Anesthesia Deconstructed: Science. Politics. Realities.

Erik Kramer CRNA FNP Mission Trips Mexico, Mosul and The Congo

October 09, 2019 Michael MacKinnon DNP FNP-C CRNA Season 1 Episode 2
Anesthesia Deconstructed: Science. Politics. Realities.
Erik Kramer CRNA FNP Mission Trips Mexico, Mosul and The Congo
Chapters
00:03:29
Moved to Mexico Full Time for 5 years
00:19:46
How the FNP Added to capability
00:30:47
How did they see APRN/CRNAs?
00:37:54
Served in Mosul taking care of trauma
00:48:25
Served in the Congo in an Ebola Clinic
00:56:00
Eric's Top 3 Take Aways
00:58:51
The Politics of Returning Home
Anesthesia Deconstructed: Science. Politics. Realities.
Erik Kramer CRNA FNP Mission Trips Mexico, Mosul and The Congo
Oct 09, 2019 Season 1 Episode 2
Michael MacKinnon DNP FNP-C CRNA

Many healthcare providers talk about going on medical mission trips but few ever take the time out of their lives to actually do so. Erik Kramer CRNA FNP not only served humanity on a mission trip but he has done many! Erik and his family spent 5 years in a small rural hospital in Mexico where he provided anesthesia, emergency and critical care service as well as encountered the Sicario Cartel daily. He went to Mosul where he took care of victims of war from both sides and witnessed some horrific cases. Finally he went to the Congo where he and one other FNP ran an ebola clinic which acted as a triage center in which they identified, treated and saved patients with ebola! Listen in as you hear a man who feels a calling to help those in need through love and service. It is an amazing story you do not want to miss!

Show Notes Transcript Chapter Markers

Many healthcare providers talk about going on medical mission trips but few ever take the time out of their lives to actually do so. Erik Kramer CRNA FNP not only served humanity on a mission trip but he has done many! Erik and his family spent 5 years in a small rural hospital in Mexico where he provided anesthesia, emergency and critical care service as well as encountered the Sicario Cartel daily. He went to Mosul where he took care of victims of war from both sides and witnessed some horrific cases. Finally he went to the Congo where he and one other FNP ran an ebola clinic which acted as a triage center in which they identified, treated and saved patients with ebola! Listen in as you hear a man who feels a calling to help those in need through love and service. It is an amazing story you do not want to miss!

Mike MacKinnon:

Hello everybody and welcome back to anesthesia deconstructed episode number two. My name is Mike MacKinnon. I am your host. On this episode we've got Eric Kramer and FNP and CRNA who has done multiple medical missions along with disaster response team. Welcome to the show, Eric. Awesome to have you here.

Eric Kramer:

Hey, thanks for having me man.

Mike MacKinnon:

Yeah , it is great to have you here. I'm really excited to hear about all the different stuff you've been doing. I know I I've been following you on Facebook and your trips both to Mexico as well as other places and, there's been some amazing skillsets and really phenomenal medical care that you're providing in places where otherwise t here would be none.

Eric Kramer:

Yeah, sure. First of all, we go farther back than Facebook. I got to say real quick, back to the old nurse-anesthesia.org website. So, I mean, we're talking an old,

Mike MacKinnon:

I know it's been a long time.

Eric Kramer:

As far as missions go. Yeah. I just moved back from Mexico. I've lived there the past five years. I worked for a little organization called Mexico medical missions and we worked with an indigenous tribe called the , Tarahumara Indian. And I did anesthesia and a whole bunch of other stuff for the admissions hospital down there.

Mike MacKinnon:

Oh , that's amazing. And how did you get hooked up with that group?

Eric Kramer:

So, I mean, I grew up kind of in Latin America. My folks worked for habitat for humanity for years. So my sister was born in Peru and stuff like that. And then I went to like a Mexican public school for a few years , and then we moved back to the States . I went to college but, my parents moved back and my mom started linguistic work with Ralámuli. She's like one of the world's leading experts on the Tarahumara language (Ralámuli). That's their, that's their word for themselves Tarahumara. The people who run, they're famous for their long distance running. Before I got into anesthesia school, I was just kinda trying to figure out what I wanted to do with my life. And I realized I, I went down and visited them and I realized that there's a huge need for anesthesia down there. They, this little mission hospital , h ad started i n, there was no, anesthesia. There was an orthopedic surgeon that was just trying to do everything under basically local or bier block . Um, and that was kind of the Kickstarter to get me going into anesthesia. So I went to anesthesia school fully intending to move down to Mexico and we paid off our debt. A couple of years after I graduated, I sought out a job that was specifically going to give me the skillset that I needed to work independently because I was by myself down there. I was the only anesthetist. And so I got a job at a small little rural hospital, which I feel is the secret gem of the anesthesia world, right? These small little places that are all over the place, that are run by nurse anesthesiologist. And there I learned how to do regional anesthesia. I learned it . It was a great span from, from very simple cases, orthopedics, all the way up to open hearts . So I got a little taste of everything and it really prepared me well for heading down South to Mexico.

Mike MacKinnon:

That's amazing. And , and so when you went down to Mexico, you brought your whole family with you.

Eric Kramer:

That's correct. Yeah. I have a wife and two kids. We immediately, after graduating I took boards. December, 2011. Uh, no, I'm sorry. December, 2010 I went and did my first mission trip down in Mexico a few days later by myself. My first anesthetic as a CRNA were delivered by myself. And that's what I really kinda decided, Oh man, I really need to start doing this long term . So my wife and my kids and I started coming down with all our vacation time. Every time we had a vacation, we come down and do a missions trip down to Mexico. And I just do the anesthesia there at the little mission hospital. Kind of trying to figure out whether or not it's what we were supposed to do or not. We're Christian . So, you know, we spent a lot of time praying about it and stuff like that . And finally, after a few years we decided we were supposed to do that yet. And I'm someone that I didn't want to drag my wife along with me. You know what I mean? That's never a good idea. So she had to kind of independently come to the decision, that's where we were supposed to do. So it took us a few years to get there.

Mike MacKinnon:

And is your wife a , is your wife medical as well? Did she assist while she was down there?

Eric Kramer:

My wife is a math and science teacher and so part of her job, she had to , I mean, when you're down there in that environment, you do a whole bunch of things. But one of the things you did was tutor kids , uh , other missionaries.

Mike MacKinnon:

Amazing. So both of you basically were involved in the service industry , in servicing humanity, basically in Mexico and did , your kids get involved as well?

Eric Kramer:

My kids went to the Mexican public school down there. The Mexican public schools really rural. A lot of the kids when they first entered the Mexican public school system don't even speak Spanish. They just speak that Ralámuli the language. And um, my daughter started in first grade and went up through fifth grade and the Mexican public school, my son's starting kindergarten and I believe went up to third grade and they just kinda , they spent most of their time if they weren't at school, we lived on the hospital compound so they would just run around on the hospital compound, you know, outside our house and play with other kids.

Mike MacKinnon:

And you felt , uh , felt relatively safe down there with your family?

Eric Kramer:

It's safe. I mean, this is a part that overdramatized a lot. It was opium and marijuana growing territory for the Sinaloa cartel that the Sinaloa guy open carried in our town. They were the police of our town. You just see them walking around with their AKs, but they left us alone. At first. It was pretty disconcerting. I remember the first time I drove into town with a team for my church, we'd come down to help us , help us finish building our house. We drove into town and the cartel guy didn't know who we were and didn't recognize their trucks . So they all poured out of their , their house with their guns aimed at us until I turned that truck sideways to like show them the Mexico medical sticker. But once they got to know us, it wasn't a big deal. Um, they tended to wave us through checkpoints and stuff like that, you know, because anywhere associated with the hospital and we're kind of a neutral party and all of that.

Mike MacKinnon:

All right . And so basically you'd be taking care of them and their family just as you would anyone else in the town, right ?

Eric Kramer:

Yeah, absolutely. I mean, part of it is because it's out of necessity. It's the politics of the thing. Right. You know , um , it, because it provides, you know, it allows us to operate there and the other people. And then the other part is honestly, because I think that's what Christians are supposed to do. One of my favorite verses. This is one I found when I was in Mosul in Iraq on a bomb shelter with samaritan's purse that inside the bomb shelter, people that turned it into like a little devotion area and um, someone had written on the wall pray for ISIS and they said a diverse really struck me. I'd heard it a lot of times before, but it really hit me there. It said, you've heard it said you shall love your neighbor and hate your enemy. But I say to you, love your enemies and pray for those who persecute you . And if I can just get on a soapbox for a second, I think love is an active thing that needs to take action, right? So if we just focus on serving and helping the people that we think are easy to serve, like, you know, indigenous people or something like that, then really we're no different than anyone else. But the way people really start to change a culture is by serving and loving the people that are hard to serve in love. Therefore the cartel people that are there , right? Cause if we just treat them like bad people that they are, then we're essentially reinforcing their own opinions and work . We're contributing to the whole cycle of thing. We're bandaging them up so they can go out there and rape and kill and hurt people all over and over again. It's this vicious cycle. But , um, I don't know if that makes any sense or not, but that's one of the deep core reasons of why we were down there.

Mike MacKinnon:

No , it totally makes sense. I mean I think that's an, an amazing sentiment that a lot of people can learn from. The fact of the matter is , is if you continue to treat people as if they're evil, they will continue to be evil. You'll push the more down that path. And , um , by accepting them and taking care of them and trying to show them a better way, you know, whatever religious beliefs you have or however you you identify with faith or, or morals and ethics, I think, I think that only pushes them in the right direction, don't you think?

Eric Kramer:

Yeah, absolutely. It's kind of, it's a fundamental human idea. I think that extends beyond, like you said, religious boundaries in the sense that, you know, like violence begets more violence. But when you confront violence with love or something different that's really radical and they've never seen before, and that often causes people to pause and think and go, wait, what is going on here? Why is this so different than anything I've ever experienced in my life? You know, because you see in the towns there , those little villages, it's super impoverished. Everybody's just completely destitute. You know, everyone's living just on what they can grow and the, the ultimate occupation out there, the occupation with all the money, glory, fame, four by four trucks, everything is to be a cartel foot soldier . sicario, you know, so like they don't have anything else to live for out there. And it makes it tough because like there's no other alternative. And when, when this, the sicario lifestyle is promoted as like this awesome thing, you end up getting into this whole horrible cycle of violence and people growing up and perpetuating the same violence that they stopped perpetuated on their own families and stuff like that. It just really kind of a difficult thing but yet the same just solution in my mind has never been more violent . You know, the solution is to inject something different into that whole , uh , dynamic to try to change it. Uh , not through hurting people, but trying to help them, if that makes any sense.

Mike MacKinnon:

I think that's a phenomenal insight. I also think that just what you said there echoes in America. I mean, you know, in areas that are economically impoverished, you know, people wonder why someone ends up selling drugs. Well, it's because all that's all they ever know is the only opportunity they have. It's their future whether they've decided on it or not. Sure. And unless you show them something else and help them along the way, they're never going to get into that vicious cycle. Totally accurate. I mean, totally agree. Yeah, I totally believe it. And so when you're down there and bring in your family and you go down, did you feel like, so I went on a mission trip with Juan Quintana to Columbia, and when I was down there, there was an absolute feeling of gratitude , uh , from the town. And they were clearly not only happy but elated that people would come from somewhere else to assist them, which would be cared they would otherwise not receive, couldn't afford to receive, or had no ability to receive. Did you feel that as well?

Eric Kramer:

Uh , I'm going to be totally honest. No. And that has part to do with the particular people group. We were serving the Tarahumara. They're super reserved and distrusting and isolated, isolated from Mexico, from even other , uh , communities with their own people group. And that for a lot of reasons, they're one of the only indigenous tribe that , uh , was not conquered by the Aztecs. They just fled to the mountains and Hid. Um, it's one of the reasons why, even though they're like only eight hours from El Paso, barely anyone speaks Spanish in their tribe or , um, not many people from the outside are able to speak the language. They're just incredibly isolated and they don't trust outsiders. They don't trust , um, they don't trust Americans. They have this story in their belief system where they say that God and Satan ran a foot race and , uh, whoever won the foot race , uh, was gonna win a prize. And I'm butchering this story cause it's been a couple of years since I've heard it, but basically the white man won the foot race. So their prize was to dominate the Tarahumara and, and, and the Tarahumara, w ere going to be subjugated. So long story short, there's been this long history, i t w ith the Tarahumara people of being abused and taken advantage of. And, and part of that is because the cartel thing, b ut it goes way back beyond that. And so when we went out there, u h, they don't trust us. They don't trust the medicine we're providing. They don't trust anything about us. So it's really a l ongterm relationship building thing. I never really saw much of the gratitude that I would see, say I went on a Guatemala missions trip or something like that where people are more open and basically used to seeing outsiders.

Mike MacKinnon:

Yeah . So even after five years of service, you really didn't, didn't feel that. I mean you obviously know their , you know, they have gratitude for the fact that you're doing these things for their kids, their family. But it didn't come across in that same way.

Eric Kramer:

Yeah. Not generally. I mean there's individual instances, you know, but generally speaking, they're just a very reserved people group and in front of the things that actually respect about them. The other thing I'll say is , uh , that about like feeling , um , gratitude or whatever is that there's a difference between a short term trip and what we did for five years. You just, it ends up being a long grind. And one of the reasons we actually left was because I was working 120 hours a week in various different capacities that was running the tuberculosis clinic. At some point I was the stand in medical director, I was the head of nursing, I was doing the critical care flight stuff. I was doing emergency room and hospitalist coverage as the nurse practitioner, you know, on and on and on. And there's no imagine doing all those jobs in the state, you know, and for a hospital and working 120 140 hours a week and it's not that gratifying. And so it was not that gratifying in Mexico either, if that makes any sense, like it's tough. You have to find that work life balance. So it's probably not what you want to hear when you're talking to someone about missions and that kind of thing. But it's the honest truth it , you know , whether you're in Mexico or in the United States, finding that work life balance and being able to figure out what your boundaries are. Super important.

Mike MacKinnon:

Well, I think you made a very important point there in that it's not like going for two weeks to Columbia like I did or to Guatemala or to any other place. This is, this is moving there. This is your whole life is there. It then becomes your job. It's very different. I , I can definitely see how that would, would differ, especially over time because the grind would get to you.

Eric Kramer:

Yeah. Five years. Yeah, you can, you can, you can hold up, you know, with the intense pace of a short term condition, super intense pace, working all day. You can do that for a couple of weeks , you know, but if that was what you did for 24, seven, it , it does get, you know, they'll get pretty tough after awhile .

Mike MacKinnon:

And while you were there, was there, were you compensated in any way for all this , all these hours? All this time?

Eric Kramer:

No, no, no. Yeah, no. We , uh, we took donations, but you know, to be really , uh, as diligent as we could with everyone's donations, we didn't use it as a , to pay for our own expenses outside of like a gas. And , electricity. We would , uh, use that to buy medications and upgrade stuff at the hospital. What I would do is every, every nine, 10 months or so, I come back to the U S and I'd would do locums anesthesia for a couple months to earn our, our , uh, money so we could live down there for the next year.

Mike MacKinnon:

So, you know, at the risk of embarrassing you basically, you did it in an entirely altruistic manner to help people for the right reasons.

Eric Kramer:

I , yeah, I, yeah , I guess

Mike MacKinnon:

you're like a one percenter .

Eric Kramer:

Yeah Dude, I know we're coming from different backgrounds religiously, but I deeply believe that Jesus taught some hard things, and not a lot of people want to do those things, you know what I mean? Like serve people.

Mike MacKinnon:

Absolutely. You're trying to walk in his footsteps, basically.

Eric Kramer:

Yeah. Yeah. And , and it's , it's hard, man. You know, I believe that when we're talking about who is your neighbor? I believe in the 21st century, our neighbors can be international neighbors , you know? Right .

Mike MacKinnon:

It's a global community at this point. Yeah.

Eric Kramer:

Yeah. It's a global community. Yeah.

Mike MacKinnon:

That's amazing. So , moving back to where, where you were in the hospital, about how large was this facility and how many beds, like what kind of services did they provide and what kind of providers were available?

Eric Kramer:

Sure. So there was 27 beds ish. I'm ballparking that number. We had a men's ward, a women's ward, and a pediatric ward. Additionally, while I was down there, like in the first year two , we opened up in ICU, just a single bed ICU. But basically all that was, was a separate room where we put either really sick CD patients or , uh, we would roll in one of my anesthesia machines or something , early on as a ventilator if we needed to. We have just a single bed, ER , um, but you know, how many to receive anything from very minor stuff to catastrophic trauma. So it just depended , uh , before the year before I moved down, a bus went down, went off of a cliff and all 40 survivors came to that one bed. ER, I mean, so you just never knew what you were going to get. x-ray laboratory, there is a , there's a growing tuberculosis program. Tuberculosis is estimated to be about 50% in the area I was in. Um, and aside from that, so aside from those inpatient services, there's an outpatient clinic pretty robust. Uh, and then from there there's well drilling projects. My parents are doing a literacy program where they're in there with the hospital and my parents and my dad started a printing press kind of thing and he is teaching Tarahumara how to read their own language cause uh, their, their language wasn't really in written form that was easily available. So they do literacy classes in both Spanish and Tarahumara people. So that's one of the other things as far as the medical staff goes, it's mostly staffed by their , I can't say now because we've been gone since April, but I'd say three Mexican family physicians. There is an orthopedic surgeon who founded the hospital. Um, my sister who just moved down there last year, she's a pediatrician. She's there for two years through Samaritan's purse. And then her husband is a general surgeon and he's also there for two years.

Mike MacKinnon:

And you were the only anesthesia there at the time,

Eric Kramer:

correct? Yes. Yeah, I was, when I was there, there was another general surgeon who has since retired , an American general surgeon . Yeah . But I was the only enough.

Mike MacKinnon:

So is it mostly staffed by Mexican nationals or is there a lot of international people coming and going?

Eric Kramer:

No, it was mostly staffed by national . That was a tough area to , uh, recruit , um, non-indigenous gap too because of the violence in the area. We used to have a couple of midwife , American midwives who were excellent, but they just burned out to being 24, seven. So just working hard. So yeah, it was mostly Mexican national staff.

Mike MacKinnon:

And you went down there originally , uh, just, just as a finishing your CRNA program, how did you find the difference after being a CRNA and then obtaining the family nurse practitioner and then going back, how did you see that expand your scope, your ability, your capability?

Eric Kramer:

So that's an excellent question. And I know you're a family nurse practitioner as well, so you can appreciate this. I think while I was down there, I tried to do hospitalists and ER work as a nurse anesthesiologist and I quickly realized how limited my scope is. I have a very deep but very narrow scope as a nurse anesthesiologist. So when I went back to school as a family nurse to get my family nurse practitioner, the intention with that was to be able to not be winging it so much and be out of the ORs situations. And I would say it was incredible. It was, it was extremely useful. Uh, when I walked back into the hospital after, after I got back with my FNP , I was immediately able to do a hundred things that I wasn't able to do before. Some of them super simple like know which antibiotic to prescribe someone, you know. Um, but also I think what was super important was the ability to have a differential diagnosis process when faced with a patient that didn't have a neatly typed up history and labs and all the rest. And all you had was your physical exam skills and you know, the question and so,

Mike MacKinnon:

and limited diagnostics too!

Eric Kramer:

limited diagnostics. Yeah. I mean we had basic lab stuff and I got really into ultrasound, you know , um, I am a huge advocate of point of care ultrasound and the anesthesia I raised money for and bought a Lumify phased array probe. It was about $8,000, but it was worth every penny. I still use it every day , even here in the States doing anesthesia. But yeah, it's limited. And that's one of the things about I think family practice or internal medicine versus anesthesia in general is there's a greater reliance on your physical exam. And I think that's something that in general and anesthesia is missing a little bit as the ability to perform a physical exam and then draw data out of that to be able to, you know, change your treatment or whatever.

Mike MacKinnon:

Well , I agree with you. I think , that that full focus assessment, physical exam though CRNA programs teach it and physician anesthesiologists get it in their medical school. I don't think it's honed until you get the experience constantly doing it after graduation in anesthesia. Frankly, we do limited exams. I mean they're limited exams focused on anesthesia with a history that they come with, whereas in the emergency room it's, it's an investigative it's a forensic files in the emergency room of what's wrong with this person and that requires a large, a larger perspective. And I totally agree with your statement that anesthesia is narrow but extraordinarily deep or family practice may not be as deep, but it's extraordinarily wide and so you learn so much.

Eric Kramer:

I really liked it that , that phrase you used forensics, that is super true where you just have these clues and you've got to figure it out. That is , that's something I didn't really understand until I started doing internal medicine and all that stuff as to how difficult that can be if you don't have that structure and background to be able to approach the problem, you know?

Mike MacKinnon:

Absolutely. You just can't Google everything.

Eric Kramer:

No, you can't. No . Yeah, exactly.

Mike MacKinnon:

And so now you brought down there not just being a CRNA and an FNP, but you brought down a whole skill set that never existed in that place before. The utilization of just basic ultrasound with blocks but also POCUS. Talk to me a little bit more about the ultrasound guided blocks that you were doing down there and , and then after that your utilization of POCUS and if you have any particular stories where it really made the difference, I think the listeners would love to hear them.

Eric Kramer:

Yeah, sure. So , blocks are crucial and like it's here in the States too. It stuns me now doing locums anesthesia all over the place. How many large institutions don't use them routinely for pretty much every single surgery, you know, out of inconvenience more than anything else. And awkwardness with staffing. When I was down there , uh , I started with your basic peripheral nerve blocks, your ISBs, Pop blocks all this stuff I learned when , uh, I was in the States right after graduation. But the nice thing about working on my own and being able to define my own program is I was able to be pretty aggressive with growing my , my block skillset. So , um, I was, I, by the end, by the time I left, I was, I was, I was starting to do Peng blocks, which are , you know , those periarticular nerve group blocks that block the , the hip capsul joint, which are pretty fantastic for hip fracture. Um, and , uh , I did a bunch of erector spinae blocks. We had a on that as an example for that. We had a bunch of , um , intestinal TB patients , uh, where you get this Miliary TB, all everything testing that causes huge fluid shifts and kind of like an ascites , a lymphocites almost into the peritoneum . And so these people were in excruciating pain. We do these laparotomies on them. But one of the problems in Mexico was, and this is what pushed my block program so hard, was narcotics were extremely hard to come by. One of the issues in Mexico, they were trying to combat cartels and the drug trade. And the way they did that was by making it pretty hard for normal hospitals to get narcotic like fentanyl and so on. So it was out of necessity, they started doing that. But when I'd have like these big laparotomy patients, I didn't like putting catheters in like epidurals , uh , for most procedures because of the risk of infection out in a place like that. So I would do a bunch of single shot , uh, erector spinae blocks, which honestly, once you get OK with them, they take like 30 seconds each. They're not that long of a block and you would get a , a solid day of relief out of them and you know, and then the other blocks that are, I mean, towards the tail end, I was starting to do quadratus, lumborum and other different blocks . But the point is that I did this because I didn't have access to narcotics. And through that process I discovered that narcotics aren't even really necessary to have really authoritative pain control. Uh, they're , they're necessary in some instances, but with most routine cases you can manage them without them, especially if you can do a nerve block if you're working in the ER or something, there's , there's definitely a role them or certain postoperative cases. But , nerve blocks are huge in mitigating all kinds of postoperative complications. And then as far as the Pocus goes , that really started becoming super important to me after I came back to the nurse practitioner and I started working in the ER , for all kinds of things, from checking to see what was going on. If someone had a sclerosis of the aortic valve or something, you know, cause if someone had a cardiac Tamponade I remember there was one night I was sleeping, I was on call, it was two in the morning. We live about 20 seconds walking from the hospital itself on the campus. And , uh, I heard a bang on my door. Normally people ring the doorbell. But I heard a banging and I thought, wow, that's weird. Something must be really going on. Someone's freaking, they forgot to ring my doorbell. So I went down and there was two cartel guys at the door armed and they said, you need to come with us right now. Two in the morning. I was like, why? What's going on? They were like, one of us hurts. I said, hang on a second. Usually when they say that and you say , we're either run over because they're drunk and they're driving all over the place or they weren't some kind of firefights. So I went and grabbed my Lumify and I went down. I was the only one at the hospital. There was no physician and no surgeon. So whatever was going to happen, I was going to have to deal with it myself. And , I went, I grabbed my Lumify the phased array ultrasound probe when I went down and I found a guy that was in the back of a truck when , uh, one of them he'd been shot and then stabbed and the shot had gone through his, right underneath his left rib, right about where the spleen might be. I told them there's nothing we can really do for this here. He needs to get to a place that can operate on him. But let me check real quick to make sure that there's nothing I can do. Like if he's developing a cardiac tamponade or maybe he dropping a lung or something. So I'm there in the back of that, that truck, I scanned them, did a fast exam on him real quick. He was negative for that. I didn't see any kind of blood in his abdomen or anything like that looked like it missed everything major even though he, he was really pale looking, I couldn't find any obvious obvious bleeding and then I started a bunch of fluids on him with some fluids and set them down the road, you know, so that's when I realized, wow, this is super handy. And then , I started getting , kids with , cardiac abnormalities. And this is super out of my realm, you know, but it's one of those things where there's no one else to check it out. So I started trying to tease out reasons why a kid would come into the ER with a shortness of breath, kind of like a funny looking kid syndrome thing. And as part of my exam, I pull out the phased-array probe and do a cardiac exam to see if there was any cardiac abnormalities, you know. And at that stage, all I could do was basically go, this is a normal looking heart or there's something weird here and it's worth this indigenous family flying out of the mountains to the capital city and going through the trouble of getting a consultation with one of the government hospitals, physicians, which is a huge process. And most of them don't want to do it. So we don't, we try to avoid doing that unless it's a really big deal. So those are a few examples of like Pocus and how it kind of started growing on me and how I start realizing was an important thing. One last example of Pocus, it still applies here in the States is just checking to see if someone's NPO, you know , people can tell you they're NPO for eight hours and it may be true, but they may have gastro-paresis for some reason and then it takes literally like 30 seconds to put your probe on someone and see whether or not they actually have an empty gap. And that was something I would employ routinely.

Mike MacKinnon:

Well , I can see that being incredibly important down there, particularly when you know they're not trusting of you from the beginning.

Eric Kramer:

Yeah. Right.

Mike MacKinnon:

Once you're doing all this stuff in the hospital, did, what was the feeling, the general feeling within the medical staff with you? And I mean, as you know, there's lots of politics in the USA when it comes to APRNs CRNAs did you feel any of that there or did, did that all just get put aside? How were you, how were you looked at?

Eric Kramer:

I had to prove myself to the American physicians. They were older in their sixties and um, so I had to kind of like prove that I was capable of handling the pace kind of patients we were getting, you know, and we're not taking ASA 1 and 2s, you know, sometimes we were talking people that would die an hour after they got off the table because they were so sick from sepsis or something. So, and that suspicion was in very concrete ways. When I first came down, I wasn't allowed to do any pediatrics. They would bring in a Mexican anesthesiologist to do all the pediatric cases unless it was a life or death emergency. And the general surgeon just generally would be very restrictive with allowing me to do nerve blocks and those kinds of things. Cause he just thought I , I didn't quite know what I was doing. But after about a year of being down there , I was doing the full spectrum , they'd gotten to understand my capabilities and my training and I was doing anything from, you know, newborn babies all the way up to whatever with no real restrictions on the kinds of cases I was capable of handling the general surgeon. And I got really close, especially the older general surgeon. he and started teaching me all kinds of stuff that had nothing to do with anesthesia, like surgical techniques, putting in chest tubes and stuff like that because I think he really grew to respect the skill set that I had and wanted to improve on that in ways that he could.

Mike MacKinnon:

And so additionally, once you started to get respected you and they saw that you were capable of these things, did that translate into a different relationship with the Mexican nationals there as well? Cause I'm sure that, you know, they, there's only so many people that were in the hospital that were foreign, like you said. So were they just as standoffish initially the staff at the hospital and then come to understand that you were capable?

Eric Kramer:

No, the Mexican staff , was always pretty approachable. they didn't come from that context. They're the , the Mexican anesthesiologist who came, had no concept of nurse anesthesiologist . He , in Mexico, there was no nurse anesthesiologists , it's pure physician a nesthesiologist. So he always half believed that I was from kind of like anesthesia tech with delusions of grandeur, I think. Although it really chafed him when he, cause he didn't know how to do nerve b lock. It really Chafed him when the, the surgeons would request blocks from him that I routinely did. C ause he would come up every once in a w hile, either while I was gone out or sometimes, Mexican , plastic surgery came that he knew a nd he would come and do like an outreach with them. U m, but he wasn't able to do the blocks and I was told that that kind of bothered him, that, that someone that was lesser than was able to do those kinds of things, you know.

Mike MacKinnon:

Was there any other APRN type roles in Mexico at all?

Eric Kramer:

Uh , you know, that's a good question. Uh, not that I'm aware of.

Mike MacKinnon:

So basically it's entirely physician driven as far as you could tell.

Eric Kramer:

Yes . Yes.

Mike MacKinnon:

And so now you did five years at that facility with intermittent periods of coming back to the US to work locums to help generate the revenue to keep keep afloat. Correct. And while you were there, I think I remember you said you had built a house while you were there.

Eric Kramer:

Well, kind of. We finished it , my parents started it and then we just did the finishing work. My parents were planning to move there . Uh, anyways . And uh, once they found out we're moving down, they just gave us a house. And so we finished it.

Mike MacKinnon:

And during the process of living there, what was the kind of expense that you generated for a family? Just to, you know, subsist. And have, you know, have general things, just the basic basic living arrangements.

Eric Kramer:

That's a great question. everyone seems to assume that life is cheaper, you know, when you live overseas. But , uh, the rule of thumb is if you want to live with some sense of comfort, which I think is important if you're living somewhere overseas, longterm , not decadence but just comfort. So you're able to come home and relax. That costs more or less the same. So our grocery expenses would be about the same. We'd pay the same on electricity and gas, you know , um, internet , the hospitals started with single satellites connection one megabyte per second download that was $900 a month. And then the last year and a half that I was there, we got a new satellite system from hughes satellite. And so my dad and I split the cost of the $450 a month connection. That was 10 megabytes per second. So there's expenses for sure. Dollar amount. I couldn't tell you, but , I think we were averaging about 2000, maybe a month in total expenses. And that's just a guess. I'm not exactly sure.

Mike MacKinnon:

Wow. Now I think that's an important point. Yeah. I think you're absolutely right. People just assume you go to Mexico and you know, you get $1.50 Cerveza and everything's like that in the whole country. But clearly when you're there, especially in an isolated area that's very rural, you're going to have a whole lot more costs to get anything.

Eric Kramer:

Yeah. So yeah, we lived in the middle of , we were really rural, but my wife is like a logistics expert. So she would plan like a month's worth of meals and then we would drive to the Capitol , maybe six hours away and there's a Costco there. Um, and so we'd picked up all the groceries and needed, you could get local stuff like fruit and some, some fruit, not a lot of fruit, but milk, stuff like that locally at a place that was 45 minutes away. But , you know, it , one of, one of the things about living long term overseas is that a lot of people come down thinking they're going to live exactly like the indigenous people too . If they poop in a ditch, I'm going to poop in a ditch. If they live in a stick hut and it's dripping and rain , then that's what I'm going to do. And those people end up burning out after six months because there was no rest from that. That's something that's super important for me. It's still important for me here in the States, I think, and it's part of the message that I want to tell people that just want to work 24 seven it's important to have a place of rest where you can just chill out and relax. It certainly was important there for us in Mexico and so we felt okay ethically okay, having like indoor plumbing, having internet, having running water, you know, all those kinds of things.

Mike MacKinnon:

Right. Well it gives you a reprieve from the 120 hour work weeks you are doing while you're there.

Eric Kramer:

Yeah. Well a brief reprieve because yeah, it ended up getting to me anyways . But yeah,

Mike MacKinnon:

that's a lot. And so you were there five years and then you came, did you come back to the States before you went on? Some of the other missions you did afterwards?

Eric Kramer:

I did. I did those things when like, well, I did Mosul while I was in NP school. I actually finished my OB rotation early so that I could head to Mosul. That was in 2017 we were in the state for that. Uh, and then I was at and ebola treatment center in the Congo just in February for a month.

Mike MacKinnon:

So let's talk, let's talk about Mosul . When you went there, what was the primary goal? What were you doing?

Eric Kramer:

That was with Samaritan's purse. It's a Christian organization, pretty large, but they have something called a DART, which is a disaster systems response team this a paid position , there , they have hundreds of people that are in their network and basically at the drop of a hat you have to be ready to go on some kind of disaster response wherever might be needed. Right now they have an emergency hospital set up in The Bahamas and they're doing surgeries over there. There'd be these big inflatable tent kind of things that's modular and they can add, do all kinds of different stuff with it. It's pretty cool. So what they did in 2017 was when the Iraqis and the Kurds were taking back Mosul from ISIS. Um, they set up a trauma field hospital right outside of Mosul and started accepting all the battlefield casualties and even ISIS prisoners. Um , they were pouring out of that city and I went there. It was my first response , with Samaritan's purse. I went there in July for a month.

Mike MacKinnon:

And what was that like? I mean, what did you feel that's gotta be a lot less safe than when you were in Mexico? So I'd imagine there was danger.

Eric Kramer:

Yeah, I definitely, yeah, I definitely felt uncomfortable there. Um , but for the most part we were within like this compound that had blast walls and then there was a Kurdish security force and like a trench that was supposed to stop, you know , IEDs and stuff like that truck with explosives on it from slamming into the hospital, that kind of thing. So it was fairly well defended. And actually, so Mosul is just a few hours away from Erbil , which is the Kurdish capital of the Kurdish people. Erbil is amazing. It's a very American friendly place. I was able to walk around with a buddy of mine for a couple hours and just the streets of Erbil and people would come up, shake our hands, say hi, they love talking with us. So it was a different animal than when you left that Kurdish zone and all of a sudden there's just this different vibe. And definitely people were not the fans of you that they were in Erbil.

Mike MacKinnon:

And so was there any US or allied forces protecting you in that time?

Eric Kramer:

No. No. We had, we had some, some Iraqi military, but it was mostly Kurdish private contractors.

Mike MacKinnon:

And was that supplied by, by that group, the group that you were there with or by some other group?

Eric Kramer:

Yes, Samaritan's purse hired them. Yep .

Mike MacKinnon:

So basically they're mercenaries for hire to cover and protect the hospital while you're there doing,

Eric Kramer:

I wouldn't call them mercenaries per se, that I would call them a private security group, but I don't know, maybe that's just semantics

Mike MacKinnon:

could be , I dunno .

Eric Kramer:

Yeah. Yeah.

Mike MacKinnon:

So what kind of surgeries, what were you doing there when you were there?

Eric Kramer:

Uh, so I, I was there , during my FNP training. My school was gracious enough to give me the time off to be able to go there and we would do whatever role and I was coming down, I came in towards the end of the response , uh , but there was still, there was a lot of trauma, a lot of burn injuries , um, a lot of broken bones and orthopedic kind of stuff. But some of the most ethically complex situations I've ever been in. I was in there , the second day I was there , there was this kid that had been blown up on IED that had been there a month initially. Uh, this was the , the hospital was supposed to be a quick turnaround. We do stabilizing surgery and then we transfer everyone to Erbil for definitive care. But as time wore on Erbil got overwhelmed with everything and they stopped accepting people. So this kid who should have had better treatment, better care was stuck at our hospital, ended up being trached and this kind of thing. And by the time I got there was septic had ARDS from black lung, all these other things, and there was no real pediatric intensivist or anything there, there was just a bunch of people doing the best they could help this kid, but they'd run out of options . He'd gone through every antibiotic on the , you know, that they had available and, and he wasn't responding to the antibiotics and they came to me and said, is there anything we can do to help him? Uh, because he was, he was starting to go into respiratory failure. The vent wasn't doing a good job. He'd been on vent without a humidifier for a month because the portable Vents we had didn't have humidifiers. Um, so I don't know. So I found myself in a situation of trying to help manage a critically ill pediatric trauma case , with sepsis and all these superimposed problems. And you know, there's, there's intense emotions on every side from people that have been taking care of this kid for a month. Um, and it , it was super difficult in contrast to that, we also were taking care of like , ISIS prisoners that were captured. And then we , you know, operated on them for gunshot wounds or whatever. And that was relatively simple. I mean, for me it went back and for all of us there went back to that same philosophy of, you know, we need to show these people some love and something that they've never seen before in their lives as far as , uh, other types of cases we did. by the time I got there, it was just, it was just a very complex situation. we would have women who would come in with these third degree burns that they said were caused by a fire. like stove fires, but they were these uniform burns that look like they , uh, look like they, they had been doused with gasoline and then set on fire. Um , and the ethically complex part of that was that any one that we sent to Erbil has to survive in the back of the ambulance without anyone in the back of the ambulance with them because of security risks . So we weren't able to send those kind of patients to Erbil, but we had difficulty managing them there . Their mortality rate was super high and so often all we could do was sit with them, give them drugs like ketamine and pray for them and just be with them, you know, until they passed .

Mike MacKinnon:

Wow. That is a tough situation to be in.

Eric Kramer:

Yeah . Yeah. For especially for the ER people that were there. Same thing with kids. There was one other case that I'll tell you, I don't know. I don't know how many , I don't know how much time you have here, but there was one other case that really, really got to me deep there. So ISIS in Mosul , took control of a hospital that was later liberated and all the patients that had been at that hospital started coming to us . One 14 year old kid came in with a mangled leg and seemed like a normal 14 year old kid when I interviewed him. But when I, when I brought him into the, or, he flipped a brick and I was trying to figure out what was going on. Um, and later on, one of the Iraqi surgeons we were working with from Mosul, and he was the surgeon from Mosul who fled, told me that ISIS had ran out of , um, any kind of anesthetics. And so they were just paralyzing people with rock or vecuronium intubating them and then doing the surgery they had to do. And this kid had had several awake surgeries like that. Um, other people had limbs amputated with no anesthesia, that kind of thing. Another kid that I got. Uh , and this was the one that kind of stick with me even today, even after everything in Mexico was a kid that had been in that ISIS hospital for months. He'd been playing with an IED and that blew up and it blew his abdomen open and blew one of his, his, his legs off. And I remember I was on call that night, so I went to the ER, they told it was a little kid with an IED, injury went in and I , I looked in with a kid with a, or like a sheet pulled up to his neck and I thought it looked pretty normal when I pulled down the sheet, his abdomen was open and his intestines were up, but it wasn't an acute injury. His abdomen had been open for a month and his leg has no dressing on it. And the femur just kind of stuck out a little bit. But it's been so long that the femoral artery had just kind of like atrophied up, you know, and they'd never done anything about it and they just waited for him to die . But the little guy who just hung on for a month , um , and he was one that Erbil wouldn't accept. So we ended up with him for two weeks until he passed.

Mike MacKinnon:

I mean, these are these, these are things that people in the US are rarely if ever going to see providers, patients, anybody. And so how do you, you know, coming from, from this place of wanting to help people coming from the US where there's so much available, you know, when you're there and you see that kind of level of suffering, how do you take that back with you? Right ? Are you dreaming about that or are you having nightmares? Are you having difficulty? like to me it sounds unbelievable.

Eric Kramer:

Not at all. I feel like I've always been able to compartmentalize really well. And , I think a lot of people in our jobs can do that. You know, it's just focused on the task at hand and you don't, I don't know. It's something that I guess maybe it's a gift that I've had, but also in Mexico, you know, you just kind of focus on the work you have to do, you do the best you can with what you got basically and well at least then you're, you're solid in the knowledge that you've done all you can. \.

Mike MacKinnon:

And anything that happens from that point is fate. Right?

Eric Kramer:

For the most part. I mean there are times when you just think back and you second guess yourself, but I mean that's part of the career, right? There's always going to be those times when you look back and you know, I should have done this different or something like that and definitely IN IRAQ there are things like that too. And in Mexico, but it's part of life and part of growing as a, as a health care professional.

Mike MacKinnon:

Absolutely agree. And so now you also mentioned that you went and did an Ebola clinic that was in February . What was the circumstances surrounding that? Was that still with the same group?

Eric Kramer:

Same group? Yup . Once again, they sent me out. They asked for volunteers to go staff and run an Ebola treatment center and the democratic Republic of Congo, which that outbreak is still ongoing. It's the second largest after what happened , in 2014 or whenever that was. So I went there for a month and it ended up being me and another family nurse practitioner being the only medical providers at the, at the facility. Um, kind of supervising the treatment of all the, all the, all the potential Ebola cases. It's mostly protocol driven . Um, and it's , it's a lot of, it's actually nursing driven, but him and I were the only ones , uh , only medical providers there. You kind of make all of them the major medical decisions

Mike MacKinnon:

and you guys manage the treatment based on those protocols. Did you feel safe while you were there? I mean, Ebola terrifies people when they hear it, you know. So when you're there and you're, you're dealing with those patients, how was that?

Eric Kramer:

I felt I felt pretty safe. Samaritan purse training is pretty thorough before you go on the field. Uh , and they're very well equipped. Additionally, actually got the Ebola vaccine. While I was down there. So yeah. So I'm, I'm ready for the apocalypse that it comes to the states. I'll be one of the survivors.

Mike MacKinnon:

What kind of treatment were you doing? What exactly was happening?

Eric Kramer:

um, yeah, so , so, so first of all the, in the GRC they cast a very wide net as far as symptoms. Um, so we had, we had so wide in fact that we had something called SHE-bola where a woman with , uh, abnormal bleeding would come in and that would be enough of a criteria, unexplained bleeding with the criteria for admission, for, to check to see if the patient had Ebola. And that meant full isolation, the hot zone, you know, where people with all the workers coming in, in the full on Ebola looking gear with aprons and everything. Um, we had guys coming in with all kinds of stuff that wasn't Ebola but met the criteria of this huge net they have. And we ended up catching some pretty serious things. And once again, it was something that was just super ethically challenging that you can only appreciate in those situations where you have someone, you know for certain, does not have ebola who is desperately sick, but they're in the hot zone and they have to get two negative tests 48 hours apart before they can be released for other treatments. You know, I had a boy with rabies that died there who came in it looked exactly like ebola. I would actually go so far to say if one of the most horrific deaths I've ever seen in my life. Um, who came in, we knew it wasn't ebola, but we couldn't transfer him out of there because the risk was just too high. We had a couple kids with cerebral malaria, but that's pretty easy to treat. Um, there's a drug called Artesunate and you can get a kid with a glasgow seven or eight. You give them a dose of Artesunate, and a few hours later they are walking and talking. It's a miracle drug. So there was interventions we were able to do, aside from treat ebola. But it's tricky when you have to gown up, you have to take everything in there with you. Once something goes into the hot zone, it does not come out. Um, the medications we have to treat these things because of a various various reasons are very limited. When you're trying to treat ebola, you can't run a full fledged clinic that treats a whole host of diseases. You have to focus on triaging and finding ebola cases. And that meant a lot of other things were left untreated. But everyone that came in would get a regimen , uh , uh , an antibiotic oral cephalosporins, oral, I believe it was a proton pump inhibitor , um, malaria drugs and uh, Tylenol I believe or some kind of pain reliever to help control some of the symptoms. And they would be in that locked down hot zone ebola zone for at least a couple days. Um , each one in an individual isolated room, they weren't allowed to leave their room the entire time. And then staff would make rounds , uh , groups of people. You were never allowed to go into hot zone by yourself. You had to go in with a partner, we'd go in at scheduled times to, you know , deliver meds , uh, do physical assessments , um, all that kind of stuff. So , and, and once you were done, it took about 45 minutes to do the whole decontamination procedure, which when you first start that, you don't realize that that has much of a big deal. But when you're in the full ebola outfit and it's like 120, 130 degrees , you may be , have half an hour to do everything you need to do with up to 20 potential Ebola patients before you have to get out of there. Because passing out inside the hot zone is a pretty difficult thing to deal with,

Mike MacKinnon:

I can imagine. And did you have, obviously you had a lot of positive patients there too. And once you, once you found in the very positive, what was the process? What was the treatment for them? What ended up happening?

Eric Kramer:

There's a , there's a process. Uh , it's all laid out. The world health organization has this neat way of doing this. But , uh , you have a suspected zones . So ambulances come in or sometimes people would walk in and they would met by a triage nurse. There's always like at least three feet and two fences in between the triage nurse and the potential patient. They're ask screening questions if they meet the criteria gowned in people that have that full ebola garb with a mask will come in and take them to their room where they'll, they'll, they'll , uh, get initial lab work, get them oriented to the room, give them some food and some water. And then if they're confirmed positive, they move from the suspect ward to the confirmed ward. And on that side, there's either a wet or a dry side, so the wet or dry side basically, refers to body fluids , right. The thing about ebola is it's famous for being a hemorrhagic disease, but actually it's more of a water loss disease. They found that the biggest way that people can decrease mortality rate for ebola is to pump them with IV fluids. So if so, people will start throwing up diarrhea. All this kind of stuff. And also hemorrhaging if it's a really advanced case. And um, so they're on one side and then the dry side, which is the patients that are positive but don't have all the symptoms yet, they're on the other side. They stay there and then after a couple weeks , if , if they survived it a couple of weeks, they're prognosis is pretty good for at least survival. Um , and so after I, you know, I'm reaching back out cause I haven't thought about this stuff in February, but I believe that after five days being symptom free, they take a test and if it comes up negative, then they're allowed to leave cured of ebola and they actually have the antibodies now in their system so that they can go back in as supporters without the protective garb to be able to help other people that are in there with Ebola and a lot of people who, yeah, yeah. A lot of people who survived ebola would come back as kind of support staff to help people who are going through it.

Mike MacKinnon:

That is amazing. What an amazing list of experiences you've had,

Eric Kramer:

I guess.

Mike MacKinnon:

I mean , that is really amazing. You know, I know from your perspective doing these things because you feel your calling, you feel it's the right thing to do for people. It's about love. But you know, from the outside looking in, how many people are willing to put themselves in a place where it's basically a third world country in a rural area for five years. How many people are willing to, you know, go into Mosul or into a war zone and then into an Ebola zone? I mean, you've done three things that probably 99% of people will not do one of , or anything close to one of, in their whole lives. You know, I mean, they're gonna watch the hot zone movie and that's going to be the last time they think of ebola that they don't want to be around it. That's what's going to happen. And yet you've done all these amazing things. So I guess then the question is, when you come back from all of this, what are the three big takeaways? And it doesn't have to be medical. Just the three big takeaways when you come back to the U S uh , from all of these experiences.

Eric Kramer:

Number one is that nurse, anesthesiologist, and physician, anesthesiologist have an amazing gift and skillset that they can offer the world. And most people don't capitalize on that nearly enough. There's a reason why doctors without borders only asks eight weeks of anesthesia providers versus a year from every other specialty. And that's because no one from anesthesia volunteers for missions. So there's a huge demand. No one wants to go do it. That's the first thing. Number two for me is this is, this is something that's taken me years to learn and I think it's important here in the states too , is to balance work and life. Be a complete human being. You know , um, don't overwhelm yourself with so much work pursuing money or pursuing same or whatever the heck it is. Make sure you have enough time just to relax and enjoy all the hard work, you know, don't think, Oh, I'll enjoy myself later on or something like that. Mental health and um, stability and just being able to live in the present is super important in our career. And I think sometimes we take it to the extreme and end up pushing ourselves a lot harder than we should. And the third , uh , takeaway point I think is to love people and to uh, extend across lines that other people will not cross in order to love those people.

Mike MacKinnon:

So one additional question, Eric. When you were working both in, you know , other countries overseas, all of these different experiences and then coming back to the States, what are some of the differences you saw? Was there a similar scope of practice? Did you feel things were unusual after all that work and basically being a primary practitioner in every, both anesthesia in the, in the ICU, in the ER? What was the difference when you came back?

Eric Kramer:

That's an excellent question. So it's actually one the reasons why when I came back to live here in Ohio and become somewhat politically active because in Mexico, I was able to practice to the full extent of my training as a nurse anesthesiologist . I went to case Western, which is a really good school and they taught me a lot. And then when I went into practice, depending on where I was working, some of those things I wasn't able to do that i was trained in school. So when I went down to Mexico , um, it truly was a full practice. If I was taught it in school, I was able to do it on the field. What started to become a little odd to me was when I would come back to these locums work in the United States, especially in Ohio. And this varies by state. Every nurse practice act as you well know that , um, that dictates what CRNAs can and cannot do. And for me, in Ohio, there's no prescriptive authority even during the perioperative period for nurse anesthesiologist . So I couldn't get a, an RN to push my mind local anesthetics for a nerve block, I had to have another CRNA do it. I couldn't in PACU ask a nurse to put oxygen on legally onto a patient. I couldn't ask them to put on a nasal cannula because that's giving a verbal order to an RN and then I would go back to Mexico and all of a sudden I was putting in chest tubes and central lines , you know? Um, and so it was this really bizarre thing. And the more I thought , the more I realized that this was kind of an artificial line for whatever reason. So when I came back to the States in Ohio, I've gotten involved with my state association and I encouraged nurse anesthesiologists all over to kind of look into CRNA to support their state boards because they really do promote some of these important practice things that can be game changing sometimes in our state in Ohio currently there's a bill where we're just trying to get peri-operative ordering authority. We're not trying to do something crazy like go outside and be able to prescribe opiates outside of the hospital setting. We're just trying to match what has always been happening with the law so that what we're able to do in the OR as experts. We can also do pre and post operative in Ohio. As soon as you take your patient from the operating room into the recovery room, you go from someone who is able to do anesthesia and handle dangerous drugs to apparently a buffoon that can't even tell an RN to put oxygen on a patient. You know, you can't even write an order for an RN to get Zofran for your nauseous patient. Something you did maybe did 10 minutes earlier in the operating room . So it's something I'm actually pretty passionate about. Uh , I, you know, I'm not this megalomaniac that wants total of authority to do whatever the heck I want, you know, but I do want reasonable abilities to practice with the tools that I was trained with and that frankly, I use every day in the OR,

Mike MacKinnon:

absolutely. Well it would be very frustrating to go from a place where you're treating ebola, taking care as the primary , um, primary care provider plus the emergency room plus the ICU intensivist plus the anesthesia with absolutely no restriction and having great outcomes and patients doing very well to not being able to ask a nurse to put oxygen on a patient in PACU. That is a unusual juxtaposition and I think it speaks a lot to the, you know, the political constraints related to trade protectionism.

Eric Kramer:

I agree

Mike MacKinnon:

man, you are an amazing human and I don't know if you ever get to hear it, but you know, the fact of the matter is is that is true. And for those that listen to this and they think, you know, I want to do some of these things, I want to give back to humanity the way Eric has, where should they go besides obviously contacting you to get more information about getting involved and you know, jumping in and actually doing some of these things, promoting love, promoting service, you know, promoting humanity. How do they get, look , what kind of places can they go?

Eric Kramer:

That is such a broad thing. I would say, you know, first of all start investigating. You know, what can be done. It doesn't have to be international. You know, it can be local and it's not just a checkoff I did my good deed for this thing. There's something intrinsically satisfying about going in serving other people, you know? Um, so, so that can be, if you don't have enough time to go on a missions trip, then just go and see if you can do something locally. Um, the other thing is I'm starting a nonprofit , that, i s g oing t o do two things. It's g oing t o number one, I'm creating an online database of 3D printable medical devices. And then I'm going to go a nd s et u p 3D printers at hospitals overseas so they can print their own medical equipment. But the second part of that mission is I want to teach, u m, mission hospitals that don't have anesthesia. And I think tons of those kinds of hospitals how to do anesthesia. I'm a firm believer that you don't have to have a certain degree to do, especially when there's no other option. I think it's cruel to say, well, there's no anesthesia here, so we're going to do this surgery on you awake because we don't have anyone that can even offer basic services. So , something that I think a lot of anesthetist can do not just through my organization. I'm going to start, what I'm going to do is I'm going to go and offer to ultrasound guided regional anesthesia and basic anesthesia techniques to non anesthetist at mission hospitals. Um, but there are CRNA schools in Africa and I believe in Somalia or other places , where national nurses are learning how to become a CRNAs and need qualified people to teach them different techniques. And from the United States, anyone that's come from the United States has a great background to be able to go and do that over there. So that's the other thing I would recommend, not just go and do surgeries, but maybe pay it forward by teaching people who will be working in a country that doesn't have any,

Mike MacKinnon:

Oh , right. Well that falls in line. It falls in line with the general belief set that, you know, you can give, give somebody bread, but if you teach them how to make it, that's 10 times better ultimately.

Eric Kramer:

Oh yeah, absolutely. Yeah, yeah. Then just doing it yourself.

Mike MacKinnon:

Absolutely. Eric, this has been amazing. I mean, I've learned so much. I already had a ton of respect for you before this. I, I've read all your stuff. I followed you, but you know you're like a CRNA hero and I appreciate that you're part of my profession.

Eric Kramer:

Yeah. Dude, I'm so glad to finally talk to you. After all these years of knowing and interacting with you, it's actually pretty exciting.

Mike MacKinnon:

This has been amazing. This is a great interview. I appreciate you , being on

Eric Kramer:

all right . Yeah. Thanks for having me, man.

Speaker 2:

That's all for this episode of anesthesia deconstructed. For more information based on today's discussion, be sure to visit us www.anesthesia-deconstructed.com you'll also gain access to our blogs, editorials, and more resources to keep you updated on the science, politics, and realities of today's medical industry. That's anesthesia-deconstructed.com.

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Eric's Top 3 Take Aways
The Politics of Returning Home