Surgeons Teaching Beyond Our Borders

Pictured: Hepatopancreatobiliary Surgeons

Memorial Sloan Kettering's surgical team in Costa Rica included (from left) scrub nurse Lystra Swift, surgeon Michael D'Angelica, surgeon Peter Allen, and Chief of the Hepatopancreatobiliary Service William Jarnagin

Earlier this year, a surgical team from Memorial Sloan Kettering participated in an example of international collaboration at its finest: an educational outreach mission to Costa Rica. They taught local surgeons various techniques for operating on the liver, pancreas, and bile ducts, for the benefit of Costa Rican patients with cancers of these organs. In return, the surgeons experienced what it means to practice medicine with fewer resources and less reliance on technology.

The Memorial Sloan Kettering team, led by Chief of the Hepatopancreatobiliary Service William R. Jarnagin, ventured to Costa Rica’s capital, San José, on a trip sponsored by the Americas Hepato-Pancreato-Biliary Association. Hepatopancreatobiliary refers to the liver, pancreas, and bile ducts.

The trip coincided with a national surgical meeting being held in San José. Team members presented lectures to their peers at that conference. Memorial Sloan Kettering surgeons also taught their Costa Rican colleagues specialized techniques for operating on the liver, pancreas, and bile ducts, spending a full day in the operating room collaborating on the complicated removal of a patient’s bile duct cancer.

Sharing Surgical Skills

“Operations involving the liver, pancreas, and bile ducts are very specialized,” explains Michael I. D’Angelica, a member of the team along with fellow surgeon Peter J. Allen and nurse Lystra Swift. “While Costa Rica is a developed country, these types of surgical cases are difficult to manage there. Local surgeons do not necessarily have the training, expertise, and support services that we have here in the United States.”

For the bile duct cancer surgery, Ms. Swift served as the scrub nurse. She also presented to the director of the Costa Rican College of Nursing and local nurses at nearby Mexico Hospital about the various types of hepatopancreatobiliary surgeries, technologies, and nursing care.

“The medical experts were most interested in how we manage day-to-day nursing activities at Memorial Sloan Kettering,” she explains. “It feels rewarding to know that I left something behind by sharing my nursing knowledge and expertise.”

Like many medical teams that travel abroad to deliver patient care services, the hepatopancreatobiliary surgical team was impressed by the ability of the Costa Rican doctors and nurses to deliver care with fewer resources. “As a surgeon at Memorial Sloan Kettering, it is very easy to lose track of how most of the world functions with far fewer resources than I typically have at my fingertips,” says Dr. D’Angelica. “Walking through a hospital with all the lights out to save energy was our first clue that things were very different in Costa Rica.”

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A Rewarding Experience

Team members found the experience extremely rewarding, and plan to return next year as well.

“This was my first time doing something like this,” Dr. Jarnagin says. “It was very positive and made me want to keep doing it. To be able to contribute to the education of doctors in another country is very gratifying.”

Dr. Allen adds, “It is always difficult to know who gains more from exchanges like this. We were certainly there to be educators, but seeing and hearing about the local problems in delivering surgical care, and the local solutions to those problems, was a learning experience as well. The operations being performed by the Costa Rican surgeons were similar to those we perform daily, but they were achieved with significantly less dependence on technology and more emphasis on basic techniques. That’s certainly something we can learn from.”

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