Home Safe From Thailand
I am safely back from my journey to Thailand with Operation Smile. I had traveled as part of a 50 person international team to provide anesthesia care for children requiring cleft lip and/or palate surgery. We also cared for numerous children with burns. I want to thank each and every one of you for providing me with the skills and knowledge to provide the anesthesia care for these children.
One of my happiest days was when I learned that I would have the privilege of joining the HUP/CHOP family for my residency and fellowship training. I have always felt it an absolute honor to work with such wonderful mentors and teachers.This trip was by far the highlight of my residency training. Since I will complete my residency training in the next 6 months, I felt empowered to know that I possess the skills and critical decision making ability to safely care for patients in an environment with only the basic meds and equipment. I never could have possessed the knowledge and skills to care for these patients without your extreme dedication, love of teaching and encouragement.
Dr. Harris at Work |
The trip was an eye opening experience. The first day, we screened a total of 189 children. We then spent a day setting up our operating room facility. It was two beds to an OR. When I walked in, all that existed was the operating room table with a sheet. Operation Smile had sent supplies in boxes which were labeled (ETT, syringes, med, ect), but there was no box with all the supplies for each anesthesia team. Therefore, I had to think of every possible supply, monitor, and emergency device I would need from the time the child entered the room until they were taken to recovery. It was actually a very difficult task. Much thought and energy went into designing a workspace I felt safe delivering a general anesthetic in.
We had two OR tables per room. No ventilator, no neuromuscular blockade and no scavenger system. We did have a Jackson-Rees system with a vaporizer and sevoflurane. We connected tubing to the Jackson-Rees system and ran it across the room to a fan in the hopes of blowing the exhaled sevoflurane out of the room to an unused facility. The typical scenario was to bring the child into the OR with no premed, get them deep with an inhalation anesthetic technique, then intubate them and get them breathing spontaneously again. We used oral rae tubes, all of which were uncuffed. I found myself needing to downsize the ETT based on the child's age since many of the kids were nutritionally deficit. Since the tubes didn't have cuffs, we would place a throat pack in the hopes of decreasing the already apparent constant sevoflurane smell of the operating room. We gave each child rectal Tylenol and got away with small doses of fentanyl for pain management since the kids were narcotic naive.
We had four operating room days altogether. We had four tables and cared for 109 children in those four days. I started and ended cases by myself. There was a supervising attending pediatric anesthesiologist available, but he would cover the PACU, preop area as well as the other 3 OR tables. I remember being so scared for the first case, as I had thought I would be one on one with an attending. However, by the end of the first day I felt much more confident in my skills and proud of the training I have received at HUP and CHOP. My only complication was one case of laryngospasm in an asthmatic child who had been cancelled the day prior. I did end up giving succinylcholine, as his desaturation to 80 for approx 30 seconds seemed like hours as my heart was beating out of my chest.
Since being back, I have enjoyed sharing my photos with classmates, friends and family. I have also enjoyed speaking with the HUP anesthesia applicants about my experience abroad. Many of my co-residents as well as the applicants are interested in international work. I will be giving a lecture in the near future for the HUP anesthesia residents. I would encourage you to attend if you have any interest in such work. It’s extremely gratifying work and the opportunity of a lifetime. Thanks again for all of your support and encouragement. I represented PENN abroad in a very positive way and continue to be thankful each day for being part of the HUP/CHOP family.
Thanks,
Katie
Dr. Harris and her Team
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