On a Mission, Part II: ISMS team tackles a full load of surgical cases in Peru

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The badly burned skin of Jose Luis is scrubbed off.

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ISMS OBGYN's discuss their cases

Meet the ISMS Team

Juanita, the 37-year-old mother of little Jose Luis, the 2-year-old burn victim in Pucallpa, Peru, waits quietly in the hallway outside the burn unit of the Regional Hospital of Pucallpa. A missionary—the woman chooses not to give her name, fearing political repercussions if it appears in print, even 3,400 miles away—talks to her quietly, soothingly, in Spanish, with an arm around her shoulder.

Juanita has just spoken with one of the doctors treating her son, who was burned by boiling water over more than 75 percent of his body in a household accident one day earlier. Swaddled from neck to toe in bandages, his breathing aided by a ventilator, Jose Luis lies semi-quarantined in the burn unit; masked nurses come in and out regularly, but so does another little boy with less extensive burns, clad in a hospital gown, peering curiously at the tiny dark-haired boy, who is quietly whimpering.

The doctor, Joseph DeBellis, a Southampton Hospital plastic surgeon, had broken the news to the boy’s mother, with the help of the interpreter: there was not much they could do to heal Jose Luis. All they could do was make him as comfortable as possible, create the best possible conditions for his recovery, and hope for the best. The best the doctor could do when it came to a positive message was, “There are always miracles.”

As the missionary consoles Juanita, the ponytailed woman holds a cluster of tissues in her two hands. She explains, through the interpreter, that she was boiling water on a fire outside the family’s spare dwelling on the outskirts of Pucallpa when the curious little boy grabbed a handle and pulled the pot over, spilling the contents over his shoulders and down his entire body.

Later, Thomas Hough, another missionary who is the key helper in Pucallpa for the medical team sponsored by International Surgical Mission Support, finds out more from Juanita. Asked to describe the little boy, Juanita answers in her native tongue, and Mr. Hough smiles. “She’s used a Peruvian word that is like ‘Dennis the Menace,’” says Mr. Hough, a native of Peru who could pass for a lifelong resident of any American city. Jose Luis is active, always into things, she says. But he also helps his mom wash clothes and wash the plates after meals, even at age 2.

Mr. Hough learns darker things, too. Juanita’s husband, an independent laborer named Francisco, blames his wife for the accident that has put his beloved youngest child in the hospital. He has beaten her, several times, and has pledged that if Jose Luis dies, he will leave Juanita and Jose Luis’s seven siblings.

And so, Mr. Hough notes, Juanita is struggling not only with a mother’s worst nightmare, and with the guilt she feels for failing to protect her child from harm, but also with the devastating possibility of even greater poverty if left without a husband to bring in the family’s meager income. “They become like slaves,” Mr. Hough says of women in this culture.

In the hallway, the female missionary leaves to tend to other business, leaving Juanita with a warm embrace and a mumbled prayer.

*

Dr. Medhat Allam, a general surgeon from Southampton Hospital, is a founder of ISMS, its president, and its clear leader. On the mission trip, he is the one barking orders, herding the team with a sharp “Let’s go!” and keeping the members focused.

The Pucallpa hospital, despite its shabby surroundings, actually has the capability to do laparoscopic surgery. The procedure involves making a series of tiny incisions instead of a single larger one, then using a camera and other tools inserted through the slits to perform surgeries without subjecting the patient to more invasive surgery that can require more recovery time and pose greater risk for complications.

Dr. Allam’s specific goal on this trip is to work with the host doctors to teach them more advanced laparoscopic techniques, and to improve their skills to make the procedures more widely available. At the same time, the procedures are rarely done in Pucallpa, because patients who might benefit from them simply cannot afford them. So ISMS has provided new equipment, including reusable metal sleeves that serve as an entryway to the body; the single-use plastic ones can be prohibitively expensive, one obstacle for local patients.

Throughout the week, Dr. Allam will perform a series of surgeries on bowels, gallbladders and other organs using laparoscopic techniques, with local doctors observing quietly and sometimes assisting. His operating room differs from most of the others in that it is frequently dark: at a key moment, the lights go out, and all eyes are on a monitor, as the patient is illuminated from the inside, and a tiny camera helps guide the blades and forceps. It feels, and is, very high-tech, and the result is almost no blood or viscera; in some cases, the patients can go home that day, with only tiny scars as evidence of an often life-saving procedure.