Surgery Day #3 Saturday in Honduras

Wow a 3 day mission really speeds by...but with all I have going on now this mission worked out well for me timing wise. Last night when we returned to our room there was a note to pack up & as a surprise after we finished today we would be going to the Mayan Ruins in Copan - that was a fun change in plans!!!
They had minimized todays schedule with only 10 patients so that we could get packed up & head out not too late. Again in the morning we went to post op & saw the cases from yesterday & also some other patients thay had there...many of whom had very sad stories. A 13 month old who weighed about 8 lbs. Sister Paula & the nuns had cared for her & she actually has gained weight but she still is incredibly emaciated & also having lots of diarrhea. Come to find out they only have 2 bottles there & obviously aren't sterilizing them when they wash them so perhaps she is getting the diarrhea from not clean bottles & also since they have so little formula they mix maybe 1 scoop in a full bottle & then with her cleft the baby drinks maybe 2 ounces of...mostly water. Elizabeth our PI really tried to intervene & got the local foundation people involved to give this baby a better chance at surviving. There was also a mom that Michelle the speech person said slept on the floor last night (the very dirty, cold floor) under her childs crib for 4 hours just from sheer aghaustion from the travel here, her childs surgery, etc. Another woman "watched" her baby while she slept. So even though we can treat the children & give them surgery & a crib post op all we offer the parents is a chair (maybe - I dont think there was even one chair per crib or family) so the parents have no where to stay. The poverty is heart wrenching.
This is the 10th mission here at this hospital - it is a much needed service for the country. It was a LONG trip for the team to drive her from Teguchigalpa but we are with the poorest people in the country who need our help the most. They have a 4 bed UCI (instead of ICU) & there was a baby in there they thought had an intussusception but then they opened her tummy she had a large tumor so they just closed her back up. She has been getting worse & worse each day. The physicians do truly heroic things with the resources they have but their resources are so very limited....20 year old ventilators, minimal medicines, they used a feeding catheter for a central line, no IV pumps I could go on & on. It really is hard to wrap you head around it all. No matter what I have seen in the past or other places I have been it gets to me every time. So very sad.
Our last patient was a teenager who had a lip & nose repair...he was probably the most complicated patient of the day & while everyone was packing up & getting ready to go we had to remind them that as Op Smile says..."the last patient is just as important as the first". We ended up changing his dressing & doing all sorts of things to get him ready to go spend the night in the "mens ward" at the hospital. My PACU peers are calling me a "mamager" (cross of mom & manager) truly that probably is how I  lead...it's just a bit humorous!!!
The town of Santa Rosa seems cute & safe...we have been able to walk to the hospital in a group the last 2 mornngs. However I must say that probably 50% of all men I see do have a gun...guards with guns, men with pistols in their pockets or back of their pants or men with big guns. The religious festival & carnival ends today. When we did finish this afternoon we had an hour so we walked into the town square. We missed the parade but there was confetti everywhere!!! We also saw the "famous" (as in if you google the town that photo comes up) beautiful white church in the center of town. I think it was built in the 1700's & restored in 1809? It was very pretty but even better was when we went into the church one of our little patients Jesus & his mom were in the church praying. Unfortunately his palate was too large for us to repair (it would have been a very complicated case) so he didnt get surgery but he did get some teethg pulled & an obturator ( almost like a retainer) to cover the gaping hole in his palate so hopefully that will help him! I took a photo with him at the church.

Some of the team members are getting sick...just the basic GI stuff...I am always super careful what I eat & grateful to not be sick.  We had a 2 hour bus ride to the area of the ruins - which really ended up being more like 3 1/2 hours with the rainy washed out roads but Michelle the Speech Therapist shared some great Honduras info on the drive that I will blog about tomorrow (I am too tired tonight) The speech girls were stationed in the emergency dept & she also said that today a man came in blood running down his face with a machete sticking out of his head. I must say I am not disappointed I missed that! The drive took us up into the hills of Honduras, it is very lush & green everywhere. In the areas where people live there are horses, chickens, mules, dogs etc all wandering in the streets. On our way we passed an LDS Church - I would guess a ward building but I didn't have my camera out to get a photo op. It always makes the world seem alot smaller when I see a church knowing there are people here in this very different world who worship just as I do. That building was about an hour & 15 min from our final destination so there was no chance to go back. I did look up on LDS.org & there is a branch in Copan Ruinas where we are but I wont be able to get their either but I did get to talk to the guys at the hotel desk about where the branch was & they asked about the boys who have the "black nametags" the missionaries!
Probably the best part of our new plans is that we are at a Clarion hotel - mind you there are 4 of us in a room but it is a much nicer hotel then we have been in! The electricity still goes out & the AC is a swamp cooler in the room, the water isnt very warm but it's an upgrade! We had our team dinner/party tonight...the food was delicious!!! and as a PACU team we got to just visit for a bit before heading to bed. Up not quite as early tomorrow breakfast at & then off to the ruins - I am excited!!!

Friday Night in Honduras - Surgery Day #2

This may be a short post as I am pretty tired. We had a full day of surgery & they added a 4th Surgical Table so we did about 20 cases today and a few of them were the ones that fit into the saying the PACU has periods of both calm & chaos & moments with alot of chaos. We had alot of that chaos today with some complicated cases but they all did GREAT in the end. The PACU team is great I am blessed to meet & then work with some amazing people.
We started the day in the post op ward & it was fun to see the kids who has surgery yesterday & how they looked today - especially my little friend Oscar who was the child with dwarfism & a huge bilateral cleft lip - he looked so good! Also some of the "problem children" from yesterday were just perfect today!
The Child Life volunteer Claudia was so wonderful to give us a heads up when she had some of the kids in pre-op so that we could see them there - Emily who was having a palate repairwas a darling little girl she was doing medical play with & Jennifer Lopez (yep that was her name) was another! Denis was darling in pre-op but gave us some of that chaos in recovery with some respiratory issues. I took some cute photos with him.
There was a very young mom who was so sweet & quite worried about her little girl, she held onto her dress & doll when the baby went into surgery & she waited outside the recovery room external door for her instead of near the pediatric room so I saw her when her baby girl was returned to her arms & it was one of those tearful moments. All she wanted was for her daughter to be "normal".
I am super tired & will blog again tomorrow. I got to skype call my family today & that always makes my day!!! I love being able to do this & use my gifts & talents to help others but I do miss my family whether it is one week or 2 weeks so catching up with ALL of them was a blessing!
Good Night from Honduras!

Honduras Day #2 - First Day of Surgery!

The morning came quickly. We had breakfast at 6 & a team mtg at 6:30 & left for the hospital at 7. I realized at breakfast that I didn't do a very good job of packing food on this trip especially when the eggs & beans for breakfast weren't really looking that great. I do have protein bars & peanut butter but usually I pack more. No worries I wont go hungry!
We set up the recovery room & surgeries started by 8:15 - it all went really smoothly. I was told that most of these patients are from the Western part of Honduras which is the poorest part of the country. We are at the top of Honduras very close to the Guatemala border. There were 15 cases today 7 lips & 8 palates plus some dental procedures. Almost all of the kids here have teeth that are rotted out - it is so sad. We just take dental care for granted in the US. The hospital is VERY old & dilapidated but they have some very strict rules that we have to follow - one is that we are not allowed to bring the parents into the recovery room after surgery to see their kids & comfort them. That makes for alot more crying in the PACU & also is a bummer to me because one of my favorite things is seeing the parents see their child with a beautiful new face for the 1st time. We had some tension as we started just different ways of doing things but it all settled out nicely by the end of the day. Our Pediatric Intensivist has flight problems & got here at 2 pm - she is fabulous & totally mended the local & international team communication challenges.
2 of my favorite kids from yesterday had surgery today a 5 year old dwarf boy with a large bilateral cleft lip - his transformation was nothing short of miraculous. He was all smiles yesterday - not so happy today but looks amazing!!! Also a little girl from yesterday who was such a cutie.
We were told it was the rainy season here but that is a bit of an understatement - it started raining about 3 pm & 8 hours later really hasn't stopped - thunder, lightening, torrential rain & power outages have been the theme of the day. In the recovery room we had a few leaks but the were manageable. Some part of the hospital were fully flooded & the store room in the OR has a tin roof & in there you cant even have a conversation. Also we were supposed to have 3 OR's but we only have 2 because last Sun the roof caved on on the other one...
We finished at 8:15 - not bad for the 1st day & it was still pouring & we had to walk a few blocks to the bus. I decided to use a black trashbag as my rain gear (picture to follow) so I put my very large backpack on, made a hole for my head & put it over me - I am not sure why I didn't make arm holes I just want thinking but I definitely provided evening humor for both staff & families as I walked thru the hospital & for the most part I stayed dry! Sadly there were people sleeping on the wet floors of the hospital hallways...again a reminder of how blessed we are.
I am on call tonight so no sleeping aids for me in case I have to wake up & function but typically that isn't the case. So I am off to be excited for 6 hours of sleep!

A LONG but WONDERFUL Day & Night!!!

The day started early with our 4:30 wake up call & we loaded the bus at 5 for our 7 hour bus ride to the mission site at Santa Rosa de Copan. We actually left closer to 5:30 & I slept until about 7:30 when we stopped for breakfast at what is normally a roadside fired chicken restaurant. They served us beans, eggs, fried plantains & tortillas...not the road trip breakfast I had imagined & my first reminder that this is a mission not a vacation :) Also the guard with guns outside the restaurant that was only serving our group was another reminder.
The drive was nice, the countryside is very green & lush but the poverty is very evident everywhere. There are little huts along the side of the road with people selling fruits just to survive & these little stands are all selling plantains, watermelon, pinapple & are all right next to each other - I dont know how you decide who to buy from? Small "shacks" that people live in varied from pieces of metal to wood or brick or cement. Laundry hung on lines & I am certain there was no electricity in most places. I did see 2 missionaries on the side of a small village we drove thru & that made me smile.
We also drove by some Mayan ruins, a lake & a national park. At those times I wish I had just a few of my sisters geography expert genes to know more about the area.
Our 2nd pit stop was at a gas station with a convenience store think Circle K by my house with the exception of a guard with a gun who opened the door to allow you in. That was at San Pedro where w had a fork in the road & we went to Copan & not to Sula (the murder capital) The guard was actually a nice young man& I took a photo op with him & my Coca Cola Light!
We had box lunches on the bus and arrived at the "hospital" about 1:30. Patients had been there since 7 am & all their photos were taken & paperwork completed. I thought it would be less chaotic but it want there were children & parents everywhere. 80 were screened and this time I did something I havent done before (typically because someone else does it) but the 3 of us from PACU drew all the labs on all the patients. Lori could get all the hard sticks & we got them all done. Basically we were the place that made every child cry - not the best for photo ops!
There were so so many precious children about 30 palates & we will only do maybe 20? Several lips & some revisions to be done. The people were so gracious & sweet. I didn't really get to interact or get "their stories" because we were bringing them in our tiny closet room 2 at a time & poking them - not the best for pleasant conversation. I am sure I will learn more as we go thru the week. There were 2 nuns there with 2 babies & I did go out towards the end of the screening & talk to them. Sister Paula is my new BFF - she is from Spain, has been in Italy, Haiti, Bridgeport Conn. USA & now Honduras. She with 4 other nuns have a home where they care for 28 babies from age 3 weeks to 4 years. Many are babies who have clefts or for other reasons are extremely malnourished. They also "pay" for 5 assistants to help them some very poor women who need to support their own families. She took us over to the "hospital" to see one of her babies who was sick & getting an IV that they cant do at their home. Th baby was a year old & weighed 8 lbs - it was heartbreaking. I was so touched by her happy spirit & love. I asked her how I could help her help the children. She said that the hospital has no medicine & they ask the sisters to get it for them when they need it & right now there was a baby with a temperature over 104 who was convulsing & they needed tylenol...REALLY...TYLENOL??? I asked to see the baby, taught them some cooling measures & immediately gave Sis Paula $$ to go get tylenol. She had to wait for her driver (so I guess it is dangerous here - I was hoping she could walk to a store real quick) Once we had that done I asked her what she needed & she said right now they were low on milk & powder (formula). I told her about my friends the Smiths & Coles Compassionate Community & that yesterday was his ANGELversary & since I wasnt there for the candles at the beach I promised I would do something else & I knew this was what I was supposed to do - help Sis Paula & the children she was caring for. So I gave her money from me for Cole & from a sweet friend who gave me money before I left. It was not hundreds of dollars but would take care of their needs for a month she said... a month of milk and formula to help these children get fed. She said the goal is to get them to thrive and maybe give them back to their parents but she said in addition to not having food "some people have poverty of the mind & cannot care for these children so God needs us to help"
Needless to say my hour or so with Sister Paula was the highlight of my day...if I do nothing else I will have made a small difference here; but hopefully there will be more to do - for certain the surgeries that start tomorrow....as in my wake up call is in 5 hours so I need to get to bed.
The internet was out all day today so I didn't get texts or emails on wifi and didn't think I would be able to blog then 45 min ago my phone made some noise as the internet came back on. A little tender mercy so I could let my family & friends know about my day via my blog & a few other FB posts & instagrams. I am so blessed to be here & know when I serve others I am only being an instrument in Gods hands to do His work for His children. Off to bed - tomorrow is a busy surgery day & we haven't even set up the recovery room yet!       

Made it to Tegucigalpa

Well I arrived in Honduras safely after my flights. I was able to sleep about 3 hours on the SLC-ATL flight but since we arrived at 6:20 it was really 4:30 am Utah time so I was still a bit tired. I made my way thru the ATL airport - its HUGE & has been awhile since I was there - it seems more like a GIAN Mall....I landed in terminal a & took the train to terminal E & since it was about 3 hours before my flight there was no one at the gate so my backpack became my pillow & I napped a bit (airport sleeping tips from Ryan & Kya). There were 4 other Op Smile team members on my flight to TGU. The flight was pretty empty - I was in an exit row by myself & after watching 2 movies we arrived! I got thru immigration & customs without any problems - I do think the Op Smile Bag tags help! Met up with our group, exchanged money & we were at the hotel by about 1 or so.
When they say "it's a nice hotel" you have to take it in context...nice in a 3rd world country. The rooms are what I would guess the inside of a motel 6 is like (I haven't been to one recently & thankfully) - not bad but the property is actually quite nice with patios & a pool area. I ran into & visited with Lori (4th mission) & Valerie (on her 7th mission) the other 2 Recovery Room nurses, so we have great experience for our area. Afterwards I came up to my room & took a good hour nap, shower & felt like a new person for our 5:45 pizza dinner & Pre Screening meeting.
We drove a short way to the Honduras Operation Smile Surgery Clinic that was opened here in 2007 - the 2nd fully operational clinic in Latin America. It is very nice & they do 2-3 surgeries here every Wed. Dr. Oscar Sarmiento is the surgeon at the clinic - I have been on 4 missions with him - he's great. The REALLY nice thing about the clinic is that those heart breaker patients that we see at screening & have to turn away wont have to wait 6 mos or a year until the next mission here they can go & get care in the clinic. That is the sustainable change the OSI establishes in may countries.
There are about 18 of us "international volunteers" at the hotel & the rest are from Honduras or neighboring countries. Its a small team compared to others & that will be nice. Since I have been on 5 missions in South or Central America there are familiar faces & reconnecting is always fun. The goal is 40-50 patients or about 15 a day - 5 per table/surgeon.
On arrival we were told again that unlike other missions sites we may have been to Honduras is not safe for tourists even for us to go out in groups - so we will be a little bit hotel bound except for team events which is fine with me. Every building has barbed wire on it. The mission site in Santa Rosa de Copan is actually a 7 hour bus ride away!!!! I think it could be 6 hours but we have to go the "long way" as there is a bridge that our bus can't pass over. That town is safer but still we aren't to go out. I guess the airport in San Pedro Sula is only 3 hours from the mission site but hey had us flu in here because San Pedro Sula has the highest murder rate in the WORLD!!! Things not to tell your mom....
My roomate Therese should be here anytime. Her flight arrived at 9:40 & then I am quickly going to bed cause we have a 4:30 a.m. wake up call & a 5 am departure & start to our bus ride. We will stop for breakfast, eat lunch on the bus & then go straight to the hospital to start screening at noon. Some of the local team is already there starting the paperwork, photos & labs & when we arrive we will set up all the other screening stations & move people thru. Then in the evening we will set up the hospital. So we are planning on a long day/night & arrival at our next hotel close to 10 pm or so.
That is all I know for now...I am happy to be here & excited to see the precious children of Honduras tomorrow!

Headed to Honduras...like right now!

I am sitting on the floor of the Salt Lake City airport waiting for my 1:07 am departure (yes that is not a typo) to Atlanta on a full flight (really!) that will then connect to my flight to Tegucigalpa Honduras. I am so excited & feel so blessed to be going. My new responsibilities at CHOC have made my schedule & life quite a bit busier the past 3 months. I was so busy that I forgot to even "sign up" or give availability for any fall missions. Typically mission teams are configured and organized 2-3 months in advance and for every mission there are MANY volunteers for each nursing position. I finally signed up on line but alot of the teams were already finalized. I reached out to some of the Program Coordinators & they said they would circulate my name. Miraculously I was offered the opportunity to return to Guatemala in Nov. & was so excited as the Op Smile Guatemalan foundation have alot if input on the team selection & they remembered me from when I was there & offered a spot to me. I tentatively said yes but when I asked my boss - she reminded me that we had our HUGE Unannounced Joint Commission visit sometime in Nov. I was devastated...these missions are what connect me to "WHY" I became a nurse...a pediatric nurse...to have a positive impact in childrens lives. I know I make a difference at CHOC but as an executive it isnt the same as giving direct care. Having to turn down that mission was really hard for me - I understood I was needed at CHOC but my heart was broken. SO I asked again if there were any needs & I was invited to go on "rotation" to Rwanda where they dont do alot of surgeries but they do alot of teaching - which is right up my alley. That was in Oct so I was hopeful BUT...it was 2 weeks & it finished just as I needed to go to Dallas to speak at a conference & I knew I couldnt be gone for 3 weeks. I asked that my name be put as available for "last minute needs" & a few days later got an email for this mission to Honduras. I called 2 hours later & in the 1st come 1st served approach - the position was already filled. Just about the time I was ready to give up on being able to go on a fall mission I got an email the next day that they needed one more Recovery Room nurse in Honduras & was I still interested...YES, YES a 1000 times YES. I already had most of this time off to be with my sweet friends on their sons "Angelversary" and move my girsl to BYU so I called all of them & independently but unanimously they all said GO!!! So I called my boss & asked her for a few more days off & she said ABSOLUTELY. That was all on Aug 13th. So here I am 12 days later packed & ready to go. When we are ready & willing God finds a way to use us to bless others - for me right now I get to bless others in Honduras.
This was supposed to be a "local mission" with all the volunteers coming from Central & South America. The unrest there has causes some of the volunteers to not be able to go there so now they have about 20 volunteers from the US & other countries coming in to complete the mission. It will be a smaller mission than I am used to. Only 3 surgical tables (instead of 5) and only 3 days of surgery. But for me it is PERFECT. One of the OR nurse & I were together in Kenya on my 1st misison and the OSI photographer was with me on a few missions & one of the plastic surgeons from South America is familiar too...so I will have a few old friends & make some new ones.
I didnt read the fine print in the information they sent us that mentions Honduras isnt really a very safe place & that we should "not leave the hotel premises without the Op Smile Program Coordinator". Guatemala was dangerous & I didnt fully realize it. I guess Honduras may be a little more dangerous? But OSI is always ver cautious & I have never felt unsafe..so I am not worried & I know I will be watched over & protected.

They are calling us to board right now...next post will come from Honduras!

    

Friday in Paraguay

How embarassing is this....months later I am finishing up my blog from Paraguay. Luckily I write notes as I go throughout the day so I can blog later. As I read the notes now I am amazed at the recall of these people whose lives mine crossed for a brief moment but they have changed my life forever.

Fridays or the last days of missions are usually less busy, typically no palates as the team would not be there for any potential problems in the next 48 hours. We got our T Shirts & took our team pictire in front of the hospital. As the most "senior" nurse in the PACU I did evaluations on all the local nurses. I got input from Brooke & then sat down with each of them. After things settled down we all worked quite well together & really they could probably do an "in country" or local" mission next time.

We did 17 patients total today & 5 cute babies. I took a photo of another sweet, sweet dad with his baby girl 8 months old Dani. This was another situation where the mom had rejected the baby wheb she was born with a bilateral cleft lip & the daddy took her & cared for her. The mom was not at all involved. He was so sweet - he told me he has to be the mom & the dad & that she is such a blessing to him. Well that of course made me teary. I hugged him & in my broken spanish told him he was a "papa muy bueno". He works an hour away from where he lives & his sister helps him with Dani. It was such a tender scene.

We also did a little spitfire 3 year old with a cleft lip - her name was Luana but we called her "little blondie" she was beautiful. She was atwin & her sister had a cleft lip & palate repair at this mission site last year but Luana was sick at the time & couldnt have surgery...but...good things do come to those who wait & she got her surgery this year. Her mom was very teary when she saw her & said "now she is pretty like her sister" :)

One of our last patients was #348 Victor a 16 year old who was just screened YESTERDAY after someone told him OSI was here & he got surgery today - talk about great timing! His mom called him a "blessed boy" & tolsd us "gracias para todo" & "you are Gods hands". He woke up very quickly & was super hungry - just as any teenager would be!

At the end of the day we packed up & all of a sudden I noticed a bunch of LDS missionaries helping us pack & move the boxes. Apparently 40-50 of them were here the 2 days before we arrived unloading all the cargo...the locals said they had a "Mormon Army of Missionaries" I took a photo of the 2 Elders helping us - one from Utah & one from Idaho & emailed the photo & a quick note to their families.

When we got back to the hotel I took Elaine to the Paraguay temple to check in - yes my VERY BAD & VERY BROKEN Spanish got us a cab, got us there, we found the temple patron apartments where she will stay, dropped her luggage then went over & wa;\lked around the temple grounds. Its amazing that no matter where you are in the world you can feel the beautiful spirit of the temple as soon as you set foot on the grounds - it was wonderful & a swwet reminder to me that these missions are part of Gods plan for my life.

We gor back just in time to change for the final party - it was at a "clubhouse" an hour away - it was nice but I was tired so after about 2 hours of fun a few of us took a cab back. My flight in the morning us super early so I have to be on the 5 am bus back to the airport - it is still going to be a short night!

I continue to be so grateful for these opportunities to serve these sweet wonderful children of God in different parts of the world...I am blessed!