RealSelf Fellow Raises the Level of Care in Nicaragua

The scene inside the hospital in Managua, Nicaragua, is a familiar one for Dr. Patrick Byrne. Dozens of young children need care for cleft lips, cleft palates, severe burns, and other issues. Some have traveled from other parts of the country–the second poorest in the Western Hemisphere–for a chance to receive care from visiting doctors.

A plastic surgeon in Baltimore, Dr. Byrne, started making humanitarian trips to Nicaragua in 2009. This time, there are a few familiar faces in the crowd. Three patients from a previous visit have returned. They aren’t seeking additional medical care. Instead, they came to thank the doctors who changed their lives.

Miguel is a young man who suffered severe burns. A lover of baseball, he was unable to play due to his injuries. That was until Miguel received a microvascular tissue transfer on his neck and chest to restore mobility and function. Now, Miguel is able to play baseball and hold down a steady job.

“It was just a smile and hug fest,” Dr. Byrne said in an interview with RealSelf.

Dr. Byrne has taken similar trips all over the world. In recent years, his efforts have been focused in Nicaragua. He is the co-director of the Greater Baltimore Cleft Lip and Palate team. His team has partnered with Aproquen to provide care to those in need and establish a standard of care comparable to what patients receive in the United States.

“It’s unbelievable how sophisticated our effort is now,” he said.

Photo courtesy: Dr. Patrick Byrne

In addition to performing cleft lip and palate surgeries, Dr. Byrne’s team has added dental care, nutrition, orthodontic care, speech therapy, and other services. 

It’s no longer a situation where visiting doctors parachute in and perform as many surgeries as possible. Dr. Byrne and his team are establishing guidelines, training local providers, and using technology to help provide aftercare. That includes a telemedicine program for speech therapy.

Dr. Byrne said the current operation is a “night and day” difference from when he first started visiting Nicaragua. Back then, he would see many poor outcomes from previous surgeries. Patients didn’t receive the full care they needed. Basic medical records were limited or nonexistent. 

“You see a kid who was operated on by some other team at some other time, and they look pretty bad,” Dr. Byrne said. “There are no op notes, no record, you have no idea who did what when. Now it’s pretty close to the type of clinic you’d see in the United States.”

Recent efforts have improved the sustainability of care. Dr. Byrne’s team trained a local physical therapist who has become better at cleft speech therapy than many speech therapists in the United States who rarely perform cleft therapy. The advances in speech therapy, complication rate, and overall success have been staggering.

On his most recent trip to Nicaragua in February, Dr. Byrne traveled as a RealSelf Fellow. The RealSelf Fellowship awards funding to medical professionals who donate time and expertise to deliver care and training in underserved communities around the world.

“The gift is really meaningful,” he said. “That goes a long way on a trip like this.”

Photo courtesy: Dr. Patrick Byrne

On this trip, Dr. Byrne operated on about 20 new patients, but the work is hardly complete. He and his team are still busy trying to elevate the standard of care and help establish a sustainable system by working with local hospitals to collect data, using technology to reduce the gap in care, and training local providers.

They are also planning to visit Nicaragua two times per year, up from one.

“Since we’ve been involved and developed all of these programs, word has gotten out,” Dr. Byrne said. “Families and doctors from all over Nicaragua send their kids to the group.

“It’s great, but we need to keep up with the demand.”

Learn more about the RealSelf Fellowship and how to apply here.

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