The Expedition began following a long , bumpy overnight ride from Guatemala City to our destination city of Jalpatagua. The following morning the team occupied the hospital clinic facilities and subsequently triaged over one hundred patients from the surrounding villages and local population. News of our arrival had spread like wildfire amongst the local villages. Dr. Cundiff and Dr. Zammit conducted dual clinics and a wide variety of different medical conditions were encountered and evaluated. Patients were seen with chronic gallbladder disease, complicated large hernias, painful varicose veins, numerous tumors and unusual growths. Surgery started the next week with two operating rooms running simultaneously with Dr. Zammit excising varicose veins and Dr. Cundiff performing various general surgery procedures. The teams worked twelve-hour days over the remainder of the week and performed approximately fifty operations during their stay. An unexpected addition to the team was a local Guatemalan medical student on winter break who joined to observed and assist surgery with her U.S. counterparts. All the procedures went well with no complication to report. The PNSO team's rapport with the operating room nursing staff took time to develop, but as we all got to know one another a well functioning machine resulted. A mutual respect and appreciation developed and we eagerly look forward to working in tandem with Nora, Maria, and Loki again. Overall the expedition was resounding success medically and we found Guatemalan people to be incredibly grateful and joy to work with. We look forward to our next visit.