Last Day of Surgeries...Headed Home in the Morning!

It is almost midnight here & I have to be in the lobby at 4:30 am to head to the airport for my 7 am flight but if I dont blog now I never will - I just dont blog after I get home - too many other things competing for my attention & to get caught up on!!!
I went straight to the bus this morning having one of my protein bars for breakfast. Lisa my post op friend didnt come today - she is really sick & miserable - it may be strep & Eva in the PACU with us may have a Cocksakie Virus...so my not feeling well on Tues/Wed was very mild in comparison.
Since Post Op was down a nurse Erika & I went & did vital signs & assessment on all 20 patients from yesterday. It was nice to see them 12 hours later all ready to go!
Today was supposed to be a shorter day - we had 16 patients instead of 20 & some were older teenages & even a few adults who would have local anesthesia & not need to stay - we finished about 4 & then packed up. For lunch they surprised us with Nactamales (Nicaraguan tamales) they are very similar to other types of tamales but have rice in them along with a meat & are wrapped and cooked in bananas. Truly this was the best lunch of the week! Supposedly you can only buy them on Fri/Sat/Sun?  They were yummy!
We had two patients today who were both 3 year old "Frenulectomy" basically they are "tongue tied" & its a little "snip" to take care of it. Neither of them thought it was a little thing!!! They were both off the chart wild!!! One little girl was kicking & screaming let me go as we waited for her mom to come in & tried to keep her from pulling out her IV the other little boy was so out of sorts we actually sedated him a bit & he woke up much happier - which is not uncommon. I have always said I love 3 year old but these 2 tested that a bit :)
The 3 year old boy was a blone haired very caucasian looking boy Dilan - he did have a bad rap for not playing nice with the other kids & even the staff but as I have always said...everyone has a story even a 3 year old & when you really listen you understand more & judge less. His dad is German I left Nicaragua before he was born. His mom was an alcoholic & smoked alot & had no prenatal care & didnt want a baby so I dont know the specifics but he was adopted by a woman who is 39 now & has 4 grown children 19-25 (yes she has her first child at 14). According to the Child Life Specialsist he could have had Fetal Alcohol Syndrome which would account for some of his behaviors. He may have kicked me once ot twice as he was struggling to be free from the IV & medical equipment but after he woke up the 2nd time he was a different boy - he even blew us kisses as he left the PACU. That's the Dilan I will remember & the wonderful woman who adopted him.
We have had 3 students from HOLA helping us every day this week Belkis is 18 & I seriously wanted to bring her home with me!!! I spoke to Megan who helps at HOLA as after talking to Belkis I was so confused. She has been at HOLA since she was 4 & she has 2 siblings there (that made me realize I couldnt bring her home) But she also has a mom 5 hours away & 2 other siblings. She sees her mom once a year. Megan says there are many kids on the street & the version of Social Services gets them to a "rehab" & then tries to get them home but many are "social orphans" with no where to go, Getting into a orphanage is a "privlidge" as then you are cared for & have a good chance at a positive successful life - especially at HOLA. I cant imagine parents not wanting their children, I can imagine them being unable to provide for them & thinking that giving them up is giving them a better future...again either way it is sad & really Belkis & the 2 boys were AMAZING teenagers for all they have gone thru in their lives. Belkis asked for flip flops for 3 little girls at the Orphanage - I had 3 matching pairs left & gave them to her :)
Throughout today I intermittently during the week we have felt SUPER TIRED in PACU - Erika even thought she mistakently took Tylenol PM one day - today we decided that the ventilation in our room really wasnt very good & it may have been that we had a accumulation ot the Sevo (sleeping gas for surgery) in our area...I really think that may have been the case!
The final party was at the hotel which was great cause I wanted to go but not stay late so I could come back & pack etc. The final parties are always great - people you didnt know 10 days ago are now your dear friends as you have now spent ALOT of time with them working side by side in an environment no one else would completely understand. So fast friendships are made & it is always wonderful to reunite with past friends from other missions too  for me that was Erika & Lisa :)
And just like that it's over....back to "real life" the "real world" and all that includes - some of which is wonderful - like being back with my family & other of which seems tedious & trivial after having been in an environment like this for 10 days. A nurse here on her first Op Smile  mission said it well - the working conditions may be challenging & the medical care not acceptable to anyone in the US & for these kids it is a small moment in time they may or may not rememeber depending on their age but I am in AWE of these parents who are battling against all odds to get their children help & trust in people they have never seen before who speak a language they dont understand - plus they do this with unwaivering composure amongst the occasional confusion and express gratitude for care & circumstances most people would complain about.
As for me I am here to help in anyway possible, anywhere needed to try & make a difference - sometimes that's at home right in Trabuco Canyon & sometimes its in far away countries but no matter where I am always grateful for the opportunities & changed by the experiences & this trip to Nicaragua was just that.
Tomorrow I will fly home, eat & drink whatever I want without worrying if it will make me sick, shower with warm clean water, sleep in a house on a comfortable bed, drive a car, have a clean bathroom, turn on heat or air conditioning and rememeber that is not the case in many places in the world including the USA...I am blessed beyond measure.  

Thursday came quickly - is tomorrow really our last day of surgeries?

Today I was able to manage the 5:30 am wake up call & be ready to leave just after 6:30.As we drive to the hospital each morning I see many children in school uniforms walking to school & other children not in uniforms walking on the street or sitting outside "houses". I asked the local students today if all children can go to school or are these private schools. She said all children can go to school but the parents have to have the money for the uniforms & supplies. Some children do not go to school because either their families do not have the money to afford those items or else the parents need them to work - either option was pretty sad to me.
So I still don't understand the guard at the chain link fence around the hospital who lets us in each morning & locked me out that one day...there are literally families talking to other family members or friends thru the chain link fence & passing items back & forth - it is so perplexing - I need to figure that one out???
Before going to the PACU we went over to the Post Op ward to see the patients from yesterday. My sweet friend Yarlin & her mom were there & waved me over. I gave them both hugs & took some photos with them before they were discharged today. SO crazy to think I did not even know them 24 hours ago & that I will never see them again & yet I have such tender love for them. The ambassador from Nicaragua came bu to see us "in action" after being so moved by seeing the patients at the shelter that day - I did have a a photo op with her in the hallway! 
Sadly each day we have to "re-set up" the recovery room because if we left out all of our supplies they would be gone by morning...we have a great system though..we put it all on a bakers rack kind of cart & wheel it into the locked storage then wheel it back in the morning & set it up.
 As soon as we were set up we were told that a patient from Tues had returned with some bleeding & they were taking her right into the OR,,,she was in the PACU by 8:30 & was NOT happy, her IV came out & she was  fussy etc. It was an ordeal to restart her IV - her poor mama was so patient. I don't think she got a dress before so with round 2 she got a dress & flip flops!!!
I also had one special dress made by a girl at my church & was waiting for just the right patient & today I gave it to a little 3 year old Maria Hernandez :)
We had our daily 90 min of chaos between 10:30 & noon when several palate patients came back all about the same time. We got 4 patients back within 30 min of each other & 3 were screamers - one baby would not be consoled by any of us, by mama, by eating etc - I really think that crying babies make other babies cry so she was stable enough I had the students take her to post op & they said she settled down en route. We are sharing the recovery room with the hospitals patients & this morning there was a 80 year old woman in there after some sort of surgery & she seemed quite ill -when she started to awaken to all the babies crying her eyes got SO BIG & she looked so distressed...they moved her out fairly quickly as well.
There is a young plastic surgeon here Jordan who has a full time clinical job at USC Keck School of Medicine (where Ryan is) but 50% of his clinical time is here in Nicaragua doing research on clefts. He & his wife & 2 1/2 year old moved here -that is quite an adventure! He did his undergrad at Harvard, Medical School at John Hopkins, Residency in Seattle, Fellowship in Philadelphia & now is at USC  -he's a pretty smart guy & SUPER nice - you don't always get that in a plastic surgeon!
We had some more parents with tears of joy -one little boy had a very simple & small cleft lip & the repair was perfect!!! His mom was so so happy & overjoyed.
I am almost done giving out all the clothes - I tell the parents or children they need a new outfit for their new smiles!!!
Our very last patient today was a teenage boy & his dad was with him - his dad kept telling Alec over & over how grateful he was for us, what a blessing we were, how happy he was....we just said it was our pleasure & honor to be here & he tapped his chest & said we had large hearts & he would remember us & love us always...I am overwhelmed by their humble & sincere gratitude...we are in a 10x10 humid area with no running water, we have 4 gurneys as beds with old torn sheets (except the ones we bought) there are flies around at times, we have minimal "modern" medical equipment, the kids are having surgery sometimes in their own clothes with their shoes on, we don't speak the same language & can't talk to them very well, etc etc and yet to them we are providing them with AMAZING medical care & they appreciate every little thing.
Sometimes when we have much we still want or expect more - not that I am suggesting we need to have substandard medical or other conditions but just that perhaps people (including myself) could recognize & be grateful for all we do have & less critical when we don't get exactly what we want & not always want more....just a lesson I have learned from these sweet people.
We actually had only a 12 hour day today & were done at 7  -that was unexpected as today was supposedly our "heaviest surgery day hours wise". Everyone is pretty tired & a few are a bit under the weather so while some people went out to eat but we just ate at the hotel & it wasn't bad at all.
Yet again I cant believe that tomorrow is our last day of surgery then packing up & the final party. The last 9 days have gone quickly, as I have repeatedly said - while we are changing lives one smile at a time - I am being changed by these children and families one patient at a time. I always leave a mission a much different person that the one I was when I arrived - my life and my heart and my spirit are forever changed by these experiences with the patients and families, and here also with the members of the LDS church I met, with people I have briefly interacted with (like the taxi drivers etc). I cannot believe that I am able to use my gifts & talents as a nurse in this way. If you had asked me 10 years ago if this is what I thought I would be doing now I am sure I would have said no..but God often brings us to wonderful places we could have never planned on going ourselves.
Well despite getting home early it is again almost midnight...time for bed & as much as I love what I get to do here I will be excited to be home & back with family be the end of the weekend....   

Wednesday 11/11/15 - Veterans Day in USA - Surgery Day #3 in Nicaragua

Wednesday is always "Hump Day" on a mission so that is always bittersweet  -nice because by about Wed I am typically pretty tired & today was nor exception & a little sad as you realize how quickly the mission's coming to an end.
I really didn't feel well yesterday but I just powered thru is. I had a horrific headache & felt crummy. I took Tylenol, Advil & drank lots of water. Last night since it wasn't too late when we got home Erika, Lisa & I went to "the port" for dinner. It is where they had gone Sat night & I wanted to see it - it is a  little area near the water (a river I think) that drains into Lake Nicaragua. even thought I felt crummy it was just what I needed to be outside with fresh air & we had a nice meal. It is a "tourist" type area with lots of restaurants.
I had allot of work emails to catch up on so that I don't come home to 1000 & did a short blog entry & it was 1 am. When the alarm went off at 6 am I was still not feeling well so I called Kim the coordinator & asked if I could take a taxi to the hospital in a few hours since PACU didn't get patients until typically after 9 - she was great about it & I called Erika too & she was also fine. The extra 2 hours of sleep were just what I needed & well worth the $6 taxi ride.
I got to the hospital about 9:30 - they had only gotten one patient in the PACU so I really didn't miss much & Erika had actually taken a little nap on a  gurney :) They were happy to see me arrive & I think they missed my oximeter, thermometer & purell more than me - LOL. Great purchases on my part! It was a TOTAL Baby morning -we had  a 5, 6,7,9, & 10 mos olds go thru on the first 2 rounds. One baby was VERY fussy & obviously hungry but would not take his formula & the dad told us it was because they added SUGAR??? He added at least 2 tbl. of sugar to a small bottle & the baby sucked it down. Maybe this is a common practice & why so many of these kids have rotted out teeth - the sugar & no dental care, tooth brushing etc. It is very sad. Yesterday I had a patient & they said she had 5 teeth removed - then restated it as well 4 just fell out & one was a decayed molar & it was removed. Despite a great deal of mission & compassionate work here by many organizations there are some very fundamental needs.
By 11 we had total chaos in the PACU - which is pretty much the standard at times. One palate patient with some bleeding who was also a difficult airway & needed some breathing treatments & suctioning & probably had an underlying "syndrome" she was a sick one for a few hours but with lots of interventions go better after awhile. We also had a 5 year old autistic boy who had lip surgery & some eyelid surgery - he was a little pistol after surgery & his poor mom is 8 months pregnant & it was hard on her to handle him & the challenges of surgery. At one point we had 4 busy patients & handed one baby to Jorge - one of the male high school students to hold for about 15 min - he did well!!!
One of the Op Smile Nicaragua board members brought in donuts from a store called "American Donuts" they were actually pretty good but I thought the name was humorous...I don't think there are Nicaraguan donuts???  This of course was in the middle of our chaos & someone from the hospital came it to tell us we couldn't eat in the PACU-which we knew...we were just keeping them there because if we put them in the common area they would be gone & we would never see them. I finally said - I promise we wont open the box but right now we need to take care of these patients. There can be flies in the room, gross things on the floor etc but our donuts were the focus?
My most memorable patient of the day was Yarlin - she was a 9 1/2 year old little girl who traveled far to get here & actually was screened on Sunday - the day after our big screening. I did not see her before surgery but apparently she had a very unusual side cleft lip that didn't allow her to open her mouth well & it also caused a facial deformity & impacted her cheek which was concave. Jordan one of the surgeons wanted to do this case & wow!!! did he do a wonderful job - he corrected the cleft & did some liposuction from her tummy to build up her cheek. When she got to me she looked so good - especially after her mom showed me a photo of her before. Her mom truly wept with joy when she saw her daughter & she grabbed my hand & pulled me to her side of the gurney. Her mom gave me the biggest hug & said how we blessed their life & were an answer to their prayers...it doesn't get much better than that!  I had given my phone to one of the students who captured it all for me & I posted the photos on social media. Her mom said her daughter was teased & shunned & now would have a "normal life"...all because a group of people came together with a common goal to help children with a wonderful organization that has the infrastructure to cause these experiences to happen all over the world.
A few other Nicaragua mission memories I want to record...Operation Smile has been doing missions in this country for 20 years & will be opening a center here soon where kids can get help in between the every 6 month missions. It may be Veterans Day in the USA but since they don't celebrate Thanksgiving here Christmas is already in FULL SWING...at the restaurants we have gone to there are Christmas trees & garland & lights. Tonight at the hotel they put up a Christmas tree. The locals say that Christmas is really a 2 month celebration here. Nicaragua is apparently now the next "retirement area" for US folks after Costa Rica - there are over 350 small volcanic created but beach front islands that you can buy & build your retirement home on - any takers?
Also the hotel key once used to open he door goes in a box inside that controls your AC (really a window swamp cooler) & controls your lights so when you get back to the room is it HOT - then cools off but when you walk in the hallway it is like a sauna. I have not had a roommate as that person went to the Estelli Mission site but I may get one tomorrow night as they are coming back here for the final party. while I love to meet new people it has been nice to have a room to myself :)
Another Op Smile Nicaragua Board Member I met when I was gatekeeper at screening was Jaffa  -she is from the US but came here with the Peace Corp for 3 years, met her husband here & now lives here with 3 darling girls. Her 14 year old daughter totally saved us during screening as our interpreter. They go to an American school here & are very well off - they have several "house helpers", a few "drivers" a "house manager" etc. Her husband owns many of the cell phone networks here (and truly there are more cell phones than toilet in this country - everyone has one) & also some plantain farms. They are very well to do with homes in the US as well but truly she & her daughters were the most kind, grounded individuals who truly offered compassionate care to the patients & kind assistance to us-I haven't had that same exposure to the "very wealthy" in the USA actually choosing to themselves offer help to organizations or people. Yes there are galas & fundraiser but they were there that long day & have come back many other days to help. I have learned a great deal from them about service & kindness.
The good news is there is a flushing toilet at the hospital the downside is there is no toilet seat & you can't flush toilet paper but at least there is a "squatty potty"! Clearly my standards on missions are low!   
Another AMAZING helper here is Alec - he is the grandson of the McGee's (founders of Op Smile) & just graduated from high school & is spending his "gap year" doing service some with Op Smile & also with other organizations. He has been in Nicaragua for 10 weeks & spent the 1st 3 at an Orphanage teaching English, Sports & Computers & he himself learning Spanish by immersion. The Orphanage is called HOLA - Helping Orphans in Latin America & was started by some women in Virginia Beach VA. They have 50 kids there from infants to teens. Last year they had 5 who graduated from high school & all were accepted at the Nicaragua University here..it sounds like a wonderful Organization & Alec has brought his "friends" some of the 16-18 year olds from the orphanage to work with us here - they are great bright kids! Alec is also pretty impressive - the kindness & compassion he shows our patients goes far beyond his 18 years. He is the oldest of the 15 McGee Grandchildren - the next generation of Operation Smile - I am thinking they are in good hands. As we talked he was at Mission Training & remembered Sarah & my talk (really the candy I gave out during my talk) on Oral Re hydration - such a small OSI world!
I have been giving out Lots of dresses, outfits, T Shirts & flip flops & families are so grateful - I wish I could transport the friends who gave me all of these items here so they could see the joy they are providing first hand. IF I have anything left over - because sometimes when its crazy in there I forget to pull it all out...I will give it to the HOLA Orphanage.
I got to facetime call some of my family tonight so that was nice & now its time for bed - I need to be ready for a full day tomorrow. No matter how tired I am of crummy I intermittently feel - I LOVE this humanitarian work - it is part of who I was meant to be of that I have no doubt.  

Tuesday Surgery Day #2 - It was all about the Parents....A GREAT DAY!!!!

What a great day!!! and not just because we actually finished at 8 pm - yep only a 13 hour day at the hospital....but just because we are making a difference in so many ways and today I really saw the day & our work thru the eys of the parents...
SO MANY grateful parents who were humble & grateful for little things like a cup of juice or water when it was apparent this was a long day for them with their child in surgery, or the gratitude & joy they had when I gave them a dress or outfit or flip flops or a t-shirt, or the gratitude when despite how incorrect it was I attempted to talk to them in spanish, or their pure joy when seeing their child for the first time after surgery with a beautiful new face, or the look of love in their eyes when I held their hand or put my arm around them & made a connection as they got emotional, or their sense of peace  when there was a problem or their child was crying & we helped them to understand it was all going to be okay, or their amazement that everyone here came to help their child that no one knew before we arrived, or the gratitude when we brought them into the recovery room & told them their child was out of surgery & doing fine, I could go on & on. I have felt this before & probably blogged about it before but the love of parents for children is universal...we all want the very best for our children whether it is related to health, spiritually, socially, emotionally, financially, physically or here in Nicaragua and at home...getting them needed medical treatment. I could have been any one of those parents today and I saw the day thru their eyes....
There were 2 very sweet single dads who were here with their kids - the moms had left them when their child was born with this defect and the dads were truly AMAZING & nurturing and brought tears to my eyes as they cuddled their babies. One of the last moms I brought in was so overjoyed when she saw her 6 year old repaired lip that it lit up the recovery room.
We may surgically fix the smiles of the children but then when the parents see their childrens their own smiles get brighter...I am so blessed to be a part of this process.
There are all sorts of other little details I could blog about that would probably be interesting (and I probably will include them in another blog post for my memories)....the hotel room, my horrific headache, the wonderful student volunteers, the gross toilets, the non edible food, the heat & humidity etc...but today it was ALL ABOUT SEEING THE DAY THRU THE PARENTS YES & not thru my eyes & what was going on with me or how I was feeling or what I was experiencing.....it makes me appreciate my parents & all they did for me, makes me grateful to be a parent & for my wonderful husband & children, lets me see my siblings as parents and my neighbors as parents. It reminds me that all of us who are parents all have so many universal feelings & we really can help & support each other thru challenging & joyful times because as parents we do somewhat understand the love we have for our families & children.
Again it is midnight - wake up at 6 am - good night and love to all my family & friends & please lets remember to sometimes see the world thru others eyes even if just for a day in a far away place or at home.  
 

Really Quick Post - Monday First Day of Surgery In Managua!

This is going to be a quick post & perhaps some things I can save until tomorrow but it has been a 18 hour days since I got up, 16 hour day at the hospital & I have to get up in about 5 hours from now. But there are a few quick things to share & remember!
The first day is always a slower start...we had to set up the PACU all the OR rooms have to be checked & surgeries started safely in one room at a time. Plus we do a mock code to prepare for emergencies. So while we got to the hospital about 7 the first patient was on an operating table about 9:30 & in the recovery room about 11. At first it seemed like for us it was going to be "boy day" as the first 6 patients were all little boys...but that was being balanced out by births at the hospital & the babies were brought to a room next to us - 5 girls & 1 boy born at that hospital in Nicaragua today!
It was ALL I could do to not ask to hold them!!!
we did start getting some girls & overall I was able to give away some dresses, some boy outfits & flip flops & CHOC T shirts....the patients & parents loved the gifts.
There was a small orthopedic team here from Wisconsin doing orthopedic surgeries. 6 of them come here twice a year...it is wonderful to see so much goodness in the world!
I found out today that Kim the Program Coordinator of this mission will also be the Program Coordinator of Sarah's mission to Peru in May!!!
When at 2 pm we realized we had only gotten 25% of our patients back we knew it was going to be a long day but we all expected that...but maybe not this long??? As is often the case we went from  quiet 1 patient in the PACU to 4 patients & total chaos - one vomiting, another bleeding, another fussy & one family that is from a far away tribe & spoke Mosquito? so we couldn't really communicate with her..just a typical mission day! We did a total of 20 cases whihc we will do each day or 100 patients this week. The site in Estelli will also do about that same # & in fact herr in Managua Op Smile sent 23 patients to that site today that we couldnt do here. It is a 3 hour drive but I am sure none of those families were bothered by that....we could not offer them suregery here but were able to offer it to them there & provide them the transportation. I am pretty sure thay all had a GREAT DAY with that news!
I am always surprised by the "specific rules that each hospital has...here we had to take patients on an "inside wheelchair or gurney to the exit door of the Operating Room area & then change them to a different wheelchair or gurney for the rest of their ride to the post op ward??? we figured it all out but is was initially a challenge!
This time difference while not much has still not made ti easy to connect with my family as I only ever have service at the hotel so before we leave early in the morning & when we get back & I am tired...Hoping to catch up with them tomorrow but for now I need to sleep!

 

Day #1 of Surgery!

Monday

Such a WONDERFUL SUNDAY & really the main part of the mission hasn't even started!

Where to begin....we left the hotel at 7:30 to get a tour of the hospital & a sense of who will be where & to go "set up" our areas within the "hospital"-mine being the recovery room - PACU. Our PACU area didn't look too bad until we were told we would get about 1/3 of the room while the hospital used the other 2/3 which is a potential challenge but on a mission you just work with whatever you have. We started going thru our supplies but were told we couldn't really "set up" until tomorrow morning so other than checking crashboxes & seeing if the typical PACU supplies were there we couldn''t do a lot. The PACU space was tight for 4 gurneys & I am a visual spatial person so I moved the gurneys around to be more of a U shape in the room & we all think that will work & will give us some floor space for walking etc - we will see. Space design is becoming a new skill for me:) I have also realized that after 10 missions there are some things you just roll with like no running water in the PACU, people with respirator masks on coming in to fumigate the room but saying its ok to just leave for a minute & come back in, etc.
The OR was really the only area that could totally set up, the Pre Op & Post Op areas couldn't do much either & they are kind of spread apart. I had a few flashback moments as I saw a nurse typing a report of a typewriter - yes they sill exist!!! Photo to follow-no Electronic Health Records here!
Since the plan was for the team to go to the patient shelter after set up & we were waiting we walked across the street to where we can buy diet Coke & got some - well we did have to go past a guard & gate to get out but didn't plan that when we got back the guard would be gone & the gate flooded with people & we could not get back in....only for about 10 min when one of the OSI coordinators came by & had someone let us in - note to self do not leave the premises during the mission you may not get back in!!!
We got on the bus to go to the Patient Shelter - the US Ambassador to Nicaragua was going to come by & they wanted some team members there & we were going to have lunch with her.Lisa, Erika & I had a great little chat with her & later her photographer asked if it was ok if they used our picture on the Managua or Nicaragua Consulate Facebook Page-we of course agreed - no royalties required so if anyone finds the page & the photo go ahead & tag me!!!
At the patient shelter I FELL IN LOVE WITH MILAGRA (no need to be jealous Doug). She is 1 month & 3 days old & since she is not eligible for surgery we didn't see her at the gatekeeper station on Friday-with the long wait they left. Her mom is 18 & her grandma brought them here to get Milagra help. She was SO SO TINY & no more than 5 lbs I bet...I saw her in her moms arms & went over to talk to them. Lunch was being served so I offered to hold her so the 2 of them could get in the line & eat & I promised I would stay right there where they could see me & they kept watch to be sure I didn't go anywhere! I found out they live on a little island & took a boat & bus to get to Managua over several days. Because the grandma brought them here she was fired from her job. when they found out Milagra couldn't have surgery they wanted to leave ASAP to see grandma could get it back but they convinced them to stay one more day so that a molding appliance (kind of like the tip part of a retainer) could be made so she wouldn't put her tongue in the palate opening & cause it to get bigger & more importantly so that she could eat better & gain weight. The local volunteer dentist came over to the shelter on Sunday to make the mold for her - she was truly a lifesaver to this little baby. The molding seemed giant for her little mouth but it fit & I gave her to mom to feed her because she is the one who needs to know how to do this each day. Little Milagra drank 1/2 a bottle so quickly - I think she has been hungry for a month! Typically a baby like this would be followed up every week but because they live so far away she will need to come back every 3 weeks for a new molding. I talked to the person in charge of the local clinic here where she will go & asked if I could help with her transportation for the appts & also with some formula again with some money from a kind friend. we talked to the mom & instead of giving her the money the clinic person will keep it & each time the mom comes she will give her the money for the full transportation at the appt. They said that will keep the mom coming to the appts which made sense.
At the shelter they had a party for the patients with 3 pinatas & games & coloring etc - just doing all the things that kids all over the world like - having FUN!!! It was nice to see them like that :) BUT boy was it HOT outside!!!
We got back to the hotel about 3 so it had already been an 8 hour day. On our way back there was a man walking to all the cars begging & he came by our bus. He literally had an odd shaped basketball  size tumor or mass of some sort in his stomach with an open wound...visuals like that always cause me to pause...why cant he get medical care or some kind of help? Jordi who is with OSI & from the US but covers part of Central America says that there aer many reasons...the government health care has wait lists for everything, even if you do get treatment before you can come if they think you will need blood a family member has to go & donate blood & they will also give you a list of everything you need for the hospitalization & you have to go & buy it before you can get the care - including IV fluid, meds, dressings etc - so financially most people cant afford even the hospital care provided by the country - such a sad thing compared to what we have & what people complain about....
At 5 pm I met Sis Solbalvarro & her other daughter Stephanie at the hotel - they had invited me to church but I couldn't go so they asked if I wanted to come meet a few people & I said yes. I got into their car & it was fun to hear familiar church music in Spanish. Stephanie had been a missionary in Arizona & spoke wonderful English so we chatted all the way. The high school kids here have seminary at either 5 am or 6 pm at their teachers house & there is one teacher for each ward. She said that teen pregnancy is a BIG problem here. Outside the church about 80% of girls have a baby between the ages of 14-18 & within the church still about 50%. They may have 450 members on the church records & about 100-125 typically come each week. For as long as she can remember her dad has served extensively in the church - she knows she was blessed with wonderful parents. The stake center was about 20-30 min away They have 12 wards (congregations) in the Managua area & each has its own building. At the church I saw Ricardo in passing with some of the missionaries serving in this area - one from Logan! & one from Arizona, another from Texas & 2 from Guatemala. I gave Ricardo another gift & a note to let me know where he is called on his mission. Stephanie said she had seen him at church that day & he was still so happy. She also told me he is the only member of the church in his family & that he gets himself to church via severla buses & is always helpful to others. That made me love him more & she said he doesn't earn $2 an hour only $200 a month & half of what he earns he gives to his family.
When I got to the church I saw the stake President & he had all the groceries they had purchased & were going to give to 8 different families this week. He gave them to one to a family that he wanted me to meet & he just asked me to tell them why I was here & why I wanted to help them - that got emotional. Then he said he had all 12 Bishoprics in the chapel & he wanted to tell them my story about me reaching out to him & helping Ricardo & buying items for future missionaries. I was SO not prepared for that & the FLOOD of emotions. fortunately Stephanie was a wonderful translator. I told them this was not from me but from many of their brothers & sisters in the United states & especially in my ward-that I was just the person who got to be here to give the gifts from others. I talked a little about Op Smile & that I am happy to go anywhere in the world to help Gods children. I told them that in the church we are all one & we want to help people who are in other countries & have different needs that we can assist with. I told them that I knew if I was here & something happened to me they too would help me. I finished by saying that when I have these opportunities I am simply following the example of the Savior & I was humbled by their faithfulness & it was a honor for me to meet them & help any of the people of Nicaragua. As if I wasn't already emotional before I left he had all 12 Bishops come by & shake my hand & thank me for the help I was leaving them...it was very tender & then we took a quick photo so while I remember it in my heart I can also remember it in print. wow..that was not what I expected at all - I was truly blessed to see these wonderful men & know that worldwide there are so many people trying to do Gods work.
I barely got back by 7 for the mtg. Stephanie asked me if I noticed that she took many different routes to & from the hotel (which I didn't) & told me it was because the police here are corrupt & they could stop you for no reason & impound your car if all your paperwork isn't perfect etc...I am glad she told me that as we were arriving back at the hotel & not before!
The pre-surgery mtg was brief  -which was such a pleasant surprise. Tonight is my time to get all my things organized to go to the hospital including all the clothes that I have to give away & the crazy 16 hour days start tomorrow so I need to get a good nights rest but before I sleep I want to really just pause to think about how tremendously I have been blessed to be able to be here and be able to be an instrument in Gods hand thru the generosity of others-I could have never imagined all of this. The person being blessed and changed the most from all of this truly is me.....
 

Saturday is our team day of rest! But I had a GREAT DAY!!!

Because we screened so many patients until so late in the night last night the team leaders didn't get together until this morning (& most all day) to create our surgery schedule. They are sending some patients to the other site a few hours away & we will have a packed schedule. I actually slept in until 9 knowing it would be my only day to sleep in! I REALLY tried to eat the breakfast they offered but beans, rice, fried plantains, & a chile type dish while all on my plate in small quantities did not end up in my stomach! A protein bar was perfect!
Erika, Lisa & I got a driver from the hotel to take us to a local "Mercado" we had looked it up on lonely planet & there was a very dangerous one we knew not to go to & this one that many tourists went to. Still as we left Jordi the coordinator asked for my cell #, told us to call if we had any problems, reminded us to watch our belongings, only ride with the Hotel Hex taxi company etc...all of which made me nervous which I hadn't been 5 min before - but it was all totally fine :)
Gustavo was our driver & I practiced my Spanglish on him - Erika & Lisa thought I was really good at Spanish - mostly because I can understand but as I told Gustavo - my Spanish is probably like a 3 year old!
We wandered around for a couple of hours, much of what we saw was very similar to what I have seen in Guatemala & Honduras the neighboring countries but Erika & Lisa had done research & said that the #1 item you should buy in Nicaragua was the handmade hammocks. We found a specific Hammock "tienda" & they had some disabled people working there so that was all it took to make me want to support it & YES!!! I bought a double size hammock. The man in charge was so happy we purchased them there cause they are about $20 more than in the market.
We called for our driver to come back & get us & as we waited, lugging around the hammocks, we wandered thru the market in search of a Diet Coke or Coca Cola Light - they actually had coke zero. Erika after now seeing my skill at locating diet cokes in 2 countries & knowing I have done it in 10 said it probably could make for a good reality show....in search of diet coke across the world LOL.
The driver that came to get us was Norlang & I practiced my Spanish on him too. I may actually try some Spanish this week - I feel like I am dusting out that part of my brain...from 2 years of High School Spanish! We asked Norlang to drive us around Managua a bit on our way back. If you look on lonely planet there isn't much they say to do in Managua - most people fly in here & then go out to the coast. We saw the central downtown area where the bigger hotels are & a nice park & had him take us to his favorite restaurant & then instead of having him wait in the car invited him to come in & treated him to lunch. He is a single dad with a 4 & 7 year old daughters. His mom lives with him to help with the girls & he drives a hotel taxi which I think is a better job than a regular taxi. He was a nice guy.
I had been emailing with a few different LDS church leaders before I left home & before bed last night emailed & said I would meet one at 5 at the hotel & perhaps we could later connect with the other. So Pres. Sobalvarro & his daughter Camilla & his wife came to the hotel with Ricardo an 18 year old young man who wants to serve a mission for the church but has some financial challenges. His parents have only elementary school educations & work in the plantain fields. Ricardo works construction & makes $2/hour or $20/day for 10 hour days. He is saving but needed some help & encouragement & that is what I was able to bring him because of some generous friends who gave me $$$ before I left & asked me to use it to do good in any way....As we drove to the store where many locals got their mission clothes (sort of like a strip mall) & I talked to Ricardo thru Camilla - he said all he really needed was a suitcase because he would never be able to afford that ($100) & probably others could use help - but Sis. Sobalvarro told him not to be humble & think about maybe a pair of shoes or something else too. We got to the store & found the suitcase...I asked him about clothes to put in it...white shirts, ties, pants & he knew his shirt size & picked out one so I added 7 more & told him he could do laundry once a week. Then has asked if he could get a pair of pants so we got him 4 & I had him pick out some ties - it was SO SO FUN as we piled it all up at the register & he was grinning ear to ear!!! They didn't have shoes there but there was a nice shoe store with "Hush Puppies" & thick soles & soft inserts so I asked him if he wanted to try those on so he had almost everything he would need - encouragement he did & we bought them. when we went back to the  Sobalvarro's truck he put all his stuff in the back of the truck & insisted on sitting back there with it so that if the car stopped on the street no one would steal anything. He also told Sis. Sobalvarro that he didn't think he was going to be able to sleep tonight!
while we were out someone from Op Smile text me to say Pres. Rivas was at the hotel waiting for me-our communication crossed & he was there with 2 girls who already had mission calls & also were in need of some good shoes & sturdy backpacks - We were on our way to a grocery store but I couldn't leave them stranded so I had the Sobalvarro's take me back to the hotel - I gave the Sobalvarro's cash for food that some of their congregation & neighbors needed that we had planned on buying (rice, beans, sugar, corn)  & went to meet Pres. Rivas & his daughter & the 2 cute girls Heidy who leaves for the Dominican Republic Dec 16th & Marlin who will go to Anchorage Alaska March 1st (boy is she in for a HUGE weather change). There is actually a "mall" by my hotel so we walked there & found them some good sturdy "Hush Puppies" shoes too- they started at a discount shoe store with $15 flats & I reminded them of all the walking they will be doing & that I saw another shoe store we passed..so with prodding we went & got the good ones! We then went to a kiosk that had nice backpacks ($50-75 each) I am curious who here buys them but it was exactly what they needed so they each picked one out. I asked if there was anything else - we laughed that unlike the young men they couldn't just get white shirts & ties! After we walked back to the hotel & they were ready to leave I told them also (but this time I got a little teary) that this was not from me but was from wonderful members of the LDS church in my area who want to help others. I told them we are all brothers & sisters & we needed to help each other - that they & Ricardo will help people in ways that we cannot & we are grateful that they want to go & serve others.
TRULY I AM BLESSED to be the one who gets to be the conduit for other peoples goodness & generosity. All of them are so humble & grateful for the help but I am more grateful that they allow us to help & that both of the Stake Presidents made the effort to connect me to those who could use a little lift as they prepare to put their lives on hold for 18 months or 2 years & go serve others. I am telling you it was like CHRISTmas came early for me watching the immense gratitude they had as we provided them with these things. I love being here for Operation Smile - that is what brings me to the country & then connecting with other members of our worldwide church is just an added blessing & have friends who help me help others is simply indescribable....PURE JOY that is what I felt & I wanted to do all I could for them because truly we are SO SO BLESSED in the USA.
The Sobalvarro's asked if I could go to church with them but we will be setting up the hospital all day tomorrow. The only break I have is 5-7 & they want to come & get me & take me to their church building so I will do that...I am sure it will be another blessing to me.
I missed a team dinner tonight down on the waterfront & while that sounds really nice & I wish I could have gone....I am 100% confident that I was where i was meant to be tonight :)
Wake up call at 6:30 bus leaving at 7:30 & hospital set up & a visit to the patient shelter is on tomorrows agenda finishing at 4 then a team mtg 7:30-9:30 (& my 5-7 plans). I am looking forward to the patient shelter - another opportunity to connect with the children & their families who will have surgery this week...things will be getting very busy starting tomorrow...and I am ready for it!

LONGEST SCREENING DAY EVER!!!! in Managua

Well it is almost 1 am & I really want to go to bed but if I dont blog I will forget some of the precious details about today. The 5:30 wake up call came much to quickly! We had breakfast at 6 where i met up with Erika & Lisa from my Bolivia mission & we were on the bus to the hospital by 6:30 or so. It is about a 25 min ride to the hospital- we chatted the entire way so I didnt really take in the surroundings much but I will have time. When we arrived at the hospital there were literally hundreds of people waiting - I am used to seeing people waiting but this was like 8 EZ ups all with people underneath plus they were standing everywhere...LOTS of people. We ended up screening 258 people...add in siblings parents etc plus the 100 volunteers & it was a 1000 person day in a very tiny space. Jeanne the CC asked erika & me to be the gatekeepers as we had both done that before. She had a VERY SPECIFIC way she wanted it done - I am pretty detailed but this was a big job for me - to keep every patient categorized 1-5 based on their condition, make sure their labs were good, that all the "stations" had signed (nursing, lab, dental, speech, anesthesia, surgeon, pediatrician, parents signed consents etc. Erika & I were a good team but we pretty much worked no stop from about 10 am when we got our first patient at our station until the last one at about 11 pm. This was my longest day of screening on a mission so far!!! Gatekeeping is sort of like riding a bike once you get started all the details come back - I even had things color coded this time thanks to my 5 color highlighter!
In the morning before we had patients they asked me to do an interview on Nicaraguan TV - just a few questions thru a translator - I was already a sweaty mess by then since it was about 100 degrees & super humid but there was no hair or make up person in sight to help me. what was even more funny was that at least 10 locals asked if I was a "guest" and on a TV show here??? Maybe I have a twin who is a Nicaraguan  celebrity.
As always there were MANY memorable patients - in Nicaragua there are over 300 little volcanic islands that people live on & places along the San Carlos river so some people took boat rides then buses to get here-one cute family from Ometepe Island :) A few had colds so we started them on medicine in hopes of getting them better so they could still have surgery the end of next week. There was a darling 8 year old boy Rosney who came in & shook my hand when he arrived - he was a crack up - I kept telling him he was "muy guapo" (very handsome) and that I would be his nurse after his surgery. By the time he left he gave me a big hug - those moments are priceless & his mom was smiling the entire time.We typically dont repair lips until the babies are 6 months old but we have about 5 who are between 4-6 months. If they are well nourished we can sometimes do an "age deviation" I am hoping that will be the case for some. by 4:15 we had gotten 100 patients thru our final gatekeeper station. It was pretty clear then that this would be a LONG night but really...that is why I came, that is why we are all here & I woule rather be there helping these people have a chance at surgery than heading back to the hotel.
We saw several adults with unrepaired cleft lips & palates. One sweet lady was 58 & her name was Blanca Nieve (Snow White). She wants her lip fixed so she can wear lipstick -I may just buy her some if she gets on the schedule :) By 8 pm it was dark outside & they were still registering patients. There were a few late nigth "heartbreakers" a 23 day old baby with a large bilateral cleft lip & very young parents who looked scaired & were clearly trying to do their best to feed her but she couldnt suck wekk & it was a tremendous challenge. She weighed 2.5 Kg or about 5 lbs & was very malnourished. We were able to get her admitted to the hospital here to get her better hydrated & nourished and some proper bottles to make feeding her easier. She wont get surgery now but I am pretty confident her life was saved. Another 4 month old had severe unrepaied hydrocephalus with a very large head, a heart defect and a cleft lip and palate & other syndromes. Her mom said she knew we probably couldnt do anythng (and we cant) but she wanted to give her little girl every chance possible so she travelled 2 days to see if  we could help. My heart broke knowing there was nothing to be done & this sweet baby would probably go to heaven sooner rather than later.
As it got closer to 10 pm we were all fading & I kept saying Doug's family saying he would tell our kids "Once a job you have begun never quit until its done, be it great or be it small do it well or not at all"....we didnt quit we did it well & in the end it looks like we have about 149 patients who qualify for surgery...sadly we will probably only be able to do 100 but this is a mega mission with another site a few hours away & supposedly they only screened 90 patients so we may send some patients who live near that region there for surgery to get more done.
THe team leaders will do the schedule tomorrow morning and then the patient announcements will happen after that. We were supposed to set up the hospital but we cant get in until Sunday so tomorrow we have a free afternoon & evening & I am going to connect with 2 of the LDS church leaders here & they are going to take me to shop & get some needed items for some of the church members here - I am SUPER EXCITED about that. I am also excited to not get up at 5:30 a.m. :)
Time for me to go to bed...excuse any typos!

Safely Arrived in Managua

Nothing much exciting to report as today was just my travel day. I was up unitl about 2:30 am last night & up at 5:30 so my main goal was to sleep on my first flight! My dear friend Linda took me to the airport & I originally was in the last row of the plane & supposedly the flight was full but I nicely asked the agent if anything opened up more in the middle of the plane would she move me & just as we were boarding she motioned me up & I ended up in row 22 with the middle seat open (tender mercy) so I did sleep for 1 1/2-2 hours of my Orange County to Houston flight. I had a 3 hour layover in Houston so I treated myself to a "Texas BBQ Lunch" of beef brisket, coleslaw & corn bread as my last "real meal" - it was yummy. I made my way to the other terminal & my gate & met 2 of the doctors who were also on my flight to Managua. Dr. Murray Kesselman the Pediatric Intensivist from Canad who will be in the Recovery room with us & Dr. George Lesznik one of the Anesthesiologists. They were both super nice & it was really nice to be traveling with other Op Smile people. That flight was fine too...we arrived in Managua, went thru customs & paid our $10 for a Visa - I could be here for 30 days if I wanted!!! we got our luggage - I was happy to see it arrived :) and then went thru customs. In amny of the Latin American countries you put your bags on a belt that goes thru the xray machine & either a red or green light comes on & if a red one comes on your bag is searched. I was SO HAPPY to get a green light because if they opened up my luggage they would probably think I was going to open a childrens clothing store!!!  Thanks to sweet friends & a generous luggage policy I packed 15 pairs of flip flops, 16 dresses, about 10 boys outfits, & 15 CHOC T Shirts plus some bath & body items I bought  for the moms of the sweet patients. That pretty much filled one entire suitcase!   
We are staying at the Hotel Hex...it is not bad - the rooms are about the size of a small dorm rrom with 2 small twin beds - & that is fine :) My roomate hasn't arrived yet, there are a few people who had flight issues. I did meet Eva the other Recovery Room nurse - so I have met our entire PACU team & that is nice! After reaching out by email I was contacted by 2  of the LDS Church Stake  Presidents in this area & fingers crossed that I will get to meet them on Saturday & use some money friends gave me to help church members here in Nicaragua - it is so AMAZING to be a part of a worldwide church - I am excited about that.
The crazy mission schedule starts tomorrow - wake up at 5:30 am, breakfast at 6, bus to hospital at 6:45, meeting at hospital 7-8 am then set up & start screening. They expect we may screen 200 children - it is sure to be a busy day. we are going to be at a "German Military Hospital" - clearly my history knowledge is lacking as I am not sure why or when the Germans were in Nicaragua???
I am looking forward to seeeing Erika & meeting the rest of the team in the morning and I am certain  there will be some very sweet & humble people that we will meet tomorrow in screening - that I will then introduce to my family & friends via my blog. Screening while hectic is often one of my favorite days! Good Night from Managua Nicaragua!

Managua, Nicaragua Bound for Operation Smile Mission #10

I am so excited to be headed on another Operation Smile Mission - this time to Nicaragua. I leave early Thursday morning & have been packing tonight as I have a full day of work tomorrow & teaching tomorrow night - YIKES!!!  This will be my 10th mission in 5 years and I have loved the opportunity to go on every one - some have been really challenging but in the end the opportunity to serve such humble people in o many countries has made me a more grateful person & truly taught me that you do LOVE those you serve - even if you have never met them before. I have also learned that everyone has a "story" and when we take time to find out their story there is always something to be learned...
I wasn't sure that I would be able to get a 2nd mission in this year since my 1st one was in June & we have had a busy summer but I had a 2 week window that would work Nov 1-15th & as is ALWAYS the case....what is meant to be will find it's way & I was fortunate to be offered a position on this mission. I do not know the details but they are supposed to be doing a Mega Mission with multiple mission sites - I guess I will learn more when I arrive.
A few weeks ago a mission friend Erika emailed me...we were in Bolivia together - it was her first mission & I helped train her. Now 3 1/2 years later we will be in Nicaragua together so I am excited to know there will be one familiar face on the team! I looked at the team list for the first time today and we have a BIG team of 60 volunteers! 34 are from Nicaragua & several of them are listed as "in training" after that there are 14 from the US, 5 from Belgium, 4 from Sweden (one of whom is the 3rd recovery room nurse with Erika & me!), then one each from Colombia, Paraguay, Venezuela 7 Canada. Truly an international effort.
As always I am blessed to bring goodness from friends here to my mission country - my suitcase is filled with 20 dresses for girls & some outfits for boys & of course some toys. Last Saturday I sent an email to some LDS Church leaders there & one emailed me back today so I am excited & hopeful that in addition to helping the Op Smile families I meet I will also be able to connect with & perhaps help some members of the LDS church in Nicaragua.
I checked on the weather tonight & was a bit distressed - we just barely have had 2 days of "cool weather -high 60's & low 70's here & even rain yesterday so I was thrilled to thin maybe fall had arrived. Well fall will be on hold for me the next 2 weeks because the temperatures in Managua have been a steady 92 degrees with 89% humidity....I am already planning on being a bit sweaty & decided not to pack a sweatshirt.
I still have a little more packing to do tonight & ALOT of loose ends to tie up at CHOC tomorrow but somehow I will be ready to get on my flight Thursday morning. I have WONDERFUL travel...Orange County to Houston a few hours in a layover then a flight from Houston to Managua Nicaragua - roughly 12 hours of total travel & only two hours time difference from California!!! 
Since I have been to the 2 neighboring countries - Guatemala & Honduras I have some ideas of what it may be like but really each mission trip is a surprise...the accommodations, the "hospital", the team, the people & the unique culture & beauty of each country as well as the challenges. But I am EXCITED & ready for another wonderful opportunity to use the gifts & talents I have to benefit others. Of course despite purchasing a Spanish language program after my last Latin American mission it remained unopened so I am kicking myself that I have very minimal medical "Spanglish".
Good Thoughts & Prayers for me & the entire team are much appreciated!!!