The surgeons, pediatricians and I went to the hospital this morning to check on the welfare of the children who received surgery on Day Six. Even a day after a cleft lip repair the results are rewarding.
As we were leaving, Priscilla popped out of the pink house and gave me a hug. Her brother, Nelson (Day Four), will be staying until Wednesday because they can not afford to leave Oaxaca and then do a return trip; their journey to the hospital originally took them several days. I don’t dare think where she found a fresh pink shirt and new “jewelry.”
Language issues can be very challenging in Oaxaca. Despite the interpreters on our team and those provided by our host Rotary club, some patients speak an indigenous language that is not easily understood by any of our interpreters. The principal language spoken in Oaxaca City and the outlying areas is Spanish, but because of the topography in the Valley, many smaller outlying communities are isolated locations that foster distinct ethnic identities that have maintained their own unique traditions and languages. There are 16 basic ethnic groups in the Oaxaca region, and each of these groups speaks its own language. Furthermore, each of these 16 distinct languages is spoken in a variety of dialects. One such language is Mixe, which has four dialects and approximately 70,000 speakers.
Today I met Anotonie, a twenty-year-old woman from a Mixe speaking town with approximately 1,500 inhabitants, San Juan Juquila Mixes. Anotonie, who speaks and reads a little Spanish, was designated by the family to travel to Oaxaca City with her 8 year-old brother, Pedro Jose who has an unrepaired cleft palate. Prior to this visit, neither had previously visited Oaxaca city, which is only four hours from their home. Her mother, who has "scars in her eyes", her father, a field worker, and an older sister who does not speak Spanish, all stayed behind.
The family learned of the Rotaplast mission from nuns in their village. Pedro Jose had his cleft lip repaired in 2004; today he will have his palate repaired by Dr. Jarquin, a local surgeon who is working with the Rotaplast doctors.
Assistant Mission Director Rose Marie Joyce, who is fluent in Spanish, acted as translator for my conversation with Anotonie. When we asked Anotonie how she would relay a message to her mother when Pedro Jose came out of surgery, she seemed confused by the question. We finally determined that the family will hear the good news when brother and sister return, in person, to San Juan Juquila Mixes.
In the ward, Mission Director Kathy Wiley has arranged for each child to receive a family photograph taken after surgery. Most of these children have never seen, let alone owned, their own photograph. Little Karla, five-years old and packed and ready to go home, could not move or stop staring at the snap shot.
Nelson, featured in Day Four, was still in the hospital this morning. His lively sister, Priscilla, was featured in Day Five as an example of the adventures of the healthy siblings who are also here. Someone asked where Priscilla was. I looked down a hallway and saw Mission Translator Carmen Sigler painting Priscilla’s fingernails. Priscilla even showed Carmen a spot missed. We think Priscilla has explored every nook and cranny of the hospital except the operating room and Post Anesthesia Care Unit (PACU).
The PACU in this hospital is heavily secured and only medical staff are allowed to attend to the patients who are delivered immediately following surgery. The Rotaplast PACU team is pictured below - translator (Ivonne Montes de Oca), patient aide (Cyndie George) and PACU nurses (Susan Fossum and Sandra Stabile). The team has a heavy burden here because parents are not present to calm their children.
PACU nurse Susan Fossum, past president of American Society PeriAnesthesia Nurses, gave me a briefing about the PACU. This is literally a forgotten part of the hospital experience because many patients (due to coming out of anesthesia) have little or no recollection that they were ever there.
The first concern of the PACU is to ensure a clear airway with ample oxygen intake. A patient may receive additional oxygen and will be monitored until it is determined that they can safely be released to the ward. After anesthesia many of our little patients have a depressed respiratory drive. The second concern is stable heart rate and good circulation. And third, pain management is crucial. When a child arrives fresh from surgery the team springs to action. The bambinos here have received first rate care. As a fond momento of their hospital stay, on leaving the PACU each of our patients receives a quilted blanket donated by a Rotary Club in Maine.
In the children’s hospital we are not only in the company of the children who are our patients, but also their healthy brothers and sisters. Rotary volunteers and social workers keep an eye on these siblings, but many of the siblings are very resourceful and inquisitive. This morning when I arrived at the hospital, I went straight to the ward to check on Nelson and his family, who were featured on Day 4. Nelson was tired the day after his surgery, but looked great. As I left, Nelson’s 9-year-old sister Priscilla took my hand, and led me on a spontaneous tour of the hospital. She pointed to various sites and I snapped photos. After each shot, Priscilla wanted to see the captured imagine in the digital camera and then we would proceed. For being such an excellent guide, Priscilla received a coloring book, a toy pony and photo of herself. Clever Priscilla found her way to dinner and our hearts this evening as we were eating pizza in the supply room at 7 p.m. It was the first time she had ever tried pizza.
Angel de Jesus, the four-month old son of Veronica and Ulises, is one of the patients who received surgery today. Angel de Jesus is receiving a repair of his cleft lip today, but he will have to wait another year for his cleft palate correction because he is still too young and too small for that operation. What makes this story unusual is the story of the father, Ulises. Ulises was born in Mexico, and moved to rural Oregon with his mother when he was two years old. Ulises grew up believing that he was an American citizen, and did not realize that he had sole Mexican citizenship, until he was twelve years old. Ulises was not permitted to stay in the United States after the age of eighteen, so he voluntarily left. Since then, Ulises has been desperately seeking a visa to return to the United States. So far he has had no success in this pursuit.
When Ulises returned to Mexico, he met and married Veronica. They live in a small town seven hours from Oaxaca, where Ulises is seeking work. Angel de Jesus is their first child. For the first few months of his life Angel de Jesus only drank from a syringe. As is often the case with these conditions, there is great deal of superstition about the cause. Vernoica’s family was convinced that Angel’s cleft palate and lip were the result of an eclipse of the sun and the moon. Ulises and Veronica did not agree, but, as deeply religious parents, they simply believed that Angel de Jesus’s condition was God’s will and that an angel would repair him. Ulises and Veronica believe that divine intervention led them to this Rotaplast team.
After Angel de Jesus’ evaluation on Day Three, he spiked fever which, thankfully, broke during the night. If the baby had remained ill, surgery would have been deemed unsafe and canceled for his health. Today Ulises and Veronica had their prayers answered. After waiting until 1 p.m. and rocking their baby in a blanket in the chapel, the surgery was performed by Dr. Capozzi. Anesthesia was administered by Tracy Gerrrero. The attending nurse was Judy Cummings.
Ulises and Veronica had an opportunity to talk with both Dr. Capozzi and Dr. Guerrero after the successful surgery. They cried after this chat and had to wait over an hour until PACU nurse Sue Fossum brought Angel de Jesus to his parents. He was then moved to a special care unit to watch his congestion and oxygen levels during the night. He looks beautiful.
Dr. Capozzi is the distinguished co-founder of Rotaplast, and has his own interesting history. He is a plastic surgeon, and has been a member of the San Francisco Rotary Club for 40 years. Dr. Capozzi spent thirty years in private practice in San Francisco, and ten years as Director of Plastic Surgery at the Shriner’s Hospital in Sacramento, California. He retired from that position in 2008. He looks and acts much younger than his actual age of 76.
Overall, this second day of surgery has gone very well. Four more potential patients arrived, although it is uncertain whether there will be room on the schedule for any of them. The team is working hard to accomodate as many patients as possible. The team members have settled into their respective roles, and as often happens on these missions, we have all bonded quickly and well. Today marks the birthdays of two team members, Ivonne Montes de Orca and Colleen Wynne. While we had planned to celebrate the occasion together this evening, as of this writing at 10 p.m., half the team is still at the hospital so celebrations will have to be postponed.
Our day started with fifteen new patients who had arrived in hopes of being added to the surgery schedule. These patients were unable, for various reasons, to come to the regular clinic evaluation. So our medical records team (Louise Capozzi and Nora Manchester) were once again busy processing the new patients, and members of the medical team took some time between procedures to evaluate the new patients.
Today was our first day of surgeries. We have three operating rooms running on this mission. Each room is staffed by three Rotaplast volunteers, a surgeon, an anesthesiologist and an OR nurse. In addition, we have additional nursing staff provided by the children's hospital. Our surgeons are Dr. Angelo Capozzi of San Francisco, Rotaplast's founder, Dr. Sibrand Schepel of the Netherlands, who has also worked on countless Rotaplast missions, and a local plastic surgeon who has also volunteered his time to work with our team.
One of the day’s more remarkable background stories involves Nelson. Today is his first birthday, and his mother's 31st. We were delighted to be able to be able to give Nelson such an incredible gift on this very special day - he had both a cleft lip and palate repair. Nelson was born in a small village in Northern Mexico. Nelson is here today because the doctor in their small village told the family about this Rotaplast mission. Nelson, his mother Justina, and his nine-year-old sister Priscilla traveled several days to meet our team in Oaxaca. Nelson’s father, older brother and sister remained at home. Nelson’s father is a field worker and could not afford for the entire family to make the trip. Justina told us that the entire family works the fields at corn planting time.
Dr. Schepel performed the delicate surgery. After only two and a half hours Nelson’s life-changing operation was complete. He was moved to the Post Anesthesia Care Unit. In the PACU, nurse Sandra Stabile, patient volunteer Cyndie George and interpreter Ivonne Montes de Oca watched over him. After about one hour Nelson was reunited with his mother. She will stay with him tonight at the hospital and sleep in a small bed with him. Justina, just a bit teary, told me this was the best birthday that she has had, even better than the day little Nelson was born.
This children’s hospital has an albergue, a small hostel, which we all call "the pink house". This is a place where families, including siblings like Nelson’s sister, can stay briefly while their loved ones are in this hospital. The men and women are separated by two wings and sleep in bunk beds. The families cook and clean together in a cooperative manner. For families like Nelson's who have traveled such long distances with so little money, the pre and post operative housing provided by the albergue is a godsend.
This is a day of great hope for the parents and children who have traveled great distances to Oaxaca in order to be evaluated by the surgeons, pediatricians, anesthesiologists, the dentist and speech pathologists. The medical team has the difficult task of deciding who will receive surgery and who will not. Barring the child having heart or lung problems, the test of whether the child should proceed to surgery is “10-10-10.” The children must be at least 10 weeks old, weigh at least 10 pounds, and have a hemoglobin level of at least 10. Most of the parents and children have traveled long distances to have an opportunity for this life-changing surgery.
One example of the determination shown by these families is Ruben and his parents. Ruben is six-years-old and lives in a small town outside of Oaxaca. Ruben came to the clinic with his father and mother. The family traveled for four hours on a bus, followed by two hours of walking to arrive at the clinic. Ruben’s father appeared to have a sight impairment, but nonetheless supports his eight children as a farm worker. A government worker told Ruben’s father of the Rotaplast Mission.
And another example is Erick, an eighteen-month-old toddler, who arrived with his mother and grandmother after a five hour van ride. They left their home in darkness in order to arrive at the clinic by 9 a.m. This little family did not know where they would sleep tonight; we told them about the pink house. However, the grandmother said that she and her family were grateful simply to have arrived at the clinic. They are praying that Erick will in fact have corrective cleft palate surgery.
One of the touching episodes of the day involved Miguel Angel, a shy, handsome four-year-old boy. Miguel first had his picture taken - part of the standard practice for all Rotaplast patients of having “before” and “after” pictures. After his own photo was taken, Miguel stayed and watched the photo team take pictures of each new patient, including pictures of the inside of the mouth of those patients with palate problems. After Miguel had watched the process several times, he began silently volunteering to help. He began by removing the photos from the printer, then progressed to putting the photo in the file and passing it to one of the adult team members. By the end of the clinic day, Miguel had been appointed as a certified photographer’s assistant, even helping the team to pack away its supplies. Miguel never spoke a word, but he earned the gratitude of all. Overall, it was a highly successful opening clinic day, with over 100 patients screened--far more than expected. For the Rotaplast team, the day was chaotic, energizing, and full of the many small emotional vignettes that make these missions so rewarding. At the end of the day, the Rotaplast team joined our hosts, Rotario Guelaguetza, for their weekly meeting. We witnessed an informative program about two cutting-edge projects in Oaxaca: one (Trechamos Una Mano, or “we give you a hand”) involving building simple houses out of recycled materials; and the other involving a group home for independent living of persons with mental handicaps. Then, to a serenade of lively Mariachi music (click the group photo below), the Rotaplast volunteers were surprised to received gifts from our hosts: a beautiful certificate framed in the hand-punched tin, a box of local chocolates, and a personalized bottle of Mezcal. (Many of the volunteers were surprised to find a dead worm in their bottles.) In all, a very hopeful day with anticipation of the successful surgeries tomorrow.
Hospital de la Ninez Oaxaquena, the Oaxaca Children's Hospital, located in a rural area some twenty miles south of town, will be our place of work during the course of the mission. The hospital is a relatively modern, attractive one story compound, with very bright colors demarcating the four buildings that make up the hospital. The administration building is painted canary yellow, while the main hospital is a vibrant turquoise. Pink indicates the housing for families, and bright red ensures that no one will have difficulty finding the emergency room. Like many Latin American hospitals, there is a growth of cottage industries just outside the hospital gates. Families and hospital staff alike are a stone's throw from food vendors, other merchants and taxis.
Dr. Octavio Manuel Corres Castillo, The Director of the hospital, led an orientation this morning to help our team of volunteers become familiar with the buildings and hospital staff that we will be working with. The facility is spotless; the equipment is well-maintained and ageless. We then unpacked our equipment and supplies and prepared for tomorrow's busy day of patient evaluations. Many of our little patients were already on site waiting for us to check them in.
Some children, such as this handsome little boy, have already received lip reconstructive surgery, but now need a second procedure to close a cleft palate. Others, such as this darling little girl, will have a primary lip repair (first operation on an operated upper lip) or a second surgery to improve the results of a past cleft lip repair.
Our Rotarian hosts told us a bit more about the Oaxaca Valley. We learned that despite its fertile beauty, some of the poorest families in Mexico can be found here. Our hosts will not only be taking care of the members of our team, but have also arranged lodging and meals for our patients' families for one day before and after their child's surgery. Not all hosts are able to arrange this extra care for the families, and threfore, on some Rotaplast missions, our patients and their families may spend the night prior to surgery on the floor of the hospital grounds.
We are quickly learning that no day will be complete without an evening of festive music and delicious Oaxacan food provided by our generous hosts. After dinner, our Mission Director, Kathy Wiley, and Assistant Mission Director, Rose Marie Joyce, thanked Club President Maria Antonieta Chagoya Mendez and her husband for the delicious meal on behalf of the team. After our day of set-up, and our evening of fellowship we are fired up and ready to meet our patients tomorrow.
Our journey together began at the San Francisco airport at 4 a.m., and by 4p.m. we were in Oaxaca, Mexico and ready to get to the hotel and hospital to prepare for the rest of our time here.
The Rotaplast office carefully packs the medical equipment and supplies that are needed on a mission (in our case 29 boxes), and a volunteer, Rotarian Tom Fox, greets the team at the airport with a trailer filled with the weighty boxes. As with all international travel, there is always the risk of lost baggage, or delays due to customs.
As we were landing, our first sight was the beauty of the land below. Particularly enthralling is the rich black volcanic soil made over the course of centuries. The Valley of Oaxaca is one of the most fertile locations in the Americas. Upon deboarding our plane, we came face to face with the disturbing fact that only eight of our boxes had made it. We prayed that this would be sorted out prior to tomorrow's clinic day. After a rather rigorous Custom's inspection of these eight boxes, we were able to finally meet the host Rotarians. The members of Rotario Guelaguetza, an all-women's club, are the most poised and efficient Rotarians imaginable.
Rotaplast International organizes missions that are made a little more special because they partner Rotary Clubs from different parts of the world together to change the lives of children born with cleft lip and/or cleft palate. The Rotary Club of San Jose, California raised $65,000 to send this medical team to Mexico, and in turn the Rotary Club from Oaxaca hosts the medical and non-medical volunteers, recruits the patients, and takes care to make arrangements for their families who have come from a distance.
The ladies of Club Rotario Guelaguetza are particularly remarkable because while it remains true that much of Mexcian culture still encourages women to concentrate on marriage, and child bearing and rearing, this club is comprised of 35 successful business women who do not conform to this traditional role. It is fitting that they direct their club resources towards bettering the lives of the next generation.
A day of travel and making new friends has the ability to wear everyone out. We were delighted to end our day in the company of our new friends on the team and in Rotario Guelaguetza. We relaxed and recharged with a delicious meal of black bean soup, corn tortillas, guacamole and mole chicken accompanied by music. During this meal, San Jose Rotarian Ivonne Montes de Oca, who was born in Mexico, translated the welcoming remarks made by our hosts and local officials.
Since I've left you all worried, at dinner we also learned that our prayers had been answered. The boxes had arrived, as promised. Jim Towery and Steve Ladowitz left the dinner early to make the trek to the airport where they would be able to retrieve our equipment. The truck used to move the boxes had no tailgate so our brave quartermaster rode in the flat bed with the boxes to protect our medical equipment. Jim and Steve arrived back at the hotel after midnight, and were the last ones settled into bed to rest up for the next day of work.