Burger Zapf M.D., Ph.D.

Otolaryngology, Head & Neck Surgery, Facial Plastic Surgery

411 Walnut Street # 4269

Green Cove Springs, Fl 32043
USA
E-mail: burger_zapf@hotmail.com
He has been working in our Clinic for the first time from the 17th of April until 23rd of
May 2004.
His second visit in Guadalupe was from March 29 until May 7 of 2005.
The third visit was from November 20th until December 14th of 2005.
The forth visit was from April 2 until May 18th of 2007.
The fifth visit was from November 15 until December 20 of 2007.
The sixth visit is from November 2 until the end of month 2008
The seventh visit was from the November 1 until 27 of 2009

Thanks you very much for your great work.

Ý
ENT Experience at Guadalupe Mission Clinic, Ecuador, in the Spring of 2004

I have to say these were an exciting five weeks, not only with the medical work but also
with the entire team here at the Clinic. We enjoyed camaraderie and weekend cookouts
galore.
The Mission Clinic serves a large rural population. From the city of Loja four-hour bus
ride away up into the mountains. Patients come the night before and literally sleep on
the front steps of the Clinic in order to be first in line the next morning.
The Clinic and the doctors’ quarters were built recently and are very nice even to “first
world” standards. Unique electrically heated showerheads, computer with internet
access, TV with a video movie collection and a large kitchen to cook to one’s heart’s
desire complete the picture. The covered veranda overlooks the tropical rainforest
mountains and the river. Weekends are free for exploration, sightseeing or just relaxing.
The Clinic is new and spacious. A large pharmacy stocked with donated and bought
drugs serves the community as in most third world clinics there is a vast amount of
donated supplies. You have to wade through it to find what is useful for you. Ideally you
would organize and bring with you donations of meds and supplies for your own use.
That way you reduce your chance of being caught short. The OR has a good
Storz operating microscope. There is a rather ancient Bowie cautery, office suction, an
OR table, OR surgical stretcher, and multiple sterilizers. There are sufficient instruments
to see patients all day without resterilizing. There are some old instruments for
septoplasties and tonsillectomies, but no mouthgag.
Any potentially interested ENT person should plan to bring all special instruments for
surgical procedures. That includes prostheses, gelfoam, eardrops, steroid nasal sprays,
PE tubes, etc. There were several ossicular reconstructions I could not do because of
lack of equipment. I used up the entire pharmacy supply of cortisone nasal sprays. Also
the chromic catgut sutures started to run low. I brought a portable audiometer that
turned out to be extremely useful.
There is a broad range of ENT problems here, similar to those found in the U.S. This
includes a large backlog of needed tonsillectomies, traumatic nasal deformities,
tympanoplasties and ossicular reconstructions. I generated the surgeries as I saw the
patients and could fill one to two surgery days per week. I often did tympanoplasties on
the spot as the patients walked in. Even though there are many children with chronic
MOE, the adults seem to hide out and only trickle in. I had some surgery patients
appear on my last day here.
There is presently no anesthesiologist or OR nurse in Guadalupe. Amanda, the clinic
nurse, helps with setting things up and sterilization. Fortunately most ENT procedures
are one-person operations. I did tympanoplasties under local. Initially I did some tonsils
and noses with Ketamine and Versed, which I bought in Quito on my way here. High-
dose Ketamine brought of course all the known emergence problems with that drug. I
switched to Propofol as long as Lori was there to help me.
Later Padre Jorge and I went to the hospital in Zamora and arranged for surgeries
under general anesthesia there. The hospital is rather antiquated and has extremely
limited supplies. We brought everything with us, from needles to meds to sutures to
instruments. Amanda was tireless in helping to translate, organize, carry supplies and
keep the financial tap running, as well as keeping the good spirit going. We got up at 5
am to catch the bus to Zamora. On the way to the hospital we scoured the large indoor
market for rye flour, veggies and meat for our weekend feasts.
The anesthesia personnel at the hospital are a mixed bag. The first anesthesiologist we
had was slick and experienced, even with conscious sedation. On other occasions it
was rather slow and rough going. In order to keep the cost down Amanda organized our
own meds and bought what each anesthesiologist requested. We even supplied the
gloves.
If an ENT person were able to bring along an OR nurse for help, like some of the
ophthalmologists do, it would simplify things greatly.
It is difficult to line up surgeries in sufficient quantities to keep an anesthesiologist you
bring with you busy all the time. The patients don't show up on time or are difficult to
reach. In the long run I feel it would be much easier to arrange for an anesthesiologist
from Zamora to come to Guadalupe as needed, and activate the donated anesthesia
machine that the Clinic has.
Bring pounds of flexibility to adjust to third world medicine. I had a very rewarding
experience, and hope to return again next year.
Burger Zapf, M.D.

Guadalupe ENT report May 2005

It was very nice to return to the Guadalupe Clinic and see progress being made.
My hope was to avoid bringing all our equipment to the hospital in Zamora and instead bringing
the anesthesiologist to Guadalupe. Despite political turmoil in Ecuador and a nationwide doctor
strike, we were able to hire Dra. Rori Cedeño, the anesthesiologist, with whom I worked together
with very well last year.

The anesthesia machine was up and running but had not been used before with gases. The
machine has an Enflurane and an Isoflurane evaporator. I learned from Dra. Rori that Halothane
can easily be used in these evaporators. The latter one would actually be better for Halothane
since both gases have the same vapor pressure.
Rori came on three days and we did tonsil and rhinoplastic surgeries. On the last visit we did
seven rhinoplasties in one day. We used general anesthesia with Halothane in the Enflurane
evaporator without any problems. The turnover time between cases was amazingly short.
Because of the inevitable snafus, we weren’t able to schedule enough general anesthesia days, so
I started doing septoplasties under local anesthesia. The lack of cocaine is a real drawback. I had
to use Afrin and 5% Lidocaine ointment, which has problems. Upon Rori’s advice I also started
using Fentanyl 2mcg/ kg as sedation which worked out quite well in conjunction with Versed.

It became obvious that once you start doing surgeries in earnest (we did 75 cases in the 5 weeks I
was there) you run out of supplies fast. The #15 blades ran out and sedation meds got used up;
also the fiberglass casting material. The Gelfoam I brought ran out on the last day.
In response to the need for more complex tympanoplasties and ossicular implants, I extended my
ear instruments for post-auricular approaches and brought a mini-drill to shape ossicular
implants.
I did all the tympanoplasties and three stapesplasties under local anesthesia without problems.
If we had a mastoid drill we could also operate the cholesteatoma patients under general
anesthesia as outpatient. I have been doing cholesteatoma surgery in an outpatient setting in the
United States for decades.
I ran out of TORP and stapes prostheses in the end. It would be nice if some TORP, PORP and
Stapes prostheses were donated. Since I myself am presently not in a clinical setting, I have a
hard time getting my hands on prostheses.

Another large need that became again obvious to me is hearing aids. I had to turn away 3 to 4
patients a day who were all in dire need of amplification.

The ideal set-up would be to have a local person trained to fit hearing aids and then have
instruments donated and sent to Ecuador. This is the way it is already being done with
eyeglasses.

There are a number of groups who provide hearing aids to the third world. For example:

Starkey Hearing Foundation, Fred Rondo, Mark McCarthy, telephone 1-800-328-8602,

www.sotheworldmayhear.org.
Siemens donates hearing aids if you are a good customer. Rayovac also donates hearing aid
batteries.
I have heard that the Rotary Club or Lions Club have donated hearing aids to Ecuador in the
past, but the nurse Amanda has not heard about it in recent years.

Someone from one of these sources could train a local person while here. The ear molds can be
made easily; we even have a dental lab that allows denture production.

A portable audiometer, an ear mold kit and maybe a hearing aid tester need to be found. Initially
we could use just analog behind-the-ear style instruments which have been essentially phased out
in the USA. The instrument adjustments can be done simply by feedback from the patient (sound
too tinny: adjust the lowers, etc.)

It appears that an avalanche of ENT problems has begun to come down on us since my initial
visit last year. I saw more ear problems, yet 60% of the surgeries were again nasal. I also noticed
again the absence of vocal cord problems.
We decided to allow cosmetic surgeries this year, but charged higher fees to subsidize the
indigent patients and help finance the anesthesiologist and the anesthesia drugs. It needs to be
seen if that actually works out.

On the social side we again had lots of fun cooking, hiking, and exploring the region on
weekends.
I plan to return in late November to continue to help meet the ENT need in Guadalupe.

Regards Burger

Useful information for new ENT-Doctors:

The Guadalupe clinic has essentially no surgical ENT instruments. For any case you would like
to perform you have to bring your own tools and special supplies. Thereare only office
examination instruments and no audiometer.
I did not see any Head and Neck cases or laryngeal pathology while I was there. There is a lot of
traumatic nasal pathology, chronic tonsillitis and chronic ear disease. The clinic is not equipped
for overnight stay of patients or inpatient therapy. Those cases have to be done in Zamorra. This
hospital in Zamora has absolutely no surgical equipment useful for ENT procedures. They do
however have a cautery and overnight stay facilities.
Retired Annapolis doctor helps the poor in
Ecuador
By THERESA WINSLOW, Staff Writer

Like many physicians, Dr. Burger Zapf got into medicine because he
wanted to help people. So, in retirement, the Annapolis ear, nose and
throat specialist saw no reason to stop.

The 58-year-old has already made two trips to a clinic in the Amazon
region of Ecuador to help the region's poor, and will depart for another
stint there next month. This is in addition to work he's already done in
Mexico and other volunteering he did in Jamaica and St. Lucia when he
still had his practice. The volunteering is interwoven with his other
passion, sailing. Dr. Zapf and his wife, Nancy, will continue a protracted
sail around the world after he completes his latest stay at the South
American mission clinic.
"If you can help someone, it doesn't matter where you are," Dr. Zapf said,
flashing a smile. "It fits my personality. ... There's clearly a need."
Dr. Zapf's previous stints at Clinica Misonal "Nuestra Senora De
Guadalupe" have lasted four to five weeks, and during that time he saw a
variety of patients, usually from the indigenous population of Saraguro
and Shuar Indians. They are examined on a first-come, first-served basis
and pay $1 per visit, Dr. Zapf said.
The vast majority of the work involves nasal and ear problems, although
he's also done other kinds of treatment there. A nurse translates Spanish
for him, so language barriers aren't a problem.
Many of the medical issues he encounters with patients aren't that
different from those in America, though there are exceptions. He spoke of
one patient who made a return visit to him after surgery and had 13 full-
grown maggots living in his ear.
Aside from those kinds of cases, one of the major differences in medicine
is the lack of red tape that exists at the clinic. When he still practiced
here, he said, dealing with insurance companies took up lots of time.
"There, it all falls away," he said. "People need you."
They also admire his dedication.
"We really appreciate him a lot," the Rev. Jorge Nigsch, the director of
the clinic, wrote in an e-mail. "He is very generous, a hard worker, with
good humor and an excellent doctor. He is a problem-solver, he knows
how to adapt to new situations and make the best out if it. He is fun to be
with."
Dr. Zapf said he gets along with the Rev. Nigsch especially well because
of their heritage. Dr. Zapf was born in Germany and the Rev. Nigsch is
from Austria.
The Rev. Nigsch said the staff is looking forward to the physician's return
next month. So is Dr. Zapf, who relishes the problem-solving aspect of
the clinic work, since there isn't always the same kind of equipment he
had at his disposal when he practiced here. He retired about four years
ago, wanting to devote more time to volunteering and sailing.
The problem-solving can involve everything from improvising his own
medical instruments, like a specialized suction machine, to making a
homemade prosthesis for the inner ear when one wasn't available.
"I like it," he said, sitting in his home and showing pictures of the clinic on
his computer. "I like to solve problems. Things like this are never easy,
and we just solve problems as they arise."
Creature comforts
While the clinic is the jungle, staying there isn't exactly roughing it, Dr.
Zapf said. He said the accommodations are fine with him and shrugged
off any suggestion that his time there represented any kind of hardship.
Still, there's no air conditioning, and he has a picture of a tarantula he
found one day in his bedroom. A nurse told him she found a pair of the
spiders in another room. Rubber skirts under the front door keep out
snakes.
Dr. Zapf first found out about the clinic after searching the Internet for
volunteer opportunities. Mrs. Zapf, who serves on the board of the Seven
Seas Cruising Association, said she recognizes his need to help people
and doesn't worry about his trips to remote regions to do the work.
"He's very self-reliant," she said.
His past trips to Ecuador have worked out great, because she said she
got to spend time at home working on taxes while he was at the clinic.
This time, he'll fly to Ecuador first and she'll join him in December. They
then plan to travel the country and nearby Peru before setting sail for the
South Pacific.
Their 50-foot sloop, Halekai, is already in Ecuador. The name is
Polynesian and roughly translates to "home on the ocean," or
"houseboat."
He finds his time at sea just as rewarding as his time at the clinic.
"I like ... adventures," Dr. Zapf said.
---

Published October 30, 2005, The Capital, Annapolis, Md.

Copyright © 2005 The Capital, Annapolis, Md.
 Third ENT visit- fall 2006

To prepare for this visit I approached several companies for help. Gyrus ENT was extremely
helpful in providing scores of middle ear prostheses, PE tubes and a new sinus Gel. They were
also willing to give us a mastoid drill but I ended up on the number 2 spot on the waiting list. My
approaches to the Catholic Mission Board turned out to be frustrating, fruitless and a total waste
of time. I updated my middle ear instrument with great discounts from Gyrus ENT and arrived in
Guadalupe ready to go.

The clinic-office set-up was now done in a flash and almost routine.The existing full
complement of office examination instruments was put aside by Amanda and we just had to open
the box to get going.

The patient mix was again similar to previous visits: Lot of stress related throat pain, TMJ,
Hyoid syndrome, traumatic and cosmetic nasal and septal problems, chronic tonsillitis
and chronic middle ear disease, some pretty bad (one very large cholesteatoma, which I was able
to operate in the clinic OR) and some otosclerosis. Scores of sensory neural hearing losses in
need of hearing aids, which we presently don´t have. A fair amount of patients came from afar (4
bus changes) for a second opinion. Often for clearly unnecessary surgery.

Again a dizzying amount of high school teenage boys who wanted cosmetic nasal surgery and
required serious talking to.

The concept of doing some cosmetic surgery to finance the indigent patient procedures under
general anesthesia seems to work out and we came out financially clean at the end.

Dra. Rori Cedeño was again hired for procedures under general anesthesia in the clinic OR. She
is a very experienced and amazingly slick anesthesiologist who can do Halothane cases with
instant wake up!

Due to scheduling problems we did one surgery day at the hospital in Zamora. With the new
Peruvian president a new hospital administrator came in and is very interested in a cooperation
with the Guadalupe clinic. They also donated the drugs and materials for the surgeries that
allowed the nurse Amanda Anderson to give refunds to the patients. The hospital OR has now a
new anesthesia machine, nice cautery and suction. Sterilization is done with dry heat process!
Watch the wraps! The nurses seemed very competent and cooperative. The anesthesia (Fredy) is
more geared to long cases and not so much for fast outpatient turn over.

On the social side we again had lots of fun, great hiking and great cooking. I showed padres
niece how to bake German rye bread hoping this will finally sink into the cooking operation at
the mission.

I was lucky to witness the festival for the Madonna de Guadalupe.

A large crowd of pilgrims (including the volunteers) wandering 23 km through neighboring

towns carrying the Madonna in front. This also included, early in the morning, the marching into
town of a steer behind a brass band, slaughter and butchering in the town square of the poor
animal and finally beef soup cookout for the whole town. During the marching the first question
of every passer by was: how much did the steer cost( $250, payed for by the large organizing
committee). The festival included car racing, motorcross racing, fireworks, public dancing and at
the end Las Chicas del Fuego- a group of scantily G-string clad girls singing and dancing
shaking their behinds at the cheering crowd.

My contribution to the festival was selecting a big piece of beef on site and cooking a real
gourmet goulash soup for the organizing committee.(Not sure of their tastes I cooked a trial
version first). All of this served for lunch with crusty rye bread and beer.

In summary it was again a successful visit and progress was made again.

Burger Zapf, M.D.

Fourth ENT visit- April/May 2007

Here a slide show reference for interested parties to look at and get a feel how to reach
Guadalupe.

http://picasaweb.google.com/svhalekai/2007TripGuadalupeClinicEcuador

Burger Zapf, M.D.

Fifth Visit in November/December 2007

My fifth visit was dedicated to bring the hearing aid service in action. In preparation I
approached my old friend Mike Canary, an Annapolis hearing aid
dealer with experience in fitting aids in the third world. He graciously
dedicated two hours of his time to allow me to brush up on mold
making and simplified fitting of analog aids. I brought the hearing aids
donated by the Madison Lions Club through the initiative of Richard
Borner and we went over their characteristics and the different modalities for
adjustments.

The annual ENT conference happened to be held close by in Washington,DC and I took
the opportunity to approach Gyrus ENT who generously donated a mastoid drill system,
stapes prostheses and TORP ceramics. Also Ethicon donated large amounts of
GELFOAM for my tympanoplasties. Cheep instruments abound to complement my typla
set. I connected to the University of Connecticut ENT staff to generate interest for future
missions and to have a university and residents getting involved. I approached Starkey
the hearing aid company who organizes hearing aid jornadas all over the world. They
appeared very interested but in the end the contacts petered out.

After my arrival in Guadalupe things were getting soon into full swing. Without too much
advertising the patients started flowing in. Successful stapesplasties on patients living at
the coast in El Oro started a local initiative. A thankful patient began a radio advertising
campaign and literally a busload of patients hard of hearing arrived. This generated 6
stapesplasties- there must be a nest of otosclerotics living in this area- and multiple
hearing aid fittings.

To separate the needy patients, Amanda explained to them that the hearing aids were
used by other people before and not of the latest technology. This invariably let people
of means seek out their local hearing aid dealer to buy the latest digital aids. Our supply
of hearing aids dwindled rapidly and Amanda agreed to learn to fit aids after I left. I gave
her some lessons and left my audiometer behind for her use.

Again an endless line of rhinoplasties emerged. I ended up doing 9 in a row on one day.
After Padre Jorges attempts to get the military anesthesia involved failed, we again
hired Dra.Rori the anesthesiologist from Loja who agreed to spend her weekends with
us to do all the general anesthesia cases. That of course let to mammoth 14 hour
surgery days. I'm confident that I could keep an anesthesia person busy through out the
entire jornada with general and conscious sedation cases. That would spread the daily
load to more tolerable hours.

Again lot of second opinions for unnecessary surgeries, lots of nasal trauma, cosmetic
cases and more chronic ear disease and otosclerosis than ever. Interesting cases, good
hearing and rhinoplasty results that will lead to more patients in the future for sure. The
concept of doing some cosmetic surgeries to finance the whole operation appears to be
solid now.

Our resident medical student Sarah Milgrom got the opportunity to learn to start IV's,
hone her surgical skills on the many minor surgical cases and even learn how to
intubate. This made me painfully aware again how many teaching opportunities are lost
to ENT residents who would greatly benefit from these many interesting clinical and
surgical experiences.

Burger Zapf, MD , PhD

Sixth Visit in November 2008

I spend all year sailing the pacific which left me with little time to prepare for my 6th visit.
For this November my good dentist friend Ekkehart found Thomas, a German
anesthesiologist who was willing to spend two weeks with us.

So we scheduled him for the second half of the jornada with the idea to collect general
anesthesia cases for him.
I was able to have plenty of suture material very generously donated by Ethicon that
helped to solve our chronic 5-0 , 6-0 suture shortage.

Well, the ENT program seems established to the degree that 92 patients showed up on
the first day! Some patients all the way from the Peruvian border literally camped out in
front of the clinic.

Overall I saw 382 patients for consultations and did 92 surgical procedures that included
45 septorhinoplasties, 10 Stapesplasties, numerous tympanoplasties, a cleft palate, a
mid face bone on lay, a mastoidectomy (Thank you Gyrus ENT for the drill system) and
numerous assorted septoplasties scar procedures TE etc. All this kept Amanda reeling.
The new fan on the microscope solved all the lamp burn out problems and we got to
enjoy the new air conditioner in the OR.

The referral of general anesthesia cases to the last 2 weeks backfired in that we again
ended up doing 12 hour surgery days to finish all these procedures.

I neglected to procure more hearing aids and ear mold material and we
again stood sorely by unable to help the numerous deaf people needing amplification.

Burger Zapf, MD , PhD

 Sixth Visit in November 2009

To see more about this visit, please, click here

Seven Seas Cruising Magazine under volunteering

(after the 7th visit in November 2009)

When I retired from my Annapolis ENT practice in 2001, my plan was to

combine our circumnavigation with medical volunteerism in the third world
countries that we visit along the way. But as I’ve discovered, it isn’t very
effective to just dinghy ashore and visit the local clinic.This can work
sometimes,but it’s much more effective to prearrange visits. In addition to
establishing contacts individually, there are a host of nonprofit organizations
with volunteer opportunities worldwide, to be found by researching the
Internet. This is mainly how I came to volunteer in Jamaica, St. Lucia, Mexico
and Ecuador over the past decade.

Our cruising mode has changed over the years, especially since our
grandchildren were born. We now leave the boat during cyclone season to do
some land travel and to return to the States for a few months each year. This
schedule lets me fit in a month-long volunteer stint at a medical clinic in
Ecuador once or twice each year. I am now on my seventh such visit, and it’s
rewarding to be welcomed by some of the same staff and see some of the
same patients and their families

in follow-up. My time in the States gives me time to seek donations of

medical supplies needed at the clinic, and to try to find other volunteers,
such as anesthesiologists and OR nurses to assist me, and, so far without
success, for ENT residents to train with me.

The Guadalupe Mission Clinic serves the rural population in the southeastern
province of Zamora-Chinchipe, near the border of Peru. Getting there
involves an hour-long flight from Quito to Loja, followed by a four-hour bus
ride through the Andes Mountains to the Amazonian highland village of
Guadalupe. The clinic is a modern building complex funded by the Roman
Catholic Church in Austria and the United States. Padre Jorge Nigsch, the
parish priest in charge, is from Austria, and the volunteer doctors, nurses
and dentists come mostly from Germany and the United States. There’s no
need to be Catholic to participate.

The clinic is fairly new and unusually well equipped for such a remote
location. It has an established dental service, a lab and a regular stream of
German dentists and lab techs. An air- conditioned operating room has an
anesthesia machine and modern equipment, including microscopes. The
pharmacy is stocked with donated and bought drugs, but volunteers usually
bring donated supplies for their own specific needs. I’ve been bringing my
own surgical tools and supplies with me each time. There have been visits by
dentists, internists, general surgeons, ophthalmologists, gynecologists and
other specialists, some of whom return every year.

The word spreads fast when visiting specialists are scheduled, and many
patients come the night before, camping out and sleeping on the front steps
of the clinic in order to be first in line the next morning. As the reputation of
the clinic has grown since its opening in 2001, some patients come from
distant parts of Ecuador, seeking second opinions and surgery. The mostly
indigent patients are seen on a first-come, first-serve basis and pay $1 per
consultation. I see the full range of ear, nose and throat cases, and over the
years I’ve treated approximately 2,500 patients and performed over 500
surgical procedures. My Spanish is rudimentary so a bilingual nurse
translates for me as needed. Occasionally I perform cosmetic nasal surgery
for higher fees to help fund our other operations. I’m still working to establish
regular donations of hearing aids and to train a staff person to fit them.

The volunteer medical staff quarters were built recently and are very nice,
even to first world standards, with unique electrically-heated showerheads,
computer with satellite Internet access and a DVD movie collection. Room
and board is gratis, but volunteers organize their own transportation.

Weekends are free for exploration, sightseeing or just relaxing. There’s a

communal kitchen for cooking and camaraderie (nuns provide meals during
the week). One of my specialties is German sourdough bread, most
appreciated by Padre Georg Nigsch! The covered veranda overlooks the
tropical rainforest mountains and the river. Popular excursions are visiting a
commercial frog farm, hiking in the cloud forest of the nearby National Park
(with exotic birds, orchids and waterfalls galore), and trips to indigenous
Saraguru and Shuar Indian villages—once known for their shrunken heads!
I’ve been able to witness the elaborate festivities of Easter Week in April, All
Souls Day in November, and the Festival of the Madonna of Guadalupe in
December.

One of the benefits of third world volunteerism is the lack of red tape, with
no paperwork or hassles with insurance companies. I can just focus on
patient care and surgery, while enjoying the satisfaction of seeing lives
improved and being appreciated for my efforts—while meeting interesting
people and experiencing different cultures. Similar to the need for self-
reliance when cruising in remote areas on a sailboat, I relish the challenge of
creative problem-solving, such as improvising medical instruments or making
a homemade prosthesis for the middle ear when they’re not available.

I’ve put together a photo slideshow with captions about my trips to

Guadalupe:

http://picasaweb.google.com/svhalekai/GuadalupeClinicEcuador# The clinic’s

website is www.guadalupe-ec.org. The Friends of the Mission Clinic of Our
Lady of Guadalupe, a 501c charitable foundation, has been formed to accept
U.S. tax-deductible donations and allow U.S. volunteers to claim their travel
expenses.

Burger Zapf, M.D., Halekai

Report of 7th visit in Guadalupe, November 2009

My musings after my last visit of having general anesthesia from the start became
reality. Interplast Germany sent My, Beate and Gerd to be there for the whole “jornada”.
Each one covered part of the visit.

Padre Jorge Nigsch had a clever radio ad campaign started well ahead of time and it
was running throughout my entire visit. This led to me seeing 82 patients on the first day
and about 60 patients showed up every day there after. With the help of our internists
we saw about 750 patients. I myself saw 512 mainly in between surgeries.

Poor Serle, our founding internist who came for his yearly two-week visit to the clinic,
was suddenly saddled with huge numbers of patients keeping him busy into the evening
hours. My “great idea” had backfired. Instead of working in a leisurely pace it became
more frantic than ever. We increased our surgeries by 70%. Over 140 cases in all. Most
under general anesthesia using a larynx mask type.

My and Beate, our first anesthetists, had to go thru a Customs ordeal in Quito in order to
bring in their supplies. The drama unfolded over several days and involved the German
consul in Quito all the way back to the Ecuadorian embassy in Germany and the bishop
in Quito. They finally made it to Guadalupe.

We then had a delightful cooperation. The OR ran smoother than ever. Of course
mainly thanks to Amanda’s ever present organization and the skilful help of Johannes
Nigsch, Padre Jorge’s nephew. At the end Johannes was my skilled OR nurse for ear
cases. This reduced the surgery time by 20 minutes per case.

The demand for rhinoplasties again was increasing to an alarming rate and I started to
think about setting a quota. I also wanted to include cleft lip and palate surgery into
future visits. I did several Furlow type cleft palates and a forked flap for a lip revision
after previous cleft surgery. However I thought it was time to get serious about it.

US interplast was cooperating in a venue in Portoviejo EC for cleft surgeries. I therefore

contacted Prof. Jorge Palacio from the University of Guayaquil who has been running
this for many years. After I finished my visit in Guadalupe I went to Portoviejo and
joined the group looking for ideas and pointers. It was a very successful stay and I’ll
return to Guadalupe in April to join Interplast Germany for more intensive cleft work.

Next November I would like to advertise for clefts as well to shift the emphasis away
from nasal surgery if possible. The ear care necessary for cleft patients was missing in
Portoviejo. We can establish that right here in Guadalupe.