Final Post from Tangier - a faith filled miracle experience I want to remember

My mission blog is really a journal for me and is often personal & this entry is just that. I am happy to allow others to read it but PLEASE know this is NOT about me & the good I was able to do here - this story & experience is about a loving heavenly father who loves all of his children of all ethnicities, religions, and circumstances and how He answers prayers & works miracles in everyones lives for good.

Let me first put this story into context. I am blessed with wonderful people in my life who when I go on missions selflessly, quietly and confidentially give me "sacred funds" and tell me to use it to meet the needs that I see when I am on my missions - there is no criteria & no plan. In some instances I am able to reach out to local church leaders & ask them about needs in other instances I ask the Op Smile coordinators & other times I am led to or placed in situations where the need is apparent to me after I meet someone.

Here in Tangier on the first screening day I met Khadija (I thought it was Khady) and her mom & was instantly drawn to them, spoke to them a bit as the mom spoke English a little, drew her blood, took a photo with Khadija & the mom took a photo of my nametag. I heard later that they were from Senegal & had a difficult time getting here. I even looked up Senegal on my phone & a 5 hour trip from another country in West Africa seemed reasonable to me (my geography skills are pathetic).

I was told they were staying at the shelter & thought of them when with these funds we bought blankets & heaters for the shelter; but then I was in the midst of the chaos & long hours of the mission. Fast forward 5 days to Wed night - I am on call & at the hospital unitl 11 pm. I was given the next day's surgery schedule & was so excited to see Khadija's name on the schedule. Late that night as I was going back & forth with the next to the last patient on the stairs between the OR & pre op I "ran into" Khadijas mom & we talked about her surgery the next day & I said I would be there. I continued to feel like I needed to help them & had talked to someone about a 2 hour train vs the 5 hour bus for them to get home & her mom mentioned that & I thought it was good & didn't want her to know I may have had any part of that assistance & I was just excited they were getting surgery & transportation home (or so I thought).

Thursday was a hectic day but the one time I went into child life for no more than 5 min Khadija & her mom were there - we talked & hugged & took a photo. Khadija had surgery late that day & I saw her in PACU as promised & kept her mom up to date when the surgery was going long & again felt in my heart & spirit so strongly that I needed to help them - but I thought I had & I was...but there was this nagging feeling I still hadn't done all I needed to do for them but I was busy & pushed that thought aside...

Friday night as we sat down at the final dinner/party Abigail sat be me...(she is the student who was sick that I took care of). She said that Ambra the Program Coordinator asked her & Caroline the other student to get a few patient stories to send back to Op Smile. The students had also bonded with Khadija - she & her mom were so loely & warm & truly their spirits I think drew people to them & the students had interacted with her often & become her "friends". So on arrival at dinner Abigail starts to share her story & it was Kahdija & this is what she told me....

Khadija who is 14 & her mom traveled here form Senegal...another African country. It was a 5 hour FLIGHT from Senegal to Casablanca & then the 5 hour difficult bus ride from Casablanca to Tangier (I had totally missed out on the flight part). It has been a difficult life for Khadija - at school every time a teacher would ask her a question because of the cleft palate & nasal deformity she has difficulty speaking & the other kids her whole life had made fun of her & laughed at her - she has had no friend her entire life except her sister. Her mom heard about Op Smile & over a long time saved enough money (about $500 US) to get herself & Khadija here but she did not have any money to get back & was not sure who or when they would get back to Senegal yet she was praising God & so thankful for Op Smile saying that without them this would have never happened because it was a complicated case. She said that her entire family and friends in her town have been praying for Khadija & for all of the volunteers & the entire team and that God is good to them....

I FINALLY knew what I needed to do - I needed to get them flights home...I looked on Kayak & flights for Sunday were about $250 each person, I knew that the fast train to Casablanca was about $50 per person as I thought that was already taken care of but it wasn't the mom when she told me that she would get help to get home was simply expressing her faith to me. I got up from the table in the middle of the party & went to Madame (head of Op Smile Morocco & told her the situation & my desire to help (she is who coordinated the heaters).She said we would do it in the morning....after all this huge party was going on, it was loud & she essentially was the hostess. So many things went thru my mind. Mostly that sometimes God tries to work thru you but you don't get the right message.

I felt like I was given a second chance to do one of the things I was sent here to do...clearly I wasn't listening with precision when God was trying to guide me the first time, I could imagine this council of angels in heaven saying "we sent Nancy Kraus there that thru her generous friends we could answer this faithful mother & families prayers  & Nancy caught on & connected with them on the first day - that was perfect but somewhere along the way she got a little off track & thought she was done when she hadn't done what was needed. She was seeing them & helping them thru the surgery but she missed the bigger part so we need reinforcements to get these people home...send in Abigail to help her they already have connections Abigail & Nancy & Abigail & Khadija. And that s how God finally got my attention :) The Operation Smile team had no idea about her or her situation or her "story" with 289 patients screened & 180 surgeries it is hard to find one need when theyr are often so many - it's that needle in the haystack unless you wont find unless you are directed to it - the Op Smile team was grateful we found out & wanted to help this patient.

If you think of the hundreds of steps that took place for all of this to happen - there are no coincidences....this family coming to this mission, generosity from friends that was significant, Abigail on the mission. Me meeting Khadija at screening, Abigail getting sick & I cared for her, the other times I "ran into" Khadija & her mom, Abigail choosing them to "interview", Abigail sitting next to me at dinner among 100 people at a party, Abigail sharing that story....this is a well orchestrated plan by a loving father in heaven to bring all of this together to care for Khadija & answer a mothers & families prayers thru others - which I believe is often how prayers are answered thru the hands & hearts of others on earth.

This was all I could think about the entire LONG party & after the party I confirmed with Madame the plan to go to the hospital & find them at the post op check (they were still staying there overnight) & offer the assistance. When I told Abigail & Caroline & Brittan the plan they wanted to come to & Abigail was such a big piece of this I wanted her to come for sure. SO as we got back to the hotel at 1:30 am thinking this was out morning to sleep in before our flight none of that mattered & we all planned to meet in the lobby at 7:45 to go & find them & do this :) My heart was bursting.

So this morning I went to the ATM to get Moroccan money & then the 5 of us went (including Pete the student sponsor) and Nour the local Program Coordinator was out interpreter as she spoke French. We found Khadijas mom, found an empty room & brought her in & reiterated the story above - which I did thru MANY TEARS...I told her that it was clear to me God was answering her prayers thru us & it was such an honor to be a part of her miracle. We made sure she had the money for the flights & for the fast train. The students & Brittany all gave her extra money for food & unplanned needs All in the room were tearful & she expressed much gratitude, hugged each of us tightly - told me thank you for listening to God & being my angel...and then we walked back to the hotel, quietly at first with some reverence for the experience we all just shared in - then talking more about how it all lined up....miraculously.

So I can go home feeling that I truly did ALL I was supposed to do here...I have finished my mission in Morocco & am ready to go home - feeling humbled, blessed, grateful & definitely a better person that I was when I came 2 weeks ago. I always pray to do what I am supposed to do wherever I am  & I am grateful to be one of the many instruments in God's hands that made this happen & thankful that He finds a way to work with my imperfect self & repeats Himself & finds a way to communicate to me when I don't always "get it" the first time.

I am headed to the airport now...ready to leave the country & people that have forever changed me


    

Friday Dec. 7th Last Day of Surgery... Post #1 of 2 I will explain....

 The extra hour of sleep was heavenly!!! I will go home tired but not completely exhausted.

On arrival at the hospital we took the team picture & went to post op. Khady was doing ok she had a big lip & nose surgery & had an extensive dressing on her face - both as s teenager & patient to be respectful I did not take a photo but gave both her & her mom a big hug - see next post

There are 22 Cleft Lips on the surgical schedule 20 of them are all less than a year old so lots of babies. With each table having only 3 patients I think the surgeons are taking their time & not feeling the pressures of a long day. They are also planning to serve us lunch here at 2 pm so I don’t think it will really be a “short” day-like other missions where we end about 2 but if we are out at 5 I’m good with that!

On missions I don’t bring my wedding ring but in my “mission supplies” I have a ring I bought at Deseret Book a long time ago that says “Arise and shine forth” (I think it was a Young Women’s theme one year?) so I always wear that on missions...it also has meaning to me...when I am having a challenge on a mission it reminds me to Arise & shine forth that my light might be visible to others...I think that is what #lighttheworld is asking is to do...to give light & live to those whose view might be dimmed in some way. It doesn’t require us to be in a different continent, country, state, or even neighborhood we can do it right where we are. I just happen to have the opportunity to be here but I need to do it just as much at home in my day today life as I do on mission trips.

First 3 patients all got back to the recovery room at 11 am so it was a later start for us. My first patient Adam was definitely not happy and there was nothing I could do about it rock, sway, bounce, give juice, give pain medicine, he wasn’t having any of it so I kept him for the minimum 30 minutes he needed to be here and sent him up to his mom and was told that he immediately calmed down in her arms. The powerful calming of motherhood is amazing and very visible in situations like this...

My 2nd patient Amir was a repeat of the 1st....he screamed the entire time no matter what I did...even when the minister of health & his entourage came thru (I guess it was just the pre visit logistics the other day) anyway my baby Amir literally SCREAMED the entire time the minister & his wife were in the PACU-so loud they could hardly do introductions.The local nurses took photo op with him but I was just fine wrangling my patient. Entire PACU team told me not to take a patient again unless he/she comes out in deep sleep or from a certain anesthesiologist...so I waited & hooray I had a perfect last patient!!! Little Hidaya & I even gave her my last dollie

Lunch was served "family style" with 10 to a table at 3 pm a traditional meal of Couscous- it was delicious & I took a picture of it. It was just like what I ate in blue city except the meat was beef & it was served on large platter family style & everyone just eats from the large plate...it was our celebration lunch. Moroccans typically have it on Fridays & special occasions 

At 4 pm the last patient of the mission came into the PACU &we clapped her out letting Ambra our Program coordinator carry her up to the post op unit at 4:30. We got back to the hotel at 5, walked around a bit then started packing. Tonight was the team dinner/party that we were to gather for at 8:30 pm, left the hotel about 8:45, arrived at the center at 9:30 & had a 4 course meal that went on unit 12:45 - I asked the Moroccans if they ever sleep!!! It was a LONG night

 

I am ready to go back to my family & my normal life...but I have had such a special 12 days here. Much of what makes this work meaningful to me is my ability to use the talents I have been blessed with & developed & simply helping those in need - people I do not know, will never see again & who can never "repay" you. It is pure service like the Savior & that leads me to my next post I will enter tomorrow night because it is already after 2 am here. It will be a fith based post - one that is a little personal but also relates to the many people who help me help others in this work I am blessed to participate in - so read it tomorrow  you want

Thursday Dec. 6th: A full day with 37 surgeries!

When my alarm went off at 5:45 this morning it seemed impossible that the night could be over. I was definitely wishing thee was an option for a "snooze button" but no such luck. Having not prepared my "Stuff" for the day I got it & myself all together fairly quickly & was at breakfast by 6:15 for the team mtg at 6:30. I now find it humorous that earlier in the week I was concerned I didn't have hair care products because in reality every day I get up, put my hair in a pony tail & then at the hospital put a scrub cap on....One of the Stryker team did gift me their hairsptay before hey left so perhaps I will do something else with my hair for the final party :)

I found out that the soup yesterday had sweet pastry type item with it (that I didn't take) that was heavy with honey - that food is what they eat each day during Ramadan after fasting. At the morning coffee they have also been serving Msemn which is a bread item sort of between a tortilla & pita type bread but dusted in sugar so it's a little sweet - they put butter, or a soft cheese & jam on it - it is really pretty yummy! Rumor has it tomorrow we will have couscous for lunch as always served on Friday

I went up to the Post op area & saw the mom of the 8 year old from last night who again gave me a tight embrace. Brittany had taken care of her (among her many patients) & told me she did well all night so that was great news. It was very chaotic up there again think pre/post is hardest RN role on missions. Their 1st 3 hours half of them are getting everyone’s vital signs & meds other half is getting discharge teaching done & patients out & then they prep for new day & patients start to come to them by 10:30...I seriously couldn’t do that. PACU works well for me even though the hours are longer at times.

After getting PACU set up I was already nodding off so the rest of the PACU team "forced me" to go & take my power nap early & again it helped. I was pretty sure it would be a 2 Coke Zero & 2 power nap day :)

Our first 5 lip patients all arrived PACU within 5 min...then 3 more 10 min later. We really only have 6 functional beds but some babies were being help so we double bedded 2 & that worked fine. My patient  was Aicha a 5 mos old (age deviation baby) & she was so cute & good. Really all my patients for the most part were good yesterday just a few needed Respiratory treatments but they were all good. This family was from 3 hours outside Tangier and the father is a farmer which seems to be common. Many of the parents here seem to be a bit older - for this baby the dad is 45, mom is 38 & they have 2 other children.

We got our team shirts to wear tomorrow- and this one is definitely one of my top 3 favorites might even be favorite so far! By 12:15 all 8 lips were back & we had cleared the PACU & within 10 minutes the first five palate patients came back all at once - that was a whole lotta crazy going on with about 25 people in our small space because each patient comes back with the anesthesiologist & nurse & the patient & the PACU nurses & MD's

Unfortunately 4 cases were canceled today-2 for low hemoglobin levels that were missed or labs were not back when scheduled & 2 who are sick. Always makes me sad as those patients will have to wait until the next mission here or elsewhere in Morocco or Africa.

There is still a baseline of being chilly & standing in front of the space heaters here reminds me of standing on heater grill of my parents house in Whittier when I was young & it was cold (or as cold as Calif gets)

I had back to back palates- my first was Fatima (which seems to be a common name here) she was 6 years old & woke up so calm & sleepy but really sweet-gave her a doll & got a tired half smile :) At 2:30 it was quiet in the PACU  so I popped my head into child life & there was Khady  my 14 year old friend & her mom (I had been identifying her in my blog as Sahko but that is her surname so I had that a little messed up & I guess I wasn’t saying her name when we talked). They both came over & gave me a bon jour kiss & greeting. Her Mom said Khady was anxious & we talked a bit. She seemed to have a bit of comfort when I told her I would be there when she woke up...there are often times you make unique connections with patients & families on missions-they feel like old friends you were meant to re-meet at this time & in this way. We will likely never see each other again & yet the 4 interactions over these past few days will always be with me & I know Khady & her mom were one of the reasons I came to Morocco. Plus I think of the fact that I met these wonderful people in Morocco who live so far from Morocco....there are no coincidences but a grand master plan orchestrated by a loving Father in Heaven!

At 6 pm after what seemed like about 30 minutes of waiting & quiet the chaos hit of course while 3 of the  other PACU nurses were at coffee leaving only 4 of us & a bunch of patients who were all not happy. Fortunately the Clinical Coordinators recognized out challenges & she got some of the moms back. I had Abder a 1 year old Bilateral Cleft lip patient who was CRAZY & the anesthesiologist told me how excited she was bout the life changing surgery she had just done & she wanted to take the patient up to see his mom but forgot to tell me she didn't secure his IV very well so just about the time I was going to give him pain medicine her pulled his IV out...not cool Abder!!! His mom did come back & was overwhelmed by his facial transformation & Abder instantly calmed down & I got over myself! It was so tender to see his mom see him for the 1st time & together we looked at his "before" picture in the chart & she and I & the surgeon all had tears streaming down our eyes.

I was still waiting for Khady & wondering why her case was going so long so I went in & checked on her in the OR & they were just being very deliberate in revising her lip & also her nose. I went out & updated her mom who was so grateful. Apparently they will stay thru Saturday for a post op visit & the fly home that evening :)

She came in about 8 pm & did great post op  -she was pretty sleepy & I'm not sure if she really knew it was me there but I was glad I could be there & it mattered to her mom. I didn't get to take her up to post op because we had a lot going on so the transporters took her up & I will see them in the morning again!

Since I stayed late last night when there were only the last 3 patients left to come back to the PACU I was able to leave by 9 with 2 other PACU nurses. Interesting that every night on our drive home we pass about 6 different coffee shops & outdoor café's & it perplexes me that ts is ALL men outside w/ an occasional woman likely a tourist tonight I counted > 100 men & 2 women???

A group is going out to dinner at 9:30 (they eat REALLY late here in Morocco)  but I politely declined. I know those dinners with 10+ people always go about 3 hours & getting a shower, connecting with family & relaxing really sounded wonderful to me. We just got a message that since we only have 22 patients tomorrow - all lips we are starting an hour later so that means breakfast at 7 & team mtg at 7:30 which sounds like a wonderful gift of an extra hour of sleep!

I can't believe tomorrow is the last day of the mission - it has gone quickly and will be an indelible imprint on my heart. I have been gone 10 days though & have 3 more before I am actually home...I am trying not to think about or worry that Christmas is 15 days I get back, that I will have a lot of work to catch up on at CHOC, that we have some fun events coming up aside from Christmas Eve/Day & trusting it will all work out as it is supposed to be. So excuse me while I turn on my Christmas music & regroup for an hour before I go to bed!

Wednesday Dec 5th - HUMP DAY 18 hours of good stuff!

It's a good thing I got a SOLID 6 hours of sleep last night thanks to my earplugs I didn't hear the disco or street noise :) I just got back to the hotel 18 hours after I woke up here this morning but I am not complaining this is an opportunity I "signed up for & said yes to" and days like this are what it's all about - I will catch up on sleep on the flights home! I want to blog tonight because if I get a day behind then I have a hard time catching up & I'm already not so good at finishing the last day of most missions & don't want to miss journaling half of it! So I turned on some Christmas music on my Amazon music & here I go!

I started the day in the post op area - they had 3 rooms of 8 Cleft Palate patients from yesterday plus one room of 8 from Monday...the ones from Monday were getting their discharge instructions so I snapped a few photos of them & said goodbye. Tonight they will have the 24 palates from yesterday & the 24 palates from today=48  plus the 16 lips from today = 64 plus the 40 pre-ops for tomorrow = 104 - that is like the average daily census at a smaller children's hospital & we are doing it in a very antiquated "hospital" in Tangier with 8 patients in rooms that at home might have 4 and with 8 nurses at night for those 104 patients...stuff like this is what miracles look like!

After I left post op I needed to get to the OR but on my way I saw the 1st 8 babies waiting with their moms as they were the first cases on every table for the day - such cute babies. Our PACU routine in the morning is always very similar - make IV armboards out of cardboard covered in the packaging from the OR kits, make flushes & draw up pain medicine so it's all ready when the crazy happens :)

It only took until 9 am for our Primary Care Clinic to open & this one was a first for both Chris & me. A Pre/Post nurse came in saying she had been nauseous since Monday & throwing up with a slight fever. Immediately I knew she would need an IV & fluids but as we asked about her stomach pain & checked her abdomen it was very localized to her right lower quadrant with rebound tenderness which is the classis sign for an appendicitis....Chris & I looked at each other then let the clinical coordinators know our impressions....we drew her labs & they had to send her out for an ultrasound to an imaging clinic somewhere - she came back with a positive diagnosis of Appendicitis & needed surgery. She lives in Casablanca 5 hours away & putting her on a bus didn't seem like a great idea. One of the local plastic surgeons called a general surgeon friend who arranged for her to have surgery in his surgery center & tonight she is staying there overnight after having her appendix removed... and all that happened as we started to get the first round of patients in the PACU. My first patient was Sara a little 6 month old lip repair & she was MY PERFECT PATIENT - she woke up from anesthesia happy, took some juice for me, was snuggly & calm. It was hard to let her go to post op! My 2nd patient was just as good - a bilateral lip repair - one of those big clefts that disrupt the
entire face - it was a 3 1/2 hour surgery to repair her lip & nose & the transformation is absolutely incredible!!! I cant post the photos on line but I do have before & afters & one of me holding her :)

By 2 pm our 1st 8 palates were done but we had 16 more to go & at 3 pm I hit a wall & took another 20 min power nap  -I am becoming a believer in power naps! At 4 we were halfway thru the palates & I estimated a 9 pm finish time which would have been close as the last patient rolled into the PACU at 9 pm & I had her recovered & awake & up on the Post Op ward just after 9:30. Unfortunately though there was a 8 year old girl who had a palate repair & some teeth pulled & about 8 she started with some bleeding on the post op ward & despite their best efforts at 9 pm she had to come back to surgery with the On Call team (who was still there & included me). The rest of the PACU team left at 8 & Samia & I finished up the last 4 patients then I had her leave at 9 while I waited for that "go back" patient to be explored & the bleeding stopped.

While I waited I ran some things up to post op & saw Sakho my 14 year old friend & her mom from Sengal West Africa. She is scheduled for surgery tomorrow - one of the last cases of the day. I spoke to her mom & she said that Op Smile helped her get a flight back after surgery so they didn't have to take the bus & she was so grateful...and I was happy to be a little part of that without her even knowing :)

A few other fun facts about this Morocco mission...they REALLY take their coffee breaks seriously & they happen at 11 am & 6 pm every day - usually with some sort of snacks & a special Moroccan green tea with mint. I don't often go in the morning - I bought some Coke Zeros & usually have that & a kind Bar in the back of the recovery room. I have gone in the afternoon though & today it was cold again & they had a traditional Moroccan soup Harira - which was very yummy. Lunch is served at 2 pm & the food at lunch has actually been pretty good - each day they serve an Tanjin which is really the tepee type pot they cook in - one day was chicken, another beef, fish & today lamb. I didn't try the fish or lamb but the other 2 were ok.

The 2 challenges are #1 the bathroom situation - as I mentioned in another post it is really not at all desirable & I have no idea why but by the afternoon the floor is pretty wet so to go in & roll up my pants & take everything out of my pockets, put on shoe covers that I change when I come out & do some serious handwashing - its quite an ordeal -  The other challenge is that in the are we made into the recovery room (maybe 12x12 & then 8x8 areas) there is one 4 foot faint fluorescent light that hangs about 12 feet up in the ceiling so lighting is a challenge....it's the basics we don't ever think about 0 turning on a light or having a decent bathroom - really a porta potty would be better they way they make them these days!!!

There always are a variety of political visitors on every mission - Op Smile has positive connections & wants them to see all the resources they bring into their country...so far we had the Moroccan Minister of Health, a donor who is paying for the food & hotel & today was a TV station - yep all of us in the recovery room (& probably other areas) were interviewed & I might have been on the Moroccan news tonight - who knows? I really have expanded my skill set this mission with the lab draws, today I did a bunch of respiratory treatments on some wheezy kids, my IV solution skills & my "clinic diagnoses" - I am feeling very well rounded in my health care roles!

Anyways my night finished at the hospital at 11 - the patient Farmina came back to me at 10 & I watched her for an hour, had the surgeons & Chris clear her to go to post op then got to go pass her off to Brittany - who I now never see since she is on nights so that was fun! Hopefully she does well tonight & everything was fixed because if not I am on call & will be called back in with the on call team  - that's why I wanted to be sure we all thought she was stable cause I don't want to get to the hotel, have her wake up & then have a problem in the middle of the night. He sweet little mom was waiting all by herself outside of the OR during those 2 hours so I took an Arabic interpreter who stayed too & gave her updates. After I took her on the gurney back to post op the mom gave me the biggest tightest hug & kissed both my cheeks & thanked me...those moments are priceless & worth any missed sleep. It's already 12:20 -I need to shower & be in bed by 1 am & may try to sleep in til 6 & get 5 hours of sleep. I cant believe we are over the hump on surgery days on this mission. I feel like I have managed the demands fairly easily & I absolutely KNOW it is because I have so many wonderful friends & family praying for me & our team - I am sustained by prayers of many & the blessings from a loving father in heaven who wants this good to be taking place for His children here so I am carried when I start to falter. It is such an honor to be one small piece of this big mission.
Good night from Morocco & go #lighttheworld it's a beautiful thing to do! 

Tuesday December 4th - Day #2 of Surgery 38 Patients & Back at Hotel before 9 pm!!!

5:30 am came WAY TOO Early - especially since there is a disco nearby that is very LOUD & seems like it's in our room. I am quite perplexed at a disco in city center Tangier open at 3 am on a Monday night??? and I think I need to use earplugs tonite....I definitely only got maybe 4 hours of sleep. My morning shower did get me awake & going. I kept reminding myself this is what I LOVE TO DO & I know Mission Life is tough so let's smile & do this :)
At breakfast I was a little tired of hardboiled eggs for the 5th day in a row so I settled for toast. The Stryker guests are leaving today on a variety of flights & Megan & Anita their leaders were both with me in in India so it has been fun to hang out with them & their team has been a big help!

When we got to the hospital I went up to Post Op to see Brittany - the surgeons were rounding like usual but none of the patients were awake until they woke them up :) I did get to see some of the patietns & there were some very grateful moms & I snapped a few photos. They put all 8 palate repair patients in the same room which I actually thought was a great idea. Those patients will stay one more night but should be stable tonight - good thing because they will have 24 more palate patients!

The on call team had to go in last night from midnite til 2 am & Samia was the RN to go in. One of our last patients last night was a small baby we did as a deviation who was the right age but had a low weight. BY the time she had surgery she was a bit dehydrated & they had to put a deep IV line into her & gave her quite a lot of fluids. In the night the nurses felt like she was working hard to breathe etc so the on call team went in & then Sarah one of the night nurses pretty much stayed with her all night. So as soon as we got in the morning they brought her down to the PACU to see how she would do & if she needed to go to a "real hospital" Samia & I traded off watching her & over the next 8 hours she got a lot better. I played pharmacy tech again because the Intensivists wanted her to have 10% Dextrose & 1/2 Normal Saline IV fluid - so I did the calculations, confirmed it with Chris & used 50% Dextrose, Sterile Water & Normal saline to make it - that honestly felt like an accomplishment! So the 2 hours of calm we usually have in the PACU from 7-9 were actually pretty busy with that baby & the Megan from Stryker came in not feeling well so Chris & I took care of here & ended up starting an IV in her & giving her a liter of fluid & some over the counter meds. Then Abigail came back & was feeling much better so we took her IV out...which was a bit traumatic  & tearful for her. Yep the primary care clinic we run in the back of the PACU was quite busy this morning!

We had 40 patients on the schedule today & 24 were palates which are much bigger surgeries with more risks. Honestly there are some missions where I think we did 24 palates total & rumor has it we have 24 palates on the schedule today, Wednesday & Thursday. Todays schedule had the first 8 surgeries as all cleft lips - one on each table then every table had 3 palates & each finished with a cleft lip. All 8 lips came to the PACU within 10 minutes of each other so we had complete chaos from 9:30-11 then we had a little calm until the palates starting coming off the tables at 12:15 & we got 3 fussy ones pretty quickly. By 3 pm 12 of the 24 scheduled palates had been thru the PACU so as always the PACU is lots of chaos & moments of calm typically!

With everything going on I didn't have much time to see pre-op patients in Child Life today & when I checked in there we didn't often have many waiting because with the 2 hour cases they let kid wait upstairs. Also with our crazy at one point we had 8 patients plus the one from yesterday & Chris somehow brought 4 moms back to help with fussy babies & pretty quickly thereafter we were told that "we don't bring mothers back in Morocco" - so we though that may have been our one & only but we may keep trying!

By 4 pm I had a giant headache & Tylenol & Motrin weren't working so I went back & just closed my eyes for 15 minutes & really that's all I needed to be back at it & get thru the rest of the night. One of the lips after all the palates was a little 5 1/2 month old that the program coordinators had to really work at getting final approval but they did & he did great! His name was Ziad & his mom was Naima - they traveled 8 hours by bus to get here - his mom spoke French & English so it was nice to be able to communicate with her. I had a so raise a male child as a single mother pecial baby quilt that a friend of mine made so I gave it to them. Naima was so grateful.

Two cute palate patients were 2 year old twins Othman & Ali who I remember from screening  - one was having some challenges so believe it or not they let us bring the mom back which was perfect because it was 2 for one with that mom there. Another patient was a 5 year old boy that Chris remembered from screening....on the registration paperwork for info about the father it just said "dead". I don't remember him at all but at screening the mom told the local girls how hard it is in a Muslim culture to raise a male child as a single mother & then to have the defect it has been even harder. It just broke my heart.

3 cases were canceled today - 1 who had a fever & probably an upper respiratory infection, another had an airway that was concerning & the 3rd was dehydrated & they didn't want a repeat of the patient from last night so they postponed her til tomorrow. So our totals for today will end up at 37 surgeries. By 8:30 we only had one complex palate (that had some bleeding issues in the OR) and 3 lips left to finish up so the 3 of us who stayed late last night got things organized for tomorrow & then got to leave!!! So I got to the hotel about 9 pm - it was wonderful & I am ready for a good nights sleep :) (with my earplugs in!).

It was another great day here in Tangier & I am so blessed to be here & be a part of this team & have my life intersect with them & these children & families of Tangier even if only for a brief moment in the middle of a chaotic day or if it's holding a fussy baby after surgery & trying to figure out if his mom sways with him or bounces him or rocks him to comfort him & I try all 3 because f that was my baby or grandbaby I would want someone to think of that...
Missions remind me that we are all humankind just living very different lives in many parts of the world but we all have more in common that we have different especially when it comes to loving our children & our families. I am trying to #lighttheworld this week with the love of the Savior & the love of family & I am really grateful for my family...the one I was born into with my parents & siblings, my extended family, my own family with Doug & the many precious friends who really are family we choose...who enrich our lives in ways we never realize when we meet them...yes I am richly blessed this holiday season & family in all those definitions  & love & service is what this Christmas season is all about.

Good night there are another 40 or 41 kids who need the best I have to offer all day & maybe the night tomorrow cause I'm on call so I need to get to bed!
        

Monday Dec 3rd - It was a GREAT 1st day of surgery! 40 patients :)

Well it is 10:30 I I just got back to the hotel...so it was a 15 1/2 hour day & a really good day for so many reasons :)
I an SO GLAD I opted to stay in last night - I got a decent amount of rest & when I got up at 5:45 am I knew it was GO TIME!!! I had some breakfast at 6:15 & then the team mtg at 6:30 & we left for the hospital by 6:50 & got there shortly after 7. Pretty much all areas were finalizing their set up & we did our "mock code" emergency plan - I am the Code Med girl as in Morocco the nurses don't dilute or draw up meds etc. So I started that role already this morning diluting & drawing up all of our Nubain (pain medicine) & saline flushes while the others got the bedsides set up & prepped IV supplies etc. We also took a PACU team photo by the OSI Morocco sign & I offered the bandage scissors that I bought on Amazon to all the local Moroccan nurses in the OR & PACU & in 5 min all 24 pair were gone - they were ok scissors not fabulous but for them to even have their own scissors or stethoscope is unheard of here.

By 0730 or so the first 8 patients (one for every surgical table) were in the child life area waiting to be taken back to surgery one table at a time. They were a cute group of little ones needing lip repairs & I was able to get some pictures & talk to the moms with a translator. It is nice having Child Life so close so I can see some of the kids before they go into surgery & introduce myself to the moms. The current plan is that we will not bring the moms back into recovery room which is a bummer on 2 levels - personally I love to see the parents when they first see their child with the cleft repaired & it is so touching & 2nd it is just better for the fussy ones to have their mom present to comfort them. The local coordinator said that Moroccan moms cry a lot so it is difficult to bring them back. I guess we will see how that goes. The Child Life folks show them photos so they understand what happens in the OR & PACU & how their child will look after surgery. They all look on very intently - for many this is their first time ever in a hospital & everything is completely foreign to them.

It is ABSOLUTELY freezing in the hospital they do not have any type of heating - which makes no sense to me but I guess that is common here? Anyway the night shift is really going to be COLD!!!
I ended up keeping my long sleeve shirt on under my scrubs & wearing my jacket. BRRR...one local surgeon brought a space heater for his OR...which then sparked an idea Nour the in country Program Coordinator who asked me if perhaps I would want to use some of the monies I had from friends & family to buy space heaters. I LOVED that idea & Nour asked Madam Mahmoudi the woman who really keep OSI Morocco going & she loved it too so they sent someone off to buy space heaters & were able to get a "good deal" from someone somewhere who is fond of Op Smile & about an hour later we had 10 space heaters for the 3 other OR's, the PACU, & 6 for the Pre/Post area :) When friends entrust me with money & tell me to just "do something good with it" I really feel a tremendous weight of  responsibility & last night & this morning I was really praying that I would be led to a need or needs & then this happened...tender mercies & prayers answered not to mentions - patients, parents & the team will all be be warmer. Plus then after this mission OSI Morocco will keep them & use them on other "winter missions" so this is a sustainable gift that will keep on giving long after this mission :) It was PERFECT & I was so excited. When they brought them back they stacked them outside the OR & we took a photo of them all stacked up. SO right now between the blankets for the shelter & the heaters for the hospital what I think we needed to bring to the people of Morocco was WARMTH....and that came thru the generosity & love of others who aren't even here & don't have the privledge of seeing these  sweet people we are helping. Plus the thermometers I bought on Amazon before I left & brought were also going to be a great help as we start today.

The morning lull did not last too long & there were patients on all 8 tables by 8:30 & we started getting patients in the PACU by 10 am & by noon the first round of 8 were all done. Some were calm & quiet & some were pretty miserable :(

Somewhere in the mix they asked me to bring a baby back to be screened - he was SO CUTE & I took a photo with him. He is a primary lip & they were going to add him on to the schedule today but I think they are adding him another day - yippee another new SMILE!!! We had lots of babies today & by the early afternoon some of them hadn't eaten for several hours so the Physician Team leaders wanted them to have some glucose (sugar) IV fluid...the problem was we didn't have any. In our crash box we had 50% dextrose but he wanted 10% dextrose so I got to be a pharmacy technician & make up with my mad math skills 10% Dextrose in Normal Saline IV fluid...

Also in the mix we were running a little clinic for the team in the PACU. The PACU physician is also the "team doctor" if anyone feels ill. The first to fall was cute Abigail one of the students who is 17 & a senior in high school...she had some vomiting Saturday night & blamed it on her tuna pizza (which made sense to me) but then she has felt nauseous since then & started having diarrhea today so we brought her in & gave her some anti nausea medicine, some electrolyte oral hydration fluids & told her to rest - we have all had a busy few days & jet lag - I gave her a "mom hug" & tucked her in & she slept there for 3 hours then got up & felt better & came back an hour later feeling worse so then we let her rest more until she vomited again & then I told her she had just earned herself an IV & IV fluids & IV anti nausea medicine - she had never had blood taken or an IV before but the other student Caroline came to hold her hand & video the event LOL &  Ranina got an IV in super easy & fast. We gave her a liter of fluid in & started her on Cipro antibiotics & sent her back to the hotel at 7. I spent a lot of time with her being both "mom & nurse". when I just got back to the hotel I checked on her & she is doing a little better but we kept the IV in locked off over night & brought IV fluids to the hotel just in case. 2 other team members came in with random symptoms but they were in & out with Tylenol or immodium. It's only day #1 I am hoping other people done get sick sometimes it starts 7 a different person drops each day!

Each of the 8 tables has 2 lip repairs then a palate repair - which is more complex. We got our first palate back at 2:45 & it seemed like we had a lot of chaos until 6:30 or so when the last one came off. At 8:30 pm we had 4 patients still on tables so we sent half of the PACU nurses back to the hotel & 3 of us stayed. I stayed & tonight & will be one to leave earlier tomorrow although tomorrow we have 24 palates...3 on each table so that should make for an interesting day...

we started bringing moms back the last 5 patients to 'try it out" & it really worked so we are going to see what we can do tomorrow. One of the patients in that last group of 4 was #40 Salma who was 11 months old getting alip repair - her mom was one we let back & I saw on the chart it said they traveled 48 hours to get here & were staying at the shelter. I asked Samia a local nurse to translate for me & asked her where she was from 0 it is a small town across the Sahara desert. I cant do justice to the story she shared & the hardships she had but she said she heard bout this on social media & she felt that "she needed to do whatever it took" to get her daughter this help that would never come to her town because she knew a boy with a cleft who had been shunned & teased & she didn't want that for her daughter...so they trekked across the desert on buses & another type of "trailer" pulled by a burro? (some of it got lost in translation). I asked if there was anything I could do to help her & she said that if she could get a "different bus" that only leaves on Wednesdays they could get back easier so I am going to ask about that tomorrow because Samia said she did not think it was a lot of money. It again reminded me that these people all "have stories" & without eh moms there we don't hear them so I was glad I had this reminder of the sacrifices these families make to get their children the medical care they need - something most Americans don have to worry about. I am not naïve - I know there are access to care issues in the US but not at all like this - we are at a whole different level of need & access here.

So now it is midnight & I have been playing Christmas Music on my phone as I have been blogging & while I am missing some Christmas events at home that I love I am feeling the true Christmas spirit in this mission opportunity & today I definitely had the opportunity to "light & warm a little part of the world" & some peoples lives here in Morocco & that is really what this season is about...giving.

Gotta get to bed my alarm is set for 5:30 & we have a busy day on the schedule!

Sunday Dec 2nd - Team Day in Chefchaouen - what a treat!

Most missions have  a team day so that we can have time together & "bond" before we will be working together in what can be a stressful situation where we need to work well together & depend on one another. Here in Morocco they offered us 2 options - because this team is so large & because not everyone would want to get up at 5 am & go on a 3 hour bus ride - but 42 of us did!!! We went to Chefchaouen - "The Blue City" there are a few different stories on how the buildings were originally painted blue  - I'm not sure which is accurate. But they have definitely increased their tourism by keeping it blue!!! And it is Beautiful!!! It's a town on a hill - I didn't realize there were so many mountains in Morocco & it is picture perfect. We had to be in the lobby by 5:45 so woke up ay 5:15 & left at 6 & got there about 9 a.m. The town was just "waking up" at that time & we walked all thru the town pathways on cobble & rock streets & heard a bit abut it. That was our first hour & then we were on our own til 2 so we all just wandered thru the town & even though it was small their medina was just as much a maze at times. There was a dear old woman who basically grabbed the 4 of us walking together & for 5 diram (5 cents) she put all of the traditional clothing on us & then allowed us to take a photo - we hadn't planned on it but it was fun & we all paid her more that 5 diram &she kissed us all on the cheek - because we essentially gave her $1 American...things like that really bring perspective to how little money people in other countries live on...in the stated people want $10 to take a photo with a fake movie start etc & here this sweet woman wanted 5 cents. Always HUMBLING.

The shops had leather & brass & silver & soap & argean oil & spices, LOTS of olives, a variety of traditional blankets & clothing & then all the "tourist souvenirs" We had fun roaming thru all the little side alleys looking at all the different hues of blue & the craftsmanship on the houses  -the doors the woodwork & iron work. We found a nice café for lunch & I had couscous which I guess they traditionally only make in Morocco on Fridays? but I guess as a "tourist spot" this restaurant has it on the menu every day - it was YUMMY!!!

I had slept most of the ride there & it was still dark most of the way but on the ride back you could see the more humble & impoverished areas different from downtown Tangier where we are at. I can imaging that these types of areas are the places that many of our patients have traveled from. Small cement houses - some better constructed that others, sheep, goats & chickens roaming on the sides of the roads. People on the roads selling fruits & vegetables.

I mostly wandered with Brittney & the 2 high school students on this mission & their sponsor Pete & a local Illam who wanted to make sure we were getting fair prices on what we bought & then  carried our bags for us! He was so nice!

While I was wandering with the girls Abigail told me a sweet story. I had been out with them for maybe 30 min during the 1st day of screening before we got patients to the Labwork station - I love that opportunity. Several parents as we were playing with the kids or after would come & pat our shoulders & say something in Arabic that we had no idea what it was but they seemed fine that we were playing with the kids so we didn't worry about it. I guess later when it happened again after I had left & a local volunteer was there the parents were patting us to show appreciation & what they were saying was thanking us for playing with their children & making them laugh & showing them love as they said they don't often get that....WOW...really all we need to do to #light the world is give love & kindness which so many people do everyday without thought of the powerful  impact it may be having on others Just another "moment" that helps me to "re-center" love & give more freely & know that it doesn't take much to make a difference :) just an open heart <3

We got back to the hotel at 6 & had to be at our Pre Surgery Meeting at 6:45 - Brittany & I crashed on our beds for 30 min - out cold!!! We went to the mtg & I was REALLY struggling to stay awake...it was all the typical pre-surgery important  info but I was seriously nodding off!!! My 5 am wake up was hitting me hard. We were told that there are 184 children on the surgery schedule for the week - so it is going to be a BUSY, LONG WEEK & I am anticipating  long days/nights...BUT this is what I signed up for, this is why I am here to do - give with my talents, heart, mind & all that I have!!!

There was a "team dinner" after the meeting  - which was 9 pm & I asked to be excused. I wanted to catch up my blog, shower, get packed for tomorrow - my scrubs & nursing supplies, lunch/snacks, dolls & stuff for the kids - plus I was tired. It's 11:20 pm & Brittney just got back & said I made a good decision 0 it was in a large home (supposedly the mayors) but there was no Mayor there, it was dark, cold & moist with mold growing & less than desirable bathrooms & dinner served at 10 pm - I sort of new that it would be a long night I wasn't up for & I need to bring & be on my "A GAME" tomorrow for the 1st day of 40 surgeries...feeling grateful I decided to have a quiet few hours in my room. After tonight I will just see Brittney in passing since she is on nights...I am hopeful she will have a goo 1st mission!

Time for bed - I need to be up at 5:45 & eat a quick breakfast at 6:15 before we leave for the hospital at 7. The last 2 days of doing some "sightseeing" have really been a bonus I rarely get on missions so I am really grateful for that but tomorrow I know we will start changing lives for both the children & their families & that is a gift that as a team we give these precious brothers & sisters of ours for we are all children of God & we are here as an extension of Him using our hands & gifts & talents to do His work. I am SO SO BLESSED to be here & truly feel so supported by so many & that will sustain me this week - so all prayers & positivity welcome as the tough stuff begins!   

Saturday December 1st Day #2 of Screening & Set Up & a Hammam

We left for the hospital at 7 am & when we arrived there were not many people there waiting for screening. We screened until noon & saw about 50 patients - it wasn't bad at all. It seemed like the patients today were from closer to Tangier while many of the ones yesterday had traveled much further. I did find out why there seems to be so many patients if they have done 106 missions in Morocco over the past 20 years...as I thought many are local (smaller missions) and Morocco is a bif Country & the last time there was a Mission in Tangier was in 2013 - 5 years ago. So there is definitely a bit of a backlog in the country despite all of the work here. I am not sure what the Cleft rate is in Morocco but it seems higher in Africa in general.

The recovery room group continued lab draws & they are definitely no for the faint of heart...most babies/children may not know what to expect - then we poke & they cry & wiggle. For some who have had surgery before they are completely clued in as to what is going on & come in screaming & kicking. A few little ones required 3 of us to hold plus the parent while one drew the blood! Not always pretty but definitely necessary.

I did get a tutorial from a cute mom on how she loads her baby on her back & wraps them on - not sure I could do it & the babies seem to just grab onto their moms clothes on their backs so they don't slip off before they are secured. It is definitely a unique skill!!! It was warmer today which made me happy and this is definitely the best view-an ocean view I have ever had on a mission :)

After we finished & cleaned up our station we had a "tour" of the hospital. We got more info there too...this is an "old non functioning hospital" & supposedly there is a newer one in Tangier but clearly we are not in it.. It's not horrible...but that is why there is not a lab here & no other patients or staff here - just Op Smile. There are pros & cons to that I think. It seems like the beds were left here from the old hospital but Op Smile got new linens so that's good. I have no idea who washed them though & we only have our cargo for supplies there are no "extras" in this hospital.

The 4 OR's are on the first floor & each will have 2 tables - it's a little cozy but it always is. The PACU (Recovery Room) or my world is right across from the OR's so we will get our patients quickly. The 2nd floor will be pre-op where all the patients are brought in the night before their surgery so be sure they are in fact here for surgery & they will have 40 beds as we anticipate 40 surgeries each day except Friday. The 3rd floor will have 60 post op beds because the Cleft Palate repairs will stay 2 nights. There is a "lift" (elevator) to get them upstairs but no one can confirm it works - I am sure it does!!! After the tour we set up the PACU (Recovery Room). We will have 2 Intensivists Chris from the US & Igor from Russia - they have very different personalities so it will be interesting. I have never had 2 PI's running the PACU. We are in pretty good shape - created tables out of cargo boxes & got our supplies organized. We will have a few hours Monday morning to finish up.  After we were done with that they served us lunch at the hospital - the food isn't bad it's just "different" so I choose carefully what parts I wanted to eat. They do have a lot of fresh fruit - bananas, tangerines (not sure of that has anything to do with Tangier?)

One of the Op Smile leaders I had spoken to about wanting to do some humanitarian work sad that with this weather the patients & families at the shelter were cold there (it is just a cement type building I guess - I have not been there) So they asked if buying blankets was something I was interested in using my "sacred service funds" funds for & I said YES!!! So I didn't go with them but they said they could get 25 blankets for about $250 & would reuse them all week then give them to the last round of families. My heart leapt at that opportunity to "light & warms this little shelter in Morocco" I am so blessed by generous friends who trust me to "do what is needed & meet the needs that I am aware of & led to".

We got back to the hotel at 3ish & had to be at dinner at 6 so we had 2 hours free!!! Ranina who is from Morocco but about 12 hours away has a friend who lives in Tangier & she came about 4 pm to walk is to the Kasbah (walls around the od city) where the medina (market) is that we were going to go to the first day when we got out crazy fun tour of everywhere else! We thought of going on our own but were advised against it - not from a safety point but just because it is a HUGE maze f streets & hard to find your way out once you are in. I was VERY happy we waited for Ranina & her friend. Some people wanted to do a lot of shopping - I have collected a lot of stuff from missions & was fine to just look. Plus this being a predominantly Muslim country I was pretty sure & so far correct in that I will not find a nativity set here :(. It is odd that it is Dec 1st and there is no sign of Christmas anywhere...we walked 10,000 steps getting to & from the medina & there are a lot of hills here - it was a good workout!.

In the Medina a very well dressed man approached us & wanted us to come to his rug shop...we explained that none of us were buying rugs as we are flying back to many different countries etc He insisted we go & Ranina agreed so we all followed him. He had beautiful rugs & explained how they were made (he did still try to sell them to us). BUT he also told us to go to the top of his roof where we could see the entire area including a 200 year old Mosque - it was breathtaking. He then walked us to the Hotel Continental which is part of the original walls of the Kasbah & has a view of the water. He was so so nice & took a photo with us before we left.

The dinner we were supposed to go to was across from the hotel & was a pizza/Italian place whose owners like to support Op Smile - I am certain I have had Pizza on all 14 missions  in every country. They had 3 options & one was TUNA pizza that some of the people ordered without realizing it cause it was just the first pizza listed. Now I like Tuna & I like Pizza but I don't really like tuna on my pizza so I opted for cheese & it was ok.

After dinner a group was going to a Hammam - a Moroccan Bath that they said was very nice & each person had a private area - they explained it all earlier & I had gone back & forth - I even "googled it" & could buy inexpensive 1 time use type bathing suits there (instead of traditionally being naked!) So I decided I would at least "go & see" Mostly I wanted the 30 min $10 add on massage!!! It actually was very nice, very private & very relaxing so I have now been to a Hammam and was so relaxed I went straight to bed (also because we had to be up the next morning at 5 am for a team day event. hence my blogging is a day behind! Another good day...tomorrow we will do some sightseeing - this is probably the most I have done on any mission & then the real deal starts on Monday!
 

Screening Day #1 in Tangier Morocco

I slept really well last night...just not long enough....that 6 am alarm was a challenge! Breakfast was interesting but hard boiled eggs & toast are always safe :) The hospital is only about 15 min away which is nice - it's older & a little worn down but I've seen worse...
I SERIOUSLY under estimated the weather. I have had Tangier on my weather feed for about a month & it was always between 60-70 degrees & my sister told me it's near the equator so it should be mild....not really. it is FREEZING & I have no long sleeve shirts & one light jacket. I clearly did not take into account that it is a coastal town with wind & moisture coming off the ocean. All of the locals, patients & parents are bundled up & it is wet & drizzly - I am wishing I hadn't taken out that sweatshirt in my "packing light" but oh well.
We arrived at the hospital at 7 am & there were over 100 people already waiting outside the gate of the hospital plus people inside on the hospital grounds under the tents that were set up - I have no idea when they arrived but this is often the scene that greets us & it is ALWAYS humbling. Morocco has actually done 106 Operation Smile Missions about 1.2 to 3/4 local (with just Moroccan volunteers) & the rest international. The in country team has this set up like a well oiled machine!!!
The people here speak a mixture of French, Arabic & a bit of Spanish (since we are only 35 miles across the Atlantic from Spain). It can be a little complicated communicating. The Pre-Op & Post Op Nurses were asked to do the Nursing history, vital signs & height/weight & the Recovery Room nurses like me were asked to do all the lab draws - basically making every child cry. Fortunately about 1/3-1/2 of the patients were seen in local clinics in the past week & had labs already done so we only drew about 140 labs today....which was a TON. Fortunately 3 of the PACU RN's LOVE to do blood draws so I helped with holding the kiddos (yes as they cried) and keeping us well supplied with everything we needed & got out labs to the courier routinely because the hospital we are at didn't have a lab???
Like other areas in Africa the moms all carry their babies on their backs - swaddled in a blanket around the 2 of them watching them get them out then back on their backs is pretty sweet. There are 4 Nurses here from Australia one of whom is Natalie in the PICU with me - she is 72 & still works 3 shifts in a "fortnight" - I had no idea what that was but it's 2 weeks - she said only Yankees don't know that - I guess that's me. She has been on 15 missions & is a spitfire but she does like an arm when she goes up or down stairs. The other nurse is Ida from Sweden, plus 3 Moroccan nurses who are great & a Moroccan nurse "Observer" or trainee. Rainia who si from Morocco came from 12 hours away past Fes so local just means they live in Morocco. I think we will have a great team we did good work together today! Plus while I will be missing my friend Gayle who was to be the intensivist Chris who is from Alabama is great - he was a navy guy & is super friendly & checked on us a few times today.
It stayed rainy & cold until 1:30 & then the sun finally came out :) When it cleared up we had an ocean view from our screening room & could see Spain across the water.
We screened 258 patients today - that may be the most I have ever screened in one day & definitely the most I have ever screened in 11 hours!!! Just for perspective the CHOC ED is busy with about 220 patients in 24 hours & these patients all have to be processed thru 9 stations....registration, nursing assessment, surgeons, anesthesia, pediatricians, labwork (that was us), dentist, speech & processed out by a large trilingual Gatekeeper team. You should be impressed I was! They also do it so that all Priority #1 patients (cleft lips/palates under 1 year that have never been treated) were screened first, them priority 2 & 3. That way the little babies don't have to wait all day - it is brilliant. Typically people line up & are brought in simply by where they were in line. So we didn't start seeing toddlers & older kids this after 1 pm or so.   Some of these sweet tender hearted moms got very teary as their babies screamed & cried with the labs so we were comforting the moms & the babies. I always knew the lab station was tough but didn't fully appreciate it til today! There was a set of 2 year old twin boys both with cleft palates that I totally was smitten with.
There was also a beautiful 14 year old girl with a cleft palate who had come with her mom from Senegal in West Africa - 1600 Km & 24 hours of travel. They made tremendous sacrifices to get here. They arrived towards the end of the day at a time when we were slower in the lab area but they had to wait for the line of people to see the dentist after us so I sat & talked to them for awhile. The mom spoke some English & was so sweet. She took a picture of me & her daughter on her flip phone (& I took one on mine but it was a little blurry) & she took a picture of my nametag. I asked the local coordinator if I could possibly help them with transportation back & a few other things (assuming she is cleared for surgery) SO I am excited to be able to help them because of generous friends. There is a mission shelter here that can house 50 patients with 1 parent so they will stay there - the criteria is that they traveled > 12 hours to get here. So I am excited they I have found one of "my people I was sent her to lift & light their way a little brighter :)
So for having so many missions here I am blown away by the number of patients we screened. On local mission they are sometimes only 2 days of surgery & maybe 20 patients (because the people who live here & support local missions also have to work to support themselves & cant take off a week of work to volunteer without a big financial impact. So they really rely on these big missions & I guess that is why we are having 8 OR tables. Many of these families found out about the mission thru the OSI Morocco Foundation & thru social media - Facebook is alive & doing good things her in Morocco.
I had a reality moment when I went to use the bathroom for the first time at 2 pm (clearly I was not hydrating properly) anyways one of the local volunteers told me to go use the bathroom in the surgery areas as it was cleaner & "the best". If that was the clean one I am in big trouble & may not want to hydrate...nothing like a trip to the bathroom to remind you that you are on a mission trip in a 3rd world area. That reality came back real quick :)
A few groups were getting dinner after we got back at 7:15 but I opted to stay in & shower & get a little more settled. That lasted about 30 minutes until our toilet overflowed & we had to move rooms...it's all good though. Somehow also in my "light packing" I did bring shampoo & conditioner but forgot my hair mousse, hair spray & dry shampoo...but I decided - "Mission Hair Don't Care" - it works are the beach it can work in Morocco cause I am by a beach! We have a team dinner tomorrow night & a pre surgery meeting on Sunday night so this is really my only night to not be exhausted & to relax and recharge a little.
We got so many patients screened today that we get to sleep in a little & breakfast is at 7 not 6 tomorrow YAY!!! It's already 10:15 so I am hoping to be in bed by 11. I am so grateful to be here & to be meeting some wonderful people on the team & some precious children & families bringing them life changing surgeries...Tomorrow is the world service day for my church (The Church of Jesus Christ of Latter Day Saints) kicking off the Light The World Campaign for December and I will be doing my global service & #lighting the world here in my little piece of Tangier Morocco with some of Gods precious children & for that I am abundantly honored. Good Night from Tangier!

Travel Tales, Arrived in Tangier, 3 Hour City Tour & Team Mtg...I'm a little tired!

This post will not be all that exciting but remember that this is also my travel =journal so some of these details are just for my memories :)
Last night as I was finishing getting ready my goal was to be in bed at midnight. I was in bed at 12:41 so I call that a success!!! It wasn't just about packing - my 50.6 lb bag was downstairs at 10 pm full of 15 CHOC Walk t-shirts, 12 donated dollies, a small quilt, about 15 pairs of socks/slippers, 20 onesies, 24 pair of bandage scissors for the nurses here, & 4 ear/temporal digital thermometers - much of which I have been madly ordering on Amazon the past week - thanks to the generosity or sweet friends! And yes there were also 5 pairs of scrubs, pj's, a pair of jeans a pair of joggers & about 5 shirts - this was a big change in my personal packing - in the past I brought clothes for every day but I know now that I will leave the hotel at 6 am in joggers & a shirt I will wear for an hour, change into scrubs at the hospital, get back to the hotel at 8 pm on a good night or often 10 pm, shower & put pj's on...so recycling my 1 hour outfits in the morning is my plan! Since my suitcase hit 50 lbs fast I moved all my food to a canvas carryon & I am pretty sure it was about 30 lbs, in addition to my backpack with my computer, camera, headphones, magazines, journal, flight snacks etc (sort of like carrying a 2 year old on your back!) It's a little crazy to look at all the food & think that is my primary diet for the next 12 days - peanut butter, tuna, bagel thins (they travel well), crackers, trail mix, protein bars, crystal light & dark chocolate almonds - sounds like a balanced diet to me??? I know they will feed us breakfast & lunch but sometimes it's questionable so I find it easier to to just pack food!
So if I finished that at 10 why wasn't I in bed earlier...well Doug is out of town, home for the weekend then gone again, so an extensive "honey do list" was needed with about 8 piles on the kitchen table!
Kristen took me to the airport & it was so nice to fly out of SNA & have my luggage sent all the way thru to Tangier. The 1st leg to Dallas was easy - one Christmas movie & I was there it seemed. Fortunately my Dallas to Madrid flight was 30 min delayed as I only had a 40 min connection time & had to take the train to another terminal. I had just enough time to buy a salad for the long flight - I viewed it as my last fresh vegetables & the cute girl at that restaurant asked if I was going to Madrid & I said yes I was on that flight but I was going to Tangier & she said "I'm from there but moved to Texas 5 years ago" I explained why I was going & she said - thank you for helping and loving my people" What a great unexpected connection. At that same foo stand I met Brittany a girl who is on the mission & it's her 1st OSI mission as a Pre/Post Nurse. I was so excited for her & it was nice to travel together.
The Dallas Madrid flight was NOT AT ALL FULL :) except for 1st & Business class where everyone was upgraded to...I ended up with great travel karma & had a full row of 3 seats to myself so I knew there was great potential for sleep!
There was a cute older lady who walked past me 3 times & I asked if I could help her - she spoke no English, had 3 boarding passes & was looking for row 42 which didn't exist on this plan - she was on the right flight but that was her last seat assignment so I helped her to row 31 - in retirement maybe I can be a flight attendant & get some travel perks??? Ya  probably not...
I stayed up for the first 2 hours of the flight then settled to sleep - I did sleep most of the rest of the flight - obviously not ideal & I repositioned myself often but it was definitely sleep! In Madrid Brittany & I got a drink at Starbucks & chatted - she is 30, recently broke off an engagement, has done some travel nursing & works in Colorado right now. She is the oldest of 8 children, was homeschooled & is so sweet! We met about 5 other OSI team members as we waited for our flight to Tangier plus 2 students & their sponsor That flight was < 2 hours & we arrived, got thru customs, exchanged money, went thru security & loaded lots of luggage in a van like a tetris game & came to the hotel. It is nice enough - $39 a night I think is the rate so you get the idea we are not at a 3 star place but it's clean, there is a decent bathroom (although you almost need to hurdle into the bathtub/shower) AND.... guess who was assigned to be my roommate??? Cute Brittany :) We were both SO SO TIRED but knew we needed to push thru to get on a Morocco time schedule so after we unpacked we decided to try to go to a market. The person at the desk told us it would be better with a guide so she called someone who spoke English & he came & got us 15 min later. What was going to be a trip to the market turned into an AMAZING 3 hour city tour. Said was our driver-  her was born & raised here but lived in London for 12 years working for Holiday inn & returned to care for aging parents as he is an only child. In 3 hours we saw 2 lighthouses & marina areas, a super cool cave, took a camel ride, saw lots of palaces, some pretty look out spots - he was our personal hop on hop off tour guide, photographer & Wikipedia on Tangier...all for $40 for both of us. What a great surprise afternoon we had.
We finished in time for our 7 pm team mtg that went for 3 hours!!! We have a GIANT team - over 60 people for sure - lots of Moroccans, only 5 from the USA, some from Sweden, Australia, Russia & a few other countries. This is going to be an 8 operating table mission (usually its 5 & sometimes only 4) so that is part of why we have so many people - 9 plastic surgeons, 9 OR nurses, 7 of us in recovery, 8 in Pre/Post & 2 in all the specialties instead of 1 (pediatrician, intensivist, speech, dental etc) plus 8 guests from Stryker, the students etc. It's probably the largest team I have been on. What that means is we have ALOT of work to do 0 the goal is 160surgers & probably 350 patients to screen in the next 2 days. We start every day with breakfast at 6:15 - I am a quick morning girl - no fluff so I will get up at 6. As the local coordinator thanked everyone for coming to Morocco to help their children my heart was immediately full. It will definitely be a long, tiring & challenging week but we are in the business of changing lives & if it was easy people would be doing it everywhere all the time - but it takes a group of people who don't know each other but have a common goal of working together to change children's lives for these 12 days! I am up for the task & the immense blessings that come with it. Now I need to get to bed it's almost midnite!
LOVE & HUGS from Tangier!
 

Headed to North Africa - Tangier, Morocco on Operation Smile Mission #14

Typically I start my blog for a new mission trip at about 2 am the night before my flight. I decided to blog tonight one night early in hopes I can be in bed before 2 am tomorrow night!!! That being said the only thing in my suitcase right now are 5 pair of scrubs, some food, 4 new digital forehead/ear thermometers (thanks to generous friends) and 12 dollies from another friend. So while I may not be blogging tomorrow night I definitely need to be packing!
So about this mission....I was supposed to be on a mission to Malawi last spring but the dates were changed and I couldn't go, then the dates were changed to summer & I couldn't go again...but I was a little busy at CHOC so that was all fine. BUT..I was anxious to get on another mission as my last one was 8 months ago. So on Oct. 11th I got an email at 12:26 & "Invitation to Volunteer" in Tangier Morocco. I immediately called Doug & my CNO at CHOC talking about the dates & where I would need coverage & they both said...."YES GO! & I replied at 12:51 & signed on for this mission. Fast forward 5 weeks & here I am today.
A little bit about Morocco...it is in the Northern region of Africa - the same area as Egypt, Libya, Tunisia, Algeria & Western Sahara. Tangier is a port city & nearly the northernmost city in all of Africa. It is on the Strait of Gibraltar near the Mediterranean Sea. I really don't know much else or what to expect there....
The majority of the team on this mission is actually from Morocco - they have alot of local volunteers but there are a few volunteers from Sweden & the US. I found out after I said YES that a dear Op Smile friend of mine was going to be the Pediatric Intensivist on this mission & my roomate - I was SO EXCITED!!! Sadly she lives in Malibu & while her house is fine several of her neighbors lost their homes in the recent Southern California fires & are staying with her now so with all of that going on this was not the time for her to leave the country for 2 weeks. So while I am sad she won't be with me I totally understand but if really would have been nice to know someone going into the mission. Instead I will be meeting lots of new friends :)
I have to be really honest this week I have been a little stressed & anxious about going on this mission...wondering "what was I thinking leaving for 2 weeks between Thanksgiving & Christmas" with all the kids coming home, some needs my mom has, alot going on at work etc. BUT...I have told my kids "Kraus' can do hard things" and I needed to tell that to myself & have faith it would all work out. Yesterday at church I was introduced to the 2018 Light the World Service Program. It is divided into 4 weeks of service and week #1 Dec 2-8 is "Light the World" focusing everyone on Global needs. I immediately felt a flood of peace wash over my anxious self realizing that I was going to be exactly where I needed to be doing exactly what I was supposed to be doing by going on this mission to Morocco and serving the people there - especially the children whose lives will be changed "One Smile at a Time".  Doug also gave me a blessing last night and that also gave me even more peace.
My flights are Orange County to Dallas, Dallas to Madrid then Madrid to Tangier...it's about 24 hours of flying which I am not super excited about but it's all part of mission work & getting to where you need to be to help the people who need this team. I will be 9 hours ahead of Calif which really isn't too bad so at the end of my day I will be able to catch up with family & life at home. 
I am now starting to get just a lil excited for this mission...for the dear people I will meet, the sweet children & parents and the wonderful team who will all have "servant hearts". I really can't think of a better way to start the month of December; when we celebrate the birth of Christ than with these 12 days of service. I am confident that all the "things" I have been concerned about will all work out at home, at work, with family, friends & even Christmas.
I am so humbled to have these opportunities. I know the days will be long, the work difficult, the circumstances and Recovery Room setting unpredictable and I will be far from home & all things familiar....but off I go because I know that the skills I have are meant to be used to help others & there are people in Morocco that I don't know but I do know they need the help I can offer. Times like these are at the core of who I am and really are the reason I became a nurse to serve others with love and compassion and follow the example that was set by my Savior. Please keep me & our team in your thoughts and prayers these next 2 weeks. They are truly felt and carry me thru my tough mission times.      

Wed. Catch Up & Thursday 3/8/18 - Long Post for my own memories :)

So I must have been tired last night because despite the local Disco sounding like it was outside of my room & playing until 3 am I did get some sleep thanks to my earplugs...seriously though every weekend & Wednesdays??? Disco Wednesday I guess - I much prefer Taco Tuesday - that doesn't disrupt the entire area! I also have a new appreciation for "It's all about that bass..." cause even in my sleep I am sure I heard the bass!

Aside from my "extended stay patients" who needed extra TLC & ICU care yesterday there were some other routine & precious patients. My little friend Jhon with the Bilateral Cleft Lip had surgery yesterday & got a totally NEW SMILE & completely changed look to his face :) His mama was so happy which makes all of us a lil teary. Also 2 bots both 3 arrived about the same time - Albert & Elizar & I had two size 4 boy outfits from a friend of mine so that was perfect for them - love how that works out! I also gave a dress to a cute little girl & her mom said she was going to save it for her birthday next month because she didn't have the money to get one :) Who new we could provide a bday dress for a girl in the DR

We have had Med Students as helpers in the PACU each day - some are wonderful & others are more interested in talking-to each other. The 3 girls on Wed were fabulous - especially with my challenging patients & it makes such a difference to us. It's different here-  after high school they go to one year of pre-med & then to 4 years of Medical School.

I have seriously improved my MacGyver skills thanks to Orquida here...and in very necessary ways. We had no oxygen adapters for our large Oxygen tanks - which is a BIG problem!!! Usually we have these upside down shaped Christmas trees that connect to the tank & then whatever devices we want to use. Without those we could not give nay oxygen or breathing treatments to patients. we took an IV Tubing drip chamber & cut it off placing that on the tank & using the part we usually put into an IV bag onto the devices - BRILLANT! We also have sheets that do not fit or stay on the beds so we tie two edges together for the top to place under the mattress & then we folded over 1 inch tape to make a bias type tape & tied those edges to the other ends - again amazing & so helpful. Finally we don't have ways to hang out IV bags so we used IV Tubing that we had opened already to make loops on the bottles & place on wall hooks - I was pretty proud of all of these!

Lunch yesterday was rice & beans & mystery meat so I didn't even go downstairs to eat & opted for a protein bar. The Pre-Post area bought pizza & I have to say I was a little jealous.
I was so tired last night that I only had a 2 min conversation with Doug before showering & going to bed. I also did not pack my bag ahead of time & really had a hard time getting up & strolled into our team mtg at 6:30 exactly when the mtg started & forgot to pack my Diet Coke - that was not good!

I did wake up tired but it is Day #4 & before I know it I will be back home so I will appreciate & enjoy every minute & even being tired and can maybe catch up on sleep next week???

Started the day at Pre/Post again & of course I remembered my 3 patients & moms I spent to much time with...Ashlie, Jordan & Elian - they all looked good & I took another photo of Ashlie. It's funny that I remember some patients & then there are some parents that remember me & reach out to thank me or give me a hug or call me in their room to see their child. It is so rewarding to be a part of their lives even just for one day. As always I will never see them again but each area I go to on a mission & the beautiful people I see there have a little piece of my heart <3

Again I saw the first 4 pre-op patients & introduced myself to them. We have 16 patients on the schedule & 11 are palates...sounds very manageable. We left so late last night that we left the PACU is a bit of a mess as we needed to get on the last bus or wait another hour so we had some cleaning & organizing to do this morning & before we knew it they brought us a patient who they couldn't get an IV in on so they wanted her to go back to pre op & drink & then we will add her back on at the end of the day...

I took the next patient Florangel & while she was no angel she was cute. She had a very bad "emergence" from anesthesia & came into me wild, crazy & with some bleeding from her nose & mouth. I medicated her 3 times without much success & it all just got worse. Todays med students were helping but I think the extra stimulation from lots of people made it worse. I brought the mom in but she was nervous herself & suffice it to say she finally calmed down but she was another 2 hours stay & I was seriously questioning what I was doing??? But she was in that same Bed #1 so everyone's question was is it the bed or is it Nancy??? Just as she left for the post op area my BEST ROOMATE EVER brought me 3 diet cokes - I had new hope for a better day & new energy!!! LOL

For my next patient I did change over to the 3rd bed & Willianny my lil 15 mos old Cleft Lip girl was the PERFECT patient to prove it wasn't me it had to be the bed. I gave her my last doll :)
Really I don't typically adhere to those ideas but every patient in that bed the last 2 days was a HOT MESS!!!  We decided we would just not use Bed #1. My 3rd patient came while I still had the other & he too was perfect - Mathias a 6 month old cleft lip. I had the translator come & talk to both moms together & they were both so happy - they shared before & after photos & I think they bonded a little over their similar situations.

Those 2 babies broke my "tough streak" & gave me back my confidence! Seriously....I did take a selfie with them for photo documentation of me & my 2 calm non chaotic patients. I had a little more time to talk to Mathias' mom since she arrived maybe 30 min after the other & found out she was from Venezuela. Wow - I am really not aware of all the struggles in that country. She & her husband came here to the DR to deliver Mathias her first baby when she knew there was a problem (I assume she had an ultrasound?) But she said that she knew if she didn't get out of Venezuela they baby would likely not survive because aside from Op Smile which is there & she could have accessed - just the needs he may have had initially she didn't think she could get. She has relatives here so they are staying with them & looking for work. They will not go back to Venezuela because the leader there is so corrupt. People are not getting medical care basic or cancer treatment etc. The leader does
not accept humanitarian aid because he does not want other countries to know how bad it is...I guess the unrest has been going on for about 4 years but just keeps getting worse. There are 2 types on currency one highly valued & one that most people have not valued at all, Nurse there make $10-15 US per month!!! We have a couple of Venezuelan Op Smile volunteers so afterwards I asked them & they confirmed it all...they said they have friend who know they are in the DR texting them to get them saline nose drops for a cold or deodorant because stores there do not have basic items. The volunteer said he has a business based on US$$$ so he "lives in a bubble there" & can order what he needs from Amazon every 2 weeks & has money but for the vast majority it is really bad.  He said about 2,000 people leave Venezuela a day for Ecuador, Colombia, Chile etc. & that you can Google how to get out of Venezuela with little money & there is all sorts of information. I asked him how I could help this newly displaced family & he is going to help me with that tomorrow :)  He personally says he only has 4 pages left in his passport & they are not issuing new ones but he will have to find a way (probably underground) to get one??? I cant fully imaging what it must be like there???

Today is International Women's Day & the Program Coordinators got all the women on the mission single Gerber daisies with a cute note - so thoughtful!  We had a steady stream of patients & NO ISSUES  (of course we did not use Bed #1...one of my patients I took was named Hyrum (a common name in my church but the students had never heard of the name). I looked into chart - dad 53, mom 40 & this was their only child. When the mom came in I asked her about the name & she said from her church - turns out she joined the LDS church but was not active now - not a coincidence. we talked a lot & I told her I went to church on Sunday & there are lots of people who would help her get involved again. I asked if I could email the Mission Pres her name & info so missionaries could come by & she said yes. I di check that it was the same phone # we had on the chart so she did give me a "good" number & maybe something will come of this. I want to do something for them tomorrow too.... 

Orchidia & Alma went on the early bus & I stayed for the last patient a 15 year old Mari - so sweet but definitely uncomfortable waking up. I managed her pain & held her hand & stroked her hair to help her relax because we couldn't find her mom...she was so sweet & I could relate to her with my girls. we did have 3 minutes of added excitement during that time when the power went out - fortunately she was the only patient & no one was in surgery & we were fine...but it made me wonder  if this happens often?

We got home at 8:30 & many people were going out to eat but those group tings often end up long & late & I am still tired. The student team was going for pizza so I went with them 3 boys all from the same school a Sophomore,.Junior & Senior - nice guys & they have had a life changing week. I was glad I got to spend tonight with them & their sponsor Elieen :)

I cant believe tomorrow is the last day of surgeries & they will all be lips - no palates so that is FABULOUS!!! I have bittersweet feelings thinking it's coming to an end...these weeks come only once or twice a year but are so impactful to my life. I am glad I was able to do my church stuff Sat & Sun as there is no free time once surgery week starts.

I do have a few more DR facts I want to remember but I will do that another time - hoping to be in bed by 10:30 & get 7 hours of sleep YAHOO!!!