Written by Jodi Grahl

Our 2017 Gyne Surgery Mission Trip Team (Jodi in green scrubs)

Of my 18 previous mission trips with Solidarity Bridge, this trip has proven to be one of the most challenging. Each morning, after a 30-minute ride through rush-hour traffic to reach the hospital, we arrive to something unexpected. The OR is already backed up due to an emergency cesarean; a patient is missing a final clearance; an overnight lab reports worrisome news. And each day, more women arrive, asking if there is space for them in the surgical schedule.

I try my best to solve one issue at a time. I track down the social worker who can corner the internist to get that final missing signature. I drop off a box of bonbons and a six-pack of Cokes for the nurses who work double-time to disinfect the OR and re-sterilize the instruments so we can proceed with the next case. I listen to the women seeking surgery, and I relay their stories to our missioners to see if we can add the cases to one of our quickly dwindling mission days.

And then there are the patients who remind me of my limits.

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Tuesday morning. As I swing though patient room 102 to check the status of Monday’s patients, I freeze in my tracks as I recognize Celia in bed 8. Celia first caught my eye on Sunday as she walked ever so slowly, balancing her swollen belly and seemingly in great pain, into the waiting room of women awaiting evaluation. I wondered why a pregnant woman would be there, as we were not planning to perform any obstetric procedures.

I later learned Celia was not pregnant. The doctors believed she had a tumor in her right ovary. It took some time to get the full story. Celia’s family speaks Quechua. They live in extreme poverty, even compared to the standards we are used to seeing among our Bolivian patients. A doctor from their village, Dr. Lopez, had been trying to help Celia obtain medical care for almost two years. She was scheduled for surgery a year ago to remove the tumor, which was then 15 centimeters across. But Celia was so scared she ran away from home rather than go to the hospital. It had taken a huge effort to get her here now. Unfortunately, the mass is now closer to 20 centimeters.

Our team pored over her labs and images. They gently massaged her abdomen to make their best guesses at what they might find inside. They had little else to go by. After a long debate, in consultation with the visiting oncological gynecologist and critical-care anesthesiologist who had joined forces with our team, we determined that conditions were inadequate to safely operate here at this small hospital with limited resources. With much regret, we explained our recommendation to our Tiquipaya partners. We all agreed that Celia needed surgery, and soon. We offered to do what we could to help get her to a more specialized hospital.

An hour later, we heard that the hospital staff had decided to proceed with Celia’s surgery. Dr. Lopez was convinced that if Celia left the hospital now, she would never again agree to go anywhere else. She would return to her village and the tumor would continue to grow. Her kidney function was already severely compromised by the pressure of the mass. She had little time left. The hospital leadership met and determined that even if the chances of success were small, the only chance of survival for Celia was to remove the tumor, here and now.

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Celia is looking back at me from her bed. Her expression seems to sway between bewilderment, resignation, and fatigue. I take her hand and smile, but I fumble for words, cursing my failure to pick up even a few phrases in Quechua. I give her hand a gentle squeeze—she seems so fragile, I’m almost afraid her fingers will break if I press too hard.

I remember my colleague Lindsay’s word from our morning reflection: accompaniment. I guess that is all I can do. Maybe all any of us can do—accompany Celia, and offer to accompany and support the Tiquipaya surgeons in any way we can.

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It’s now Thursday morning. Three Bolivian surgeons are scrubbing in for the operation. Dr. Carrie Giordano and I adjust Celia’s gown over her shoulders while the anesthesiologist finishes putting her to sleep. Her cheeks are noticeably plumped and pinker today, thanks to two days of IV fluids and an overnight blood transfusion. The anesthesiologist motions for her to relax her shoulders, and I remember the one word I recognized as our social worker counseled another Quechua patient: tranquila. It is, of course, a Spanish word adopted into the local Quechua—tranquila means to be calm. “Tranquila,” I say to Celia, as I cup her shoulders. She exhales and the sharp edge of her shoulder bones soften. Carrie looks around worriedly and whispers in my ear: “It’s really hard to be here and not have any authority.” The Bolivian team has graciously accepted our offer to accompany them, but we are only observers here. A few minutes later they invite Carrie to scrub in—they will need as many hands as they can muster. Carrie happily obliges, and then stands aside until instructed where she will be needed.

Three hours later, they are still in surgery. I’ve set up my computer just outside the OR door, ready to fetch any of the “just-in-case” supplies we kept on hand. They have already asked for most of them—they’ve placed a central venous line, our stocks of clotting agents are depleted, and I notice they’ve emptied a second unit of blood. But the tumor is out, and they begin to stitch Celia up. Our interpreter, Francisco, gives me a thumbs-up through the glass doors. Celia survived the surgery. It turned out not to be a tumor exactly, but rather a massive encapsulated cyst resulting from a long-standing bacterial infection. In the best of outcomes, Celia will be in the hospital for a week or more on antibiotics, under close observation as her organs ease back to their normal function.

For our team, this was a humbling experience. Our role was simply to walk with—and even behind—our Bolivian peers, respecting their decisions and following their lead. We realize that they make difficult choices like these every day. They are quite often forced to choose between doing the best with what they have or doing nothing at all. Their experience working this way has clearly sharpened their instincts, as well as their abilities to improvise and adapt.

We are indebted to them for allowing us to come along, to stand beside them, and to accompany their patients. To be one with them in this terribly imperfect world, where we all have something to contribute, even if it is just our solidarity.

Jodi Grahl is our Director of General Surgery, Gynecologic Surgery, and Pacemaker Programs. She has been on staff at Solidarity Bridge for more than five years and has traveled with more than 18 mission teams.

The Solidarity Bridge Gynecologic Surgery Program aims to help low-income Bolivian women receive needed interventions such as hysterectomies, endometrial ablation, and bladder repair. Through these surgeries, women who may live with discomfort or debility to the degree that it limits their daily activities can enjoy restored quality of life and productive capacities. This, in turn, maintains the welfare of their families and the larger community. The program works in partnership with Bolivian gynecologists, training them in novel techniques and outfitting them with the latest instruments and equipment donated by our corporate and individual supporters.

Practicing Accompaniment through Difficult Circumstances