Rotaplast Missions

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.

Day Ten, Mission to Guatemala City 2009

The Vice President of Guatemala, Dr. Rafael Espada, came to the hospital today amid heavy security and media attention. Dr. Espada is a renown cardiac surgeon who practiced in Houston for 40 years. He met with Rotaplast’s international team of surgeons pictured with him below - Dr. Jitka Vritskova (Czech Republic), Dr. Carlos Beltran (Argentina), Dr. Debra Johnson (USA), the Vice President, and Dr. Milton Solis (Guatemala).

Dr. Espada was amazed to learn that from this mission, 105 Guatemalan children have had corrective surgery as of last night. He took a moment to meet and thank volunteers from the medical mission before touring the ward with head surgeon, Dr. Johnson. The doctors discussed the various theories about the cause of clefting. Dr. Espada showed obvious interest and compassion for the children as he visited each ward room.
As the tour wound down, Dr. Espada expressed regret for the “bumps” we had incurred in the first few days of our mission. He spoke to local Rotarians and pledged direct communication with Rotaplast for future missions. Our dedicated team of surgeons bid the Vice President adios and then hurried back to their operating rooms to begin their day.

The Vice President and his staff were particularly smitten with Ana and her beautiful eyes. Ana’s mother, Claudia, lives in Guatemala City with her mother. The media returned this afternoon to follow Ana’s medical journey from ward room, to surgery, to recovery. Ana’s father has left them and gone to Washington State. Claudia heard about the Rotaplast mission on television.....and now her daughter will be featured on the evening television news. As soon as mother and grandmother were united with Ana after her surgery, tears and cell phones came out.

Seems like a day wouldn’t be complete in Guatemala City without a new patient showing up. Today Dr. Johnson made room on the surgery schedule for three-month-old Julian. Julian’s mother is a housekeeper here in Guatemala. Earlier today her employer had taken her to a clinic so that Julian’s mouth could be examed. The clinic staff told Julian’s mother that Rotaplast was currently set up at the military hospital. The family is familiar with cleft problems; Julian’s six-year-old sister has had surgeries for a cleft lip and palate. Julian was our last patient of the day and looked perfect when we left the hospital at 7 p.m. (our earliest exit time yet).
At this stage of the mission, when we are feeling a sense of satisfaction with 123 surgeries completed by the team, we also sense the end of the mission; it is amazing how quickly time has passed. Tomorrow is our last day of surgeries. We ended today by thanking the enthusiastic hospital staff for their assistance throughout our stay. Please visit the team website at www.guatemala2009.com to see more photographs and meet the team members.

Day Eight, Mission to Guatemala 2009

After a sweet day of rest yesterday in Antigua, today we were back at the hospital by 6:30 a.m. facing a full schedule of surgery--we had eighteen children scheduled for today. Two of the children who had been schedule failed to show up, but we added two who arrived at the hospital today for the first time. Surgery commenced by 7:30 a.m.

Here is an example of a patient added to our list at the last minute. Around 9 a.m., a cowboy, who manages a cattle ranch, arrived with his fifteen-year-old daughter. The father was asking that she receive corrective palate surgery. He had heard about the Rotaplast mission on the radio. Although he doubted that we could take new patients this late in the mission, he spent his two and and half hour bus ride praying that our team could help his daughter. He had even declined food and drink for his girl in case we could fit her into our schedule...we did.

A heart-tug to each mission is that not every child can be treated. For example, this morning little Ana Francisca arrived with her mother from San Juan, Zacatepee, which is six hours away by bus. Ana will be two years old this week. Sadly she had pneumonia and could not be cleared for an operation. Dr. Quintana sent them home with antibiotics and directed Ana and her mother return in July to another scheduled Rotary-sponsored medical mission in Guatemala.

The comfort of our patients depends in part on our ability to effectively communicate with them and their parents. This mission has two translators, Paola Ferraté and Raphael Diaz. Also speech pathologist Kathi Hoffer and mission director Rosalie Wells frequently step in to translate for the families, children and volunteers. But this mission is fortunate to have an unusually high number of bilingual physicians.

Our two pediatricians, Paul Quintana and Ken Bloome, are both fluent in Spanish. Dr. Quintana primarily attends to children in the ward and Dr. Bloome is stationed in the recovery room. Their language skills are obviously comforting for the parents and children and lead to effective directions to the local hospital staff. Medical Director Dr. Johnson as well as surgeons Solis and Beltran are also English-Spanish speakers. Dr. Vrtiskova is trilingual (German, Czech and English) but she uses our translators in the operating theatre.

During missions, local doctors often take training from the Rotaplast medical team. This afternoon Dr. Quintana gave a lecture to medical residents on pediatric issues.

There is someone on our trip who no one sees or hears from during the day, Colleen Wynne. Her friends and family must be wondering why she hasn’t shown up on the website yet. We haven’t forgotten her valuable contribution. Colleen is a career pediatric nurse in Stanford, California but here she has taken care of all the sterilization duties in a back room away from the hustle-bustle.

It was another fine day in Guatemala City for the mission team - more children were added and we operated on a total of 21 children. This was our busiest day yet. Please go to the team website to see more photos and meet the team members.

Day Seven, Mission to Guatemala 2009

We took a forty-five minute bus ride to beautiful Antigua. It is one of the oldest cities and was the country’s capital until 1773 when an earthquake demolished it. It now has beautiful colonial buildings set against three volcanoes. We walked the city; visited a coffee plantation; saw a day of the cross celebration and even experienced an earthquake. (We were not at the 5.9 epicenter.) Please visit "Photo Albums" at www.guatemala2009.com to enjoy some of the sites we saw on our day off in Antigua. 

Day Six, Mission to Guatemala 2009

It is already Saturday, the half-way point of our mission. The cooperation among team members and the warmth of the Guatemalan people are making this mission a tremendous success.

This morning volunteers paid special attention to a seventeen-year-old single mother, Glenda. She is just a child herself, lives with her mother in Escuintla and cleans houses part-time. Like many of the other parents, she came here by herself on a bus. Glenda only has a fourth grade education and can barely read and write. But Glenda had the initiative and determination to find help for her darling six-month-old, Kiristel.

This morning, the ward was filled with children recovering and children awaiting surgery. Each small ward room holds three beds or cribs. The space is filled with supporting family members, Rotary volunteers and Guatemalan nursing students. The chaos doesn’t seem to bother anyone.

Fourteen-year-old Kenneth is a brave boy. Today he underwent the fourth surgery of his life. He was born in Morales, Izabal, a city on the Atlantic coast of Guatemala. Monday, he and his mother took a five hour bus ride to the hospital after hearing about the mission on radio and television. He met with our dentist Dr. Brian Dugani before surgery. Kenneth had his bilateral cleft lip repaired when he was a baby. He was a toddler when he had cleft palate surgery. Just a few years ago Kenneth had nose surgery to improve his speech and breathing.

Today, Kenneth had a bone graft from his hip to his the ridge line for his teeth done by Dr. Oren Leong; anesthesia was administered by Dr. Helen Vajk; and two teeth were extracted by Dr. Brian Dugani. When Kenneth arrived in the operating room he started to tear up a bit. Translator Paola Ferraté was summoned; soothing music was turned on; nurse Lois Borie comforted him. Dr. Debra Johnson stayed until the boy was well settled.

Kenneth’s mother doesn’t work outside the home and told us that Kenneth’s father is a “cowboy.” Kenneth’s mother has not able to take him to a doctor between these surgeries. She was told he will need a fifth and final surgical repair to his nasal passage in a few years.

Kenneth does very well in school and loves “football” (we call it soccer). His mother secured a doctor’s note so Kenneth will have a written excuse for missing school. He said he wants to be an agricultural engineer when he grows up. Given his bravery and his mother’s perseverance, he will likely accomplish his dream.

The team completed sixteen surgeries today. We all look forward to our day off tomorrow. We are going to tour the historic town of Antigua. Please visit www.guatemala2009.com for more photos and information about the team members.

Day Five, Mission to Guatemala 2009

Today is May Day, a national holiday in Guatemala. It is equivalent to the American Labor Day. So the roads were much less crowded during our 30 minute commute to the hospital.  A visit to the pediatric clinic proved that yesterday’s surgeries had been very successful.

Many of our patients do not have any outward signs of needing surgery. But without corrections to the mouth and palate, these patients with hidden problems will not be able to eat properly or to communicate effectively.

Marlen is a beautiful eleven year old girl from La Florida in rural Guatemala. She is the oldest of five children. Marlen has already had two surgeries. Today she received a bone graft on the alveolar ridge - a surgery that involves taking a small bone graft from the hip area and placing it in the bony palate, to promote good bone growth in the area of the jaw. Her speech is clear and she is on the sixth-grade honor roll at her school. Marlen’s dream is to be a paleontologist; we believe she will achieve her dream.

Fifteen-year-old Mario, who gave a speech to us on Day One, had surgery today to repair a pharyngeal flap in order to be fitted with an obturator. In other words, although his lip had been repaired by an earlier Rotaplast mission; he still had three visible holes in his mouth that needed closure. The obturator is a plate that will cover the holes. Kathi Hoffer, our speech therapist, had a long session Mario’s father about speech exercises that Mario will need. Mario’s father will work with him ten minutes a day for the next six months, changing his habitual speech patterns which are hyper-nasal. Mario’s dream is to be a dentist; we believe he will achieve his dream.

There were all sorts of hidden treasures in the hospital this morning. Maria, who was quarantined after coming in from Mexico, was cleared for surgery today. She awaited surgery in a little hammock that her mother fashioned under one of the ward cribs. And Dr. Beltran found a little blue bird in the pre-op area.

Late in the afternoon, we experienced a different twist to the meaning of our medical mission. A distraught Guatemalan father rushed into the Rotaplast area. His five-year-old son had been bitten in the neck by a rattlesnake several hours ago. The father first took his son to a public hospital, which did not have the proper anti-venom medication. The father was directed to a private hospital that did have the proper medicine. However, that hospital quoted a fee for the medication (approximately $70 U.S.) that the father did not have. The father had somehow heard that an American medical mission was at Centro Medico Militar, so he came here seeking help. Dr. Paul Quintana, one of our talented - and bilingual - pediatricians, talked to the father. A quick passing of the hat raised the money, and the father left to get the medication. Our entire team is hoping and praying for a happy ending to this story.

We are fortunate to have experienced another amazing day. Please visit www.guatemala2009.com to see more photos and meet the team members.

Day Four, Mission to Guatemala 2009

By Day Four, the team set into a practiced rhythm. We arrived at the hospital around 6:30 in the morning. The day began with a quick breakfast, then the pediatricians met with the patients who had spent the night awaiting surgery today. The surgical team prepared the operating rooms, and the surgeries began. The pediatricians also examined those patients who underwent surgery yesterday... Oh and the great news - the remainder of our medications from the airport arrived finally.

Our medical team was pleased to find that the patients who had surgery yesterday were doing well. For example, Dahyrin was sleeping well in the arms of her mother, Katerina (whose story we told in Day 3). Katerina had no food last night and had little rest, but she is ready to take that two hour bus ride home with her precious Dahyrin.

Yesterday we wrote about a mother, Katerina. Today fathers grabbed our attention:
Mayan father, Byron Escalonte, showed obvious adoration of his family. Guatemala is primarily made up of Mayans (60%) and Ladinos (close to 40%, meaning those of European descent). Many Mayans have large families; the men are the providers, and the mothers typically run the household. Byron arrived with his wife, one of his daughters and two-and-a-half-year-old Christian who needed cleft lip surgery. Two other children stayed at home with an aunt. Byron works in a laundry and his wife creates pottery. Christian’s mother wore a traditional Mayan dress, called traje. Christian’s younger sister was strapped to his mother by a rectangular piece of material called a tzute.

Two years ago Byron heard about Rotaplast from a family friend. Christian had his cleft lip repaired by a Rotaplast team in 2007; he returned this year for repair of his palate. Byron said that his family did not have money for these surgeries. Without Rotaplast, Christian never would have had his cleft lip and palate repaired. In very sincere tones, Byron express his gratitude to Rotaplast for helping his son and the Guatemalan people.

During discharge today, Byron received instructions from our speech therapist, Kathi Hoffer. Speech therapy is critical for the success of treatment for cleft lips and palates. Palate patients such as Christian must work on quality sound production. Playing with sounds is actually an important aspect of speech therapy. Kathi gave directions to all the parents as part of the discharge process, including a handout in Spanish with illustrations which demonstrate speech exercises. In addition to Rotaplast, Kathi devotes her time and energy to Earth Speak, a non-profit organization dedicated to promoting speech remediation. Another of Kathi’s patients was baby Jeremy, who yesterday had his first surgery, a lip repair. Kathi asked Jeremy’s father to encourage his baby to babble; this is an important precursor to speech. Jeremy’s father is a twenty-one-year-old who works in a cold storage facility. He is the primary caretaker for Jeremy during this journey because his wife is ill. He was extremely pleased to have heard about Rotaplast on television.

Another successful day, 17 children received surgery and we head back to the hotel in pouring rain. Please go to www.guatemala2009.com to meet team members and view more photos.

Day Three, Rotaplast Mission to Guatemala 2009

A medical mission in any country requires adaptability by all involved. Today was a perfect illustration of that fact. Our team and the patients rose to the challenge. A sampling: All of our medical supplies reached us today, except the box of medications. (The rumor as of this late posting is that Paola Ferraté, one of our translators, is on her way to the airport to recover our medicines after paying an additional “tax.”) Dr. Ken Bloome, one of our pediatricians, was resourceful and ordered from the pharmacy for today’s procedures.
Cindy George, our recreational therapist, was drafted to construct “no-no’s” out of cardboard, chucks and tape. These are improvised splints are placed on the arms of infants immediately after surgery, so that the infant does not scratch the surgical site.

Amazingly enough, the hospital ran out of diapers today. Those are a necessity given our young patients. A local Rotarian saved the day with a quick trip to the store.
Our biggest challenge is always the surgical schedule, and on this trip it was complicated further by concern over Swine Flu. One child was scheduled for surgery, but our staff then learned that the papers filled out by the parents were not completely accurate. The family had come from Mexico within two days, and had not been in Guatemala for the required quarantine period of five to seven days. The hospital mandated the child quarantined this morning. However 14 unexpected potential patients arrived and were evaluated today. Nine of them will likely be added to the mission’s surgery schedule.
Of course the most adaptive persons were the families of our patients as exemplified by one mother’s story:

Today we were all impressed with the strength of Katerina, who is only 19 years old. Katerina is the mother of a darling daughter, Dahyrin, who is five months old and weighs just 13 pounds. Despite her cleft lip, Dahyrin is a happy and thriving baby. Dahyrin’s father paints cars for a living in Guatemala City and was not able to accompany her to the hospital. Katerina took a two hour bus ride to the hospital with Dahyrin. After Dahyrin was accepted for surgery, Katerina spent the night sleeping in a plastic lawn chair in the pediatrics ward next to her daughter.

Katerina heard about Rotaplast from a television ad. She wanted the surgery for her baby, but expressed concern that Dahyrin would be left with a scar. During clinic, Katerina was reassured by the medical team that the scar would be minimal, so Katerina decided to proceed with surgery for Dahyrin. Our medical director, Dr. Debra Johnson took Dahyrin into surgery, assisted by anesthesiologists Dr. Helen Vajk and Dr. Mojca Konia, and operating nurse Lois Borie. The surgery was preformed by Dr. Milton Solis. Cyndee George tended to Dahyrin in the recovery room. Five minutes after surgery it was evident that the lip repair surgery was a success. This young mother had not anticipated the beautiful result, she just kept saying, “Garcias, gracias." In a few years Dahyrin will need to have her palate repaired. Tonight Katerina will sleep in a plastic chair by her daughter’s crib.

We left the hospital after 15 procedures completed under ever-changing circumstances. We also left with the gratitude of many families and satisfied by the beauty of our little patients.
Please visit www.guatemala2009.com to see more photographs learn more about the team.

Day Two, Rotaplast Mission to Guatemala 2009

The dominant emotion today was hope. As the sun was rising, 180 children and their families were waiting when we arrived at the hospital Centro Medico Militar in Guatemala City. Those families were motivated by the desire to make their children’s lives better with cleft lip and palate surgeries. Tonight, as the Rotaplast volunteers retire to our hotel, there is another group of children and parents who are contemplating surgeries tomorrow, with all the hope, fear and uncertainty that goes with surgery.
Rotaplast missions occasionally have real adventures with local customs officials, and this trip proved to be a classic example of that. Last night when our team arrived with 35 boxes of equipment, supplies and medications, the local officials decided to hold it at the airport. The rationale was variously expressed as a prohibition on importing medications, lack of proper paperwork, and failure to pay a 5% tax on imports. Nine boxes holding durable medical equipment as well as one box of narcotics and medicine were held at the airport. About half of our boxes were delivered this morning, and we are hoping for more deliveries tonight. The only permanent loss appears to be the meds, which we may have to buy from our host hospital. We are all hoping this does not delay the start of our surgeries on Wednesday.
One ritual of most Rotaplast missions is the welcoming inaugural--when the host Rotarians and hospital welcome the Rotaplast volunteer team. This was a moving inaugural. The highlight a former patient of Rotaplast who told us he was embarrassed to attend school and in the first grade was ashamed to show his face in public. When he was seven years old, he underwent a cleft lip repair when Rotaplast made a trip to Guatemala. He told us that this operation changed his life; he now aspires to be a dentist.
This first full day of the mission is known as clinic day. The basic purpose of the clinic is to determine which patients are eligible for surgery and which are not. This requires evaluation by pediatricians, surgeons, anesthesiologists, the dentist, and speech pathologist. All children who will proceed to surgery receive a “before” picture to set the context for the “after” one. Some of the kids are natural hams for the camera giving high-fives and fist bumps after the photos are snapped; others are frightened and crying. More than a few are seeing a digital picture of themselves for the first time in their lives. When the surgery schedule for the first few days was announced by Paola Ferraté the overwhelming emotion was hope.
Please visit www.guatemala2009.com for more photos and more information about the team members.

Day One, Mission to Guatemala 2009

On Monday April 27, volunteers began their journey to Guatemala City. They come from around the United States - California, Colorado, Pennsylvania, Oregon, Washington State, Florida, Minnesota, New York - and from around the world - Argentina, Canada, The Czech Republic as well as parts of Guatemala. To learn about the volunteers, consult the team page.

Pre-dawn, half of us met at San Francisco. We checked all the medical crates and after a short delay (and some repacking) took off for Dallas.

In Dallas we met many more of the team and after a short delay took off for Guatemala.
In Guatemala we had additional paper work to complete because of feared spread of the Swine Flu. As of this writing we have encountered a serious delay. Our Mission Director Rosalie Wells has learned that the government wants additional customs papers in order to release the thirty some crates of medical equipment we have brought. As of this writing (midnight) Jim Towery and Dave Roberts are still at the airport with our equipment. Our Rotary contact, Carlos, is in contact with the Vice President of Guatemala who should be able to help obtain the release. I am signing off because we are scheduled to head for hospital at 5 a.m. The volunteers remain upbeat; the adventure has begun.
Please visit www.guatemala2009.comfor more photos and information about individual team members.