Rotaplast Missions

Pereira Colombia - Day 11: The Last Day

Today is bittersweet.  this is the day we break down our respective rooms that we have been accustomed to working in for the last 10 days.  Today is the day when many of the patients we were able to serve came back for their final visit to the doctor.  As in day one intake, there were many chairs filled with parents and children.  However, there was no sadness today.  All of these children had received a procedure and were happy to see us.  Picture an outdoor waiting room, filled with sunshine, families, and a Rotaplast team waiting to give them all of the gifts brought from the United States.   It's the kind of waiting room we would all enjoy being in.  It was like Christmas Day for these families.  We gave out toothbrushes, toothpaste, silly bandz, beanie babies, balloons, a multitude of crayons, coloring books, books, plastic toys, barrettes, princess stickers, sunglasses, colorful pencils...it was a child's dream come true.   The sound of laughter was everywhere with  families smiling, posing for pictures, and lots of hugs and kisses. 

 

Last night was our farewell party thrown by the Rotarians.  We arrived by bus to the Volkeswagon showroom.  The Rotarians lined the entry way, applauding.  We entered through the lines feeling like the honored guests they wanted us to be.  The showroom was set up with tables with beautiful flower arrangements.  We enjoyed some food and drink, and some live entertainment.  There was a live singer, as well as traditional dancers.  Many types of colorful drinks were on the table, and we thoroughly enjoyed our final night of hospitality from the Club Rotario Pereira del Otún.  We have seen most of these Rotarians on a daily basis.  This was more like a family party than a farewell.

At the party, many speeches were made about our days of service.  One of the stories that stood out, was that of a young man in his 20s who had a large acid scar on the side of his face and head.  When he awoke from his surgery, he said, "For the first time, I feel handsome."   

We performed 137 procedures on 90 patients.  Today, in Pereira, there are 90 people whose lives have been made better, whose self-esteem is a little higher when they look in the mirror, and whose families have been touched by a Rotaplast visit.

Pereira Colombia - Day 9: A Little Education

Plastic Surgery – working with soft tissue

Maxillary Surgery – working with bones

Cleft lip and cleft palate is mostly caused by lack of folic acid  in the mothers diet.  At 9 weeks gestation, the skull bones connect.  This is when malformation can occur.

Cleft lip – lip and gum are separated under the nose in a formation of upside down “V”.  unable to smile or take a simple glass of water.

Cleft Lip Surgery closes the lip muscles and completes the gum.

Cleft Palate – A hole of varying degrees in the roof of the mouth.  Nourishment filters through the nose.

Cleft Palate Surgery closes off the hole in the roof of the mouth.

Lip Revision – years after cleft lip surgery, the lip muscles in the center need to be reattached as the face grows larger.  If not done, the nose is pulled down and appears flat.
Speech can be affected.

Tongue Flap to Palate Fistula Surgery – A fistula is a small or large hole that fluids can pass through.  A palate fistula is “plugged” surgically by a flap from the back of the tongue.  It stays as an ‘attachment’ for 8 weeks.  At that time, a surgeon releases the flap from the tongue as it has become integrated with the palate.  AMAZING!

Maxillary Advancement Lafort 1 surgery – reconstructive facial surgery to bring the upper jaw into better alignment with the lower jaw.  Facial bones must be broken and adjusted (pulled forward) sometimes with the help of a piece of hip bone.  Can be a 5+ hour long surgery.  Prominent jaw can be caused by environmental exposure to the mother who works in the farming industry.

It is important to fix cleft lips and palates in babies and young children before the child learns to speak.  If not, the brain learns the speech pattern (see Blog Stevenson) and it is difficult to relearn.

An older child without surgical intervention becomes emotionally scarred.  Their appearance, the nasal vocal sound and inability to form words makes them targets for cruel teasing.  Our Rotaplast Team saw children 8 and 9 who had not yet entered school.

Pereira Colombia - Day 8: A Typical Day at Hospital Universitario San Jorge

The Rotaplast medical and volunteer teams generally arrive at the hospital by 6:30am.  The Quartermaster unlocks the supply room and  the operating room (OR) staff start to set up the Ors.  The medical and volunteer teams change into their scrubs to start their various tasks.  While this is going on, the patients who are scheduled for surgery are arriving in the waiting room.  There are two waiting rooms where the patients wait.  The first, outer room is the general waiting room, and the inner waiting room, the Intake Room, is where the patients come to be prepped for surgery.  In the Intake Room, a Patient Coordinator keeps track of who is in surgery, who is in recovery, who is in the intermediate care room, and who is waiting.  Once in the Intake Room, the patients change from their street clothes into a hospital gown.  Some are weighed and have their hemoglobin measured in preparation for the anesthesia.  For the children who are waiting, there are crayons and coloring sheets, balloons, stickers, and small toys to play with.  Once the patient is ready for surgery, the surgeon and the anesthesiologist come to evaluate the patients and take him or her to surgery.

After the surgery is finished, the instruments that were used are taken to the Sterilizer, and the patient is moved to the Post Anesthesia Care Unit (PACU) where all the patients begin the recovery from their procedures.  In the PACU there are two nurses to oversee the patients’ care.  Generally patients stay in the room for one hour.  The goal is to have the patients’ vital signs read close to what they were before the surgery, and to make sure the patient is alert before they leave.  This does not mean the patient cannot sleep, but that the patient knows where he or she is, and what is going on.  In addition, the PACU nurses like to have the patients drink some water before they leave.  Before each patient leaves, he or she is given a quilt and some small toys that were donated for the mission.

After the patients leave the PACU, they go to the third floor to the intermediate care room.  This is where the patients complete their recovery.  Some patients stay for a little while, and some spend the night.  Periodically throughout the day the patients are evaluated by the Speech Therapist.  She reminds the patients about the after care from their surgery, and instructs the parents and patients how to continue their speech recovery.

To make this mission work, there are many people who have to work together for one common goal: Saving Smiles and Changing Lives.  We are proud to say that so far, we are working to the best of our ability to help the most important people: our patients.

Pereira Colombia - Day 7: Salento

Our day off was a trip to Salento, about an hour outside Pereira.  

We began our day at a small restaurant called "Camino Real Parrilla Bar."  Trout is the local delicacy.  Many of us ordered the "Trucho con Ajillo," which is trout in garlic sauce.  The garlic sauce is made with white wine, cream, and garlic.  While we were eating, we were serenaded by "Las parranderos del Quindio."  Loosely translated, this means, "the traveling singers from Quindio."  Also, the Pereira Rotarians provided a cake for one of our PACU nurses, Melanie, to celebrate her birthday. (The Club Rotario Pereira Perla del Otún truly does think of everything!)

After lunch, we browsed the local shops in the market.  We were able to purchase traditional Colombian bags and shawls, as well as jewelry, knick knacks, and candy of all varieties.  We were also able to barter with the shop owners to get great deals on the merchandise.

At the end of the day, a few of the team members purchased a dessert made from cream and meringue that was one of the best we have ever tasted.  Local flavor is second to none.

Pereira Colombia - Day 6: Ema

Ema was another one of our special patients who was close to our hearts.  She is a very short woman who quietly went through the intake line to be evaluated for surgery.  She nodded to everyone who smiled at her, but didn't smile back.  She looked so sweet, we wanted to know her story.

A few days later, we had the opportunity to meet Ema again.  Ema is 45 years old with a cleft palate.  She doesn't have any teeth because they had been pulled when she was younger.  Ema was evaluated by Dr. Delaney, who determined that Ema was not a candidate for surgery.  Her palate was not able to be stretched to close the gap.  Ema was then referred to the Sonrie Foundation, which hopefully could provide a prosthesis.  We then discovered, that the foundation would not be able to provide one.

Ema (center), her brother, and Alicia.

However, all hope was not lost.  One of the Pereira Rotarians, Alberto, has a niece named Paola who is an orthodontist, and her husband owns a lab where prostheses are made.  Meanwhile, a member of the Women's Auxiliary, Maria Elena, took Ema and her brother to a local shelter, Hogar Depaso, because they had nowhere to stay in Pereira.

Paola was able to make the impressions, and her husband's lab donated the whole prosthesis for Ema.  We were able to watch as Paola fit Ema for the prosthesis.  When she finished, Ema smiled for the first time.

 

So, even though we were unable to provide the surgery, we helped Ema smile.  Rotaplast is truly "Saving Smiles, Changing Lives."

Pereira Colombia - Day 5: Stevenson: A Special Case

That first day of intake, Andrea Dolak and Jill Long (photojournalists) noticed a 5 year old boy sitting in the first row trying to get their attention by waving.  They were taken by his happy, outgoing personality and nodded to each other, this is one boy we want to follow through surgery.

Stevenson and his mother.

At his turn to have his picture taken for his file, Stevenson flashed a big, mischievous smile, then went to Andrea to kiss her.  They both hoped that whatever was wrong, Stevenson would qualify for surgery.

Monday night the chart had a red dot on it, meaning no surgery.  They were heartsick as this cute little boy couldn’t make his speech understood, not one word.  Our speech therapist, Carolyn Muller, went over the red dots and pulled a few to be seen, including Stevenson.  She brought him in and observed that he understands what he hears and tries hard to form the words.  The inside of his mouth looked normal, however his sounds came through his nose, as a cleft palate.  Had he mislearned to talk or was something physical going on?

In consultation with Dr. Ann Delaney, it was decided since he had had speech therapy before and clearly he was a smart boy, they would look at his throat muscles through an endoscope.  The clinic didn’t have a scope.  A local ENT doctor volunteered to see him the next day.  The police escorted Carolyn, and a local speech therapist (also a Rotarian) and an interpreter from the hotel to the ENT office to meet Stevenson and family.

Stevenson, his mother, and his cousin.

The endoscopy procedure showed the structure  and how the muscles move when he talks.  It was discovered that he has a “submucous cleft.”   That is a cleft palate that you can’t see by looking in the mouth as skin has covered the separated bones.  This condition is uncommon and hard to diagnosis because the mouth looks normal inside.  He also had some muscles not functioning properly.  The doctor wrote a summary and supplied a video.  (Carolyn took the opportunity to explain Rotaplast and the need for ENTs and language therapists for future missions.)

Dr. Ann Delaney reviewed the report and cleft palate surgery was scheduled.  Today, this bright, expressive boy had surgery and is in the recovery ward this evening playing with toys.

Stevenson (center), Helen (left), and Bonnie (right).

Pereira Colombia - Day 4: A View of Club Rotario Pereira Perla del Otύn

There is more to being a host than a nice welcome.  The Club Rotario Pereira Perla del Otύn (PRC) begins to plan for a Rotaplast mission 6 months ahead of a proposed date by requesting a mission from Rotaplast International. 

Olmedo and Alberto, two members of the Club Rotario Pereira Perla del Otύn

Once a date is approved, they begin by contacting the hospital manager for  2-3 operating rooms, recovery room space, a ward, waiting room and intake room, lunch area, changing and storage areas.  They need a large area for first day of intake which is held outside.  They need a big waiting room and 4-5 consult and evaluation rooms.  It’s a huge amount of space.  They hold a dance for 400 people surrounding the ballroom with Rotaplast pictures. Sponsors need to be solicited to help pay for the hotel, bus, lunch and snacks.  They request local, city and state government grants.  Permits have to be obtained from Risaralda (their state) to get more funding.  Interpreters must be secured.  Police need to be set up for our protection.

6 weeks before the mission, they make up and distribute flyers and pamphlets to companies in Pereira and the surrounding communities, to priests to announce in their churches. Then there is TV and radio. They arrange and pay for shelters run by the nuns for those patients who travel many hours for this opportunity.  They start pre-registration to determine how many patients might show up.      

If needed, some doctors and dentists are provided by the hospital and some volunteer from the Pereira community.  Additionally, Rotaplast sends a medical team.      

Martha (left) and Judith (right), two of the Women's Auxilary Members

A multitude of tables and chairs and cloths have to be secured, set up and taken down or locked in every day.  THIS IS LABOR INTENSIVE FOR A ROTARY CLUB THAT HAS 31 MEMBERS! 10 Rotary members join us and work every day.  Rotary wives work hard to arrange snacks and lunches.  One even translates every day as long as needed.  And then, they serve us in the hospitality of Colombia.  PRC works with  the Sonrie Foundation – that follows up with medications and speech therapy.     

So Rotarians and friends, you work hard to raise the funds for the smiles.  You send District volunteers for non-medical needs.  Without the host Rotary Club structure, there would be less accomplished.  PRC is an excellent partner.

PRC Rotarian Master of Ceremonies. Hedmann Alberto Sierra Sierra (left), Volunteer, Alicia Ruiz-Orbin (center), and Interpreter, Jose David Gonzalez Villada (right).

Pereira Colombia - Day 3: Partnership to Success...

...is often in the preparedness of both the medical personnel and non-medical volunteers who join with the host Rotary club in the name of Rotaplast.

The Club Rotario Pereira Perla del Otύn (PRC) hosts a mission every year.  We non-medical volunteers from District 7430 are privileged to be in Pereira for a twelve day mission.  PRC met us at the airport in the late evening with welcome signs, many tropical flowers and many willing members to carry and load our luggage and medical boxes.   They provided bus transportation with a ten-man police escort.  This police escort will last 24/7.  Safety and security are a priority and community service of the police commander.

The next day, PRC set the staging for the intake process, operating room set-up, and the carrying of countless chairs and tables.  There were 25 Rotarians and 15 student interpreters from bilingual schools  who all were a part of day 1.  Each day 10 Rotary members and 10-15 auxiliary women worked along side us.  After all, we are an English speaking team with one interpreter, partnering with a Spanish Rotary club and hospital.  It can't work without interpreters and local Rotary club support. 

If it looked like one of the team needed help, the PRC was there. They were there with snacks, drinks, lunch, and more snacks.  They were serving juice on trays to the waiting families, including sandwiches.  They served, lifted, ran errands, hugged, sang, and advised.  It's hard work preparing and hosting a mission.

See tomorrow's post for more information about our hosts.  PRC has the "primo" formula!

We are only on day three, but know we will have served the families in this area with experienced, compassionate doctors and medical personnel along with PRC and D7430 volunteers.  No task is too small or too big for all of us.  There is always a way to create another smile.

Pereira Colombia - Day 2: Surgery Begins

We arrive at the clinic at 7:00 AM for a full day of surgery.  First, the families waiting for surgery are brought into a waiting room.  Then, three at a time are brought into a second waiting room to put on an operating gown and wait to go to the operating room.

Byron is one of the small children awaiting surgery.  He is three years old and was brought to the hospital by his mother.  They traveled for five hours yesterday from Marmatocaldas.  Last night they stayed in a homeless shelter so they wouldn't have to travel five hours home, and five hours back.  Byron has a brother and a sister at home, likes to play soccer, and watch Disney's "Cars."

Jonathan is a one year and eight month old boy who has an eight month old brother at home.  He lives in Buenaventura, which is also five hours away from the clinic.  Johnathan's grandmother found out about the mission through the Sonreir Foundation.  The local Rotary club arranged an over night stay in a private home for them.  Johnathan sat quietly waiting for his surgery, playing with cards, but he was fascinated with Senora Martha, who was wearing Minnie Mouse ears.

Pereira Colombia - Day 1: Pre-Clinic

We arrive at the clinic at Hospital Universitario San Jorge at 6:30 AM. The site of over 150 people waiting in lines and overflow under tents, brings a lump to our throats.  While we were having juice and eggs, these families have completed sometimes a very long journey and have been in line waiting for us.  We are touched by their patience.

Intake is located outside under cover.  Our first 2 intakes are babies.  We’ve seen the pictures of the enemy, cleft lip and palate.  Up close, personal, it breaks our hearts.

The morning and part of the afternoon is spent interviewing the families, taking medical information, ending with a ‘before’ picture of each. We are grateful for high school volunteers who are translating for us.

All the families have such patience.  Many have to stand and wait.  The goal is to get under the tent close to the intake area and wait for their numbers to be called.  They then are ushered to a ramp to the second floor consult area to now wait for medical personnel to evaluate their information.  It’s a long, waiting process with lots of Rotary volunteers and medical people efficiently working together.

By 11:00 AM Intake has processed 100 hopefuls up to consultation.  By 2:45 PM 200 have had intake.  By 3:30 PM intake is finished and there are lines waiting to get to the busy 2nd floor consultation rooms. 

7:00 PM Intake is finished. Charts are complete. Families have gone.  The first charts have now been reviewed and 10 patients have been contacted to come back tomorrow.