Updates from the May 2018 American Society for Surgery of the Hand (ASSH) Touching Hands Project mission trip to San Pedro Sula, Honduras
May 5-12, 2018 | Authored by Fraser J. Leversedge, MD
A week ago, as part of the Touching Hands Project through the American Society for Surgery of the Hand, eleven of us met in the San Pedro Sula airport, just outside this industrial capital of Honduras (population approximately 1.2 million). We arrived from Michigan, Texas, New York, Rhode Island, and North Carolina eager to make a difference. As a group, we quickly appreciated that we were serving a greater cause than that defined by our individual roles. We became a true team – a term illuminated by our shared experiences, our dedication to our collective mission, and our passion for what we do. We evaluated 152 patients on Sunday to start our week and to create our surgical schedule. We performed 52 cases over the week; almost all the procedures were complex cases that included both adult and pediatric/congenital reconstructions. We struggled mentally with not being able to “cure” everyone in a week, but we could sense the hope provided to those we treated, and the awe of such a responsibility that can still be realized by simple gestures and nervous smiles from the many children and adults of Honduras with whom we connected.
Pictured left: There were 5 members of the team from Duke (from left to right): Alex Lauder, MD – Duke Hand Surgery fellow; Monica Mohe, BSN RN – Duke Eye Center Nurse Manager; Fraser Leversedge, MD – Duke Orthopaedics and Duke Hand Surgery; Fred Fesel CRNA – Duke ASC; Juliann Hobbs MD MPH – Duke Anaesthesia staff.
Sometimes the unrealized mission is what we experience unexpectedly. The moment when tears accompany our evening debriefing, or we realize our great fortunes based on circumstances and opportunities, appreciated while assessing a patient 8 months from an injury for which the outcomes have been devastated by time and a lack of access to care, or appreciated by driving through the neighborhood and gazing silently down a side street lined by the haphazard collection of corrugated metal buildings. As individuals and as a team, we became unified by our experiences and, I am certain, we will all return home with a refreshed outlook on why and how we do what we do each day. One of our team sent the following as a group text upon arriving home this weekend – a summary of my humble attempts to explain our experiences in Honduras with THP:
“Prior to this our journey, I felt like I was stuck in an eddy like a leaf going round and round and round while this enormous river of life flowed past. But your cumulative life’s energy, laughter and camaraderie released me back into that powerful river of life and once again you guys made me feel alive and productive to our strange world. We created, for a week, our own little Woodstock. A happening. Thanks. You guys are swell. See ya.”
Pictured below, left: Dr Alex Lauder (right), one of the Duke Hand Surgery fellows was able to participate in the Touching Hands Project as part of his educational experience at Duke, exposing him to numerous complex surgical reconstruction cases involving adult and congenital / pediatric patients. Dr. Lauder is pictured with other young hand surgeons who participated in the mission.
Updates from the March 2017 American Society for Surgery of the Hand (ASSH) Touching Hands Project mission trip to San Pedro Sula, Honduras
May 4, 2017
Last week, we completed our third outreach trip to the Ruth Paz Clinic/Hospital in San Pedro Sula, Honduras, through the American Society of the Hand (ASSH) Touching Hands Project. We had 13 team members, including 3 hand surgeons, 3 hand surgery fellows, 3 anaesthesia staff, 2 nurses, 1 hand therapist, and 1 member from an industry partner. Five of the team members were from Duke: Fraser Leversedge, MD (Duke Orthopaedics - hand surgeon; team leader), Steven Koehler, MD (Duke hand surgery fellow), Meredith Muncy, CRNA (anaesthesia); Don Moede, CRNA (anaesthesia); and Kelly Boyd, RN (Duke Nursing). In addition, Scott Kozin, MD; a Duke undergrad, previously the President of the ASSH, and our 2016 James R. Urbaniak/Duke Hand Club Visiting Professor; participated as a hand surgeon team member from the Shriner’s Hospital in Philadelphia.
We evaluated 130 patients in our Sunday clinic (about 50% pediatric/50% adult) and then completed 57 cases over the course of Monday – Friday. Almost all of the cases were reconstructive in nature with many nerve and tendon reconstructions due to machete injuries.
Our next trip to Honduras will be in November 2017.
Fraser J. Leversedge, MD
Read a day-by-day account of the trip at: http://www.assh.org/For-Physicians/Get-Involved/Touching-Hands-Project/2017/Touching-Hands-in-Honduras-2017
Pictured above: Dr. Steven Koehler assisting Dr. Scott Kozin during surgery.
Pictured below, left: Dr. Fraser Leversedge is assisted by Kelly Boyd, RN, from Duke in order to harvest a sural nerve for a forearm nerve reconstruction.
Pictured below, right: Dr Fraser Leversedge and Dr Steven Koehler from the Duke Hand Surgery program in between cases.
Updates from the March 2016 American Society for Surgery of the Hand (ASSH) Touching Hands Project mission trip to San Pedro Sula, Honduras
This trip to Honduras was comprised of a special group that bonded from the outset and we enjoyed many special memories together; from the busy Sunday clinic seeing over 120 patients, to our community visits that included two orphanages, the inspirational Motivo School, an educational session by our therapists for Genesis Apparel, a tour of Elcatex and Francis/SanMar – and, of course, a week filled with incredible experiences in the operating room.
The THP brigade, the second to the Ruth Paz Hospital and Clinic in San Pedro Sula, Honduras, performed 51 cases from Monday to Friday.
THP – Team Honduras included members of several institutions and was comprised of 3 attending hand surgeons, 3 hand surgery fellows, 2 hand therapists, 3 anesthesia staff, 1 pediatrician, and 2 nurses. The team included: Drs. Fraser and Kimberly Leversedge (Duke University), Dr. Julia Katarincic (Brown University), Dr. Anthony Smith (Mayo Clinic – Scottsdale), Dr. Andrea Halim (Brown University), Dr. Katherine Faust (Duke University), Dr. Peter Letourneau (University of Louisville), Julie Lunich, CHT, OTR/L (Duke University), Christine Khelfa, CHT, OTR/L (Duke University), Dr. Marcy Tucker (Duke University), Dr. Sid Sata (Duke University), Donald Moede, CRNA (Duke University), Melissa Reavie, RN (Mayo Clinic – Scottsdale), and Sarah Prunuske, RN (Mayo Clinic – Scottsdale).
Many cases were complex in nature, involving chronic tendon, nerve, and fracture related injuries and congenital reconstruction cases. In all, the team performed approximately 122 primary-type procedures in adults and children including:
- Birth brachial plexus tendon transfers (4)
- Adult brachial plexus related nerve transfers (4)
- Major nerve repair (5)
- Nerve reconstruction/grafting (4)
- Neurolysis (1)
- Joint contracture releases (9)
- Extensor tendon repair or grafting (12)
- Extensor tendon transfers (4)
- Extensor tenolysis (4)
- Flexor tendon repair (12)
- Flexor tendon reconstruction/grafting/transfer (20)
- Flexor tenolysis (5)
- Flexor pulley reconstruction (3)
- Digital joint arthrodesis (3)
- Carpal tunnel release (4)
- Ulnar nerve anterior transposition (1)
- Proximal row carpectomy (2)
- Total wrist arthrodesis (2)
- Darrach procedure (1)
- Wound irrigation/debridement for chronic wound infection (4)
- Skin grafting (4)
- Dorsal wrist ganglion cyst excision (2)
- Excision biopsy of forearm mass (1)
- Fracture repair – ORIF (3)
- Fracture repair – percutaneous pinning (3)
- Congenital hand/pediatric hand:
- Lateral condyle malunion and elbow instability (1)
- Syndactyly reconstruction – simple (1)
- Syndactyly reconstruction – complex (1)
- Apert's reconstruction (1)
- Proteus Syndrome / macrodactyly reconstruction (1)
- Polydactyly reconstruction (2)
Above: The THP team performed complex thumb and index finger deletion, debulking, and middle finger pollicization in this young girl with Proteus Syndrome.
We leave Honduras happily exhausted from a memorable week of experiences that have touched our hearts and our emotions, have inspired us, and have taught us to make the most of our opportunities. We are excited to return soon.
Fraser J. Leversedge, MD
“As you grow older, you will discover that you have two hands, one for helping yourself; the other for helping others.” – Audrey Hepburn
The THP team included (numbered from left to right): 1- Marcy Tucker, MD; 4 – Chelsea Leversedge; 6 – Scott Kozin, MD; 7 – Fraser Leversedge, MD; 9 – Jeremy Miles, MD
This past September, Duke hand surgeon and Vice Chair of Education, Fraser Leversedge, MD; Scott Kozin, MD (Duke Class of 1982); current Duke hand fellow, Jeremy Miles, MD; and Marcy Tucker, MD, PhD, a Duke Ambulatory Surgery Center anesthesiologist, along with physicians and nurses from around the country, travelled to San Pedro Sula, Honduras, for six days as part of the Touching Hands Project (THP). The Touching Hands Project was the vision of Dr. Kozin and was developed during his presidency of the ASSH in 2014. THP is coordinated by the American Society for Surgery of the Hand and its Foundation and currently sponsors 8-10 mission trips per year to underserved regions around the world.
The Honduras brigade was based at the Ruth Paz Hospital and Clinic where they treated both adults and children and participated in several community events.
Day 1 began with a pre-mission planning conference, where the THP team went over the week’s itinerary and safety precautions. Later that day, the team saw 65 patients at the inaugural Ruth Paz foundation THP clinic. Eighteen pediatric surgical cases and 28 adult cases were performed over the week; many cases involving chronic and disabling injuries such as burn injuries, machete injuries, gunshot wounds, nerve and tendon injuries, fracture malunions, and congenital deformities. Two operating rooms, with two operating tables per room, were utilized full time throughout the week.
On Day 2, the THP team treated an 8-year-old boy with substantial healed burn scars over most of his body from a house fire. They later performed web space reconstruction surgery (using local flaps) in a subsequent procedure to address the web-creep restricting the motion of his 2nd, 3rd, and 4th web spaces. Several open wounds and chronic flexor tendon injuries required reconstruction.
The caseload on Day 3 ranged from a trigger finger on a two-year-old, to median nerve grafting, arm fractures, and machete injuries to the hand.
Jeremy Miles, MD (left), a current Duke Hand Surgery fellow was able to gain invaluable pediatric/congenital hand surgery experience working with Scott Kozin, MD (right)
On Day 4, the THP team visited a local orphanage. Upon arrival, the team was excitedly greeted by children ranging in age from 4 to 13 years. After playing a competitive soccer match with the children, the team enjoyed dinner with the founder of the Ruth Paz Clinic and daughter of Ruth Paz, Mary Ann.
On Day 5, the team performed 8 surgeries, including two brachial plexus palsy cases. The first was a 3-year-old boy with a neglected, upper-trunk birth palsy who lacked shoulder external rotation. He had marked
improvement in functional arc of motion after a humeral osteotomy. The second patient was a 45-year-old male with a traumatic injury involving nerves C5 thru C7 that required nerve transfers.
Dr. Leversedge provided care for numerous patients with chronic tendon and nerve injuries during the THP visit to Honduras
On the final day, the THP team performed eight cases in two rooms. During the day, various items were packed and tallied. The team rounded one last time, making sure post-operative plans were well-detailed for the local orthopaedic surgeons, who perform follow-up visits with patients treated by the THP. A strategy for communication between the local surgeons and clinic and the senior THP surgeons was established.
During the THP’s trip, 42 cases were performed and 73 patients were evaluated.
Dr. Leversedge will be returning to Honduras as team leader for the THP in Spring 2016, and is eager to continue helping those less fortunate and to make a positive impact on the global community. Six members of the Duke medical community are committed to the multi-institution trip already!
To read more about the THP and their trip to Honduras, please visit the Touching Hands Project in Honduras website.