Here in Madagascar it’s 10:30 in the morning on Thursday, but still more like 3:30 in my slowly adjusting brain. I did finally sleep last night, so the fog is lifting. Today we will be traveling to Antsirabe, the site of the mission. It’s about 3-4 hours away and in the mountains, cool and windy but humid, according to the locals. There are 250 pre-screened patients waiting for us in the “shelter,” the term used by Op Smile for the facilities used to house pre and post op patients and their families, close to the hospital. Some are hotels, some wings of the hospital, some dormitories. The pre-screened patients come from all over the country and include some who have had previous surgery with Op Smile, for instance had lip surgery and are now returning for the palate closure. Historically, there are also many “walk-ins” for missions here, people who hear about the opportunity and show up. We have been told to expect 100-200 unscreened patients in addition to those who were pre-screened. The choices of who to put on the schedule are very difficult. Babies and toddlers with open lips benefit the most from closure; they can eat and speak normally, their teeth come in properly and they avoid growing up shunned and ridiculed. Children under the age of 10 benefit most from palate closure as it helps their speech. After that age, even with palate closure, the speech doesn’t change as much. However, what about the 15 year old with the open lip or 30 or 50 year old? They have had a life-time of ridicule that could be eliminated in 45 minutes. Turning them away is, for me, heart breaking. And then there are the teens or young adults who want their palate closed so food and liquids don’t come out their noses when they eat and drink. They deserve consideration as well, but are unlikely to make the cut on this mission.
Although the local Op Smile team has been active since 2007, there are very few plastic surgeons here who are trained in these techniques and therefore a big backlog of patients. The last international mission in Antsirabe was 8 years ago, and we will only be able to do 150 procedures at most. This means that there will undoubtedly be patients who qualify for surgery but will not fit on the schedule. There is currently a “master plan” for Madagascar being developed to address the problem; scheduling two to three international missions per year and increasing the training of physicians and nurses, but it doesn’t help those who will miss out on this mission.
Last night we had a team dinner followed by a team meeting and then a team leaders meeting. That I managed to stay awake, much less retain anything that was said was a major miracle. The program coordinator from Madagascar, a lovely but perhaps overly conscientious young woman decided to try to inject some of the local culture into the evening. The first part of the culture infusion was great. Local artisans brought their wares to the hotel for us to check out before dinner. However, the second part was inviting a local band to play. Although I’m sure they were excellent musicians, they were very loud in a small space. It made dinner conversation impossible, and though they took a break during the main team meeting, they resumed when we broke up into specialty groups. By the time the team leaders were ready to meet, the band was packing up, so we didn’t have to ask them to quit. At the team meeting we learned a couple of phrases in Malagasy which I have forgotten – I’ll try again today – and two cultural taboos. In Madagascar, it’s considered very rude to point at another person with your finger extended; when pointing, first you bend the middle joint and point with that. The second gesture involves beckoning someone over. Instead of extending your hand palm up and waving your fingers toward you, (very rude,) you extend your hand palm down and make a “sand raking” motion with your fingers, (very polite.)
I’m trying to upload photos to Shutterfly – no success so far but I’ll keep working on it. I took them from the bus from the airport yesterday so they are not great. They show what look like rice paddies and the homes of people living around them. There's also a canal with open sewage connected to the paddies. There were kids swimming in the canal and women doing laundry, but I wasn't able to get pictures. There were men pulling wooden carts full of mud bricks everywhere, and many cattle. I hope to get more, better photos today and to solve the upload issue.
Although the local Op Smile team has been active since 2007, there are very few plastic surgeons here who are trained in these techniques and therefore a big backlog of patients. The last international mission in Antsirabe was 8 years ago, and we will only be able to do 150 procedures at most. This means that there will undoubtedly be patients who qualify for surgery but will not fit on the schedule. There is currently a “master plan” for Madagascar being developed to address the problem; scheduling two to three international missions per year and increasing the training of physicians and nurses, but it doesn’t help those who will miss out on this mission.
Last night we had a team dinner followed by a team meeting and then a team leaders meeting. That I managed to stay awake, much less retain anything that was said was a major miracle. The program coordinator from Madagascar, a lovely but perhaps overly conscientious young woman decided to try to inject some of the local culture into the evening. The first part of the culture infusion was great. Local artisans brought their wares to the hotel for us to check out before dinner. However, the second part was inviting a local band to play. Although I’m sure they were excellent musicians, they were very loud in a small space. It made dinner conversation impossible, and though they took a break during the main team meeting, they resumed when we broke up into specialty groups. By the time the team leaders were ready to meet, the band was packing up, so we didn’t have to ask them to quit. At the team meeting we learned a couple of phrases in Malagasy which I have forgotten – I’ll try again today – and two cultural taboos. In Madagascar, it’s considered very rude to point at another person with your finger extended; when pointing, first you bend the middle joint and point with that. The second gesture involves beckoning someone over. Instead of extending your hand palm up and waving your fingers toward you, (very rude,) you extend your hand palm down and make a “sand raking” motion with your fingers, (very polite.)
I’m trying to upload photos to Shutterfly – no success so far but I’ll keep working on it. I took them from the bus from the airport yesterday so they are not great. They show what look like rice paddies and the homes of people living around them. There's also a canal with open sewage connected to the paddies. There were kids swimming in the canal and women doing laundry, but I wasn't able to get pictures. There were men pulling wooden carts full of mud bricks everywhere, and many cattle. I hope to get more, better photos today and to solve the upload issue.
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