Dr. Carlos Duran headed to Bogotá, Colombia with Physicians for Peace for the first time in 2018, to share his vast knowledge in burn care with medical providers there. He returned with his own skills sharpened, his own insights expanded, and a shift in perspective that has made him a better doctor. “It was really valuable,” he says.
That trip cemented his desire to continue volunteering with Physicians for Peace. As Chief of Pediatrics at Shriners Hospitals for Children in Boston, Dr. Duran was impressed at the setup and resource management while visiting hospitals in Bogotá. “They look at burns as a public health matter,” he notes.
“They really do an excellent job. It taught me to look at the economics. How can we get to this same level of care with fewer resources?”
A Different Approach to Global Health Solutions
That wasn’t Dr. Duran’s first volunteer trip—he had previously joined surgical missions with other organizations to Guatemala and Ecuador. Then a nurse colleague told him about Physicians for Peace, with its “teach one, heal many” philosophy. “This was different,” he says.
During his past volunteer experiences, the team would arrive to perform specialized surgeries not readily available in the region. “We’d see 25, 30 kids a day. Those kids would go into surgery, and it would continue like that for two weeks.”
That approach centered on the patient, rather than the provider. “With Physicians for Peace, it’s about sharing different approaches to care,” Dr. Duran says. “Seeing what could work in their particular setting.”
While teaching at Physicians for Peace partner hospitals in Colombia, Dr. Duran reinforced the importance of a comprehensive team approach to burn care. “Often during rounds, or when discussing plans of care, they would include physicians and nurses; on occasion a pharmacist, and that’s it.
“At Shriners, we incorporate post-acute care providers: physical and occupational therapists, nutritionists, care managers—all of them—in our burn rounds. Because we continue to follow these patients as outpatients, (surgeons) can learn a lot from those providers from the beginning.”
He acknowledges that some facilities are slow to warm up to that approach, but says his Colombian colleagues embraced it. “It does take time for some to see that the multidisciplinary approach has important, long-term value to the patient,” Dr. Duran says. “It can be new and challenging in terms of workflow for certain hospitals.”
Sharing Knowledge: a Mutual Benefit
Many elements of the care his Colombian colleagues provided, with resources far more limited than at Shriners, left a deep impression on Dr. Duran that added to his own breadth of knowledge. He noted their diligence in the difficult task of keeping burned children free from infection during the acute phase, during sometimes lengthy delays as they awaited grafting and other surgical procedures.
Dr. Duran also noted how they managed pain and anxiety in their littlest burn patients. “In the past,” he says, “the focus on pain and anxiety mostly has been related to procedures the children were going through in the moment”—while caregivers he observed in Colombia were addressing post-traumatic stress from the accident that caused the burn. “Seeing how they treated PTSD has helped my own practice a lot,” he says.
The type and degree of burn injuries he encountered in Colombia were another point of difference. Scald injuries, which typically happen on a smaller scale in the U.S., tended to be much bigger and more serious in Colombia, where many families cook on ground-level stoves.
“That’s one reason for the considerable amount of major scald injuries in children," he says, “because pots of water are cooking for a family of 10-15, and the size of the injury is much bigger.” Also novel to him: electrical burns specifically from “wires left in the street or connected to trains and other moving vehicles.”
Dr. Duran now finds himself at Shriners contemplating how practices in front of him could translate to hospitals worldwide. “I do find myself thinking in terms of—is this something we could do there? How could this impact care when there is a lower nurse-to-patient ratio?”
As soon as he was able, Dr. Duran returned to hands-on volunteering, and has recently returned from a training trip to Costa Rica. “I have really enjoyed getting to be part of this,” he says, laughing, “and happy I met the nurse who introduced me to Physicians for Peace!”