Today was selection day, and Charlotte, the young woman who is the Madagascar Op Smile coordinator developed a new way to tell the patients and parents. The usual way is to have all the patients gather in the morning and then have one of the surgeons or the program director give a little speech about how we would have loved to do surgery on everyone but that for medical safety reasons and for reasons of age and surgical benefit, some patients would not be having surgery on this mission. There would be other missions, the next one will by in… (April 2017 in this case…) and that Op Smile will contact those who did not make it onto the list for this mission. After that, the names of those who are scheduled for surgery are read off, “in no particular order.” When it is done this way, those who are chosen are very happy and often laughing and hugging family members. Those who are not chosen, especially if they were expecting to have surgery, are disappointed and probably feel like they are surrounded by a party to which they were not invited. They aren’t just sent home; Op Smile coordinators speak with them and set up a plan for each patient, but it still isn’t the best environment for hearing bad news.
Charlotte’s plan was different in several ways. The first thing she did was have the shelter director bus the patients over in four groups rather than all at once. That alone made it feel much more personal. Next, she had tables set up outside at the hospital on two levels. On the upper level courtyard were the main table where the line of patients started, five tables for surgeons and their interpreters, and one table each for dental, speech and the feeding program. On the lower level courtyard, down a set of stairs, a table was set up for each day of surgery, Monday through Friday with an Op Smile nurse and an interpreter. At the main table, patients would step forward and give their number to Charlotte who would consult the master list. She would then send the patient with an Op Smile runner to the appropriate table. If the patient was not having surgery, they went to a surgeon’s table and the surgeon, who had been instructed to take as long as he or she needed, would explain why there would be no surgery and would answer any questions. Each patient was also given a paper with the contact information for the April mission.
Patients sent to the feeding program table were mainly babies who were malnourished or under weight for age. They will remain in the shelter for the week receiving help with feeding and return for the April mission as well. The dentists, who are from Italy and Egypt, saw patients who need work under anesthesia which they will do in the dental unit in hospital here. They also will make obturators to fill the space of the open palates for those patients who are not having surgery this mission. The obturators are like thick retainers and help prevent liquids and air from flowing up through the nose. Finally, the speech therapists will see some patients who will stay this week for intensive speech therapy.
There’s a last group of patients that are very difficult for all of us. They have conditions that are beyond an operation smile mission and likely beyond the expertise of plastic surgeons in their home country. What they need is a miracle – some charity group or organization or philanthropist to take them on and treat them. One is the 16 year old girl I saw with the extensive nevus, progressive left arm weakness and badly healed femur fracture. She needs a combination of neurology, plastic surgery and orthopedics to make her whole. Another is a middle aged woman who had noma, a severe infection that can occur around the mouth in malnourished people. It often results in gangrene and the loss of large amounts of tissue. This patient lost most of her upper lip and jaw and the base of her nose. She will need extensive plastic and maxillofacial surgery to reconstruct her face. The last on this mission is a young woman with a large benign facial tumor. All of these people would be taken care of if they had access to modern health care. What they need are guardian angels.
After lunch at the hotel, we went on a different type of team day. Usually there is a trip to a beach or some other team building event. Instead, we went to two artisan workshops and a small shop of hand-embroidered linens. The first workshop is run by two brothers who make utensils, jewelry, boxes and other things out of the horns of the Zebu, the Madagascar cattle. The Zebu are raised by most of the rural people here and provide milk and meat, hides for warmth and dung to burn. Nothing goes to waste, and these brothers have made a business out of the horns. After the animal has been slaughtered, they remove the horns and heat them in hot water. This separates the inner bone from the outer horn. Next they tap the horn with a wooden hammer and the bone comes out in one piece. The bone is ground up into a powder and used as a medicine for headache and sinus congestion. The brother giving the presentation said you inhale it and it feels just like ammonia. “Great for clearing up your headache.” The horn is cut with a rotating cutting wheel they make from tin cans. A washing machine motor runs the spinning wheel. They use a hand made wooden mold to shape spoons and shell shaped necklaces. They showed us the process of smoothing and polishing the horn using sand, denim cut from pants, clay and plants. They pour oil over the wheel while polishing the horn. Black Zebu have black horns, white grow white, and the “marbled” Zebu have beautiful marbled horns. They have a small shop with an amazing variety of objects made from the horns.
Next we went to a shop where a man makes miniature bicycles, rickshaws, cars and busses from found and recycled materials. He uses rubber and wire from tires, fishing line, used IV tubing and small pieces of wood. I’ve posted photos of both the horn and bicycle workshops on shutterfly that I hope will show up this evening.
Well I’m off to team meeting and tomorrow we start the surgical week. No more lazy days.
Charlotte’s plan was different in several ways. The first thing she did was have the shelter director bus the patients over in four groups rather than all at once. That alone made it feel much more personal. Next, she had tables set up outside at the hospital on two levels. On the upper level courtyard were the main table where the line of patients started, five tables for surgeons and their interpreters, and one table each for dental, speech and the feeding program. On the lower level courtyard, down a set of stairs, a table was set up for each day of surgery, Monday through Friday with an Op Smile nurse and an interpreter. At the main table, patients would step forward and give their number to Charlotte who would consult the master list. She would then send the patient with an Op Smile runner to the appropriate table. If the patient was not having surgery, they went to a surgeon’s table and the surgeon, who had been instructed to take as long as he or she needed, would explain why there would be no surgery and would answer any questions. Each patient was also given a paper with the contact information for the April mission.
Patients sent to the feeding program table were mainly babies who were malnourished or under weight for age. They will remain in the shelter for the week receiving help with feeding and return for the April mission as well. The dentists, who are from Italy and Egypt, saw patients who need work under anesthesia which they will do in the dental unit in hospital here. They also will make obturators to fill the space of the open palates for those patients who are not having surgery this mission. The obturators are like thick retainers and help prevent liquids and air from flowing up through the nose. Finally, the speech therapists will see some patients who will stay this week for intensive speech therapy.
There’s a last group of patients that are very difficult for all of us. They have conditions that are beyond an operation smile mission and likely beyond the expertise of plastic surgeons in their home country. What they need is a miracle – some charity group or organization or philanthropist to take them on and treat them. One is the 16 year old girl I saw with the extensive nevus, progressive left arm weakness and badly healed femur fracture. She needs a combination of neurology, plastic surgery and orthopedics to make her whole. Another is a middle aged woman who had noma, a severe infection that can occur around the mouth in malnourished people. It often results in gangrene and the loss of large amounts of tissue. This patient lost most of her upper lip and jaw and the base of her nose. She will need extensive plastic and maxillofacial surgery to reconstruct her face. The last on this mission is a young woman with a large benign facial tumor. All of these people would be taken care of if they had access to modern health care. What they need are guardian angels.
After lunch at the hotel, we went on a different type of team day. Usually there is a trip to a beach or some other team building event. Instead, we went to two artisan workshops and a small shop of hand-embroidered linens. The first workshop is run by two brothers who make utensils, jewelry, boxes and other things out of the horns of the Zebu, the Madagascar cattle. The Zebu are raised by most of the rural people here and provide milk and meat, hides for warmth and dung to burn. Nothing goes to waste, and these brothers have made a business out of the horns. After the animal has been slaughtered, they remove the horns and heat them in hot water. This separates the inner bone from the outer horn. Next they tap the horn with a wooden hammer and the bone comes out in one piece. The bone is ground up into a powder and used as a medicine for headache and sinus congestion. The brother giving the presentation said you inhale it and it feels just like ammonia. “Great for clearing up your headache.” The horn is cut with a rotating cutting wheel they make from tin cans. A washing machine motor runs the spinning wheel. They use a hand made wooden mold to shape spoons and shell shaped necklaces. They showed us the process of smoothing and polishing the horn using sand, denim cut from pants, clay and plants. They pour oil over the wheel while polishing the horn. Black Zebu have black horns, white grow white, and the “marbled” Zebu have beautiful marbled horns. They have a small shop with an amazing variety of objects made from the horns.
Next we went to a shop where a man makes miniature bicycles, rickshaws, cars and busses from found and recycled materials. He uses rubber and wire from tires, fishing line, used IV tubing and small pieces of wood. I’ve posted photos of both the horn and bicycle workshops on shutterfly that I hope will show up this evening.
Well I’m off to team meeting and tomorrow we start the surgical week. No more lazy days.
No comments:
Post a Comment