Friday didn't really go as planned - back at 11 pm but MIssion days are alwasy unpredictable!

We had such high hopes for today maybe an 8 or 9 pm finish time in the Recovery room but no such luck! It started out well but finished differently. We had 5 cute babies all cleft lips for our first round on all the OR tables & they all had new smiles by 10 am – I took a pic of my schedule with the first row all marked off & was thinking good thoughts for an early finish!

Among those 5 was Naileth a cute little girl with palm tree pony tails on her head. Her mom came in & was older (we have had SO MANY young moms) & spoke a few words of English. They live 4 hours away & traveled by car both the mom & dad with Naileth & all the other kids stayed at home. I found out Naileth was the youngest of 5 & her siblings were 21, 19, 15 & 11 years old. Mom said she was “surprised” when she found out she was pregnant but Naileth was “sent from God to our family”. I said yes sometimes we call them “Bonus Blessings”. She was slow to wake up so all the other 4 babies that were in the first round were out of the recovery room before her & a student volunteer said the dad was outside & nervous. Typically we only let one parent in the PACU but since she was the only patient in there I told them to let the dad in – it was a tender reunion for this couple & Naileth & I got a few pics of them. She is totally a “Daddy’s Girl” & once he was holding her & was comfortable that was quite apparent. What a sweet family they are!

During the lull before the next patients would be coming off the tables – Dani one of the OR in country volunteers here was talking to Alec (the founder – the McGees grandson) about how she has volunteered here for the past 12 years at all 23 Paraguay missions since she was a high school student & her twin sister also volunteers & her sister has been to the Virginia Beach in the USA & met the McGees but she has always “just missed him” coming to Paraguay or Latin America & one day she hopes to meet him to thank him for all he has done for the children of Paraguay & around the world. Alec stepped aside for a minute after the conversation & quickly reappeared with his phone in hand face timing Dr. McGee his grandpa & handing the phone to Dani – she immediately burst into tears & told him how much she loved OSI – her passion & love was palpable & she got so emotional that we all got emotional even Alec & he stepped out & later said that never happens to him.  Again what a great kid to think of doing that – he made her dream come true! And Dr. McGee was so kind on the phone & genuine as we all waved to him & said hello on Facetime. Alec is the oldest of their 14 grandchildren.

It took awhile for the 2^nd round of patients (all palates) to come off the tables but they did okay & I was still hopeful this would be an earlier night even though we were doing 19 palates again. About noon someone randomly brought 2 pizzas to the OR break room & they lasted about 15 min! Pizza seems to be universal – I think I have had it in every country I have been to on a mission!

I went to the Child Life area during the 2^nd round of surgeries to see who we would be getting in round 3. There were some real cuties. A little blonde 3 year old who I am certain is going to be a soccer star – he was kicking a “soccer beach ball” with great style & coordination all across the room to the ceiling! I also me little Milagro a 5 year old & we took a photo with a white board that says “what makes you smile”. I ended up caring for her post op & her dad was so sweet. She was a bit restless & when I brought him in & got her in his arms she immediately settled down. I asked if he had any questions & he said no this was her 5^th surgery. Today she had a revision of her lip repair & a correction of a fistula or opening in her original palate repair – hopefully this will be the last surgery she needs. When she left recovery I gave her a doo & some frilly pink socks & she grabbed onto both of them immediately!

By 3 pm we had done 13 of the 24 cases for the day & I was still thinking we were doing ok. They said there was a “massage person: in the hallway outside the OR area & encouraged the international volunteers to go – so I did. Something was lost in translation – I was ready for a “massage” & this was more of a Chiropractor who did adjustments & quickly took my head in his hands & cracked my neck then back…oh well!

As I have always said the PACU is a combination of moments of calm & chaos & we got some chaos about 4:30 pm. A palate repair was brought in & within a few minutes was bleeding in his mouth pretty significantly we suctioned quite a bit of blood, put pressure on it, called for a surgeon then called for anesthesia, replaced the breathing tube & carried him back to the operating room all in about 15 min. When there is an “emergency” things move quickly. He was in the OR for another 2 hours as they totally undid & redid his surgery. He got back about 6:45 pm & I barely looked at him as one of the other nurses was going to recover him & a few minutes later another patient came in who I helped get settled on the bed & when I put the monitoring equipment on him he wasn’t oxygenating very well so based on the prior patient we initially tried to suction his airway, got nothing but his oxygen level was still low so we gave him oxygen with only minimal improvement, I gave a breathing treatment with still little improvement & he was on 100% oxygen. This scenario basically went on from 7-9 pm I gave a total of 8 resp treatments, a variety of IV meds – steroids, diuretics, antibiotics etc. Unless someone physically had an oxygen mask in place with a tight seal on his face he wasn’t oxygenating well or breathing well & sometimes we were breathing for him. Nathan one of the anesthesiologists & I rigged up a CPCP kind of mask using tourniquets to hold the mask in place & that actually helped & he also started waking up a bit. He had very diminished breath sounds on his right side so we weren’t sure if he had aspirated something into his lungs or what. The military hospital we are hat had not ability to do a Chest XRay? Or a blood gas? Both very simple things…he was still requiring 100% oxygen so we decided we needed to transfer him to a place where they could better care for him OSU always has a PICU bed somewhere in the are & had one at a private hospital nearby. So we prepped all the supplies for transport but here we got a semi legit ambulance with some oxygen & supplies! (unlike Ethiopia my last transport situation) He was also pretty stable just required the oxygen & some tests. We brought the parents in after the physicians spoke to them & they were doing ok. We decided that just Nicole the Intensivist & an anesthesiologist would transport him & I would stay back in the PACU as we still had 4 other patients coming out during this time. They were loaded up & on their way a little after 9 & the hospital was only 15 min away. We did the clean up from the chaos of the last 2 hours, other patients came in & by 9:30 we got most of them out but still had one on the table…that patient came to the PACU at 9:45 & was slow to wake up. The transport group got back to the hospital just about the time we sent that last patient to the post op ward at 10:50 pm. The patient we transported had lots of stuff in his right lower lobe of his lung 0 which is where we could not hear good air exchange & got his Xray, blood gas & was put on a good oxygen BiPap system & looking good. Had this happened about 1 or 2 in the afternoon we probably could have waited it out & kept him but at 9 pm we just didn’t know which way he would go & had to get him to a place with more services. It was all good & in 24-48 hours he should be fine…but that idea of getting out “earlier” was definitely not happening. We got back to the hotel at 11 pm. I don’t think I have had consistent late nights like I have had this week – I think it is just the large # of palate patient & a combination of things but this is what I signed up to do so it’s all good! A shower & bed is on my to do list & then tomorrow is the last & a short day of surgery with only 15 cases & no palates.

Dale the student sponsor was our angel tonight – about 5 she was leaving & said to me “you never get out of here & get to go to dinner” (which many team members get to do/enjoy) & asked me “can I bring you something” I said a salad would be great & that typically I am here with Nicole & Dusty & a PC. In the midst of all the 7-9 chaos someone called me to the door of the PACU & handed me a bag of food. About 9:30 while waiting for the last patient we all enjoyed 4 chicken Cesar salads & she brought us dessert too! That perhaps was one of the best “saves” of the day as at that point we were all a little spent J there are always so many wonderful people on these missions! I am ready for some sleep!    

Day 4 is done - 5 lips & 19 Palates..some great & funny things happened today!

This system of me not going with the team in the morning & having an extra hour makes ALL the difference – I think all Clinical Coordinators should adopt it!!!  Seriously though most of the team leaves 1-2 hours before PACU & its just me & the 2 Program Coordinators, the Clinical Coordinator & Intensivist there til the end. Tonight we got back to the hotel by 9:30?  So a little better each day. This was our hump day – after today only 2 days left & Saturday will be nice as there are no palates done on the last day of the mission – but we will have had plenty before then!

The first round of patients were all Cleft lips – one on each operating table & those are always rewarding because you can visually see the difference immediately. Just about all of the moms were young (17-20 years old) and many families all live together so the abuelas or grandmas help care for the babies. We only let one parent come into the PACU because the space is small & it’s often chaotic. Today when the moms came in it was apparent that some of them were very scared, nervous & uncomfortable with their fussy baby coming out of anesthesia so I spent time calming babies then giving them to the moms & reassuring the young moms they were doing just fine holding & comforting their babies.

After that first round of lips it was all palates the rest of the day & quite a few young ones who did not come out of the “black hole” of anesthesia very well so for many there was LOTS of crying, thrashing, screaming no matter what we did, who held them etc…we try to let them calm on their own or with a parent but we did quite a bit of medicating today…of the patients & 2 rounds of Tylenol for the recovery room staff. For about 3 patients there was nothing we could do to calm them, meds, walking, rocking, parents & staff holding them…those are challenging & make the environment chaotic – poor kids have no idea what is going on!

After Sunday I thought I was done with my help for church members but on Monday I got an email from another Stake President/Church Leader here that I had also emailed. Pres. Rivolara had his clerk email me in English that they wondered what kind of help I could offer. I explained what I had done in other countries for missionaries etc & he replied back & said that when he read that I wanted to help someone preparing to serve a mission he immediately thought of Manuel. He also mentioned that to the Stake Pres. Who also said Manuel is the one person who most needs help. He is a young man of a very humble family, his maternal grandmother just died 2 days ago. He has an older brother serving a mission in Posadas Argentina. Manuel wants to leave on a mission but his dad thinks that Manuel should wait until his brother returns home so that Manuel can use the same luggage & clothes; but Manuel wants to go sooner so he is trying to get as much work as he can to buy the luggage & clothes.

My heart immediately swelled & I replied back that I would love to help. I can’t imagine that what seems to us to be simple resources (like a suitcase & clothing) would delay someone from serving a mission but here it does as resources are scarce & just getting the physical resources to have a son leave for 2 years really is a huge sacrifice. At home in the states most families go on a big “pre mission shopping trip” to get their son or daughter the needed items without much thought. Tues & Wed went by & I hadn’t heard back from them despite trying to call & sending emails. I was feeling a little frantic as I knew I needed to help Manuel even though I have never met him. Yesterday morning I called Pres. Wilson the mission president to see if he could help me connect & in ur very broken English/Spanish conversation he said he would have Pres. Rivolara call me today. So at the hospital I have not had much luck with my 3G international network on my phone & I have no idea why…before it got crazy I asked Bella a student who had been there that had been helping the last 2 days if I could connect to her wifi to check emails & there was an email from Pres. Rivolara saying he had come to the Military hospital to find me but couldn’t locate me. I had Bella reply in Spanish that I am up in the Surgery area & she gave him her phone # & he immediately called her phone & we had a 3 way conversation. He is going to come to the hotel on Saturday at the end of the mission with Manuel – I am so happy this will work out & again thru the resources of generous friends we can help this young man. All things came together today to get that coordinated…yes God is involved in the details of our lives!

Bella explained to me the private vs public hospital system & that this hospital is a public hospital for the very poor but people who are more well off (teachers, business, economic professions etc) have insurance to go to private hospitals. While that makes me feel a little better for some this public hospital in this country really has challenges we would never see in the states. The water & electricity are intermittent, there are flies & bugs everywhere, lots of roof leaks & water all over the floors, minimal supplies etc. No matter what time we leave at night there are always people sleeping on the floors or chairs in the hospital with bags of belongings – it is heartbreaking. And of course the bathroom situation is no better so I have just resorted to not drinking during the day to avoid them as much as possible!

Little Dalma was one of my special patients today – she wanted a 2^nd armband on her that said princess & was wearing a crown! She was a 4 year old palate repair & was here with her mom & dad who were so nervous. We assured them pre op that all of us here are moms or grandmas & that we take care of these children as if they were our own. That seemed to calm them a bit & while she was a little feisty after surgery she did well & they were happy! One of my last patients was Marcos a very BIG 4 year old who weighed 55 pounds & was tall too. His mom was tall I bigger in stature & she said her husband was a big man too. He really looked more like he was 10 size wise so it was hard to remember he was only 4. He had some breathing challenges after surgery so he stayed with me in recovery for 2 ½ hours. Mom held him almost the whole time & I held him for a bit & he was heavy! He did well though & finally went to post op about 7 pm. When I helped take him up all the pre-op kids for tomorrow had checked in so it was busy up there. They had all just finished their happy meals – the McDonalds here donates 25 happy meals every night for the kids having surgery the next day – I am sure they done know it is their “last meal” for a few days!              

The last patient rolled in just after 8 pm – the local nurses had left about 7:30 to get back to their homes & families – I know how hard it is to be doing something as big as a mission but also be managing your “real life” home & family so I applaud their sacrifice & service to the mission. Francisco or “Franny” as his mom called him was a 14 year old palate repair. He had his lip repaired as a baby but then never got his palate repaired & his mom was crying & anxious for him to have surgery which made him anxious too. I brought her in to the PACU as soon as he arrived so she could see he was okay & she was very teary. He was pretty sleep with the anesthesia & it took him about an hour to wake up but her woke up well which was good. We got him to post op just after 9 & I put all the PACU equipment away, changed the sheets on the gurneys and got things somewhat set up for tomorrow!

Once we got the the hotel all I wanted was a decent bathroom so I went straight there & surprise I got locked in!!! Fortunately Dusty my roommate was in the rooms so she tried to call the front desk but they didn’t answer & she has minimal Spanish so she text Kim the PC who thought we were “punking her” & Dusty got dressed (minus one shoe) & took my phone & went to the lobby to pantomime the situation. I thought of taking a shower but really didn’t want to be rescued from the shower so I did brush my teeth & waited. There is no “maintaince dept” so the hotel front desk guy came & took the handle off the door to get it open. As soon as he left Dusty & I laughed hysterically…at the situation & in the text she sent Kim asking her to come help her explain this to the front desk it autocorrected to come expose yourself to the front desk. The entire situation in general was a humorous relief…we had a good long laugh! Between that & my sleep deprived “lost phone” encounter last night we decided we needed sleep & will be in bed by 11 tonight!

I am so grateful to be here for so many reasons…

Wednesday but not quite hump day here....

It was SO GREAT to get a few extra hours of sleep & boy did I need it as today was not as long as yesterday but we didn’t leave the hospital until 10 pm so for me a 14 hour day….we really thought we’d be out by 8 or 9 but the last patients took longer & had problems. I have just decided to plan on being there until 10 pm every night & if we get out earlier that will be a bonus!

It must have rained all night & it was raining still this morning. I had 2 choices to either walk in the rain or take a taxi. I decided to take the taxi as I didn’t want to arrive both late & wet. It was on $2 American & its not a “formal taxi” it is someones car – I am thinking places like this are where people got the idea for UBER in the USA.

Because I went in later I missed post –op again – which also may not happen on this mission with this schedule. Brigid the local nurse & I got the PACU set up quickly & the other local nurses arrived a little later. Brigid has a 5 year old daughter & its her Bday tomorrow so she wont be here on Thursday & lives 2 hours away so I was hoping to get her out early to head home but 9 pm was all I could do. Her daughter is having a Frozen Bday party – Disney is always universal! Also Angel another local volunteer was in a car accident on his drive home (also 2 hours away) last night – he is fine but his car not so much. He took the bus in to the hospital today & got here at 11  - what dedication!

Our first patient got to us by 9:30 & was a real cutie & I tucked a little dollie I had under her arm J It is so rewarding to see how happy the parents are when they see their child lip repair for the 1^st time – I decided today it is the same emotion people try to capture in that “1^st Look of the bride at weddings” but to me much more tender as it is a parent looking at their child. I have captured them before on missions but never really thought of it this way. I have a few pics I will post. The palate reapirs are all internal so it doesn’t seem like any change – but it truly is life changing to their speaking & eating etc.

The water went off again today – as I understand it there is just not enough water here in general so the water provider just turns off access to different areas at different times of the day. The hospital has some back up but it doesn’t seem like much. I guess the hospital couldn’t do the hospital laundry last night as it had no water – this too I think will be a day to day experience here…again something we rarely experience & when we do it is for a few hours & we are given advanced warning.

A favorite patient today was Jesus he had a large Bilateral cleft lip & his repair was AMAZING – I really cant post “after photos” that show the surgical incision etc but his I took from far away & will post – it was AMAZIN & his moms “first look” was precious. Mariana was also another one of our lips & did great & looked “muy bonita” her repair was “perfecto”!

I have figured out a bit of the military hierarchy here – the “enlisted” folks seem to be in white uniforms & they always stop & salute the people in the green uniforms…

Before the last 3 hours of chaos there were 2 cases that really touched my heart…we did Carlos the 60 year old man I talked about on screening day. I did see him going back pre-op but didn’t get a photo of him & then he did great post op – he was all smiles. His some & 2 grand-daughters were with him & his wife. In recovery it was his son who came in while his wife was caring for the grandchildren & I could sense so much love & respect between this 40 year old son & his 60 year old dad. He caressed his hand, wiped his brow, helped him drink some juice – the love was palpable. When he was ready to leave PACU his wife  granddaughters were just outside the door & his wife had the biggest smile on her face & the 2 girls clapped for him as he gave us all a thumbs up sign – that was a highlight!

It was “super hero day” they gave out super hero masks to the Johnson & Johnson volunteers & then they passed them off to OSI volunteers so Kim who has really helped me in recovery gave me her – she is so nice!

Probably the most heart wrenching story today was a dad who came in for a VERY FUSSY little girl who had a palate repair. Once she was in his arms & he was whispering in her ear she immediately calmed down. He was from 360 KM away or about 225 miles & lives in a rural area & is a farmer. In some of those areas they speak Guyarenes a different dialect bt some of the locals also speak it so they can still function as translators. The little girl Tatiana was 4 years old – she was supposed to have her palate repaired last year but was sick & her surgery was canceled. When there was a mission here 6 months ago they could not come as his wife was very sick – she died 4 months ago from Breast Cancer & he promised his wife he would get Tatiana to this mission for her palate repair-and he did :) They also have a 10 year old daughter Maria who now has become the one to care for Tatiana while the dad works his farm. The dad brought both of them here on the long journey that involved walking & buses. When we realized the other daughter was here we brought her in to the PACU so she wasn’t waiting alone. She was so loving to her sister. I gave them both dolls & checked with Libby to see if we could provide any easier transport for them back home. The dad just emanated love for his 2 daughters & thanked us profusely for our “corazons muy grande” (big hearts) that we would leave our homes and come help him….the locals translated the word but the feelings were deeply felt by all our hearts & we were all wiping tears from our eyes. I have a picture of them I will post & I really am going to figure out how to add photos to my blog when I get home! Truly it is  the patients who are the super heros!

We left the hospital at 10 – it had been rainy all day & that reminded me of Honduras…we grabbed some tapas & showered, tried to connect with family & clearly I was tired because I was talking to Doug on my cell phone & told him I had to hang up because I thought I left my cell phone at the restaurant…I even text Kim the PC that I left my phone there & she was going to go back to get it – it took me about 2 minutes to realize it was in my hand – I need to go to bed!!! And I am going in a little later again tomorrow…flexing my hours to the patient needs just like at home! Good Night!

Missions are a bit like Childbirth....

So yes Missions are a lot like childbirth…you may go thru a lot of difficulties & challenges but that is not what you remember – you remember the joy :0. Today really hasn’t been “a challenge” just LONG…waking up at 5 am & getting back to the hotel at 11 pm makes for a 18 hour day. Mind you the 1^st few hours were slow & not busy at all but none the less a long day.

This was really the “first” full day of the mission with all 5 Operating tables running & “everyone” here including a lot of observers. We didn’t get the 1^st patient on a table until close to 9 so we got the 1^st patient in the recovery room at 10:30. It was nice because it takes us about 45 min each morning to get our Recovery Room/PACU set up. Unfortunately we cannot lock it so we have to take down all our monitors & equipment etc and lock it up in the supply room otherwise it will get stolen in the night??? The morning tims is also when I can sometimes go up to post op & see the kids from the previous day who had surgery but I didn’t get there today – I did get a little time in Child Life where the kids wait & that gives me a chance to tell the parents I will take care of their child after surgery & I will bring them to PACU to see them ASAP after surgery. It was busy & chaotic by noon & stayed that way off & on all day/night right until the end. We gave lots of IV pain meds, respiratory treatments, and anti nausea meds today – more than normal it seemed to me  - or again like childbirth maybe I am just forgetting? The last 4 patients were the most challenging.

As always there are a few patients or families that “steal my heart” each day…Venus was the first – a little 8 month old girl who was to have her lip repaired but they couldn’t intubate her (get the breathing tube in for anesthesia) 3 different anesthesiologists tried & she must have some unusual anatomy. I had seen her & her mom in Child Life. Brining the mom in to tell her that they couldn’t do surgery was sad – the Drs explained they aren’t sure why & the good thing is that Op Smile will try to get her to an ENT & then hopefully she can have surgery in the future. The mom was very tearful – we told her not to lose hope & surgery can likely happen in the future – still she was so very sad. I gave her a blanket & dollie & socks J & she wanted to go home from the PACU & not go back to the big post op ward which was understandable. We also had what was to be a 1 ½ hour palate case that had 2 big fistulas once they got him in to the OR so it ended up being a complicated 4 hour case – which we typically don’t do on missions but he did fine!

Usually I bring & eat my own food on missions – often because the lunches are rice, potatoes, bread & a questionable meat..todays lunch was hamburgers with a fried egg on them plus a slice of ham & cheese??? Maybe the Paraguay version of a Bacon cheeseburger but the egg??? I politely declined & enjoyed pnut butter. As a Latin American mission it is also supported by Pepsi so we have access to a large cooler with pepsi, 7 up products. I am not a Pepsi fan in general…have always been a diet Coke girl but have had only about 3 since the 1^st of January so it was easy to skit the soda & drink water but there are a few other “coke product lovers” and tonight some coke zero showed up in the frig so by about 8 pm I did have one J

A few other challenges today – the water in the hospital went off for about 2 hours? That wont stop a mission we just brought in gallon jugs of water for the surgeons to scrub in with, then after the water was restored the electricity went out on the floor below us but not on the surgery/recovery floor. I of course was on that floor to use the “better” bathroom…in the dark. The hospital does not have air conditioning & the temperatures here are about 88 with 94% humidity so it’s a bit “warm & sticky” to say the least. We had some rain tonight so that brought the temps down but the humidity up. There are windows open all in the hospital which moves some air but also brings in flies & bugs. I don’t think to put bug spray on when going to the hospital so I did get a mosquito bite…they say Zika is here but Dengue fever is more common – I am pretty sure I will be fine!

Alec the 18 year old grandson of the OSI founders who was with me in Nicaragua is at this mission too so it was really fun to catch up with him & he helps us a lot in the PACU taking patients up to the 6^th floor post op ward & helping however we need so that has been really nice. Jordan one of the surgeons from Nicaragua is also here & he is great too – familiar faces are so nice!

We were halfway done at 4 pm & at 6:30 pm had 6 more patients to go but 4 of those last ones were a little more intense or complicated (woke us as fighters, some bleeders, pulled IV’s out etc) & if that wasn’t enough when I was taking the next to last patient up to the 6^th floor and had a questionable elevator experience – maybe just because it was late at night? They told us the elevators aren’t reliable but I would say more than that. The main elevators have 3 but only one works the other 2 have the call buttons pulled out & the one that worked would open the close so we couldn’t/didn’t get in. The next set of 2 elevators on was an open elevator shaft you could look or fall right into & the “functioning one” had an error message. We finally got a military guy from the hospital to take us to the 3^rd back of elevators – this one also had an empty/open shaft but had caution tape across it & had one that worked…I did make it to the 6^th floor with the patient & opted to walk back down…it’s the little infrastructure things like that I never understand??? The last 6 of us on the team left the hospital at 10:30 – me the clinical coordinator, the 2 program coordinators, the Intensivist & a in country coordinator – we took a pic in front of the hospital then…for womens day LOL!

Today there were a lot of dads who are the caregivers/single parents of these children whose tender ways I observed just touched my heart. 7 year old Fernando was VERY NERVOUS for surgery his mom had gone into a hospital less than a year ago & died after a severe asthma attack. He was here with his mom & grandma & when we brought his dad in her was so sweet & tender with him & very emotional himself – there were no dry eyes in the PACU. Also one of the last 4 patients the dad came in & was extremely emotional when we let him hold his fussy son-I was worried he was feeling queasy & going to pass out so we brought the aunt in to hold the boy & helped the dad outside to get his composure & make sure he was ok. He was fine it was just that his wife – they boys mom abandoned them both when the boy (who is 4) was born with a Cleft lip and now seeing it repaired was very emotional…for all of us. SO yes while apparently today was “national womens day” I saw several very tender dads in my part of the world who have the role of mom & dad. I will post a dads pic on social media.

In the end we did 22 surgeries (3 were canceled because the child was sick) – those are also a bit heartbreaking but it is the beginning of the surgery week & if they can get better by the end of the week we can possible add them back on the schedule. Back at the hotel we were going to get food but everything was closed so we headed to the room & after a very “sticky day” a semi warm shower felt great & the PC’s were so sweet & brought us something to eat just about midnight. With the Clinical Coordinators support I am making some changes to the PACU staffing…the local volunteers are at their homes sometimes 2 hours away so they get in about 9 or 10 & leave by about 6. That leaved Brigid & me in the PACU in the evenings. So since we don’t get patients until after 9 I am going to sleep in until 7 & get to the hospital at 8:30 tomorrow & see how that works to try & avoid 18 hour days all week. So yippee so 5 am wake up for me & I am ready to sleep!

*I got to talk to Doug during the day & Sarah & Kimmi tonight, I caught Kelli & Clark yesterday so just missing Ryan & Kya   

 

 

 

A Slow Day & I am Tired

This is going to be a short blog post because I am super tired. I didn’t sleep well last night. I kept going over in my mind the De Santos family. I cannot imagine me with my 3 girls & my mom living on someone’s patio with a makeshift roof in the rain…it was so mind boggling. When I got up at 5 Dusty my roommate & the Clinical Coordinator said I really didn’t need to leave until 7 not 6 so I slept for another hour. Since the bus had gone earlier I walked to the hospital which was a hazardous experience – the street has lots of holes & missing stones & uneven walkways plus no one here pays attention to the light signals – especially the buses so crossing the street is a bit of a challenge & a risk…I don’t want to get hit by a crazy bus driver in Paraguay!!!

I got to the hospital by 7:30, we had the mock code & they were set up to film some of todays cases for a live stream to another room in the hospital for some Latin American surgeons to observe…it was sort of a +/- A great teaching opportunity – everyone raved about it but it basically doubled the surgery time – a 2 hour case was 4 hours etc.  It became a “waiting game” in the PACU which allowed us to get it all set up & organized but we didn’t get our first patient until 1:30. Our Peds Intensivist arrived this morning – Nicole who is from John Hopkins PICU.

The 2^nd floor bathroom was way more disgusting that the one from screening day – I will be going to the 1^st floor as needed or in an emergency use a mask with toothpaste inside to mask the smell.

We only did the 8 extra patients today & they were some of my cuties I remembered from screening – Marinelli who I mentioned in my blog on Mon who is here with her mom & her 13 year old sister & Yenifer who was the one here with her Grandma as her mom had abandoned her. I gave Yenifer a dollie that friends sent with me & also gave away some socks.

I am working with 2 local nurses who are credentialed & can work independently & 2 who are in training so I am really in preceptor/mentor mode. We will do 64 palates this week which is a TON!!! I don’t think I have EVER done that many palates on a mission so I am thinking late nights & lots of chaos – we will see. Off to bed for me – tomorrow is for sure a 5 am wake up call.  

A Day I lived in 2 Worlds in Paraguay

To those who read this remember that this is really a part of my journal so these are lessons I am learning & feelings I am having :)

Today I felt like I lived in 2 different worlds in Paraguay. It was our “Team Day” where we go as a team to relax & bond & enjoy a day together before we all start working very long days together. We traveled   on a bus for about an hour & a half going out to the more “county” area & went to a very nice hotel/resort for the afternoon. The type with small groups of 4 rooms & each has a little patio.There was also a nice pool area. It wasa cute little boutique type resort.  We had a great lunch there & then about 3 hours to relax at the pool. For just a moment I was thinking this would be a nice place to be for the week instead of where we were staying but I reminded myself that I am not here for vacation & can vacation whenever I choose J Because of the travel by the time we got back it was 6 pm.

I had gotten some communication from the President of the LDS Asuncion Mission who I had emailed that they could meet me today at 2 or 8 pm – with the team day I arranged to meet them at 8 pm. About 7:45 the front desk called that I had someone in the lobby so I went down to see Sis. Wilson the missions Presidents wife & 2 missionaries Elder Howard from Wyoming & Elder Poulson from Washington-both of whom spoke English - YAY!!! Despite having some email communication (which was a bit challenging in translation) I wasn’t sure what the plan was & they told me we were going to the Mission office – sounded fine to me! When we got to the van there were 3 girls in the car – Camilla who was 17 & is the mission president’s daughter & Erica who was 16 & Abigail who was 14. My assumption at that time was that these were just 3 cute girls who were friends. We talked on the 30 min drive to the mission office – in my broken Spanish & with the missionaries translating as needed. I told them about Op smile & showed them pics from screening. I asked them about their school & friends etc.

When we got to the Mission office there were 2 women & another young girl there – the DeSanto family with a grandma, Monica the mom & her 2 older daughters (Erica & Abigail) who had been in the car with me & then her younger daughter Julissa. When I emailed that I would be in the area & had friends that would like to help people in this are the mission president fairly quickly emailed me back about this family that he said had a housing need. I initially thought…I emailed back that I didn’t know that I would have the resources to help with housing but maybe other needs. Now here they were & I wasn’t sure what the plan was. The mission president and missionaries started sharing their story with me as we all sat in the office.

There is not a dad in the family & hasn’t been for some time, they have a son/brother who is in jail. Monica the mom supports the 5 of them by cleaning houses & makes about $10-15/day. They had been living in a rented apartment that the landlord still stored things in so they really had no privacy. Here financial challenges are understood & most landlords are relaxed if people fall behind on rent. IN this situation the landlord was not so kind & with a variety of other things going on he evicted them almost 2 months ago. They have since that time asked several other friends/families to store some of their belongings & are living in another families back yard on basically a cement slab with a leaky metal lean to roof that the missionaries put over it. (of course my mind had 1000 questions…aren’t there other places for them to stay, other people to take them in, wouldn’t it be better if they slept at the church etc – none of which I asked as clearly I trusted that they were doing all they could to help this family with the means they had available)

The elders told me that they have been looking for housing fro them & think they can find them a place for $150-$200/month which they could afford but you have to have a 1 month deposit as well & that makes it hard to get into a place. It was then I realized I could help them with housing after all.

I got quite emotional as I explained that some very kind & generous people in my congregation had given me money to use to help others here in Paraguay & we would love to help them get back into a place to live. As I have done in the past I told them this gift is not from me it comes from many  people & I am simply the person who gets to deliver it & what a blessing that is to me & how grateful I was to meet them. They had not idea that this was happening (I don’t know what the mission president told them when he picked them up that night & brought them to the mission office? So they were a little stunned when we started talking & the mom & grandma got a bit emotional too.

The mission president then said – “I want you all to know there are no coincidences. As a mission we have been praying for the De Santos – God knows when we need help & he knows how to answer prayers & this is a manifestation of just that”. I knew what he said was true….I would have never thought this was how I could use the money I had to help someone but that is how it worked out because it wasn’t about me & my plan it was about Gods plan.

The missionaries & mission president said they would help them with the finances of their needs. He also told me that $20 would pretty much cover a week of food for this family & the girls needed school uniforms as school just started in Feb & said anything I could help with would be enough. I had American cash & some Paraguay $$$ & was able to give them what I think will be enough for a deposit & 3- 4 months rent but I felt so compelled to help more so I had the missionaries take me to an ATM & got money for food & uniforms too. Before leaving I told them that we are all Gods children no matter where we live & we are all brothers & sisters & there were people who didn’t know them but who are kind & generous & want to lift and help them. That truly we are just trying to follow the example to the Savior and serve and love one another & that once things are better in their life all we would ask is that they too help someone else & Monica said yes the circle of love will continue.  We took a few photos (that I posted on Instagram & FB) & then hugged & parted ways – the mission president taking home the De Santos & the missionaries & Sis Wilson & Camilla driving me back to the hotel.

On the drive back I did ask a few of those questions in my head…some of which I wasn’t sure I wanted to hear the answers to. I expected that many families here live in humble circumstances but were there many situations like this – the missionaries said no – while there are many who struggle this family was in the worst situation he had seen in the 18 months he had been here & despite all the efforts & resources  of the congregation/ward they could not get them to a better place than what they were in. They also said the amount of money I gave them most people here would never have all at once (while in the states at a minimum wage job people could get in a few weeks).  I asked if they could get hep with food from the church food warehouse & they did say they could get that. I asked if they would be able to move forward & be okay of would they be in a similar situation in a few months & they said that truly they just needed this “jump start” & would be okay.

We got back to the hotel & I thanked the missionaries for coming to get me & helping this night to happen & hugged Sis Wilson & Camilla good bye. The missionaries took my email & said they would update me. I walked to my room & thought about it I was a bit overcome….was part of the reason I was here was that I was sent here to “jump start” people I never met, that thru the generosity of people in California this family of 5 women/girls would now have a place to live, that many people who had been praying & a mission president who got an email aligned us for a “miracle” in both of our lives. There are no coincidences….

How humbled I am when I think of the meager ways people live. Earlier today I wanted a nicer hotel room with a softer bed/pillow & a deluxe bathroom & cable TV….while this sweet family has been living on a patio with a make shift leaky roof in a rainy season in this country…perspective certainly changes when your eyes are opened to ALL that you have & all you the ways you can serve others. I am a different & better person after today & grateful to be a conduit for the goodness of others in ways I would never have imagined.

Tomorrow was to be ½ day for patient announcements & a prep & set up day & then free time with full surgery days Tues-Sat. But earlier today Kim the PC asked if I would mind going in as another mission day. She needed one recovery room nurse in order to get more cases done & she asked a few of us from all specialties if we would go in this one day early  & we will start 1-2 surgical tables & do 10 extra cases. ABSOLUTELY was my answer – I don’t need “free time” I came to serve/work and the more kids we can help the better. So for me it will be 6 days of surgery & I am okay with that J So now its midnight & I need to go to bed for a 5 am wake up call but I wanted to capture my experience tonight while it was fresh in my mind. God knows us & is in the details of our lives – that is a lesson I was reminded of today!        

 

 

Day #1 Screened 229 Patients in Asuncion 130 or so will get Surgery!

It's 11 pm here & it has been a great Screening Day. At our team meeting last night & then today at screening I realized that I had that sweet feeling of "coming home", returning to a familiar place and some familiar faces. I will be the only International (USA) recovery room nurse but I will be working with 3 of the nurses that I worked with & helped train here 2 years ago - Brigida, Delsi & ???? THey were not at the team mtg last night as they live far away from here but I saw Brigida today at screening.

I am also with Rodrigo a surgeon I have been with in a few south or Central American missions, Carlos who was a photographer with us in Guatemala, Alessi an Anesthesiologist I have been somewhere with??? and Marta who does medical records here & in Nicaragua. Plus Ian another Anesthesiologist here is from CHOC - small world (but I don't know him from there!) Dusty who is my roommate and the Clinical Coordinator is from Salt Lake City & her sister is one of my Charge Nurses at CHOC in the NICU...it really is a small world & quite interconnected.

When we arrived this morning there were a few hundred people with children & family members already waiting but the in country organization here is really good & it didn't seem chaotic at all. I took some time to play with some of the kids outside & made a "beach ball buddy" that I played catch with. I will have to post a pic of him. I was again asked to be the "gatekeeper". I wonder if there is a memo that goes out when I am on a team that says "have Nancy be the gatekeeper". I am pretty sure I have done this on 10 missions? What that means is that I handle each of the 229 patients chart, note their surgery priority and keep a record of it all for the Clinical Coordinator. We have a big group of "volunteer guests" from Johnson & Johnson who provide all of the suture materials for all the missions Op Smile does & I had 4 of them help me off & on all day as gatekeeper & they were Fabulous!!!

By 11:30 we had already given out 200 numbers but I had only seen 23 at my station so I was gearing up for a late night but we finished screening the last patient at my area (the last stop) at 8 pm - so about 12 hours of screening - really not bad at all. There were some very cute kids that I fell in love with (as always) and part of my job is to write down how far away the family lives  so that if they have traveled far they get surgery early in the week or to see if they need to stay in the shelter here. It doesn't matter that I think I have "herd it all" I am always amazed when I write down that they live 600 KM away & took 2 days to get here by bus; or a family that went on a boat & a bus them walked & was the last to arrive today. The majority of the people were from 8-12 hours away by bus...and I have probably 6 hospitals within 30 min of my house - things I take for granted.

It was unusual that we saw 3 sets of twins today. I was so busy that I didn't get a lot of "stories" but 2 of my favorite were a little girl Marinelli who is 3 & traveled from afar to be here & had come to the mission 6 months ago & then got sick & couldn't have surgery & her mom was heartbroken. They came back today & she will have surgery this week. The mom brought her oldest daughter who is 13 years old to help & left her husband at home with 3 boys & the Marinelli is the baby of the family. They were overjoyed. There was also a sweet grandma of a 5 year old, the mom had abandoned the baby when she was born with a cleft lip & the Grandma has taken care of her but she has never really been out of the Grandmas house because she is "made fun of" -the Grandma heard abut Op smile on the radio & cant believe we will "fix her for free" & said that we are giving her granddaughter a "new life" . On the other end of the spectrum we also screened a 60 year old man & when the surgeons asked why he wanted to have surgery he said he wanted to be able to kiss his wife before he died...that brought a tear to many of our eyes...such a sweet man & I think he will be added on at the end of the week if all goes well :)

We are at the same military hospital I was at here 2 years ago & its really not bad - no air conditioning so at 88 degrees & 94% humidity its a little warm & sticky. The bathrooms are a little sketchy  & it took me a few minutes to remember you pull a string above the toilet to get the water in to flush it!

Before I left I had some email contact with a mission president here & a stake president asking if I could assist any members here with the kindness of friends. The emails lost some details in translation but last night one of the coordinators called Pres. Sergio Wilson for me & he is coming to the hotel tomorrow night at 8 pm to get me so I can meet & hopefully help some families here - one he mentioned is a grandma, a mom & 3 young children who have no permanent place to live :( So I am excited to again see the connections of a worldwide church and share the love & generosity of friends with our brothers & sisters here :)

Well it is nearly midnight & my day started at 5:30 am so I am tired & headed to bed! Love & Hugs to family & friends. Tomorrow is our "team day" - not sure what the plan is but it is a time to get to know & bond with the people we will spend the most time with this week!

Medical Mission #12? Headed back to Asuncion Paraguay.

Well I am sitting in the Sao Paulo airport with a 5 hour layover en route to Asuncion Paraguay. I typically space my missions about 6 months apart so having been in Nicaragua in November & now heading to Paraguay is atypical especially since I was in Madrid Spain last week with West Coast University Public Health students doing some work in the more rural areas there. A 20 hour flight home from Madrid on Sunday - 3 long days at work playing catch up Mon-Wed, unpacking & repacking has made this a crazy time BUT....I am SO GRATEFUL for the opportunity to go & serve the people of Paraguay. I have to plan my mission availability based on what is going on at CHOC (& there is ALWAYS a lot going on there), family events etc. I had hoped for a mission Mid March to Mid April, after Madrid & before Kelli & Clark Graduations the end of April but the dates were not working out. I tried to get on missions with friends to Mexico or to new places like Vietnam & nothing was aligning. Kim the Program Coordinator I was just with in Nicaragua emailed me & asked me to go with her to Paraguay & I said I would check if I could. I had already requested time off to maybe go to Utah for a long weekend so it worked out that I could add a few days on & go to Paraguay. SO that is where I am enroute to. I was in Asuncion Paraguay in March of 2014 so exactly 2 years ago. I re-read my blog & looked at the photos I have to remember those people and experiences & that got me excited. There are some very special people I met there. I also contacted the LDS Church Stake President and Mission President in that area to see if I can possibly meet them & offer some help to people there. we had a few emails & I am hoping to connect in person once I get there.
As is always the case I turn my life & house into a tornado in order to get out the door & Doug is so patient (even when I asked him to go get me earplugs at CVS at 11 pm the night before I left). I tried to unpack Monday & then started to repack on Tuesday night. I am getting pretty good at this & packing less for me (scrubs & clothes) and more to take to the people there - Dolls from a friend who does "Dollies for Daughters", flip flops & clothes I bought at Wal Mart with money from friends, sox from my dear neighbor Jane...and food for me to eat. After many missions I have learned that I do MUCH better when I have some control over what I eat - pnut butter & sandwich thins are a new one this trip, tuna, protein bars, nuts, dried fruit - yep that will pretty much be my diet the next 10 days.
We got to LAX airport in great time, I was seated next to a single dad taking his 2 year old daughter Lucy to Florida to see his sisters. Lucy was darling but after a few hours needed a nap & was very fussy & cried a lot - her sweet dad was so apologetic & I tried to play with her & distract her. At the end really...if that was the worst part of anyones day we are all doing great!
I thought I had a 2 hour layover in Atlanta but my first flight was late & by the time I got to the international terminal gate there was only 20 min to board. I made a few calls & was off again (or so I thought) someone had put luggage on the flight but not boarded so they had to go thru ALL the luggage on the plane (and it was a BIG plane with a lot of people so that took an hour & delayed us an hour or more) I was sitting by Demi - a 25 year old who is also going on the missions the PIT (she takes photos of all patients before & after surgery. She is a DARLING girl, had been an OSI intern for a year & went on 10 missions in a year - talk about travel & jet lag! She lived in Ca for a bit & now is in So Carolina during Nursing school pre reqs so we chatted the time away before take off. It is always fun to find an OSI friend en route. It was a 9 hour flight & I think with some "pharmaceutical assistance" I slept for about 4 hours. We arrived in Sao Paulo & instead of having a 5 hour layover it was closer to 3. Demi wasn't feeling well so we found her a lounge & she paid to go in & hopefully is resting now as I sit in the Sao Paulo Airport Starbucks blogging. 6 other OSI folk just came up who are also on out flight to Asuncion. Our 2 High School students Tiga & Ang both from the East Coast & their student sponsor Dale. This mission will also have some guests from Ethicon (a Johnson & Johnson company) that donates ALL the sutures to OSI & among them was Kim a person I was in Bolivia with. After you do a few missions it is crazy how many people you see again or people who know people. By the time our flight leaves I think there will be 20 of us all together from OSi on this last leg to Asuncion. Of course all of that gets my heart racing & energy level up thinking of what a blessing it is that I have these opportunities.
Again I am humbled to go be able to use the talents I have developed to help Gods Children in other parts of the world. As I look at the team list I am the only International Volunteer in the Recovery Room everyone else is from Paraguay...kicking myself that my Rosetta Stone Spanish Lessons are still in the box unopened :/ The Pediatric Intensivist is from the US so that will be good. Overall the international team is small most everyone is from Paraguay so I am wondering if there will be familiar local faces from 2 years ago :)
My heart swells as I think of the families who are likely already en-route to or in Asuncion waiting for us to arrive, waiting for us to see their child & hoping & praying that their child will be able to have surgery. Truly this is for me "The Healers Art" & why I became a nurse....I am here to serve & love as the Savior did to people I have not yet met & don't know. I am ready...and will share my experiences on my blog...again really for me as my "journal" but also for my dear friends.   

Placeholder for final thoughts on Nicaragua

Often the last day of the mission is busy & goes straight into the team party & then a flight home that I never blog that day. I always write notes about that last day but they never get to my blog. I actually just found the notes so I will update them here .