A Bright New Dawn
Written by Jodi Grahl, General Surgery Program Director
Dr. Magued Khouzam and I met Marian on Sunday morning, a few hours after landing in Cochabamba. We had convened at the Hospital del Norte with the Bolivian surgical team to meet half-a-dozen previously-identified patients for our week of general surgeries at the hospital. Although the mission would also provide gallbladder and hernia surgeries, those convoked for this final evaluation needed the most complex surgeries the team would perform: Nissen procedures to treat hiatal hernias, a sigmoidectomy to treat megacolon, and heller myotomies with fundoplication for patients suffering esophageal achalasia.
At age 20, Marian was our youngest patient. I was immediately struck by her dark brown eyes, scrunched tight with anxiety and barely holding back tears as she told us about her symptoms. Around the time Marian became a teenager, she started to have trouble swallowing food. She eats only tiny bites, washing each mouthful down with water, and still struggles to pass food down her throat. Some six years ago, gastroenterologists diagnosed her with achalasia, the failure of the esophagus to properly contract and relax to move food down to the stomach. They attempted to dilate her esophagus, but the treatments failed.
Our Bolivian partners had already determined Marian was a candidate for a laparoscopic heller myotomy with Dor fundoplication. The surgery involves opening some of the muscle surrounding the esophagus and then wrapping the lower portion with part of the stomach. It is a difficult procedure to perform in the best of cases, but it is considered the best option to relieve symptoms and allow patients a chance at a normal life.
Marian’s father accompanied her, and described the family’s distress. Like his daughter, he also struggled to hold back tears. His pride was clear when he told us that Marian is in college, studying to be a lawyer. He asked how soon she could resume her classes, which are currently online. Dr. Magued assured them that, if all went well, Marian would be in the hospital only a few days and could resume her classes as soon as she returned home.
Marian’s surgery took place Tuesday morning, and went remarkably smoothly, clocking in at just two hours. It required three surgeons to manage all the laparoscopic instruments—US missioner, Dr. Magued Khouzam, and his Bolivian counterparts, Drs. Luis Herrera and Johnny Camacho. Another Bolivian partner, Dr. Alejandra Azogue, provided anesthesia care.
After she woke up, Marian was again overwhelmed with anxiety. The team kept her in the O.R. recovery room for several hours to personally and carefully monitor and continuously reassure her. Dr. Magued and I visited her before leaving the hospital late that evening, and again the next morning. Finally on Thursday, when we peeked in on her before our first surgeries, we found her smiling. She sat up in bed, and pointed out the crackers on her table. Magued asked her what it was like to eat. “The food went right down! It didn’t get stuck on the way!” For as long as she could remember, Marian didn’t know what it was like to swallow a bite of a cracker without suffering.
At our team’s morning reflection, Marcela had presented Magued with a hand-written note from Marian’s father. Now I was the one struggling to hold back tears, as I translated it for Magued:
Cochabamba, 23 March, 2022
Dear Mr. Dr. Magued Khouzam,
We want to express our profound gratitude for having liberated our daughter Marian from illness. It is a new and bright dawn for all of our family, leaving behind the suffering and pain that consumed us, day after day. It is a new dawn with great hope.
For this good and beneficent work, we are very grateful to you, Dr. Magued, and to Solidarity Bridge. We hope that you continue with this work that brings so much good to individuals and families like ours. Thank you, a million thank you’s. May God bless you and all the staff of Puente de Solidaridad/Solidarity Bridge.
Sincerely,
Wilson
“Papa”
It is indeed a bright new dawn here in Cochabamba!