. This program will continue to grow in order to serve thousands ofpeople in Guatemala each year.The Community Development and Housing Program bring safe, clean homes to families living inthe most deplorable conditions. These modest homes include electricity, running water, plumbing,fully functioning windows and doors with secure locks. Community development has includedimprovements to local schools, water systems, clothing and shoes, community events and clinics.With support from private individuals and organizations, The Shalom Foundation has servedchildren and families for more than 14 years.In 2005, The Shalom Foundation and Monroe Carell Jr. Children’s Hospital at Vanderbilt beganworking together to improve the lives of children in Guatemala launching the “Medical Initiative”.The Medical Initiative has transformed the lives of children through surgical care. It has alsochanged the lives of participating doctors, nurses and medical team members, transforming theirlives here. In 2007, The Shalom Foundation began seeking a facility in Guatemala City to remodeland equip as a modern medical facility to better serve the children and to provide a surgery centerfor medical teams year round. With the purchase and renovation of the facility, The MoorePediatric Surgery Center opens in 2011 to serve children and families from across Guatemala.Joint efforts also involve Belmont University, Vanderbilt University, VU Institute for Global Health,Rotary, Living Waters for the World, Children’s Hospital in Denver, Mayo Clinic, various loyalchurch partners as well as numerous other organizations in both countries.
  3. 3. The Moore Pediatric Surgery CenterThe Moore Pediatric Surgery Center serves as a base of operations for medical services andsurgical procedures for children living in acute poverty from across Guatemala. Withoutintervention, these children would otherwise go untreated sometimes as social outcasts, facinglife-long suffering or death. All funds contributed toward the purchase of the properties, equipping and operation of thesurgery center will be tax deductible. With support and guidance from architects, engineeringfirms, doctors, nurses, administrators from hospitals and surgery centers, The Moore Center willfunction as a modern, short-stay facility with all necessary and expected features. Great attentionhas been given to the facility’s design based upon its intended purpose and future use.The 12,000 square foot facility features 3 operating rooms, 3 pre-op beds, 5 first-stage recoverybeds, 21 recovery/overnight stay beds, crib room, nurses’ station, laundry facilities, sterilizationsuite, family waiting areas, elevator, conference room, kitchen, office space. Detailed floor plansdocument the use of all space. The facility is located at 6 calle, 0-55, zone 1, Guatemala City --convenient to many areas of the city. You can visit our website and take a tour,www.TheShalomFoundation.orgThe Moore Pediatric Surgery Center serves as an international “home base” for the Children’sHospital at Vanderbilt and for Children’s Hospitals, Medical Centers, and medical teams fromacross the country supporting Slalom’s Medical Initiative. The facility will be utilized by teams year-round. These teams will work with local Guatemalan medical specialists to provide much-neededsurgical procedures to the poor within a modern facility. By partnering with in-country doctors andnurses for any follow up treatment, the most and best care can be provided to the most children.This unique model can provide on-going services where there are otherwise none available. TheMoore Center provides hope and the opportunity to heal hundreds of children each year.Charitable care services provided through the surgery center will transform hundreds of familieseach year, touching thousands of lives.The total cost including purchase, renovation, and equipment is approximately $1.6 million. Thisfigure reflects the purchase of the property, all related fees and taxes, and numerous significantcontributions of professional services including: design work, construction, remodeling andspecialized installations. Projected costs also reflect in-kind donations of medical equipment, partsand supplies both large and small impacting all areas of the surgery center and every function.Financial support and in-kind contributions arenecessary to sustain on-going operations of thesurgery center. Donations from private individuals,grants, partner institutions, music industry events,annual benefits and funding campaigns will supportThe Moore Center. Recognition is available toorganizations and individuals making significant andgenerous contributions. Donors will beacknowledged at the facility through the Patrons Walland at specific locations throughout the building. Specialists from the United States and Guatemalacontinue to work together to properly equip, operateand sustain the facility. Your participation is greatlyappreciated.
  4. 4. IntroductionGUATEMALALocation:Guatemala is located in Central America. Its bordersare shared by Mexico to the north and west, thePacific Ocean to the south, and to the east Belize,Honduras and El Salvador. Guatemala covers anarea slightly smaller than Missouri at 67,661 squaremiles. It is located in the Central Time Zone.Weather:Guatemala maintains a tropical climate and is calledthe “Land of Eternal Spring.” Average year-roundtemperatures run 75 degrees during the day and50-60 at night. June through October is the rainyseason, while November through May sees the drier,most pleasant conditions.People:Guatemala’s population is 14.2 million, with approx. 5million living in Guatemala City. Fifty percent of the country’s population is under the age of 18.The primary language spoken is Spanish, with up to 40 indigenous languages spoken in theremote and rural areas of the country. Culture: Guatemala’s culture is a unique product of ancient tribal influence and a strong Spanish colonial heritage. About half of Guatemala’s population is mestizo (known in Guatemala as ladino), people of mixed Spanish European and indigenous ancestry. Ladino culture is dominant in urban areas, and is heavily influenced by European and North American trends. But unlike many Latin American countries, Guatemala still has a large indigenous population, the Maya that has retained a distinct identity. Deeply rooted in the rural highlands of Guatemala, many indigenous people speak a Mayan language, follow traditional religious and village customs, and continue a rich tradition in textiles and other crafts. The two cultures have made Guatemala a complex society that is deeply divided between rich and poor. This division has produced much of the tension that has marked Guatemala’s history.Government:Guatemala operates under a democratic constitutional government. President Alvaro Colombegan his presidency January 15, 2008 and will be president for 4 years. The vice president,Rafael Espada, is a well known heart surgeon who practiced medicine in the United States formany years. This is an election year in Guatemala and a challenging time.
  5. 5. Currency: Guatemala’s currency is the quetzal.The exchange is approximately 7.7 to 8 Q =1 US dollar. Most businesses (or vendors in Antigua)we frequent accept US dollars of a VISA, MasterCard of AmEx card. Each member can easilymake a modest exchange of US dollars at the front desk of your hotel (which should be all that youwill need for personal purchases).Background:The Maya civilization flourished in Guatemala and surrounding regions during the first millenniumA.D. After almost three centuries as a Spanish colony, Guatemala won its independence in 1821.Since, it has experienced a variety of military and civilian governments as well as a 36-yearguerrilla war which left the country in human and economic despair. In 1996, the governmentsigned a peace agreement formally ending the conflict, which left more than 100,000 people dead(some estimate 200,000) and created some 1 million refugees.Guatemala City is one of the largest urbanagglomerations in Central America and thecapital of Guatemala. It sprawls across a rangeof ravine-scored mountains, covering an entiremountain plain and tumbling into the surroundingvalleys. The city’s elevation is just less than5,000 feet above sea level.Antigua is among the world’s best preservedcolonial cities. It sits in a highland valleyoverlooked by the spectacular Agua Volcano(3,765 meters high). A little further away are twoother volcanoes Acatenango and Fuego.Tourists visit Antigua every year from around the world to enjoy its incredible natural beauty,historic architecture, and unparalleled local shopping.Electricity:110v the same plug configuration as in the United States. All travel appliances will work in yourhotel rooms.
  6. 6. Population, Health Statistics and Outcomes Guatemala, Central AmericaPopulation: 14,280,596Population below poverty line: 75%Population living in extreme poverty: 16%Under-5 mortality rate (per 1,000 children): 57 / 50 (m/f)Percent of population age 60 and older: 5.3%A significant share, 59%, of Guatemalan residents lack access to any healthcare services.Even when health facilities are present, they are often understaffed and lack medicines andequipment.In terms of diseases, major causes of death in Guatemala still include treatable and communicablediseases such as diarrhea, pneumonia, malnutrition and tuberculosis.Guatemala has among the worst performances in the world in terms of child growth attainment,with an overall stunting rate of 44% of all children under 5. Guatemala ranks fourth in the world forstunting rates.Life expectancy at birth in Guatemala is the lowest in all of Central America and infant mortality isthe highest.Over four-fifths of the women in the poorest quintile give birth at home, where they lack sanitaryconditions for safe delivery.*Statistics taken from the World Health Organization and the CIA World Fact book, CLAS Vanderbilt.
  7. 7. Team InformationSurgical Team Members:Dr. Steven Lovejoy SurgeonDr. Jonathan Schoenecker SurgeonDr. Laura Zeigler AnesthesiologistDr. Jason Daume AnesthesiologistDr. Amy Halliburton Anesthelogy FellowJill Moore CRNADee Vandivier CRNACarmen Bobbitt OR NurseAngela Sparks OR NurseElla Taylor LPNTammy Edmonds LPNLaurie Nielson Scrub TechDebra Klotter Scrub TechAnna Brummel PACU NurseSara Anderson PACU NurseRoni Nylander CRNADr. Chris Karsanac AnesthesiologistThe Shalom Foundation Team Members:Dr. Ken Moore, MD Medical Director-USAllison Bender Executive Director, The Shalom FoundationMaria Jose de Gallardo Director-Guatemala, The Shalom FoundationTommy Sanders Director of Operations, The Shalom FoundationClaudia Hurtarte Missions Coordinator-Guatemala, The Shalom FoundationElisa Arenales Intern-Guatemala, The Shalom FoundationThe Moore Pediatric Surgery Center Team Members:Dr. Sidney Hagen Acting Medical DirectorMiriam Garcia Head NurseRafael Paredes Social workerJose Fernando Rios Business AdministratorJoseline Pinzon Receptionist, CoordinatorMara Morales Book keeper, FacilitatorNurses, Residents, Social Worker, Translators, Volunteers, Housekeepers, Maintenance
  8. 8. Travel Information**A security tax of $3 (or Q20) per person previously required to leave the country at the airporthas now been included in the ticket price.Carry-On Baggage Restrictions:On instruction from the Transportation Security Administration, airlines advise customers that thefollowing items are permitted inside the sterile area through the screening checkpoint: • Liquids, gels and aerosols in small containers (3 oz. /90ml or less) in a clear re-sealable 1 quart/1 liter plastic bag. The bag with its contents must be subjected to inspection separate from carry-on bags. • Medications (including non-prescription medicine) without the requirement that the customer’s name appear on prescription medicine. • Baby formula/milk (to include breast milk), baby food, medications, and liquids/gels that are needed for diabetic or other medical conditions if not contained in a closed/sealed transparent re-sealable 1 quart/1 liter plastic bag and/or if in containers larger than 3 oz. (90ml) each must be declared to the TSA at the security checkpoint for screening.In U.S. domestic airports, liquids (to include beverages), gels and aerosols purchased in the sterilearea of the airport may be taken on board the aircraft. Customers may be subjected to a secondaryscreening if entering the screening checkpoint with liquids, gels and/or aerosols.Baggage Allowance:1 carry-on plus 2 checked bags per person; checked baggage size & weight restrictions: maximum50 lbs and 62 linear inches (total length + width + height) per piece. Each team member is asked toutilize their second checked bag for team or Moore Center supplies. We will discuss neededsupplies and “wish lists” so that everyone will know what to pack and how to utilize their secondbags.For international flights, all bags must be checked a minimum of 60 minutes before departure time.Accommodations:Clarion Suites Hotel14 Street 3-08 Zona 10, Guatemala City P: 011-502-2421-3333 Antigua, GuatemalaPorta Hotel Antigua8 Calle Poniente No. 1, La Antigua, Guatemala, Sacatepéquez P: 011-502-7931-0600
  9. 9. Cellular Phones, Internet Service:Your cell phone may not function in Guatemala City without additional services and arrangementswith your provider. Individual cellular phones require international service to function inGuatemala. There are fees for international calls, email and texting services. These vary bycompany and can be quite expensive even with pre-planning.Two basic cell phones will be provided for Team Leaders by The Shalom Foundation in Guatemalaand provide excellent clarity and communication for simple calls home. Additional minutes areeasily purchased.Internet connectivity is available at hotel and at The Moore Pediatric Surgery Center.Emergency contact info for your family:Maria José de Gallardo, Shalom FoundationCell: 011-502-5318-6372MJGallardo@TheShalomFoundation.orgThe Moore Pediatric Surgery Center, 6 calle, 0-55, zone 1, Guatemala City, Guatemala615-656-3499, US number (local call from Middle Tennessee or domestic long distance)011-502-2220-2020, International long distanceTo call home during the trip:If you wish to call home in the evenings, you may do so from your hotel room. You may use acalling card or credit card. To do so, dial “0” for the hotel operator, then request to be transferred toan AT&T operator. Have your credit card ready and they will connect your call using your creditcard. Prior to departure, make sure your particular credit card will accommodate international call.Three Guatemalan cell phones will be provided to Team Leader.Temperature Forecast:From - estimated average temps: hi of 72 degrees and low of 61 degrees. October isduring the end of the rainy season.Recommended Vaccines: Vaccine Vaccine Information Sheet Hepatitis A Typhoid Hepatitis B Tetanus
  10. 10. Team Roles & ResponsibilitiesTrip/Team Leader• Responsible for overseeing conduct and adherence to safety guidelines and is accountable to the international leadership committee.• Identifies procedures for the surgical mission.• Makes final decision on the number/type of team members and approves medical staff.• Works with clinical coordinator to ensure correct supplies and/or necessary equipment available, packed, and included in the shipping manifest.• Participate in pre-trip planning and post-trip follow up meetings as required.• Works with other surgeons/anesthesiologists to schedule/prioritize cases• Sets daily schedule if changes are considered while in GuatemalaSurgeons (including any residents and fellows)• Help determine surgical procedures and required team members• Work with team and Shalom Foundation to ensure correct supplies, medications, and/or necessary equipment available, packed, and included in the shipping manifest.• Participate in pre-trip planning and post-trip follow up meetings as required.• Screen patients at clinic in Guatemala• Participate in prioritizing and scheduling patients for surgeryAnesthesiologists (including any residents and fellows)• Help determine surgical procedures and required team members• Work with clinical coordinator to ensure correct supplies, medications, and/or necessary equipment available, packed, and included in the shipping manifest.• Participate in pre-trip planning and post-trip follow up meetings as required.• Screen patients at clinic in Guatemala• Participate in prioritizing and scheduling patients for surgery• Set up operating roomsCRNA• Works with clinical coordinator to ensure correct supplies, medications, and/or necessary equipment available, packed, and included in the shipping manifest.• Participate in pre-trip planning and post-trip follow up meetings as required.• Set up operating rooms
  11. 11. Clinical Coordinator / OR Nurse• Participate in pre-trip planning and post-trip follow up meetings as required.• Recruit nursing staff by reviewing applications and determining qualifications• Work with team to ensure correct supplies, medications, and/or necessary equipment available, packed, and included in the shipping manifest.• Supervise packing• Determine team work flowOR Nurse• Participate in pre-trip planning and post-trip follow up meetings as required.• Work with team to ensure correct supplies, medications, and/or necessary equipment available, packed, and included in the shipping manifest.• Participate in packing supplies• Participate in clinic as needed and/or assist in setting up ORsPACU Nurse• Participate in pre-trip planning and post-trip follow up meetings as required.• Work with team to ensure that the PACU has the correct supplies, medications, and/or necessary equipment available, packed, and included in the shipping manifest.• Participate in packing supplies• Participate in clinic as needed and set up PACU
  12. 12. Health & Safety Guidelines • Before you leave, give copies of your passport and any credit cards you plan to use to a family member or trusted friend. Contact your credit card company to alert them that you will be using this card in Guatemala so that your card is not suspended due to potential fraud concerns. This is important for your ease of travel. • Several days prior to departure, begin drinking plenty of water. Guatemala City’s elevation of just less than 5,000 feet is significantly higher than Nashville’s elevation of 746 feet. • In Guatemala, drink only purified water; use only ice made from purified water. • First aid kit will be available (Cipro, Imodium, Tylenol, etc.); see Lori Graves. • Do not eat ANY foods from street vendors. You can get sick. • Eat only fruits that can be peeled. • Take and use hand sanitizer often. • NEVER go anywhere alone; remain with the group AT ALL TIMES. • Clean out your wallet. Take only necessary identification, credit card(s) or cash. It is advisable to purchase a special pouch or belt for the purpose of discretely carrying your valuable items. If you don’t need it, don’t take it. • We suggest you leave all non-necessary valuables at home, including all jewelry. • When possible, always ask permission before you take a picture of someone: “¿Un photo, por favor?” • While traveling in vehicles in-country, always wear your seatbelt. Tips for Communicating through a Translator• Speak to the audience/individual, not the translator.• Speak slowly and clearly.• Speak loud enough for the translator to hear and understand you.• Use short simple sentences. Allow time for the translator to speak.• Be conscious of the time factor. Remember, everything has to be repeated.• Avoid slang. Slang confuses the audience because it does not translate well.
  13. 13. Packing ListsEssentials: • Passport and vaccine card if one was provided for you • Second ID such as driver’s license • Cash (new /$ 20.00) and credit card (only what is necessary – for dinners, incidentals and shopping. Please contact your credit card provider to inform them of your travel to Guatemala or your card could be suspended due to potential fraud worries.) • Travel wallet • Team manual, notebook/journal, pen • Camera, batteries, battery charger and/or disposable camera • Personal prescriptions, medications (pack in carry-on), vitamins and eye drops • Glasses, contact lenses, contact lens cleaner • Hand sanitizer and handi-wipes • Sunscreen • Umbrella and/or rain jacket • Reading materialClothing List: • Scrubs will be provided by The Moore Pediatric Surgery Center each day. You are welcome to bring your own scrubs in addition to those provided at the center if you have a preference for a particular design or fabric choice. • Work shoes (for clinic and surgery days) • Casual pants such as jeans, cotton pants, khakis and/or casual summer skirt(s) • Casual shirts of your preference: T-shirts, button-downs, long-sleeved, polos • Casual shoes for the evenings; comfortable walking shoes for Antigua • Light jacket, sweatshirt, fleece or sweater for cool evenings • Slacks, skirt, jacket for dedication activity Saturday evening • Sleepwear, slippers, flip flops • Work out clothes, running shoes, running socks, iPod • Belt(s), socks, underwearSundries and Miscellaneous: • Shampoo, conditioner, hair gel, hair spray, blow dryer, curling iron, comb/brush • Any special soap in plastic container or shower gel (soap provided by Clarion Suites along with bottled water each day for brushing teeth) • Deodorant • Toothbrush, toothpaste, dental floss, mouthwash • Tweezers, nail clippers and file (pack in checked bag) • Cosmetics, cosmetic bag, compact mirror, makeup remover, cleanser, moisturizer • Razor and shaving cream (pack in check bag) • Quart size zip lock bags for any liquids carried onto plane; one per traveler
  14. 14. Useful Spanish Phrases and WordsPleasantries Introduction / Introducionplease Por favor Whats your name? ¿Cómo se llama?thank you Gracias My name is . . . Me llamo . . .thank you very much Muchas gracias Pleased to meet you. Mucho gusto. Id like you to Querria presentarieyou’re welcome De nada meet . . . a…no problem No hay de que This is . . . La presento a . . .Im sorry Lo siento Where are you from? ¿De dónde es usted? Im from . . . Soy de . . .Hello and Goodbye / Hola y Adios How are you doing? ¿Cómo está usted?Good morning Buenos dias Im (very) well. Estoy (mui) bien.Good afternoon Buenas tardes Im (very) bad. Estoy (mui) mal.Good evening Buenas noches Im so-so. Estoy asi-asi.Hello Hola Miss SeñoritaGoodbye Adiós Mr./Sir SeñorSee you tomorrow Hasta mañana Mrs./Maam SeñoraHave a nice day Que pase buen diaHealth / SaludHow are you feeling? ¿Cómo se siente? doctor el medicoI dont feel well. No me siento bien. nurse el enfermeroI feel well. Me siento bien. height la alturaI feel better. Me siento mejor. weight el pesoI feel worse. Me siento peor. pulse el pulsoIt hurts. Me duele. blood pressure la tension arterialPain El dolor medicine (drug) la medicinaWeak Débil bandage el vendaje La cirugía seThe surgery is finished. termina a pill una píldoraYour child will be well. Su niño será bien. wound la heridaSurgery wassuccessful. La cirugía tuvo éxito scar la cicatrizThe Body / El CuerpoBrain la cerebro heart el corazónNeck el cuello stomach el estómagoShoulder la espalda belly la barrigaArm el brazo hip la caderaHand la mano skin la pielWaist la cintura bone el huesoChest el pecho blood la sangreThigh el muslo skull el craneoKnee la rodilla lung el pulmon WHAT TO EXPECT AT THE MOORE PEDIATRIC SURGERY CENTER
  15. 15. THE MOORE PEDIATRIC SURGERY CENTER STAFFThe Moore Association employs a full time Medical Director, Business Administrator, Chief Nurse,Bookkeeper, Maintenance Supervisor and Social Worker. Part-time staff members for eachsurgical mission trip will include surgeons, nurses, residents, pharmacists, laundry and cleaningstaff, translators and a patient transportation/housing coordinator.A group of fine local surgeons have been assembled to provide the proper pre-screening andappropriate follow up care for each mission team’s patients. Proper and excellent post –care isone of the most important keys to a successful outcome for each child.The Shalom Foundation’s Director for Guatemala also works with our teams providing overallprogram leadership and coordination between US teams and our Guatemalan partners.FACILITIES, EQUIPMENT & SUPPLIESThe Moore Center is equipped and furnished with support from medical partners from across theUS. Visiting team members will feel at home. The more modern equipment will improve efficiencyand effectiveness in the work we are doing.Surgery Center amenities include: • 3 Operating Rooms o Each OR is equipped with:  OR Table  Anesthesia Machine  Central Suction  Central Oxygen, Nitrous Oxide & Medical Air (two locations each OR)  OR lights  Air Conditioning  Back-up Generator  Electro-cautery units (Tour is available on • PACU with 5 beds with air conditioning • Instrument Washing Area • Instrument Sterilization Room with 2 steam sterilizers and one small autoclave. • 20 over-night patient recovery beds including cribs with guest chairs, side tables, wall lamps and over-the-bed tables • Semi-private patient bathrooms with each recovery room
  16. 16. • Nurses’ station • Pharmacy • Elevator for patients transportation from 1st floor into ORs in 2nd floor • Consultation area • Team members’ dressing rooms, showers with hot water • Doctor´s lounge area with AC • Conference Room with Telemedicine Option • WIFI Internet Connection within the Moore Center • Clean water systems for the OR floor and Kitchen • Patient and family waiting room • Patio waiting and play area • Family Cafeteria • Prayer and ministry room • Secured parking for Guatemalan and US team members • Back-up generator • Telephone and internal communication system • Electronic security system, 20 cameras, continuous online visibility • Sewage treatment plant • Soap and hand gel dispensers throughout facility • Resident sleeping quarters with bathroomMPSC will provide: 1. Med Gases (oxygen, nitrous oxide, medical air), central suction 2. Purified water to surgery suites, scrub areas, sterilization room as well as hot water. 3. Electricity including emergency generator with automatic switch after 3 seconds of power loss 4. Laundry service for all towels, linens and drapes 5. Basic surgical instrumentation and supplies to aid in cases as required
  17. 17. 6. Resource for meds, prescription drugs and anesthetic gases to be purchased in country thru MPSC. A list of basic supplies and drugs available through MPSC will be provided for each team during the planning period.7. MPSC will be responsible for all building maintenance and up keep. A Maintenance person will be available for needs regarding the building, furniture, equipment or utilities.8. Onsite bio-med technician during surgical mission to assure function of medical equipment.9. An adequate inventory of basic supplies and medicines according to a published list.
  18. 18. STAFFING FOR MISSIONS TEAMMPSC WILL PROVIDE: 1. Physician who will work with the team, surgeons and specialists in advance of the mission, during the mission to insure surgeons’ orders are followed, medication is given as indicated, charting is completed, family members are informed and patients discharged. MPSC Medical Director will be on call during the night (along with the Guatemalan residents who are on site) to attend any emergency that may occur and will contact the team leader for questions or assistance as needed. 2. Nursing staff to cover post-op and over-night stay patient care through well trained nurses who have been carefully selected 3. In-house Resident(s) on-site, rotating every 24 hours during the week of the surgery mission 4. Medical Director´s guidance, assistance and support at all times prior, during and after any surgical mission 5. Secure and pre-screen patients according to specialty and dates of team with charting and labs in order. Minimum age and weight requirements will be established. Feeding protocols can be recommended for malnourished patients prior to surgery. 6. Contact, screen and secure a specialist surgeon according to the team’s discipline who will be responsible before the Guatemalan Health Ministry for follow-up care for all patients. This surgeon will sign off on the license for US Surgeons and Physicians to practice medicine in Guatemala. 7. Volunteer and paid English/Spanish translators to assist the team at the MPSC stationed throughout the building and during their activities. US TEAM LICENSING, PREPARATION & SUPPORT MPSC WILL: 1. File for the medical license of each and all physicians that come to the MPSC. Nurses and aid staff do not require licenses. 2. Coordinate and secure all permits from the Guatemalan Health Ministry to import medications that the team is bringing into the country. This can only be achieved if the team’s inventory of meds along with other necessary information is receive by TSF / MPSC staff at least 6 weeks in advance of team´s arrival 3. MPSC will utilize a paid, professional customs agent who will facilitate the drug import process along with Health Ministry Letter of Authorization while the team passes through Customs at the Guatemala City Airport. TSF & MPSC will coordinate the team’s payment of the taxes on the importation of meds. 4. Provide Lunch for team members at the surgery center (screening day and days of surgeries).
  19. 19. 5. Ground transportation. TSF will provide ground transportation thru an in-house service or outsourced with insurance. Ground transportation will be provided for the team during the mission and one day of sightseeing activities in Guatemala City or Antigua, Guatemala. a. 14- passenger van (s) from 1 day prior to patient screening “clinic” day and up to 3 days after surgeries are completed. Appropriate vehicles will be provided for team members in excess of one 14-passenger van up to 2 total vehicles. b. Truck (basic pick-up truck) for luggage transportation (arrival and departure). 6. TSF will provide,Two cell phones for team administrator and Lead Surgeon with 50 local minutes included to be used for communication between MPSC staff and team. Additional minutes can be purchased in any retail location safe and convenient to team member access (convenience stores, grocery or drug stores). Cell phones provide excellent communication and can be used to make international calls. (Additional minutes for cell phones are at team’s own expense.) 7. Plan a Celebration Dinner hosted by TSF & MPSC.TSF AND MPSC WILL: 1. Make available to patients, access to clinical lab at a very low cost and at a close distance, but will not be responsible to cover such cost. Each patient is responsible to cover their own pre op, trans-op or post op testing (including but not limited to blood work, clinical laboratory, x-rays, MRI, CAT scan, ultrasound, or any other requested or ordered by physicians of the MPSC). a. The MPSC has subcontracted a clinical lab “on demand” and “on call” to manage samples for testing including processing and reports needed. 2. Manage a patient’s transfer to ICU if necessary. The Medical Director, Surgical Team Leader and Guatemalan surgeon will assess the best option for patient care according to MPSC Procedures. The Moore Association of Guatemala Medical Chairman may also be consulted if necessary. He should be made aware immediately of any potential transfers to ICU. The MPSC Medical Director and/or Medical Chairman will have the power and authority to decide what is best for the patient and will secure parent consent for transfer in the event visiting physicians are not in agreement with the decision on how to handle patient, 3. Provide and coordinate two weeks of post op care and updates on follow-up care of all patients. 4. Provide patient data available for follow-up and updates. An electronic patient data system is being investigated and will be employed as soon as possible .PATIENTS WILL BE PROVIDED WITH: 1. Information regarding upcoming surgery trips through advertising, an online calendar and pro-active communications with health care providers, the medical community and humanitarian aid organizations.
  20. 20. 2. An initial evaluation by a physician along with necessary testing for proper evaluation and care including appropriate pre-op care to bolster overall health. 3. Chart and Patient History. 4. Admission to MPSC on day patient’s surgery is scheduled. 5. A satisfying waiting area. 6. Basic hospital supplies while patient is in surgery center (including meals, fluids for patient only, waiting chair for relative, cafeteria area, waiting area). 7. Post Op Care according to physician’s orders. 8. Guidance and coordination with social worker in advance of surgical visit for housing, transportation and other needs. 9. Guidance and coordination with MPSC personnel for labs, x-rays, tests and other needs. 10. Post Op and follow up appointments with local physicians.OPERATIONAL COSTS:TSF & MPSC has furnished, equipped and staffed The Moore Surgery Center, providing for alloperating costs year-round through fundraising efforts, in kind donations and the generosity ofpartners.Patients will be required to pay a minimal dignity fee according to their socio-economic status asevaluated by a social worker. No patient will be denied treatment for lack of funds. No paymentagreements will be established with patient families, as the fees will be manageable for this poorsocio-economic group.Each Surgical Partner Team is asked to assist with the continuance of this project by raising anddonating to The Shalom Foundation/ MPSC for each visiting mission trip $ 10,000 US.Another simple cost reduction is the efforts of team members getting donations of supplies andequipment from their vendors and bringing them in their checked luggage. This reducesoperational costs of maintaining inventories. The Shalom Foundation can provide tax identificationforms for deductibility should suppliers request it.CONTINUED COLLABORATION IN GUATEMALA & THE USThe Shalom Foundation strives to improve overall health, nutrition and medical care for children,women and families in Guatemala and the US. Through education, training, deployment ofresources and expertise, research, heightened awareness and a strong commitment to service,TSF hopes to achieve these goals via The Moore Pediatric Surgery Center.Medical partners and non-profit organizations with an interest in Guatemala have successfullyreferred patients to TSF. Our intent is to build sustainable relationships across the United Statesand Guatemala to serve children from across all of Guatemala, to increase medical education andresearch opportunities. Partnerships and collaborations with fine medical institutions, universities,
  21. 21. medical schools, service organizations and research entities are essential to the program. Weseek these opportunities with and through our Surgical Partners.We will rely upon our own efforts, those of our Surgical Partners and endowment Patrons to learnmore, to establish and grow an excellent medical program touching thousands of individuals eachyear.THANK YOU FOR YOUR INVESTMENT OF TIME TO PLAN AND GO!! YOUR EFFORTS WILLCHANGE LIVES! AND WATCH OUT, YOURS MAY BE ONE OF THOSE CHANGED!
  22. 22. Orthopedic Surgery Mission - Guatemala October 1-9, 2011 Detailed ItinerarySaturday, Oct 1 4:30 am Meet at Nashville Airport near the American ticket counter 6:00 am Depart BNA on American flight 3506 9:10 am Arrive in MIA 11:50 am Depart MIA on American flight 983 12:25 pm Arrive in GUA Clear Customs; pick up luggage 1:00 pm Maria Jose waiting outside Baggage Claim to pick us up to travel to the hotel and check in 1:45 pm Team checks in to the Clarion Hotel 2:00 pm Lunch at Hotel 3:00 pm Entire team travels to hospital for tour 5:30 pm depart for hotel 7:00 pm DinnerSunday, Oct 2 6:00 am Breakfast in hotel restaurant, second floor 7:00 am Team departs hotel for surgery center 8:30 am Clinic begins at clinic site 12:00 pm Lunch for entire team at clinic site 4:00 pm Surgery team meets to set surgery schedule 5:00 pm Depart clinic and travel to hotel for personal time 7:00 pm DinnerMonday, Oct 3 6:00 am Breakfast in hotel restaurant 6:45 am Team departs hotel and travels to surgery center 7:25 am Arrive at surgery center 8:00 am Surgeries begin 12:00 pm Lunch 5:30 pm Conclude surgeries for the day 6:30 pm Travel to hotel for personal time 7:30 pm DinnerTuesday, Oct 4 6:00 am Breakfast in hotel restaurant 6:45 am Team departs hotel and travels to surgery center 7:25 am Arrive at surgery center 7:45 am Surgeries begin 12:00 pm Lunch 5:30 pm Conclude surgeries for the day 6:30 pm Travel to hotel for personal time 7:30 pm Dinner
  23. 23. Wednesday, Oct 5 6:00 am Breakfast in hotel restaurant 6:45 am Team departs hotel and travels to surgery center 7:25 am Arrive at surgery center 7:45 am Surgeries begin 12:00 pm Lunch 5:30 pm Conclude surgeries for the day 6:30 pm Travel to hotel for personal time 7:30 pm DinnerThursday, Oct 6 6:00 am Breakfast in hotel restaurant 6:45 am Team departs hotel and travels to surgery center 7:25 am Arrive at surgery center 7:45 am Surgeries begin 12:00 pm Lunch 5:30 pm Conclude surgeries for the day 6:30 pm Travel to hotel for personal time 7:30 pm DinnerFriday, Oct 7 7:30 am Breakfast in hotel restaurant 8:00 am Check out of Clarion Hotel (leave luggage in storage at Front Desk) 8:45 am Team departs hotel and travels to surgery center 9:15 am Arrive at surgery center to Round and finish packing 11:00 am Depart for Antigua – Lunch on the way 12:00 pm Arrive Antigua – Check in Hotel Porta – Personal Time 7:00 pm DinnerSaturday, Oct 8 Free time in Antigua. We will be departing from Antigua to travel back to the city at 4pm.You must check out of the hotel by 1 pm. You may leave your luggage in storage at the front deskand continue sight seeing until departure time. 4:00 pm Meet in lobby of Porta Hotel and load van 4:30 pm Depart Antigua for Guatemala City 5:30 pm Check in Clarion Suites. Pick up luggage in storage – personal time 6:30 pm DinnerSunday, Oct 9 6:00 am Depart for airport, breakfast enroute 8:20 am Depart GUA on American flight 2162 12:45 pm Arrive DFW 4:44 pm Depart DFW on American flight 1558 6:40 pm Arrive BNA