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.

The Department of Orthopedics at Clinica San Rafael

Dr. Victor Lizcano, Chief of Orthopedics

Spent the day with several surgeons from the Department of Orthopedics at Clinica San Rafael – which has a city-wide reputation for excellence.

Dr. Victor Lizcano, MD is the charming Chief of Orthopedics who opened his busy, 11 surgeon department to me. I watched surgeries, talked to patients, reviewed films, and interviewed the surgeons in his department, with free rein.

Orthopedics surgical team; two instrumentadors and 4th year resident (center)

Dr. Maria Angela Gomez, MD, a busy surgeon who nevertheless took the time to talk to me; manages dual practices; both as a plastic surgeon (at Clinica de Marly) and an orthopedic (hand) surgeon. She’s currently involved in a very interesting research project – tell you more about it later… A very fascinating lady.

Dr. Martha Pincon, MD an orthopedic surgeon specializing in foot and ankle surgery, also a very interesting and enjoyable surgeon.

Dr. Martha Pincon, during a complex case at Clinica San Rafael

There’s a lot more to tell – but I have another interview in a few minutes..

In the OR with Dr. Diego Pineros, cardiac surgeon

Dr. Diego Pineros, cardiac surgeon

Spent an enjoyable morning with Dr. Diego Pineros in the operating room at Clinica San Rafael, watching him operate on a four-month old girl. Surgery went well, with no intra-operative or post-operative problems.

Spent the remainder of the morning talking about cases, the history of cardiac surgery and seeing patients.

Like many of his counterparts here in Bogota, Dr. Pineros spends his “leisure time” in ways we might not expect. Right now, he is coordinating and arranging for his surgical team to fly to Tolima (300 miles away) to perform several pediatric cases over the weekend. The team will spend several days to make sure their little patients are well on the road to recovery before returning to Bogota, and to another full week of surgery.  When asked about this, Dr. Pineros quickly shrugs off any praise – stating, “they need surgery, and there is no one [at that hospital] to do it.  It’s hard on the families that travel to Tolima [from outlying rural communities] for care.”

Dr. Diego Pineros

Cardiac Surgeon, Clinica San Rafael

Dr. Diego Pineros, cardiac surgeon, (revisited)

Clinica San Rafael – Bogota, Colombia

Most of you haven’t heard of Dr. Diego Pineros but I originally interviewed him about three months ago, (long before I set up this website.) He is one the many genuinely nice people I have had the fortune to meet during this trip (and a great tour guide since he knows quite a bit about the history of Bogota). Today, I went back to visit him, at Clinica San Rafael, which is one of several facilities where he operates.

The case for this morning was cancelled, but it was nice to catch up with Dr. Pineros, meet his residents (young future surgeons) and see the clinic itself.

While we were there – we ran into Dr. Mario Lopez (thoracic surgeon) who has now added Clinica San Rafael to his roster. If you remember, we last saw him in the operating room at Mederi.
I tried to get a picture of him (without his mask) but it’s a bit blurry..

Hope to be back at Clinica San Rafael soon, so I will be able to tell you more.