DOVER — The calling has always been there for general surgeon Brandt Feuerstein to travel abroad and help heal the less fortunate.

It just seemed as if the timing was never right.

That all changed when Dr. Feuerstein and his team of three from Bayhealth Kent General Hospital traveled to Nicaragua in the heat of last July. They performed much-needed surgeries over eight days in the underserved and impoverished country.

While Dr. Feuerstein, general surgeon Thomas Barnett and anesthesiologist Jeffrey Ruiz provided vital services, performing 60 elective and emergency operations during the short trip, they were also taught a lesson by the people of Nicaragua.

“It seemed to me that people were asking for surgery that I didn’t initially think maybe they needed as bad,” Dr. Feuerstein said. “That was my own misperception, because they don’t complain at all.

“That was probably the biggest sense of the population that I got was that they didn’t complain before surgery, they didn’t complain waiting for surgery, waiting for the clinic or after surgery. They didn’t use the pain medicine. They were very, very reserved and dignified.”

Dr. Feuerstein added, “So I misinterpreted that as them not necessarily needing the surgery urgently but that wasn’t the case. All of their gall bladders together were terribly diseased and the hernias weren’t subtle.

“Some of the people that we had to turn down for surgery, which is heartbreaking, never said anything.”

One thing is for sure, it was a great learning experience for the doctors and family members who accompanied them and actively participated on the trip.

Dr. Feuerstein’s daughter, who is studying to begin a career in the medical field, was among the volunteers. He said it was the possibility of working with her that finally made the timing perfect for the doctor.

Terry Murphy, president and CEO of Bayhealth, said he was proud of the contingent from Dover who volunteered their time and made the effort to reach out.

“As a member of the medical staff a lot of people do a lot of the charity work, taking the time off, traveling to parts of the world that are tough places and to be able to do the work that they do,” Mr. Murphy said. “We’re proud that they’re affiliated with the Bayhealth organization. It’s really special.

“They work hard. It’s their time, it’s their profession that they step away from to do that, so it’s a big deal. We’re supportive and we just think it’s a great work.”

Some tight bonding took place as the surgical team from Dover performed operations with some outdated technology that was three generations old, power that often went out in the middle of operating sessions and cramped working conditions.

La Dalia Hospital featured outdoor hallways and tight working conditions, with the waiting room and recovery area jammed right next to the operating station.

With dogs sometimes meandering through the hospital, it was a far cry from the sparkling confines of Bayhealth Kent General Hospital in Dover.

However, Dr. Feuerstein said, it was well worth the trip.

“It was a very rural, remote area,” he said. “Some people traveled for hours and walked for miles to get there.

“We concentrated only on surgical diseases — mostly hernias, gallbladders and tumors. Many were diagnosed with a problem but had been waiting six months to see someone. The public healthcare system is overwhelmed and overstaffed.”

Putting the mission together

The will to give back has tugged at Dr. Feuerstein in the past but this time he knew he couldn’t ignore the call.

So, he reached out to others at Bayhealth in January to gauge interest in putting a medical mission to Nicaragua together. He was overwhelmed by the initial response he received.

“It was interesting because at the beginning everybody wants to go,” said Dr. Feuerstein. “By the time it came to signup though a lot of those people could not go.”

The group from Bayhealth teamed up with Esperanca, a nonprofit charity organization out of Phoenix, Arizona, to help coordinate their mission.

Esperanca helped put the doctors in touch with people who could help them navigate through the different culture of Nicaragua.

“Unless you are plugged in to somebody on the ground to really help you navigate, you’re going to do nothing,” Dr. Feuerstein said. “It takes a little bit more than good intentions, you really do need a lot of coordination.”

The traveling medical team embarked on a six-and-a-half hour flight to the airport in Managua before they took a rain-soaked five-and-a-half journey to La Dalia.

It was quite an experience, with people walking in the middle of roadways and hanging out of the backs of trucks, but they made it to their destination.

Dr. Feuerstein credited Esperanca with making the trip much easier than it could have been.

“This (mission trip) was sort of unique, it said, ‘You tell us what you can do and who’s going to be on your team and we’ll get you into the place,’” he said. “I really like that because then you’re working with people you know, there’s a certain comfort, and I liked that the trip was only a week.

“It wasn’t two days traveling on either end, I didn’t have to close my office for two weeks. It was very concentrated. It wasn’t a lot of travel.”

Getting to work

Upon arriving at La Dalia hospital, it didn’t take the team of doctors from Delaware very long to realize they were in a far different place.

After all, Nicaragua is one of the poorest countries in Latin America with an average income of around $430 per year. The economy has been severely damaged by years of Civil War.

Despite those factors, the team of doctors from Bayhealth said they felt safe.

“The actual situation was that people were waiting, sometimes six months, eight months, with a known problem,” Dr. Feuerstein said. “They were just waiting for their number to come up to have surgery.”

On their first day at the Nicaraguan hospital, they held a clinic where they saw upwards of 65 patients.

“One thing that was confusing to me when I got there was that these people already had a diagnosis,” said Dr. Feuerstein. “I didn’t understand that. I thought they’d be just coming in saying, ‘I have pain.’

“Instead they were coming and saying, ‘I have pain. It’s my gall bladder, here’s my ultrasound,’ By the way it’s six months to have the surgery to fix it. We were there all day (the first day) and it never seemed like the crowd got smaller. It seemed like they just kept coming.”

The doctors said the Nicaraguan people had trust in the Americans. They expected them to be trained and to have a certain expertise.

The team did have a tower with video equipment to assist them in their surgeries, but there still were struggles.

“We did the first (gall bladder) surgery open because we couldn’t get the system to work and then, really through persistence, got the system working and we were able to do the first laparoscopies that were ever done in this hospital,” Dr. Feuerstein said.

“We did about 16 (gall bladder surgeries) with equipment that is probably about three generations behind what’s outdated (in the U.S.).”

Overall, the team performed 60 successful surgeries despite using mix-and-match older equipment.

Dr. Feuerstein said he probably would have done four or five surgeries over the same time span in Dover.

“My expectation was very modest,” he said. “I remember when we got there that if I did four or five (surgeries) a day I would be happy, because we didn’t have an anesthesia machine, didn’t know if we were doing laparoscopy … there were so many questions.”

In the end, the contingent from Dover was able to answer them all.

“All of the patients did well,” said Dr. Feuerstein. “I have followed up with the local physicians and there were no complications. Everyone involved in the project was pleased with what we were able to accomplish.”

Well-equipped for success

The team of Delaware doctors tipped their surgical masks to the Bayheath Warehouse and Bayhealth Pharmacy, which provided them with surplus materials, medicines and scrubs that they could no longer use in the United States.

In all, there were 10 cases full of supplies that arrived with the team in Nicaragua. The only thing they couldn’t bring were intravenous fluids, which are just too heavy to lug around.

“Getting supplies was a big part of the trip because we didn’t know what we were going to need,” Dr. Feuerstein said. “I guess the assumption is that anything that you don’t bring that you need to take from a local hospital is sort of counterproductive. You don’t want to be taking their supplies.

“What we hoped to do was be completely self-sufficient and bring our own supplies and we were very successful with that part to a large degree because of Bayhealth.”

The team did receive a bit of a scare when they arrived and didn’t have a working anesthesia machine. However, it did show up on the truck the night they got there.

“It gave me an idea of what’s essential and what’s nice to have,” said Dr. Feuerstein, of the trip. “What’s nice to have we didn’t have but we had what was essential and we were able to get things done comfortably for the most part.”

They also didn’t take a First Assistant or a Scrub Tech on the trip but the hospital provided them with some and also provided medical doctors for pre- and post-op care.

There were also surgeons from Nicaragua that did some cases with the Dover team.

The first day lasted around 11 hours for the team but Dr. Feuerstein said they got more and more efficient as the days went by.

They even got the opportunity to take a little sightseeing tour, where they took in a waterfall, before they had to head back home.

An encore performance

Dr. Feuerstein is already planning on returning to Nicaragua in March for another medical mission trip.

This time around, he has assembled a team of himself, Dr. Robert Hartmann, of Ob-Gyn Associates, anesthesiologist Glenn Madara and John Glenn, a semi-retired surgeon, Olga Mendez, a surgical tech, and Tina Sykes, a registered nurse and midwife, for his second venture to La Dalia hospital.

The group has a GoFundMe webpage titled “Volunteer Int. Surgical Outreach” and is trying to raise $10,000 to help defray the cost of in-country transportation, pre- and post-operative care, translators, processing of government documents and other vital services.

So far, they have reached more than $3,000 of their goal.

With one mission trip under his belt, Dr. Feuerstein said he expects things to run even smoother this time around.

He might even get to use some familiar equipment.

“We felt that leaving the supplies would be a nice gesture to getting invited back,” Dr. Feuerstein said. “All of the scissors, disposables, knife blades, all of the medications that we had extra, we donated to the hospital.”

There is no doubt he is looking forward to making the trip again. He said it helps to put a different perspective on things.

“We take for granted services that are so immediately available here and don’t exist in other parts of the world,” said Dr. Feuerstein. “We were using materials that were donated that are surplus her and are vitally needed there.

“To be able to do 60 operations in a week in an area where it’s very much needed is an overwhelmingly gratifying experience.”