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By Matt Skoufalos


Founded by the Association for Healthcare Resource and Materials Management (AHRMM) and supported by medical device manufacturers Becton, Dickinson, and Company (BD), the Project Perfect World Foundation aims to support the health care needs of underserved children throughout the world. For nearly 25 years, the project has supported a minimum of two medical mission trips annually that help qualified medical professionals reach pediatric patients in need of maxillofacial, dental and orthopedic surgery.

Its longest-running relationship is that with the Roberto Gilbert Hospital for Children in Guayaquil, Ecuador, where recurring visits from Project Perfect World (PPW)-sponsored specialists have helped the facility build a robust spine and general orthopedics program. During their visits, PPW volunteers have helped train Ecuadorian surgeons to create a lasting, sustainable continuity of care that persists beyond the length of their stay.

When Travel Nurse Brenda Duncan was invited to participate in a PPW visit to Guayaquil – paid for by her employer, Cross Country TravCorps of Boca Raton, Florida – it was an opportunity she couldn’t pass up. Duncan had always wanted to do medical mission work, but said the chance had never come her way.

“For whatever reason, I would find out about things too late, or I would already be committed to a contract,” Duncan said. When Cross Country selected Duncan and her TravCorps colleague Paula Zito for the mission, it was the call she’d been waiting for.

“I don’t consider nursing my career, but my vocation,” Duncan said. “For me, it was very rewarding to be able to share what I can do with somebody that might not ever have the opportunity to have that done. It’s a very, very worthwhile thing.”

Duncan was moved not only by the chance to get to a worldwide area of need but by the opportunity to improve the lives of children who live in significant poverty. Even though the city is the largest in the country and home to its leading commercial port, the average monthly income in Guayaquil approaches just $300. Situated on the Gulf of Guayaquil, the city is also susceptible to natural disasters, including tsunami and earthquakes, which compound the precariousness of its populace. Leprosy is a common local concern because the mycobacterium that causes it is prevalent in the soil; despite being inexpensive to treat, “most people don’t have the wherewithal to get to the clinics or pay the minor amount of money it would take” to do so, Duncan said.

Guayaquil is also the most technologically advanced city in Ecuador, Duncan said, and a tourism destination as a launching point to the nearby Galapagos Islands. The conditions of its poverty are also synonymous with its rebirth, she said, with buildings in need of redevelopment often adjoining examples of ultramodern architecture.


As those economic projects continue to search for more solid footing, the work of groups like the Junta de Beneficencia de Guayaquil, a national non-governmental organization that provides a network of subsidized health services in Ecuador, is critical to sustaining the welfare of the indigent, the elderly, expectant mothers and people with mental health issues. One of the hospitals through which the Junta delivers services is the Roberto Gilbert Hospital for Children, and Project Perfect World is one of its key partners.

“In Ecuador, to be selected for Project Perfect World is like literally winning the lottery,” Duncan said. “The Junta has a national lottery that pays for a girls school, a boys school, a nursing home, a national cemetery, and a children’s hospital. Families are responsible for a certain percentage of their care, and so parents have to sign a paper for their children and pay their portion of the bill.”

Duncan said the penalties for patients failing to meet their copays can be all-encompassing, and the services at the hospital are closely rationed.

“At the entrance to every department, there is an armed guard with a bulletproof vest, and you cannot get through that door if you don’t have the proper paperwork,” she said.

Compounding the severity of their conditions, many of the patients who sought care at the Gilbert Hospital had traveled for hours on a bus to get there, and would travel hours back in restrictive casts in which they could spend as many as six weeks before getting follow-up care from an orthopedic surgeon.

“Most of the surgeries we did were for congenital hip dysplasia and club feet,” Duncan said. “Then, we did some surgeries related to trauma in the past that needed to be corrected. These kids were in casts that go from the belly button to above the knee on one leg and on the other leg to the ankle or all the way to the toes. Their parents would have to take them home on that bus ride.”

Joining Duncan and Zito on the trip was a pair of pediatric anesthesiologists and two pediatric anesthesiology fellows. On their first day, the surgical and anesthesia teams set up the supplies and unloaded equipment while the surgeons met with patients. Inside of a week, the group saw roughly 160 patients and performed 20 surgeries: two per room per day from Monday through Thursday, and one case each on Friday, their departure day.

“We got there at 7 every morning, and were normally going back to the hotel at 11 at night,” Duncan said. “They were long hours, but everybody was OK with that and we were happy to be there. It was truly amazing, and the families were so appreciative.”