Thursday - Day 4 of Surgery - anything but ordinary

So I will be making 2 posts for today - one for the morning thru 5 pm & another for 5 pm thru this morning - yes I did an "all nighter"
When we got to the hospital we went to Post Op & I said good bye to Sara & her mom - her grandpa was there to take them home & spoke some English - he was so sweet & said to me "so you are the nurse she loves - when are you moving to Guatemala to join the family" - it was so nice of him & I took a last photo with her.
Our schedule was changed up a bit as there were 4 patients they had to cancel because they had gotten sick plus 2 no shows...they ended up adding 5 lips from Fri onto the schedule so it looked like it was going to be a nice end to the day with all the added lips.
Aside from the wonderful patients and families & feeling like you are making a small difference & changing a few lives in the world...the other great thing is meeting other wonderful volunteers on the team & hearing their stories. Today before we got our first round of post ops back Melissa who was doing medical records came in to bring us something & we all started talking. she used to volunteer with OSI with her husband who died from colon cancer at age 59. He was a retired attorney & sounded like a wonderful down to earth man - there is a OSI Volunteer award given each year in his name.
Finally on day #4 we got it right with the 1st 5 patients which are always the babies with lip repairs - we did teaching with the moms, asked them to not leave to get breakfast as their babies may be out soon & asked them to be ready to feed their babies after surgery (breast or bottle) and it all worked!!!
The 1st round of palates also went well - there were a few problems with bleeding but nothing significant. It was a much more manageable day, with a steady flow & less chaos - the PACU was actually often quiet & calm. I was taking less photos and enjoying more conversations. Hugging many grateful parents & just doing the work I came here to do.  During  the day I jot down notes to myself & I even wrote it's really just a "typical mission day"
BUT just when you think that it's a typical day you encounter a patient with a story that reminds me that what we are doing here is anything but typical. We as a team are changing lives like Arjen a 2 1/2 year old little boy who had a HUGE palate & lip repaired - his precious mom could not contain her emotions and tears streamed down her face for several minutes when she saw him after surgery.
OR...14 year old Manuel who lives 22 hours (via 4 different buses)away from here in a small village. His family consists of 9 siblings plus himself & his mom. He is the 2nd oldest and they are very poor and live in a one room "shack" without running water. His mom nor any of his family can read or write. A man who befriended the family - he travels to the smaller villages in Guatemala looking for some of the most desperate & tries to help them - after hearing that Op smile was coming & remembering that Manuel had a cleft lip he took the 22 hour trip to go & get Manual, brought him back on the 22 hour trip & brought him to screening, took care of him until today his surgery day, will keep him thru the weekend then make the 22 hour trip there & back to take him home. What a service to this boy & family. I got this storey from Andrea the student we have been working with. When I asked the man if he had any questions he said no but thanked me for all the service I  was doing...I got a little choked up & thanked him for all he was doing for this young man & the difference he was making in his own country and said we should all be so lucky to have a friend like him in our lives...
Then if that wasnt enough patient 001 - yes our very first patient from screening Juan David came in after having his lip repaired. The local coordinator asked if I knew "his story" & I said no. She told me that they were from about 13 hours away but it was a 2 day trip - leaving at 6 pm from their town to take an 8 hour bus ride then waiting in that location until the next early evening to take a 5 hour bus into Guatemala City. They wore more traditional Mayan Clothing & seemed very sweet. For the last MONTH - yes MONTH the priest in the town has been asking the people to give any money they could to help raise the money to get the mom & baby & moms sister to the city and they would pack all their own food & stay at the shelter here. I know at home people are very generous & supportive of others so this isnt something we are unfamiliar with. What moved me to tears was when I asked the coordinator what the bus fee was & she said $8 per person each way $32 TOTAL - many of us spend that when our family goes out to Chipolte or somewhere for dinner...but here it took the kindness of people in a small town donating for a month because the town priest asked them to give & try to help someone in need. she was telling me all of this in the 1st 15 min I was getting the baby settled  then I was ready to bring the mom in & the mom who was 19 came in & after seeing her baby with a beautiful new face - cried then then bowed her head in prayer...it was a very touching moment for me. Her 24 year old sister then came in & you could see the love between the 2 of them . The sister had an  6 year old at home she left with her husband to come help her sister. I knew as all this was transpiring that I needed to help this family. I asked the coordinator if I could give them some money that had been given to me to help others and she said yes. I did the math to come up with the amt it would take to = the $32 for the bus fare plus some extra money for food & a place to stay between buses along the way & rolled it all up in the local money & gave it to the older sister & just told her that there are people in "my town" that wanted to help them too & I wanted to give this to them. she told me they could never repay my friends or me for giving them this gift but that she was sure God had sent this to them and whoever gave it would be blessed & they would help the many others in their village. By this time I could barely speak & was such a mess that Rachel asked if everythng was okay & I told her all that happened. We showered Juan David with several of the toys I brought & gave the sister some for her 6 year old. We snapped a couple of pictures & I thought that what I had deemed " a typical mission day" about 3 hours earlier had turned out to be anything but typical. Little did I know what the next 30 min would bring - a baby in a real crisis & me ending up staying the night in the hospital with her . that I wil leave for tomorrows blog entry - its too long to write now & I need to get to bed.
These 2 girls reminded me of the sisters in the family of the friend that gave me the $$$ for a need I saw & also of my own girls...I can see how much FAMILY means to everyone all over the world. I am so GRATEFUL to know that Familes are Together for ever and that there is no greater love than family.

  

Day #3 Hump Day... Sara had Surgery & All sorts of Chaos!

I got a good nights sleep a solid 5 or 6 hours - slept in a bit & went without makeup (not unusual for me!) I was excited when I got the schedule at breakfast & saw that my new Guatemalan best little friend Sara was scheduled today for surgery. when we arrived at the hospital we went to pre/post and they have it so well organized one hallway is pre & the other post. As soon as I stepped on pre Sara came running out of her room & literally jumped into my arms & kissed me made me drop my backpack it was so unexpected. If she didnt have such a darling mom here I would certainly take her home with me! She was in a room with 2 other girls & a little boy - I gave them all sticker activity packs (thanks Joanne) & explained to mom I would take care of her after surgery.
as always the 1st 5 babies were all lined up an 8 mos old, 3 mos old & 4 all that were 4 mos old. The pre post nurse who is somewhat "in charge" is wonderful & she coordinated with the students to have a super hero day & have capes for the kids coming to surgery - it was fabulous.  By 9:30 we already had recovered 4 of the 1st 5 lip patients & they were out of the PACU. Those tiny ones are so darn cute but they sure do wake up hungry after not nursing or having a bottle for 6 or so hours.

The 1st round of palates caused crazy chaos for us with lots of pain management needed, some bleeding to control, low oxygen to treat & suctioning needed - basically for all of them. Our Intensivist was convinced it was related to a medication they were using but who knows suffice it to say it was loud & busy. I did manage to go out &  was there for pre op holding - she literally squealed when she saw me - everyone asked how I knew her...I said we have been BFFS since friday! she did some medical play with me putting the mask to my face & I gave her & another little girl Jenely tiaras to be princess patients. I wasn't there when she went back to the OR cause I was in with the 2nd round of palates which was equally as crazy if not more....a patient had to go back for some bleeding, one needed another stitch and the pain management was full time....we definitely did not have good karma in our recovery room :)

Sara came out about 1:45 & truly was voted by all as the perfect patient - she woke up slowly, calmly & with a smile on her face. I gave her a few more toys that she held onto & she blew me kisses. Her mom told all the translators how much she "loved me at first sight". We came full circle & it will be hard to say good bye to her in the morning.
After Sara I got perfect patient #2 Nicole her roomate who is equally as cute. That mommy was very tearful & grateful. Another nice surprise was little Rebecca who was cancelled Monday with a cold or fever was able to have surgery today...she was a feisty one but darling.
I had a few long term patients one that needed narcotic reversal that we watched for a few hours but Rachel had the longest a 5 hour patient with all sorts of problems whose mom went to the floor praying for her son - he was doing fine just alot of care needed & even though we were explaining it all she was very worried.
Overall it was just a VERY BUSY DAY - Mary Laura & I explained to Rachel that the facilities we are in are pretty nice compared to some mission locations however the day today was very different than most missions - you dont typically send 3 patients back or have to manage bleeding,  oxygen, suctioning & pain the entire day. There have been missions where I have never used the suction!!! so today was an outlier & in true form we ended it with a little girl that we could not make happy no matter what we did :( and another little one from early this morning who needed to go back at 8 pm for an extra stitch. So tonight was my latest this week but not as late as other missions for sure.
This really is a phenomenal team & I am so grateful to be a part of it - I have met some people who will become dear friends I am sure. Joe the coordinator is wonderful - EVERY COORDINATOR I have had has been amazing & he is too. Hard to believe we only have one more big day of surgeries tomorrow & then a half day on Friday - time flies when you are doing good :)  

11/12/13 What a day to be in Guatemala - Surgery Day #2 was GREAT

So it seemed like a short night...even though I was SO SO tired I didn't get to sleep right away & the 5:30 alarm seemed like to went off not long after I fell alseep.  When we got to the hospital we went to post op to see yesterdays patients - little Milagros was there with her sweet mom, Mario was there with his son & out little boy who had to go back was there with his mom & looking good :) I took some pictures.
When we went to PACU the 1st 5 patients of the day were there lined up in seats with a mom or dad & waiting to go into surgery. I did a little teaching with the moms re coming into recovery etc. Many of the moms were very tearful waiting for the surgeries...they want that surgery but it's a scary thing to hand your baby off to someone.
A quick follow up from yesterday - Steven the 20 year old also has had hearing problems - not sure if it is unrelated to his lip or what but he has had to always sit in the front row at school & learned to read lips. Mike & Bonnie May's daughter is a Dr of Audiology & on this mission to honor her brother & has been working with the speech therapist - but typically there is not an Audiologist - much less one with hearing aids available for free!!! Today she fit Steven for a hearing aid & I was told he got tears in his eyes as he could hear clearly for the 1st time in his life. What a tender mercy to have her here to help him. She is also fitting some others including a sweet 80 year old nun from an orphanage that brought some children here for cleft repairs.
One of the patients from round #1 was a cute 5 mos old boy Fredy - his dad is professional soccer player here in Guatemala - but still didn't have the resources to help his son or perhaps was told to bring him to Op smile - I didn't get to ask.
 Because there were so many palates & those are 2 hour or more surgeries it was a slow morning & we only recovered 5 patients by 11 am so we knew we had a busy afternoon ahead of us. Jim the MD who broke his foot went to get his cast spilt before he flies home tomorrow - so we were without a specific Dr in the Pacu for a while but had plenty of support.
Pt #30 Carlos was a 2 year old who apparently had a lip repair last mission but it opened up or something went wrong after the mission so he needed a lip revision & WOW what a difference in his pre & post photos. He was a patient that one of the students followed from screening thru surgery so she was very excited to share his story & also bring the family into recovery to see him.
The dad of one of our palate patients almost passed out at the sight of the bloody drainage from his sons mouth so that called for some quick work on our part so he didnt go down...also I posted this on FB & Instagram but one of my patients Jose who was 9 came thru & had a black pair of Toms - thru the translator I asked his mom where he got them & she said they were given out free to some children in her home area - so it's true they do give awy shoes to kids when we buy them! We had a couple of tough palates early afternoon - ones that needed lots of pain meds, oxygen, suctioning etc.
I got to lunvh at 2:30 today but the fried chicken & rice was not on my top 10 list of things I wanted to eat so I opted fro peanut buteer & ritz & some of the snacke my friend Cheri sent with me :) I alos found out the donuts are delivered at 2 om & I successfully passed by them today.
One of our last patients was a 16 year old Cleft Palate patient who had a repair last year and had total recall of the surgery etc - I dont know the details but he was scaird for the small revision he had today. Bonnie said that everyone had talked to him to help him be less anxious but when he went in the OR & they were getting ready to start with just the IV etc & he was on the Operating table he told the surgeon & anesthesia to wait he needed to pray & he sat up & said a beautiful prayer for himself & the surgical team - apparently there were a few teary eyes as they got started.
It was a busy day with lots of work - I didnt take many pictures or get as much patient contact but really I am here to "do the work" & that in & of itself is rewarding.
A few new fun facts before I go to bed:
1.  Kids here are out of school Oct-Dec so we have LOTS of great high school volunteers here helping the children & families of their country
2. It's very green here because there is a few months of a rainy season
3. They are getting ready for Christmas in the nice areas with lights & trees - it is very festive
4. We had a sponsored dinner tonight at the intercontinental hotel which is literally 2 blocks away 6 of us asked if we could walk back & we were told no it just isnt safe but they would call us a cab. This safety thing is real - Naive me just found out today that in adition to the policia on our buses to protect us we also have a "Follow Car" that follows behind us & at the hotel tonight we counted visuble just as you walk in 8 security agents with earpieces. so the message is Op Smile is VERY SERIOUS about our safety!!!
5. There is a holisitc group here offering us & the parents 10 minutes of therapy that will help blood disease, immunity etc so in a lull Rachel & I went out there it was 5 min of one finger on your head & one on your neck & no real pressure then 5 min where they held both your big toes...I am not sure I felt anything but just sitting still for 10 min I didn nod off...
Time for bed tomorrow is another day. I love getting little info from home when I can get onto Facebook or get a text - its only 5 cents for me to receive & I am on my CHOC Cell 714 337 7917 so hearing from Doug & the kids is a boost to my day :) so feel free to send me a text if you want!!!
Good night from Guatemala

Surgery Day #1 - 27 Patients

It has been a wonderful, long, tiring, rewarding day and I would really like to just go to bed cause the 5:30 wake up call is only 7 hours away & i still need to shower but there are so many things about this day I want to remember so here I go :)
The PACU set up this morning went well - we have ALOTof space & even expanded into 2 sides/walls of the room which was good - a is the case everywhere the gurneys are a bit old with siderails that may or may not work, the sheets not so great, not a single pillow to be found and the blankets not ones I'd ever use but it all works out. Thank goodness for the plastic Pepsi tables we used at screening as we put 4 in there for our set up as well as used boxes for tables . The hospital is doing minimal surgeries while we are here & their one nurse "Marina" is delightful & gets the kids warm blankets when she thinks they look cold. The pre op waiting area is right outside our door so that is fun to see the kids again as we go in & out.
We had a good start & got our 1st patient by 9:30 & another right after - both were cleft lips and had happy parents - the lips are external vs the palates which are internal so they have to most visible change. We pretty quickly went from calm to madness as the next 4 came out about 30-40 min later when we were sending the 1st 2 to the ward. Little Karina was the 1st one to make me get teary - her mom had tears streaming down her face as she looked at her little girl with a repaired bilateral lip - it was precious. But after that a dad named Mario got the tears flowing for all 3 of us. We have a wonderful translator Sofia a high school girl who stayed with us for 12 hours & was amazing. It was busy when the dad came in & he was standing at the edge of the gurney with tears rolling down his face - I gave him some tissues & he really got to me but I had to keep it together as we had alot of patients at that time. About 10 min later I went back & helped him hold his son & had Sofia ask if he had any ?'s & he said no but then tearfully said "I want to thank you for coming to help those who need it the most, like my son & the children of Guatemala. I heard on the radio to come here & all I could afford was bus passage for me & my son and I didn't even know if it was true but here you are earths angels. I thanks God for people like you with a pure heart. I will pray God Blesses your health to keep you helping many other children" all of that just came out of him after I asked if he had any ?'s. Rachel & Mary Laura & I were all there & he has us all in tears.  These are the moments I want to remember and would love to bottle up for those days that seem difficult in the very blessed life we live.
Since Jim the anesthesiologist broke his ankle Judith our Intensivist for this mission(who is also an anesthesiologist) covered his surgical table & he became our Recovery Room Dr. Poor guys was in a wheelchair & as his leg got more swollen we put him on a gurney elevated his leg & iced it. Doug the Team Leader for the Mission gave me the job of Drug Czar since Jim wasn't mobile. so I was Narcotic Nurse Nancy giving most all the pain meds to everyone today
One of the babies with the most profound change was Milagros - she had a HUGE bilateral Cleft & I am sure I probably took a picture of her at screening - a "Mission Guest" (aka generous donor) had followed her case & was very moved by the transformation. Her mom also was very tearful (yes there was ALOT of tears flowing today - even more to come). Her mom just kept saying "Muy Bonita Gracias"
Unfortunately one of our 1st cases a simple lip had some bleeding in the post op ward so they brought him back to us...and bleed he did no matter what we did to try to stop it. It was very unusual & the little boy also has a seizure disorder & a few other things. His poor mom was having such a hard time that the surgery didn't work & now he was bleeding & we knew he would have to go back to surgery. she was crying cause he was crying...it was bad. I tried to distract him with some of the toys I brought & a book worked for a bit, then a ball then a car. The bleeding worsened so we sped up the plan to take him back, had to restart an Iv & medicate him & the poor mom was so so sad. I went back into the OR to help them get him settled & the anesthesia started for the next surgery to find the source of the bleeding & was able to come back & with Sofia tell the mom he was settled & I was there  & it would all get fixed & I promised it would be better.
By then it was 3 pm & I hadn't gone to lunch & when I did I was less than excited to see fried fish??? Thankful for my bars & almonds. I do have to again give a shout out to pepsi - there is a full frig section like you see at 7/11 filled with water, diet pepsi, pepsi, 7 up, diet 7 up, ice tea & liquid yogurt drinks. They are a HUGE supporter of Op Smile especially in Latin America & even though I am really a diet coke fanatic here I appreciate the full access to diet pepsi products. Also I learned today thet Dunkin Donuts brings 200 donuts a day for the team  all the volunteers etc. So a donut & diet pepsi break while being a nutritional disaster was a great pick me up about 7 pm tonight
There was the sweetest couple who just clung to each other & both cried as they saw their childs intact face & smile for the 1st time - that was a tender sight I captured from behind to respect their privacy.
My little "do over" patient came back about 4:30 they thought they got all the bleeding stopped & packed his nose area where it may have originated. He was VERY SEDATED & Doug the team leader said to plan on keeping him a few hours. I had Sofia get the mom so she could see him & told her I would be with him until he went to the post op ward. she was so relieved it all was "fixed"
The last patient that really got to all of us was a 20 year old boy Steven who went to a small school in his town but didnt like to go out or talk to people as he had an unrepaired cleft that also involved his nose. He has a twin brother who is fine & it was his older sister who brought him here 6 hours from home to see about the surgery. He was a category 4 & she was worried we would not do anything for him. BUT WE DID - the amazing surgeons not only fixed his lip but basically did a full nose reconstruction using cartlidge from his ear - the difference in his before & after was incredible. His sister just cried & cried & cried & cried when we brought her in to see him & he slept the entire time. I so wished I was there when he looked in the mirror & saw himself - no need to hide any more! What a life changing day for him. I guess it touched me cause I have a 20 year old & I cant imagine a childs life being completely impacted by this simple medical issue that can be so easily corrected. It was overwelming.
A few other tidbits to remember - the post op ward was on the 1st floor - surgery & Recovery on the 2nd & NONE of the elevators worked - it made transporting pateints a challenge as does the fact that in the evening bout 50% of the lights are off???. Another patient at the end of the night was a 3 year old palate who also needed 16 dental extractions - they only did 12 but really I think we all take for granted our healthy teeth & having toothbrushes & toothpaste! Finally - I am exhausted but happy , my feet are killing me after 16 hours on cement type floors but I would still not trade this for anything.
Tomorrow we have 28 cases and 20 are Palates - that is ALOT of palates which are more complicated & more painful for the kids. Send us your good wishes, positive karma & prayers for another wonderful day for Team Guatemala

A Weekend in Guatemala - surgeries start tomorrow

Just a quick recap of my weekend in Guatemala - it is typical to have one day "off" before surgery starts as a "team bonding day" but never have I had a full weekend. There was supposed to be an educational session we participated in on Sat but it was cancelled & we didn't have to got set up the PACU so this was a luxury :)
I slept in til 8 on Sat bypassing the hike to the Volcano which I hard was wonderful but there was one casualty one of the anesthesiologists on the way back "rolled his ankle" but today we found out it was actually broken!!! so they are changing some of the physician coverage. I was ale to skype the girls one night & Doug on Sat morning but the hospital IPad has the camera locked down so I saw them but they didn't see me. I had a leisurely breakfast with some of the team then came back & did some emails & computer work. While we were at breakfast there was an American couple with a maybe 10 year old caucasian son & another maybe 7 year old "brown skinned son". Turns out the younger son they adopted from here when he was a baby & they were bringing him back to learn about & see the country he was born in - that was so cool!
In the afternoon we went over to a small local weekend artisans market - and I did a little shopping - found a Guatemalan Nativity & some other uniquely Guatemalan treasures.  I also tried to find live streaming of the BYU vs Wisconsin game but ended up only able to get the radio transmission from KSL...not a great game but I do think I should get some recognition for listening all the way in Central America!!!  When I have down time & am not busy that is when I miss my family & home, worry about all that is going on there etc so I tried to keep busy today & I know that wont be a problem starting Monday :)
For dinner they took us to Plaza Cayala a very high end area that honestly reminded me of Fashion Island - it was beautiful as they were getting it all decorated for Christmas. We were on our own for eating & Heather & I went to a steakhouse with a group - it was a bit expensive but quite yummy!
Today was our "team bonding day" & we went to this truly wonderful town Antigua - a colonial Mayan town with wonderful ruins, a cathedral where mass was going on, churches from the 1700's,  convents, a monastery...the history was palpable & the streets all rocks & cobblestones. The Op Smile Foundation in Guatemala took us to a beautiful area for lunch there and we also went to another market. aside from the patients & team...a little shopping is also one of my favorite mission activities. One humorous moment - I mentioned the "security or policia" that travel with us - well I guess I am a bit oblivious to all of that cause there are actually 4 full time security Op Smile has here for us in addition to tons of security will full on headsets at every door & turn in the hotel. The Op Smile Security detail sit in the front of the buses & I just didn't realize it til the other day. Today in Antigua one big group went in one direction, another went the other way & Heather, Mary Laura & I were creating our plan - we ended up going in the same direction but were aways back from one group after walking about 15 min I noticed a man walking behind us...he seemed familiar & said in Spanish to me "I am with you". I am fairly certain he must have thought that if any in the group might  need help it would have been the 3 of us. as we got closer to the big group he was gone...I truly don't feel "unsafe" we were in a very tourist town but you are approached by lots of people - beggars (often children), people wanting to sell you things or take you places as a tour guide etc. We are very cautious at night but our "personal security detail" today made me more mindful of safety.
We left Antigua at 4 & those of us who needed to go to the hospital went on one bus, drove to the hotel grabbed scrubs & left immediately for the hospital. Only Rachel & I went for PACU & we couldn't get in because the one staff person on shift had "gone for a walk"???? Out of 90 min we only got about 30 min of set up so we will finish in the morning. we can straight back to the Pre surgery mtg where Bonnie & Mike shared the story of their son Adam - it was tender...and then we had another 90 min of pre surgery review. We have 28 on the schedule for tomorrow - usually Mon is a lighter day so we are hitting the ground running. A 5:30 wake up call, 6:30 departure to the hospital & I would anticipate getting back between 8:30 & 9:30 pm...so glad I enjoyed the weekend - let the real purpose of the trip begin tomorrow. I am sure I will return with stories to share :)

Day #2 Screened 83 Patients for total of 201 Highlights & Heartbreaks

It was another early morning...the hotel has a nice breakfast buffet but I just cant bring myself to eat beans, rice, tamales and chilitas (quesadillas) for breakfast....luckily they will cook eggs to order :) We got to the hospital & the 1st face I saw was 5 year old Sara who was with her mom & 1st in line for today. I said hello, told her how cute she was & we were instant friends. a I walked around to see other patients she followed me when I sat down she ran over & sat in my lap, when I went inside she followed. Finally I showed her mom where I was & where Sara would be when they started screening. she just melted my heart little #119. She has a small cleft palate that will be repaired so I will see her next week & certainly give her some of the fun things I brought. When she was ready to leave she ran to me & gave me a "beso" (kiss) on my cheek.
There were LOTS of babies today & some were heartbreakers because they were too young or too small to have surgery. #152 was my 2nd love a cute little girl in a pink blanket& her mom was in pink too - she was 4 months old but too small for a lip repair - broke my heart. There was also a 40 day old with a large Bilateral Cleft lip that we couldn't to the criteria for lips is minimum of 6 mos but if well nourished 3to6 month olds can be done as an age deviation with team leaders approval. so the 40 day had no chance - the mom was teary we reinforced the idea of nutrition & reviewed the feeding tools & special bottles & I took a leap & promised her & most of the others that if they came back the next mission their baby would get surgery (which 99% will) she kissed my hands & said Bendiciones - God Bless You
The truly hardest 2 patients were  a 2 month old who was a preemie (without any preemie care) #127 with very young patients who themselves had lots of cavities & missing teeth & were under nourished as adults but the baby wasn't getting any formula & instead was getting a diluted powder milk? I asked the coordinator if I could help by giving them $$$ but she suggested we get them food & formula so she had them wait at the shelter & got it for them & gave it to them. I didn't see what they got or when they got it but I was happy to help them. They have no resources, no phone & it just made me realize once again how much we take for granted in the states....I hope somehow what we got them will help for awhile :(
The other super sad case was a 3 month old with several severe birth defects & some sort of a syndrome - it was so sad to me because you could tell the mom was used to people staring at her very deformed baby. There was nothing we could do but the team was trying to connect them to some world health help.
We also had lots of kids who were "tongue tied".  At  home a little "snip" & its all taken care of - some of these kids were school age & had difficulty talking just because of this simple thing...we will be doing ALL of those cases!
The other thing we didn't realize yesterday was that the "lab" method of getting blood in kids is ARCHAIC...they were taking a needle, breaking of the plastic "hub" trying to insert just the metal needle in the child's vein & then letting the blood drip out into the tube & squeezing the hand or arm to make it drip & if it stopped dripping & they didn't have enough blood they would do it again & again!!! This morning since we started with so many baby's we heard LOTS of crying & asked the volunteer to see what was going on & she told us they were "sticking & sticking the babies" we sent Mary Laura in to check it out & she told us about that practice & we were horrified...I had the idea of getting butterfly needles from the Op Smile Supplies, Rachel went & got them & Mary Laura & 2 other nurses taught the lab people to use those. We were told that even in this private military hospital they didn't think they had supplies to do blood draws on kids any other way...It was eye opening...
There were LOTS & LOTS of other cuties today - I took lots of pictures & I think we will have a full schedule for next week. The OR got set up but since all 3 of us were at the gatekeeper position we didn't get the PACU set up. We were going to have to go tomorrow & set up but Judith our PI convinced the coordinator we could set up quickly early Mon morning so we actually have a free day tomorrow. A few people are going to hike to a volcano but I am going to stay local with others.
We went to the Plaza Fontanella for dinner tonight & ate at an Italian restaurant...yes Italian food in Guatemala. Of interest was that on our bus they have a "policia" hired to ride with us after dark - even though it is our large group & they don't have lights on in the bus so people cant see it is a bus of tourists....puts into perspective a little re the safety here even in nice areas? Wilma a local female doctor told me...if you go out be in a group not just 2, don't wear jewelry or a watch, don't take out your cell phone,  don't carry your passport, don't show your money, don't go out after dark even in a group....maybe its just better not to go???? I feel safe but I haven't ventured out of the hotel or the hospital much....as much as I would love to see the sights I am happy to be here just meeting these humble people feeling of their humble spirits and seeing their gratitude for such simple things...again my attitude of gratitude DAY #8 is recognizing that we can each make a difference.

Guatemala Day #1 Screened 118 Patients :)

So the crazy is starting but its a good crazy!!!! We slept in til 6 and still made it to breakfast and the bus. The military hospital is about 45 min away without traffic & up on a mountain top - where it is secure we were told. It is old but large, it is considered a private hospital & as such is supposedly much better then the National Hospital which we have been told is REALLY BAD but not as nice as the private non military hospitals that people with a nice lifestyle here would go to. I didn't get pics today but will tomorrow, all around the hospital are murals of men carrying wounded bloody soldiers - kinda creepy. I have decided that it is all about perspective & exposure...this hospital seems ok...for a mission hospital, better than some not as nice as others but none are ones I would want anyone I know to be in....
When we arrived there were about 100 people waiting...not sure how many patients that was but is was all set up by the Colgate people & super well organized. as luck would have it I ended up being....The Gatekeeper. But I had both Rachel & MaryLaura (the 2 nurses who will be in the PACU with me) as Gatekeepers also. It is Rachels 1st mission but she is really bright & so is Mary Laura so we were a good team. as is always the case we knew we wouldn't see a patient at our station #10 until about 10 so we took that time to go outside & see the patients and families. There are some cuties & many sweet young families. Also many families with parents who also had clefts - not that i know the genetics of it all.
We finally got out 1st patient - Patient #1 Juan David just after 10 a 16 month old with an upper cleft lip that will be repaired. He was so cute & he was one of the ones I visited with & took pictures of outside. We have to log each patient in & they all have 4 names - a first name middle name & 2 last names - I think it is both parents last name but I am not sure? Just as in other places many of the people are illiterate & so when something is explained o them if they can't write their name they put their thumbprint on that line of the form.
The patients here hadn't traveled as far as on other missions - the average I think was maybe 4-6 hours by bus with the longer ones being 13, 18 or 21 hours by bus. We tried to get the more distant ones to stay in a small shelter here that houses 40 people but the one mom said she needed to take the 19 hour bus ride back to tend to the rest of her family & would come back the day of the surgery on another 19 hour bus ride. That is just not even real to me.
By noon as gatekeepers we had seen 20 patients & they had already given out 90 numbers. By 4 we had only seen 68 of 118 total so we were 50 patients "behind". The bottle neck is at the dental and speech stations. It started to get a little crazy about 4 as all those patients & families were waiting in a very small area. The priority #1 & #2 patients who for sure were having surgery we sent to the lab then home after our area so I decided to start sending them to the lab while they were waiting for speech. It worked but keeping track of where everyone was & needed to be was intense. Then by 5:30 people wanted to just leave because the public buses don't run after 6 pm to some of the more dangerous areas. we did quite the juggling act. Everyone was seen by 6:30 & we got back to the hotel about 7:30 with the evening traffic.
The families were very grateful, many of them told our cute college girl Andrea who was our translator the tell us "God works thru you", "Thank You", "Bless You"  We told the #1s & #2s that the 3 of us would be with their child after surgery. One cutie that stole my heart (& was in my photo collage in FB & Instagram in a pink outfit) was #28 Jackelin a tiny little girl with a bilateral cleft lift. He parents were very young but very sweet the mom didn't want to take her to get labs & see her cry so the dad took her & the mom stayed with us. She told us her family didn't want to see her or the baby cause they are "cursed" - it was so sad & in my minds eye I could see her with her full repair next week & can only imagine the PURE JOY that sweet mom will have - all because of a 1 hour surgery.
There were about 6 little ones we had to turn away because they were too young or too small - we told them to come back to the next "Smile Marathon" in 6 months & there is a cleft lip clinic that will follow them until then.
BTW I am surrounded by significant others of "stars" Mary Lauras boyfriend is on the "Boardwalk empire" HBO show - his real name is Joey & he plays a Federal agent now turned bad??? Had to admit I've never seen it. Rachels nephew is 19 & is on Parenthood & has been on it all 5 years. Me...I got to claim to Hollywood or NY.
Since we got back late we just ate at the hotel "Sports Bar" it was pretty good. Tomorrow there are going to be several Guatemalan Film crews here? so we are wearing our team shirts then to all look good???
 I was able to get the packages sent to Daniel Perez & Nancy Kalifi from folks at home - hoping they get them!!! Going to shower & get to bed...despite the nice hotel the shower is either scalding or freezing so its a challenge - but if that is all I have to be concerned about IT IS ALL GOOD!
My ATTTUDE OF GRATITUDE DAY #7  is all about being grateful that I live in the USA & am blessed with so very much! 

One More Post Before it Gets Crazy

So I ended up taking a 2 hour nap before the team mtg & dinner. I knew I didn't want to start out the mission tired. It seems that the country of Guatemala really supports the work Op smile does...this is alot like my experiences in Mexico & Bolivia where there is corporate sponsorship from Colgate & Pepsi & other organizations as well as in country volunteers. This is their 3rd mission here & they actually call it a SMILE MARATHON.

When we walked into the room for our "dinner mtg" it looked like we were walking into a wedding reception - I honestly felt under dressed...The Ministry of Tourism sponsored this meal & show. It was AWESOME...and showcased their rich traditions, colors, textiles, music & dancing. Disney has nothing on them. The did about 6 different traditional dances - one for All saints Day or Dia Del Mundo, another Festival Dance, a Planting Dance, a young Love Dance, a traditional Mayan Dance & the finale was the Dance of the Patron saint with animal characters, a candle So I ended up taking a 2 hour nap before the team mtg & dinner. I knew I didnt want to start out the mission tired. It seems that the country of Guatemala really supports the work Op smile does...this is alot like my experiences in Mexico & Bolivia where there is corporate sponsorship from Colgate & Pepsi & other organizations  etc.  It was truly amazing.

Originally I was sitting to the side with the Child Life Specialist then we both moved to the middle then Bonnie & Mike invited me to sit with them. I really think my 3 years of facilitating the grief group will be helpful to me this week as I am with Bonnie. Originally they were going to have her tell Adams story tonight but it didn't seem right after this big Cultural festival & some team members are still arriving & she didn't want to say it twice & there were some community members tonight so it was a big group not just the team so we talked & I suggested she said share at our Sunday meeting when its all "the team" so that is her plan.

We got our schedule...yep it's the typical 5:30 wake up call, 6 am breakfast  & 6:30 leave for the hospital...so I am going to bed soon to get my rest. My roommate arrived  - I was with her on another mission...she is an OR nurse.

It looks like they are trying to get us some places - they told us to not go outside the hotel after dark & never go anywhere alone & that if it was safer they would split the set up jobs so we could have half a day to explore but its just not an option. They are coordinating events for us though. The team day on Sunday will be in Antigua an old Colonial Town an hour away and they have team dinners Tues & Thurs at different Plazas (shopping areas I believe). We will be at the Hospital Militar & supposedly there is lots of space which will be so nice - but also all the military restrictions & expectations.

A few other "FUN FACTS"about Guatemala I learned....it is the worlds #1 exporter of Snow peas to the US, a scene of Star Wars was shot in the National Park Here, in addition to Spanish there are 21 Mayan languages, Guatemala is the main supplier of Starbucks coffee, there are 4 active volcanoes, cars have the right of way so we have to be careful & punctuality is not a virtue here so we need to be patient (that might be helpful to me!)

I have already met some wonderful people - truly almost all people who give of their time in this way for children are great - I met another BYU Grad (10 years after me though) Heather who is an OR Nurse at Primary Childrens in SLC, Mary Laura from NYC who is the other recovery Nurse with Rachel & me and others. Every Mission is great but I am expecting this one to be wonderful for so many reasons & I am super excited to start meeting the people of Guatemala tomorrow. They say people travel for days from far far away to get here & since this is the 3rd Smile Marathon word has traveled throughout the country. I am looking forward to a BUSY day tomorrow & told Debbie our coordinator to just put me wherever she needs me, start, finish, crowd control....it doesn't matter where I serve I am simply here to serve as one member on this big team representing 10 countries to CHANGE LIVES ONE SMILE AT A TIME. So Buenos Noches from Guatemala I have an early wake up call in the morning! 

Operation Smile Mission #6 Guatemala City

So here I am in Guatemala City so blessed to be on another Operation Smile Mission. I was scheduled to go on a Mission to Toluca Mexico in Sept. but because of some things at CHOC had to cancel that one & I was so disappointed as it is actually very hard to get on Mission & that one in particular I was supposed to be with my friend Katrin who I had been in Tlaxcala with so I was beyond disappointed to have to cancel.  when I did cancel I told the Mission Coordinator Joe that if he had any opening on later missions to please consider me I would LOVE to go on another mission before the end of the year. @ days later he called me back & asked if I wanted to go to Guatemala City in November - I said YES instantly :)
Because i had so much going on at work I knew I had the dates blocked & was going but hadn't really told anyone or done ANY prep until this past week or so...what a week & SO SO MANY friends have been so supportive in so many ways, money for me to use her to help others as I see the need, a shopping trip to Target to buy toys for the kids, treats for me to take, sweet notes & texts. I feel very loved & supported as I go to do this work.
In the 3rd Team Packet there was a PS..this mission was being sponsored by Mike & Bonnie - 2 anesthesiologists a husband & wife in honor of heir son Adam who died in Dec. I was in Ethiopia Round #1 with Mike & Bonnie last Oct & felt so honored that I was going to be able to be a part of this mission. So as much as I missed being with Katrin I was happy to be a part of Guatemala City with them.
I think I have this packing thing down...my bag was 49.5 lbs with a 50 lb limit If I wasn't bringing a bunch of stuff for the kids & a bag for a friends son on a mission here I may have even just brought one bag & a carry on - miracle compared to my 1st mission with 2 giant bags & 2 of the biggest carry ons possible. I was also excited to hear we were in a "nice hotel" that also had internet. Op Smile "stories" have talked about these great hotels in places like Vietnam & China but mine have probably not been places I would choose on my own...
I took the Red Eye last night from LAX & even used points to upgrade to 1st class thinking I could sleep. Well it is only a 5 1/2 hour flight so with take off & landing etc there was maybe 3-4 hours to sleep which seemed to elude me but I did have a nice big seat & no one next to me so I was comfy!
I arrived at 7 am & from the sky I could see all these "houses" as i got closer I realized many of them were "shacks" all next to each other. I got thru immigration quickly, got my luggage & breezed thru customs :) The Hotel shuttle wasn't there so  shoe shine guy - realizing I had no shoes for him to shine offered   to call them for me then asked for a tip..I was happy for the help & happy to give the tip.
The hotel shuttle drive told me its 10-15 min away without traffic & 30 with traffic - we got there fairly quickly & his REALLY is a nice hotel. I would stay here on vacation!!! Pool, Spa, work Out Area...WOW!!!  My room wasn't ready but the local coordinator had left me a key to her room - I was tired but didn't want to sleep in her room or shower so I just read a little & bout 90 min later she came back & my room was ready. she suggested I enjoy the hotel today as after this we will really only be here to sleep - REALITY CHECK - YES I am on a mission & even in a wonderful hotel we do 16 hour days.... It was great to be one of the 1st people here  - I got myself all unpacked...after all I am here 10 nights...showered & was then aghausted. I couldn't decide if I should work out or take a nap...I went down to the lobby at noon & Monica the local coordinator was waiting for her volunteers to welcome arrivals cause she needed to go to the hospital which...is over an hour away in a much more destitute area. We will be at a military hospital - that should be interesting & LOTS of guards with guns...Anyway I ended up being the greeter until her volunteers came - I got to pass out the t shirts & a little bag they had for each volunteer with a pound of Guatemalan coffee in it :)
Once the volunteers came I went to explore the hotel more - it is so nice...there a beautiful pool area, a patio area, little shops...like I said I could vacation here!
When I came back thru the lobby I saw Mike & Bonnie & gave them HUGE hugs - their room wasn't ready either so we sat to visit with other friends of theirs & I found out the store of their son Adam. he was being treated for Testicular Cancer when we were in Mekele - the treatments were brutal but he finished them last Nov.. The end of Nov he was having some breathing problems & it ended up he had a 1 in 100,000 person side effect of lung tissue damage from one of his Chemos. He worsened & was put on ECMO (heart lung support) for 6 weeks & in Dec they removed him from that & he passed away immediately. what a journey they have had. Their son Adam wanted to go on a mission with his parents & loved the photos from Mekele...so this is HIS MISSION..they selected the entire Anesthesia team, their neice is doing her 1st mission in the Recovery Room with me their daughter is here as a guest audiologist, 3/4 of the team were hand selected by them & then how lucky was I to get to come on this mission with them. They are going to tell their story tonight at the 1st team mtg. Bonnie said her challenge all week will be the tears that will flow. I feel honored to have them welcome me with such open arms.
Our Team meeting & dinner is tonight at 7. I am sure we will learn more about the schedule then but from what we were given before we will be screening the next 2 days - I cant wait to see all the beautiful Guatemalan children!

Oops I never finished Day 4 & 5 from Ethiopia

I really am not a very good blogger....I blog when I am gone really as a way for me to remember my experiences but if i get busy or something changes then I forget to go back & finish up. Luckily I try to jot down notes during the days when I am on a mission & while they aren't totally "fresh in my mind" several months later the memories do come flooding back as I read my notes. So I will attempt to finish off my Mekele Ethiopia Mission #2 so that I can start on my next adventure!!!

Thursday morning at breakfast we were told that they were moving all the remaining cases to Thursday rather than having a half day on Friday....and Friday we would just pack up. so this was a busy day. We did 20 cases all lips & all on patients under 5 years old. That meant 20 new smiles which is why we are here...it is the basic focus of the mission.
The very first patient was one that we had to cancel on Monday due to a fever so that mom was so so happy - she kissed my hands when she came in the recovery room. Those are the moments & memories I treasure.

We actually had several tearful and grateful moms today...another mom told us thru the interpreters that she was "so thankful her daughter now is beautiful & she can uncover her face" I gave her the last little blanket I had...one that would no go over her pretty new smile & face.

Another mom I took pictures of (someday I will learn how to upload photos to my blog) she had a beautiful red scarf on & when I complimented her on it she wanted to give it to me - I refused & she put it on me - I told her instead we would take a picture of the 2 of us with the scarf & that worked. Mema was her daughters name & she was supposed to have surgery last mission but it was canceled as she developed an eye infection. I don't recall meeting her last time but she said she recognized me & thanked me for coming back. She kept giving me the hand language sign for gratitude...exactly from my Youth Conference talk.

Pt #134 I remembered from screening...Darge - a little boy - his mom was crying she was so happy & we too took pictures :) We also got patient #007 today so we were all calling him James Bond - not sure any of the Ethiopians understood that...

Also first thing this morning I saw my little friend from screening day #2 & from the shelter - the big sister to a little boy - she would come up to me & HUG me everytime she saw me - her little brother had surgery today so she was my very best friend in the Recovery Room today - I gave her flip flops & felt like I came full circle from screening day to the last day of surgery.  Another little girl I had seen often was also in the hallway most of the day...she was recognizable because she was actually a little chubby & most of the kids are very thin & she had the brightest smile.  She looked at my friend from screening day when I gave her the flip flops & I could tell she wanted some & I had one pair left so I gave them to her & we took pictures too.  Her reaction to the $1 Flip Flops was as if I had given a teenager a brand new car - such simple things they need & appreciate.

We ended up doing most all the packing at the end of the night - it was a crazy mess and I was trying to help Doris & come up with a system. We seriously repacked about 100 boxes of random extra supplies in about 2 hours with my "system". Everyone was happy to let me lead the process cause it meant we were going to finish sooner.  Every box had to be labeled with what wa in it - did it go back to Op Smile Ethiopia or was it being donated to the hospital...some of it was random stuff we dont even use on missions!!!

We got back to the Hill Top Hotel...just calling it a hotel is rather amusing...and we all went out to Karibu for dinner it was really fun.  Some of us weren't sure what we would do all day in Mekele tomorrow & since we were going to be there all day tomorrow we didnt want to be there all day Sat too. So Chris & all the Swedish girls & me & anyone else who wanted to  - we all changed our flight from Mekele to Addis to the early morning one so we could spend a day in Addis at the Sheraton a 5 star hotel to unwind - yes 10 of us are checking into one room just to store our luggage & use the facilities. We are paying $350 US to basically have the room from noon til MN - Craig & I are the last to leave at MN.You can get a massage for $25 :) We talked Craig into going with us - the only man. He is going to visit museums while we relax at the pool and shop. I have to say for the $30 I have to pay for the room it is totally worth it - I am excited




In the middle of the night I heard people calling the names of others & assumed it was because some more people were sick. I had hoped to sleep in but woke up early & when I did I found out that they had to take a little boy back to surgery cause he opened up his lip repair. I was the Recovery Nurse on call so I told them I would go in to recover the patient. Now remember we had completely disassembled the OR's & packed everything away so basically we had to re set up one OR and I set up a modified Recovery Room and  a mattress on the flor became Bryants post op area