The Team

I have mentioned a few of the folks that I am working with mostly in passing.  I've really focused on the kids because they are the reason we are here.  But let me tell you something....26 people have been thrown together to work as a team, for two weeks and I have never seen anything like it! 

team·work/ˈtēmˌwərk/

Noun:

The combined action of a group of people, esp. when effective and efficient. That pretty much sums up the group of people that I have been fortunate enough to work with for the past two weeks. But allow me to add a few words to effective and efficient.  How about talented, caring, humble, compassionate, brilliant, steady, congenial, generous, warmhearted, social, thoughtful, accomplished, skilled and how about just plain "Cool".  For some like me this is their first ROTAPLAST trip for others this is trip number 16.  For one this is the 3rd ROTAPLAST this year.  We range in age from 26 to 72, the majority of us are from the West Coast but we've got one from Texas, one from Massachusetts, one from Florida and one from Canada.  We are doctors, nurses, lawyers, retirees, Realtors and the list goes on. I am working next to Stanford grads, UCLA and believe it or not we have two Huskies in the group (Washington Huskies that is) and you know they just aren't all that bad :).  I'm nobodies fool I know that not every mission can run this smooth, but I tell you what - God has blessed me with awesome teammates..."shout-out to Melanie the best roommate a girl could ask for!".  These plastic surgeons are some of the best in the country (maybe the world?) yet there is no "high and mighty" attitude.  They are real caring people.  I have watched approximately 8 surgeries this week and every single one of them is willing to teach and explain what it is they are doing and why they are doing it.

Dr. David and Dr. Ron "fight" over who will have local "Dr. Ebel" to assist

Dr. David, Head Nurse Diane, Chief surgeon Dr. Janet, look at the days schedule

Recovery room staff - Nurse Melanie, Nurse James, Pediatrician Dr. Amie and PACU Assistant Garon

Ward Coordinator gets Anderson ready for surgery

Surgeons and friends Dr. Janet and Dr. Ron

Pediatrician Dr. Collin enjoys one of our delicious Peruvian lunches

our tallest and shortest team members Nurse Melonie and Garon

Nurse James, Interpreter Siuna, Dr. Colin, Anesthesiologists Dr. Sal & Dr. Zak

Local surgeon Dr. Margaret & anesthegiolgist Dr. Brad

Surgeon Dr. Tom

Equipment sterilizer Bill with Mission Director Tom & and surgeon Dr. Tom

Speech Pathologist Dianne & Ward Coordinator Ellen

Team Photo Journalist Darlene

Medical Records manager Laile

Sunday a Day off

So Sunday was the teams day off, but the doctors still had to make their rounds on Sunday morning.  And although I didn't get in until 3:00 AM I was bound and determined to get up and go see the kids and so I did.  Poor kids as soon as they saw the Americans come in they wanted to run and hide.  It had been a nice peaceful morning but by the time the doctors got done poking and prodding them they were all screaming their fool heads off.  My buddy Anderson was up and smiling, that is until the doctor touched him.  I took some photos of him and then showed him the pictures on the view finder.  He was completely enthralled with it.  So I held the camera and let him point at the subject and I punched the button -

Dr. Tom, Anderson's mom, nurse Lourdis, Me & Anderson

Shots by Anderson

He had a great time with the camera

Perhaps one day with his new hands he can take pictures on his own

After we left the hospital we headed back to the hotel to pick up the rest of the group that slept in....then we headed off to the museum Museo Nacional de Arqueología, Antropología e Historia del Perú. www.arqueotur.org But the condition I was in was not the best for taking in a museum, I was miserably tired, falling a sleep standing up, so I completely missed my Inca history lesson. After the museum we went to lunch at a really cool restaurant who's name I can't remember, but I do remember this, they were cooking beef heart on skewers over an open fire as we walked in the door. We had wonderful wonderful food and drinks.  After lunch we went to an "arts and crafts" market.  It was wonderful because our Rotary hosts accompanied us so that they could help us barter and get some good deals on souvenirs.  All in all it was a great day off, we went back to our hotel and crashed completely exhausted, by 8:00 PM. 

The vessels that the Pisco is fermented in

The Pisco still

All Work and No Play......

We actually have gotten a day off since we've been here.  Sunday was our day off, therefore I did not blog on Saturday night because we spent the night out on the town.  We got back from the hospital at 8:00PM, and a group of us planned to meet for dinner at 9:00.  We met in the lobby of our hotel and took off towards the beach where there is a mall filled with great restaurants, bars, clubs and of course shopping.  When we go to the restaurant we were informed that there was a 40 minute wait.  It just didn't dawn on me that 40 minutes meant we were going to eat after 10 PM.  So we sat in a bar near the restaurant and drank Pisco Sours.
The national origin of the pisco sour is debated. Both Chile and Peru lay claim to the drink.^[3] In both countries, the variety of lime used is what North Americans would call Persian lime but Peruvians call simply "lemons". In the United States, the drink is usually made with commonly available Lisbon or Eureka lemons. With the increased availability of Pisco and regional bitters outside South America, the Pisco Sour, like the Mojito and Caipirinha, has increased in popularity in the United States.
Since 2003, Peru has a National Pisco Sour Day which is celebrated on the first weekend of February. ^(Wikipedia) 

Melanie, Joelle, Collin & Maureen with our DOUBLE Pisco Sours

Here is a Pisco Sour recipe -
4 cups ice cubes
     1 cup pisco

1/3 cup lemon juice

1/3 cup white sugar

1 egg white

aromatic bitters

Place ice cubes, pisco, lemon juice, sugar, egg white, and bitters in the bowl of a blender. Blend on high speed until finely pureed. Pour into two glasses and garnish with an additional dash of bitters.

And then there was dinner -

Most of us had not eaten much that day so the double Pisco Sour was probably a bit of overkill.  I don't remember the name of the bar nor do I remember the name of the restaurant.  But I must say that a good time was had by all. We didn't finish dinner until after midnight!

Ceviche

A beef dish with fries and rice

This was mine - Rice with seafood Yumm

After dinner someone had the bright idea to go dancing and so we did - a place called "Ohm". A few turns around the dance floor another Pisco Sour and me, my roommate Melonie and our friend James decided to call it a night. But before we returned to the hotel we stopped by one of the numerous elaborate casinos found about town. I let Melonie drop some change into the roulette machine she lost, then I drug Melonie and James back to the hotel. We got in at about 3:00 AM. I can't remember the last time I stayed out that late. 

Aimee, Melanie, Collin, James

Lima Day 5 - Anderson Gets Thumbs

Nurse Lourdis keeps Anderson occupied

After a bit of drama and lots of discussion, the decision was made this morning to proceed with the surgery to separate Anderson's thumbs from his webbed hands.  The hope is that once separated and with some physical therapy, he will be able to pick up his own fork, and pen among other things.  Right now his mother does most everything for him.  Surgery began at 9:00AM, with two surgeons, both with some background in hand surgery.  Dr. David was the lead surgeon and Dr. Tom was there with the assist.  They began by marking with a pen the area of the hand in which they would make the incisions.

The area to be cut is marked with pen

And then slowly but surely and carefully, began separating the thumbs, going through all the layers of skin, fat, muscle etc. It was fascinating to watch. Once the left hand had been successfully separated, the decision was made to go ahead and operated on the right hand also.

The left Thumb is separated

While Dr. David moved to the right hand, Dr. Tom began the skin graft, once again making pen markings very low on the stomach. Then carefully cutting around and separating the skin from the body.

Skin from the stomach will be used on the thumb

Once separated the Dr. Tom carefully scraped off the little bit of fat that was still connected to the tissue then the it was placed in a a small bowl of saline water to keep until the second thumb was successfully separated and the area where the skin was taken from was closed up.

The area is sewn up

Human Skin.  Awesome!

A blood pressure cuff was used as a tourniquet, to slow the blood flow to the hands, this way the surgeon is not trying to cut through a pool of blood. One fear was that the fused fingers may not have enough blood flow and they would die, but it looks as if Anderson has good blood flow to the fingers.

The skin from the stomach is sutured to the hand

The finished look

After he was all sewn up, the hands and much of his arms were wrapped up in sterile gauze and bandages. Upon waking up from the anesthesia, Anderson was not a happy boy. Something that I learned earlier in the day was that Anderson cannot talk and he can only hear you if you yell at him very loud, so he expressed his pain and frustration at having the bandages on his hands by yelling. He immediately tried to remove the bandage with his mouth. He is such a smart and resourceful kid. Nothing was going to make him happy. Except for moments of fascination when he would stop and look at his hands and the small amount of blood coming from the top of the bandages. He tried to pull the blood pressure cuff of of his leg and wanted to pull the needle and line to his IV bag out. He will have to keep the bandages on his hands for 10 days (or at least try to). I think that what we did to help Anderson will better his quality of life. I would love to be able to see him 3 months down the road.

Anderson and his mom getting wheeled back to his hospital bed

The other fascinating operation that I saw today was a bone graft for a left aveolar cleft on Jorge who is 8 1/2 years old.  It must be good to be the last surgery of the day.  Jorge had four surgeons working on him.  While Dr. David and Dr. Margaret took a 1 inch canoe shaped piece of bone from Jorge's hip, with what looked to be a hammer and a chisel.  Drs. Janet and Tom opened up Jorge's gums to place the piece of bone in -

The bone is removed from the hip

And sewn into the gums

The bone is then taken and sewn into the gum line in hopes that it will grow and attache to the bone that is already there. All in all it was a fascinating day and the end of a fascinating week. As tired as we were we went out Saturday night for a night on the town, dinner, dancing and the casino. We stayed out until 3 AM, and though I had an awesome time, I am exhausted. Sunday was a day off, after rounds at the hospital to see how the kids were doing. Then it was lunch, a visit to a museum and shopping. Tomorrow, more surgeries.

I felt My Heart Breaking

Anderson gives me a big Oregon "O"

He has touched my heart
I had no idea I would react this way to the kids coming in for treatment.  I knew when Anderson came in on Tuesday that he was special, he is just a big goofy kid that likes to give a show, he has boundless energy and an infectious smile, he doesn't talk but you know when he is happy.  Dr, David was very sure that he could improve Anderson's quality of life by taking his fused hands and giving him thumbs.  We had to remember that we are not in the United States and sometimes getting what we need is not always possible.  It took two days to get the correct x-rays of Anderson's hands to see if the surgery was possible and then once we got them it still wasn't clear as to what we were looking at.  It was assessed that the hospital may or may no

t have all of the instruments that are needed to conduct the the right and left thumb syndactle release...a certain sort of saw, wire and all kinds of other things that I can't remember or pronounce.  The decision was made to NOT do Anderson's surgery.  My heart sank, I wanted to cry and I did.  I couldn't even bring myself to go onto the ward to say goodbye to Anderson as I left for the day, but in the end I did.  He clowned around for me like he always does and I gave him a rubber duck.  While there the doctors were conferring about the case.  All is not lost they may still attempt the surgery tomorrow.  I am praying that they can get everything that they need to perform the surgery.

 

Sebastian 24 hours after surgery
Sebastian had a cleft lip and palate surgery therefore must remain in the hospital for one more day.  He appeared to be in quite a bit of pain but I did get a very small smile from him.  I am sure he will be up and about tomorrow.

Veronica Celebrates her 74th birthday

Yesterday Veronica at 73 years old had cleft lip surgery, today she turned 74. Many of the ROTAPLAST Team went to see her and sing happy birthday to her. Ellen one of our ward coordinators gathered up a small bag of gifts to give to her, a scarf, a key chain among other things, she didn't smile, in fact she gave no expression at all. But we are told that she was very happy with the gifts and the recognition. Apparently she rarely shows emotion. After five kids all conceived from being raped, I suppose I might be farely emotionless also. Who knows once her surgery scars have healed she will find something to smile about. All of our surgeries from Wednesday went home except for Sebastian. Cleft lip surgeries stay for one day, cleft palate surgeries stay for two. Its a long night for the team. Tonight I came back to our hotel early to set up for a class to be given by two of our plastic surgeons to a group of our local medical hosts. While the rest of the team stayed behind at the hotel to finish up two more surgeries. There seemed to be quite a few babies today, but also some four 20 somethings. Tomorrow is Saturday, another full day of surgery. Tonight is the earliest I will have gone to bed. I think I need this sleep desperately.

Sebastian - Peru Day 3

I am truly using restraint in writing this blog.  I want to talk about so much, but today let's talk about Sebastian. No, first lets talk about me. I spent about 6 hours in the operating room today, watching and learning.  There was cutting of body parts, bleeding and giving of stitches, I got up close and personal.  I felt as if I was the lone student of "Dr. David".  "Joelle, come and look at this", and he would explain to me exactly what he was doing.  I had no idea what my reaction would be to the blood and cutting, but I held my own. I've also been spreading the gospel of "Duck Love".  We have a team of 26 people and they all know that I AM A UNIVERSITY OF OREGON DUCK!  I'm putting Duck stickers on everyone and everything.  I brought with me rubber ducks to give to the kids when they come out of surgery.  I wear a Duck shirt everyday of the week down to my University of Oregon surgical scrubs, who knows perhaps we will get an influx of Peruvians attending the University of Oregon, but if all I do is make people smile and say "GO DUCKS" then I am alright with that too.
 Now let me tell you about one brave 7 year old boy named Sebastian - Sebastian has a "hole" in the soft palate and from his previous cleft lip surgery he has scar tissue that has caused his nose and lip to be a bit off, so that was repaired

"Dr. Sal" (anesthesiologist) takes Sebastian to the OR

today.  Such a brave little boy with a wonderful smile.  The first order of work was to close up the hole in Sebastian's soft palate (the very back of the mouth on top), "Dr. David" conducted what is called a "Z-plasty.  Z-plasty is a plastic surgery technique that is used to improve the functional and cosmetic appearance of scars.
I was truly fascinated by it all, from the anesthesia, to the cutting and the suturing.  Once Dr. David had completed the cleft palate procedure, he inquired with the parents,the head nurse and the chief of surgery as to whether he should continue on with the repair of the lip and nose correction, the parents wanted that very much and all concluded that he should go ahead with the surgery.  After about a 10 minute break for the surgical team it was back to work on the nose and lips.  He made several cuts in and around the nose and lips to create "flaps". He then took those flaps and over lapped them to straighten out and correct the lip that was off center and the nostril that was smaller than the other one. 

The hole in the palate has been closed

Creating the flaps to create the "cupids bow" in the lips

The left nostril is now more symmetrical with the right

I followed Sebastian in to the recovery room. where he like the rest of the kids received a hand made quilt provided by quilting organizations from all over the United States. All of the Rotaplast volunteers also tend to bring toys of all kinds to give to the kids once they wake from surgery cars, Beanie Baby's, Ducks....  I checked on Sebastian before I left this evening.  He was still pretty knocked out, but resting quietly.  I guess I should mention that Doctor David is a multi-talented person.  Plastic surgeon by day...professional drummer by night.  He can be found anytime day or night carrying his drums sticks around in his bag, during down times he will take the sticks out and practice.  I haven't figured out yet which job is his true career, I'm thinking he is pretty damn good at both of them.

Dr. David (L), Head Nurse Diane (C), Chief of Surgery (R) discuss a procedure

Today had to be one of the most rewarding days of my life.  The team of people that I am working with are - to put it simply...awesome.  Great teachers, great friends, I have laughed harder than I have in a long time, cried tears of joy and sadness, eaten some awesome meals and seen some pretty cool sights and this is only our third day.  Tomorrow, I get to see "Mr. Anderson" and hopefully we will give him some hands that he can really use.

Peru Day 2 - Clinic

"Mr. Anderson"

A full, chaotic, fulfilling day.  If you read my earlier posts I stated that I hate writing "diaries", that I really NEED something - an event to write about, to say something significant.  The problem that I am having now is that so much is going on, I want to say soooo much, that I have to narrow down what I post or else I will be up all night and too this point, I really have been up most nights working, dining and then blogging.  There are so many stories to tell, and I have only been here two full days. 
Today was our clinic day.  The word had been spread throughout Peru that there was a plastic surgery mission going on.  That the Americans were in town to "fix" cleft palates and cleft lips".  So when the team arrived at the hospital this morning there was a line of people waiting to be seen.  We hadn't even set the clinic up yet.  Each of the four surgeons, their nurses and anesthesiologist needed to set up their exam room, there was a room to take vital statistics a room for the pediatric nurses and doctors to conduct exams, the intake and waiting room, the dental room etc, etc, etc.  Some were there for the most simple of plastic surgery procedures; to to get rid of that tell tale sign of what was a cleft lip or palate surgery, that small scar on the lip or to repair some of the most severe clefts like the bi-lateral cleft lip and palate.  From 3 months old to 36 years old they came from miles away to be seen and to be "fixed".  There are so many stories to tell, but one truly melted my heart - his name is Anderson and he is 6 years old.  Anderson has fused hands and feet.  His toes are fused together, but he appears to walk just fine, his fingers are fused together so his mother has to feed him among other things that she has to tend to. He also has cranial deformities.  What is it about Anderson that touched me so?  Okay, I will admit the fact that he took the "fighting Duck" sticker that I gave him and then stuck it on his forehead and gave me the funniest face ever probably endeared me to him forever.  But he was such a clown and so happy.  His mom just really wants him to be able to do more things on his own.  There is a lot of work to be done on Anderson, but it simply cannot all be done in the short amount of time we are here in Lima, but "Dr. David" is going to do the best that he can to improve Anderson's (and his mom's) quality of life.  This Friday "Dr. David" will do a skin graft on Anderson, taking skin from his hips and give Anderson thumbs and perhaps pinkie fingers so that he has hands that he can work with.   Perhaps when Anderson has those working thumbs I can come back and teach him how to hold up both of those hands and give a big Oregon OOOOOOOOOOOOO.  One day.

Amy

The other story that touched me today was that of Amy.  Amy is five months old she has a bi-lateral cleft lip and palate. She is such a good baby and barely made any fuss as she was poked and prodded.  The problem is that we will be unable to perform surgery on Amy because she is "underweight" for her age.  But we were able to do is something as simple as placing tape or "steri-strips" across her upper lip; this will stay on for a few weeks and help to bring the upper lip together and prepare Amy for next year when she is older, weighs more and can have the surgery that she deserves in order to better her quality of life.

In all 76 patients were processed through the clinic today.  Not all of them will have surgery over the next two weeks, but many of them will.  Every moment I learn something new.  I must thank the doctors and the nurses who have taught me so much in such a short amount of time.  I love when the doctor says to me, "hey Joelle, come take a look at this", then shines the flashlight into a kids mouth and proceeds to explain to me what a bi-lateral cleft palate or a partial cleft palate, full cleft palate or what hyper-tuberism is.  I love that I can ask questions of them and get an answer that I can really understand.  We are 26 individuals that have been thrown together and we are becoming a team in very short order.  Becoming a team that is changing the lives of some of the most vulnerable individuals. 

End of the day.  Part of our very tired but silly team.

If all goes well tomorrow we will begin with surgeries.  The hospital decided to renovate the operating rooms and as of 8PM, they were still putting the finishing touches on them. We will be up early heading to the hospital and preparing the ORs for surgery.  As always the last thing I did today before leaving work, was to count the boxes, the first thing I will do tomorrow is....count the boxes.  36 is the magic number.