Rotaplast Missions

First day of surgeries, all is well

First day of surgeries and so far success! The surgeons were able to operate on 12 people, all of whom are doing well in recovery tonight. Our youngest patient was a six month old girl, our two oldest patients were both male, 28.

In the waiting room, which happened to be right outside the office I was working in, were families. They didn't seem anxious or worried, and it was so different than what you may experience in the U.S. It's like they have complete and utter faith in the surgeons and know everything will be okay. It was actually very calming.

The siblings of the patients waited quietly for their brother or sister to emerge from the O.R. Without so much of a complaint about time or lack of things to do, these little ones blew me away with their awesome behavior. Kudos to them! And yes, it was nice to look out our office door to see a shy smile and a wave.

Our volunteers were once again very helpful and their humor and lightheartedness are a joyous aspect of our day.

As is to be expected, our Internet connection has not been that great, so please excuse the lack of photos in today's blog. I will post pictures as soon as our connection improves. Thanks for reading!

Day 1 was a Success

What a day!  Along with the 230+ patients the clinic saw today, we were also visited by the U.S. Ambassador to Bangladesh's wife, two national newspapers and a local news crew that managed to get their camera in and out of every tight room we occupied.  Those that sought help yesterday were all ages, it truly was incredible.  The medical records department, headed by Sherry, saw and entered every single patient that walked through our doors.  Screening involved the help of 20 local volunteers that were invaluable to the team.  They did initial interviews, interpreted for the surgeons, nurses, anesthesiologies, pediatricians, the dentist and speech pathologist.  They also helped keep the organized chaos that lead to a very successful day, ending in 97 scheduled surgeries in seven days.

the wife of U.S. Ambassador to Bangladesh visits the hospital during in-take 

The scene at Nurture Hospital was crowded but generally happy.  Groups of families waited downstairs on the first floor for their number to be called to come upstairs.  Our office was a long hallway with six rooms, each had a specific function.  As patients were guided through, they were consulted by the surgeons and then seen by the pediatricians and anesthesiologists, had their hemoglobin and other vital signs examined then finished by seeing our dentist and speech pathologist.  Like I said, it was organized chaos. 

Surgeons doing a consultation of a young boy.

I, as the photojournalist, was lucky enough to see and meet every patient that came in yesterday.  I was so humbled by their grateful, happy spirits, the smiles on their faces and how they tried to speak English with me as much as they could.  One little girl, dressed in a purple salwar kameez, was carried by her mother over to me and she looked me in the eyes, smiled and said "Thaaaaaaaaaaank Youuuuuuuuuuu." I was rejuvenated.  There were so many kids like her, with their tiny voices saying thank you.  One mother was trying to get her daughter to look at the camera for me, and she said "auntie, auntie" and the little girl turned and looked and gave me a huge smile.  Oh man, I love these kids. I'm hooked.

the line waiting to be screened during in-take day 

The majority of surgeries scheduled over the next seven days are cleft lip and palate; however there are a large number of burn related surgeries as well.  It's nice that the surgeons have flexibility in what they can do, so we can treat more children, whether they have cleft issues or not.  It's great to say that we have a happy and enthusiastic group of patients, and it's going to be exciting to see them throughout the next week.

 

 
Pediatrician Leonard Friedman interacting with a patient.

Other eventful activities: we had a wonderful welcome dinner hosted by the Rotary clubs of Chittagong and neighboring areas.  The enthusiasm these Rotarians have can get anyone excited.  They are a wonderully jovial bunch with a true love of service for others.  And I will say, I have never received so many flowers in my life.  Three bouquets and the richest lei I have ever laid eyes on.  We also enjoyed a lovely dinner hosted by the Ispahani family in their home on a little oasis in the midst of chaos that is Chittagong.  Their genuine hospitality made us all feel very welcome.

The team at our welcome dinner hosted by the local Rotary club.

Tomorrow surgeries begin!  Write  to you then!

 

 

 



Ae Je from Chittagong!

Its been an incredible journey but the team has arrived in Chittagong, Bangladesh!  We are currently acclimating to time, temperature and pollution in our beautiful hotel, Well Park.  Having just finished lunch, the medical team has been spending time organizing the schedule for tomorrow's hectic day. 

Upon our arrival into Chittagong International Airport, we were greeted by the enthusiastic Rotary Club of the area.  After gathering all 30+ mission boxes from the baggage claim, the team left customs and was immediately given beautiful leis, the most lush and hearty and wonderful smelling leis I have ever seen. 

 

The drive to the hotel from the airport was relatively long, but great for me to get to know the people in my car.  I, being neither a Rotarian nor a medical specialist, have had a great time learning about these amazing volunteers and why they choose to take their own time and money to help children in other countries.  One surgeon even said he wishes he could retire early just to volunteer full time, and in response, an anesthesiologist said that's exactly what he did.  The passion and love that I have already witnessed amongst these volunteers is incredible and I can't wait to see their hard work benefit the lives of over 100 children in these next two weeks. 

About Chittagong so far: I've never seen so many people smile at foreigners.  The driving is frightening, the roads clogged with rickshaws, tuk-tuks, cars, vans and buses with not a single stop light or stop sign that I could find.  Apparently, the country is known for it's "rickshaw art" on the sides of rickshaws, and even big trucks.  The paintings are colorful and all different.  The city sits on a river and we saw so many freighters, tanks and even little wooden row boats that almost resemble decked-out gondolas, but still dwarfed by the tankers flowing up and down the river.

 

This was the truck that we loaded up all 30+ boxes into to go straight from the airport to the hospital.

Tomorrow is going to be a long day, apparently there are over 300 children that will be coming to the clinic to seek attention, if the surgeons perform 15 surgeries a day, which is feasible, then hopefully a big dent can be put into that number. 

Until then, wish us luck on our jetlag and send good thoughts our way.

Thanks!

The group enjoying the first of many great meals to come in Chittagong.

 

p.s. "ae je" is how you say "hello"

Every Child Has A Story

Every child has a story.  Most have come from the highlands of Peru or the sierra, days away by bus. On the front cover of every story reveals a tender little face, marred by an abnormality that would, if not corrected dictate the rest of his/her life.

 
Angela Before

Angela is three months old with a bi-lateral cleft.  “We don’t understand why this has happened to her," said her father.  “Thank you for giving her this chance and for helping us because there are so many cases in the sierra.  It is very difficult to get treated.”

Angela After

Through the generosity of those who donate to Rotaplast, doctors, nurses and non-medical alike, these abnormalities are being corrected.  Children are given a chance to grow beyond the stigma of which their abnormality cast them into.

Britany Before

Britany After

Leonel Before

Leonel After

Over all, this Rotaplast mission preformed approximately 90 procedures on nearly 70 patients.  Most, like Gina are too young to understand the necessity of treatment.

 

But each time she smiles her mother will always remember Rotaplast and the gift given by the generosity of strangers.

 

A Gift That Can Only Be Heard

Of course the cleft lip repair can make a dramatic difference in a child's life. In an hour and a half, the skilled hands of a plastic surgeon with the help of the Rotaplast team can change a little girl or boy's destiny from being shunned by family and society alike, to a normal-looking, smiling, laughing, playful child who is ready to take on the normal challenges of everyday life.

It is the operation everyone can see, witness the transformation, and the inevitable "oohs and ahhs" in the recovery room remind everyone why we travel thousands of miles to do this rewarding work.

However, the cleft lip repair is only part of the work we do during a Rotaplast trip. In addition to the "glamorous" restoration of the cleft lip, the plastic surgeons spend a great deal of time with our hands deep in a place barely visible to even our scrub nurse in the operating room. Our big fingers and hands work in a cavity barely a few inches in diameter, like a craftsman assembling a ship in a bottle. A cleft palate is a split or separation in the "roof of the mouth" which is also the floor of the nose, and can involve the bony "hard palate" which also serves as a foundation for the teeth, and/or the soft palate, located way in the back of the throat, which also is connected to the uvula, the small fleshy "little tongue" that hangs in the back of the throat, the small piece of flesh subject to some folklore and mystery.

The child with an un-repaired cleft palate can suffer from a variety of maladies, from the aforementioned dental misalignment, poor nasal-oral hygiene, frequent ear infections that can lead to hearing loss, and most importantly and dramatically, poor speech that in some cases can be almost to impossible to comprehend. These children can be reluctant to raise their hands in school, refuse to converse, and be mistakenly considered to be unintelligent because of their reluctance. They can be subject to intense ridicule and bullying because of their reluctance of their speech itself, which can lead to a sort of isolation status typically expected for the un-repaired cleft lip patient.

It is for these reasons why the plastic surgeon will lean and bend into this small cavity in the back of a baby's mouth, for hours at a time, tolerating suboptimal lighting, room temperatures, and noisy suction machines, performing a relatively misunderstood and unglamorous operation to rearrange the tissues responsible for speech. It may be a Z-plasty (furlow) repair, a pushback method, an intra-velor veloplasty, or even an operation on the back of the throat itself, called a pharyngoplasty. These back and neck stretching operations are all designed with the same outcome in mind; to restore a child’s ability to speak.

 

It is a gift that cannot be pictured on a poster or in an ad and shown at fundraisers, it doesn’t easily lend itself to a "before and after photo" during a report to supporters, it is not described by a catchy phrase like "saving smiles," and at times these palate operations take a backseat to the cleft lip repairs. However, it is a gift that can make it possible for a child to speak clearly to his parents about his wants, answer a question in school with confidence, or one day give a speech that can move the audience, or actually one day in the future reveal what is truly in her heart - it is the gift of speech.

 

Thanks for being so gracious.

by Dr. David Morwood, M.D.
  

A Day in the Life of a Mission

I planned to write about a typical surgical day of a Rotaplast mission.  The truth is, there is no typical day.  Each day presents different challenges, new patients, and changing surgery schedules.  Everything is not exactly on time or at the ready; and we adapt.  Everyone on the team has a job to do.  Each morning when we step on the bus at 7am we know the key to a successful day will be to be flexible.  

 

At the hospital, pediatricians do rounds; surgeons check on their patients and the ward coordinators account for each patient and ensure they have their medical chart ready to go.   The head nurse reviews and revises the schedule while the anesthesiologists and nurses prepare the ORs for the first surgeries of the day.  Each day we utilize three operating rooms from the time we arrive until approximately 6pm or 7pm.  The recovery team remains at the hospital until the last patient of the day has moved to the ward floor.

 

Throughout the day there is a buzz of activity as children are brought into the OR; transported to recovery room after surgery; and finally the Moms, Dads or in many cases Grandmothers are brought in to comfort their child.

Today, our 6^th day of surgery we had another in-take. Reison is a sweet 5 month old child with a bilateral cleft lip.  He and his family live in southern Peru.  He is here because his grandfather saw TV coverage of the Rotaplast mission to Peru.  Reison will have surgery tomorrow; our last surgical day of the mission.

 

Impact of Press Conference

By the fifth day of surgery we’ve evaluated 112 patients; 78 at the opening clinic and 34 as walk-ins during surgery days.  One of those walk-ins on day four of surgery was Luhana.  Luhana is plagued by the same type of cleft abnormality as her mother was born with.  Her Mom’s cleft was corrected when she was 6 years old.  Luhana is 3 years old.  She came to Rotaplast because her grandfather watched our press conference on TV when Rotaplast first arrived in Lima.  Though Luhana lives in Lumbayeque province, she and her parents traveled the 15 hours to get here.  Luhana will have her operation today.

A Letter from Lissette's Mom

 

Dear Dr. Gemberling,

I give thanks to God for giving you and your team of surgeons these wonderful hands. I will eternally be grateful for your surgical intervention for my daughter Lissette and for giving her the most beautiful smile I have ever seen. 

Appreciatively, please accept this little gift,

Hadie

The gift Hadie enclosed was seven 1 sol coins each with a different symbol on the back; much like the USA issued state quarters.

A Wish Come True

 

We've completed three days of surgeries and changed the course 25 young lives.  While the majority of Rotaplast patients are children, we do see the occasional young adult who's life would be positively impacted by a surgery that could not be possible without Rotaplast.

Grecia was abandoned by her mother at the age of 2 ½ months.  If a child is born with a cleft facial abnormality, they may be socially stigmatized, their family punished or they may simply lack the same attention and care as other children as a result. The child may be kept in the shadows of society; locked away from view and hidden by his or her family.  In Grecia's case, she was left to her husband’s sister, Nellie.  Nellie took the baby and loved her.  Grecia grew into a young woman of 21 and dealt with a lifetime of eating difficulties. The food she put in her mouth would  fall out of her nose due to the gaping whole.  Her young life was spent being tensed and tormented by others who saw this.  Yet she persevered and entered nursing school until someone told her that she could not become a nurse with food falling out of her face.  She left nursing school embarrassed and humiliated. She made a wish to get her cleft palate repaired by her 22^nd birthday.

Soon after that wish, a neighbor saw and advertisement for Rotaplast on TV the day after our team landed in Lima.  Nellie and Grecia packed their bags and were on a bus to Lima that very night from the north coast of Peru.

One and one half hours change a life forever

 

Lissette was born with a cleft lip. Although her mother, Haide could not afford surgery for her baby, she was not going to give up nor trust just any foundation to operate on her child.  A former student of social work, Haide researched the foundations that offered free surgery.  She chose Rotaplast because of our reputation and results.  Rotaplast has been coming to Peru for five consecutive years.  Lissette will receive a surgery that will take approximately 1 1/2 hours that will change her life forever.

Leonel Atpoma Chumbe was born 4 months ago with a right unilateral cleft lip.  His mother, Doris, 20 heard a radio advertisement promoting this Rotaplast mission to Lima.  Although they live in a mountain province called Huancayo, they traveled the 8 hours in hopes Rotaplast could help Leonel.  We will.  One and one half hours of surgery will change Leonel's life forever.

Andre, 5 months old lives with his parents and seven siblings in Chucampa province, 12 hours away from Lima.  They were unable to get to Lima for opening clinic.  We evaluated Andre on the first day of surgery.  He is in need of a right cleft lip repair.  Andre was scheduled for surgery for the next day. 

Eydam is a beautiful boy of 4 years old.  He looks like a normal little guy but inside his month Eydam needs a repair to his soft palate so he may eat normally.  Eydam will receive surgery; one and one half hours later, his life will be changed forever.