Rotaplast Missions

Sohag, Egypt: Wrapping Up the Mission

Though the team has left Egypt the goodwill is still reverberating from this visit. After the majority of the team, led by Mission Director Michael Fish, had left, seven Rotaplast volunteers stayed behind to take a tour down the Nile. Dr. Sherif took this opportunity to have the group meet yet another local TV station for an interview. Then he had a special treat – to have them meet with the Grand Mufti of Egypt, Dr. Ali Gomaa. Dr. Gomaa is a leading dignitary in Egypt. The meeting went very well. Dr. Gomaa presented gifts of appreciation certificates and presents to all the members of the team. He also promised to collaborate with Rotaplast on future missions.

In the meantime, Peter Lagarias, Co-Founder, Heather Merriam, Executive Director, and Brian Walker, Volunteer, were staffing the Rotaplast booth at the 100^th annual Rotary International Convention. Having a booth at this convention, which was attended by more than 16,000 Rotarians from all over the world, gave Rotaplast the opportunity to spread the word about the success of the Egypt mission. The booth was visited by Rotarians from, among many other countries, Egypt. Thanks to the publicity generated during the visit, the Egyptian Rotarians were had already heard about the 127 new smiling faces in Egypt. There was even a rumor that it had been shown on CNN (we couldn’t find this reference, however). They were helped at the booth by DG Ayman el Dakhakhni, an Egyptian himself, who led district 5000 (Hawaii) to co-sponsor this mission.

Sohag, Egypt: The Last Week of Surgery

All of the residents and staff of the El Balyana Hospital were extremely hard working. The student nurses were unsung heroines. They were at the hospital first thing in the morning, waiting for the arrival of the minibus, and the last to leave at the end of the day. Assigned to PACU and the post-operative ward, they were seen scurrying around with files, escorting family members to see the patients, changing very tall heavy oxygen tanks, and informing the patients of the post operative instructions.

Though there were two translators on board, it would still have been very much of a struggle to communicate without the help of the residents. This mission had the benefit of plastic surgery, family practice, and even gynecology residents who greatly assisted in translating information to the patients and their families.

During the last week of surgery, there were many “walk-ins,” or people who had heard about the mission via word of mouth and showed up in hopes of getting a chance at having their child operated on. Many walk-ins were accepted for surgery. For even though the schedule was fully booked at the week’s onset, there were other patients who don’t show up for surgery, or who, at the last minute, were not deemed healthy enough to have it on that day. “Walk-ins” filled in the gaps. A total of 22 walk-ins were reviewed after clinic day. In addition, a fourth surgery room was opened to handle procedures that could be done under local anesthesia. The total number of surgeries completed was 170 on 127 patients.

Monday through Wednesday of week two were full days of surgery. The intense schedule was interrupted by visits from several local dignitaries, as well as visits from 5 television stations. The Rotaplast mission was locally famous by the end of the trip. Thursday, the last day, was a “half day”, ending at 2:30. Quartermaster Brian Walker had packed most of the boxes the day before. So at 2:30, after Dr. Capozzi finished the last case, there was time for an appreciation party for the all of the local staff. Everyone received thank you gifts and shared the half vanilla, half chocolate cake made for the occasion.

At the seemingly early hour of 4:00 pm, the bus was off to the hotel for a celebratory buffet dinner with the local Rotary partners and many of the resident doctors. Certificates of appreciation were given to everyone who had worked to make this mission such a success. One resident doctor, “Dino” (His nickname, given to him by his friends, was short for “Dinosaur” because he is tall) gave a different gift to every Rotaplast Volunteer.

Friday was post clinic day. The team was pleased to see so many patients turn up for a quick check up and photo. Everyone was seen by 1:30 pm. Then it was time to part ways.

POST TRIP
Some of the team returned home to get back to work. Others stayed in Egypt for a week-long tour,  finally able to take their majestic Nile River Cruise. Still others flew to the UK to attend the 100th Anniversary Convention of Rotary International. Rotaplast had a booth at the Hall of Friendship (number 670) from June 20-24.

The Day Off: Touring Luxor

After a long work day on Saturday, the team was ready for a day off – a tour of the ancient sites of Luxor. Various guide books had been passed around among volunteers hoping to absorb 5000 years of history before viewing some of the many temples there. The four hour bus ride from Sohag to Luxor included beautiful picturesque countryside.

The first stop upon arrival to this small city, was Karnak Temple, which is actually a complex of temples constructed over thousands of years by many pharaohs, including Ramses II. The temperature was 100 degrees and rising as the team spilled out of the bus and scurried across the scorching pavement to the newly constructed visitors’ center which had air conditioning, among other amenities. A very knowledgeable guide had been obtained by Dr. Sherif. After an overview of Karnak’s history, “Mena” allowed the team to wander among the magnificent tall columns laced with hieroglyphics, seeking shady spots while admiring the grandeur. The next amazing site was the Valley of the Kings, about a 20 minute drive to the other side of the Nile River. By the time the erstwhile tourists arrived, the temperature had climbed to 110 F. The volunteers boarded a tram to travel the short distance up the road to the tombs which were buried deep in the hill walls. Anyone who had had thoughts of walking instead of taking the tram was dissuaded by the possibility of fainting from the heat. As there were too many tombs to see in the allotted time, the team chose to see 2-3. Those who insisted on a challenge braved the 210 steps up to the highest and most inconveniently placed tomb, that of King Tuthmose III, that had a view from the top of the climb.

By the time the team returned to the bus, they were completely wilted. But there was yet another important destination – the market. Those with an inclination to shop were given only 25 minutes to select a shop, view the array of goods, and haggle for a bargain price. Several volunteers accepted the challenge with gusto.

To top off a wonderful day, the team was treated to a late lunch at one of the most pleasant hotels in Luxor – the Hotel Sofitel, which has a lawn on the Nile. It was very pleasant to cool down again. Those who weren’t totally dehydrated partook of their first chilled beer of the week. It was a long but wonderful day for all.

Sohag Day 3: The Boy With Donkey Ears

The Rotaplast team is gratified that there is such a need for our service in this region of Egypt. “We are finding a variety of cleft lip and palate cases here in Sohag, with lots of primary lips,” says Dr. Joe Anderson. “It is good to see that the majority of cases are the little ones.” Out of the 70 cases the team has done so far, only 10 have been non cleft lip. 

One non-cleft case was the very compelling story of one boy with unusually wide ears. “Hakim” had experienced much taunting by his age of 14 years. He was taunted and called “donkey ears.” His mother begged the surgeons to pin his ears back. “Psychologically, this is a very significant issue. It affects them deeply,” said Dr. Al Goldberg. For that reason alone, the surgery was a high priority and Hakim was squeezed into surgery on day two.

“Pinning back ears is a relatively straightforward but very gratifying procedure,” said Dr. Granger Wong, “and it doesn’t take long.” After the surgery, Hakim was brought into the recovery room and soon, his anxiously awaiting mother was allowed to see him. Though he was bandaged around his head, his mother was extremely happy at the sight of him. She kissed recovery room nurse Paula Fillari on the cheek several times and fell to the ground in gratitude. Through an interpreter, she said, “I had such a bad impression of Americans before… until you came and fixed my son’s ears and you gave him a blanket. Now I don’t think badly of Americans anymore. I am so happy – God is truly great.”

Sohag: Surgery Day 2

The majority of people in Egypt are Muslim. Five times a day, the hundreds of minarets located in the town of Sohag issue calls to prayer. The first call to prayer is at 1 am in the morning. 

Wake up calls for the team begin at 4:30 am, coinciding with the second Muslim call to prayer. Breakfast starts at 5 am and the advance team of ten rush to the hospital at 5:45 in order to set up the operating rooms. The rest of the team follows 15 minutes later in the larger bus. The bus ride is an hour through the Egyptian country side which in the early morning light is very picturesque. The bus is not permitted to depart until the police escort (complete with quipping sirens) is ready to escort us. The team has quickly learned to use the bus ride to and from the hospital as nap time. By 7:30 to 8:00 am, the team is ready for its first surgery. There are three operating tables in two rooms. Sometimes a fourth table is added to handle cases that can be done under local anesthesia.

By the third call to prayer, approximately 8-10 surgeries have been completed and it’s time for lunch.  The medical and non medical volunteers, as well as the very hard working Egyptian staff, take turns eating lunch in the nicely chilled break room. As the day progresses, the temperature steadily rises to over to 100 degrees F. Though there is AC in the key rooms, the hallways and third floor, where several consultation rooms and waiting rooms are located, do not have that luxury and are lucky if they have a fan. By 5:00, the surgeries are winding down. The last kids, tired and cranky from fasting all day long, are brought down for surgery. By the end of the day, 14-16 people have been given new and improved faces. The volunteers pack up for the day and are bussed back. A very nice buffet dinner coincides with the last call to prayer, about 8:30 pm.

Sohag: Conference Day

Today the team took a break from surgeries and participated in an all day “Scientific Program.”  The program was organized and sponsored by the plastic surgery department of Sohag University and took place on an island across from our Hotel in Sohag. The panelists included the four Rotaplast surgeons (Angelo Capozzi, Granger Wong, Ron Gemberling, Don Larossa) , our Speech Pathologist, Barbara Saffer, as well as presentations by our head anesthesiologist, PACU nurse, Paula Fillari; Dr. Al Goldberg, and Dr. Alex Habel, our two pediatricians, and our dentist-orthodontist, Mabel Garcia, who came all the way from Uruguay to participate in this mission. Five Egyptian doctors also made presentations. The program was attended by the Governor of Sohag, and several foreign dignitaries. 

While the medical professionals discussed the technicalities of cleft palate surgery, the non-medical volunteers were whisked off to see the sites around Sohag. Sohag is known for having a sizable Christian community. About 35% of the population is Coptic Christian.  The Coptic Orthodox church is the oldest form of Christianity. Thirteen volunteers were taken by the Rotary club of Sohag to two monasteries, the Red Monastery and the White Monastery. At the Red Monastery, the team was able to see a church service in process. The priest was preaching in the ancient Coptic language. He graciously welcomed the volunteers in English afterward and allowed us to take pictures of the church and his vestments. Then, after a box lunch we toured the Abydos temple, a very impressive example of the extensive pharaonic carvings on every inch of wall.  Lastly, the volunteers got a 20 minute shopping trip at an outlet of the weaving workshop.

To top off this already culturally rich day, the volunteers reunited in the evening and attended a cultural show. A folkloric dancing troop did three very intense dances for the team, and then allowed them to leave early so they could turn in for a few hours of sleep before another long day of surgery.

Sohag: First Day of Surgery

Wednesday, June 10 was surgery day. After the sifting process of the day before, a list of 13 patients were scheduled to be in three Operating Rooms.  Each Rotaplast surgeon had an Egyptian plastic surgeon counterpart.  After so many months of planning, it was exhilarating to watch the surgeons from the two countries perform surgery side by side.  Though they spoke different languages, they had the common language of surgical training. “It’s very uplifting to be working with the great interest displayed by the plastic surgery department of Sohag University,” said Dr. Angelo Capozzi, Medical Director of the mission, and co-founder of Rotaplast.  Given that the volunteers were very fatigued from jetlag, the day went remarkably smoothly. As with most countries, the family members of the patients had to be reassured and comforted during and after the surgery. The best practice is to bring in a parent as soon as possible in order to calm the patient. Sometimes the parent needs to be more reassured than the patient! 

Clinic Day Beats the Heat!

Equipment arrived at 3 am this morning. While this meant no sleep for the team (Mission Director Mike Fish, Quartermaster Brian Walker, in country coordinator extraordinaire Dr. Sherif al Bakri) who delivered it, it did mean we started the clinic on time. And what a clinic it was! We started early in the morning. We had everything ready to go at 9ish, and did not finish processing 217 charts until after 8 pm. At certain points of the day, the heat and chaos was challenging. However, patience and cooperation persevered. The team, with a lot of help from Egyptian volunteers, managed to see everyone who waited long, hot hours to see if they could be evaluated. The Egyptian partners were extremely supportive. When we ran out of folders, forms, and printing paper, they made sure we had replacements in short order. There was every echelon of volunteer, from residents, to people who monitored the crowds, to those who served several glasses of water during the day. Everyone was intensely busy and time flew by. By the end of the long day, veteran Evelyn Abad, head nurse, had carved out a schedule for all of the surgery days. Tomorrow we start bright and early – 5:45!

Arrival In Sohag, Egypt

Most of the Rotaplast team has arrived in Sohag, Egypt. The medical and non medical volunteers came from several directions: Hawaii, San Francisco, Seattle, Pennsylvania, the UK, Germany and last but not least, Uruguay! With so many connections, there was bound to be a glitch or two. Our Orthodontist-Dentist, Dr. Mabel Garcia, will join the team Wednesday morning due to a canceled flight from Latin America. Furthermore, some of our boxes were detained by Egyptian customs for lack of a key signature. As this is our first mission to Egypt, it is not surprising that, in spite of the best efforts of planning, there was one more hoop to jump through.

After two flights, a layover, the four hour delay in customs, and a 7 hour bus ride with only one pit stop, the team was eager for a shower and lunch when they got to Sohag (pronounced “soHAG” if you are from northern, or lower Egypt, and “soHAJ” if you are from Sohag itself. Sohag is a town of about 133,000 in Upper Egypt. It sits on one of the widest places of the great Nile River, which flows south to north. The summer temperatures range from a cool 80F to 110F. Rotaplast has been planning this mission for nearly a year with the Rotary Club of Sohag and the plastic surgery department of Sohag University. The team was warmly welcomed at the new “Nile Hotel” which, true to its name, sits on the Nile River. Each of the volunteer rooms has a balcony overlooking the Nile. Though it is hot, there is a breeze coming from the river. The AC in the rooms is welcome.

After the volunteers settled in, had a delicious lunch, and a good rest, an advance group of the head nurse, Evelyn Abad, head anesthesiologist, Peter Townsend, and one of our two interpreters, Amanda el Dakhakhni, headed off to El Bayana hospital, which is 50 km away from the hotel to see what lay in store for us. They returned with the news that all was well. As long as the remaining equipment arrives late tonight, the team should be set start clinic day on time. Stay tuned.

Final Day in Guatemala City, 2009

Today, the last full day of this mission, went by in a flash. Fifteen surgeries were conducted but none was complex. Because we will be traveling tomorrow, Dr. Johnson only scheduled the simplest procedures for this final day of surgery, which require minimal recovery.
Now that there have been a few confirmed cases of swine flu in Guatemala, the hospital was very strict about everyone wearing face masks....or at least trying to make everyone wear one.

Dr. Paul Quintana gave his daily departing-nutrition and post-surgery talk to parents and children this morning. Dr. Quintana patiently described to the mothers and fathers (in fluent Spanish) how to take care of their children following surgery--wound care, diet, etc. He used the opportunity to instruct the parents on basic nutrition (balanced diets, less Coca Cola), wean children from the bottle, and so forth. When he had answered the last question, the children (and the parents) were ready for discharge.
On Day Six, we posted a photo of Hilda, a courageous 17 year-old single mother, and her darling daughter while telling their story. Now we can tell the rest of the story. Cyndie George first spotted Hilda in the ward and took special care of her, as Hilda was the youngest mother and had traveled three hours with her daughter by bus. Cyndie and the webmaster talked about how beautiful Hilda was and what a shame it was that she was missing her front three teeth. Cyndie and the webmaster wished that Dr. Dugoni could fashion teeth for Hilda. Cyndie set the wheels in motion and explained Hilda’s plight to our dentist. Dr. Dugoni examined Hilda and decided that he could fashion something with the equipment he had brought from San Francisco. Hilda refuses to explain why several of her teeth are missing; the remainder of her teeth are very healthy. Cyndie slipped Hilda a small sum that would cover a return bus ride. Between Day Six and today, Dr. Dugoni worked his magic and created a retainer-type device with teeth.

This morning we nervously awaited her arrival. Paola Ferrate called and confirmed that Hilda and her baby were enroute. The bus ride normally takes three hours, but today it took Hilda five hours. She arrived at 3 p.m. just as the mission team was finishing packing. So Paola Ferrate, Jennifer Lindberg, Cyndie George, Dr. Dugoni (now known as the tooth fairy) and photojournalist stayed behind to see Hilda fitted with her new teeth. As Dr. Dugani said: “No patient left behind.” And just look how beautiful Hilda and her daughter Kristel now look. Mother and daughter both face a more optimistic future.

Our last evening concluded with a farewell ceremony hosted by local Rotarians. This is a standard and valued part of every Rotaplast mission. The success of the missions depends upon close cooperation and mutual support between the host Rotary club and the mission team. This celebration was notable for a slide show of our mission that brought the entire team to tears.
We will leave the hotel for the airport Friday morning at 5:00 a.m. Thank you for following our journey to Guatemala City. We experienced a strong earthquake, pouring rains and swine flu. We are proud that surgical procedures were performed on 137 patients.
Our team leaves Guatemala with several important lessons learned.  One has to do with team dynamics-this was an exceptionally cohesive team.  We worked hard and smoothly and accomplished a great deal. Another lesson has to do with the Guatemalan people--their pride, diversity and rich tradition.  Yet another lesson, universal in many Rotaplast missions, has to do with the fierce determination of parents, especially mothers, to protect their children and make their children’s lives better. Our team feels honored to have played a role in helping these Guatemalan families have a brighter future.
For more information about the team and more photographs, please go to the team's entire website - www.guatemala2009.com.