Friday, Screening Day 2

I didn’t write on Friday because I had been up since 5:30 am, at the hospital by 6:30 am, and not back to the hotel until shortly after midnight. I was just a little tired. So, for a recap of the day…
Screening started a little bit late because many children were being bussed from very far away and the bus didn’t arrive until almost 9:00. After we got our screening areas set up, we had a little time to wait. Since I didn’t mention it yesterday, I’ll give the overview of screening. As kids come they are assigned a number. They give some basic information and then they go to medical records to give a case history which also includes questions for outcomes research. This process can take a long time if things have to be translated. After medical records, they have a polaroid photo taken and that is stapled in the medical chart so that kids can be tracked. Next they go to the PIT (patient imaging tech) where they have special frontal and side view photos made, as well as photos of the oral cavity. These are used for before/after photos, outcomes research, and patient tracking. Then they’re off the get their vital signs assessed by nursing: height, weight, O2 saturation, pulse, blood pressure, etc. Next, on to plastic surgery where the surgeons decide if the child could benefit from surgery, what type of surgery, and how long it would take. They are assigned a priority number 1-5. 1=cleft lip (over 6 months of age), 2=cleft palate (1-6 yrs old), 3=cleft palate (6+ years), 4=other surgery (rhinopplasty, pharyngeal flap, etc.), 5=other types of plastic surgery like scars, syndactyly, microtia, etc. From plastics they are assess by the pediatricians for general health issues and by anesthesia to make sure that they are safe to put under. Next the kids see the dentist/orthodontist for screening. The dentist reviews oral hygiene, decides whether or not teeth need to be removed while the child is under anesthesia for surgery, plans orthodontia, and makes obturators (retainer-like plates to fill holes in the palate from unsuccessful surgeries). Speech is the last screening station. As mentioned previously, everything backs up here since there are several people at every other station and only one of me. After I screen the kids they stop to have blood drawn for labs and then they are done. The whole process takes 1-2 hours…once their name is called. They may have been waiting for 6 hours or more to be called.
We were expecting about 100 children on Friday, but ended up screening over 140. I had to screen all 140 again by myself and didn’t finish until about 5:00. It was a pretty exhausting day! Cool thing about the screening was that one girl coming through looked really familiar to me. The thing is, after screening over 220 kids, they are all Nicaraguan and they all have clefts, so they start to run together and look alike. However, this girl’s face AND name rang a bell. She was one of my favorite kids from my 2006 OpSmile mission to Managua. I loved her because she had such a friendly, outgoing, and mischievous personality. She walked in that hospital like she owned the place. I have a photo of us together from Managua, so we took another one here since she was 8 before and now she is 12. Such a cool experience to have seen her again and remembered her!
Some other tidbits from the day…There was one child in particular that I felt very strongly should have a secondary procedure like a pharyngeal flap. A flap is done in a child who has already had a cleft palate closed, but still has very nasal speech because the soft palate doesn’t reach all the way to the back of the throat adequately so the air escapes out through the nose. This is because either the palate is too short or the palate doesn’t elevate of move posteriorly as it should (if any of my grad students are reading this, you should know the difference…insufficiency versus incompetence). Anyway, I thought this child needed the surgery and the surgeons had put the child at a priority 4. I thought the child should have been higher on the list so I went and discussed with the plastic surgeons and got the kiddo moved up on the list. Success! I don’t yet know if the child made the final cut for surgery on this mission, so I’ll have to check when I get my copy of the schedule. I can’t think of any other highlights of screening but it’s all kind of a blur, plus I’ve slept since then.
After a full hard day of screening we came to the hotel, showered, and went to dinner. I had this incredible chicken called Pollo Relleno, which was basically like Chicken Cordon Bleu. It was so delicious! Following dinner some people were going to a disco. Being of the “When in Rome” mindset I decided to go too. It ended up being me, my pediatrician roommate (we were the only two Americans), a plastic surgeon, a medical student, a PIT (patient imaging tech), a nursing student, and a biomed tech (all Nicaraguan), and another PIT and a child psychologist who were both from Peru. When we got there we found out that the disco was closed for remodeling so we went to the bar next door and played pool. It was hilarious and I discovered that, at least for that one night, that I was a better than average pool player. Who knew? We had a lot of fun just hanging out and talking. However I was the ONLY person who couldn’t speak Spanish and there were two people who couldn’t speak English, so most conversation was a good mix of Spanglish. A couple of time I just zoned out though because my brain was so tired of switching from Spanish and English all day. I came home “early” at midnight. My roommate stayed out until 2:00 am. We have now coined the phrase “going pediatric.” It should be in the Urban Dictionary soon. It means to totally shift gears, shed your inhibitions, and party hard.
Now to update on today’s crazy adventures…but it’s currently 1:08 am so that will have to wait until tomorrow morning.