The Guatemala Mission

The laparoscopic image on the monitor went black. The image had vanished from the screen.

“Can someone fix this?” yelled the surgeon. “I’ve got bleeding. I need to control it! Hurry!”

A flurry of activity resulted, with people rushing around and shouting instructions. In a blur of motion, the nurse sprinted to the monitor, the cold plastic of the machine jarring against her fingers as she fumbled for the on/off button. Nothing. She yanked the monitor’s plug from the wall, the plastic feeling slightly warm to her touch, and tried a different socket. Still nothing. The sound of hurried footsteps echoed as the other circulating nurses in the single operating room converged to help.

“Call a MacGyver! Tell him it’s an emergency!” commanded the nurse in charge.

Throughout the week-long HELPS medical mission in the rugged Guatemalan mountains, the MacGyvers faced a constant stream of repairs, dealing with everything from broken medical devices to damaged shelters under difficult conditions. Remembering the resourceful MacGyver from the 80s TV show, they lifted the name, conjuring images of his quick fixes and problem-solving skills under pressure—a legacy they hoped to emulate. These guys were truly remarkable, their work exceeding expectations.

“The monitor is completely fried; it’s beyond repair,” Kenny, the senior MacGyver, said grimly, the smell of burnt electronics filling the air. “It’s fifteen years old, outdated, and the technology feels clunky. There’s no way to repair it. A deep, bitter disappointment resonated in his tone, colouring every syllable.”

The surgeon glanced at the crowd of nurses, MacGyvers and others who had attempted to resurrect the ancient monitor. The back up monitor had quit the day before. Performing a laparotomy seemed to be the only solution. This was not something she had done for years. She had yet to meet a gallbladder that defeated her….until today. The patient, a healthy Guatemalan woman with symptomatic gallstones, although stable, was actively bleeding. This was the last of ten laparoscopic cholecystectomy procedures today, and the equipment donated years earlier had let her down.

“Let’s get the laparotomy set up,” she suggested.

Within the next ten minutes, with a right upper quadrant incision, she extracted the gallbladder and the scrub nurse put it on the table. The suction bottle had five hundred cc of fresh blood.

“I can’t see anything,” said the surgeon, “I cannot tell where the bleeding is coming from.”

“Here, take my headlight,” I said as I placed it on her head.

“Yikes,” she said. “It keeps welling up. I’m going to pack it with surgicel and sponges, What do you think?”

“Good idea,” I said, nodding slowly in agreement. “If the bleeding continues unabated, we might have to leave the sponges in place and return her to the OR for further intervention in the morning; the sight of so much blood is alarming. I’ve dealt with this situation previously; a cholecystectomy complicated by profuse, uncontrollable hemorrhage. With leaving the sponges in overnight, the bleeding will stop.”

“Let’s see how she does with ten minutes of pressure.”

The ten minutes crawled by, each second feeling like an hour. The sterile environment, the rhythmic beeping of the heart monitors—these are our realities. It is agonizing for us surgeons to simply sit and wait for divine intervention. A deep, persistent urge, a compelling need to take action, inevitably settles upon us. However, the operating surgeon’s skill was evident; when she removed the sponges ten minutes later, the bleeding had stopped, a testament to her precision and expertise. She closed the wound and wheeled the patient to the PACU, the rhythmic squeak of the gurney echoing in the hallway.

The first day of operating was finally over.

Managing the bleeding in the remote mountains of Guatemala during an operation

My annual week-long trip to Guatemala with HELPS, a healthcare philanthropy, has become a tradition for two decades. I’ve witnessed the profound impact of bringing medical care to Guatemala’s remote and underserved areas. The gratitude in their eyes is something I will never forget. On average, sixty to one hundred volunteers come, their hands ready to work, their hearts full of compassion, providing both care and essential surgeries. I am part of the team from Bakersfield. Gathering donated surgical gowns, drapes, sutures, gloves, and equipment from dedicated healthcare professionals takes a year of meticulous planning and coordination; the sheer volume is staggering. This year, our medical team includes two general surgeons, a gynecologist and her resident, three anesthesiologists, and my wife, Ileana who works the clinic. Physician assistants, nurse practitioners, paramedics, and roughly thirty nurses are also volunteering their time and expertise to staff the operating rooms, post-anaesthesia care unit, and clinic.

Our team of volunteers for the 2025 medical mission

The journey from Guatemala City took four long hours on a crowded bus. Finally, they reached the abandoned schoolhouse, its dusty, neglected interior soon to be filled with the sounds of suffering and the scent of medication. Large trucks rumbled in, their engines groaning, carrying generators that sputtered to life, medical equipment, whirring anesthetic machines, stretchers, crisp linen for the patients, and boxes of pharmaceuticals….the list goes on. With a hushed efficiency, we prepared the operating room, arranging three tables for the three simultaneous surgeries, the rhythmic beeping of monitors a constant background hum. A small, sterile room, quiet except for the occasional clinking of instruments, was prepared for minor procedures performed under local anesthetic.

Getting the three OR tables set up

Weakened and weary from their long journeys, the patients arrive from faraway places. Some have travelled for days, the scent of wood smoke and sweat clinging to their clothes. Others have walked for miles on dusty trails, their boots heavy with each step, to reach this place. The stark reality in Guatemala is that 5.6 million people—a quarter of the population—live in extreme poverty, earning less than $3.65 daily, a figure insufficient for basic necessities. Sixty per cent of families live below the poverty line, struggling to afford necessities like food and shelter. To simply say they are grateful for the basic medical and surgical care they received is a vast understatement; their gratitude is immeasurable. For days, they lined up outside the old schoolhouse, now a makeshift hospital, a silent, hopeful line of people, hoping for a glimpse of the doctors. We see over 1000 patients each week and perform 150 surgeries, including laparoscopic cholecystectomies, hysterectomies, and inguinal hernia repairs – a demanding but rewarding workload. Most hernia surgeries fall to me; my fellow general surgeon shows a strong preference for laparoscopic gallbladder removals.

The hernias observed here differ significantly from those found in wealthier nations, often presenting with more severe complications and distinct characteristics. Their sheer size of them is overwhelming, dwarfing everything around them. In my 40-year surgical career, I’ve performed over 3500 laparoscopic inguinal hernia repairs, favouring this minimally invasive approach over traditional open surgery, except in rare cases. I perform ten surgeries for these large inguinal hernias every day when I come on these medical missions. Crippled by years of suffering, many of these patients can no longer perform the strenuous labour required to work in the fields and support their families, leaving them destitute and despairing. This operation is completely life-altering, bringing relief from constant pain and opening up a world of new possibilities. The weight of their previous struggles lifts.

Waiting to see the doctor

More than two decades ago, Ileana’s invitation to a medical mission in Guatemala—a country whose name evoked images of ancient ruins and unknown challenges—filled me with a mixture of apprehension and a thrilling sense of anticipation. Guatemala City, with its ever-present threat of violence in the eighties, was where she’d completed medical school, leading her to flee to the safety in Canada. Having completed a hematology fellowship at the University of Toronto, she felt a pull to return home and provide care to those in her underserved country. In the bustling clinic, she examines patients, ensuring their fitness for surgery while also managing their underlying conditions such as diabetes and hypertension, often a delicate balancing act. They all left the clinic, each clutching a small bag filled with the promise of better health – vitamins and deworming medication. All of them are infested with worms. Some of the stories they tell her are harrowing, filled with chilling details of survival against impossible odds. They leave, expressing their deep gratitude for her medical expertise and care, only after thanking her profusely.

Several years ago, when I presented to the resident’s council at the University of Toronto my proposal to bring in a resident trainee, their primary concern was the trainee’s safety and well-being, voicing worries about potential risks and the need for robust safety protocols. I explained that the buses are escorted by armed soldiers, who also guard the gates and patrol the grounds at night; the soldiers’ presence is a significant deterrent. The government doesn’t want to risk our safety, which is why they’re keeping things quiet. I showed pictures of myself with the soldiers, their large rifles slung over their shoulders, a tangible weight in the air.

“No way,” they said. “We’ll send them to your hospital instead.”

I neglected to mention the hospital’s location in the Jane/Finch corridor, a notoriously violent area of Toronto, filled with the sounds of sirens and the ever-present tension in the air. The Canadian army’s patrols do not reach that desolate and unmonitored region. I’m told the police refuse to go there at night, citing the area’s violent reputation and the unnerving silence broken only by the occasional gunshot and howl.

Shift change from our ever present Guatamala guardians

The week is only halfway through, and there’s still so much to do. The team, buzzing with energy, is enthusiastic about treating as many patients as possible, eager to make a difference in their lives. The smell of coffee and frying eggs fills the air as the breakfast crew begins their 4 a.m. shift, preparing a feast for the rest of us at 6 a.m. A line of patients, bundled in coats and scarves against the chill morning air, are already lined up outside the gates. They have waited for hours, the silence punctuated only by the occasional bird call. By 8 a.m. we are ready to start surgery.

OR team ready for another great day!

Our team leader, Deanna Salyards. Presentation to her from the mayor of the town

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