We are back at the hotel in Antananarivo, the capital of Madagascar. Most of the team leaves tonight on a flight to Paris and then on to their various destinations. Three of us leave tomorrow at 3:00pm for Johannesburg and then JFK where we split up. I’ll arrive at Logan late morning. This has been an exhausting mission but extremely satisfying in that we were able to do surgery on 166 patients. Because Headquarters Op Smile in Virginia made the decision to let the the “floater” surgeon do cases under local anesthetic each day while being available to break scrub to help with any emergency, we were able to do primary lip repairs on seven patients age 14 years and up each day. This translated into 35 young adults who can now step out into the world, confident that no one will be targeting them. One group of three teenage boys came from nearby villages and had bonded over their difficult child and adolescent years. As they were leaving yesterday, some clueless person asked if they thought the girls would notice them more now. As I was trying to curtail my anger over the insensitivity of the question, the boys began to tease one of their group about a particular girl he was interested in and joked about how this boy had been working on his muscles for years. With his new handsome face, They were sure she wouldn’t be able to resist him. They left in a great mood and I had to do one of those attitude adjustments on myself that seem to occur so commonly on these missions.
Another “opportunity to open my mind to different ways of doing things,” came yesterday. An 11 month old 8 pound baby came back from the shelter on Wednesday to be checked because his lip, which had been closed on Tuesday had split open at one spot right in the center of the suture line. He had subcutaneous sutures (dissolvable stiches under the skin,) and Dermabond, a skin glue on the outside. (Unless the suture line is cleaned gently, the Dermabond can dissolve and the superficial layer of the skin can pop open.) In his case, though the open area was small, it wouldn’t stop bleeding. The surgeon came to look at it and placed a piece of gauze over it with tape holding it tightly to create a pressure bandage, but the bleeding continued. After several “mustache bandages,” the surgeon placed Steri-strips and another pressure dressing over the suture line and sent the patient back to the shelter. In the afternoon the parents returned with the baby because the dressing, though still in place, was soaked through and blood was dripping from the lower edge. The surgeon took it off and reapplied the Seri-strips, put on a new dressing and told the parents to return Thursday morning, keeping the baby NPO after four in the morning in case he had to take the baby back to the operating room. On their return Thursday morning, the bleeding had stopped, but there was a large dry hematoma stuck to the incision line. The surgeon reassured the parents and instructed me and the nurse to apply wet gauze to the hematoma, changing it every 15 minutes. I was positive that when the clot began to dissolve, the incision would begin bleeding again and felt this would be a waste of time. Both the nurse and I were already running our buns off and didn't really have time to keep track of every 15 minute dressing changes. I also was sure that even if it wasn’t bleeding, there would be a big hole underneath the clot and a very unsatisfactory scar. Between us, the nurse and I changed the dressing every 15 minutes for four and a half hours without seeing any change in the hematoma. However, at the five hour mark, the surgeon came to check the progress. When he removed the gauze, ¾ of the hematoma came with it, revealing beautiful smooth pink skin underneath. The parents were ecstatic, the surgeon had a big grin on his face, and I was dumbfounded. He stopped the soaks, gave the parents a tube of ointment to apply three times a day and sent them back to the shelter. His method avoided a second trip to the OR and likely there will be a perfect result. Live and learn.
A few little notes: Parents on the wards get meals delivered by Op Smile. They come in plastic boxes and contain rice (a staple here) with vegetables and spices mixed in and meat or chicken or eggs. I posted a picture of one of the boxes. Post-op kids who are not on clear liquids get a local home-made yogurt that is full-fat and delicious. There are a moderate number of cockroaches in the hospital. Nobody seems surprised or excited. I’ve been eating the vegetarian meals that we get since the others have Zebu or undercooked chicken. Our lunches come in Styrofoam boxes that contain either rice with veggies and a hard boiled egg, chicken or Zebu, or sandwiches on a roll with ham, beef, chicken or, for the vegetarians, shredded cheese and mayonnaise. They remind me of what was served to the few vegetarians that were in my dorm at Stanford in the late sixties.
Madagascar is a very poor country. On our drive to the hospital each morning we see people and dogs digging in trash piles along the road, competing for the best stuff. Wherever we go children and adults are trying to sell trinkets and other hand made items. They push them into the bus through the windows and drop them, hoping we’ll be too embarrassed to drop them back out. The population of Madagascar is 22,000,000, up from 20,000,000 in 2004. This explains all the brickmaking and construction along the route to Antsirabe.
The last blog entry was rather short, so as a brief follow up, the girl who bled had a fairly rough time in the OR as the artery that had cut loose was very difficult to isolate. However, it was eventually found and cauterized and a catheter was put into each nostril, the balloon blown up and then the catheter pulled tight to put pressure on the adenoids. She was kept in the recovery room all night; Isabel, the intensivist “slept” in the bed next to her and the mother slept in the next bed. Isabel was amazing in that she engaged the mother as her “assistant” in the care of the child. She explained that she was going to keep the daughter sedated all night so that she wouldn’t be uncomfortable from the tubes, but if the child did wake or become upset, it would be the mother’s job to get into bed with her and soothe her so that she wouldn’t dislodge the tube or her IV. The mother went from being very frightened to taking on her role very seriously. In the morning when the surgeon, anesthesiologist and Isabel very slowly first deflated and then removed the tubes, they did it with the child seated in the mother’s lap in the bed. The mother played an active role in calming the child and all went smoothly. There’s been no more bleeding and the child is spending an extra few days on the pediatric ward under the care of the local ENT surgeon who came in to help when she was bleeding.
Yesterday was our “1/2 day” of surgery and we did 23 lips, all under local anesthetic. We also admitted a one year old, two days out from his surgery, with cellulitis of his lip. He had IV antibiotics and stayed until this morning when he changed over to oral meds. One of the babies was cancelled because of fever, cough, wheezing and vomiting and needed IV fluids, so he needed to stay. So after all the surgical patients went home and we packed up our stuff, we still had two patients who had to spend the night. Two of the night nurses came in, therefore missing the team party. Luckily they are Op Smile veterans and didn’t really care. By the time the last five of us – team leaders, clinical coordinator, etc. got to the hotel, the party was in full swing with local vendors, local dancers and a local band in the courtyard parking lot. I managed to dress up and stay for part of dinner, but I still needed to pack and have my bags downstairs by 6:00 this morning. One of the surgeons and I had to return to the hospital to discharge the two babies as the bus was leaving for the capital at 7:30.
Though the dinner was so-so, Charlotte, the local coordinator had arranged for the mother of an 8 year old girl who had received her third operation on this mission, to speak to the team about what Op Smile means to parents. The mother’s English was slow and sometimes hard to understand, and she started at the very beginning, telling how she and her husband had three boys and had decided that their family was complete but despite her IUD found she was pregnant. When their daughter was born with a cleft lip, they were devastated but luckily a friend knew about Operation Smile and the child has received timely care. The talk was getting long and people were tired and hungry, and there started to be a little shifting and muttering in the back of the room. The mother then began to speak about the people who were not chosen for this mission and said that she had been in that position two years ago and explained how heart-broken and angry she was. She said that she knows the parents sometimes say “bad, angry things” about Operation Smile when they are not chosen, be cause they have travelled so far with the dream of a changed life for their child and themselves and then have to return home to the same sad life and the same situation of being “other.” She asked us to forgive them because she knows from having been through it that these parents don’t mean those things, they just want their child to have what other people have, to not be stared at or treated like a lesser person. She said that when they go to other doctor appointments, they’re made to wait till the other patients are gone and are treated “like dogs.” “Here, you treat us with respect and it’s new for us. We almost don’t know what to do when you look right at us and our child and talk to us like we are the same as you and like we deserve to be treated kindly, and it’s a strange feeling for us.” The room was silent and then applause erupted and everyone stood. She looked bewildered, and when things quieted down she said she didn’t understand why we were applauding her, we should be applauding ourselves; she was just bringing the message from the grateful parents. Charlotte explained we were applauding her strength as a mother and advocate for her child and her courage to stand up in front of this group. I don’t think there was a dry eye in the place. There certainly was no more muttering.
I did go up to pack then, but the party went on until three. This morning, after discharging the little guys and checking on the girl with the bleeding who was eating yogurt, we came back and drove for 3 ½ hours to this hotel. The road is extremely curvy, and once again the driver seemed offended by all in front of him, passing on curves, blind spots – no challenge too great. We made it by about noon, had a quick lunch and left for a Lemur preserve. Since this blog entry is way too long, I’ll start another about the lemurs after I do some suitcase rearranging – or maybe tomorrow.
Another “opportunity to open my mind to different ways of doing things,” came yesterday. An 11 month old 8 pound baby came back from the shelter on Wednesday to be checked because his lip, which had been closed on Tuesday had split open at one spot right in the center of the suture line. He had subcutaneous sutures (dissolvable stiches under the skin,) and Dermabond, a skin glue on the outside. (Unless the suture line is cleaned gently, the Dermabond can dissolve and the superficial layer of the skin can pop open.) In his case, though the open area was small, it wouldn’t stop bleeding. The surgeon came to look at it and placed a piece of gauze over it with tape holding it tightly to create a pressure bandage, but the bleeding continued. After several “mustache bandages,” the surgeon placed Steri-strips and another pressure dressing over the suture line and sent the patient back to the shelter. In the afternoon the parents returned with the baby because the dressing, though still in place, was soaked through and blood was dripping from the lower edge. The surgeon took it off and reapplied the Seri-strips, put on a new dressing and told the parents to return Thursday morning, keeping the baby NPO after four in the morning in case he had to take the baby back to the operating room. On their return Thursday morning, the bleeding had stopped, but there was a large dry hematoma stuck to the incision line. The surgeon reassured the parents and instructed me and the nurse to apply wet gauze to the hematoma, changing it every 15 minutes. I was positive that when the clot began to dissolve, the incision would begin bleeding again and felt this would be a waste of time. Both the nurse and I were already running our buns off and didn't really have time to keep track of every 15 minute dressing changes. I also was sure that even if it wasn’t bleeding, there would be a big hole underneath the clot and a very unsatisfactory scar. Between us, the nurse and I changed the dressing every 15 minutes for four and a half hours without seeing any change in the hematoma. However, at the five hour mark, the surgeon came to check the progress. When he removed the gauze, ¾ of the hematoma came with it, revealing beautiful smooth pink skin underneath. The parents were ecstatic, the surgeon had a big grin on his face, and I was dumbfounded. He stopped the soaks, gave the parents a tube of ointment to apply three times a day and sent them back to the shelter. His method avoided a second trip to the OR and likely there will be a perfect result. Live and learn.
A few little notes: Parents on the wards get meals delivered by Op Smile. They come in plastic boxes and contain rice (a staple here) with vegetables and spices mixed in and meat or chicken or eggs. I posted a picture of one of the boxes. Post-op kids who are not on clear liquids get a local home-made yogurt that is full-fat and delicious. There are a moderate number of cockroaches in the hospital. Nobody seems surprised or excited. I’ve been eating the vegetarian meals that we get since the others have Zebu or undercooked chicken. Our lunches come in Styrofoam boxes that contain either rice with veggies and a hard boiled egg, chicken or Zebu, or sandwiches on a roll with ham, beef, chicken or, for the vegetarians, shredded cheese and mayonnaise. They remind me of what was served to the few vegetarians that were in my dorm at Stanford in the late sixties.
Madagascar is a very poor country. On our drive to the hospital each morning we see people and dogs digging in trash piles along the road, competing for the best stuff. Wherever we go children and adults are trying to sell trinkets and other hand made items. They push them into the bus through the windows and drop them, hoping we’ll be too embarrassed to drop them back out. The population of Madagascar is 22,000,000, up from 20,000,000 in 2004. This explains all the brickmaking and construction along the route to Antsirabe.
The last blog entry was rather short, so as a brief follow up, the girl who bled had a fairly rough time in the OR as the artery that had cut loose was very difficult to isolate. However, it was eventually found and cauterized and a catheter was put into each nostril, the balloon blown up and then the catheter pulled tight to put pressure on the adenoids. She was kept in the recovery room all night; Isabel, the intensivist “slept” in the bed next to her and the mother slept in the next bed. Isabel was amazing in that she engaged the mother as her “assistant” in the care of the child. She explained that she was going to keep the daughter sedated all night so that she wouldn’t be uncomfortable from the tubes, but if the child did wake or become upset, it would be the mother’s job to get into bed with her and soothe her so that she wouldn’t dislodge the tube or her IV. The mother went from being very frightened to taking on her role very seriously. In the morning when the surgeon, anesthesiologist and Isabel very slowly first deflated and then removed the tubes, they did it with the child seated in the mother’s lap in the bed. The mother played an active role in calming the child and all went smoothly. There’s been no more bleeding and the child is spending an extra few days on the pediatric ward under the care of the local ENT surgeon who came in to help when she was bleeding.
Yesterday was our “1/2 day” of surgery and we did 23 lips, all under local anesthetic. We also admitted a one year old, two days out from his surgery, with cellulitis of his lip. He had IV antibiotics and stayed until this morning when he changed over to oral meds. One of the babies was cancelled because of fever, cough, wheezing and vomiting and needed IV fluids, so he needed to stay. So after all the surgical patients went home and we packed up our stuff, we still had two patients who had to spend the night. Two of the night nurses came in, therefore missing the team party. Luckily they are Op Smile veterans and didn’t really care. By the time the last five of us – team leaders, clinical coordinator, etc. got to the hotel, the party was in full swing with local vendors, local dancers and a local band in the courtyard parking lot. I managed to dress up and stay for part of dinner, but I still needed to pack and have my bags downstairs by 6:00 this morning. One of the surgeons and I had to return to the hospital to discharge the two babies as the bus was leaving for the capital at 7:30.
Though the dinner was so-so, Charlotte, the local coordinator had arranged for the mother of an 8 year old girl who had received her third operation on this mission, to speak to the team about what Op Smile means to parents. The mother’s English was slow and sometimes hard to understand, and she started at the very beginning, telling how she and her husband had three boys and had decided that their family was complete but despite her IUD found she was pregnant. When their daughter was born with a cleft lip, they were devastated but luckily a friend knew about Operation Smile and the child has received timely care. The talk was getting long and people were tired and hungry, and there started to be a little shifting and muttering in the back of the room. The mother then began to speak about the people who were not chosen for this mission and said that she had been in that position two years ago and explained how heart-broken and angry she was. She said that she knows the parents sometimes say “bad, angry things” about Operation Smile when they are not chosen, be cause they have travelled so far with the dream of a changed life for their child and themselves and then have to return home to the same sad life and the same situation of being “other.” She asked us to forgive them because she knows from having been through it that these parents don’t mean those things, they just want their child to have what other people have, to not be stared at or treated like a lesser person. She said that when they go to other doctor appointments, they’re made to wait till the other patients are gone and are treated “like dogs.” “Here, you treat us with respect and it’s new for us. We almost don’t know what to do when you look right at us and our child and talk to us like we are the same as you and like we deserve to be treated kindly, and it’s a strange feeling for us.” The room was silent and then applause erupted and everyone stood. She looked bewildered, and when things quieted down she said she didn’t understand why we were applauding her, we should be applauding ourselves; she was just bringing the message from the grateful parents. Charlotte explained we were applauding her strength as a mother and advocate for her child and her courage to stand up in front of this group. I don’t think there was a dry eye in the place. There certainly was no more muttering.
I did go up to pack then, but the party went on until three. This morning, after discharging the little guys and checking on the girl with the bleeding who was eating yogurt, we came back and drove for 3 ½ hours to this hotel. The road is extremely curvy, and once again the driver seemed offended by all in front of him, passing on curves, blind spots – no challenge too great. We made it by about noon, had a quick lunch and left for a Lemur preserve. Since this blog entry is way too long, I’ll start another about the lemurs after I do some suitcase rearranging – or maybe tomorrow.
No comments:
Post a Comment