Rotaplast Missions

La Romana 2011: Leaving for Home

Having finished our work earlier than expected, we advanced our departure date by two days. We packed medical supplies and boarded a plane in Santo Domingo on Thursday, June 16. 

The profile of the surgical work performed here was different than on other trips. As a result, we served fewer people more intensely.  For example, Livensi's procedure lasted 7 hours and Yohan's was 8.  Other burn scar patients operations didn't require as much time as theirs but, nonetheless, the medical work was very intense and detailed. We did good work here.

On our visit to the hospital, Livensi was recovering quickly with his spirit clearly in evidence and his mother by his side.  Yohan was recovering with his healing eyelids and lips despite his disappointment that more cosmetic restoration couldn't be done to his brutally scarred face.

  An additional patient, Juan, was added to the ward to recover from burn repair surgery.

Our experience with the people of the Dominican Republic was positive and engaging.  Our young translators, Jonathan and Juan Carlos, were attentive, helpful, reliable and polite.  We wish them the best for their careers in medicine and I hope we can help them achieve their goals of becoming doctors.  The OR nurse, Fifi, was similarly supportive, knowledgeable and a great help to the medical team.

We were also impressed with the families we saw in the hospital.  There were many caring families with beautiful children who didn't mind my taking a few photos of their kids.

Thank you for following our trip to La Romana, Dominican Republic.

Carl Cilker
Photojournalist

La Romana 2011: Dog Attack

Jackie Arata is a PACU nurse from Sacramento and she is a vibrant part of our group.  She has a friendly, caring demeanor and I was particularly impressed with how she reads people and their needs so well.  Her nursing work clearly fits her observant, understanding personality.

Last Sunday evening, Jackie, one of our PACU volunteer nurses, was badly bitten by a dog while walking with Nan, a volunteer doctor. Jackie was treated as much as possible at the hotel, but since there wasn't any anti-Rabies medicine available in the area, she was sent home the following day so her personal doctors could attend to her injuries. She has since been treated and is following a recommended anti-Rabies regimen.

We were sorry that Jackie had to leave the trip since she plays a very important role and has an engaging, caring personality. Jackie reports that she is doing well.  There were no wounds that required stitches or unusual treatment and she is receiving the necessary shots to prevent Rabies.

Carl Cilker

Photojournalist

La Romana 2011: Day 5, Armoncier & Patient Update

Armoncier is a 28 year old man from Haiti who escaped to the Dominican Republic after the earthquake in 2010 and now works planting bananas.  He has a wife, and a daughter and son who are 5 and 3.  Of the few new patients who came to the hospital yesterday, he stood out immediately due to his pronounced cleft lip and because our our medical team can treat it effectively.  It was fortunate that he hadn't eaten which enabled us to scheduled him immediately for surgery.  Within a few hours, was having his lip and nose repaired by Dr. Fred Tomlinson and OR nurse Pat Lowell.

After a two hour surgery, he was in the recovery for a short time, stayed in the hospital last night and walked out today with a much improved smile.  His teeth still need a lot of attention and we don't have enough time in the remainder of the mission to deal with his dental repair needs.  Hopefully, he will have access to a program to fix the rest of his smile.

We saw Livensi and his mother during rounds today.  He was bright, alert, and smiling.  He is progressing well with lots of spirit and personality.

We're still having a difficult time getting the number of patients and surgical candidates we'd like to see.  As a result, we'll likely not be doing surgeries on two days when they would ordinarily take place.

Altagracia (below) had a revision of a prior lip repair, and her nose was corrected .

Yohan, the policeman, is progressing although his situation is particularly difficult.  Since repair work was done on his eyelids, he has to keep his eyes closed while the skin grafts heal.

It's a disappointment that we don't have greater numbers but we have provided very significant help to some.

 

Carl Cilker

Photojournalist

La Romana 2011: Day 4, Livensi and Yohan

Livensi, our young burn and skin graft patient, was awake when Nan and I visited him this morning.  He was groggy from his pain meds, and he occasionally played with the matchbox cars he was given.  His left arm is fully bandaged and his grafted lip is swollen and has stitches.  When I walked into the room he looked with at me with wide eyes and his face looked almost fearful.  I was clumsy in offering encouragement in a language he doesn't understand.  Nan engaged with him easily and he responded with his wide eyes but an expressionless face.  It’s difficult to know what he is feeling although he is not in obvious pain.  As Nan and I left after our brief visit she gave him a thumbs-up sign and said, “Muy valiente!”  As I followed her out the door I waved to him and he, with his free right arm, enthusiastically waved back. 

Our surgical patients yesterday included a baby with a cleft lip,

a young man with a facial nerve problem,
 

and Yohan. 

Yohan is the policeman mentioned a few days ago.  He is a husband and a father of a one year-old boy.  Last year, Yohan was the target of a non-work related assault with “acid of the devil” that essentially melted his face and left his shoulders and arms badly scarred.  There were openings for his eyes but the damage to his eyelids prevented him from blinking.  The opening for his mouth was very small and his lips couldn’t close.

In a 7 hour operation, Dr. Karla Werninghaus, Dr. Bill DeShazo and Dr. Fred Tomlinson grafted skin to his eyelids so they can close to protect and moisten cleanse his eyes.  Additional grafts were made around his mouth so it can close and work was done to create a canal for his right ear.

These changes are more functional than cosmetic.  Unfortunately, there is little that can be done without extensive, expensive work that offers him any possibility of restoring a more normal appearance.

Be Flexible.  Tenga flexibilidad.

Carl Cilker
Photojournalist

La Romana 2011: Day 3, Meet Livensi, A Very Special Boy

It's fitting that 5 year-old Livensi is patient #007. With his ready smile, intense eyes, and playful nature, our little James Bond Jr. entranced our group; we swooned over him from the beginning. This boy came to us from Bateo Guaimare in La Romana, a couple of hours away, with his Creole-speaking mother.

 

Livensi is very different from the cleft lip and palate patients we were expecting to see. When Livensi was just 2 weeks old, his left arm, face and scalp were severely burned in a house fire. During clinic evaluation, doctors found it difficult to tell where his hand ended and his fingers began. His wrist was frozen backwards.

Seeing him for the first time, those less-experienced among us (me) wondered what could be done for this absolutely charming boy in the short period of time allotted. Never having experienced this type of work before, I didn't fully appreciate the brilliance of the Rotaplast surgeons. Being able to watch Livensi's surgery is an experience that will stick with me forever.

Dr. DeShazo did some great work on Livensi's face, taking a flap of skin from an umbilical hernia, removing any trace of fat, and then performing a graft.  When Dr. DeShazo was finished, Livensi had a perfect little belly button and new patch of soft skin on his beautiful, shiny, albeit scarred face.

Dr. Werninghaus worked on Livensi's arm and hand with quiet, determined patience. The left elbow which had been bent for 5 years was straightened. The backwards wrist that hadn't served its purpose since the beginning of Livensi's life was released and now will be functional and flexible. This lovable little boy who never hesitated to greet us with a wave, now has five more perfect fingers to display. Those of us who were lucky enough to witness this life-changing surgery couldn't believe what we had witnessed. Livensi was been given back the arm that was taken away when he was just an infant.

The road to recovery won't be easy. The skin grafted onto Livensi's arm was taken from his thigh ... for some patients, the donor site hurts more than the receiving site. He faces more surgery to remove the wires holding his wrist in place while the tendons stretch to accommodate the anticipated new range of motion. And with his swollen lip, eating and drinking will be painful for a while. We can only hope he'll receive the follow-up care he requires and deserves. But for now, Livensi is in our care and we will do everything we can for him.

Meredith Cilker

Ward Coordinator/Sterilizer

 

 

 

La Romana 2011: Day 2, Registration and Patient Screening

Today started early with breakfast at 6, the bus at 7 and evaluations at 8.  Last minute instructions were delivered on the bus and we were ready to hit the ground running.

Upon arriving at the hospital we find it unusually quiet.  Rotaplast veterans tell me that patients, many having traveled long distances, are normally lined up at the door with the hope of clearing the many hurdles of candidacy for surgical repair.  Today it was quiet.

We prepared, tested our systems and readied ourselved for the many who surely wanted our help.  They weren't there at 8, or at 8:30, but near 9 they began to trickle in.  This is our first mission to the Dominican Republic so maybe the message didn't reach the right ears?

In time the patient flow increased but we didn't see the cleft lips and palates that are the specialty of our team.  There are very significant needs here but we suspect that they may be different from the services Rotaplast teams typically provide.  We're living our motto of "Be Flexible", "Tenga Flexibilidad!"

 There were a few who can and will be helped but the patients who came to us today had more scarring from burns, most by fire, a few by other means.

We worked through the people as they arrived, creating patient records, taking vitals and meeting with physicians. 

Quite a few were turned away because of health or due to the type and complexity of surgery and follow up required. Some hopes were dashed but also some patients realized that their conditions weren't serious enough to require this level of treatment.

And then there are some for whom a prayer and a miracle wouldn't be enough.  We had two today, a man and a boy, who were burned in different ways and in different events but whose physical damage and scarring are so severe that whatever repair we can do here will be far less than what they need.  The man, a policeman, had very significant chemical burns over his head, face and arms in an acid attack.  The boy suffered burns in a house fire as an infant.  Our sympathy for them is deep but what they need is our help.  The surgeons will do what they can.  Dr. Fred Tomlinson is optimistic that his face can be more functional even if little can be done for him cosmetically.

Our scarred policeman discusses surgical options with his wife.

After seeing over 60 patients today we still have fewer than 20 scheduled for surgery by the end of the day.  The hospital arranged for a late afternoon press conference with the local media and hopefully, we'll see have more patients later in the week.

Dr. Maria Jaramillo discusses surgery with the selected patients.



Nan Madden, PHP, pauses after a full day of screening patients.
 
Carl Cilker
Photojournalist

La Romana 2011: Day 1, Hospital Setup

We arrived in La Romana after 20 hours of flying, waiting and napping.

Our team was greeted by Emilio, Rudolfo and Luis who are our local guides, interpreters, bus drivers and on-site trip support team.  Their anticipation of our needs is excellent and they are very patient with our requests.

Today we scouted the El Buen Samaritano hospital in La Romana and made preparations for the surgeries to come.  The hospital leadership are serving us well in this preparation phase as we prepare for the patient evaluation and procedure planning set for tommorrow.  We understand that we're in the calm before the storm that will happen on Wednesday.


The types of surgeries we'll perform have changed somewhat as it is now likely that we'll see more burn victims than cleft palate/lip patients.  Our trip motto is "Be Flexible".  That, we will be.

Our clinic and evaluation day is tomorrow with surgeries to start on Thursday.

Carl Cilker
Photojournalist