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Operation Ecuador

Recently returned from a medical mission in South America: foreground, Patrick Byrne with, left to right, perioperative nurses Michelle Elassal, Ani Aaparyti, Brenda Nack, Eunice Guillem and, left rear, surgical tech Greg Ruff. Not present: anesthesiologist Devin Sanders, pediatric surgeon Dylan Stewart, OR nurses Malaya Robinson and Irene Wright.

This past winter, a group of 10 men and women from The Johns Hopkins Hospital embarked on a medical mission to Ecuador. Organized by the Ecuadent Foundation, a Westminster, Md.-based non-profit, the mission included four surgeons in three specialties (pediatric, general and facial plastic), anesthesiologists, nurses, dental specialists, translators and techs—45 in all, from Hopkins, Maryland and York Hospital.

They arrived in Guayaquil, one of the largest cities in Ecuador, on Friday, Feb. 13, and settled into officers quarters at a naval base there. They were divided into two teams: medical and dental. Patrick Byrne, director of the Division of Facial Plastic and Reconstructive Surgery at Hopkins, led the medical team.

The next morning, they went over to the military hospital. Hundreds of people were waiting to see them. “It was overwhelming ... a mad house,” recalls Byrne. Fortunately, the navy, which had advertised the mission throughout the country, had also organized the medical patients according to the three surgical specialties. Byrne specializes in facial plastic surgery (a subspecialty of otolaryngology-head and neck surgery), and in his group alone there were 130 potential patients, mostly kids, all lined up with family members—some 200 to 300 people in all.

“We triaged all day, saw everyone, and then sat down to create the operating schedule. As medical director, it was my responsibility to decide who gets what. I felt a tremendous amount of responsibility and hated sending the majority home, but I had to focus on the greatest need, with the greatest likelihood of success and least risk.”

The next day, Byrne’s medical team started operating at about 7 a.m. and didn’t finish until 10 that night. Patients were rotated non-stop on and off the operating tables. The two facial plastic surgeons did the cleft lips and palates, the pediatric surgeon repaired the hernias, the general surgeon removed the diseased gallbladders. Everyone performed only duties and procedures he or she had hospital privileges for in the United States. The surgeons, for example, were the attendings; the residents assisted.

With a dozen or so miscellaneous cases added to the mix, the total, in five days’ time, amounted to 101 surgical procedures. There were no adverse outcomes. (The dental team performed 1,047 procedures, including extractions, restorations, flouride treatments and cleanings.).

“We worked long hours, and we worked hard,” says recovery room nurse Michelle Elassal. Fluent in Spanish, Elassal served as a key liaison between the medical team and the Ecuadorians, often accompanying the doctors to deliver reports to families. “It takes lots of energy because you’re not familiar with the environment or the people.”

Patrick Byrne with a young Ecuadorian patient.

Byrne is no stranger to grueling, 16-hour days as he typically does a high volume of extensive cancer reconstructions as well as procedures at the JH Cosmetic Center. He has donated his services as a surgeon ever since he was a resident. While he was doing a fellowship in cleft work at Children’s Hospital of Minneapolis, a mentor inspired him to volunteer on overseas missions. He has since gone on missions to Mexico several times, as well as China, Vietnam and Africa, operating predominately on indigent children with disfiguring acquired and congenital abnormalities. “I love this kind of work,” he says. “To help kids who have no other real option for care is incredibly rewarding. It’s just fun.”

Not a few of their colleagues, Byrne and Elassal say, genuinely want to do similar work and help change lives for the better in poverty-stricken countries. The prospect of paying one’s own airfare and expenses, using precious vacation days and spending about 10 days in a foreign country far away from family, however, can be a deterrent. “But once you go on a trip like this and see the amount of help you can provide,” says Elassal, “you put all that behind you.”

-Anne Bennett Swingle

For more on humanitarian-aid missions abroad:

  • The American Medical Association’s Office of International Medicine ( for links to humanitarian groups and volunteer opportunities overseas for physicians.
  • The American Council for Voluntary International Action ( for specifics on non-governmental groups in the United States that offer medical help overseas.
  • Those wishing to contact the Ecuadent Foundation can call 410-561-1800 or e-mail


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