Becoming a Better Planner

Day one.  As my airplane landed in Sao Paulo, I was to be picked up by Regina, a dear friend of Marcia and prominent doctor at HEPATO (Transplant Organization in Sao Paulo).  Not knowing what she looked like, not having her phone number, and definitely not inquiring for her address, it was about 45 minutes of waiting till I realized I was upstream with out a paddle.  Now, 'call Marcia,' some of you might be saying.  That sounds easy if it weren't for the country code, city code, and out going Sao Paulo code I needed to know.  You can imagine, if I wasn't in-tuned enough to ask for Regina's address you know I didn't know ANY of these numbers.

But call me Sherlock Homes, because after about 10 minutes of asking around I was able to make contact with Marcia and connect my dots.  Regina thinking I arrived the following day, was just as surprised as I was, still being at the airport late Saturday night.  Luckily, Tercio (my sudo-host for the week and Transplant Surgeon at HEPATO) swooped to the rescue.  I was soon home in a comfy bed reading myself to sleep.

Unlike my leisurely weekends here in Belem, come Sunday afternoon we were off to tour the ICU at Hospital Bandeirantes.  We started and didn't stop.  People in Sao Paulo work a lot.  I could safely say they work three times as much as Americans and accomplish half what we do.  It isn't the people but the bureaucracy.  If anything I finally understand what my Dad means when he says, ,"Life here [America] is just easier".  Beyond the beautiful beaches, wild Carnival, rhythmic samba, and psychotic soccer fans, Brazil can be a hard place to work and an even harder place to succeed.  Watching the dedicated and compassionate team at HEPATO you have to marvel at how they can accomplish anything at all.  And I think how much easier it could all be.  But I guess that is something I hope to change.  With the protocols and policy and procedures, one can provide a standardization of care and not only be more efficient but improve patient outcomes. My goals for this week were to share with HEPATO and the nurses of Bandeirantes my experience with this organized system.  Through observations, conversations, and presentations ( a lot of -ations) I would share our process for management of liver transplant patients.

My Aunt having already told me about the importance of Bandeirantes for the city of Sao Paulo, I was excited to see the place.  Much to my surprise, I felt right at home.  Almost half of the hospital being newly built, the beautiful building was a nice change from the mundane architecture of Brazil.  A 200 bed private hospital with specialties including transplantation, cardiology, and oncology.  My initial impression was positive.  I was impressed by the display of advanced technology, the cleanliness of the facilities, and the organized system for providing care.  We visited Tercio's newly transplanted patient.  Two days prior to her surgery she had a MELD score of 39 (out of 40) and the day of surgery had a MELD score of 36.  For those of you that are not transplant savvy, that means she was sick as snot.  One difference I discovered and will dissect later was the selection process for their transplanted patients.  Proving to have a high effect on your outcomes and development of complications, this was one of the most important challenges this institution faces.  And with further research into the reasons for transplanting extremely sick patients, it showed a challenge for ALL Brazilian transplant institutions.

But much to Tercio's relief his patient was stable and well.  We continued on our rounds and called it a short work Sunday.  And no day would be complete in Sao Paulo with out a delicious dinner.  Meeting the rest of the HEPATO team, we started our long debates about healthcare, politics, culture, and of course Transplantation.  I met Tercio's partner, Marcelo, who is conveniently married to his sister, Nuninha, whom also happens to be the HEPATO administrator, and lastly Regina, their heptologist.  I could tell this was the start to a wonderful week.