In addition to the two Belmont sponsored mission trips to Guatemala this spring by health science students, Belmont pharmacy student Bethany Bedford also traveled to the country this spring with a surgery team from Mending Kids International and Duke University Children’s Hospital on another mission trip for The Shalom Foundation. The doctors saw 174 patients and the team performed 48 surgeries on children from across the country at the Moore Pediatric Surgery Center in Guatemala City. Bethany and other team members blogged about their experience and some of Bethany’s posts about her learning experiences are excerpted below:
April 14, 2012 – Today is a “get acclimated” day, and tomorrow will start the screening process, with Monday being the kick off for the surgeries. Meanwhile, I’ll be in the pharmacy, finding places for things, cleaning things, checking medications/ expiration dates, drinking more amazing coffee, and looking at names I’ve never seen before. . . . .(click link below for more)
While the surgical team is doing the screenings, I’ll be logging the medications they brought with them/had shipped in from the States, so my morning will consist of finding more places in the pharmacy for medication and ensuring that everything we have is up-to-date in terms of inventory. I think I’ll be using Excel more this week than I have the whole of my pharmacy career so far. . . . . .
April 16, 2012 – We had a lot of no-shows for the screenings, but we still ended up staying at the Center until about 6 pm last night. I, of course, was not involved in the screening process (even though I’m pretty sure I could have contributed something…probably just entertainment), but I had plenty to do in the pharmacy, organizing the drugs that the awesome team brought with them and making sure that all the “surgery boxes” were ready to go. . . . . .
I am proudly primarily a community pharmacist, which means I’m completely at home in any Walgreens, Walmart, grocery store, mom-and-pop pharmacy setting that you can imagine…but it means that much of hospital pharmacy is foreign to me. This definitely includes anesthesia and operative medications, so there’s a huge learning curve for me this week. While I certainly recognize the medications and can tell you mechanisms of action and reasons for use, it’s a different ballgame to dilute and draw up these medications – especially when the concentrations are not the same as what is listed on the vial (and you know how pharmacists are – we like to do things exactly as the instructions say)! All this means that I am absolutely blessed to have Brad, Carrie, and Emily as the anesthesia team, since they are all willing to teach me how things are supposed to be. This morning they even showed me how to reconstitute to their normal concentrations and helped me fumble through some new techniques. Needless to say, that meant my morning was incredibly busy – they did 13 procedures today, and expect to do 11 tomorrow. We have the schedule for the rest of the week, as well, but things change on a daily basis as new patients ask to be screened and some are fit into the already busy schedule. The team of doctors, nurses, and scrub techs is phenomenal – they work well together and, though they said they felt slow today, they got all the cases done and we left the center by about 7 pm tonight. . . . .
April 18, 2012 – Today was another busy day – the team did 10 surgeries at the Moore Pediatric Surgery Center, and most of the children from the past two days surgeries have now gone home. After hearing some of the stories of how these children came to get their surgeries, I am so grateful to get to be a small part of this process! From my perspective, the day was incredibly smooth, though I believe the surgery team had a few surprises (all handled with grace and all the kids are doing well, no worries)! Because of the amazing team and their preparation/attention to detail, I was able to get all of the medications except for one batch ready for tomorrow. Putting this in perspective for you…Monday, these batches were literally getting done right before the surgeries started, and the first batches only got done in a timely manner because the awesome anesthesia and nurse practitioner team helped me get them done 
. Yesterday was better, with me being able to send 2-3 batches (one batch per child/surgery) at a time, and finishing up about 2 pm with medicines needed for the day. Today, the first patients were ready to go when we arrived at 7:45, and by 1pm, the batches were being started for the next day!! I’m hoping this translates into “kid time” tomorrow and I’ll get to meet some of the children. Being on the first floor, I get to hear them and see some of them as they roll past me out of surgery and into their rooms (and they are absolutely precious!), but I haven’t interacted with them besides smiles yet. . . . .
On the bus into the surgery center yesterday, I learned about an injectable drug that can be used by mouth, I’ve learned about dosing for drugs not commonly used in children (as well as good substitutes when what we know is not available!), and I had the opportunity to convert capsules into an appropriate solution dose for a child today – when I expressed how excited I was about these things, one of the team members said to me, “it’s good that you’re excited – this is obviously what you’re supposed to be doing!” I love being able to apply the things I’ve been learning about and get exposure to new medications and processes.
April 20, 2012 – I can’t believe the surgery part of the week is over! 48 surgeries later – 48 kids and families lives changed forever. I think the majority of the team is exhausted and ecstatic, if it’s possible to be both of those at once. We’ve all had opportunities to do things outside of our comfort zone, we’ve all learned a lot, and we’re all excited to come back to Guatemala again next year. The last two days have been full of adventures, with surgeries being scheduled and unscheduled, medicines being made and adjusted, and allergies cropping up, calling for substitutes of other drugs. I feel like I’m more prepared for my boards now, that’s for sure!
Much of my morning (after dosing for the surgeries scheduled for the day) was spent preparing discharge medications for the kids. Now, these are kids who have had urological surgeries, things like circumcision and inguinal hernia repair, along with other things I can tell you the names of, but if you asked me to describe them, I’d have to use a lot of hand gestures, and look them up (just like you) on wikipedia. The culture in Guatemala doesn’t lean toward using any kind of narcotic medications for discharge, so, where in America kids would be going home with ibuprofen and lortab prescriptions (at the LEAST), most of these children left with about 10 mg/kg of acetaminophen, scheduled every 6 hours for three days. (and yes, I can write the directions in Spanish now: Dar una tableta por la boca cada 6 horas por fiebre o dolor)!! The team of MKI and Duke staff brought a boatload of liquid acetaminophen for this purpose, so I would draw up one dose as an example, and send the families home with a bottle plus a dose. This actually saved me a lot of time, as previous teams had worked with a slightly more limited supply of acetaminophen and had to draw up however many doses of medication were needed for each patient to send them home. We ran out of any size of oral syringe except for 5 mL by Tuesday, which meant we sent lots of kids home with 3 syringes with which to dose their medications. Another part of my day was spent preparing “now” doses of medications – I would get an order from Marciele, one of the floor nurses, for the dose needed immediately plus 3-4 doses for the rest of the day. Since we had about 10 patients there at a time, I would get staggered orders throughout the day. Some children required a little bit more medication than just the standard acetaminophen order – one child had a way more extensive surgery and required diazepam, toradol, and flavoxate doses frequently during his recovery. He stayed with us most of the week and seems to be well on his way to recovery…and I am now really good at dividing round pills into fourths. I’d usually get a few doses to do RIGHT as the team was ready to leave, but they were all awesome about waiting for me.
April 21, 2012 – Friday was our last day of surgeries, and it ended up being a much shorter day than the preceding ones. I got to go upstairs for the beginning of two procedures, where Emily patiently told me the details of what medications were used for what procedures and why. It was a great “put it all together” moment for me, as I got to see what my contributions in the pharmacy had been doing for the team upstairs. The surgeries were smooth, the recovery of the patients operated on earlier in the week was deemed appropriate, and the party given by MKI and TSF that afternoon boosted all of our spirits. We got to see the kids enjoy their pizza and cupcakes, dance around and visit with each other, and had an opportunity to talk to the families present for the celebration through the translation of the amazing Maria Jose. This day was one of the most important for the pharmacy, as the responsibilities included making sure all kids had their discharge medications (and the right doses), making sure the inventory taken out for use during the week was matching the numbers on the computer, and, especially, making sure that all of my control inventory matched what it was supposed to be . It ended up working out, I have my wish list for the next group (which DEFINITELY includes some compounding syrups…), and everyone went home with the medications they needed – success!!!! It was tough to leave at the end of the day, not knowing the details of how things would work out for me to come back. I absolutely adored being involved at the Moore Pediatric Surgery Center, and feel honored and humbled that I got to be there with the amazing team from Mending Kids and Duke.
The entire blog can be accessed by clicking here.