Operacion Sunrisa-Saturday

Sunday morning 7:30 am. I’m sitting in a rocking chair on the already very warm patio still in my pajamas, listening to the brids. We have a late start to our morning (9:30) and today is our one day off---team building day. We are spending it at the beach, Pacific Ocean side of Nicaragua. However, for now I will update on the wonderful day that was Saturday. One of my favorite movies is “City Slickers.” One of my favorite parts of that movie is when Billy Crystal asked Bruno Kirby and Daniel Stern “What is your best day?” Although my true best days center around my faith, my wedding day, and the birth of my children, Saturday, February 6, 2010 at least makes it into the top 20. It was a Mother Teresa “We can do no great things, only small things with great love” kind of day.
Saturday is spent setting up the hospital for surgery week. Out of 229 children screened, 120 were selected for surgery. These surgeries will take place over 4.5 days with 5 operating tables per day. Each plastic surgeon doing about 5 surgeries per day or 25 surgeries total each day. The operating rooms have to be set up and organized with supplies like sutures and surgical instruments, plus the anesthesia machines have to be up and in working order. The recovery room and crash cart have to be planned out and the pre/post op ward has to be carefully organized. On this day I had scheduled individual speech therapy sessions. I got started at 9:45 with my first kids. I had a translator to help me, but this is the time that I hate not knowing Spanish the most. So many of the kids are usually terrible embarrassed by the way they talk and very shy about talking at all. In “real life” I could joke around with them and break the ice a little and get them to warm up. Since my Spanish is pretty darn limited that definitely impedes any rapport building since I just have a handful of phrases I can say to joke around with them. However, almost every kid who I saw was very stimulable for speech so I felt it was a pretty successful day nonetheless. I saw about 8 kids for therapy that day.
At about 12:30 I went to the shelter where the kids and families are housed. These people come from all over Nicaragua and are very poor. Travel is provided by different benefactors, corporations, etc. (more on that later) since most families can’t afford it. The families are then housed in a shelter of some sort free of charge. The shelter in Chinandega is very nice. It is a private residential school started by a priest. However, the children are supposed to be accompanied by one family member only. Often both parents want to come, or a grandparent comes, or there are other children who have to tag along. I have heard that because of this, the shelter is housing 200 people although there is occupancy for 105.
The reason I went to the shelter was to assess swallowing and work on feeding problems with two babies with clefts who are “failure to thrive.” One baby, Jesus, has holoprosencephaly. He is 14 months old and looks about 3 months old. Holoprosencephaly is when the lobes of the brain don’t separate correctly. It is often fatal in utero or shortly after birth and babies usually have severe facial deformities that include a single eye, no nose, and a midline facial cleft. Jesus had the mildest kind which results in significant cognitive delays, possible seizures, midline cleft lip/palate, etc. He will likely never walk or talk. At 14 months he coos, doesn’t really respond to sounds, can’t hold his head up, etc. He is essentially like a newborn. His mother told me at screening that he choked when drinking from a bottle. I assessed him at the shelter and the reason he was choking is because mom had cut a huge hole in the nipple of the bottle. Her motives were right and good. Babies with cleft palates can’t suck. However, she was essentially pouring milk down his throat. Since he has neurological problems, he has trouble coordinating swallowing and he couldn’t keep up. I gave her some special bottles to use with babies with cleft palate (you squeeze them to control the rate of liquid flow) and educated her in how to use them. I also explained his cognitive status and prognosis, all via an interpreter. Again, it is so hard to deliver the devastating news that her baby will never be normal and will likely always required total care and not be able to quickly respond to her questions and offer comfort in her native language. I had to depend on the interpreter to do that for me. I tried as best I could to reassure the mother that she should continue to talk to him, sing to him, love on him, and hold him. She has to either hold him all day long or lie him down somewhere. She has no swing, carseat, stroller, etc. My translator was going to buy an umbrella stroller for him.
The next baby I saw was little Cindy Perez. Cindy is 8 months old and weighs 10 lbs. I don’t know if she made the surgery schedule or not because her nutritional level is quite a concern. I asked mom what she was feeding Cindy. They are very, very poor. Mom said that she was breastfeeding (nearly impossible with cleft palate), but her milk dried up at 3 months. They couldn’t afford formula or milk, so she had been grinding corn, mixing it with water, and straining it and feeding the baby the corn water. Almost zero nutritional value in that! I asked mom what she and her husband ate---tortillas and beans every single day. I asked if she had ever fed that to Cindy and mom Is worried that either Cindy will choke or the food will go in her nose (because of the cleft). I told mom that food would definitely go in her nose, but that’s not a problem; just clean her nose after she eats. Our mission coordinator went to the shelter kitchen and got me some soft mushy rice in a tomato based sauce to try with Cindy. I fed her some tiny bites to see how she would do. She happily gummed it and swallowed it on down, then opened her mouth and leaned toward me for more! She couldn’t get enough, fast enough. She did just great with it. She did cough a couple of times, but she was fine. I showed mom how to position Cindy upright (she’s also not sitting up yet), how to give her very small bites, and how to give her a bottle. Mom had also cut very large holes in Cindy’s bottle, but Cindy could suck if the nipple was tilted to the right where it could be pressed against the largest part of her open palate. I gave mom several of the Mead Johnson cleft palate nursers as well. As I showed mom how to use the new bottles I poured the formula in and noticed there were brown chunks in it. I asked what they were and it was crumbled cookies. Mom had been told that sugar was very important for babies who didn’t eat much, so we had to provide much education about nutrition. We also got a case of formula for Cindy. Now that she will hopefully begin eating table foods like mashed beans, potatoes, carrots, rice, etc. she should begin to gain weight. In spite of her severe malnutrition she seemed pretty cognitively intact and was easy to engage and she smiled and laughed readily. If I do nothing else the entire mission, my time spent with Cindy was so special and significant for me. I felt like Mom felt more confident in how to feed and care for Cindy and Cindy can start to get some better nutrition. I can’t imagine how it feels as a mother not to be able to provide daily food for your own child. She was such a sweet mama too. She asked how she would know what Cindy could eat and when. I talked her through a progressive schedule of adding more variety and texture to the diet, but ended with just simply trusting in her own instinct. I truly feel that maternal instinct and intuition are universal.
By this time it was 2:00. My translator, Donya, had her two children and their two friends with her and no one had eaten yet. I was at the mercy of Donya for transportation and she asked if I wanted to go to lunch with them. Since I hadn’t eaten, I tagged along. We picked up another friend along the way and then two more met us at the restaurant. Donya is very wealthy and part of CISA, which is one of the largest coffee exporters in Nicaragua and a huge supporter of Operation Smile Nicaragua. She had her driver take us to the restaurant. They made me sit in front so I would have plenty of room and crowded 5 people in the back seat. We ate at Buenos Aires which was the same restaurant from the first night. We had a community meal and Donya ordered a little bit of everything. Oh my goodness! So many delicious things that I had never tasted! I had the tostones con queso again, grilled chicken and steak and sausage, yucca, pickled grapefruit rind (sounds gross, but it was very sweet and had a great texture—I could have eaten the whole plate of them), some stewed kind of fruit that we don’t have in the states similar to a plum and soaked in a delicious sauce. You just suck on the fruit and it kind of melts in your mouth and then you spit out the large pit. I ate homemade corn tortillas wrapped around cheese and chicken. The tortillas tasted like the Nicaraguan equivalent of my grandmother’s cornbread. I don’t even remember what else I ate, but I liked everything and was stuffed afterward. While at the restaurant I needed to go to the bathroom. The women’s bathrooms are usually labeled with either “damas” or “mujeres.” I went into the bathroom and realized that the toilet seats were up in every stall. With horror I thought that I had misread the sign and had gone into the men’s bathroom. I poked my head out of the door, read the sign again, and realized I was in the right bathroom. The guy at the restaurant saw me and laughed.
At lunch I was talking with Donya’s friends who had joined us, Rosita and Noel. Noel and I were chatting and he asked where I lived, where I went to college, etc. I told him I went to college in Alabama “at a school you’ve probably never heard of.” He told me he used to live on the AL/FL stateline, so he may have heard of it. I asked him where he lived and he said “Dothan, AL”---my hometown!!! I almost fell out of my chair. Without fail, every single time I travel internationally I meet someone somewhere like that and realize that it truly is a small world. His family had to leave during the Sandinista Revolution in Nicaragua in the 1980s and they relocated to Bonifay, FL where they had a hog farm. He came into Dothan 2-3 times a week. He knew Chipley, DeFuniak Springs, etc. and ended up going to college at the University of Mobile. To make matters even freakier, he has Wisconsin connections. I asked him was business he was in and he sells cow semen. I told him, “Ummm, I don’t know quite how to respond to that.” Anyway, he is into agriculture and deals with breeding cattle so he makes frequent trips to Wisconsin and Texas to sell and buy semen, do genetic testing on it, etc. He is in Madison, Plymouth, and Fond du Lac, Wisconsin twice every year and will be back in August, so he may try to come visit us. I had so much fun talking to him! One of the high school students who was eating with us goes to a private international school in Managua. She says that LSU recruits there and she has a lot of classmates who want to go to LSU. Her sister was also just accepted at LSU. See how my parallel universes collide? That’s why I love to travel and I love to talk with people. So cool! I’ll end my Saturday story here because Saturday night deserves its own post.