Surgery Day #2 and Unexpectedly “On Gods Errand” for Elvia & her son Leonardo

 Another 5 am wake up call & I have been surprised to be awake just before my alarm each morning as that is typically not me. Often I am dragging in the morning barely making it to breakfast as we simultaneously are almost ready to board the bus. Maybe I'm not yet exhausted because this is only a 5 day mission but definitely feeling blessed. Because we are not returning to this hotel and will be traveling back to Guatemala City tonight in preparation for flights tomorrow, we had to check out & have our luggage with us at breakfast. I didn’t eat a lot of my food & snacks so I left them for the housekeeper w/ a gratuity 😊 On the drive from the hotel to the hospital we passed by many many coffee fields where workers were harvesting coffee beans. With the early time I also called Kim in Texas & we got caught up a bit so that was good.

After our parking lot team mtg I decided to go up to the pre & post op area. That is one of my favorite thigs to do-seeing the patient's from the prior day awake w/ new smiles even if they still have some stitches; and then also seeing the patients who will have surgery today. With such a small # of patients the moms & I recognize each other from screening to the OR & PACU & then afterwards, its really nice.

The pediatric area is MUCH NICER than any other place in the hospital I had seen. The Rotary and other donors raised money specifically for pediatric care in this region, I just hadn’t seen any evidence of it until I went to the 4^th floor. It’s newer & bright & cheery, still as hot as ever but a nice new space.  I recall now that is why they selected this hospital as the “spoke” from the Guatemala City hub which is just over 2 hours away. They also have a small PICU & NICU so that made me feel right a home 😊 A little less technology & a lot less resources but they have space & are providing critical care so that was impressive- it was like walking into another world compared to every other square inch of the hospital.

Then it happened…an unexpected little miracle. I had just over $120 left in Guatemalan Quetzals from money that had been given to me by friends that I specifically had for unexpected needs at the mission site – for patients or things like the thermometers. I prayed & pondered this morning that I would know what to do with these “sacred funds”. On the way up to the pre/post area I had followed other team members but as I left there by myself  I went down the stairs & made a wrong turn when I got to the 1^st floor. As I looked around to try & figure out where I was I saw a young boy about 10 years old in a wheelchair with gauze bandages on both arms & both legs – he was being pushed by a nursing student in white & his mom or grandma was with him. Knowing that people cook over open fires in their homes I assumed he had burns & was reminded of a young man with burns I saw with on another mission only he had been electrocuted (I will have to look back on my blog for the details). I kept walking wondering where I was, then realized I had to turn around to go the correct way & passed them again now waiting down a hallway. I felt & knew immediately I needed to help them & give them the  money…a lil tricky when you don’t know them & they don’t know you. I went up & asked the nursing student if she spoke English & she said a little, I told her I spoke a little Spanish. I introduced myself & said that I was there w/ Operation Smile. Most everyone in the hospital knew our large group was there; I asked if he had burns & she said yes from a cooking fire. I told her I wanted to give them money  ”dinero” to help them with whatever needs they have (I could not remember the name of the Guatemalan money) and asked her if that would be okay? She translated all of this to the mom who got very emotional. We all introduced ourselves – Maria the student, Elvia the mom, super cute Leonardo the son & me - Nancy the nurse or enfermera. I had to rummage thru my backpack pulling out my scrubs and everything else to get to my neck wallet with the cash. I pulled out all the Guatemalan bills I had & rolled them up & discreetly placed them in Elvia's hand. She hugged me & I asked if we could take a photo so I could always remember this moment. We took the photo (this is where I wish I had the photo posting skills for my blog but I will put it on my social media) and I walked away. Before I could get to the end of the hallway she hurriedly walked to catch up to me & thru Maria said “God sent you to us” I had been tearing up as I was speaking to them early & now couldn’t hold back the emotion and I said “YES He did”…. This was not a coincidence; the timing was divinely orchestrated. I went to the Pre/Post area for a random amount of time, took the stairs down & made a wrong turn just in time to see them. I initially pushed away any thought to help them then remembered how I had helped the other young man w/ burns to buy needed supplies for his dressings as the hospitals in these countries don’t supply them; I had to turn around & pass them again and stopped to do what I didn’t even know I was sent there to do this morning. I am grateful to be a cog in the wheel on this journey where there is a much bigger picture than the one I can see and where I can be an instrument in God’s hands. I have no idea who they are beyond their names or what their needs are or how they will use the money - but that didn’t matter- what I did know was that I needed to give them the rest of my “Sacred Funds”. I was still processing it all & teary when I got to the OR/PACU area & briefly told Dusty about it.  What a start to my day & the last day of the mission.

In the PACU many of our supplies in our closet had “disappeared” again over night – boxes of gloves, baby wipes, diapers. All I can assume is that someone had a desperate need. We got an earlier start today & the first patients cam to PACU about 10 am, the 2^nd at noon & the last about 1 pm. All the cases went well, todays lips were a little more complicated - larger & some had cleft palates that will be repaired later. They were exposing & progressing the mentee surgeons to a higher level of the defects. Still each parent was grateful and happy to receive these services that otherwise would not be accessible to them in their country. At about 2 pm we had a good rainstorm, you could hear it in PACU but if you went to the hallway or other areas you could really hear it on the metal roof. We packed up and cleaned up & were on the bus just after 3 pm. Traffic in Guatemala is horrible 24/7 largely because of the condition of the roads & many times it is one lane each way. This was “rush hour” as well so it took us 2 ½ hours to get back to Guatemala City & our hotel.    

I was finally rooming w/ Dusty for this last night. We showered & got our bags organized & then went to a simple but nice dinner nearby to catch up personally & talk about the mission & the champion program since we are now committed to helping here the next 3 years. We think the next mission is not until next April but we will have some Zoom mtgs & education sessions in between. We will need a new PACU next time & the hospital does have some “Construction plans” so we will see! We went to bed at 9:30 for another 5 am wake up call for me. This time to get to the airport for my 7:30 am flight to LAX then connecting to SLC to meet baby Drew!!! Reza was on my same flight so we went to the airport together. He is such a nice man & was so kind to everyone on the team, he does this type of work for several organizations & that is so nice to see in a successful surgeon. So I am finishing up this blog post on my flight. I may or may not do a post mission blog of thoughts just for myself. While it was a short time away it was time well spent and I am so grateful for these mission opportunities they allow me to use my nursing skills, to connect with and help church members in the areas I go to & to provide unplanned humanitarian aid in ways I can never predict – today for Leonardo & his mom. I am so very blessed to do this work with the support of so many friends, my boss & others at CHOC, and most importantly Doug & my family….I am so happy post pandemic to to be back doing OSI mission work & might have to see if I can fit another one in before April 😊

Monday – Surgery Day 😊 Including Batman Just a normal mission day!

 It was an early start to the day, up at 5 am breakfast at 5:30 & arrived at the hospital at 7 am for a Team mtg outside. It was already hot at 7 am! Not sure why I bothered to put on some makeup – since I sweat it all off in the 1^st 5 min – oh well it will save me time in the morning tomorrow getting ready. The hospital was also already an oven inside. We solved the PACU location dilemma-David was thoughtful & heard what we all had to say & we will be in their PACU. It’s going to be a bit cramped & we will definitely be inconveniencing them but it’s our best option for this time. I guess this is part of the “Fact Finding” we are doing. This space would not work in future missions with more patients & bigger kids/teens so we will need to brainstorm. We got the PACU set up. We did our Mock Code & I will be responsible for the monitor & Compressions should an emergency occur.

OSI had a donor who purchased wall mounted AC units that were installed in 3 OR’s & a portable AC unit they brought to PACU. We got ours about 10 am & it was like getting the best gift ever-I was so excited. Since there is not a door on the PACU it doesn’t fully cool the room but it absolutely makes a difference-it’s the little things & this was actually a big thing!

We have 10 cases today all primary lips. Each case will take double the time so a 1 hour case will be 2 hours as the surgeons & anesthesia train the local physicians. Some of what we set up last night had “disappeared over night” so we had no thermometers or diapers. I had $$ from a high school friend & gave it to Ambra to go get those that will stay w/ OSI Guatemala for future missions.  Our Blood Pressure cuffs also disappeared but those were harder to replace in country fortunately BioMed had an extra set.

This is a regional hospital & the only hospital in the area & for many miles. It is very busy as it serves such a vast area. They do about 25 deliveries a day which is A LOT & it seems there are many C Sections that take place here. It breaks my heart to see these new mons in recovery on metal gurneys w/o sheets. There are not many “Nurses” in Guatemala – they do have aides & that is who is in recovery w/ us but they do very little for the patients, some patients would raise their hand for help & while we couldn’t do anything for them I did smile & hold a few hands. It is a different world here & this was a big dose of 3^rd world medical care reality that came rushing back.

We got our 1^st patients at noon, the 2^nd set at 2:45 & the last set between 5-6 pm. I was grateful my PACU clinical skills kicked in the moment the 1^st patient arrived – just like riding a bike 😊. We have a GREAT PACU team – David the Intensivist is from PA & we have been on 2 missions together including my last mission in Morocco pre-pandemic. He is young & works as a PICU doctor Part Time & does one OSI mission a month which is a huge commitment & contribution. 

In the PACU we brought all the moms back in w/ the babies once they were settled. It is always so touching to see their reactions – some had tears of joy & others prayers of thanks. My little friend Lorenzo from screening who was in the Batman outfit at screening had surgery today & I got some cute photos – he is such a cute boy who now has a new smile!

Visiting w/ Ellel re, life in Nicaragua. Last year the Nicaraguan President (who is more of a Dictator & wants his country to be like Venezuela) kicked all the Non Profits out of the country – he felt their “western influence” was causing some unrest in his country – such a loss to the people of Nicaragua & OSI as they had a clinic there & a strong “in country workforce of trained volunteers” It was heartbreaking to hear him talk. He also said that Nurses there & here in Guatemala make about $300-$400/month for full time work 40 hours/week so that is about $2.50 hour??? If you make $400/month

We left the hospital by 7 & were at the hotel by 8, went straight to dinner there, took a shower, called my family, packed my suitcase & went to bed – another 5 am wake up call!

Sunday - Screening Day & Hospital Set Up - A BIG Dose of Mission Reality I had forgotten – this is a bit of a long one!

The logistics of this mission site are a bit unusual with the “Hub & Spoke” concept. We have been in the Hub & today we transition to the spoke which is Escuintla. Escuintla however does not have housing/hotels for the full team – they have a few rooms secured for the “on call team” but the rest of us will stay near Antigua which is an hour away. So this morning at 6:30 we checked out of the hotel in Guatemala City, had breakfast, & loaded our luggage on a bus that will go to the Antigua hotel. I hadn’t really unpacked but getting myself repacked was more difficult than I imagined & my backpack I am certain weighed 40LB…with 6 bottles of Coke Zero, 2 bottles of water, my computer & mission supplies.

We arrived at the screening location – a church that was behind a large wall. We did introductions and  had our morning team mtg standing a large circle  & afterwards they sang & clapped Happy Birthday to me since we were not all together yesterday. I hadn’t told anyone it was my Bday so it was a nice surprise 😊

We all wore our Team shirts & they also gave us scrubs…this program is all about being “one united team”. We did photos of our specialty – so that’s PACU for me which is when I found out 2 of our mentees tested positive for Covid (& 3 others in different specialties)…so disappointing for them & a lil bit for me – but I still have one – Claudia. They also did individual headshots…not quite sure where these will be used but I asked the photographer if I could pay for the touch up package LOL. We have to write a Bio & what it means to us to be a “Op Smile Guatemala Champion” .

We then set up for screening – the local volunteers are very organized & use a color coded system which of course I loved. I was assigned to Vital Signs & weights & then to help at the end w/ Gatekeeper chart review. We had to screen in full PPE (gown, masks etc) This is not like the missions where people just show up hoping for surgery. These patients were pre-screened by the local OSI team as we are only doing primary lips on this trip. We had 30 cute patients to screen & were hoping for 16-20 cases who were not sick, not malnourished or anemic. This was initially going to just be a “fact finding mission” & then they decided that w/ all these resources in the country we should do some simple lips…that was already decided when I was asked to join the team.

I was getting photos & texts all day long from Donald Morales with information about all the people in the areas of Guazacapan, Chiquimulilla & Taxisco who benefited from the generosity of my friends in my church congregation. He said that “we had changed lives and the future trajectory of many of these people and that there were tears of joy” One man who tirelessly serves others is a Covid survivor who was in an ICU for 2 months fighting for his life… As someone told me with regards to these connections & the ability to help these people “it is so touching because it confirms to us how much God loves his children that He would supply their needs from unknown & unseen sources from afar in ways to them that might seem like miracles, and it affirms to us that God would do the same for us if situations were reversed”. Despite my time in several 3^rd world countries I am always humbled when I see the poverty of people who are doing all they can to work & raise a family and just need a little extra help.

I saw & screened such cute babies today! Just seeing those children & the hopeful parents melted my heart & reminded me why I love this work…we have the opportunity to change lives one surgery/smile at a time. There was a cute 2 year old boy in his Bat Man PJ’s who after screaming was very cute & interactive & so many sweet moms.  I sort of whish I had brought toys as since we were screening so few patients Child Life (the keeper of all toys) was not with us. I did bring some stickers & bubbles & was reminded that bubbles are always a good idea!!! Screening went fairly quickly &we were done by noon or so then I helped Dusty with the “Gatekeeper role” really just familiarizing myself with the new forms. We had lunch at the screening site – the food has been good 😊 and were supposed to leave for hospital set up at 1 pm..then it was hurry up & wait-which is often the case on missions. I was fine not setting up – I have an awesome PACU partner Ellel from Nicaragua who has done many missions & speaks Spanish. So I volunteered not to go & put myself on stand by for a seat in the van BUT…they planned on a seat for me…so I went & it was probably good I had the “Shock Factor” of the “hospital” today vs tomorrow. The instant we drove up to the hospital all my “Mission memories” I hadn’t thought of for 2 ½ years came rushing back. While it is their “regional hospital” & they are trying to focus on Pediatrics  it was very dilapidated, all cement, few windows…basically a “sweat box”. Matt (my new anesthesia friend) noticed about 10 bats in the open stairwells then reminded me that w/ the bats we won’t have an insect problem. That really didn’t make me feel any better. Despite the condition of the “hospital” they are ABSOLUTE in making sure that anyone who comes into the OR area is in clean scrubs…so it’s a good thing they gave us scrubs today as I did not pack any since I wasn’t planning on setting up…

Behind all the things that make me gasp…the temperature that I am sure is what people refer to as a “sweat shop”, rusted out sinks w/ concerning black dots (we are not using that one), some bugs on the floors, broken beds & a lack of linens…they are truly trying to invest in children’s healthcare in this area which is why we are here – so I need to get past the “challenges” & remember that fact. But I probably would place this location in maybe my top 5-7 worst from my 17 missions. I was mostly aghast at the adult care I observed just while we were setting up; their patients – some of them moms after c-sections are lying on metal gurneys without any cushioned pads on them…yep a metal stretcher & they have no pillow & sheets over them either. Whoa…and we complain when a hospital pillow isn’t just right???

We understood that we had some options in the location of the PACU. The first was a horrible room with water leaking from the ceiling, no running water & the hospital trash location adjacent to it -that was a hard NO for me. The 2^nd was their existing PACU but it is tiny maybe 3-4 patients could be in there & the hospital will have their own patients while we are here. So not ideal but a good environment plus the proximity to the OR’s is perfect. The last option was their “Pediatric Observation Area” where they had 3 beds for us; however it was located in their Pediatric Emergency area quite a ways away from the OR’s so we would have no support for PACU needs/emergencies & could offer no support for OR needs/emergencies & who knows the germs that are there…no masks and lots of kids & parents – seemed to me like a infection petri dish. Ellel & I agreed the PACU was best & decided how we would set it up… that was until the Intensivist came & wanted to be in the Pediatric Obs Area. I am pretty “go with the flow” on missions. I spend every day at work making decisions & I LOVE being the follower here…but this one made me nervous – So I encouraged Ellel to share his opinion re why we liked their PACU & still we had pushback. I explained my concerns as well. We left not selecting either area until we could talk to the team leaders. So we set up a PACU “closet” that could be moved to either location.

Ellel & I finished before to OR & Anesthesia & BioMed teams.  He was helpful to Biomed & I ended up checking surgical Instruments – a new skill set that simply required me to match numbers on an instrument w/ the # on a list & on the tray -still it was a lil tricky & something I have never done in almost 40 years of nursing – everyone could use a lil cross training! We missed the 6 pm team mtg & dinner at the Antigua hotel & didn’t leave the Escuintla Hospital until 7:30 getting back to the hotel at 8:30. I was a “little spent” probably from the heat & lugging my 40 Lb. backpack everywhere w/ me so it didn’t get stolen! I checked into the hotel & I had my own room again!!! That is a HUGE blessing to me – I don’t ask for it but I truly need & appreciate it. My luggage was placed in my room so I quickly went to dinner & luckily Pippa & Maria were still there so they let me decompress & chatted while I ate. All I really wanted to do was shower – so I did that – checked in w/ Sarah, Aaron & baby Drew, and called Doug.

This mission will be different with small number of surgeries, with all of the education focus but I had the realization that whether we did 2, 12, 32, 62 or 102 patients the # didn’t matter because of how much it matter to each ONE child & family. Off to bed – it is midnight & I have a 5 am wake up call. 

Saturday's Team Bonding/On Baby Watch/Red Carpet LATE Dinner/Baby Drew!

So the Friday night team mtg was really an overview of the Champion Program. The first site was Rwanda & now Guatemala - so it is a very new program and in the development phase. These mtgs tend to go a bit long & then dinner is even later one of the many things I have forgotten about missions after not having been on one for 2 1/2 years, Still it is a really wonderful organization & I love being apart of it.

I was a bit distracted knowing Sarah was supposed to go in to the hospital for her induction between 6-9 pm based on "open beds" but by 10:30 pm when I was ready for bed she hadn't been called yet but at 11 pm she was headed in - I knew nothing would happen over night so I was ready for a good nights sleep. I woke up to some text updates & stayed pretty connected to my phone all day.

This morning we all got Covid tested & we will test again I believe. Masks are required indoors everywhere. Today the team leaders had a meeting with the local university about the partnership and the rest of us had a team bonding day in Antigua a colonial city about 90 minutes away. I had gone to Antigua 9 years ago when I was on an Op Smile mission here so once we got there the town square & a beautiful cathedral from the 1500's  looked familiar along with the very primitive cobblestone roads. One of the Op Smile Guatemala Board Members Carlos & his girlfriend Maida & her son Denzel were our "Tour Guides" & really showed us a wonderful day. 

On arrival I was reminded that I was not "mission ready" as I needed to use a restroom & hadn't put my own toilet paper in my backpack - fortunately someone else had some & I was well stocked on hand sanitizer :). We first saw the old buildings from the 1500's & wow what history...then we went to a market & Maida (who is an attorney) was quite the "barterer" for anything we wanted to buy. I forgot how mountainous Guatemala is - we drove up  a really steep windy road to see the famous Volcano Agua  that towers over Antigua that I had not seen last time - it was really pretty & then we planned to go to a restaurant on a cliff but our van couldn't make it up the road!!! So the local volunteers suggested we go to Pollo Campero...a fried chicken chain restaurant & we did,,,not quite the cliffside restaurant but fun getting to know each other. I had been getting updates from Kelli all day about Sarah's labor progression & was wishing I was there while knowing all was being taken care of. We arrived back at the hotel at 4:40 & had a team mtg at 4:45 where we were also supposed to be ready for a "fancy dinner". we all took 10 min to at least change clothes. 

The "meeting" went from 5:30-7:30 & we were supposed to have left at 6:30 but time seems relative, We went over all the new charting system which allows Op Smile to collect more data, do more research & have a dashboard re. theory outcomes. It has only recently been used so we spent alot of time reviewing it & then there was a BIG presentation about this Guatemala Champion program, their values, pillars & goals - it was actually quite inspiring. We loaded buses after the mtg & went to a very fancy restaurant where they greeted us on a red carpet & background w/ all of our names on it & a photo op. It really was quite nice. They gave us our team shirts to wear for screening tomorrow & a fanny pack. Dinner was slow to come out & we were not done eating until 10 pm...so my table of friends & I got on the first bus back about 10:15. 

BY this time Sarah was at the point she had been pushing for an hour or so & I didn't want to bug them for info but was also anxious to know how things were progressing & just after 10:30 Kelli test me to say he was here & Sarah did great! They had some skin to skin time so we didn't get his info until later & his weight was 5 lbs 14 oz & 18.5 inches long born at 10:32. Drew Jordan Jackson. 

In the first phot I got of him on Sarah's chest he looked SOOOO TINY (& in the Kuehner/Kraus family we do not have tiny babies). Later in other pics he looked a little bigger but since her was born at 37 weeks he will be in preemie diapers & clothes for a little bit, While I was not there she had amazing support from Kelli at the hospital who having just given birth to Ford a year ago was probably a much better resource than my experiences > 25 years ago. Then Kelli had Kya's help as she watched Ford so Kelli could be at the hospital. So so blessed by family love & support. I Facetimes Sarah before I went to bed & felt such a relief that all had gone well.

Tomorrow is screening & hospital set up...I really need to pull out of the crevices of my brain all that it takes to be in mission mode!!!

Made It To Guatemala- Good things are already happening

 It's been a busy week w/ longer than normal hours at work & lots to do at home in order to be ready to leave. I had my bag packed & downstairs before I left for work yesterday which was my goal so that there wasn't a last minute "packing frenzy". I always LOVE the little "tender mercies" that become part of the plan you never knew about...Monday morning I was not on the CHOC Covid Command center call where they said we had some items that were donated in Oct 2020 & per the hospital guidelines after 2 years are "expired for CHOC use" (even though they aren't really expired?) & what could we do with them....I got texts from 2 people during the call who knew I was headed out on this mission; so I immediately messaged Ambra the program coordinator to ask if they could be of use on this trip AND she was AT THAT SAME TIME on a call w/ the in country team in Guatemala talking about supplies and YES  in this 3rd world country they are grateful for anything . So Tuesday after work I did some "shopping" in the CHOC storeroom for "expired items" & got about 1000 adult masks, 500 pediatric masks, 30 containers of Hand sanitizer gel & foam, probably 30pkgs of sanitizing wipes, 50 pair of goggles, & a box of Face Shields. Doug helped me pack them in a duffle a friend had given me several months ago & all that was 37 lbs so on Thursday I "shopped" some more & added more masks, more gel & wipes to get closer to the 50 lb weight limit...it will be a HUGE blessing to the people of Guatemala-all for  a $40 2nd bag fee. :)

Yesterday before I left for the airport I called Donald Morales who is a local Guatemalan leader from my church who live outside Guatemala City. I told him I had some generous funds for humanitarian & church member support. He said there are several young men & women who want to do service missions in Central & South America but they do not have money to cover the $30 passport fees or enough clothing to take with them or even suitcases.  They are ready & willing to serve but need support. He is meeting me at my hotel after he is off work tonight - it was the only time that we could match schedules  & while I might not be able to go shopping w/ them or even meet all of them he is going to tell me about them & facilitate giving the financial support to these young men & women because of the generosity of followers of Christ in my congregation in California thousands of miles away. 

So my flight last night was delayed by an hour but we were already on the way to the airport so I arrived at LAX at 9:45 for my now 1:15 am flight. I went to the Delta Lounge to wait & it was quite nice, had some good food & gave me a chance to relax. Matt the Peds Anesthesiologist from Salt Lake City was connecting thru LAX and he arrived at 10:30 so we visited for about 90 min & then went to the gate where we met up w/ Reza the Caraniofacial Surgeon from UCLA - a super nice guy who has been to Guatemala often with Op Smile & other NGOs. He lives 20 min from LAX so he strolled in just before boarding :)

I have always been annoyed that Doug can sleep anywhere/anytime & especially on airplanes. So I channeled my "inner Doug" & once in my seat - I took a melatonin gummy, put on my sleep mask, pulled out my pillow & blanket & I was asleep before we took off. I woke & repositioned but slept pretty well until they said we were descending into Guatemala City...so a good 5 hours of sleep I think?

The 3 of us got thru customs, got our luggage & met Monica who was there from Op Smile Guatemala to take us to the hotel which is nice. My roommate was going to be Dusty Clegg who I roomed with in Nicaragua (where she got locked in our bathroom!) so that was nice to be with someone I know but an Op Smile friend who hasn't seen her in many years wanted to room with her & was in a private room & asked if I would switch - works well for me as I have some CHOC work & mtgs today. ) I ventured out to the local mini mart to get a stash of Coke Zero (no diet coke here) & realized how bad my Spanish is; perhaps that should be a goal if I will be coming here regularly

We were given some info on the area that I am including for my own "memories" as it reminds me why I am here. Guatemala is the largest country in Central America w/ a population of 15 million. Half the population lives below the poverty line & have no access to healthcare. In the US cleft conditions are repaired in the first few months of life in Guatemala there are thousands of people of all ages birth to adults who are living w/ Cleft Lips or Palates & have very very limited access to any healthcare. Op Smile estimates 10,000 clefts in children <14 years of age. In this country there are 3.6 surgeons, anesthesiologists and OB's per 100,000 population - WAY below the basic WHO recommendation of 20 per 100K & only 4 hospital beds per 100K people. Aside from clefts 47% of children her have stunted growth & development (6th highest in the world) because of malnutrition & there is a 25% child mortality rate...trying to wrap my head around 1 in every 4 babies born does not make it to age 5 years. The needs here are immense & that is why this work is so important. I am told that Escuintla where we will do surgery is a very impoverished area. SO that all takes me back to "MY WHY"...WHY do I or have I traveled far from home to be in rural countries with such poverty & lacking the basics we take for granted (clean water, electricity, plumbing etc) & WHY do I use my PTO to go to places like this instead of just on vacations? & WHY I/do I miss important events from high school dances to baby/bridal showers, wedding receptions, gatherings w/friends & even this time the birth of a new grandbaby...BECAUSE I have always felt that Nursing was more that my "work" it is my talent or gift from God, it is at the very core of who I am, I have regularly felt pulled or called to help...at home, abroad, wherever needed and so I go & here I am. I feel so grateful & blessed for these opportunities, for the humble patients & people I meet, the like minded team members also here serving, the friends & family at home who encourage & support me & this work in so many ways - especially w/ their love & prayers. I am SO HAPPY to be back doing this work & while this trip will be different with smaller numbers of surgeries, it is the enduring changes that we will be making that will matter. This time I can also make an impact on the future of healthcare in Guatemala by training & mentoring nurses here - it will help me come full circle. 

I was working remotely most of they day & texting with the Hruskas about the service needs & they said they were nearby & did I want to go to lunch. That was such a fun surprise. They are Houston neighbors & friends of our friends the Packs & we had a really nice visit. They shared stories of their experiences here the past 2 years that were really interesting & inspiring-it is a tale of two cites a small percent of wealth supposedly from drug money & a majority of poverty. When I got back from that visit Donald Morales came by...what an amazing man. He is one of 9 children in a Guatemalan family raised in the Church of Jesus Christ of LDS and called to be a Bishop/Minister of a congregation at age 24 1 week after his wedding. Then at 29 he was a counselor to the stake or larger diocese in Guatemala for 10 years & now has been helping to lead missionary work here for 10 years. What a life of service to his fellowman. He has seen the church grow exponentially here & says Guatemala is full of good Christian people, He shared wiht me his plans for the money I gave him...the missionaries we spoke of yesterday, a family that needs shoes (that story was touching) & a father who needs some shirts because he uses all his income for his families needs, He will be in touch w/ me re. the details.

Tonight was a meet & greet dinner to get to know the team & mentees. It will be very low key & focued on teaching while doing some Cleft Lip surgeries. My "airplane sleep" is catching up to me so I am heading to bed.

Good Night from Guatemala City! 

Tonight is the team meeting & dinner so I am going to take a lil rest & will finish this post later.

Heading to Guatemala City on Thursday – excited for Operation Smile Mission #17

It's been awhile since I have blogged I wasnt sure if my blog was still here...

***Reminder this blog is my “journal” so this entry has a lot of what may be “boring details” of how this opportunity came to be – feel free to skip or speed read!

It has been 2 years & 8 months since my last Operation Smile Mission….with Covid all international missions were stopped & when they re-started mission in late 2021 they used more “locally trained” and “in country team members” in all specialties. I have been anxious to get back to my mission work. It fills a piece of my heart & soul that isn’t filled in any other capacity. Earlier this year I had several  “Mission Opportunities” that just would not work for a number of reasons…. Paraguay in March – but we were going to be in Maul, Madagascar in April but we had a wedding, Brazil in early June but the travel was over 36 hours & wasn’t going to work, Lima Peru the end of June also didn’t work. I was just recently considering Madagascar in Aug or Sept even though the travel would have been pretty horrendous. 

Then unexpectedly on June 7^th I got a voice message from someone I thought was “Sandra” about a “long term opportunity in Guatemala” that involved mentorship & education". She said she was on vacation in Italy but was trying to reach me specifically for this. I replied back to “Sandra” that I am very passionate about mentorship & nursing education & I had been to Guatemala in 2013 & loved the people there, but I am still working full time at CHOC & couldn’t consider a “long term opportunity”.   I said I had been hoping for a mission & could do shorter missions & would love to chat with her more, but I was leaving on a girl’s trip to Nashville the next day & with the time difference perhaps we could talk the following week. As I sent that reply via WhatsApp & then realized I had that phone # already in my contacts & it was AMBRA not Sandra who left the voice message…. Ambra was a program coordinator who I had been on 2 missions with in India & knew well. I quickly sent another message apologizing for not realizing it was her on the voicemail.  With the time difference she replied the next day when I was already in Nashville & said the “long term commitment” was actually short programs 5-10 days max but a long term commitment to a team to come back & work with the same mentees for 3-5 years. She said it was called a “Champion Program” & that was her new role at Operation Smile, that it was complicated to explain via text & we would talk after June 14^th. I told her that would be workable for me & an AMAZING opportunity & I was definitely interested & we would chat then.

So about 3 ½ weeks ago on June 14^th in the evening we spoke….the champion program has just been introduced by Operation Smile as a way to ensure sustainable programs & surgeries in different parts of the world…they just did this program in Rwanda & now will do it in Guatemala. It is a “hub & spoke” program. The main hospital in Guatemala City is the hub & then we will go out to surrounding cities (the spokes) & train people in these more remote areas throughout the country. The first place we are going on this trip is Escuinltla Guatemala…I have no idea where that is? My sister who teaches geography would be so disappointed in me!

There are 1-3 “USA Champions” for each of the roles on a typical team – in this instance a Medical Director, 3 surgeons, 3 anesthesiologists, 1 intensivist, 1 pediatrician, 1 clinical coordinator, 2 surgical nurses, 1 Recovery/Post Anesthesia nurse (that would be me), 2 pre & post op nurses, a night nurse, a child life specialist, a dietician, a Bio Med tech, Medical records, & translator. In some of these roles there are also Guatemalan partner champions who have done Op Smile Missions before & then 3 or so  mentees in each specialty, plus the Op Smile staff. So it is still a good size group of people. In order to be on this champion team you had to commit to the inaugural fact finding mission July 15-20. Before I could commit I needed to check on a few things I already had going on….a baby shower I was helping with, Sarah being pregnant & due on Aug 5^th, a Palm Desert trip w/ Kya & little girls & then getting off of work.

By the night of June 16^th I had all of that “figured out” and said YES!!!!! So I will be spending my birthday on July 16^th in Guatemala

We were traveling for July 4^th & I just got home today & now I am getting ready to leave in 4 days on a Red Eye – it’s coming fast. I truly feel like this was “meant to be”. It had been stressful for me trying to figure out if the “mission opportunities” would ever work out & the various travel. Now I know that I will go to Guatemala probably twice a year with a wonderful team of other champions who I will get to know better each trip & a Guatemalan team we will each mentor in our specialty. The travel is very manageable – a 6 hour flight direct from LAX to Guatemala city.  Plus, I just found out on July 4^th that a dear high school friend of mine has a friend who is doing missionary work in Guatemala City for the next 3 years – so I will be talking to her tomorrow & hopefully able to connect with her to do some humanitarian work each time I am there on a mission. What a blessing to not only help the patients & families but also others there. I love how God always has a “master plan” that we just don’t know about 😊 I have “sacred funds” from generous friends & I will simply try to be an instrument in Gods hands to help some of His children there – not only thru OSI but also thru my new connection Anita.

There was a “plot twist” this week, Sarah has had some pre-eclampsia & hypertension with her pregnancy & now they are going to induce her on the 16^th, The treatment for high blood pressure is delivery of the baby. She will be 37 weeks so I trust that baby & mom will do well but I would typically be right there at the hospital or nearby as she delivers so I had some angst. I could not back out of this commitment & Sarah totally understands but I did have a little heartache. She has some wonderful 2^nd moms in Utah plus Kya so I know all will be well. She may be in the hospital until the 19^th & I will fly directly to her on from Guatemala the 20^th. So I am getting a new grandson as the best birthday present ever!!!   

I am excited to get back to this important work of “changing lives one smile at a time” & also training nurses who can do this work in their own country…what a wonderful opportunity I have been given. I could not have planned a better OSI Mission #17. Now I need to get to packing & preparing to be gone again.