Tuesday: Surgery Day 2

Since I’m stuck on a plane for 3 hours, I thought I would finish up my blog. Obviously I’m not connected to the internet. I’m typing in Word and will transfer it when I get home. I was going to nap in the plane, but the movie is “The Invention of Lying.” I wanted to see it and it never even came to central Wisconsin, so I’m watching it. I can’t just sit and watch a movie—I have to multi-task, so I’m writing too.
I got up early Tuesday to finish with the packing and we left for the hospital at 6:25 as usual. We had our team meeting and got to work. Today there were quite a few palates on the surgery schedule, so I had a few therapy sessions with different kids. One girl I worked with was named Eskarleth and she was 12 years old. She had a repaired bilateral cleft lip and palate. She was getting a lip revision. Her lip was very short and tight from the previous repair, so much so that she can’t put her lips together to produce /p, b, m/. This is further complicated by the fact that she needs a bone graft in her upper alveolus (gumline). The premaxilla, which is the part of the gum with the 4 central incisors, protrudes forward so much that even after her surgery she probably won’t be able to put her two lips together without effort. She also has compensatory misarticulations. She is unable to produce /k. g/ because she produces it in the back of her throat because she could never build up the oral pressure in her mouth. It’s so frustrating for me because it is a hard error to correct and requires quite extensive therapy typically. I worked with her for about 45 minutes and showed her mom how to work with her at home. I am under no illusions that I was able to successful teach a woman with no education a crash course in speech therapy techniques and it is going to change her daughter’s life. Maybe her speech will improve a little bit, but the reality is that an improved facial appearance will increase her chances of marriage, which will increase her financial situation and security. That’s the ultimate brutal reality of utter poverty in north Nicaragua, lack of education and health care for the poor, and thoughts enveloped by superstition and folklore.
Rebeca, one of the Operation Smile Nicaragua coordinators, called one of the kids with microtia who didn’t get picked for surgery to come back for therapy. He wasn’t talking very much and only has one good ear due to the deformity of the other one. Yet another reason that we need an audiologist and ENT on the mission—lots of ear problems, esp. associated with certain syndromes. We had a good therapy session and I had a high school guy translating for me. After I finished the therapy session I asked mom if she had any questions and she was concerned that her son was not yet potty-trained and asked my about that. (Sidenote: We get all sorts of questions. They think we are all doctors and I have been shown rashes and asked about scoliosis.). Here’s the thing about potty-training…the age of toilet training differs greatly according to culture and each culturally group has its own words for the way that kids say bodily functions like “pee-pee” and “poop.” I had no clue about Nicaraguan potty training, so I asked the 16 y/o male translator what he knew about it. He looked and me and said, “I don’t know. I was born in the US.” However, I give him props because he translated all of this potty talk without flinching. I had to get him to ask the mom what age kids are toilet trained. Her son was 20 months old and she was worried that he wasn’t. I didn’t even think about training my boys at that age! Kids do have to have a certain amount of speech/language skills usually to learn to use the toilet because they have to express the need gesturally or verbally. So, I taught her how to start attaching the physical sensation of needing to go with the words to say it. This kid was a trooper and hung in there with me. I learned that Nicaraguan kids say “poo-poo” (but more rapidly with a shorter “o”) too and I really complimented my translator. I told him that he probably never imagined that he would be talking about poop and pee when he came to the hospital that day, but I was amazed with how mature he was about it all.
When I finished with my therapy on Tuesday I helped out some more with medical records. That’s a huge job and I have a newfound appreciation for it. I spent the afternoon back in PACU/recovery holding babies. There was one child with a unilateral cleft lip/palate that the psychologist and I worked with. I had seen mom with the child at the shelter and was concerned about possible abuse. The little girl had ecto-dermal dysplasia, syndactyly (webbed, claw-like) hands and one foot, and lesions all over her skin from her syndrome, as well as microtia. She was also nonverbal and likely had a moderate cognitive impairment. She was scheduled for lip surgery and was on the table and put to sleep. They went to intubate her and they found a large red, bleeding cauliflower-like mass at the base of her tongue that would likely compromise her breathing. It was not visible on inspection, it was only with the laryngoscope that they could see it. They had to cancel her surgery on the table. Very heartbreaking. She is being referred to an ENT in Managua for follow-up and hopefully this issue can be resolved and she can get surgery later.
I was getting a ride to Managua that afternoon with one of the Operation Smile Nicaragua board members. We were originally going to leave at 1, then 2, and we finally left at 3:45. That was fine with me. Since I was cutting the mission short by 3 days anyway I wanted to stay as long as possible. At about 3:15 I made the rounds and told most of the team members good-bye. It’s amazing how close you become to people after living with them and spending 12-16 hours a day working with them in just one short week. As I hugged them good-bye I got a bit emotional. Since I wasn’t sterile, I missed getting to say bye to most of the surgeons, OR nurses, and anesthesiologists. I now have 67 new friends from all over the world and have learned so much from all of them. It’s so neat to be a part of a multi-cultural interdisciplinary team that comes together and works so well.

Albertina, a Operation Smile Nicaragua board member, drove me back to Managua that afternoon. We saw people selling iguanas and armadillos along the highway and she told me that it was for people to cook and eat. I asked her if people seriously ate armadillos and she said that they were very good and she had two in her freezer at home. We call armadillos "roadkill" back home in Alabama and here these affluent people eat them. I was astounded. Anyway, got to the hotel in Managua and it was very nice. What a thrill to have a room to myself! My friends from Diriamba, Nicaragua (south of Managua) who we work with when our church goes down came to pick me up for dinner. We ate at a Mexican restaurant and I had delicious chicken enchiladas with a spicy verde sauce made of green tomatoes. It was so fun to see Claudia, Daniela, David, Kevin, Steven, and Claudita! We didn't eat until 9:00 pm and I didn't get back to the hotel until about 10:30. Finished up packing, showered, and got to bed for a wake-up call at 5:30 again to catch an 8:30 flight out to Miami-Chicago-Wausau.