Editor’s note: The 14 ACS Advisory Councils, which act as liaisons between surgical societies and the Regents, periodically submit articles highlighting notable initiatives within their respective specialties.
This week’s issue features a submission from the Advisory Council for Rural Surgery.
Global surgical missions not only provide care to underserved populations but also offer an opportunity to reflect on how such care can be sustained.
In September 2025, I participated in a mission to Honduras with the World Surgical Foundation. In Honduras, only approximately 64% of the population has access to essential health services. This mission provided free surgical and perioperative care to patients who otherwise lacked access to care due to financial or systemic barriers.
It was my third such mission, and I was struck by the importance of sustainability in resource-depleted countries. Although the service we provided offered temporary relief, the need for equitable access to surgical care through mutual learning, long-term partnerships, and capacity building was evident.
The most important aspect of this mission was not simply the delivery of care, but the sharing of knowledge and skills through collaborative practice. Our team worked at Leonardo Martinez Hospital and Mario Catarino Rivas Hospital, both in San Pedro Sula in Honduras’s Cortés Department. I joined the adult surgery team at Leonardo Martinez, where local physicians screened patients and visiting surgeons performed procedures. Common cases included cholelithiasis, hernias, thyroid tumors, and breast cancer.
Many patients presented with advanced disease after years without treatment, requiring approaches tailored to available resources rather than what surgeons in high-income countries would consider standard of care. For example, breast cancer patients often underwent mastectomy rather than breast-conserving surgery due to limited access to adjuvant radiotherapy, even for low-stage cancers. This made me realize that global and rural surgeons and patients often face similar resource and personnel limitations.
Resource limitations significantly influenced intraoperative decision-making. Advanced procedures such as ERCP were unavailable, requiring reliance on clinical judgment and skill in real time. This brought home the concept of “clinical courage.”
Laparoscopic surgery was performed using a single monitor with limited visualization. Improvisation was essential, including the use of soap solution or omentum to prevent lens fogging and tied surgical gloves as specimen retrieval bags. Equipment incompatibility was addressed creatively, such as modifying a Nelaton catheter to connect laparoscopic components.
Despite these constraints, procedures were completed safely through teamwork and adaptability, deepening my respect for the local surgeons with whom I worked. At Mario Catarino Rivas Hospital, the pediatric surgery team worked closely with local surgeons, engaging in hands-on collaboration and exchanging practical techniques. In one gastroschisis case, a temporary silo was constructed from a sterile IV bag, demonstrating how knowledge and ingenuity can be shared and adapted in resource-limited settings.
For me, this experience was not a one-sided effort, but a bidirectional learning process. Working alongside local providers exposed me to different clinical priorities and decision-making approaches. It reinforced the importance of mastering fundamental techniques and prompted me to consider how equitable access to surgical care can be expanded globally. I will remain committed to refining my skills and contributing to global surgery through education and collaboration.
