A Girl...Remembered

Josephine Peña comes from a remote village, seven hours away. Bringing his daughter for surgery was the first time the father has left his village in seven years. The father’s only earnings come for 3 months out of the year, when he plants and picks coffee. The rest of the year he grows pinto beans and corn on a lot smaller than the size of the room we were in. To complicate matters further, the mother of the children left the family, leaving the father with 3 kids to take care of on his own.

The father and daughter were accompanied by the local priest, who had spent the last year and a half trying to get them help. As he told the story, the priest broke down in tears. He cried because there are no resources available to help, and he loves the people he works with. He describes his mission as “trying to help those who have been ‘forgotten’” – like Josephine.

The first time the priest came to Josephine’s house, she hid from him. We then learned that she had not been out of the house for the first four years of her life because of the way she looked. Josephine has refused to go to school and be in first grade because the kids would make fun of her.

Today Josephine comes here to repair the cleft in her lip. Today her life changes.

Profile of a Plastic Surgeon

Sibrand Schepel, M.D., is a Rotaplast veteran. He has been on 6 trips with Rotaplast, and 10 trips with Interplast, which is another cleft lip and palate mission group. This year alone, he has already completed 5 missions. In the last few years, he has traveled to Pakistan, Guatemala (twice), Ecuador, India, Tasmania, and returned from Brazil 3 weeks ago. He hails from the Netherlands! (We bet you got that from the drawing...)

He is a retired plastic surgeon with many other hobbies, including having a pilot’s license since age 14, sailing, vacationing in Northern Finland, and hiking. You can always find Sib reading his book between surgeries...he´s an avid reader as well! Sib told us a great story about how he took his family (wife and 2 children) on a whirlwind vacation around the United States, traveling over 35,000km in a VW camper. They saw 25 states in all.

Sib says that he’s “never done anything more rewarding in his life than cleft lip surgery.” He recalls one surgery on a 65-year-old man…when his wife first saw this man after surgery, she fainted with joy. Sib says that in 1-2 hours he can completely change someone’s appearance…and with a young child, change their life in the process. He hopes to be able to continue these missions for many years.

Sib, or “Dr. Holland” as Debby Rice (the assistant mission director) calls him, also loves to have some fun. Here are some pictures of his other talent…besides plastic surgery!

Observations by the Guatemalan chief surgical nurse

Miriam de García, is the chief surgical nurse here at the Military Hospital. She has a staff of 22 who has been assisting our surgeons and nurses in the operating room. She had some kind things to say about our mission here these 11 days. She has experienced 3 other groups similar to ours. She noted that our group in particular seems to cooperate and work together in a manner that she thinks is exceptional. She admires the fact that we as individuals have different skill sets and different life experiences – but are able to come together to accomplish our mission. Miriam has seen a lot of fear among the patients and their parents, but the way we have responded to it breaks the tension. She feels there is a lot of respect between the doctors and the non-medical staff. She has appreciated the sense of humor we share with each other. She said, “We get down to business – it is a well orchestrated process from beginning to end.” She particularly respects the fact that the doctors treat the Guatemalan nurses with dignity. She said, “There is no difference in status among you, and the respect you have with each other is shared with the patients and families as well.”

“Please keep coming.”

EVELYN’S STORY: “Do I Look Pretty?”

Evelyn is a beautiful 3 year old who was here 2 years ago for lip surgery. She returns today for a complicated surgery – her premaxilla (the front part of her gum) has protruded through her lip, and she has a tooth growing there. She also needs her palate repaired. We asked her mother how Evelyn felt about her face and her appearance – “I feel bad, people stare at me.” She asks her mom, “Why was I born like this and other kids weren’t?” “Do I look pretty?” “I want my lips to look like my brother’s.” Her mom told her that her lips would look like her brother’s… “when the American doctors come.”

Evelyn’s mother gave us a little background on her own life. She was only able to go to school for 3 years as her father died when she was 2. Her own mother couldn’t pay for her school supplies, so she had to quit school and clean houses once she turned 10 years old. Evelyn’s mother didn’t go to the doctor for the first 5 months of her pregnancy and therefore knows now that she should have been taking folic acid from the beginning.

While Phil was talking to the mother, the translator – a general practitioner – told him that she has never seen a lip surgery done in a national hospital for the past 4 years – and the poor cannot afford medical care from a private hospital. Evelyn’s mother ended the interview by saying, “please keep helping us poor people.”

What DOES the speech pathologist do on this trip?

I’m Kerry, the speech pathologist on this trip. Several people have asked me exactly what my job entails…and I’m here to tell you! I’m taking a quick break today between doing rounds this morning with the surgeons (asking the moms how their babies are feeding), making “no-no’s” (the arm boards that the babies / kids wear after surgery so they don’t put their fingers in their mouths), and then making “feeding rounds” in the afternoon (visiting each of the parents and helping them feed their babies for the first time).

One of my main responsibilities is making sure that the parents know how to feed their babies after surgery. When the babies have a cleft lip surgery, the parents need to be careful about keeping the surgery site safe – no rubbing against their clothes, no excessive cleaning, no fingers touching – so that way it has a chance to heal safely and securely. These babies can go back to the bottle or breastfeeding pretty quickly after surgery. The babies with a palate surgery (roof of the mouth) are not allowed to put ANYTHING in their mouth – no bottle, no spoon, no fingers…you get the picture. This surgery leaves the palate VERY fragile, and we want to prevent it from re-opening up – so the kids aren’t allowed to put any pressure (for example, from sucking from a bottle or a straw) on the surgery site. We tell the parents, “three days – liquid only, the next three weeks, pureed/blended/cooked food.” We encourage the parents have them drink water to wash out their mouth. The surgeons do the tough work…and I’m there to protect it – that’s the way I see it!

Because I am a speech pathologist, I evaluate their speech production skills when the kids come through the pre-op clinic, the post-op clinic, and all the clinics in-between. When the palate is open, the mouth is not separated from the nose – so when the kids talk, all the sounds are nasalized (turned into ‘m’ and ‘n’). The kids are not able to make sounds like /p/, /t/, /k/, and /s/. AFTER the palate surgery, we hope that they can make these sounds – so I help the parents teach their children how to do this. It’s wonderful to be able to interact with the kids in this way, and to encourage and empower the parents to help their children after this life-changing surgery. There are very few speech pathologists available here…so my job rests on the parents once they go home.

During feeding rounds one day, I noticed an inspiring thought coming from several parents - “from this day forward, things are going to be different.” It brought tears to my eyes when we realized how the lives of these children are so tough – unable to talk correctly, with kids making fun of them, and teachers not allowing them to come to school. One parent told us that she was grateful that so many other children were going to be helped just like hers. I feel so lucky that I get to spend this time with the parents, answering questions, and with any luck, imparting hope that their children’s life WILL be different…in many ways.

One last side note – the amount of learning that is going on here is AMAZING. Everyone is having the opportunity to learn from each other – I have been able to scrub in and assist on surgeries (cutting sutures, suctioning) – the surgeons are very patient and so willing to explain everything that they do. The translators are able to learn all the feeding precautions and can deliver the news quickly and efficiently. I’ve learned what’s most important immediately in the post-op period – Airway, Breathing, Circulation…it’s an environment that I’m sure is unique to trips like this. Every day is a new experience.

Here are some pictures from feeding rounds…

We are skilled professionals

Day 8

Ladies from the Rotary Club on Wells, Maine have made quilts for each of the kids.

Mark and Ron W. are the hit of the hospital with their transport team hats!

Day 8 – a new author


It's not too much of a surprise when you are working with lots of kids and their parents in less than pristine conditions, that a few of the sturdy go down (even kicking and screaming). That’s what happened to Ron Whitcanack and me (Debby). We were told in no uncertain terms to stay in bed. I don’t do that particularly well, so I am giving Phil Young a break and assuming blog writing today. But I hate to miss out on what is going on at the hospital.

I thought I’d give you my opinion of our mission so far. It’s been absolutely wonderful. You would all be so very proud of our team and your fellow Rotarians, who are working tirelessly, cheerfully and cooperately. I haven’t heard anyone complain, rather they all ask “what can I do now?” There is a lot to be done, and they roll up their sleeves and do it.
The comaraderie among all 28 of us is terrific. There is a lot of tragedy and sadness in the stories of our young patients and their families, so a little humor helps. And there is plenty of that on this trip.

Except for Dr. G., the rest of us Saratoga Rotarians are on the non-medical side of the team, and we have 17 doctors and nurses who’ve never met us. The medicals work so hard and efficiently and have quickly earned our respect, admiration and friendship. Some have told me that this is the best mission they’ve been on. It certainly is mine.

We have struck up some friendships with the local Rotarians and have invited them to come visit Saratoga. We’ll keep you posted on the dates and hope you will extend to them a firm hand of friendship.

All is well, very well. Once again, thank you all for your contributions, support and kind words.

Debby

Day 7

Bella is doing a superwoman's job of translating for us. We would be lost without her. She speaks fluent Spanish, is tireless and so kind to the parents and kids. Everyone loves her. Wait until you see the "after" shots of this little boy. (to come)

DAY 7… A SECOND CHANCE FOR ALVARO
Today 15 surgeries are scheduled and we are one half way toward our goal of changing 110 kids' lives by week’s end. We have selected one child to tell you about today. His surgery was performed by our own Ron Gemberling, assisted by our own Julie Herndon.

Alvaro Garcia Chinchilla is one and a half years old, very cute, happy and in serious need of surgery. His mother, Rose Marie, is 27, married for 7 years. Neither she nor her husband have any education whatsoever. They, like many others, heard of the Rotary program through TV. Because of a lack of money they never would have been able to afford help for Alvaro. Rose Marie says: “The baby is in your hands…God give you strength and support for the work you do….People won’t laugh at him anymore…I know the scar will be minimum because these surgeons are excellent in their work.”

We are doing our best, while keeping our priority on the kids, to send photos and short stories about the kids those of you who donated to our Norm Damico Challenge sponsored and will be giving them a whole new life.

This whole experience is very emotional, so a little levity goes a long way.