Through its Global Surgery Program, the University of Colorado Anschutz Department of Surgery has longstanding relationships with medical centers in Tanzania and Vietnam.
In May, Ton Doan, MD, the CU surgery department’s inaugural global surgery fellow, expanded the program’s reach to Central America when he joined a CU Anschutz medical team on a trip to National Hospital Juan Jose Ortega in Coatepeque, Guatemala.
Introducing ultrasound
The trip was led by Philip Angelides, MD, assistant professor of internal medicine and pediatrics in the CU Anschutz School of Medicine. Then the Global Health Hospital Medicine Scholar at CU Anschutz, Angelides had established a relationship with the Guatemalan hospital, leading an effort to introduce an ultrasound curriculum there to elevate medical and pediatric care.
Dr. Angelides and Dr. Doan attended interdepartmental grand rounds led by chief residents.
“We have been trying to find ways to expand our global reach as a surgery department, and here’s someone who exists within the CU ecosystem who was teaching Guatemalan doctors how to use ultrasound for diagnostic guidance and interventions. It seemed like a low-hanging fruit to get surgery involved in a meaningful way," Doan says. “This is a rural hospital eight hours from the capital of Guatemala City. They have two x-ray machines and a CT scan machine. Local funding for an ultrasound machine is out of the question, so we brought our own portable ultrasound.”
Doan describes the two-week trip as a needs assessment, where he spoke with hospital leadership about the benefits of ultrasound guidance in future surgical interventions. Using silicone models, Guatemalan surgeons were given the opportunity to visually confirm in real time their placement of central lines in the intensive care unit, which has historically been done “blind” using anatomical landmarks.
“With an ultrasound, they're able to see where they're going with the needle,” he says. “This reduces the chance of puncturing the lung or causing hematomas. I would hope a simple intervention such as ultrasound training, which would only take two to three days, can result in less patient discomfort and pain, and fewer complications and even deaths, I hope this endures well beyond our limited time there”
Future partnerships
Doan also talked with hospital leadership about bringing CU surgery residents and fellows to Guatemala to work alongside the surgeons there. With a second global surgery fellow set to join the CU Department of Surgery this year, Doan plans to make a return trip to National Hospital Juan Jose Ortega to finalize details on both initiatives.
The CU cohort poses with local leadership following fruitful discussions on future collaboration.
“From this trip, we have laid the foundation for a longstanding relationship between the University of Colorado and the National Hospital Juan Jose Ortega of Coatepeque,” he says. “By cultivating interdepartmental bonds between surgery, internal medicine, and pediatrics with the help of Dr. Angelides, we established a shared interest in the widespread adoption of point-of-care ultrasound (POCUS) across all aspects of clinical care, from diagnostic and procedural aid in medicine-pediatrics to ultrasound-guided central line placement in surgery for patient safety.”
Furthermore, Doan says, his discussions with hospital leadership opened doors for future collaborative projects, including standardized protocols regarding blunt head trauma, which was noted by local attendings as highly prevalent in their rural community.
“We hope to continue working to maintain a sustainable system that endures to improve patient care and safety in rural Guatemala in the future,” he says.
Global impact
“I was deeply impacted by this trip,” Doan says. “Despite having limited resources, the doctors and surgeons caring for patients in Coatepeque demonstrated great character, tenacity, and enthusiasm in the care for their patients and colleagues. They welcomed any effort in advancing care and improving systems within their hospital. Genuine involvement spanned from medical students to hospital administrative leadership, both to learn from and teach our visitors from the University of Colorado.”
Featured image: Dr. Edwin De Leon, former surgical director, and fellow surgical attending staff show Dr. Doan, right, around the operating center of Hospital Nacional de Coatepeque.
