Rotaplast Missions

Final day in Aracaju

We maxed out our final day at the hospital with surgeries in the morning followed by our post op clinic in the afternoon. We had a great turnout for the post op which is always a hectic affair. About 70 patients with one or more family members pass through a series of stations, first to have their post op photo taken then to be seen by the surgeon, pediatrician, dentist and speech therapist.

The scene was hot, humid, crowded and loud but we all saw familiar faces that looked a little different now. High fives and hugs were the order of the day with lots of photos taken by the team to help remember our new friends.

It's been a great mission with 80 patients receiving a total of 120 surgical procedures. Many people had both their cleft lip and palate repaired. We received terrific support from the hospital staff and many local students who served as volunteer translators. We are all proud of the  fine work we have done, giving new smiles to so many.

Jerry Meshulam, Photojournalist

An opportunity to learn and educate

If an anesthesiologist has a defining skill it is airway management. Intubation, the ability to obtain and manage a patient's oxygenation and ventilation is at the core of all life saving techniques and our training allows us to be experts in this arena.

One of the most challenging aspects of Rotaplast is encountering patients with anatomy that makes intubation difficult or impossible. Additionally, it is impractical to carry along fiber optic equipment or other methods of indirect laryngoscopy that would aid in intubation. For these reasons the Rotaplast experience is an excellent measure of our training and ingenuity.

On our second day of operating we encountered a four year old child with an as of yet undefined syndrome that included facial features predictive of difficult intubation. The rarity of his condition was the subject of a previous blog post. He had a very small chin but more interesting, a limited mouth opening because of tissue bands that tethered his lower and upper jaws together. Working with Dr. Fleming to intubate the patient was both nerve racking and exciting. The obscurity of the child's syndrome along with the anesthetic/airway management makes this case particularly valuable from an academic perspective.

I intend to present this patient at WARC. This is a yearly conference where anesthesia programs present research, new technologies, and interesting cases to each other with the goal of improving anesthetic practice and patient satisfaction. I am very grateful for being allowed the opportunity to serve and learn from this trip and I am sure that it won't be my last experience with Rotaplast.

Dr. Katie Strohmeyer, Anesthesiologist Resident

All Points Bulletin

Elielma was ready for surgery when we arrived at Hospital São José at 6:30 this morning. She was the first patient of the day with her mom to follow in the afternoon. It was a happy ending that almost didn't happen though.

When we called them a few days ago to let them know when to come to the hospital, the phone number we had been given turned out to be invalid. A volunteer tried driving to their home and, unfortunately, the address was not valid either.

We really wanted to be sure they were able to get their new smiles so all local resources were brought into action. With the aid of local Rotarians, the Department of Health, radio station and police, they were finally located. The city sent a car to bring them to the hospital.

As I write this, Eliene is a few feet away in OR #1 receiving anesthesia from Dr. Charles Williams with OR Nurse Jodelle Myhre ready to assist Dr. Jann Johnson who will be performing the life changing surgery. Several volunteers with a moment to spare are also observing. Everyone is anxious to see mom and daughter with their new smiles.

Jerry Meshulam, Photojournalist

Oliveira's new smile

A 27 year old woman arrives in operating room 3 and Dr. Sibrand Schepel examines her cleft lip and nasal deformity realizing that she has no cartilage in her  nose. "This will be a difficult case," he says as he contemplates how to go about rebuilding her nose. He decides to take cartilage from her ear to sculpt a septum and nose tip. As the case proceeds, his audience grows. A plastic surgeon, medical students and nursing staff from our host hospital as well as our Rotaplast speech pathologist and university student gather around to see the 35 year veteran surgeon at work.

Dr. Schepel is an artist and a perfectionist when he operates. He constantly checks and rechecks his work, making small adjustments and refinements to ensure that Oliveira will have the best outcome.

He takes cartilage from behind her right ear in such a way that the resulting scar will not be visible. Once the cartilage is removed, he forms it into a septum, using a special press to make it just the right thickness. It's then inserted into the nose and he reshapes the nostrils and nose tip using sutures. The lip is closed to finish off the proecedure.

Oliveira leaves the operating room, a beautiful Brazilian woman with a new nose and new smile.

Andi Coniglio, OR Nurse

Handmade quilts: a touch of love

Thanks to Wrap-a-Smile, each Rotaplast patient here in Aracaju has been rolled off to surgery under gorgeous, colorful handmade quilts. The operating suites are nicely air-conditioned for the comfort of the medical team and the quilts keep the patients snugly warm throughout the procedure. Everyone enjoys how much they brighten the room. The quilts stay with the patients in recovery and on to their homes. They bring a generous dose of love to the experience. The quilts here have labels identifying them from Rotary Clubs around the United States and Canada.

Please visit the Rotaplast website for more information about Wrap-a-Smile:
http://www.rotaplast.orgpartnerswrapasmile.php.

Here's a collage of some of the quilts from Aracaju.

Jerry Meshulam, Photojournalist

Rotaplast: The next generation

Christin Blaney, a junior at Ohio State studying medical dietetics, is working in the post operative recovery room . Here are her impressions after the first few, 14-hour work days of the mission.

I came on this mission extremely nervous, not knowing anyone or what I would really be doing. As the team got together and settled in I soon became very acquainted with everyone.They assigned me to the recovery room where I help out with the patients as they come out of anesthesia. As they were bringing the first child in, I wasn't sure if I was going to be able to handle it. This was my first drive to see if I could handle nursing school. I jumped right in and did everything I was told through all the commotion.

My teammates in recovery soon explained the process and I caught on quickly. I am very thankful for them teaching me and answering all my annoying questions. They have encouraged me to absolutely follow through with nursing school. Apparently I am a natural. :-) I love this and am so lucky to be working and learning from such a diverse and educated group of individuals. It is like I have known them for a few years instead of a few days.

We are all here for the same reason and seeing these amazing patients give you the thumbs up for their new face is so rewarding that all anxiety about the mission is gone. This team, the people from Brazil and the patients are wonderful.

Lucas: Patient 001

You have to get up early to be first in line for a Rotaplast clinic but you're rewarded with patient number 001. Lucas and his family made the effort and he received his combined lip and palate repair yesterday in a two and a half hour procedure. Notice not only his repaired lip but also how beautifully his right nostril was reshaped to match his left side. His puffy lip will look nearly healed by the time he returns next week for the post op clinic. He'll have lots to celebrate on his fourth birthday next month.

Jerry Meshulam, Photojournalist

A very rare case

With a combined experience of 117 years in practice and 92 volunteer missions among them, you would think our four surgeons had seen it all. A four-year old boy came through our clinic with what must be quite a rare condition. He was born with two vertical columns of tissue between the floor of his mouth and his palate that effectively locked his tongue from moving freely. This severely restricted his ability to eat and speak.

This obviously piqued everyone's interest. Once the patient was under anesthesia, the four surgeons each took a look and collaborated on a plan. Dr. Schepel would use the tissue to close the palate in two layers. This turned out to be very useful since the size of the cleft would have been difficult to close without having the excess tissue to use. I photographed each stage of the operation for use in future medical discussions.

The docs won't know how successful the procedure was until the post op clinic next week, but with 117 years of knowledge behind it, the young boy certainly got the best treatment available. Thanks to Rotaplast and every one of its donors and volunteers that make these missions possible.

Jerry Meshulam, Photojournalist

Pre Op Clinic Day

Regular followers of the Rotaplast blog know that each mission begins with a screening of all potential patients for surgery. The host organizers spread the word for weeks prior to the mission that free reconstructive surgery will be available for children and teens afflicted with clefts. Our supply boxes still have not arrived so some creative improvisation was in order. Despite the glitch, we were still able to screen over 80 patients today with another 80 on tap to go through the process tomorrow.

Basic requirements of age, weight and general health must be met to qualify for surgery. Post-it notes on white boards and large colored posters were brought into service to begin triaging the patients and setting the surgery schedule. When we arrived, about 100 people - patients with parents, siblings and friends - were gathered in a large lecture hall watching a video about the dental school where the clinic was held. We're right on the coast, only about 10 degrees south of the equator, so although it's technically winter here, it's pleasantly tropical. A tad hot and humid to be in the direct sun but just right in the shade when breeze blows. And it's always blowing. 

One interesting observation on this mission is the number of older patients who had their cleft lips repaired at a very early age but were left with their cleft palates unrepaired. The ability to acquire correct speech patterns must occur before about age five, so those who are now older will have far more difficultly speaking clearly even if their palates are corrected.

This led to a most interesting debate among a few team members. If you could only have one operation, would it be better to correct a cleft lip or palate? Is outward appearance and the ability to fit in socially more important than the ability to eat and speak properly? A fascinating but obviously frustrating and sad point to have to consider. Life is not always fair.

Jerry Meshulam, Photojournalist

Touchdown in Brazil

A few of us flew over the vastness that is Brazil as the sun was rising over the Atlantic then lunched in the coastal port city of Salvador while we waited for the late afternoon arrival of the team. The disconnect between our Portuguese phrasebook and effective communication, as well as the realization that Spanish is not a viable alternative, was quickly realized.

The international make-up of our team meant that everyone had been traveling for at least 28 hours by the time that bags were collected and we were greeted by Adenilson, Mayara and Richard, our local hosts. Drooping eyes brightened as acquaintances from previous missions were renewed and everyone's spirits were reinvigorated as we boarded our bus for the final 8 hour leg of our journey to Aracaju.

Unfortunately, mission director Dan Bronson and surgeon Todd Farnworth were still in Sao Paulo with our one ton of medical supplies spread in 37 boxes, negotiating last minute custom's snafus. As the mission gets underway, special recognition must be given to Rotaplast staffers Paola Ferraté and Julian Arnaud for extraordinary efforts to secure our visas with additional thanks to the Brazilian consulate in San Francisco. It gave new meaning to nail-biting trip planning with visas being overnighted to the team the day before departure.

At our roadside dinner stop on the way to Aracaju, head nurse Kim Capps started polling the team to find out what medical supplies, such as stethoscopes and blood pressure cuffs, might have been brought personally. Since our boxes were still in transit, we may need to improvise a bit for our pre-op clinic tomorrow. The expertise and resourcefulness of a Rotaplast team is a beauty to behold.

Fatigue and travel frustrations will have faded as our band of 27 volunteers arrives bright and early tomorrow morning for the pre-op clinic, anxious to give new smiles to the waiting children.

Jerry Meshulam, Photojournalist