Guatemalan Residents Get Pediatric Surgery and Anesthesia Training at Duke

Several faculty members at Duke are collaborating with the Roosevelt Hospital in Guatemala City on a new clinical training initiative to improve the surgical care of children in Guatemala. In October, Gustavo Perez and Daniela Palencian, clinical residents at the Roosevelt Hospital, were the first visiting scholars in a new program for international trainees to rotate at Duke and University of North Carolina (UNC) hospitals to learn advanced pediatric surgical and anesthesia skills.

While in North Carolina, the visiting residents observed a wide range of advanced pediatric surgical and anesthesia procedures, teaching conferences, simulator sessions and clinical rounds. Their curriculum was designed to deepen their existing training; Perez is a general surgery resident and Palencian is an anesthesiology resident at Roosevelt Hospital. Their faculty partners include:

• Henry Rice, chief of pediatric surgery at Duke and DGHI affiliate faculty member
• Brad Taicher, assistant professor of anesthesiology at Duke
• Sherry Ross, associate professor of pediatric urology at UNC

Longstanding Pediatric Surgery Connection between Duke and Guatemala

Rice, Taicher and Ross have been traveling back and forth to Guatemala to improve pediatric surgery access since 2010. What began as a desire to increase the service and research base has evolved into an expanding educational partnership that aims to improve global surgical care. 

Since the Duke-Guatemala Pediatric Surgery and Urology program began, Duke has sent surgery and anesthesia residents to Guatemala for part of their training. This is the first time that Duke has been able to host the Guatemalan residents in return, and the exchange was designed to allow Guatemalan trainees access to similar experiences to augment their training. The month-long program was sponsored by California-based Mending Kids International, a non-government organization that has partnered with Duke for many years to support pediatric surgery in low and middle income countries.

Unique Opportunity for Guatemalan Residents

Although their time in the United States is short, the impact of this training has been significant. “We know in just one month, it's hard to teach too much,” Rice said. “But we can communicate principles and approaches to care that are transferable, like processes of safety and quality along with the power of data collection.” 

Taicher agrees that this is a great opportunity. “There is only one pediatric surgery fellowship and no anesthesia fellowships that we know of in Guatemala, so we think this is a unique offering to bring back skills,” he said.

Perez and Palencian were hand-selected by their faculty in Guatemala for this opportunity based on their work ethic and their goal to apply this new knowledge to improve the surgical care of children in their country. “There are training skills and technology here that are not available for us in Guatemala. For example, laparoscopy is an emerging surgical specialty in Guatemala, but the training programs are still in their infancy,” said Perez, who is the chief resident in general surgery at Roosevelt Hospital.

They were able to observe first-hand the differences in patient management during pre-, inter- and post-operative periods, which they noted as very different from care at home. They’ve also had opportunities to use some of the most cutting-edge technology in surgery and anesthesia. “I loved the simulation lab! There was a patient ‘dummy’ and an anesthesia machine, and when the ‘patient’ had multiple complications, we had to decide what to do,” Palencian said. 

Residents’ Eyes on the Future of Pediatric Surgery in Guatemala

Both residents believe this experience will enhance their clinical practice in Guatemala and allow them to develop new teaching methods to share with future residents. They feel they can help their hospital become a leader in clinical care, training and research by better managing patient information and data, as well as advocating for new technologies and training programs.

Perez shared his plans for the future after he completes his training: “My main goal is to improve my hospital and to open doors. I think we have been doing the same thing for some time, but we need fresh insight and information. There are more solutions. It’s not always a money problem; there are things we can be doing. We can set an example.”