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!!!

 

Wed. March 7th - Great Day - Short Blog - Need Sleep!

It's already 11 pm here & I need to get to bed but I wanted to at least do a short blog entry & I can perhaps get caught up tomorrow on some generic stuff :)

My roommate Cathy & I carried out our secret mission this morning with Maria & Samuel's families. we had to be discreet as there are 4 families sharing a room in very small quarters but we were successful!!! Cathy said Samuel's parents came to find her afterwards & asked where I was & she said back in recovery & they were so grateful....such small help makes such an immense difference here.

Going to pre/post op was just as fun today as yesterday & I met the 1st four patients for today. Surgeries started at 8:05 & the first patient came to us at 9:45 & it was Ashlie who I had met this morning & took a photo of her & her mom just resting on a bed :) She came back a little bit wild & unstable & ended up staying with me for almost 3 hours - YIKES!!! Her mom was super cute & very nice & gracious

This seems to set the precedence for the day for me...we have 4 beds in PACU so each of us take one & then rotate to the 4th as needed. Today I seemed to have the "extended stay bed" because 3 of my patients in that bed were each there about 3 hours for any number of problems....first Ashlie  then Elian who was a bleeder & lost a fair amount of blood so we did IV fluid replacement & he had a dresseing sutured to the top of his mouth for packing overnight & I watched him closely for 3 hours, then Jordan who ended up with a complicated 4 hour surgery to repair a fistula opening, a palate & his nose so he could breathe better - which he wasn't doing well when he came to me...he was the last patients I took to post op at 8;30 pm.. Seriously I am not taking that bed tomorrow...I couldn't catch a break. But the day overall was pretty calm & steady without too much chaos other than when each of my extended stay patients arrived unstable.

In the morning there were lots of little ones & I gave away many dolls & clothes. So I appreciated the steady pace of the day & we even had maybe a 20 min period with no patients about 5 pm & YES I did put my head on a bed & fall asleep! By this end of day #3 of surgeries & day #7 of travel I am a little tired! And I made today a 2 Diet Coke day but that didn't seem to give me any extra energy. I will fill-in the other details of today tomorrow cause I am tired & need more than 5 or 6 hours of sleep. If I go to be now I might get 6 1/2. 
 

Tuesday March 6th - Surgery Day #2 was a lil wild & crazy!

Today came in 3 parts 6 am-noon, noon-4 & 4-9,,,,,

The first part was fairly "mission normal". I slept well - the cold I am battling is still here but manageable so I was up at 6 & at the hospital by 7:30 with all of the team. I have figured out it works well if I pack up all my stuff at night so I roll out of bed get dressed & am ready to go.

I went to visit the Post Op ward to see the patients from yesterday & the first round of patients for today (they stay over night so there is no delay in starting the morning surgeries). That is truly one of the best parts of the day.....I get to see the patients from yesterday awake & ready to go home & their happy parents, give hugs & smiles & take photos. I can't post a lot of the post op (after photos on social media - it is an op smile rule) But I take lots of pics :) I also say hello to the morning cases - introduce myself to the moms & tell them I will see their child in the recovery room after the surgery & bring them in to see their babies. I LOVE this part of the day.

Then I change into scrubs & go to the OR & Recovery Room (PACU) . Today the first patients were going on the surgery tables by 8:15 which was wonderful. we got the PACU re-set up, prepared our medicines for the day etc. There are 20 children on todays schedule with 4 surgeons. We got a quick patient back before 9 am - a baby who was "tongue tied" - Sharily & I gave her a doll. The next patient I took - Sandy was a 7 month old boy of a mom I had met this morning. He was having some troubles breathing after surgery & needed a respiratory treatment & was fussy so I got him settled & held him until the mom came in. I had some cute clothes for him from a friend & the mom was so happy. I got some fun photos of him!

Things were still sort of normal - the OR needed help with a specific IV so I went in there to help, more patients came out including Emerola who I also saw this morning before surgery.She was a lip repair & had a tooth sticking out that disappeared with her repair. I got & posted great before & after pics of her sweet new smile. She was sleepy but washing her face woke her right up!
By 11:45 we had 5 patients in & out of the PACU and it seemed like just a normal day.

PART 2 - noon - 4 pm was a bit of a blur....we had palate after palate most all had some sort of issues, they had been difficult intubations, difficult IV starts, had some bleeding, breathing issues, crying, scared parents & a baby with this crazy medical history of sleep apnea & a heart defect but was cleared for surgery & had a rough go of it afterwards & so did we! It was complete chaos & at one point we had 5 patients on 4 beds. In those 4 hours I probably gave 8 breathing treatments, a whole lot of meds, inserted a nasal trumpet, placed kids on oxygen, managed pain and lots of screaming. At some point when there was moderate chaos Orquidia was at lunch, Jacob was helping in a room & it was just Alma & me. I didn't at all feel the chaos but I knew it was going on....seriously though I just went from one "event" to another because the international nurses cannot always draw up meds - it's not in their normal scope where they work so I was helping with a lot of that. It was a lot of coordinating multiple needs all at the same time. Finally at 4 pm the PACU was empty. Literally those 4 hours were one continuous event....and I feel like I came up for air after 4

I went to eat lunch after that & took one look & walked away...it was cold fried rice, fried plantains & potatoes. Peanut Butter, crackers & my diet coke never tasted so good! It was after that I realized how crazy it was because just about everyone who had come in the PACU during that time period came in to see if we were okay...The nice Australian nurse brought us special chocolates that were exactly what we needed! At this point we had 7 patients to still come in....I took care of 2 of them and that was when some of the magic happened.

I met 2 sweet families....baby Maria whose mom is 16. Mom sold her clothes to have money for the bus fare here & the 23 year old dad got angry about that plan & it sounds like that was not a pleasant event so she is here alone - 16 with a baby having surgery & not sure if she has enough money to get back home. Through kind friends tomorrow morning we are going to quietly help her with her transportation, food for the baby and getting replacement clothes once she gets home. She was overwhelmed with gratitude :) We will slip her the money in the morning.

My last patient was Samuel - he was here with his young but very attentive & loving mom & dad. They are Haitian & live right on the Haiti/DR border in the DR so it was a 8 hour travel for them and cost them $25 per person each way on many buses. The dad does construction but he left a job he had because he speaks better Spanish & the mom speaks Creole or Haitian & he was worried she would not be able to communicate with anyone here (which is somewhat correct). So they had many concerns about the basics: food, transportation and baby formula - again because of friends we will be able to help them also in the morning (I have to get US dollars changed into Pesos tonight at the hotel).

After this CRAZY day I thought about how everything falls into place...the surgery schedule today was all moved around & we got patients randomly not in the order they were scheduled. I don't know when these patients were scheduled originally but had it been during the 4 hours of chaos...I may not have ever met them & certainly would not have had time to talk to them & hear their stories. BUT...they were in the last round of patients & they came to me at a time that was calm & when I could sit and with a student translator really talk & listen to them....I cant wait to see them tomorrow morning & discreetly give them this help.

Back at the hotel about 10 different team members said to me in a variety of ways "wow you had quite a day!" I guess I did in many ways :)  
 

Day #1 of Surgery 16 New Smiles & Back at the Hotel By 10 pm :)

I have to say I was a bit worried about this day because last night at 9:30 I got a call in my room from the PC asking if I had any experience sterilizing surgical instruments??? I said no but if they needed help I was willing to go down & learn??? They didn't take me up on my offer which was probably a good idea. Come to find out the hospital person who was supposed to do that went home to go to Carnivale??? so our poor clinical Coordinator was there doing it by herself for the most part - but of course it got done as somehow things always do on mission trips. .

Wake up call was t 6 & breakfast at 6:30 with a team mtg at 6:45 & leave for the hospital at 7. Day #1 is always a slow start but this one was faster than normal I think we got to the hospital at 7:30 & had the first patient on a table at 9:15. We finished setting up the PACU - it really is pretty nice. We also had the mock code & then they started the tables one at a time. It turns out that we could only have 3 official surgeons because 2 were not credentialed by Op Smile; so they set up 5 tables & the surgeons after completing a case instead of having down time between patients would then go to another table . We only had 16 on the schedule for today so we did all of them & an additional DR Surgeon came over after lunch to help.

We got our first round of 3 patients rapid fire at 11 am - all lips & little 7-8 month olds 2 boys & a girl. We brought all 3 of the mamas back & they were all tearful, emotional & grateful for their child's surgery & how new smiles to them meant new lives. Truly those responses by parents just never fail to choke me up & remind me how rewarding this work is. I was able to give all those little ones cute new outfits - Elian, Jhalise & Aris. I got cute photos of them I will post on FB & Instagram.

The 2nd round of patients were all palates so by 2:15 we had only had 5 of 16 patients back plus a 6th patient that was a BIG bleeder & needed to go back to the OR. As is always the case the PACU is either feast or famile somehow....

I did go to "comida" lunch during that time. There was in a white Styrofoam box enough white rice for a family of 4, a separate cup of beans, a macaroni salad with lots of mayo (warm I'm pretty sure) & a piece of meat in sauce that might have been ham??? I opted not to have that & was glad I packed peanut butter, crackers & protein bars! The bigger crisis is there was not a diet soda to be found. I thought Pepsi was one of the sponsors but if they were there was only regular Pepsi available. I asked my roommate to get me 4 Diet Cokes when she got back (cause I knew the store would be closed by the time I got back) so I can have one a day to get me thru my afternoon/early evening hump!

16 patients seemed so manageable & like a nice day but when 11 of the 16 are palates those are big, painful surgeries with a lot of unhappy kids waking up. Fortunately Jacob is all about pain control so we were liberal with the meds to keep the kids comfortable.

One of my afternoon patients was an 11 month old boy Oscarlin & he was a CHUBBY BOY - rolls & rolls everywhere - I gave him a 2T outfit & loved snuggling him! I also gave some dolls away today especially to little Ashley the patient who had to go back to surgery - anyone who has a day like that needs some sort of prize! When we only had one patient left I let Orquida & Alma leave & stayed with Jacob to finish the last patient. We got out about 9:30 & to the hotel at 10 - a 16 hour day but not too bad. I worked a lot on my Spanish today sometimes to great outbursts of laughter but I tried!

We should have a bigger day tomorrow with 5 tables I think?, more patients & an earlier start so hopefully an ending time similar to tonight & then I am on call :/ No giant life changing events today just 16 families who were so appreciative that this team of strangers is here with the sole purpose of helping their children - the clothes & toys we share are a bonus & much appreciated but it is the life changing surgeries that are so powerful. A year between missions has been a long time. I am not sure when I will be able to go again but I am grateful to be here in this place now doing what I can on this mission. GOOD NIGHT!!!

Sunday March 4th - Church & a Little More Sightseeing

Today was a free day which was totally unusual for a mission trip. Typically it would be a team day  -go somewhere as a team for "bonding", but there was not one scheduled. For most of us this is the first mission without a team day but it was fine...about half of the team decided to rent a bus & go to the beach at 8 am. I opted to go to church here & then meet up with others later.

I took a taxi to the church. I thought of walking but the hotel suggested I take a taxi so I did. I went to the Gazcue Ward & thee were about 100 people there. An area seventy who lives in this area said that in recent years there were only 20 members in this branch. The LDS church opened & dedicated this area in 1978 & now there are 3 missions here & 8 stakes & that does not include Haiti. A lot of the new converts are actually teens & college age people. They have strong seminary & institute programs  - I don't know what that means as far as numbers but they say that parents here may not be interested in the church but they call & ask for their children to be taught because their want them involved in the strong youth & young adult groups. The church was a nice building & the mission office was there too. They did have a fence that stays closed when there ae not people there & private security (which many plaes have).

There were some youth/young adults at church without parents but also families. They are very gracious people & while I didn't understand everything I felt the spirit there in the words & songs I heard. It was a Testimony meeting & there was not a pause at all between testimonies up til the very end & even when it was about to end 2 other people went up one after the other. There were sister missionaries in that ward & they talked to me about a couple they were working with that were gone this week but were going to get married & baptized with the support we were offering - they perhaps were more excited that the couple I think :) They also told me about a Branch they cover with only 30 adults but 28 Primary Children because one woman in the Branch rounds up all the children in the area like the Pied Piper & brings them to church. I told them of some of the dresses, clothes & dolls I have that they thought would be wonderful for them so I am going to leave a few at the hotel for them to pick up tomorrow - bummed I wont be able to see them again but it will all work out.

After church I called the cab driver to take me back & met up with a few of the people from the Team & we went on the Choo Choo Tour of the colonial area - 500 years in 45 min is what they promised. It really was good & made me dust off some of my high school history of Cortez and other settler in this area. After that we went & toured a beautiful Cathedral here - I always feel such reverence for these sacred buildings that hold both history and faith. It was a bright sunny Sunday with people walking about the square, men playing games of chess, checkers or dominos, musicians playing for money. Today was also the Carnival Finale - I guess there are Carnivals in all the counties or areas (really parades) and this one was the one that the top people from all over were invited to. We walked down to it - it was on the highway near the water & I could not believe that the entire beach area here was covered with trash - everywhere....and the entire area was packed with people. We got there a little late & the viewing was 10 people deep but we got the feel of it. There was a separate children's Carnival that we had seen & I think that was the best part! Lots of people selling food & snacks - some grilling on the street etc. The surgeon we were with asked in we knew what he called those food stands & he said "Eating Here Gets you 6 Weeks in the ICU". I wasn't planning on eating but that was pretty funny!

Got over 12,000 steps in today - walking back from the Carnivale to our hotel a different way it really did feel like we were walking thru the slums. I didn't ever feel unsafe but it was a different view of the city. There are electrical wires hanging  EVERYWHERE & I found out that is because one person gets and pays for electricity & then everyone else just plugs into them. Seriously there aer crazy spaghetti wires on every corner. With the trips to the hospital, church & temple I have noticed they have KFC, Little Cesar's, Wendy's, Papa Johns & even a Denny's here.

Packing up my backpack for our first day of surgery tomorrow then heading to bed - 6 am Wake Up Call - Let the Mission Week Begin!

P.S. Fun Fact Sis Smith the mission presidents wife is the sister of Kendra Hada in the Santa Margarita Stake - married to Dave Hada - small world! She knew exactly where I was from :)

Saturday March 3rd. PICU VIsit, Set up PACU, Santo Domingo Temple & Team Mtg

It was a VERY FULL DAY...we did get a little later start & only had to be on the bus at 8:30 to go to the hospital. I went with the Team Leaders to see the local Pediatric ICU (I am not a Team Leader but my Intensivist Jacob from Norway - this is his first mission & he asked me to go with). If a child had to go to a higher level of care Op smile always contracts with an ICU in the area. They vary in sophistication & ability based on the location (some have been pretty scary) but this one was actually at a "Hospital de Infantil" or the only Children's Hospital on the island & was pretty good. They had 10 Pediatric ICU beds & decent equipment so that was reassuring - hopefully we have no need for it.

The Medical Hospital de Policia is where we are at & it's not far from there. It is a new government hospital and is actually quite nice. Our recovery room is small but we can fir 4 beds in there. Orquida, Alma & I got as much set up done as we could in about 2 hours -my Spanglish is already improving & I am going to try to just speak Spanish to them...mostly because they don't understand English - pretty sure I will slaughter the language! We will have 2 translators in the Recovery Room with us so for parent conversations I will use them. We will have a few hours on Monday to finish the "detail set up" while the first cases get started.

I keep saying I am in Central/South America - seriously bad at geography - & my sister is a college geography teacher! I guess really I am in the Caribbean and there is a heavy Spanish & French influence in this country. There are dogs laying in the street everywhere...they don't bark or bother you they are just laying around sleeping mostly.

After set up I came back to the hotel & had made plans to meet the Santo Domingo Mission President & his wife - The Smiths at the Santo Domingo Temple. I arrived about 30 min before they did just so I could enjoy the temple grounds. My taxi driver asked if I was Mormon & I said yeas he said the Temple is the most beautiful building on the island & that Mormons always dress nicely...in my Spanglish I thanked him! Within 5 min of arriving on the grounds I felt a flood of emotions...the temple is a big part of the help needed here. I thought of the children's song - I Love to See the Temple and I felt a great sense of peace and also order - that temples dot the earth to bless everyone. I felt so fortunate to be having this experience & just walked around the grounds. A small bus pulled up to the temple & the youth & leaders just kept getting out - it mush have been packed. One of the women greeted me with a hug & kiss on the cheek as she walked by.

The Smiths met me there at 3 & it seems like we drove forever - it wasn't really that far but the traffic here is HORRIBLE! Pres. Smith said there is a list of the top 10 most dangerous places to drive & Santo Domingo is 3 or 4 after Qatar & Kuwait etc 

So here in the DR most relationships are common law as in 90%. People just don't get married here or value marriage. Some have been together 30 years & have children & grandchildren but feel no need to be married. In some churches it doesn't matter if a couple is married but in the LDS Church you cannot be baptized if you are living together & not married. So families have had their children baptized but the parent are not - some have attended church for many years & are "dry Mormons" aka fully participate but not baptized. In order for these couples to be baptized they need to first get married. It is very expensive to get birth records & you physically have to go get them in the area you were born - The DR only began Electronic Records in 1978. Plus if one of the couple is from Haiti (the other half of the Island) you have to go to Haiti & get the records there - which are still paper & many lost in the storms etc. So the process is time consuming & cumbersome and on top of that very expensive. If both people are from the DR it is about $100 but if one is from Haiti it is $200. with the majority of families brining in about $200/month that is a tremendous financial burden or something they have to save for & then if another need comes up that money is used for that.

So when I contacted the Mission President about needs this was the primary one he & his wife identified - removing the roadblocks for people to be married, baptized & then go to the temple by providing the funds for them to be married. With friends we committed to helping & I believe at least 10 couples - more if some are both from the DR will be getting married & baptized in the next 2 weeks. The Smiths & a pair of missionaries Elder Martinez from Temecula & Elder Lanzas from Panama took me to meet the Lopez family. The father works for the government but still the $200 was a lot for them as they raise 4 children Palmela who is 18, Junior who is 16, Francelsa who is 11 & Camilla who is 8. They have been coming to church for several years & they were lovely people & had prepared juice & crackers for our arrival. we visited a bit & I did get to tell them that I have generous friends who want to help others both within the church & the good people in the DR in general. I told them that I believe families are forever & I have wonderful people in my area who recognize that we are all brothers & sisters & or family we wanted to help them get baptized & go to the temple - the same way we would help our own family at home. I of course was emotional as I shared that because yet again I never know what God has in store for me outside the Op Smile mission & I couldn't have imagined this - they will be married next Fri March 9th & Baptized on March 11th. I truly believe that if you take the first step not knowing what you are to do God will guide your path. There are several other couples they are offering to help - one was married today a bit away from us & the sister missionaries were having a wedding party for them. I will likely never see of=r meet these people nor will my generous friends but that doesn't matter - we are doing good & providing the help that is needed. (Although Sis Smith said she would send me some photos as she could)

They introduced me to a few other missionaries one was from Honduras where I have been - we talked about the corruptness of that country & the drug lords there - his parents are not members of the church - his dad is a carpenter & he got a call demanding a certain amount of money or they would kill his son (the missionary) the dad said he had no money & they told him to sell his tools which he did then he could not do his work as a carpenter. A year later they came back again asking for money & this time told him to sell his house or they would kill his son & he again complied. Just as he was building his life back his son decided to go on a mission so they would not have anyone to "ransom" but he is due to go home next month & knows that these people will know when he returns so he is fearful for his life...I could barely handle hearing the story much less living it - I have seen a lot but I still don't understand the trials people have in so many countries. Yet here was this young man serving others in another country. They introduced me to another missionary who came here from Haiti & came with only one pair of pants & one white shirt that he washed every night for the next day. As other missionaries left they have given him shirts & if they didn't fit he has tailored them himself to make them fit. I asked that we be allowed to help him with clothes & he declined but I insisted saying we mom's in the US want him to not have to do so much laundry :)

Some people here live by selling fruit & water on the streets or trying to wash car windows when you stop just hoping for 20 pesos (about 10 cents). The church has many members here but it is hard for them to attend church always as many people work 7 days a week or even have day & night jobs. There are 8 Stakes (like Diocese) here. The Smiths are from Florida & have been leading this mission with 157 missionaries for 8 months since last July. I was so grateful they took the time to spend with me & they were so grateful for the generosity of the people in So Cal. They said "this comes at a perfect time when we have needed something to assist these families move forward & this will change lives and change families eternally - Sister Kraus you are not here by chance".  I had 2 other missions fall thru, & recently another future mission fall thru but I always seem to end up where I am supposed to be. God's hand is in the details of ALL of our lives - mine & the people of Santo Domingo & for that I am grateful.

I got back in time for our Pre-Surgery Team mtg - 3 hours - but it is all part of doing what we do safely & well :) Called my family for a lively conversation with Doug, Kelli, Sarah & baby K & off to bed. I am going to get to go to church in the morning! I am feeling immensely grateful to have the ability to be a conduit of others goodness & generosity...I am truly blessed

Friday March 2nd 2018 Screening Day :)

We got a wake up call at 6 am & were to have breakfast & be ready to leave by 7 am. However in South & Central America these times tend to be more suggestions than absolutes & we actually didn't leave until 8:15. It was a 45 min drive to the screening area thru lots of traffic. We seem to be on the outskirts of Downtown Santo Domingo.

The screening area was outside in a park type setting which is a new one for me - fortunately there was plenty of shade as it is definitely warm here & a bit humid. Operation Smile has had an office in the DR for 10 years so they are somewhat of a well oiled machine as far as screening children & people in this country knowing to refer children to OSI. They don't however have any plastic or cleft surgeons in the country I am told - so the surgeons for this mission have come from other South/Central American countries or the US - ours are from Spain, Honduras, Peru & the US. There are also 2 surgeons from Argentina here to get credentialed. There are also no OP Smile nurses in this country part of that is they don't have time off their work to come & get trained & if they could get trained they often cannot take a week off of work to volunteer and lose that weeks income.

They support services however are wonderful & they had "pre-screened" 130 patients fro us to do final screening. So instead of screening 200+ kids to get the patients for surgery we only screened about 150. Often when we arrive for screening we have to set the screening area up  - they had all the stations set up & a separate area for the families to wait which helped to manage crowd control because each child comes with at least 2 adults so we still had 500 people here but they brought them over to screening 10 at a time for better flow. I was once again the gatekeeper with Orquida a nurse from Honduras who is a Clinical Coordinator in her own country & has done 35 local missions. I was supposed to train her on this new system our Clinical Coordinator had (which I loved & was all color coded). The challenge was she spoke no English & my Spanglish is weak...fortunately all we really have to do is review & record names, numbers & surgeries so it worked! Orquida will also be in the recovery room with me along with Alma also from Honduras - I definitely need to work on my Spanish!!! They have mostly done smaller local missions here and they were hoping for 100 surgeries but there is a glitch in the surgeons so we may only have 4 OR tables & our #'s will be closer to 85-90 I think. We also added all of the photos to the chart so that added another piece to the process but was fine.

We had a great day at the Gatekeeper Station - of course we are the last to leave so while the RN station was done at 4 we weren't done til about 6 but even that is EARLY compared to other missions where I have screened over 300 patients & been there til MN. There were SO MANY cute little babies who need lip repairs. A little 6 month old girl Alesia that I held was so precious & reminded me of little Baby K at home. This is a bit of a different  mission now that I am a MIMI. There is a new place of tenderness in my heart. I have always  been touched but these sweeties but it was in a different was as I left Kensie on Wed to come here & see baby girls her age here.  

There are always a few heartbreakers - some babies that were not pre-screened & heard about this mission from FaceBook & other media. These are the babies with Multiple deformities - one was blind, had microcephaly (small head) & a cleft palate & lip. The multiple deformities make the NC or not a Candidate which is the right decision but still hard news to deliver :(

MY little friend Luz hung out with us off & on during the day - she was 3 years old carrying around big pink balloons & Manuel another little boy with protruding teeth played near us a well. I got some fun pics of them & a few others but we were steady busy most of the day & I didn't take a ton of pics.
They did not always come to us in specific numerical order so mid afternoon when we saw patient #1 we did a little cheer for him "You're #1" So even though it was super organized it was still busy & chaotic at times. The dental & speech areas all get a little backlogged because they do intensive one on one evaluations - it's just unavoidable.

As we wrote where the patients each came from those here have not traveled the days as I have seen on other missions - most were 1 hour-4 hours away because we are in a large city area. I realized though I have a tainted perspective because many people traveled 608 hours by bus on multiple buses  - that is like driving to Arizona from my house or further. Also while I complained about the hotel hot & cold water; I was told that the water & electricity is rationed here so in home you do not have control over when you may or may not have either water or electricity - yet again - PERSPECTIVE IS KEY!!! There is also a Diphtheria, & Cholera outbreak in Haiti (the other side of the island) and after the rainy season dengue Fever & Zika always spike up - these are true health crises/challenges.

Punta Cana where are the resorts are at is about 3-4 hours away from here. I have never really thought of "vacationing after missions" for a few reasons - typically I am tired & need a day or 2 to recover & also my best vacations are with Doug, family & friends so I don't really want o vacation on my own or with folks I have just met - not that a day or 2 at a resort isn't welcome but I can do that at a different time & fully enjoy it.

Lunch was pizza - unfortunately really BAD pizza - so I was glad I brought bars to eat. I am pretty sure I have had pizza in every mission country I have been in!!!At lunch though I got a call from Sister Smith - the wife of the mission president in this area. I try to contact leaders of the LDS Church before I go asking what the local needs may be & heard back from President & Sister Smith that the greatest need is to have couples get married???? They are mostly "common law" families because it is expensive ($200 US) to get married even at a courthouse. Also in the LDS Church you need to be married in order to go to the temple etc. So REALLY this one thing is a HUGE roadblock to the members of the LDS Church here- some save for years & years to do this & THANKS to generous friends at home we are going to make that available to some couples here in the Santo Domingo area. Sis Smith said they have several couples/families that want to be married formally & we are going to make that happen this week! AS a friend of mine said when she gave me a donation "who doesn't love a wedding!" They invited me to the wedding that are in this area (some will be farther away) but I will not be able to attend the marriages at the courthouse as they are only open Mon-Fri when I have mission work but I may get to meet a couple tomorrow :)  I am simply the conduit for the good that other people help with & THAT is a humbling role to play....I believe there are always reasons why I go where I go...aside from the actual mission work and this is why I am in Santo Domingo! More to come tomorrow perhaps - stay tuned!

One of our last patients was $85 a little 7 month old boy Jhon who had a Bilateral Cleft lip - those are the ones that look the worst and after surgeries they are totally different babies. I get super excited about those repairs! One patient I saw brought a GO Fish Game so I played that with him during a lull :) We had a 2 year old with pretty bad Hydrocephalus who also had a cleft but got a VP Shunt to help her Hydrocephalus  a month ago & was cleared by her Surgeon for this so I think that child well get surgery!

We got back to the hotel just in time to get ready for a team dinner at a nice restaurant that was sponsored by a DR Health Insurance Company - probably because we are doing the surgeries they done have to pay for??? Anyway my mission wardrobe is limited as are other team members so walking in wearing jean capris & a nice shirt I felt a bit underdressed as locals were in dresses & heels - oh well! It was a nice dinner but way to long...I get the casual drawn out dinners of South America but 3 hours into it when I had finished my meal some of us headed back & weren't going to wait another hour for dessert! It was very nice of them to host us though & the restaurant was packed as we left at 10:30 pm.

Tomorrow we set up the OR's & Recovery room at the Policia hospital...a government hospital. Fortunately we don't have to leave until 8 so it wont be too early of a morning. I got to call home then headed to bed! Excited for what tomorrow will bring!

Wed Feb 28 to Thursday. March 1st Night of travel, day as tourist & team mtg

I am not quite sure why I thought a Red Eye was a good idea???  Perhaps because I needed to work half a day, then get Sarah in & settled & that was the best option when I agreed to flights a month ago??? Note to self skip the red eye flights - although I do have one going home too - YIKES! I think I slept maybe 2 hours on the very full flight because I was exhausted from not sleeping the night before getting ready. I got into Miami & had a 4 hour layover. I did connect with a "friend of a friend" who is on this mission - Cathy & we were on the same flight to Santo Domingo. That flight wasn't too bad & I watched a good movie called All Saints - a true story about a fledgling little church in Georgia - it was perfect for my flight!

It took about an hour or more for our luggage to come & to get thru immigration & customs. Weyu our Program Coordinator was there to meet us but we waited another hour for our van to take us to the hotel which was about an hour from the airport so basically a LONG day of travel!!! We did get to see the coastline on our drive but I am told it is covered with trash??? at least where we are at. The hotel is decent - I have pretty low standards for mission hotels - 2 beds, a bathroom with a toilet & shower & my new friend Cathy as my roommate :)

I was tired but I knew I needed to power thru the rest of the night so once we got unpacked we went into the Colonial Old Town area of Santo Domingo - town plaza, old buildings, a big statue of Christopher Columbus because he landed here first before America -I honestly had no recall of that little history fact...we also saw their memorial building & 2 days ago was their "independence day or memorial day" (not exactly sure which? But we arrived at 6 pm just as they were retiring the flag in a formal military ceremony - it was very cool to see. We are somewhat near the main area of Santo Domingo versus being out in a remote area - I am sure I will figure out a little more of the geography tomorrow. I was definitely fading by 6:30 but had an 8:30 dinner & team mtg to get thru. These late style meals & meetings do not match my internal clock very well. I decided to shower first so I could go straight to bed after. The shower has 2 temperatures - scalding hot & very cold...not exactly what I was hoping for. The dinner & meeting went for 2 hours & I literally went straight to bed & slept like a rock until the 6 am wake up call came! Screening day tomorrow - let's get this mission started. I am excited to be here and grateful that I have this opportunity :) I did get to facetime my family before the meeting so that is always good!