Rotaplast Missions

From the Ward Coordinator: Anthony's story

As the Ward Coordinator, my role is to keep track of the patients, both coming and going.  I work very closely with the pediatricians and the PACU (recovery room) staff.  The pediatricians are charged with ensuring that the kids are still healthy for surgery and for monitoring their progress post surgery.  The pace is frenetic and at times, felt chaotic.  But by the second or third day, it became controlled chaos.
 
I feel so fortunate to have been assigned as the Ward Coordinator because I get to spend so much time with the families.  I answer their questions throughout the day, I keep them informed about what is happening with their child and I spend a lot of time reassuring the mothers not to worry and that their child is in very good hands when they send them off to the OR. This is the most difficult part for most parents – the moment when they must put their child in to the hands of a foreign doctor.
 
I have been so humbled to hear the stories of these families  and the struggles they have overcome to get their children a chance at a life changing surgery.  One family had to walk for three hours just to get to a bus stop. 
 
The story that touched us all the most was that of two-year-old Antony and his mother Jacelyn. We first met them on Pre Clinic day and got to know their story quite well over the following two weeks:
 
Five months ago, Jacelyn and her husband were on their way to sell their truck to pay for surgery for Antony when they were ambushed by a gang.  After demanding what little money they had, the gang opened fire. Five shots were fired and all three in the truck were hit, including Antony.  Antony’s father died when a bullet entered one side of his jaw, came out the other and lodged itself in to Antony’s shoulder.
 
Jaceyln now lives in fear because the gang has come after her and has threatened Antony’s life and her own.  Her mother-in-law has also been threatened because she attends the hearings in Guatemala City for the man accused of killing her son.  He faces 50 years in prison for murdering Antony’s father and 25 years for the attempted murder of Antony. 
 
Somehow, they both made it to Retalhuleu for the Rotaplast Mission.   Antony was checked in and sent down the hall for surgery  on day two of the mission.  Shortly after he went in to the OR, he came back out again.  He did not respond well to the anesthesia and surgery was aborted.  He needed to take antibiotics for at least five days before surgery could be attempted again.
 
The problem was that Jacelyn and Antony lived so far away, they would not be able to make the trek in to Reu twice.  Our staff didn’t hesitate and offered to contribute money personally to get a hotel and pay for food for Antony and Jacelyn until he could be reevaluated for surgery the following Monday.  Jacelyn was so grateful and she cried when we gave her the news.
 
The following Monday, Antony was cleared for surgery and had a very successful palate revision surgery.  By then, an older woman whom I understood was Jacelyn’s mother, had joined her in Reu for Antony’s surgery.
 
Jacelyn was let in to be with Antony as he recovered from anesthesia.  I saw the grandmother in the hall weeping uncontrollably and I stopped to reassure her that Antony was okay and that the surgery had gone well.  She understood that.  She said Antony was the only reminder she had of her son who was gone.  She was actually Jacelyn’s mother-in-law, the one who had spent all her time in Guatemala seeking justice for her son's killer.
 
Antony spent the next two days roaming the halls of the hospital blowing kisses to all the staff.  He finally went home on our final day of clinic.  His mother and grandmother left with thanks and asked that God may bless each one of us. 
 
I have been forever changed by my experience in Reu with Rotaplast. Hearing stories like these and spending time with families who have so little and give so much, I can’t go home the same person.     --Rebecca Weaver, Ward Coordinator, Foothill Communities Rotary Club

 

Experiencing a "Rotary moment"

Our Rotaplast mission reached its climax yesterday as we celebrated the successful completion of over 100 cleft lip and cleft palate surgeries with cake and  lots of hugs and photos with both the mission participants and the local hospital staff.

I am extremely proud of the eight non-medical volunteers from Rotary District 5300 who worked tiredlessly, each pulling and adpating under stressful conditions to bring smiles to the children of Gautemala.

I was truly impressed with the professional medical volunteers whose commitment to this outstanding humanitarian effort approached "hero" status. I was taken aback somewhat when one of the physicians told me the medical staff feel the same way about us non-medical volunteers!

As Iapproach my year as Rotary District governor this coming July, I feel confident that I can now count seven more Rotarians who have experienced their "Rotary moment" and will now be lifelong Rotarians who will be motivating others to reach within to embrace humanity.  -- Doug Fowler, Sterilizer, District Governor Elect, District 5300

 

A Medical Records moment

With all the things happening simultaneously on a Rotaplast mission, the one constant is that each patient is assigned a Medical Records number before they even come into the pre-clinic door on the first day.  In a perfect world, they would also get input into the computer at the same time.   Reu did not turn out to be the perfect world from that standpoint.   We were delayed in arriving here the first day so there was no time to come to the hospital and get anything ready ahead of time.  There was a large tent set up outside where three translators met with the waiting families and took brief information.  We just used numbered charts for that first day.   Within a couple days we caught up with all of those who had been given the green light (a green dot) for surgery.  Eventually I came to realize how everything fits together, and I am loving this job.  We record every action and each procedure so we have accurate spreadsheets of everyone we saw on this mission.

The set up of the hospital for each mission is different, but the way this hospital is laid out my Medical Records area is right in the center of things.  So while I have lots to do, it provides a great vantage point to see the parents and kids waiting for surgery (their bench is about 3 feet away) and everyone moving to and from surgery.   The children that are waiting are often really hungry, especially if they are babies who haven’t been allowed to eat for awhile.  Moms and dads are so patient with these beautiful little kids.  They sing, they bounce, they sway back and forth just like parents everywhere but they also have a more unusual way of comforting their children.  They rub the top of their heads really hard – and it seems to do the trick!   Moms here often carry their young children in a sling on their back and it is just magical to watch how they do it.  I am pretty sure I would have dropped my children on the ground.  If you watch the face of a mother right after her child is taken to surgery, they almost always have tears in their eyes and deep concern all over their face.  This is a direct contrast to the look I see later in the evening when their child has come back to recovery and is even more beautiful than before.   Their whole manner is light-hearted and relieved.

One of the most moving sights for me is to see the patients coming out of the OR, especially the little ones.   There are a group of quilters in the Northeast, coordinated by a Rotary Club in Maine that make beautiful, brightly colored quilts for each patient.   When surgery is over the doors bang open, and out comes the nurse and anesthesiologist moving very quickly, one holding the child covered with the quilt and the other carrying the IV bag.  They pause as they go by the parents so that they can see their child and then the whole entourage moves quickly to the PACU so that they can begin to recover.  It makes me grin every time I see it.  That’s why we are here.

-- Mary Ann Avnet, Medical Records,  Rotary Club of  Las Vegas

 

 

The view of a Rotaplast rookie

I chose Family Medicine because it allowed me to see the whole family from birth to death. When I asked my attending Dr. Bryan Stamm over a year ago if they take Residents on Rotaplast missions, I never expected that I would ever learn so much about what family medicine really means.

On the first day I was extremely apprehensive and nervous that I would miss something or that my knowledge would not be adequate. At home I saw how our privileged country detects this condition during pregnancy and deals with it early on. Coming here I expected to see infants and small children, but I soon was amazed to see teens and even adults who have never been treated. I saw more cleft palates and lips in one day than I have seen in my entire medical training up to this point

I learned an amazing amount of patience, courage, faith, and love from these children and their families. I saw devotion that is beyond words. Their stories are courageous and each child deserves the best, which is what we try to provide them. We treated one little boy, Franklin, who was 2 years old with Down’s syndrome. He had his palate closed and did not tolerate being off oxygen after the surgery. He was the first case of the day and subsequently spent the rest of it in the recovery room. While other children came and went this poor mother sat here diligently with her child, trying to comfort him and help us take care of him on oxygen and giving breathing treatments. As the day progressed we got more concerned about leaving him on the ward for the night without a pediatric ICU. We essentially already had one set up in our PACU, but we didn’t have the staff to keep it running 24 hours a day without diminishing the care we could provide for the other children needing to have surgery. The team worked diligently to determine what could be done for Franklin. We worked out a differential and even in a third-world country where we did not have the tools of home, we were able to provide him the same care he would have received if he were one of my patients in Spokane. In the end, he recovered nicely and went home after two days in the hospital without any problems. Franklin taught me to trust myself and my instincts when faced with a difficult situation. I forget how lucky I am to have received my education in the U.S., and how much I have truly learned.

We not only care for the patients, but also their families, the hospital staff, and last but not least our amazing Rotaplast team. We have treated over half our staff for various illnesses, injuries, or other ailments as every role here is vital and we can’t lose one or we chance decreasing the number of people we can help.

 I came on this mission to learn about cleft lip and palates, but instead I learned much more than just pre- and post-operative care for these children. First and foremost I learned: be flexible, think outside the box, patience is a virtue, cry with your patients, and teamwork is the only way to accomplish anything for the greater good. The biggest personal lesson I learned from my faculty, the team, and most importantly the patients is to believe in myself. These children have endured the most impossible odds and they trust me to help them.

 They have been bullied and picked on. They have been banished or cast off. Yet they are the bravest, most patient, and loving children I have ever met and are forever grateful for even the smallest amount of care or attention we can give to them. I will forever be touched by this experience and what they have taught me not only as a family physician, but as a person.
-- Dr. Amie Shaw,Pediatrician, Spokane, Wash.

 

From a seasoned team member

Don't ask me how I ended up as lead anesthesiologist on another mission.  I think it's good that they don't tell me these little details until the last minute because then I can't obsess over all of the unknowns.    This job is very unscripted. 

If you come with a decent skill set and ability to think outside the box, however, you will be fine.  The rest, my friends, is not taught in any residency program or board review course.   Things you can expect: Machines from three decades ago, oxygen gas resupply issues, simultaneous electrical/generator failures,  and active volcanoes.

 But I would not trade this Rotaplast experience, or my other 10 or 12, for anything.   We meet amazing characters on our team from many parts of the world who share great stories during our long days at the hospital.   But most of all, the kids' smiles keep us all coming back, and the force helps me  make the right decisions when the road becomes rough.    Wish us luck in our last two days in the country.

--Dr. Enrique  Abreu,  Lead Anesthesiologist

 

A life-changing experience

This is my first time on a Rotaplast mission and it has changed me forever. The days are long and tiring but not nearly as much as they are for the parents and children, many of whom have traveled days to get here and then wait patiently to ensure that their child gets necessary surgery. The work is humbling and rewarding. The change that will take place in the lives of the patients and their families is immediately evident. The parents and children are so grateful for what we do that they constantly shower us with wishes for a blessed life forever.

 My primary assignment is patient transportation, coordinating with the doctors and nurses and taking the parents and children from pre-op to the staging area immediately outside of the OR. Making sure that the patients are ready and waiting when the surgical team is ready to start is critical. Clearing the way for the patients as we transport them from the OR to PACU, then from there to the recovery room and comforting them along the way as needed is also part of the work. I am also available as a second translator on the team whenever needed to facilitate the communication between the medical staff and the parents or anyone who may need it.

 The first day was clinic and I started it assisting our highly focused and patient-centered pediatricians who were examining the children, clearing them for scheduling or giving them medicine and advice so that they could return for later consideration, Every child came to us with their own unique and amazing story. Behind the deformities of the lips and mouth are children who are beautiful in so many ways; we want to help them all.

 I also work with our very caring speech pathologist who would talk to the parents of those we would not be scheduling for operations such as underweight babies - this was tough. She would provide help by advising them about how to best feed and care for their children with the hope that they could return with a healthier child next year.

My greatest experience every day is working with a wonderful team, seeing the look of gratitude when a child is taken to the operating room, the look of wonder and joy as parents see their child for the first time after an operation, hearing the words of thanks and sharing them with the members of the team and knowing that with Rotaplast I can contribute to making a difference.

-- Luciano de Sylva, Patient Transportation Coordinator, Rotary Club of Walnut Valley

 

Watching Juan Daniel's life transformed

As the photojournalist for the mission, I have the opportunity to roam as I please throughout the hospital, taking photos of the children and parents in the pre-op room, the PACU where our team takes care of the children following surgery, the recovery ward and surgeries. Today I decided to latter -- watch Dr. Dennis Dundas perform a bilateral cleft lip repair on 14-month-old Juan Daniel.

I put on my scrubs, shoe covers, hair cover and mask and went into operating room number 3.  Dr. Dundas was gracious and explained what I would be seeing for the next 90 minutes. Sharron Newton, the OR nurse, asked if I could handle watching the procedure without fainting and I assured her I could.

 
Soon, a crying Juan Daniel was carried into the operating room and Dr. Gustavo Lozado, the anesthesiologist,  went to work to get the patient ready for surgery.  For the next hour and a half, I stood and watched Dr. Dundas do the most amazing thing: he transformed a boy's face - and his life - forever.

Once the surgery was complete, he was awakened and Sharron brought the boy out to head to the PACU. On the way, she stopped long enough for his mom to take a look and make sure her boy was OK. As she saw her son, she began to cry tears of happiness. This happens countless times a day, but it is no less rewarding and wonderful for those of us working here at Hospital Galindo as part of Rotaplast.   It brought a smile to MY face to know I had been a very small part of Juan Daniel's journey.

 

Follow the jump to see graphic images of Juan's surgery.

 

Osvaldo asked mom for a mirror

This is my first Rotaplast mission and as translator, I am available to the doctors and nurses to relay important information to parents before, during and after surgery.

On our first day, I staffed the initial registration table during Pre-Clinic. The registration table was set up outside in the hospital's courtyard and a tent was erected for relief from the relentless tropical heat and humidity. While I registered patients, I had the opportunity to hear some of remarkable journeys families had taken to reach Hospital Galindo. Most had traveled more than four hours to arrive at the site while some up to 16 hours by bus. One family walked three hours by foot just to arrive to a bus stop.

It was late during pre-clinic day and while working registration, I spotted a disoriented woman and her teen-age son walking in from the main gate. I greeted her and wrote down all her basic information so her son, Osvaldo, could be evaluated by the pediatricians and surgeons. I translated to our Medical Director Dennis Dundas that Osvaldo, 15, had been bullied at school and he had a hard time socializing with classmates because of his fear of being isolated.

 Mom said that they live in a remote village and wasn't aware the cleft palate surgeries existed until she got word from her local priest. As Osvaldo was doing his first communion, the priest told her there would be a foreign medical team in Retalhuleu. They caught the first bus that left with only the clothes on their back -- and hope.

 
 
This morning I spotted Osvaldo's mother and she asked me in Spanish if the hospital would be supplying meals because she had not eaten and did not have money to buy a meal. I referred her to our Mission Coordinator Joanne Wessles, who was distributing meal tickets for parents that had children checked into the hospital. She was beyond grateful.

Later, I inquired with Osvaldo’s mother as to how he was doing following his surgery. She responded that he was doing well. She said the first thing he asked for when he woke up was a mirror to see his new face and smile.   -- Jesus Lara, Translator, Rotary Club of Pico Rivera

 

A quartermaster's view

 
One of the most impressive aspects of this Rotaplast experience is seeing the incredible endurance and acceptance of the Guatemalan people. They seem to expect little and accept what is. Most came by bus, some took two hours, some took one or two days. They waited outside the hospital and they waited inside the hospital...They waited and hoped for the best. A great percentage of the women and girls were in colorful traditional dress, most likely their Sunday best. Many were confused during the admission process, but knew that Rotaplast was here to help.

The admission process itself was hectic, confusing but well organized. Information and pictures were taken and the children were examined by the doctors. All of this time we could sense the anticipation, confusion and fear of the unknown in the parents' eyes. The most disconcerting was when, due to the child's condition, he/she could not be operated on. The parents' eyes reflected their disappointment and resignation. Most simply aked if they could leave. And that was that.

As quartermaster I have had the advantage of seeing almost every aspect of Rotaplast in action. After schlepping around boxes and making sure things were where they should be (according to Mission Director Brian) I was on call to run errands and find this and that. Being quartermaster is a rather reactive type of job, from making sure there was plenty of water available, finding a fan, a pen, making cardboard "no-nos" to helping with patients as needed. I also get to go into Retalhuleu daily to pick up necessary supplies (sodas, snacks, stuff that goes with limes, cups, paper towels, stapler, pens, etc.). These trips have enabled me to get a sense of the city's vibrations. I am driven in by Spencer Buchanan, a member of the Guatemala City Rotary Club. He has lived here for 39 years, knows the place well and is an experience in himself.We spent a dark and very rainy evening driving on the wrong side of the road. His memorable quote was, "You can be a bonehead here and no one really cares". And so it goes.    -- Alan Bowman, Quartermaster, Boulder City Sunrise Rotary

 

Wednesday: The first day of "wow"

Wednesday was much smoother in the hospital. We weren't over-run by children and families and the medical team spent the first hour getting ready for the first day's surgeries. Since I took the patients' "before" photographs, I was looking forward to spending some time in the recovery ward and seeing the patients "after."

Many of us brought coloring books and crayons and various toys from home for the children to play with while their were waiting for surgery. It proved to be a great distraction for them as many of them were nervous about what lay ahead in the "sala de operaciones." As the sometimes crying children were carried by a member of the medical team, their parents followed - equally anxious, but excited too.

After one mother saw her 15-month daughter following surgery, she began crying and saying, "She is so beautiful" over and over and expressing how happy she was. Those in the room got choked up,  realizing how valuable the work we do really is.

Anthony, the boy who had the bullet in his shoulder, was scheduled for surgery on this day but doctors were unable to go through with it because he had a bad reaction to the anesthesia. They suspected he had a case of bronchitis and placed him on antibiotics. Hopefully they will be able to try again later this week.

As I mentioned, I was able to spend a lot of time in the recovery room and see the children post-surgery. Usually not at a loss for words, all I could think (and sometimes say aloud) was "wow!"  I would look at these patients, remembering what they looked like just the day before, and after just a few hours, they were completely transformed. It was only day one and I knew that more "wow" moments were to come.