Operation Smile Adventures

Tuesday: Surgery Day 2

2010-02-10T22:05:00.001-06:00

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.

Surgery Day 1

2010-02-10T07:52:00.001-06:00

Starting Monday it was surgery week. If you’ve been reading then you know I didn’t post on those days. The fun part is over and the hard work is in full swing. Too tired to think about blogging. Also when you consider that I am typing on a tiny keyboard and the internet at the hotel in Chinandega was spotty at best, it took a lot of time to blog and post.
Monday we arrived at the hospital at 6:30 am and we had a team meeting. Unfortunately the first bit of news was not good. One of the children we had screened had died overnight. I have never been on a mission in which a child had died and it was definitely not a good way to start. The child was 14 months old. He had not had surgery. He started running a fever the night before in the shelter and the team pediatrician sent him to the hospital, started him on antibiotics, etc. He took a turn for the worse and died during the night. We don’t know why or what he had. So very sad.
After the team meeting the medical personnel practiced a mock code in the OR and the rest of us went to our respective areas. About 4 kids got taken off of the surgery schedule because they were sick, but 27 children were still given new smiles on Monday. Everyone came out of surgery well. I didn’t have much to do in speech therapy world on Monday because all but two of the surgeries were cleft lips. A cleft lip doesn’t affect speech and most of the children were infants anyway. Since I didn’t have much happening, I helped out where I could. I folks. I did have to screen a couple of latecomers and I did an evaluation and some parent training with the waitress from the beach who brought her son in. Turns out he’s just a late talker. I had a really good translator helping me with him. Our translators are groups of students from the International schools (American-Nicaraguan) in Managua and Chinandega and they are members of Operation Smile clubs at their schools. They are very helpful!
I finally found a good way to keep busy in the afternoon. I was a baby wrangler and baby whisperer in the recovery room. The nurses needed to get vitals, chart, and all of that stuff, but some of the babies are very agitated and combative coming out of anesthesia. The student volunteers were scared of hurting the babies or didn’t know how to hold them. I am used to manhandling kids when I need to so I held several bucking, screaming kids as their blood pressure was taken or even when a new IV was started. I also got to cuddle and love on them—my favorite part. The cool thing about being in recovery is that I get to see the mamas come in and see their babies and their new smiles for the first time. The moms are so relieved that their babies came out of surgery okay and usually delighted with the result. Of course by this time I was already tired and my emotions were at the surface, so I cried right along with the mamas.
I spent the rest of the day in recovery and left the hospital at 7:30 pm—a 13 hour day. I was too tired to even think about eating, plus I had to go ahead and pack everything to leave straight from the hospital on Tuesday. After being covered with drool, urine, blood, and other assorted body fluids from the babies, plus being so sweaty myself (temps in the mid 90s, no a/c) I took the best shower of my life when I got back to the hotel and then to bed around 10:30. The long days and early mornings are catching up to me.

Final catch-up post for Sunday

2010-02-07T22:36:00.002-06:00

Today was a lazy day and tomorrow it is back to work. We left at about 10 to head out to the beach. It was a beautiful sunny and hot (mid 90s)day and we were on the Pacific Coast. It was a black (volcanic) sand beach with lots of shells and water that was just the right temperature--pretty warm, but just cool enough to be refreshing. We went swimming, ate a big lunch (fish, chicken, or steak) followed by Tres Leches cake, lounged about in the sun, and just relaxed and talked. My favorite thing to do at the beach is to go walking and looking for shells, but they told me it wasn't safe because of robbers. However, I finally found a small group willing to go, so we went for a long walk along the beach and I found some really cool shells.

While at the beach, Mark, our anesthesiology team leader, called me over. He had been talking to one of the waitress and she had asked about our group. He told her that we were with Operation Smile and what we did. When he mentioned that there was a speech pathologist in the group she told him that her 3 y/o son didn't talk. He wanted me to talk to her about it. With Mark (biligual American) and our Nicaraguan plastic surgeon translating for me I was able to talk with her. It sounds like her son has a pretty significant phonological disorder that won't likely resolve without intervention. However, speech therapy is pretty non-existent in Nicaragua, so there is no place for her to go. She's going to come to the hospital tomorrow or Tuesday and bring her son so I can evaluate him and teach her how to work with him at home. The plastic surgeon gave her his cell phone number so she can call and they can track me down if she can't find me at the hospital. I so badly would love for a few Nicaraguans to come to the states for training as SLPs. The need is so great. The speech/language and ministry opportunities in Nicaragua are both so great and Robert and I have such a love for the Nicaraguan people that the possibility of us retiring in Nicaragua has been tossed around. At any rate, I do hope she comes to see me and brings her son.

Another interesting sidenote...Mark, the anesth. mentioned previously, and I were talking. He used to be a PT and then he went back to school to go to med school. I asked where he went to school and he told me in Kirksville, MO. I commented that he must be an osteopath since I knew there was a D.O. school there and I told him I had never heard of osteopaths until I lived in MO. Long story, short, turns out that he lived in Carthage, MO (where we used to live and where Noah was born)!! He was a PT at McCune-Brooks Hospital and asked if the Precious Moments Museum was still there. Yet another small world experience! Mark is originally from NE and now lives in VA Beach.

Back to the story...
It was time to leave the beach and we loaded onto two busses headed for the different hotels. One bus had music blaring out. Turns out that it was our bus, henceforth dubbed the party bus. Everyone who boarded the bus had to dance down the aisles while everyone cheered. It was pretty hilarious and our bus was rocking. We really have such a great team here. Everyone gets along so well and really likes each other. It's amazing how well we work together, having been strangers before. My roommates and I were laughing about how when we first came here we all stayed in our little respective corners of the room, closed the door in the bathroom, etc. However, 3 days in and there were 3 of us in the bathroom at the same time, doing all of the different things that people do in the bathroom. I'll just leave it at that. :-). It has turned into a big dorm room now.

We lazed about the hotel for a couple of hours and I swam 10 laps in the pool. Between walking the beach and swimming, I feel like I finally got some much needed exercise, esp. considering how much I've been eating. We got to watch up until about 5 minutes into the 2nd quarter of the Super Bowl and then we had our big team meeting. The meeting took a couple of hours and we didn't see the Super Bowl again until right at the end. I had on Noah's Saints jersey and almost everyone here was pulling for the Saints. My roommate was mouthing the score to me across the room at the meeting because she was getting ESPN updates on her blackberry. We had really great pizza at the meeting tonight and then met in small groups afterward. It's now 11 pm and we get a 5:30 wake-up call tomorrow. Tomorrow is the first day of surgery, so it will be a very busy day! I'm off to put my very sunburned body into bed...

Lifestyles of the Rich and Famous

2010-02-07T22:08:00.002-06:00

Saturday night

So on Saturday night we were invited to a birthday party for a woman who, along with her husband, are big financial supporters of Operation Smile. They also have a foundation called the Coen Foundation that provides education, medical care, and lots of other things to children in Nicaragua who can't otherwise afford it. We went to their ranch for a party last night.

I have been a lot of places and had a lot of cool experiences in my life, but last night was surreal. The Coens have to have 100s of millions, if not billions, of dollars. They own every Western Union in all of Central American. When you consider how many people from Cent. Am. live and work in the US and wire money back to their families in Central America, you get an idea of the scope. They also breed and sale horses. This party and the property were truly like something you'd see on Lifestyles of the Rich and Famous. The party was in a huge cabana-type thing (A few thousand square feet) with a straw roof, marbles floors, sofas and lounge chairs, tables and chairs, a pool table, a buffet, a bar, very fancy bathrooms, etc. It was decorated in an African theme. The minute I set foot under the roof waiters materialized to take drink orders and then they started coming around with appetizers. We had plantain chips, fruit, this really delicious fried kind of doughnut made out of mashed yucca and banana and dipped in honey, and then these strips of steak that were to die for. It was the most tender and delicious beef that I had ever had and I ate a few pieces. Then I found out (Robert, you'll love this)that I had been eating venison all along. This is quite humorous since I don''t eat venison, for 2 reasons: (1) I don't like the way it tastes and think it is gamey and (2) It makes me sad for people to be Bambi-killers. But here I was chowing down on venison and loving it. To make matters worse, I found out that the deer had only been shot a few hours before the party.

We walked outside of the cabana to a little hut where there were 2 whole pigs roasting over a pit. That would be dinner later. When it was time for the buffet we had the pork, salad, yucca, cheese and homemade tortillas, and beans and rice. Each plate was a different handpainted African scene, painted in Zimbabwe. We had a variety of delicious cookies and cakes for dessert. At one point in the party, the Coens asked if we wanted to go on a safari. We loaded up in small groups and they took us in 4 small Caterpillar type ATVs on a tour of the property. Oh my goodness!! There is a whole building just for people to hang out in, eat, drink, etc. while they view the horses and consider buying them. There are 2 guesthouses that are bigger than my house. There are gorgeous stables and we got to meet some of the horses. One of the horses that we got to meet is the all-time champion of Spain. He's won 2 Olympics, many awards in Spain, and is 17 hands tall. He was huge, beautiful, and quite cocky. They have over 300 horses on the property and about 60 new colts each year. All of the males are stallions. As we continued the tour we saw the pastures, the corrals, the main house, the family chapel, the mausoleum, the children's play area (a whole neighborhood of playhouses and a carousel, complete with ticket booth, from Italy), and a huge building whose sole purpose is to store party supplies like decorations, plates, costumes, etc for different themed parties. They also bought 3 Nicaraguan train cars since the railroad no long exists in Nicaragua. Two of the train cars have been made into guest suites with marble floors, mahogany walls and ceilings, and bathrooms. The other railcar is a bar. The fenced part of the ranch is 1500 acres, all beautifully landscaped. My words nor my pictures will do it any justice. However, Jaffe and Piedros, were very down to earth people and gracious hosts and they are doing a lot to give back to the community, not just financially, but personally as well.

After the tour and dinner, there was a DJ and dancing. You just can't sit still to all of the Latin music that is played. Just about everyone ended up on the dance floor. Yet again I have been given dance lessons by a great Latin dancer, but I think it is a lost cause. Omar, one of the PIT crew from Nicaragua, is a hilarious and friendly guy. He made it his mission to teach me salsa. Never mind the fact that I am about a foot (at least) taller than him. He was very patient and I did get the footwork down, but to move my feet, hips, and shoulders all in different directions simultaneously is too much for this poorly coordinated white girl. I kept apologizing and told him that I was sorry that I was the whitest girl (in terms of dancing ability) at the whole party. Anyway, our whole group was just being silly and having fun, so a good time was had by all.

It was quite a night in a place of unsurpassed beauty, surrounded by wonderful people. It was a fun way to end a busy work day. Pictured will be forthcoming.

Operacion Sunrisa-Saturday

2010-02-07T18:03:00.000-06:00

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.

Friday, Screening Day 2

2010-02-07T08:54:00.000-06:00

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.

Operacion Sunrisa-Screening Day 1

2010-02-04T22:31:00.001-06:00

We got a wake-up call at 5:30 this morning, were at breakfast by 6:10 and on the bus to the hospital by 6:30. We spend about an hour setting up for screening and then got to work. Between 8:30-4:00 I single handedly screened 86 kids. Fortunately one of the nurses saw that I hadn’t taken a break and she saved me some lunch. I didn’t even know we had food! I ate at 2:00 pm. Speech is the last screening station because it always causes a bottleneck. This is because there is just one SLP, whereas there are 4-7+ nurses, plastic surgeons, dentists, anesthesia/peds people, etc. Also, I have to look in their mouths and assess palate function, get a speech sample, screen language, ask about hearing, and check on feeding. It’s a lot to go over in about 10 minutes, then when you add in the translation factor that adds even more time. Most of the crew was already back at the hotel lounging around the pool before I got back. Although screening days are tough, I have a lighter load once surgery starts.
Some interesting (and sad) tidbits about the day:
*Saw one child with Treacher-Collins syndrome. There was also a little girl with Turner syndrome, but I’m not familiar with that one, so I missed her.
*On the intake form there is a question something like “What do you believe caused your child’s problem?” On over 50% of the forms parents indicated that either a solar or lunar eclipse caused the cleft. Some parents said things like “so God could teach me patience.” The saddest one simply said “incest.” The mother of the toddler was 13, which means that she was 11 or 12 when raped. Just heart-breaking.
*A 14 or 15 year old guy came in with a medical mask on his face. Before I had him take it off I asked the translator to ask him why he was wearing it. I wanted to mask myself if he had TB or something. Turns out that he was wearing a mask because of the severity of his deformity. He had a hemangioma, which is a large tumor—like and highly vascularized birthmark all over his upper lip. It had also grown into his nose and premaxilla (from part of the palate where the 4 central incisors are). He had had surgery to remove it, but it was not highly skilled. He had no upper lip at all, was missing the columnella (the tissue between the nostrils), and his whole premaxilla. His face look very pushed in and he had extensive scarring on his cheek as well. He needs major reconstructive surgery and a bone graft and that is beyond the scope of the mission. Just not equipped to handle such complex cases. In spite of his problems, he did have good speech though.
* A couple of people coming through screening said that their only speech problem was the “rr”-rolled r. Sorry---can’t help you with that since I can’t even produce it myself.
*Lots of fat, healthy babies coming through screening which was great. It’s virtually impossible to breastfeed babies with cleft palate because babies can’t create the necessary vacuum to suck when there is a gaping hole in the mouth. If it’s a small incomplete cleft sometimes the breast can fill the cleft and it’s okay, but moms of babies with complete clefts usually have to bottlefeed. However, several moms today have somehow figured out how to nurse their babies, even with complete clefts and it was a great thing!
After screening, got back to the hotel at about 4:30 and everyone hung out by the pool for a couple of hours, then we went to dinner at Buenos Aires restaurant. Had a great meal of tostones con queso (mashed and fried plantains with a salty fried cheese), brocheta de pollo y carne (steak and chicken kabobs), rice, fries, and some dessert kind of like dulce de leche. It was all such great food and it was $6 a person. I washed it all down with a nice room temperature (read: HOT) Coca-Cola light since I can’t drink the ice here.
It’s now 10:30 and all my roommates have been asleep for about an hour. Signing off to start another morning at 5:30 am. Apparently over 100 kids are being bussed in for screening so it should be a busy, busy day.

P.S., It's hot, really hot. Upper 90s high humidity, then packed in a room with about 60 people at a time. I'm wearing shorts tomorrow!

I'm here!

2010-02-03T22:30:00.003-06:00

It's 10:30 pm and I have to get up at 5:30 am, so this will be very brief. I arrived in Chinandega, Nicaragua today at about 4 pm. We had time to unpack and rest a bit before dinner and the first team meeting. There are 68 team members including plastic surgeons, anesthesiologists, nurses, (OR, recovery, pre/post op) dentists/orthodontists, pediatricians, medical records, child life specialist, and me...the lone SLP. The team is composed of people from US, Canada, Nicaragua, Peru, Paraguay, and Equador. We don't know each other very well yet, we speak different languages, and we come from different cultures, but somehow over the course of the day tomorrow we will learn each other's rhythms and learn to work as a cohesive team. It's pretty cool how that happens.

I am staying at the Villas del Cortijo http://www.hotelvillasdelcortijo.com/). Usually the whole team is in one hotel, but no one hotel here can hold all of us, so we are split among three. The largest group contingency is here and this is where most of the group dinners and gatherings will take place. According to what I've heard, this is the nicest hotel and it is the only one with a pool. I am in a "dorm room" with 4 single beds. It's a large room with a large bathroom. Not fancy, but clean. There is no mattress pad on the bed though, but I am trying not to think about that. My roommates are Jeesun (pediatrician from LA), Jean (PACU nurse from CO), and Kate (pediatric anesthesiologist from NYC). Our room has a nice patio and our view is of palm trees and an active volcano just a few miles away. Very pretty. It is hot! Mid 90s and the pool water feels like warm bath water. At night it is a very comfortable 70-something.

I'll write more later about today, but I need to go to sleep. 5:30 will come very early, I'm sharing a bathroom with 3 other women, and I'm not a morning person. We will start screening children tomorrow and the expectation is that we'll have about 100 kids to screen. It should be a long, exhausting, wonderful day.

The rest of the story

2007-11-16T19:40:00.000-06:00

When last I wrote, I was not a happy camper. Tuesday and Wednesday were better though. I took over the child life area since we no longer had a Child Life Specialist. That person is responsible for explaining the surgery to the kids and playing with them and keeping them busy while they wait for surgery. I did therapy and post-op instructions while they were waiting and played with them. I was busy all day and had a lot of fun. I got to consult with the surgeon a couple of times about some pharyngeal flaps and palatoplasty so that was cool too. I also went in and saw surgery for awhile in the mid to late afternoon. The ORs are so small and there are 2 tables per room, so by the time you have a scrub nurse, anesthesiologist, and surgeon (or 2) for each table there is not much room so I didnt observe too much because I was in the way. The other room was much bigger, but they were doing skin grafts in there and no craniofacial surgery because it had all been done.

The skin grafts were pretty gruesome. One guy had had a car accident and the skin on his upper right face was missing all the way down to his skull. Yes, I could see bone. They took skin from his groin and patched him up pretty well. The other guy was a mangled mess on his face. He had hit a horse while riding his motorcycle and his face was scabbed, bruised, and bloody and his lower left eyelid had been torn off. They were going to do a skin graft on him but ended up being able to move some of the skin on his face around and take care of things.

Elsa, was a 17 y/o on Wednesday who got surgery. She had a complete unilateral cleft lip and palate and had NEVER had surgery on it. She was so embarrassed of her appearance that she sat all balled up with her hand or jacket pulled over her face at all times. She hated having her picture taken (and everyone was taking them), so waited until she was asleep in surgery. I want to be able to share the transformation. She came out of surgery with a beautiful new lip, but she hasnt quite found her smile yet. Shes still so shy and withdrawn.

Thursday there were just 3 surgeries and then we spent the bulk of the day packing everything up. Thats quite an ordeal!! We finished by mid afternoon and then a group of us went to tour a cigar factory. I wasnt really excited about going and just went for the camaraderie, but I am so glad that I did. It was absolutely fascinating. The cigars are completely handmade and it takes over a year from start to finish. I really enjoyed the tour although we were all coughing and wheezing from the tobacco particles floating in the air. The girls in the sorting room (sort through leaves and categorize by size and color) make $5 a day and the most expensive cigar they produce costs $15 US dollars. They produce over 60,000 cigars a day. $5 a day to produce thousands of cigars worth $15 each...something wrong with that picture, dont you think?

I spent most of today in a bus headed from Santa Rosa to Tegucigalpa. We were all so excited to have a nice hotel again without cold damp sheets and with a real bathroom with a real shower and toilets where you can actually flush toilet paper. Its the little things in life. Most of us just hang out at the hotel, ate dinner here, and did our final bit of shopping. It was a nice afternoon. Im about to go pack and rearrange my suitcases to make it easier to go through customs. I am so ready to be home!!! Pictures forthcoming.

(The apostrophe on this keyboard doesnt work, FYI)

Days 4 and 5

2007-11-12T21:06:00.000-06:00

Day 4---We had a 3 hour bus ride to the Copan Ruins. These are huge Mayan ruins and it was very fascinating. There were lots of Macaw parrots there and some weird rodents that look like nutria. We also learned a lot about Mayan history. We were told to prepare for chilly weather since we´d be at a higher altitude, but it was actually sunny and quite warm. It was the first time here that I haven´t been cold and I even broke a sweat. We ate dinner in a quaint little town and then had time to roam and shop. There was some really nice jewelry and interesting things to look at. Then the long 3 hour bus ride home where we had to pull over when one of the team got sick and had to vomit on the side of the road. There was also the incident of driving the bus through a washed out dirt road (we didn´t get stuck) and when we were going about 50mph and our driver slammed on the brakes because there was a random horse in the road. The drive was absolutely beautiful though. I didn´t realize that Honduras was so mountainous. It is also very green and lush, so we´d drive through mountains covered with greenery and flowers and rivers flowing through. Santa Rosa, the town we are in, and the town we went to are like Honduran versions of San Francisco with the hilly, winding streets.

Day 5-The official start of surgery. We only had to plastic surgeons (should have 5) because the other Honduran doctors decided not to come. Yes, lovely. We should have had 4 operating tables with a floater, so instead we had 2...and 4 anesthesiologists. One of them told me that there were basically 4 anesthesiologists inducing each child. Way too many nurses too, since we usually do 20-25 kids per day and we only did 9 with general anesthesia and 4 with local. I was bored out of my head. Usually there is one speech pathologist (SLP) on a mission and we have two. The other is Honduran and she is bilingual. She actually got her B.S. and M.S. at Baylor and came back to Honduras. There are only 4 SLPs in all of Honduras and they have no degree program here. So, since there is another SLP, she knows the culture, and she speaks Spanish, then there is really no need for me here. Generally there is additional scut work to do which I don´t mind doing, but since the whole mission is over-staffed, there isn´t even that. I did work with one teenager today and even tried to get him into surgery for a pharyngeal flap, but they said that he is likely to be a bleeder and they´d rather catch him on the next mission in San Pedro Sula in February. Michelle, the other SLP, is really great and has tried to include me. She wanted me to give the post-op education for a few pts. and she was the translator, but that´s just kind of redundant because she could just go ahead and do the whole thing herself. So I just hung out most of the day and shivered.

It´s been in the 50s-60s almost every day except for yesterday, overcast, and today a constant drizzle so it is a damp bone chilling cold where I just can´t get warm. Our towels never dry and my clothes feel damp when I put them on. Plus, I´m having to re-wear the few long sleeves that I bought, so everything is just icky.

A few cool stories about the kids. There is a little boy named Hernando de Jesus who is 6 years old. He looks about 2.5. He is as smart as a whip, but doesn´t go to 1st grade because his mom is worried about him being bullied. However, I found out today that she is not his mom. He was born with a bilateral cleft lip and palate and his mother left him at the house of this older couple who are raising him. His ¨dad¨ brought him tonight for pre-op and he´ll have surgery tomorrow. The kids are sleeping 2-3 to a bed and the parents have no place even to sit. Pray for the parents and kids...lots of waiting, lots of crying, lots of worry, and no sleep.

More info as I am able. We have free internet here, but it is very tempermental and only 2 computers for 44 of us.

Operacion Sunrisa Days 2 and 3

2007-11-10T22:40:00.001-06:00

Yesterday I was too exhausted to update. We got up at 4 and we on the bus by 5. Our bus broke down about 30 minutes down the road and we had to wait for a new one and transfer all of our luggage. It took 7 hours to reach Santa Rosa. We were miserable on the bus ride because it was freezing and they had the air on full blast. We finally got them to turn it off.
My seatmate for the trip was Pam, the pediatrician. It´s an interesting group because we have 2 Pams, 2 Eileens, 2 Kathys (and 1 Katherine), 2 Lindas, and 2 Michis...crazy! I enjoyed talking to the other Pam about books, medical ethics, what peds learn about speech and language development, and everything in between.
We got to the hospital at about 2 and started screening at 3. We screening 58 patients that day. I was one of the last ones finished and got back to the hotel at 9:15 pm, having been up since 4. I never even ate supper and was too tired to think about eating...or blogging. I took a shower, ate a pack of cheese crackers, and went to bed.
This hotel in Santa Rosa is not quite as nice as the one in Tegucigalpa (an understatement!) I am rooming with Kathy, another pre-post op nurse from New Jersey. We have a double bed and a single and we barely have any room for our luggage. There is no dresser or closet, so we will quite literally be living out of our suitcases for the next week. That won´t matter too much since I will be wearing the same clothes all week as I am very ill-prepared for the weather. The internet said that it would be in the 70s and 80s, but it is pretty consistently staying in the 50s and is very damp. We are all having a hard time staying warm since we all mostly brought capris and T-shirts. We were all very cold last night and Kathy and I did get extra blankets for tonight. There is no heat in our rooms. We are also on the first floor and have a window with no covering on our shower. Really nice. Plus we have one outlet in our room. We moved my bed about 2 inches from the wall to plug in hair dryers and couldn´t open the door this morning. Crazy!
Today we screening 11 more kids. There are 52 scheduled for surgery and the goal was 100. As of now, surgery is only scheduled Mon-Wed and was supposed to go through Friday. Looks like we´ll gave lots of free time. I´ve gotten some great pictures of kids and gotten to see a few really interesting ones, including one with a partial facial cleft and a little guy with the most severe hypertelorism that I´ve ever seen. Our first kiddo today had scabies, so I´m a little paranoid about that, but I wore gloves and have been using antibacterial gel like crzay. We were finished by 1 today, so six of us walked around town and had coffee at a really neat coffee shop. The town is pretty boring on a whole and there is not much to do here. The shops were junky and we have seen no souvenirs yet.
Went back to the hospital at 4 for the posting of the list of who gets surgery and when. It´s so neat to see the faces of the parents light up when their child´s name is called. Even the older kids get really excited about being selected for surgery because they know it will change their lives. The only kids who don´t get selected are the ones who are too young, too involved (and they be seen locally later), or are sick (heart murmur, pneumonia, etc.). After that we came back and tried to nap, but this horrible band was practicing right outside of our window...the same 3 measures again and again, but at different times and not together at all for 45 minutes. Then, they finally played a song. It was horribly obnoxious! Hope it´s quite tonight, but from the sound of things that will not be the case. Thank goodness for earplugs.
We all went to dinner tonight at 7 and didn´t get out food until after 9. Yep, Honduras is just like Nicaragua in that regard. By the time our food came most of us weren´t even hungry anymore. We just back back to the hotel at 10:15 and some were going to a disco tonight. While it would have been fun, I´m still exhausted from the week of my defense and I need one more night of good sleep before I´m game to do anything late at night. Tomorrow we have a fair amount of travel to and from the Copan ruins for our sightseeing day and then we hit the ground running with surgery on Monday.

Operacion Sunrisa Day One

2007-11-08T20:18:00.000-06:00

I got up at 4:00 this morning and was at the airport in Baton Rouge by 5:30 am for my 6:30 flight. I actually arrived early in Houston and was in Tegucigalpa, Honduras by 12:30 pm. There were about 8 other OpSmile volunteers on my flight from Houston. We got to our hotel--a very nice Clarion Hotel--and then a group of us walked a mile to the mall and ate something at 3:00 since none of us had had lunch yet. Came back and took a little nap and had our first team meeting and pizza at 7:00. It´s almost 8:30 and I will be going to bed VERY shortly.

My roommate is Michi, a pre-post op nurse from Oregon. She´s going to be great--very funny and full of life! One of the anesthesiologists, Mike from Arizona, is from New Orleans so that was cool. He actually brought an LSU shirt here as did I, so we talked Louisiana stuff. There is no one on this mission from my previous one, but there are people who know people from my previous mission. One of the nurses, this is her 13th mission!

Tegucigalpa is very much like Managua, except it is located in a valley and there are lush green mountains all around. I can´t believe it, but they actually drive worse here! Didn´t think that was possible. I just close my eyes in the bus and hope for the best. Nothing like zipping through the streets of Tegucigalpa in a bus with the horn honking every few minutes and Abba blasting on the radio. The Honduran missions are usually here, but for some reason we are going to Copan this time. I´m glad as we have repeatedly been told that it is not safe here on the streets, although in a group during daylight we had no problems.

When I checked the weather before I left it was supposed to be in the 70s all week. A cold front has moved in and we´ll be at a higher elevation tomorrow and it is supposed to be in the 40s. I mostly have scrubs, capris, sandals, and short sleeved shirts, so it should be interesting. Hopefully it won´t last long. I do have a couple of sweaters and long pants, so I may just wear the same thing every day and do lots of laundry.

My time on the next is running out, as I paid 3 bucks for 30 minutes, so I´ll sign off for now. I have no time to proofread and I am typing on a Spanish keyboard, so there are likely many typos and no time to correct. Off to shower and hit the sack. Hopefully, more tomorrow. (Right now in the lobby, there is a live band and the guy is singing Ain´t nothing but a hound-dog)