Rotaplast Missions

Orthodontist, Dr. Rosie, explains the role of the dentists on the Rotaplast Team

"We start our day setting up the dental tables to check each patient who comes in. We need to check the dentation of each patient. Some of them have been scheduled for extractions, so we have to make sure that they have identified the right teeth and patient. We go into the OR either before or after the surgical procedure, according to when the surgeon wants the teeth removed. The next step is to go down to the dental room to take impressions on the patients who need obturators. (These Palatal plates are prosthetic devices generally consisting of an acrylic plate and retention clasps of orthodontic wire, which covers a fistula of the palate. In simpler terms, a palatal obturator covers any fistulas (or "holes") in the roof of the mouth that lead to the nasal cavity, providing the wearer with a plastic/acrylic, removable roof of the mouth, which aids in speech, eating, and proper air flow. Source: Wikipedia).  The impressions are made using stone molds, then prescriptions are written for the way the obturator has to be made in the lab. We then proceed back to the OR to help with the checking of the patients before they go into the OR... then we help out in the OR. So there’s lots of running to and fro. Another of our tasks is that we have to teach the mothers how to feed their babies with a bottle."

It's a jam-packed day for the dentists (Rosario Mayro DDS of Jenkintown, PA, and Natividad Gervasio DDS of Manila) who voluntarily give their time and expertise to Rotaplast to help these children, who would otherwise not receive dental and surgical intervention, towards better oral health.

Cebu City, Philippines: Anesthesia and Rotaplast

The anaesthesiologists, Sarah, Steve, Helen, and Denise (pictured) often experience difficulties that they might not have to face back home in the USA. Denise explains: My major challenge is in making the kids comfortable so the surgeons can perform. We have to keep them medically stable, which is sometimes difficult with their frequent respiratory infections. With the intense heat, and having to keep them NPO in a non air-conditioned waiting area, they are sometimes dehydrated before they come to us. It can be a real challenge getting IVs into those tiny veins.

Thanks Cebu City Port Center Rotarians and Partners

Last night the Rotary Club of Cebu Port Center, our superb hosts during our stay here in Cebu, had a few surprises for us. It was the wind-down night, where certificates and plaques were presented to the key players in the Rotaplast Mission. Following some expert dancing, notably by our own PACU Assistant, Marnee, a young woman took the stage. Her name is Anna Marie Quillo. I met Anna Marie outside the Operating Room when she was awaiting surgery last Friday. She was comforting another young woman, Marjorie, and assuring her that the surgery would be soon over, and that her life would be changed forever. It was a touching sight. I asked Anna Marie about her hopes and life wishes, and she told me of how she loved to sing. I asked her to sing for the OR staff. When I heard her pretty voice, I had to hold back a few tears. Anna Marie looked the picture of poise and perfection up there on the stage in the Jose Rizal Memorial Library and Museum – one week post-op. Her mother and little Evan, her one-year-old son who was but two days post-op from a cleft lip repair, looked on proudly. At the conclusion of her second song Anna Marie received a standing ovation from the audience. It was a beautiful end to a memorable mission. Thanks local Rotarians and your wives for making this an evening to remember, and for all your kindnesses during the Cebu 2008 Mission. You have gone beyond the call of duty and then some.

Cebu City, Philippines: Medical Records

Consuelo is our medical records keeper. She describes her job: "I keep all the records in order and change the skeds when necessary. I also audit the anaesthesia records. The last day is always hardest as you are re-sorting all the files alphabetically. There was an emergency today as one patient who was operated on a couple of days ago fell over and split open his stitches. This meant relocating the file, which was easy enough because I knew who the doctor was. Tomorrow, I will see that all the yellow copies stay with the hospital, and the rest of the copies are returned to Rotaplast. One problem can be when patients don’t show up for surgery on time. In one case, the communication wasn’t understood and the family showed up a day late. However it turned out OK as the little girl needed an extra procedure – she needed to have her mouth widened. I also help to print out certificates for the nurse volunteers – this will help them get their foot in the door for future employment. The final step is to do summary reports – how many patients were walk-ins, how many were done in total, the categorization the procedures, and the sum total of the value of the mission. This is done via an Excel Sheet. If there are multiple procedures, the first is amounted at 100%, the second at 50%, etc. Notations are made on the charts by the doctors if they do secondary procedures. Sometimes there are lulls so I try to catch up on other things, but usually there are no lulls.”

Cebu City, Philippines: On the Ward

The Children’s Survival Center is the building used as a ward for the Rotaplast patients. It is divided by curtains into a pre-op and a post-op area, with a central nursing station. It’s a busy, noisy area with parents and patients using the small green army-type cots both before and after surgery. With fifteen pre-op families and fifteen post-op families on average, it is not always conducive to rest; but as these families are so grateful to have the opportunity to receive these cleft lip and palate repairs, there’s a remarkably upbeat atmosphere.

In the ward area, the PACU Assistant, the Patient Ward Coordinators, and the transporters all have important jobs. Vasanth and Bent (Ward Coordinators) and Bob (Transfer Coordinator) sometimes attend with the PACU assistant, Marnee, when the paediatrician is checking the patients. The paediatrician, Collin, checks the children in the morning for fever, etc., and establishes that they have not eaten or drunk anything. He then clears the patient to be taken to the Operating Room. When the surgeons ask for their patients, the transporters bring them to the OR area. The route from the ward goes all the way up the side of the hospital, in through a side door, then up the elevator, or via a long ramp to the operating room area on the third floor. When the patients are seated outside the OR rooms, the dentist, Natividad, and the orthodontist, Rosario, call them to check if there are any dental requirements; when the OR room is ready the surgeon will come out and ask for the patient in order to check them again, before taking them to the OR. When the surgery is finished, the patient is taken to the recovery area, and, when stable, the Recovery nurses (Joanne and Margaret) ask the transporters to take them back down to the ward. Two hospital employees help with the transport, but a Rotaplast team member always carries the files. The child is then assigned a cot in the ward. The local Cebu nurses, headed by Henry, take over daily care from there. There is quite a bit of overlapping of roles, as sometimes the patients need to be kept occupied. For example, Bent, a major Rotarian fundraiser for this Mission, spent time printing photos for the kids, and ward volunteers were often seen blowing up balloons, or helping the kids color pictures. The assistant mission director, Rosalie, taught the older girls how to make braided bracelets from thread. It may not be your normal hospital scene, but it works well. Several of the kids became really attached to the Rotaplast team members, and on Saturday’s final post-op final check day, there were many teary, but happy, scenes.

Cebu City, Philippines: Rotarians on the team

The non-medical Rotaplast team members in Cebu – all Rotarians – fill roles necessary to the success of the mission. One role that can be stressful if things go wrong is that of Quartermaster. Our QM, Don, describes his work: “Both at the beginning and the end of the mission, and during the mission, the QM is required to float to fill whatever is required. Sometimes it is just getting supplies. Primarily I’m just trying to support the team where I can, but because this team is so efficient, I find myself having less and less to do. Mainly, you have to learn where to find things. We are lucky in that we have the resources here in Cebu to find everything. It’s not always the case. In India, the hospital was a long way away from our living area. Probably, the biggest danger of my job here is crossing the street!"

Cebu City, Philippines: Starry Starry Smile

This morning little Jesimiel Lopez was scheduled to have a cleft lip repair. Nurse Sandy was helping him become familiar with the anaesthesia mask. He was having such a good time blowing into the mask, she decided to pop her crazy star sunglasses on him. When anaesthesiologist Steve came in, he continued with the game, and started the flow of gas. Little Jesimiel Lopez was soon sound asleep, and plastic surgeon, Sib, started the repair. When he woke up, there was yet another changed smile in Cebu. (Photo by Sharron Newton)

Cebu City, Philippines: Operating Day Five

The walls of the “Conference Room” at the Vicente Sotto Memorial Medical Center in Cebu are plastered with cute drawings from the patients. The volunteer Rotarians working in the ward had handed out coloring pens and paper, and some of the kids had drawn thank-you pictures.

One young lady, Jessica, drew a cat and a dog and wrote: “To all doctor of rotaplas. Thank you for your helping for me ... you give me a chance to voice fixed and possible back normal. I never forget this time to help me. This is my great day ... thank you to all doctor and volunteer - to all doctors and volunteers- good heart! .... WE LOVE YOU! Jessica Celocia.” Jessica is 19. She is here with her twin sister, Jezebel, from Lapu-lapu, a town about half an hour from Cebu City. Jessica and Jezebel look very similar and both are very pretty. Jessica’s greatest wish is to be “normal.” She wants to work, but currently, with her palate problem, she is unable to get a job, mostly because of her inability to speak properly. Other missions come to Cebu City, but for some reason Jessica’s repair has not been a priority. The thought was that even with the cleft palate repair, without speech therapy her speech will not improve. A family friend from Australia, Mr. Rick Black, has been pushing to have Jessica put on a list for surgery and is willing to find speech therapy help for her; but four times, her case has been denied. So imagine her joy when she found out that this time, she made the list for a repair. Rosalie, our assistant mission director, took to Jessica and has been following her progress. She was there along with twin sister Jezebel when the surgery finished, and with the recovery room nurses, Joanne and Margaret, and local nurses, Ean and Von, helped her through the anaesthetic recovery period. Her other "biggest wish" after her palate repair is to see her mom and dad who are with the rest of the family back in Lapu-lapu.

This afternoon, one of the Cebu City Rotarian’s wives, Jojo Hong, a civil engineer by profession, brought along another set of twins, twelve-year-olds Rose Mary and Mary Rose. They had received palate repairs last year. Rose Mary and Mary Rose live in extreme poverty. Jojo has undertaken to make sure they get a decent meal every day, and is responsible for them having had their palates repaired last year by a Rotaplast team. When their mother didn’t bring them to the pre-clinic, Jojo sent her office staff out to find them. When Jojo brought them here today, they recognised Dr. Rosie, a familiar face from last year. The tears began to flow – they were so overcome with happiness to see her. Dr. Rosie is an orthodontist from Philadelphia who has been on several Rotaplast missions. The two girls sang beautifully for us. A year ago, this would not have been possible, but thanks to wonderful, caring people like Jojo and many other volunteers both in Cebu and from afar, miracles can happen.

Today the Rotaplast team completed fifteen operations at Vincente Sotto - fifteen more lives that will be changed forever.

Cebu City, Philippines: Operating Day 4

This morning Rosalie handed me a pin with the words “A smile lasts forever” surrounding the Rotary wheel. There was a quote on the backing paper that really brings home what a Rotaplast Mission is all about. It says: Too often we underestimate the power of touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around.” (Leo Buscaglia). Here in Cebu there are acts of caring all around, especially at the Vicente Sotto Memorial Medical Center where Rotaplast, in conjunction with the Rotary Club of Cebu Port Center has been busy.

On Friday, a cute little guy called Nelson with an enormous smile tore at the heartstrings of the post-anaesthesia care unit assistant, Marnee, and sent her on a journey she wasn’t quite expecting. Nelson is two; he has both a cleft lip and a cleft palate, but nothing can get in the way of this little charmer’s happy personality.

Each time Marnee went into the ward where he awaited his surgery, his arms went up and his face broke into a sparkling smile. She was his. In fact, she laughs, “He had me at ‘hello’”! “You can call me Nene,” she told the playful little fellow. Today, Marnee followed Nelson’s surgeon (Dr. Bill) into the Operating Room, and she was there to meet his mom when he emerged from the anaesthetic. When Nelson’s mother saw her baby, the tears welled, and that’s when it all came rolling home for Marnee. The two very new teary-eyed friends bonded there in the recovery room, as they held a sleepy Nelson between them. Marnee took the beaming mother and her dramatically changed baby back to the post-op ward and helped them get settled to await discharge in a day or two. Another small miracle has taken place on the Rotaplast Mission.

The hospital is inundated with these stories of caring. This afternoon, two young women arrived at Vicente Sotto with a 71-year-old woman and her two little ones, a girl of about 7, and a baby of two and a half. This beautiful, but frail grandmother is raising five of her daughter’s children alone, and in very poor circumstances. The young women are employees at the La Farge cement company in Danao, a couple of hours north of Cebu City. The company has been holding forums to determine any concerns that the people in the area might have regarding the cement company. During one of these forums, a manager noticed young Gabriel who has a cleft lip. He arranged to have the child brought to Cebu City by his employees, as he had heard there was a medical mission in town. Gabriel is what Rotaplast calls a “walk-in”, a case not seen before. Within an hour, Gabriel had been seen by a paediatrician, an anaesthetist, and a plastic surgeon, all volunteers with Rotaplast, and the steps were put in motion to arrange to have him operated on tomorrow. His cleft lip will be repaired because Rotaplast will not refuse treatment to any child, and because, somewhere out there in Danao, there was a small act of caring.

Cebu City, Philippines: Day 3 in the Operating Room

Early morning rounds in the ward saw all of Monday’s patients discharged except three who will stay another day. The ward was immensely busy, with parents and children eating, being treated, being discharged; but there was a general feeling of warmth, smiles, and happiness that their lives would be taking a new direction – there would be hope for a normal childhood for these incredible children and their families. The surgeons, Jed, Bill, Jitka and Sib, and paediatrician Colin, visited each of their patients, removed gauze and stitches where appropriate, and worked quickly between the cots before heading off to start the day’s cases. Normally, 12 to 15 cases are done per day in three operating rooms. We have four surgeons and four anaesthesiologists on the team, which allows for a float surgeon/ anaesthesiologist.

A San Francisco woman who was on the same plane as the team, and who had heard about what we were doing, dropped into the hospital to see how she could support the mission. She had a nephew who had a cleft lip and she remembered how difficult it was. Ken, Don, and Rosaline explained how Rotaplast is associated with Rotary, how Rotarians fundraise to provide money to send a Mission Team, and how the local club here supports us. This particular club, the 32-member Rotary Club of Cebu Port Center, in District 3860, pre-screen the cleft lip and cleft palate patients, and give them vitamins. They make all the arrangements necessary to get the children ready to come into the hospital. They arrange food for us; they liaise with the hospital to set up the schedule for the team here; and ... they treat us royally while we are here. I have yet to experience such hospitality by a Rotary club.

Some of the pre-screened children make the list; others are put on standby in case there are cancellations because of illness. This year, of 140 pre-screened children, 110 made the list, with 30 put on standby. One such patient arrived at the hospital this morning. Nine-month-old Christel Joyce is a very pretty little baby with a unilateral cleft lip. Home is about an hour away by jeepney - the colourful open buses that fill Cebu’s streets. Dr. Colin and Dr. Bill both examined the child. Christel’s parents were asked to come back on Thursday when maybe there will be an opening. Rotaplast tries to accommodate all patients, so hopefully she will receive an operation very soon – if not on this mission, she will be placed at the front of the list for the next mission. By the end of the day, two more standbys and one walk-in (i.e. not seen before) had been processed and scheduled for surgery, one for late today and the others for later in the week.