Managua, Nicaragua, an oppressively hot and overcrowded hospital
that ministers to the poor and uninsured.
'Dios cuida de sus animalitos'
The memory of the conditions at Lenin Fonseca and the paucity of
resources I will carry to my grave. But throughout my stay in
Nicaragua, I became increasingly impressed by the resiliency of the
doctors and nurses at this facility.
Arthroscopic surgery was considered a real luxury. Upon learning that
I was a shoulder specialist, the staff asked me to perform an arthroscop-
ic rotator cuff repair. After establishing a very crude lateral decubitus
positioning scheme, and with the use of outdated (and hopefully sterile)
implants, we were able to negotiate a complete cuff repair using inspired
tricks that MacGyver would have been proud of. I'll never forget the
sight of my wife, extraordinary nurse Marie Sakosky-Kelly, RN, manually
compressing IV bags in order to generate enough shoulder distention.
The most challenging surgical case was a multiligamentous knee
injury in a young female. High-energy knee injuries are commonplace,
given the inordinate amount of motorcycles populating the streets of
Managua. With scanty instruments, we were able to pull off a PCL
reconstruction and lateral side augmentation. Cannulas were hard to
find and electrothermal ablation was not available. Thankfully there
was a drill available that day!
I was appalled at the many hip fractures waiting around for several
days before surgical fixation. I remarked to one of the staff surgeons
that I was amazed that more patients did not succumb to bedrest-
induced pneumonia or thromboembolic disease. He replied: "Dios
cuida de sus animalitos." (God takes care of His little creatures.)
Cutting Remarks
CR
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