I spent a week with Mercy Ships in San Pedro Sula, Honduras. SIGN had sent ahead three sets of SIGN instruments and nails, one set each for use by surgeons in Honduras, El Salvador and Mercy Ships. A surgeon from El Salvador, who had been with the Mercy Ships team a year ago, was reputed to be a skilled surgeon, and I concur in that opinion now that I have seen him operate.

Our goal was to form partnerships with these three groups of surgeons. Mercy Ships, especially, can spread the use of the SIGN nail as the ship sails from port to port. The El Salvadoran surgeon, Dr. Darwin Pereira, drove seven hours to San Pedro with his anesthesiologist, Ricardo Loza. They were a fine pair and we all had a lot of joy, laughter and just plain fun together.

We left for the hospital each day at 6 a.m. and returned at 6 p.m. There were frequent delays before surgery and between cases, but everyone worked hard and stayed on Honduran time. The OR scrub nurse and circulators were volunteers from the United States . . . but performing different functions than they were accustomed to in the U.S. Our scrub nurse, Kirk, was a cardiac nurse on his way to PA school. Our circulating nurse, Alison, was a physical therapist. Working with the local Honduran nurses was a pleasure; they caught on to the SIGN technique quickly. I believe we must teach the nurses as well as the surgeons.

Working in the hospital clinic the first morning gave me a chance to see the results of previous fracture care in Honduras. There were many unhealed and infected bones, often with large defects in the bone. These are drastic life-altering problems that will not heal without specialized treatment. The SIGN Intramedullary nail system, which has a very low infection rate, set the stage for improvement. Our emphasis is on getting patients with open fractures into the operating room as soon as possible to remove infected tissue, and then implant the SIGN nail.

Mercy Ships and SIGN have good synergy. Our goals are similar but we approach them differently. SIGN’s approach is to teach local surgeons how to use SIGN implants and then to provide the implants. In return, each surgeon agrees to send us case reports on each surgery so we can evaluate both the surgery done and the SIGN nail. Mercy Ships, on the other hand, has large teams with many functions whose main approach is to deliver service. This service has several aspects including evangelism, outreach, well-drilling, and medical services. In summary, SIGN is more purely medical although we do have some outreach functions focused primarily on contact with doctors and patients.

Two anecdotes characterize our trip well:

Elver is a 15 year-old boy who fractured his femur above the knee playing soccer. He worked long days in bean and corn fields and his primary recreation was playing soccer. X-rays showed that a bone cyst had weakened the femur in the area of the break. The accident had occurred four weeks before and Elver's X-rays and his story were brought to my attention by Mercy Ships worker, Laura Grazier. Elver's fracture, without surgery, would have left him with a completely disabled leg. With the agreement of the local chief, Dr. Cruz, we operated on Elver, placing the bone in correct anatomical position and fixating it securely with a SIGN nail. He was discharged to his home the following the day. Elver's and his mother’s smile were contagious.

A 40 year-old man, riding his bicycle home from work, was stopped by a gang who demanded his bicycle and his money. They then shot him in the leg twice. Quick rehabilitation was especially important for this father of four because part of his wages from the textile factory were needed to pay his oldest son's college expenses. He was up and on crutches the day after SIGN nail surgery and returned home.