WEBVTT

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and welcome to Style Points. Today, our guest

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is going to talk to us about her experience doing

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volunteer anesthesia in environments where resources

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are particularly scarce. Dr. Erica Alcibiade,

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who once told me to pronounce her name using

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the letters L, C, B, A, and D, is an assistant

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professor of anesthesiology and former chief

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resident of our program here at the University

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of Cincinnati. After graduation, she did her

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fellowship in regional anesthesiology and acute

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pain medicine at Johns Hopkins before coming

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back to our group at UC. When she isn't practicing

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aerial yoga, she's planning her next trip to

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some amazing locale where she takes pictures

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of herself eating snacks next to a waterfall.

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Erica, thank you so much for joining us. Absolutely.

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So I've got a question for you, which is pretty

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commonplace at this point. I've asked it to many,

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many people over time. But it's our dinner question.

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So if you could have dinner with anyone in the

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world, could be somebody from the past or even

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from fiction, who are you having over for dinner

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and why? I've always traditionally been really

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bad at answering this question. You know, all

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of my guests say the exact same thing. So I'm

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interested in your bad answer as well. But I

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have two and I can't decide which is the more

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accurate answer. So I'm going to give you both.

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Excellent. The first is my... grandfather on

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my dad's side uh he passed away when my dad was

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a teenager and came over to the us from italy

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so i feel like he would have some really cool

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stories both about you know family and some historical

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stuff uh so i think that would be really cool

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to find out and figure out you know what terrible

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things my dad was doing as a teenager so you

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could use this blackmail against him exactly

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excellent And then my other answer is John Muir,

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because I love doing the national parks and outdoorsy

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stuff. And I think he would have some really

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cool stories about what he saw that used to exist

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prior to everything becoming modernized. That

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makes a lot of sense. And that sort of plays

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into what we're going to talk about today, which

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is essentially you being a world traveler and

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somehow turning that into something that you

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can do at work as well as on your own free time.

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Let's talk about that. How did you get into doing

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what it is you do? So I wish I had a, you know,

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great story, but it's just kind of a culmination

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of everything that I love to do. As you mentioned,

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I love to travel and I always knew I wanted to

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take care of resource limited areas. I went to

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medical school in East Tennessee where there

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is not a whole lot of rural medicine population

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being taken care of. So we used to do clinics

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for them and just combining some of the things

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that I love. International mission trips have

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become something that I am. super passionate

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about. It's one of the reasons that I did a regional

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and acute pain fellowship. I want to be able

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to teach regional in resource -limited areas,

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places where general anesthesia is not necessarily

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safe, that people can have surgeries with much

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less risk. So is regional safer somehow than

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general anesthesia? Let's walk through that.

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Yeah. A lot of the studies that look at resource

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-limited areas in anesthesia show that there's

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just not well -trained anesthesia providers and

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in some areas, not anesthesia providers at all.

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So managing airways and respiratory status is

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one of the leading causes of morbidity in these

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areas. So if you can avoid needing to manipulate

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an airway and knock out someone's arm or leg

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or, you know, whatever it is that they can have

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surgery comfortably without needing general anesthesia,

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it can actually be much safer for them in the

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long run. So that's what inspired you to do your

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fellowship? It did. How was your fellowship geared

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towards that what sorts of techniques things

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did you learn did you gain expertise in that

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made this easier for you? One of the reasons

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I chose to go to Hopkins for fellowship was because

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they have a lot of global connections already.

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And I had asked during my interview process about

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the ability of spending my elective time doing

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mission trips and doing global health work. And

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they were very supportive of it. Although they

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didn't have a program involved for regional at

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the time, they were very supportive in figuring

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out how I could do that. And I was actually able

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to spend two weeks in Ghana. and another week

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in Uganda during fellowship, both on regional

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-based trips, one through ASRA and another through

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another local group that one of the surgeons

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that we worked with was involved in. So I got

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to go and do and teach blocks and be really involved

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in kind of more a regional -focused trip rather

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than a generally anesthesia -focused trip. So

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it was really cool to see all of that. I had

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the privilege of being and attending while you

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were here in training, and I remember you as

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a trainee. And you were always somebody who was

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really steady and good with blocks and good with

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your needlework. So I think it surprised some

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of us when we thought about you doing a regional

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fellowship. But that makes it make a lot more

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sense for me, at least in my mind, why you would

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want to do a regional fellowship. It wasn't necessarily

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that you needed any extra skills with a block

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needle, which, again, you were always great at.

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But more about... gaining a global perspective

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on things yeah yeah and that was a large part

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of you know doing the fellowship learning how

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to kind of teach these things better um to trainees

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that you know have never done a block have never

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even seen an ultrasound in some of these locations

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so let's talk a little bit more about what you

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do as part of your work here in all these different

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countries? Do you have some different buckets

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that you like to put things into? Yeah, every

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trip's a little bit different. You know, there's

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teaching trips, there's doing trips, there's,

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you know, educational things. So here at UC,

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we have two trips that we have gone on multiple

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times, one being started by Mike Howershock.

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with Partners for Medical Relief in Belize. That

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is more of a doing with a slight component of

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teaching trip that we regularly take residents

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on. That is more of a general anesthesia type

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trip. It's mostly with ENT surgeons and general

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surgeons. So it just leads to more general anesthesia

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happening for those type of procedures. And then

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in Uganda, it's kind of a combination of both

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doing and teaching, which is another trip that

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Josh tried. had gotten involved in with one of

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our surgeons, Dr. Zender, with his nonprofit.

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So that's a little bit more doing and teaching

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simultaneously. They tend to bring trainees from

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all over the country to the hospital that we

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happen to be at so that their trainees can learn

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from us. And they have anesthesiologists as well

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as what they call medical officers there, which

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kind of function similar to how we think of like

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CRNAs and AAs here. But a lot of them practice.

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a little more independently just because of lack

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of providers throughout the country. Sure, that

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makes a lot of sense. So let's talk about sort

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of start to finish what one of these trips looks

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like, generally speaking. I'm sure that with

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these longstanding trips, you have a date in

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mind that you're going to go. What does all the

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logistics look like between having the idea and

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actually going and doing? Uh, there's a lot that

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goes into it that, you know, people don't necessarily

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think of or recognize. Um, Mike has got me a

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lot more involved in the planning stages of the

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Belize trip. I'm actually now on the board of

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partners for medical relief and I'm involved

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in a lot of their planning and logistics and

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figuring that out. Um, so, you know, things from

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ordering medications, ordering supplies, what

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do we think we'll need? Who's coming with us?

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How do we get everyone there safely? You know,

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Most of these countries, whenever medical trips

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come in, go through the supplies that you're

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bringing in, make sure they're not expired, make

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sure that there are things that are safe that

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they would use on their patients, which is totally

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appropriate. But it's common questions that I

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get here is, hey, we have all this stuff expiring.

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Can we just give it to you for a mission trip?

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And while I wish we could take it. the answer

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isn't always yes um so it's just little things

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like that how do you have a big enough team how

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do you account for if somebody gets sick making

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sure you have you know a backup plan in that

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scenario if someone can't go last minute if a

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flight gets delayed What medicines do you want

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to have with you? What medicines can you readily

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obtain and take into places? Obviously, we're

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not going to, you know, buy fentanyl off the

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street and take it down to a foreign country

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with us. So that's something we have to rely

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on getting there and knowing, you know, their

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health system can help us as well. So making

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connections within whatever city hospital system,

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even government that you're, you know, going

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through can really help safely get your group

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there, do the work that you need to do. connect

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with the people you want to educate i don't actually

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have any personal experience with buying fentanyl

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off the street and i have never thought about

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the logistics involved with getting controlled

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medicines in a foreign country yeah how do you

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do you send an email how does how does that work

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how do you how do you start to think about obtaining

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something like that yeah um in belize which is

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where i have like the most experience you know

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getting um kind of the medications and the involvement

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in that is we actually use the hospital system,

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uh, that we work through is, um, narcotics. Um,

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so we have what we lovingly call the drug lady,

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uh, and she comes every morning with a locked

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box, um, that has fentanyl and morphine in it,

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as well as, um, usually a couple of pills and

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things that they can like coding, uh, Tylenol

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number threes that they can send patients home

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with, um, if they so desire. Um, and we sign

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it out from them. And at the end of the day,

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she comes back around and takes whatever vials

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are unused and redocuments it in her book and

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puts how many milligrams each patient got and

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who it went to. And they're all the glass ampoules.

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So one of the big things I have to teach trainees

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is not to throw that glass ampoule in the sharps

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bin because she wants it back. She wants proof

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that that is gone. So many times trainees are

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digging. With, you know, long forceps or something

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to get a fentanyl vial out of the sharps container.

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So that's always a learning curve. That sounds

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actually like a more intensive wasting process

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than I maybe would anticipate for that sort of

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environment. In Africa, the experience I've had

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is just one of the other providers gets it and

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we use it. I don't know what waste process we

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go through there. Well, that makes sense. Okay,

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so. What other supplies do you need for a trip

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like this? And how does one obtain those things?

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A lot of it is, you know, things that we think

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of as, you know, disposable, reusable things,

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endotracheal tubes, needles, syringes, oral airways,

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just anything you would think of for it. normal

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anesthetic, even IVs and tubing. And typically

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we don't take fluids with us because they're

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heavy. That's something else we buy from their

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hospital system to use just because it's hard

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to ship fluids. But we'll often take the medicines

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with us and things. There are a couple of places

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within the city that do, I guess, donation -based

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things that people can donate from hospital systems.

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There's Matthew 25 Ministries, and then there's

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a place down in Louisville. I can't remember

00:11:30.659 --> 00:11:33.600
currently, but they get a lot of medical supplies

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and you can send them kind of a wish list or

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go dig through some of their bins yourself. And

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then they are able to you buy it for a very cheap

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price in comparison to what you would buy on

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like the medical market to take with you. So

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are you packing that all into a checked bag?

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How does that work? Checked bags. or duffel bags

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or whatever you know you can get um this last

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trip to belize that i went on um The first week

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where we take down a majority of the supplies,

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the second week they bring some more supplies,

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but a lot of the stuff goes down the first week

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just to make sure we have everything that we

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need. I think we had 75 checked bags that were

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going with us. Whoa. Are you carting these through

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the airport? How does this work? Are you taking

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multiple trips from your car? It's a big group.

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They have people, you know, there's a couple

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houses that do the packing of the supplies, and

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then they tell people, hey, start coming to pick

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up. checked bags. Um, so people will stop by

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all these, you know, different people's houses

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and pick up bags and it's your responsibility

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to get them to the airport and they check you

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in, in one big group and scan them all through.

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And somehow I got involved in that process last

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year. So I was, you know, handing passports back

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to everyone and counting bags and doing all sorts

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of crazy stuff. So it was kind of cool to be

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on that side of things, but it was definitely

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very labor intensive. I would hate to be. behind

00:12:58.149 --> 00:13:01.269
you in line oh yeah at the airport they specifically

00:13:01.269 --> 00:13:04.629
gave us our own um our own uh ticket counter

00:13:04.629 --> 00:13:07.809
and made everyone else go elsewhere wow yeah

00:13:07.809 --> 00:13:10.710
i can imagine that is that some is that a situation

00:13:10.710 --> 00:13:12.850
where they sort of know that you're coming and

00:13:12.850 --> 00:13:15.409
are doing this or is it just you show up and

00:13:15.409 --> 00:13:18.250
they're like oh great Probably a little bit of

00:13:18.250 --> 00:13:22.690
both. I know Mr. Kirby that organizes the tickets

00:13:22.690 --> 00:13:25.529
and that kind of stuff had messaged American

00:13:25.529 --> 00:13:27.889
back and forth about some of the logistics and

00:13:27.889 --> 00:13:31.809
getting some approvals for free bags just since

00:13:31.809 --> 00:13:33.350
it was a mission trip and that kind of stuff.

00:13:33.470 --> 00:13:35.750
So they had maybe an idea, but I doubt the ticket

00:13:35.750 --> 00:13:38.590
counter realized that that was happening until

00:13:38.590 --> 00:13:42.250
we showed up. Okay, so you've packed all of your...

00:13:42.679 --> 00:13:45.200
drugs and equipment you've gotten on the plane

00:13:45.200 --> 00:13:49.159
i assume that you're massively jet lagged um

00:13:49.159 --> 00:13:53.120
you get there then what what happens um well

00:13:53.120 --> 00:13:55.700
kind of depends you know which trip it is the

00:13:55.700 --> 00:13:57.840
belize trip is about a two hour drive from the

00:13:57.840 --> 00:14:00.539
airport to where we're actually going to be working

00:14:02.059 --> 00:14:04.019
The Uganda trip, which is my next most frequent

00:14:04.019 --> 00:14:07.120
trip, is about an hour from the airport. So you

00:14:07.120 --> 00:14:10.039
have to wait for all of those 75 or however many

00:14:10.039 --> 00:14:12.500
bags you're checking to come through the terminals,

00:14:12.620 --> 00:14:14.379
put them all on the thing, load them up into

00:14:14.379 --> 00:14:17.159
vans. You know, 12 passenger vans are typically

00:14:17.159 --> 00:14:20.960
what we travel in. Um, so however many of those

00:14:20.960 --> 00:14:22.899
you need for however many people are going, Belize,

00:14:22.940 --> 00:14:26.379
we often have like six, 12 passenger vans packed

00:14:26.379 --> 00:14:29.460
full of people and bags, um, on the way up to

00:14:29.460 --> 00:14:34.220
Corozal where we typically are based. Um, so

00:14:34.220 --> 00:14:36.259
you, you know, you land, you wait for everyone

00:14:36.259 --> 00:14:39.740
to get their stuff, um, personal bags and all

00:14:39.740 --> 00:14:42.480
the checked equipment bags. Uh, if somebody goes

00:14:42.480 --> 00:14:44.179
and gets the vans, I don't take responsibility

00:14:44.179 --> 00:14:46.200
for driving those. That seems like too much for

00:14:46.200 --> 00:14:48.860
me. That was going to be my next question. Are

00:14:48.860 --> 00:14:52.200
you driving? Someone from the trip is. I have

00:14:52.200 --> 00:14:56.559
yet to volunteer for that role. You do all the

00:14:56.559 --> 00:14:58.419
other stuff. You don't need to drive the van.

00:14:58.600 --> 00:15:00.620
Yen Shay once made me bounce my head off of the

00:15:00.620 --> 00:15:02.240
ceiling when I was sitting on the floor of the

00:15:02.240 --> 00:15:06.100
back of the van. So that was on purpose, but

00:15:06.100 --> 00:15:09.960
you know. Excellent. Well, I imagine when you're

00:15:09.960 --> 00:15:12.820
packed in tight with all those 75 bags, it's

00:15:12.820 --> 00:15:16.029
probably inevitable. Yeah. Flat tire the last

00:15:16.029 --> 00:15:18.250
time we were driving to the hospital in one of

00:15:18.250 --> 00:15:20.909
those vans. So that was fun Okay, so tell me

00:15:20.909 --> 00:15:22.990
the flat tire story though There's you know,

00:15:23.009 --> 00:15:25.769
six van six white vans just following each other

00:15:25.769 --> 00:15:28.070
and all of a sudden we see like some smoking

00:15:28.070 --> 00:15:31.230
coming From the one really go what's going on

00:15:31.230 --> 00:15:33.029
and they pull off and we realize they have a

00:15:33.029 --> 00:15:35.309
flat tire So everyone just kind of you know files

00:15:35.309 --> 00:15:37.070
off to the side of the road since we're traveling

00:15:37.070 --> 00:15:41.330
in a large caravan and I didn't know this, but

00:15:41.330 --> 00:15:43.730
apparently there's spare tires like tacked up

00:15:43.730 --> 00:15:48.129
to the bottom of a lot of these vans. But between,

00:15:48.190 --> 00:15:51.169
I think, four vans, we could only find one tire

00:15:51.169 --> 00:15:53.350
that A, we could get off or B, that wasn't also

00:15:53.350 --> 00:15:59.710
flat and destroyed. So they sent a bunch of us

00:15:59.710 --> 00:16:01.909
on our merry way. They sent another van from

00:16:01.909 --> 00:16:05.309
the rental company up to meet them and they eventually

00:16:05.309 --> 00:16:08.970
made it to the hotel and the hospital. Excellent.

00:16:09.799 --> 00:16:12.639
Okay, so you get there to the area where the

00:16:12.639 --> 00:16:16.000
hotel and the hospital is. What does that...

00:16:16.799 --> 00:16:19.360
hospital operating room look like? How is it

00:16:19.360 --> 00:16:22.139
different from what we have here? So the hospital

00:16:22.139 --> 00:16:25.259
that we go to in Belize is the Corazal Hospital.

00:16:25.799 --> 00:16:29.299
It is in northern Belize and just across the

00:16:29.299 --> 00:16:32.620
Mexico border. The system or the hospital that

00:16:32.620 --> 00:16:35.299
we typically do our surgeries in there does not

00:16:35.299 --> 00:16:37.000
have functional operating rooms unless a team

00:16:37.000 --> 00:16:39.480
is there volunteering. So they are just used

00:16:39.480 --> 00:16:42.620
for volunteer teams. About 45 minutes away is

00:16:42.620 --> 00:16:45.320
a city called Orange Walk where they do their

00:16:45.899 --> 00:16:50.220
um, actual surgeries for that area. Um, which

00:16:50.220 --> 00:16:52.080
I actually personally haven't been to, but some

00:16:52.080 --> 00:16:53.639
of our other colleagues have, have been there.

00:16:53.679 --> 00:16:55.139
They've done surgery there in the past, just

00:16:55.139 --> 00:16:57.759
depending on what's going on. Um, so I've never

00:16:57.759 --> 00:17:00.460
seen those operating rooms, but the ones in cortisol,

00:17:00.799 --> 00:17:05.200
uh, there's two ORs that we use. Um, you know,

00:17:05.220 --> 00:17:08.079
they're big white rooms with whatever equipment

00:17:08.079 --> 00:17:12.140
that people have left behind. Um, our group has

00:17:12.140 --> 00:17:15.700
actually, um, Found I don't remember where they

00:17:15.700 --> 00:17:18.440
came from, but had donated and had anesthesia

00:17:18.440 --> 00:17:21.759
machines donated in the last couple of years.

00:17:22.000 --> 00:17:24.140
So they're actually newer than the ones that

00:17:24.140 --> 00:17:27.400
I started going there with. Mike knew very well

00:17:27.400 --> 00:17:29.900
how to use the I believe he calls them narco

00:17:29.900 --> 00:17:32.660
meds machines that are sitting now in the back

00:17:32.660 --> 00:17:34.880
hallway that we use as a display for the residents

00:17:34.880 --> 00:17:36.960
when they come down to see what anesthesia machines

00:17:36.960 --> 00:17:42.759
used to look like. But now we have. some more

00:17:42.759 --> 00:17:46.079
updated equipment um there's you know a hospital

00:17:46.079 --> 00:17:50.900
bed uh or our bed and each one um that is not

00:17:50.900 --> 00:17:53.700
electronic it does not go up and down most of

00:17:53.700 --> 00:17:55.859
the time it has a foot pedal to raise and lower

00:17:55.859 --> 00:17:59.339
that that might work sometimes uh so you're kind

00:17:59.339 --> 00:18:02.019
of just working with the equipment that is readily

00:18:02.019 --> 00:18:06.019
available when you were using those older machines

00:18:06.019 --> 00:18:09.609
back back a few years ago what were some of the

00:18:09.609 --> 00:18:11.710
biggest differences between those machines and

00:18:11.710 --> 00:18:13.869
maybe the slightly more updated machines we have

00:18:13.869 --> 00:18:16.890
here um definitely the co2 absorbent was different

00:18:16.890 --> 00:18:18.630
it was just one of those ones that you dumped

00:18:18.630 --> 00:18:21.869
pellets in rather than had the exchangeable canisters

00:18:21.869 --> 00:18:24.809
that we now take down with us for you know the

00:18:24.809 --> 00:18:29.029
trips um but it was just a very um saturated

00:18:29.029 --> 00:18:32.009
co2 absorbent so you never really knew exactly

00:18:32.009 --> 00:18:34.390
when your gas was gonna wear off the gas analyzer

00:18:34.390 --> 00:18:38.920
was a little questionable um The machines also

00:18:38.920 --> 00:18:43.200
progressively the screen that showed like the

00:18:43.200 --> 00:18:45.339
title volume and your minute ventilation and

00:18:45.339 --> 00:18:47.380
that kind of stuff throughout the week that I

00:18:47.380 --> 00:18:49.619
was there as a resident when Chris and Mary were

00:18:49.619 --> 00:18:53.000
there also just progressively kept getting blacker

00:18:53.000 --> 00:18:55.619
and blacker up the screen as the week went on.

00:18:55.700 --> 00:18:57.599
So at the end of the trip, you could only see

00:18:57.599 --> 00:18:59.440
where it said the date and time, which wasn't

00:18:59.440 --> 00:19:04.369
accurate anyways. I would imagine that would

00:19:04.369 --> 00:19:06.710
be the least helpful thing to know is the date

00:19:06.710 --> 00:19:09.029
and time when you're trying to anesthetize somebody.

00:19:09.210 --> 00:19:13.490
Yes. So what we're dealing with is doing anesthesia

00:19:13.490 --> 00:19:16.549
in this completely resource -limited environment.

00:19:17.250 --> 00:19:19.829
What else besides the machine being a little

00:19:19.829 --> 00:19:23.369
out of date is different? Yeah. So with Belize,

00:19:23.410 --> 00:19:25.690
we take pretty much everything with us. So we're

00:19:25.690 --> 00:19:27.750
able to tailor it a little bit better to what

00:19:27.750 --> 00:19:30.930
we're more used to here in the U .S. You know,

00:19:30.950 --> 00:19:33.890
we take the meds that we can get with us. Some

00:19:33.890 --> 00:19:35.990
of the things that are harder to get, obviously,

00:19:35.990 --> 00:19:38.730
the controlled substances. For whatever reason,

00:19:38.789 --> 00:19:41.569
it's hard to get phenylephrine ordered, but we

00:19:41.569 --> 00:19:43.789
can usually get ephedrine ordered, which is wild

00:19:43.789 --> 00:19:45.269
to me considering it's a controlled substance

00:19:45.269 --> 00:19:49.400
here in Ohio, but it's not everywhere. Just knowing

00:19:49.400 --> 00:19:51.579
what meds you have, how much of those meds you

00:19:51.579 --> 00:19:54.220
have, because it's a finite resource. However

00:19:54.220 --> 00:19:56.539
much propofol you take with you is how much you

00:19:56.539 --> 00:20:00.819
have available for that week or two weeks, depending

00:20:00.819 --> 00:20:04.720
how long you're going for. Also sizing of things.

00:20:04.880 --> 00:20:07.019
We can take a bunch of endotracheal tubes down,

00:20:07.160 --> 00:20:08.759
but if we end up doing a bunch of peds and only

00:20:08.759 --> 00:20:13.200
have a few peds -sized things, you can't do any

00:20:13.200 --> 00:20:15.759
more peds safely. So just different things to

00:20:15.759 --> 00:20:20.869
plan for. A colleague down there that has a basement,

00:20:21.029 --> 00:20:22.970
which is apparently rare in Belize, but he keeps

00:20:22.970 --> 00:20:25.529
a lot of equipment in his basement for us that

00:20:25.529 --> 00:20:27.410
he brings up in a trailer every time we come

00:20:27.410 --> 00:20:31.029
to visit. So we have a lot of disposable supplies

00:20:31.029 --> 00:20:33.710
kind of tucked away in there so that we know

00:20:33.710 --> 00:20:35.849
we have some endotracheal tubes and things like

00:20:35.849 --> 00:20:38.789
that left there. And we donate a lot of it to

00:20:38.789 --> 00:20:42.329
their local teams as well whenever they ask for

00:20:42.329 --> 00:20:44.349
certain supplies. That way we can always bring

00:20:44.349 --> 00:20:47.559
more the next time. What about monitoring? Are

00:20:47.559 --> 00:20:49.759
your monitors significantly different than we

00:20:49.759 --> 00:20:53.160
use here? I wouldn't say significantly different,

00:20:53.299 --> 00:20:57.579
but intermittently functional might be a correct

00:20:57.579 --> 00:21:02.359
wording. In one of the ORs, we use two different

00:21:02.359 --> 00:21:05.380
monitor screens to get all of the vitals we are

00:21:05.380 --> 00:21:07.819
used to having. I think one of them has the blood

00:21:07.819 --> 00:21:09.900
pressure. One of them has the pulse ox and end

00:21:09.900 --> 00:21:12.980
tidal. And I don't remember which has the EKG

00:21:12.980 --> 00:21:15.599
on it. But we have to use two different monitor

00:21:15.599 --> 00:21:17.920
screens and two different sets of cables to get

00:21:17.920 --> 00:21:20.940
the appropriate vitals that we would normally

00:21:20.940 --> 00:21:24.599
have here during surgery. We also have portable

00:21:24.599 --> 00:21:27.299
monitors out in PACU. There's four PACU beds.

00:21:28.079 --> 00:21:30.599
But it kind of just depends on, you know, as

00:21:30.599 --> 00:21:33.059
a patient is waking up more, sometimes that monitor

00:21:33.059 --> 00:21:34.839
shifts to the patient that's just coming out.

00:21:34.940 --> 00:21:37.000
That's, you know, someone's awake and talking.

00:21:37.529 --> 00:21:39.250
they're probably more fine than the person that's

00:21:39.250 --> 00:21:41.849
still just coming out of general. So you have

00:21:41.849 --> 00:21:44.990
to kind of allocate your resources and prioritize

00:21:44.990 --> 00:21:49.549
your resources as needed. So tell me a story

00:21:49.549 --> 00:21:52.670
or two about some different situations that you've

00:21:52.670 --> 00:21:55.869
been in while you're there that required a different

00:21:55.869 --> 00:21:59.470
plan than you would have maybe done if you had

00:21:59.470 --> 00:22:02.170
more unlimited resources like you have here.

00:22:02.910 --> 00:22:05.750
Yeah, I think there's definitely different scenarios

00:22:05.750 --> 00:22:08.289
where... You just kind of have to be adaptable

00:22:08.289 --> 00:22:11.549
and figure out what their norm is. On my trip

00:22:11.549 --> 00:22:14.589
to Ghana, which I said was more regional focused,

00:22:14.730 --> 00:22:17.109
we spent most of our time in their what they

00:22:17.109 --> 00:22:19.430
call their accident and emergency operating theater,

00:22:19.630 --> 00:22:22.529
which is a lot of ortho trauma and a lot of kind

00:22:22.529 --> 00:22:25.130
of trauma based surgeries that come in through

00:22:25.130 --> 00:22:30.940
their ER. Again, it's relatively unsafe to do

00:22:30.940 --> 00:22:32.940
general anesthesia in a lot of these places.

00:22:33.500 --> 00:22:35.420
So we'll never forget this little eight -year

00:22:35.420 --> 00:22:38.880
-old girl who had broken her arm in a motorcycle

00:22:38.880 --> 00:22:45.140
accident. And she was tearful, but in good spirits.

00:22:45.140 --> 00:22:48.700
And they did a nerve block on her. They did an

00:22:48.700 --> 00:22:52.059
infraclav block on her. No sedation, no warning,

00:22:52.259 --> 00:22:55.529
just. poking her with a needle and she's crying,

00:22:55.650 --> 00:22:57.930
screaming through it. But in the operating room,

00:22:57.990 --> 00:22:59.990
she is wide awake, singing along to the music.

00:23:00.509 --> 00:23:02.809
And, you know, they let her pick the music. And

00:23:02.809 --> 00:23:05.829
in the U .S., an eight year old awake for surgery,

00:23:06.029 --> 00:23:09.069
awake for a nerve block is unthinkable in most

00:23:09.069 --> 00:23:11.829
places. So just kind of seeing that and realizing,

00:23:12.170 --> 00:23:15.869
oh, like this is real different than what I would

00:23:15.869 --> 00:23:18.630
see at a children's hospital at home was one

00:23:18.630 --> 00:23:21.920
of those moments that I was like, oh, OK. I have

00:23:21.920 --> 00:23:24.839
a seven -year -old who I consider to be a reasonably

00:23:24.839 --> 00:23:28.359
tough kid, but would he be okay with getting

00:23:28.359 --> 00:23:32.779
a completely unsedated infraclav? I don't think

00:23:32.779 --> 00:23:35.660
so. Infraclavs are, like, sensitive, too. I mean,

00:23:35.680 --> 00:23:38.140
she was small, but, like, you know, you got to

00:23:38.140 --> 00:23:40.380
go through some muscle to get there. Yeah, that's

00:23:40.380 --> 00:23:44.500
pretty impressive. Absolutely. Another time that

00:23:44.500 --> 00:23:48.220
I had to definitely change my anesthesia plan.

00:23:50.060 --> 00:23:53.539
Derek Florence and I went on a trip to Uganda

00:23:53.539 --> 00:23:57.980
with Chad and his group a couple years ago. And

00:23:57.980 --> 00:24:01.079
we actually decided we were going to stay for

00:24:01.079 --> 00:24:03.720
a safari. So we flew separately from the rest

00:24:03.720 --> 00:24:07.160
of the group. And we happened to get there. We

00:24:07.160 --> 00:24:08.380
were supposed to get there 30 minutes before

00:24:08.380 --> 00:24:10.119
them. So we were like, great, we'll start grabbing

00:24:10.119 --> 00:24:11.980
bags. We'll see you all when you get here. We

00:24:11.980 --> 00:24:13.160
aren't going to be the reason for the delay.

00:24:14.140 --> 00:24:16.759
I start getting texts as we land from Katrina,

00:24:16.940 --> 00:24:22.190
who says, hey. we've been delayed in rwanda it'll

00:24:22.190 --> 00:24:24.289
be another hour before we get there okay fair

00:24:24.289 --> 00:24:26.990
all right fine keep getting texts from katrina

00:24:26.990 --> 00:24:28.890
hey we're getting more and more delayed hey we're

00:24:28.890 --> 00:24:32.210
getting more and more delayed okay she's finally

00:24:32.210 --> 00:24:33.730
like why don't you go find jeff which is the

00:24:33.730 --> 00:24:35.650
local surgeon she was like you've been there

00:24:35.650 --> 00:24:38.170
you know him you've met him he will get you guys

00:24:38.170 --> 00:24:39.509
out of there you guys don't have to wait for

00:24:39.509 --> 00:24:44.819
us our flight's gonna get cancelled um so They

00:24:44.819 --> 00:24:48.279
had given Derek and I equipment bags of just

00:24:48.279 --> 00:24:49.960
like gauze and some things that they were like,

00:24:49.980 --> 00:24:51.500
well, you guys are more likely to get delayed

00:24:51.500 --> 00:24:54.299
than us. So you take the, you know, the lighter,

00:24:54.380 --> 00:24:57.720
less necessary equipment to have. We'll keep

00:24:57.720 --> 00:25:00.220
the surgical equipment, the airway equipment,

00:25:00.339 --> 00:25:04.299
that kind of stuff with us. And, you know, we'll

00:25:04.299 --> 00:25:06.359
get you there. So we had our bags of gauze and

00:25:06.359 --> 00:25:08.640
who knows what else that we didn't really, you

00:25:08.640 --> 00:25:11.359
know, necessarily need for anesthesia purposes.

00:25:13.620 --> 00:25:15.900
It's midnight and Jeff gets us to the house that

00:25:15.900 --> 00:25:17.940
we're staying at. And he says, you guys just

00:25:17.940 --> 00:25:19.160
want to come to the hospital with me tomorrow?

00:25:19.339 --> 00:25:23.279
Like, you know, everyone else is stuck. We're

00:25:23.279 --> 00:25:24.519
like, yeah, sure. That's what we're here to do.

00:25:24.640 --> 00:25:26.000
He's like, great. I'll pick you up at eight.

00:25:26.519 --> 00:25:28.619
Picks us up the next morning. He's like, I'm

00:25:28.619 --> 00:25:30.299
just going to do a couple little surgeries. Do

00:25:30.299 --> 00:25:32.609
you guys want to help out? Like, yeah, absolutely.

00:25:32.809 --> 00:25:36.029
Like, why not? The local team who I had worked

00:25:36.029 --> 00:25:38.390
with there before, Barbara, has become a good

00:25:38.390 --> 00:25:40.670
friend to me. She's one of their medical officers.

00:25:40.750 --> 00:25:43.190
She was there with some some of her trainees.

00:25:44.710 --> 00:25:46.809
Jeff says, I'm just going to do a quick biopsy

00:25:46.809 --> 00:25:49.769
of this guy's, you know, oral tumor, figure out

00:25:49.769 --> 00:25:54.809
what it is. And, you know, it'll be a quick case.

00:25:55.589 --> 00:25:58.670
You say, OK. Whenever I'm hearing these stories.

00:25:59.240 --> 00:26:01.079
They always start with, oh, it's just going to

00:26:01.079 --> 00:26:03.019
be a quick case. How many times have we heard

00:26:03.019 --> 00:26:06.359
that anywhere? Many. Many. Our surgeons say that,

00:26:06.359 --> 00:26:09.000
too. Surgeons don't necessarily understand quick

00:26:09.000 --> 00:26:11.980
case. I was just in a 15 -minute case that lasted

00:26:11.980 --> 00:26:14.039
about an hour and a half yesterday. Right. I

00:26:14.039 --> 00:26:16.920
understand. Right. And most of the cases we do

00:26:16.920 --> 00:26:19.140
in Uganda are big flap cases. My longest case

00:26:19.140 --> 00:26:21.619
there has been 15 and a half hours. Oh, my gosh.

00:26:21.720 --> 00:26:24.460
Quite lengthy. Definitely life changing. Wow.

00:26:24.660 --> 00:26:27.200
But Jeff says this will be a quick case. He saves

00:26:27.200 --> 00:26:29.920
generally his big giant cases for when his colleagues

00:26:29.920 --> 00:26:31.779
are there that can help him out and have multiple

00:26:31.779 --> 00:26:36.500
surgeons in the case. Sure. And so we induce

00:26:36.500 --> 00:26:40.599
this guy has a normal external airway exam, I

00:26:40.599 --> 00:26:42.339
should say, as well. Can't see anything of what

00:26:42.339 --> 00:26:44.119
we're biopsying. So I'm like, OK, it's probably

00:26:44.119 --> 00:26:49.119
something small. We induce this guy goes to sleep.

00:26:49.140 --> 00:26:52.839
He's maskable. it's fine their team uh takes

00:26:52.839 --> 00:26:55.579
a look uh under do because that's all they have

00:26:55.579 --> 00:26:57.880
available and they're not able to get a view

00:26:57.880 --> 00:27:00.779
i notice they start suctioning some blood out

00:27:00.779 --> 00:27:03.700
of the airway that's a little weird but okay

00:27:03.700 --> 00:27:08.299
um so they look again can't get a view uh so

00:27:08.299 --> 00:27:09.980
either derek or i don't remember which one of

00:27:09.980 --> 00:27:12.599
us first took a look and was like there's also

00:27:12.599 --> 00:27:14.640
nothing here now there's 400 of blood in the

00:27:14.640 --> 00:27:17.400
the canister oh my gosh just from the airway

00:27:17.400 --> 00:27:19.990
just from the airway which we have not secured

00:27:19.990 --> 00:27:26.029
at this point. Luckily, Snow Maskable, their

00:27:26.029 --> 00:27:29.190
team goes to push a second dose of sucks because

00:27:29.190 --> 00:27:32.470
it has been roughly 10 minutes that we are working

00:27:32.470 --> 00:27:34.730
on this airway at this point. And I had to stop

00:27:34.730 --> 00:27:37.170
them from A, redosing sucks, and B, I was like,

00:27:37.210 --> 00:27:40.130
if we can't get this guy's airway, we can't give

00:27:40.130 --> 00:27:42.089
him more paralytic. Maybe we need him to start

00:27:42.089 --> 00:27:44.930
breathing again. We need him to wake up or, you

00:27:44.930 --> 00:27:48.079
know. We have to get his airway. So I looked

00:27:48.079 --> 00:27:49.880
at Jeff, the surgeon, and I said, I need you

00:27:49.880 --> 00:27:53.180
to take this man right now. And he's like, what?

00:27:53.240 --> 00:27:54.700
And I was like, seriously, I need you to take

00:27:54.700 --> 00:27:58.539
this man right now. And they open up trach supplies

00:27:58.539 --> 00:28:03.359
and we masked this man through a trach. Wow.

00:28:03.660 --> 00:28:07.700
And after. His trach was in and Jeff was actually

00:28:07.700 --> 00:28:10.700
able to take a look at his his equipment. This

00:28:10.700 --> 00:28:15.509
man had a giant molecular tumor. which was the

00:28:15.509 --> 00:28:17.130
reason we couldn't get a view and he had a lot

00:28:17.130 --> 00:28:19.210
of bleeding. But it was a moment that I was like,

00:28:19.269 --> 00:28:23.190
holy crap, like what would have happened if I

00:28:23.190 --> 00:28:25.430
wasn't here to say that? And I'm hopeful that

00:28:25.430 --> 00:28:27.269
things would have gone differently, but I'm not

00:28:27.269 --> 00:28:30.289
100 % sure they were. The volykia, of course,

00:28:30.309 --> 00:28:33.089
being the area right where you want to put the

00:28:33.089 --> 00:28:36.250
tip of your blade when you're trying to intubate.

00:28:36.390 --> 00:28:38.450
Yeah, yeah, which makes sense as to why he had

00:28:38.450 --> 00:28:43.369
a normal external airway exam. That is scary.

00:28:43.920 --> 00:28:47.400
So it sounds to me like this was a situation

00:28:47.400 --> 00:28:50.880
where you made a pretty rapid call that saved

00:28:50.880 --> 00:28:55.119
somebody's life. I'm hopeful, yes. And, of course,

00:28:55.240 --> 00:28:57.259
we brought a McGrath and a Glidescope with us,

00:28:57.279 --> 00:28:59.259
but it was stuck in Rwanda with the rest of the

00:28:59.259 --> 00:29:01.420
team. And the other bag, of course. Excellent.

00:29:02.660 --> 00:29:05.519
So what is it like collaborating with these people

00:29:05.519 --> 00:29:09.019
like Jeff who work there and are used to that

00:29:09.019 --> 00:29:12.650
sort of environment? What's the difference? between

00:29:12.650 --> 00:29:15.809
your experiences everyone is typically very laid

00:29:15.809 --> 00:29:18.410
back in all scenarios like even in that scenario

00:29:18.410 --> 00:29:22.269
he did not seem like anything was emergent like

00:29:22.269 --> 00:29:24.930
he worked quickly but you know it's just like

00:29:24.930 --> 00:29:27.369
everyone is calm at all times i think they deal

00:29:27.369 --> 00:29:29.230
with a lot of these emergencies more frequently

00:29:29.230 --> 00:29:32.309
than maybe we do and can handle it appropriately

00:29:32.309 --> 00:29:35.349
the funny thing is the last time i had been in

00:29:35.349 --> 00:29:38.829
that same operating room in uganda with the same

00:29:38.829 --> 00:29:42.630
team We left as they were doing an emergency

00:29:42.630 --> 00:29:46.450
awake trach on that same bed. Oh, wow. The patient

00:29:46.450 --> 00:29:48.609
was wide awake because it was an awake trach

00:29:48.609 --> 00:29:51.130
respiratory distress and they anticipated difficulty.

00:29:51.609 --> 00:29:56.210
But the very next time I was back, it was a masked

00:29:56.210 --> 00:29:59.670
trach, emergency trach on that same bed. So kind

00:29:59.670 --> 00:30:01.509
of seeing the flip side of the two scenarios

00:30:01.509 --> 00:30:07.410
was kind of wild. So they're very good at handling

00:30:07.410 --> 00:30:09.750
those sorts of emergency scenarios, at least

00:30:09.750 --> 00:30:11.930
from the psychological perspective, you'd say.

00:30:12.029 --> 00:30:14.990
I think so. Yeah. What are some differences where

00:30:14.990 --> 00:30:17.490
you notice that maybe our team has a little bit

00:30:17.490 --> 00:30:21.329
more expertise in? I think knowing when something

00:30:21.329 --> 00:30:24.680
is going to go wrong, that anticipation of. you

00:30:24.680 --> 00:30:27.180
know, this could be bad, um, where they were

00:30:27.180 --> 00:30:29.700
going to try again and again to DL when it was

00:30:29.700 --> 00:30:31.480
clear to me that we weren't getting any sort

00:30:31.480 --> 00:30:32.920
of view and we're just getting more blood. And

00:30:32.920 --> 00:30:34.319
eventually probably we're not going to be able

00:30:34.319 --> 00:30:36.700
to mask this man, um, that either we were going

00:30:36.700 --> 00:30:38.240
to have to wake him up or do a trach. And those

00:30:38.240 --> 00:30:41.920
were going to be our two options. Um, so I just

00:30:41.920 --> 00:30:44.039
think anticipating those definitely our airway

00:30:44.039 --> 00:30:47.039
skills are more advanced. Obviously we also have

00:30:47.039 --> 00:30:49.900
more advanced equipment. Here in the U .S., we

00:30:49.900 --> 00:30:52.799
at UC here have McGraths and, you know, every

00:30:52.799 --> 00:30:56.680
OR. So sometimes that's people's default. But

00:30:56.680 --> 00:30:59.640
they don't have, you know, any of those video

00:30:59.640 --> 00:31:01.599
equipments that could potentially save them in

00:31:01.599 --> 00:31:04.839
scenarios such as that. So you are obviously,

00:31:05.039 --> 00:31:07.779
to me, an excellent teacher. The residents always

00:31:07.779 --> 00:31:09.619
really enjoy working with you, learning from

00:31:09.619 --> 00:31:12.059
you, all these different things. What kind of

00:31:12.059 --> 00:31:15.119
situations do you get to use your teaching skills

00:31:15.119 --> 00:31:18.119
over there? Are you passing on some of the knowledge

00:31:18.119 --> 00:31:20.200
that you have to some of the providers that are

00:31:20.200 --> 00:31:23.380
over there? Yeah, absolutely. Like I said, in

00:31:23.380 --> 00:31:26.339
Belize, it's more of a doing trip, but we regularly

00:31:26.339 --> 00:31:29.839
take SRNAs and residents with us on those trips.

00:31:30.220 --> 00:31:32.279
So they get to see kind of a different environment,

00:31:32.400 --> 00:31:36.140
different thought processes. We do a pre -op

00:31:36.140 --> 00:31:39.480
clinic day where, you know. You're screening

00:31:39.480 --> 00:31:41.980
these patients, but you don't have lab results

00:31:41.980 --> 00:31:44.599
or echoes or any sort of testing. It's how functional

00:31:44.599 --> 00:31:47.839
can you be? What do you do for work? Do you get

00:31:47.839 --> 00:31:49.400
chest pain with those kind of things? And you

00:31:49.400 --> 00:31:51.599
have to make judgment calls based off of that.

00:31:52.119 --> 00:31:54.000
So it's a different environment for the residents

00:31:54.000 --> 00:31:57.160
and SRNAs that we take with us to learn. So we

00:31:57.160 --> 00:31:59.039
don't just get to send them for their cardiology

00:31:59.039 --> 00:32:01.559
consult. Unfortunately, no. Get a full million

00:32:01.559 --> 00:32:05.000
-dollar workout. Unfortunately, no. But it tends

00:32:05.000 --> 00:32:10.849
to work out just fine. And then in Africa, there's

00:32:10.849 --> 00:32:13.109
a lot of teaching opportunity. They bring trainees

00:32:13.109 --> 00:32:15.109
to the hospitals where they have groups coming

00:32:15.109 --> 00:32:16.869
in, knowing that they're going to have that opportunity

00:32:16.869 --> 00:32:21.410
for educational learning. And a lot of my teaching,

00:32:21.430 --> 00:32:23.569
I like to do just about whatever scenario we're

00:32:23.569 --> 00:32:25.450
in, because I think it's the easiest to learn.

00:32:26.039 --> 00:32:28.299
in that modality, if you can relate it to something

00:32:28.299 --> 00:32:31.599
that you're doing. But we've talked about doing

00:32:31.599 --> 00:32:34.539
more formal education programs with the Uganda

00:32:34.539 --> 00:32:36.480
curriculum as we get there and topics that they

00:32:36.480 --> 00:32:40.319
are interested in with blocks for me and Josh

00:32:40.319 --> 00:32:42.079
that frequently goes is critical care trained.

00:32:42.180 --> 00:32:48.160
So he has a lot to teach as well. And in Ghana,

00:32:48.420 --> 00:32:50.680
which I'm hopeful to go back to at some point

00:32:50.680 --> 00:32:52.319
as well with the ASRA trip, I've been talking

00:32:52.319 --> 00:32:56.289
to one of the coordinators there. They're very

00:32:56.289 --> 00:32:59.630
interested in learning regional pain and even

00:32:59.630 --> 00:33:02.269
chronic pain things. They actually have somebody

00:33:02.269 --> 00:33:05.490
that's doing a fellowship in just pain, which

00:33:05.490 --> 00:33:07.529
is acute and chronic there to learn all the procedural

00:33:07.529 --> 00:33:10.769
stuff. And she wants to she's been teaching everyone

00:33:10.769 --> 00:33:12.509
things that she learns from everybody else. So

00:33:12.509 --> 00:33:14.509
it's really cool to see that kind of do one,

00:33:14.549 --> 00:33:18.130
see one, teach one method throughout the process.

00:33:18.349 --> 00:33:22.289
They even have a program through the World Society

00:33:22.289 --> 00:33:25.140
of. Federation of Anesthesia, I think WSFA, I

00:33:25.140 --> 00:33:27.740
think that's the correct acronym, where they

00:33:27.740 --> 00:33:29.940
send trainees from other countries in Africa

00:33:29.940 --> 00:33:33.480
to this hospital in Ghana to learn regional because

00:33:33.480 --> 00:33:37.599
they have so much exposure through ASRA. ASRA

00:33:37.599 --> 00:33:39.819
being? The American Society of Regional Anesthesia.

00:33:40.140 --> 00:33:42.700
Thank you. Just for my audience who may not be

00:33:42.700 --> 00:33:46.319
as aware of the acronym as you and I have gotten

00:33:46.319 --> 00:33:49.299
more accustomed to. What about ultrasound availability?

00:33:49.640 --> 00:33:52.559
Is that something that you have access to that

00:33:52.559 --> 00:33:54.980
they have access to there? Are you bringing something

00:33:54.980 --> 00:33:57.700
handheld? How does that all work? It really depends

00:33:57.700 --> 00:34:01.539
where you're at. The hospital in Ghana that regularly

00:34:01.539 --> 00:34:04.160
does their own regional procedures and is building

00:34:04.160 --> 00:34:06.079
this fellowship and has people come train, they

00:34:06.079 --> 00:34:10.940
do have an ultrasound. It is one of the, I think

00:34:10.940 --> 00:34:14.139
it's a sonocyte. either m turbo or m max which

00:34:14.139 --> 00:34:16.059
doesn't mean a lot to a lot of people but it's

00:34:16.059 --> 00:34:17.500
one of those ones that like flips open like a

00:34:17.500 --> 00:34:20.280
laptop and is kind of old school for a lot of

00:34:20.280 --> 00:34:22.780
places here um but they have one of those readily

00:34:22.780 --> 00:34:26.099
available um that is the only hospital that i've

00:34:26.099 --> 00:34:28.340
ever been to internationally that has their own

00:34:28.340 --> 00:34:32.780
ultrasound wow The hospital I went to in Uganda

00:34:32.780 --> 00:34:35.280
for my regional trip had told us they were regularly

00:34:35.280 --> 00:34:37.099
using ultrasound and regularly doing blocks.

00:34:37.980 --> 00:34:40.539
So I thought, great, we'll be able to build on

00:34:40.539 --> 00:34:42.900
that. Turns out they were regularly doing blocks

00:34:42.900 --> 00:34:44.820
but had never seen an ultrasound before. So they

00:34:44.820 --> 00:34:47.869
were doing landmark -based. anatomical blocks,

00:34:48.110 --> 00:34:52.050
but had never seen an ultrasound before. So luckily,

00:34:52.230 --> 00:34:54.070
Research International, the group that I had

00:34:54.070 --> 00:34:55.730
went through, had sent an ultrasound with us

00:34:55.730 --> 00:34:58.889
just in case, which was actually the same ultrasound

00:34:58.889 --> 00:35:01.650
that I found in Ghana, which I thought was kind

00:35:01.650 --> 00:35:05.230
of coincidental. But we had to teach them how

00:35:05.230 --> 00:35:07.969
to use an ultrasound and how to find a needle

00:35:07.969 --> 00:35:10.559
and all of that kind of stuff. So I went. had

00:35:10.559 --> 00:35:12.360
a colleague go down to the market and bought

00:35:12.360 --> 00:35:15.340
chicken breast. And we started playing with needles

00:35:15.340 --> 00:35:18.059
and ultrasound on the chicken breast before we

00:35:18.059 --> 00:35:21.119
started poking on patients. Yeah, it's definitely

00:35:21.119 --> 00:35:24.260
good to block a chicken breast before you start

00:35:24.260 --> 00:35:30.539
on the patients themselves. Yes. Yeah. So when

00:35:30.539 --> 00:35:33.480
you left, though, the ultrasound probably also

00:35:33.480 --> 00:35:36.400
went away too, right? Unfortunately, yeah. How

00:35:36.400 --> 00:35:39.380
do you make sure when you're doing all this teaching

00:35:39.380 --> 00:35:43.579
and telling people how to do the latest and greatest

00:35:43.579 --> 00:35:45.280
thing, how do you make sure that your efforts

00:35:45.280 --> 00:35:48.980
are having a lasting impact? Yeah, a lot of that

00:35:48.980 --> 00:35:51.260
is figuring out what equipment they have available

00:35:51.260 --> 00:35:53.840
and how to use the equipment they readily have

00:35:53.840 --> 00:35:58.579
access to. Obviously, donations are great, but

00:35:58.579 --> 00:36:00.679
they're not necessarily sustainable unless it's

00:36:00.679 --> 00:36:06.230
a continuous donation pipeline. From a just resources

00:36:06.230 --> 00:36:10.010
standpoint, talking to Obi, the fellow in Ghana,

00:36:10.389 --> 00:36:13.050
they didn't have block needles there. She was

00:36:13.050 --> 00:36:15.250
like, yeah, sometimes we get them when, you know,

00:36:15.250 --> 00:36:16.630
people come through and do this kind of stuff,

00:36:16.730 --> 00:36:18.630
but it's not something we can easily and affordably

00:36:18.630 --> 00:36:21.829
get. So I asked her, you know, what they typically

00:36:21.829 --> 00:36:26.309
use for doing their blocks. And the answer was

00:36:26.309 --> 00:36:30.130
an IV needle, an 18 gauge for adults and 20 gauge

00:36:30.130 --> 00:36:35.159
for children. Wow. Because that's what they readily

00:36:35.159 --> 00:36:39.059
and cheaply have access to, where you and I would

00:36:39.059 --> 00:36:40.880
never think of doing a block with an IV needle.

00:36:41.679 --> 00:36:45.019
Not only because that's a larger size than we're

00:36:45.019 --> 00:36:47.539
used to using. It's not a blunt tip needle, you

00:36:47.539 --> 00:36:50.000
know, just different things that from a safety

00:36:50.000 --> 00:36:52.420
perspective. But that is their norm and that's

00:36:52.420 --> 00:36:53.800
what they train with because that's what they

00:36:53.800 --> 00:36:57.480
can reliably get and use. Right. You worry about

00:36:57.480 --> 00:36:59.639
things like cutting through nerves and all that

00:36:59.639 --> 00:37:01.840
sort of stuff. You'd have to be a lot more careful.

00:37:02.000 --> 00:37:05.820
Right. So just I was like, oh, I've never thought

00:37:05.820 --> 00:37:08.679
of doing that. But that's, you know, their norm.

00:37:09.820 --> 00:37:12.539
So just kind of adapting to teach with the equipment

00:37:12.539 --> 00:37:17.199
they can readily and easily use is one of the

00:37:17.199 --> 00:37:20.079
things that can be helpful. And then figuring

00:37:20.079 --> 00:37:21.539
out, especially if you're going to go back to

00:37:21.539 --> 00:37:23.539
somewhere regularly, you can figure out what

00:37:23.539 --> 00:37:28.980
they need in. Uganda, one of the local anesthesiologists

00:37:28.980 --> 00:37:31.539
has her own like pocket butterfly that she will

00:37:31.539 --> 00:37:34.900
use for blocks, but that's her personal equipment.

00:37:35.199 --> 00:37:37.559
Sure. So it just kind of depends. Some people

00:37:37.559 --> 00:37:39.239
are willing to, you know, spend some of their,

00:37:39.320 --> 00:37:41.960
you know, hard earned money for these things

00:37:41.960 --> 00:37:44.760
and other places are not. So it just kind of.

00:37:45.210 --> 00:37:47.210
kind of depends you know either building a fund

00:37:47.210 --> 00:37:49.250
to donate money to get them the equipment that

00:37:49.250 --> 00:37:51.889
they need um or bringing things that you can

00:37:51.889 --> 00:37:54.809
leave behind i know um josh has actually found

00:37:54.809 --> 00:37:57.849
multiple things on ebay um that we have left

00:37:57.849 --> 00:38:00.329
in uganda um that he has generously you know

00:38:00.329 --> 00:38:03.070
paid for out of his own pocket um an entitled

00:38:03.070 --> 00:38:05.789
co2 monitor being one of those things that he

00:38:05.789 --> 00:38:08.349
found on ebay uh because we didn't have entitled

00:38:08.349 --> 00:38:13.010
monitoring in uganda entitle monitoring is one

00:38:13.010 --> 00:38:16.300
of those things that is very important to an

00:38:16.300 --> 00:38:20.699
anesthesiologist yeah i can imagine that it probably

00:38:20.699 --> 00:38:23.880
makes a big difference to them yeah um so you

00:38:23.880 --> 00:38:26.139
know a couple hundred dollars he was you know

00:38:26.139 --> 00:38:28.179
able to donate that and leave you know that we

00:38:28.179 --> 00:38:30.219
were able to teach them how to appropriately

00:38:30.219 --> 00:38:32.559
use it and and what the numbers meant and all

00:38:32.559 --> 00:38:33.840
of that kind of stuff where it's something that

00:38:33.840 --> 00:38:36.719
they didn't regularly see but here it's one of

00:38:36.719 --> 00:38:40.780
our uh standards of monitoring so yeah absolutely

00:38:40.780 --> 00:38:44.920
that's something that i guess you more often

00:38:44.920 --> 00:38:46.699
think about in the context of the history of

00:38:46.699 --> 00:38:49.440
anesthesia is when they started adding things

00:38:49.440 --> 00:38:52.519
like pulse ox and then tidal CO2 to make sure

00:38:52.519 --> 00:38:56.300
that we can keep our patients safe. But when

00:38:56.300 --> 00:38:59.219
you are going somewhere like you've been with

00:38:59.219 --> 00:39:01.699
very limited resources, I guess you can't necessarily

00:39:01.699 --> 00:39:06.579
take that stuff for granted. So what other memorable

00:39:06.579 --> 00:39:10.059
moments do you have from your experience taking

00:39:10.059 --> 00:39:12.769
these trips? That's such a broad question, John.

00:39:13.769 --> 00:39:16.670
I have many. I know. And I've heard you tell

00:39:16.670 --> 00:39:19.530
a lot of these stories before, but I just really

00:39:19.530 --> 00:39:23.170
enjoy every time you come back hearing all the

00:39:23.170 --> 00:39:26.210
new stories that you have. I think one of my

00:39:26.210 --> 00:39:32.530
most just memorable patient stories was my first

00:39:32.530 --> 00:39:36.829
trip to Uganda. We had a 17 -year -old who came

00:39:36.829 --> 00:39:42.039
in for a head and neck. camp. He had a tumor

00:39:42.039 --> 00:39:46.139
on his face. He had told everyone that he was

00:39:46.139 --> 00:39:49.760
21 because he was still 17 and could not technically

00:39:49.760 --> 00:39:52.380
consent for himself. But he had been largely

00:39:52.380 --> 00:39:54.619
disowned by his family because of this tumor.

00:39:54.760 --> 00:39:56.619
He had stopped going to school because he had

00:39:56.619 --> 00:40:01.320
been made fun of so frequently. And it was very

00:40:01.320 --> 00:40:04.599
disfiguring. It was mostly on his maxilla, kind

00:40:04.599 --> 00:40:09.019
of in his nose and cheek region. But it's very,

00:40:09.079 --> 00:40:11.920
you know, scary looking whenever you just see

00:40:11.920 --> 00:40:17.360
it in general um so jeff had saved this case

00:40:17.360 --> 00:40:19.320
knowing that the team was coming that it was

00:40:19.320 --> 00:40:21.900
going to be a big procedure and he had uh told

00:40:21.900 --> 00:40:23.900
this kid that he would you know help him out

00:40:23.900 --> 00:40:28.559
as as best we could um so seeing his airway for

00:40:28.559 --> 00:40:30.539
the first time i was still a resident on this

00:40:30.539 --> 00:40:33.400
trip i was like holy crap this is terrifying

00:40:33.400 --> 00:40:37.179
what do we do um and i you know i wish i could

00:40:37.179 --> 00:40:39.869
show pictures and things on a podcast but makes

00:40:39.869 --> 00:40:42.989
it a little tough, uh, in this modality. Um,

00:40:43.250 --> 00:40:45.130
but we did a, you know, very thorough airway

00:40:45.130 --> 00:40:46.989
exam and actually found out he had a great mouth

00:40:46.989 --> 00:40:50.769
opening. Um, it was just all maxilla. Um, he

00:40:50.769 --> 00:40:52.369
was a grade one view whenever you actually took

00:40:52.369 --> 00:40:56.110
a look, um, at his Malin potty score or, uh,

00:40:56.230 --> 00:41:00.389
yeah. And, um, but he was not going to be maskable.

00:41:00.690 --> 00:41:02.789
Um, so we had to come up with a plan where we

00:41:02.789 --> 00:41:06.980
could, um, you know, either rapid sequence intubate

00:41:06.980 --> 00:41:09.000
or keep him spontaneously breathing and so we

00:41:09.000 --> 00:41:10.840
figured out exactly what we needed to do airway

00:41:10.840 --> 00:41:13.400
wise and luckily his airway you know wasn't that

00:41:13.400 --> 00:41:16.599
terrifying it all ended up going very well he

00:41:16.599 --> 00:41:19.340
had a 12 plus hour surgery where they created

00:41:19.340 --> 00:41:24.139
a flap and removed this mass and And unfortunately,

00:41:24.260 --> 00:41:27.420
his flap failed the first day, so we had to bring

00:41:27.420 --> 00:41:29.460
him back to the operating room for a second 12

00:41:29.460 --> 00:41:31.719
-hour procedure from a flap for the second day.

00:41:32.059 --> 00:41:34.739
So this guy had, you know, two 12 -plus -hour

00:41:34.739 --> 00:41:39.980
general anesthetics back -to -back. But his second

00:41:39.980 --> 00:41:43.280
flap luckily took. He had a trach for about three

00:41:43.280 --> 00:41:44.960
months, and then they were able to decannulate

00:41:44.960 --> 00:41:48.469
him as he healed and is now back to living. you

00:41:48.469 --> 00:41:51.289
know, a normal life. Um, luckily whenever they

00:41:51.289 --> 00:41:53.969
sent the tumor to pathology, it was a non -cancerous,

00:41:53.969 --> 00:41:57.389
just rapidly growing, uh, benign tumor. Um, so

00:41:57.389 --> 00:42:00.690
he doesn't have to worry about, you know, well,

00:42:00.769 --> 00:42:04.010
malignant cancer, um, happening there. Um, but

00:42:04.010 --> 00:42:05.969
definitely a life -changing story and something

00:42:05.969 --> 00:42:07.769
that I was like, holy crap, how does this even

00:42:07.769 --> 00:42:12.409
happen? Um, kind of moment. Those sort of moments,

00:42:12.610 --> 00:42:15.610
I imagine, make it all seem worth it when you

00:42:15.610 --> 00:42:17.750
can make that big of a difference to somebody

00:42:17.750 --> 00:42:21.929
who otherwise would have had a totally different

00:42:21.929 --> 00:42:25.110
outcome to their lives. Absolutely. And when

00:42:25.110 --> 00:42:27.949
I had talked to him beforehand and even after,

00:42:27.989 --> 00:42:30.289
he said he wanted to be a doctor after all of

00:42:30.289 --> 00:42:33.210
this. And he was a very smart kid, but he had

00:42:33.210 --> 00:42:35.650
stopped going to school because he was being

00:42:35.650 --> 00:42:39.070
made fun of and bullied. But now that he was...

00:42:39.519 --> 00:42:42.340
back to living a normal life, he can, you know,

00:42:42.340 --> 00:42:43.940
go and get the education and that kind of stuff.

00:42:44.059 --> 00:42:46.039
So I'm hopeful to one day see him when I'm over

00:42:46.039 --> 00:42:49.260
there as a, as a physician. Well, I look forward

00:42:49.260 --> 00:42:51.739
to reading his personal statement. He applies

00:42:51.739 --> 00:42:56.239
to our program. He can, he can probably name

00:42:56.239 --> 00:43:03.980
drop you. Um, if somebody were in the early phases

00:43:03.980 --> 00:43:06.079
of their career about to become a resident, or

00:43:06.079 --> 00:43:09.780
maybe they're a resident already, and they think

00:43:09.780 --> 00:43:12.539
that what you are talking about sounds amazing

00:43:12.539 --> 00:43:15.179
incredible and that's a direction they want to

00:43:15.179 --> 00:43:17.860
go with their career what recommendations do

00:43:17.860 --> 00:43:21.019
you have for them um definitely let people know

00:43:21.019 --> 00:43:22.920
you're interested it's one of those things that

00:43:22.920 --> 00:43:25.300
a lot of global health stuff happens by word

00:43:25.300 --> 00:43:28.079
of mouth i constantly get people reaching out

00:43:28.079 --> 00:43:30.179
to me both other you know attendings from other

00:43:30.179 --> 00:43:31.539
places that i've worked with saying like hey

00:43:31.539 --> 00:43:33.099
what connections you have what do you know what

00:43:33.099 --> 00:43:37.590
can i do or what programs can we grow Just letting

00:43:37.590 --> 00:43:39.449
people know you're interested. I know when I

00:43:39.449 --> 00:43:41.869
interviewed for residency here and Mike had talked

00:43:41.869 --> 00:43:44.289
about the Belize trip, I was like, I am interested.

00:43:44.409 --> 00:43:46.250
I want to do that. It's part of the reason that

00:43:46.250 --> 00:43:50.110
I was interested in this program. And Mike knew

00:43:50.110 --> 00:43:52.630
from the day one of me being an intern that I

00:43:52.630 --> 00:43:54.190
was going to Belize and I was not going to have

00:43:54.190 --> 00:43:57.690
it any other way as a CA3. And then COVID happened

00:43:57.690 --> 00:44:02.769
and it almost ruined it, but we got to go. But

00:44:02.769 --> 00:44:04.329
just letting people know you're interested, seeing

00:44:04.329 --> 00:44:06.489
what opportunities are available. There's a lot

00:44:06.489 --> 00:44:09.550
of different groups that go all over the world

00:44:09.550 --> 00:44:13.489
that are big groups, both anesthesia as well

00:44:13.489 --> 00:44:19.309
as surgical and just even medical wise. A lot

00:44:19.309 --> 00:44:20.909
of it's kind of doing your own research or finding

00:44:20.909 --> 00:44:23.949
out who knows what in whatever area you're in.

00:44:24.889 --> 00:44:26.949
Mike redirects a lot of people to me now, which

00:44:26.949 --> 00:44:29.610
is totally fine. But I've made a lot of contacts

00:44:29.610 --> 00:44:33.760
through him. And that's also how I got involved

00:44:33.760 --> 00:44:36.340
in Uganda. You know, Josh was like, hey, who's

00:44:36.340 --> 00:44:38.500
who's interested? And I immediately jumped on

00:44:38.500 --> 00:44:40.559
it. And now I've got to go back a couple of times.

00:44:41.900 --> 00:44:43.539
So just letting people know you're interested

00:44:43.539 --> 00:44:45.780
when those things come up, you know, things get

00:44:45.780 --> 00:44:48.699
sent your way and somehow it ends up working

00:44:48.699 --> 00:44:53.940
out. That's fantastic. What about. Any societies

00:44:53.940 --> 00:44:56.679
that you recommend joining or being a part of

00:44:56.679 --> 00:44:58.800
that have maybe been of help to you? What do

00:44:58.800 --> 00:45:02.699
you think about that? I joined the ASRA, again,

00:45:02.780 --> 00:45:04.679
the Anesthesia Society of Regional Anesthesia.

00:45:05.280 --> 00:45:07.559
They have a global health special interest group.

00:45:08.039 --> 00:45:10.360
I joined that. So they have a lot of little updates

00:45:10.360 --> 00:45:12.780
here and there. They have a couple of different

00:45:12.780 --> 00:45:17.340
trips that go various places. throughout the

00:45:17.340 --> 00:45:19.320
world um so i'm trying to get a little bit more

00:45:19.320 --> 00:45:21.599
involved in one of those and then actually one

00:45:21.599 --> 00:45:23.659
of our colleagues here is uh trying to get his

00:45:23.659 --> 00:45:26.119
uh brian's trying to get his tanzania trip i

00:45:26.119 --> 00:45:28.000
think he actually has it recognized by azra now

00:45:28.000 --> 00:45:30.380
oh that's great um so creating more opportunities

00:45:30.380 --> 00:45:33.300
out there um and his is primarily a education

00:45:33.300 --> 00:45:36.409
-based trip in um one of the hospitals in Tanzania.

00:45:37.289 --> 00:45:40.449
So just getting involved like that, even if it's,

00:45:40.449 --> 00:45:42.329
you know, doing a virtual lecture at first, trying

00:45:42.329 --> 00:45:43.869
to, you know, get involved with that hospital

00:45:43.869 --> 00:45:45.650
and then seeing what connections you can make.

00:45:46.309 --> 00:45:48.469
If you're willing to do a lot of legwork, there's

00:45:48.469 --> 00:45:50.289
definitely a lot of opportunities. If you want

00:45:50.289 --> 00:45:52.150
something that's already a little more established,

00:45:52.429 --> 00:45:54.690
there's definitely a lot of those things out

00:45:54.690 --> 00:45:58.349
there too. So could you briefly talk about the

00:45:58.349 --> 00:46:01.969
opportunities that our residents have if they

00:46:01.969 --> 00:46:06.460
were doing a residency here? towards one of those

00:46:06.460 --> 00:46:10.239
trips yeah absolutely um so here you see um we

00:46:10.239 --> 00:46:13.719
take um usually three ca3s every year to belize

00:46:13.719 --> 00:46:16.699
with us um that number can be flexed just kind

00:46:16.699 --> 00:46:19.320
of depending on um how many trips there are in

00:46:19.320 --> 00:46:21.579
different things um the group that we go to belize

00:46:21.579 --> 00:46:23.900
with typically goes twice a year um for at least

00:46:23.900 --> 00:46:25.760
three weeks among those trips so we definitely

00:46:25.760 --> 00:46:27.840
have availability if we have enough staff to

00:46:27.840 --> 00:46:30.840
to cover those trips for the residents um but

00:46:30.840 --> 00:46:34.250
we There's usually a couple of residents, if

00:46:34.250 --> 00:46:36.150
not more, that want to go on those trips. So

00:46:36.150 --> 00:46:37.889
we have to figure out who has the time and availability

00:46:37.889 --> 00:46:40.230
to spend some of their elective time doing that.

00:46:41.289 --> 00:46:44.449
And then we also take residents on the Uganda

00:46:44.449 --> 00:46:48.369
trip as well. Usually just one just because it's

00:46:48.369 --> 00:46:52.010
a smaller trip overall and it's a lot farther

00:46:52.010 --> 00:46:54.929
and more difficult to get to. And oftentimes.

00:46:55.789 --> 00:46:58.329
10 to 14 days. So it's a little bit longer of

00:46:58.329 --> 00:46:59.789
a time commitment and a little bit more of a

00:46:59.789 --> 00:47:03.110
money commitment. But, you know, we help our

00:47:03.110 --> 00:47:06.210
residents with some of the funding and the opportunity

00:47:06.210 --> 00:47:10.030
and giving them the information that they need

00:47:10.030 --> 00:47:13.570
to make those decisions. And it's always a very

00:47:13.570 --> 00:47:15.570
positive feedback from the residents that get

00:47:15.570 --> 00:47:18.289
to go. So I would love to be able to take all

00:47:18.289 --> 00:47:21.469
of them if they all show interest. And it's something

00:47:21.469 --> 00:47:24.010
that counts as real rotation time, right? It

00:47:24.010 --> 00:47:27.170
does. We have it approved through the ACGME as

00:47:27.170 --> 00:47:31.269
a recognized rotation for the CA3s. We just submit

00:47:31.269 --> 00:47:33.329
a thing every year for the ones that are going

00:47:33.329 --> 00:47:36.590
to get it approved for them. And it's seemingly

00:47:36.590 --> 00:47:38.429
a pretty seamless process at this point, but

00:47:38.429 --> 00:47:40.550
definitely something that can be done for a lot

00:47:40.550 --> 00:47:42.090
of global health trips at other institutions

00:47:42.090 --> 00:47:45.070
with a little bit of legwork as well. So what

00:47:45.070 --> 00:47:47.050
kind of advice would you give to somebody who's

00:47:47.050 --> 00:47:51.880
just about to take their first global trip? Be

00:47:51.880 --> 00:47:54.840
ready to be adaptable and troubleshoot and be

00:47:54.840 --> 00:47:58.099
prepared for everything. I know that seems silly,

00:47:58.260 --> 00:48:00.380
but it's one of those things that you just never

00:48:00.380 --> 00:48:03.599
know what's going to happen. I remember the first

00:48:03.599 --> 00:48:06.500
trip I ever did. Me and Mary and Chris were in

00:48:06.500 --> 00:48:08.619
the white van on the way up to the hospital,

00:48:08.719 --> 00:48:11.500
and Mike was going through emergency scenarios

00:48:11.500 --> 00:48:13.760
with us and said, if this happens, what are you

00:48:13.760 --> 00:48:15.340
going to do? If this happens, what are you going

00:48:15.340 --> 00:48:19.619
to do? And one of his scenarios was, if the power

00:48:19.619 --> 00:48:22.860
goes out, what are you going to do? You know,

00:48:22.860 --> 00:48:24.360
the power goes out here and the generator kicks

00:48:24.360 --> 00:48:28.219
on. Right. Power goes out there. It's not a generator

00:48:28.219 --> 00:48:30.679
to kick on. And we're all like, oh, that's not

00:48:30.679 --> 00:48:32.900
going to happen. Lo and behold, happens to me.

00:48:34.420 --> 00:48:37.619
Excellent. So you're already working with unfamiliar

00:48:37.619 --> 00:48:40.880
equipment and in a situation where you've never

00:48:40.880 --> 00:48:43.440
been in taking care of somebody's life is in

00:48:43.440 --> 00:48:46.179
your hands and the power goes out. What are you

00:48:46.179 --> 00:48:49.309
feeling in that moment? Oh, crap. But, you know,

00:48:49.309 --> 00:48:53.150
a little more explicit, I think. Thank you for

00:48:53.150 --> 00:48:56.650
sanitizing it for the podcast audience. Luckily,

00:48:57.030 --> 00:48:58.949
you know, Mike had run through this. You know,

00:48:58.969 --> 00:49:00.250
I think I would have been able to think through

00:49:00.250 --> 00:49:02.849
it just a little slower, probably, if we hadn't

00:49:02.849 --> 00:49:05.150
already talked about it. Luckily for me, it was

00:49:05.150 --> 00:49:06.829
an ENT surgery where they had some headlights

00:49:06.829 --> 00:49:09.269
on. So the room wasn't totally pitch black, but

00:49:09.269 --> 00:49:11.969
it is a room without windows. So, you know, if

00:49:11.969 --> 00:49:13.190
there were no headlights, it would have been

00:49:13.190 --> 00:49:16.500
pitch black. I also popped on the. the light

00:49:16.500 --> 00:49:18.780
on my cell phone, my flashlight and just laid

00:49:18.780 --> 00:49:21.940
it so that it was flashing up. Luckily, the other

00:49:21.940 --> 00:49:24.400
OR had just excavated and was rolling to PACU

00:49:24.400 --> 00:49:26.280
when this happened. So at least their patient

00:49:26.280 --> 00:49:29.079
was no longer under general, but obviously still

00:49:29.079 --> 00:49:33.960
needed monitors. And switched over to an ambu

00:49:33.960 --> 00:49:37.119
bag and was drawn up some propofol and Mary ran

00:49:37.119 --> 00:49:40.380
in and said, what can I do? So I handed her the

00:49:40.380 --> 00:49:42.320
propofol and said, I don't know, start being

00:49:42.320 --> 00:49:47.900
an infusion pump. assign assign mary as the infusion

00:49:47.900 --> 00:49:50.639
pump and you got to squeeze the bag so you guys

00:49:50.639 --> 00:49:54.800
became the anesthesia machine correct um and

00:49:54.800 --> 00:49:58.199
then last year uh john latrimoy and i were there

00:49:58.199 --> 00:50:01.280
and i briefly ran through said scenario with

00:50:01.280 --> 00:50:06.039
him and it happened to him It sounds like this

00:50:06.039 --> 00:50:08.260
is actually a pretty high yield scenario to run

00:50:08.260 --> 00:50:10.559
through. Yeah, it turns out. I think those are

00:50:10.559 --> 00:50:12.159
the only two occurrences that I know for sure

00:50:12.159 --> 00:50:15.000
it's happened. And luckily, it wasn't a long

00:50:15.000 --> 00:50:17.119
power outage. It felt like it was forever. But

00:50:17.119 --> 00:50:19.559
in reality, it was a couple of minutes. OK, so

00:50:19.559 --> 00:50:21.860
it's something where the power did come back

00:50:21.860 --> 00:50:23.699
on. You're able to turn everything back on and

00:50:23.699 --> 00:50:25.940
it resolved. Yes. But you don't know, you know,

00:50:25.980 --> 00:50:27.860
when it's when it happens. Apparently, one of

00:50:27.860 --> 00:50:30.159
them was a planned power outage that no one had

00:50:30.159 --> 00:50:36.369
told us about. You just didn't think to put planned

00:50:36.369 --> 00:50:38.230
power outage as part of your anesthesia plan.

00:50:38.349 --> 00:50:41.230
Right. Well, next time maybe you can consider

00:50:41.230 --> 00:50:45.050
that. So now it's a scenario that is high yield

00:50:45.050 --> 00:50:46.630
to run through for the residents going this year.

00:50:47.449 --> 00:50:49.030
If you guys are listening, go ahead and plan

00:50:49.030 --> 00:50:54.309
for that. Oh, excellent. So let's back up a little.

00:50:54.369 --> 00:50:57.170
I'd love to hear some of the style points that

00:50:57.170 --> 00:51:01.409
have helped make you more successful in your

00:51:01.409 --> 00:51:06.960
life and career. Um, you know, I think just being

00:51:06.960 --> 00:51:09.739
able to be adaptable, being able to work with

00:51:09.739 --> 00:51:12.119
whoever you're working with in whatever scenarios

00:51:12.119 --> 00:51:15.360
you're working with is is important. You know,

00:51:15.360 --> 00:51:17.780
there's some people that are very rigid and probably

00:51:17.780 --> 00:51:19.980
aren't the right people to to do these kind of

00:51:19.980 --> 00:51:23.300
trips. The other thing is just being friendly

00:51:23.300 --> 00:51:25.900
and social and communicating can go a long way.

00:51:26.639 --> 00:51:29.599
Building relationships and having people trust

00:51:29.599 --> 00:51:32.699
you and know who you are and coming into an area

00:51:32.699 --> 00:51:35.670
that. you're not necessarily familiar with, um,

00:51:35.849 --> 00:51:39.570
is super helpful. Um, I now have, you know, WhatsApp

00:51:39.570 --> 00:51:42.909
messages going with, you know, Barbara and patients

00:51:42.909 --> 00:51:45.050
and some of the other people in Uganda and I'm

00:51:45.050 --> 00:51:46.989
Facebook friends with some of the people in Belize.

00:51:47.050 --> 00:51:48.750
So, you know, just kind of keeping that rapport,

00:51:48.969 --> 00:51:51.510
um, going, going back to the same locations.

00:51:52.730 --> 00:51:55.090
Being willing to help and being adaptable and

00:51:55.090 --> 00:51:57.110
doing whatever they need you to do. Sometimes

00:51:57.110 --> 00:51:59.829
it's not just doing anesthesia. Sometimes it's

00:51:59.829 --> 00:52:01.949
helping with a pre -op IV that they're having

00:52:01.949 --> 00:52:05.070
trouble getting. Sometimes it's scrubbing because

00:52:05.070 --> 00:52:08.349
they need somebody in the OR to scrub and we

00:52:08.349 --> 00:52:11.530
have an extra person. So just kind of being adaptable

00:52:11.530 --> 00:52:14.010
and ready to do anything and friendly and willing

00:52:14.010 --> 00:52:17.409
to take whatever role you need to take goes a

00:52:17.409 --> 00:52:21.449
long way. Well, when I think of. the people on

00:52:21.449 --> 00:52:24.630
my short list of having high adaptability and

00:52:24.630 --> 00:52:27.030
emotional intelligence and being friendly, you

00:52:27.030 --> 00:52:29.630
are close to the top of that list. So thank you

00:52:29.630 --> 00:52:31.489
so much for joining us. Absolutely. Anytime.

00:52:34.909 --> 00:52:37.070
Thanks for joining us for this month's episode

00:52:37.070 --> 00:52:39.789
of Style Points. If you found yourself particularly

00:52:39.789 --> 00:52:42.710
interested in the topic of this episode, Erica

00:52:42.710 --> 00:52:44.969
has offered to share her email address with anyone

00:52:44.969 --> 00:52:47.480
who is interested in global health. For that,

00:52:47.619 --> 00:52:50.099
or if you have any other thoughts, please email

00:52:50.099 --> 00:52:53.380
me at stylepointspodcast at gmail .com, and I

00:52:53.380 --> 00:52:55.820
would be happy to send that to you. I genuinely

00:52:55.820 --> 00:52:58.219
appreciate everyone who has taken time out of

00:52:58.219 --> 00:53:00.699
their day to listen to the podcast. If you really

00:53:00.699 --> 00:53:03.380
enjoyed it, leave a five -star rating or a review

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and share it with your friends. Lastly, take

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a deep breath, open your eyes. We're all done.