The great fistula adventure

Just back from Sincelejo  – and off on another adventure!


Dr. Barbosa was asked by a local nephrologist if he would be willing to come to Clinica San Rafael in Sabenalargo to make dialysis fistulas for several patients who are currently dialysing through subclavian catheters.  (These in-dwelling catheters, which are made of plastic, place patients at a much higher risk of infections including systemic infections like sepsis (due to easy access to central blood supply.)

This medscape article gives a nice overview regarding Dialysis Fistulas.  (However is mainly focused on maintaining fistulas rather than creating them.)

So off we went to Sabanalargo in the Colombian state of Atlantico.  While small, with just 2 operating rooms, Clinica San Rafael was a fine place to operate.

Despite its small size, the clinic had an intensive care unit, a neonatal unit and fluoro for catheterization and endovascular procedures (in operating room #1).  The hospital also had a large maternity unit.  Looking through the previous operating room procedure log showed that most of the procedures were C – sections and general surgery procedures (like hernia repair.)

One of the nicest aspects of this facility is something that is essentially unheard of in the United States.  At the end of the day, Dr. Barbosa was paid in full.

outside Clinica San Rafael

outside Clinica San Rafael

All of the staff were very welcoming despite the fact that it was our first time there.  The patients were happy to see us – and the surgeries proceeded at a rapid pace.  After receiving discharge instructions and prescriptions for a daily aspirin along with pain medication, all of the patients were discharged home.

with Liliana, circulating nurse

with Liliana, circulating nurse

All told, Dr. Barbosa performed 4 Cimino – Brescia fistulas with excellent results.  All of the fistulas had an easily palpable thrill at the end of the procedure with no evidence of limb ischemia or other complications.  (Cimino – Brescia fistulas utilize the native artery and vein versus PTFE grafts which are not as durable).

The way home was a lengthy process since one of the main roads was closed so we had to back track to Barranquilla to get on the main coastal highway.  (I’m sure it was lovely, but it was too dark to know.)

But all-in-all, it was a fun and interesting day.

Checking in with Dr. Hector Pulido at Clinica General del Norte

After spending some time in my old neighborhood in Bogotá visiting friends and family over the holiday weekend – it was time for a quick trip to Barranquilla for another reunion, of sorts.  Dr. Hector Pulido, the Chief of Surgery at the Clinica General del Norte (and a long-time friend) invited me to Barranquilla to take a look around..

with Dr. Hector Pulido (left) and Dr. Barbosa in Cartagena (2010).

with Dr. Hector Pulido (left) and Dr. Barbosa in Cartagena (2010).

The City of Barranquilla: Colombia’s Golden Gate 

Barranquilla is the capital of the Colombian state (province) of Atlantico, and is the largest city within Atlantico.  Barranquilla is the fourth largest city within Colombia – after Bogotá, Medellin and Cali.  While population estimates vary greatly, the generally published estimate is around 1.6 to 2.4 million people*.  Much of Barranquilla’s historical importance is related to its position as the major port of Colombia.  This is reflected in Barranquilla’s continued growth and reputation today.

Barranquilla: More than Shakira and Carnival

While Barranquilla is widely considered to be Cartagena’s ugly big sister; it is also the coastal region’s more serious, intellectual and industrial side.   Excluding the internationally famous Carnival; among the Colombian coastal cities of Barranquilla, Cartagena and Santa Marta; Cartagena is viewed as being for play, Santa Marta for relaxation… But Barranquilla is viewed as the city where the work gets done..

That impression; of business-like efficiency and competency certainly held true during my tour of the main facility of the rapidly expanding Clinica General del Norte health system.

Clinica General del Norte

The Clinica General del Norte facility on Calle 70 is the main facility of the nine hospital network.  (There are 4 hospitals in Barranquilla itself, with several other hospitals in Cartagena and other coastal areas.)  The Calle 70 facility is also the biggest with 464 beds, and an anticipated addition of 300 beds in the works.

Care of the critically ill

Clinica General del Norte has 100 intensive care beds, with a dedicated coronary /cardiac intensive care, a burn unit, pediatric intensive care and a 24 bed neo-natal unit.  They also have an intensive care unit for patients requiring hepatic dialysis for patients with liver failure.  This last unit is of particular interest – since it is where Dr. Hector Pulido, as a general surgeon specializing in Liver, Biliary, Pancreatic Surgery and Transplant) cares for many of his more critically ill patients after surgery.

But no real chance to observe Dr. Pulido at work – at least, not today.. Just a quick whirl around the facility, accompanied by Yolanda Basto de Hossman, and Dra. Maria del Carmen – to the 14 operating rooms to check out the cardiac surgery room along with the updated and modern equipment, to  the neo-natal unit to talk to the Chief of Pediatrics, and see babies as young as 20 weeks gestation.

MRI/ CT scan and Angiography facilities

Dr. Pulido encourages them to show me everything (everything! he says) – so they do; the dual angiography suites, the 64 slice CT scanner with 3D reconstruction, to MRI – meeting and talking to staff along the way.  No PET/ CT yet but it’s on the way – they say – which will make this the only facility on the coast with such diagnostic capabilities. (They are building the structure to contain it as part of the new building being constructed in front of the existing facility).

But, of course, for me – it’s not enough.. I need to talk to the surgeons, spend some time with them; observing and talking to their patients – getting the feel and the rhythm of their practice.. I need to watch them in the operating room, and to know them – before I can be completely satisfied.

So even now, as Victor takes me back to the airport, I am thinking, questioning, planning.. “Are the rents very expensive near here?”, I ask.  “No” he says as he drives through the nearby small streets with gaily painted houses.. Well, then I think I have my answer.

Sunset in on the air field as I prepare to leave Barranquilla

Sunset in on the air field as I prepare to leave Barranquilla

Links for more information:.

City of Barranquilla  – government website

Official Colombia Travel page: Barranquilla

El Heraldo – news of the Colombian coast

Clinica General del Norte

*Local residents estimate the population at almost 4 million people in the metropolitan area