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.