Better Late than Never….Cairo Day #4 of Surgery & Travel Home 😊

 So, I got home 6 days ago but it has been a busy week at work and a big adjustment to the time change. and I am just now “closing out” this blog. Fortunately I put notes about each day in my phone so I don’t have to try & remember a week ago …..

After our busy day on Friday, I got a good night’s sleep. I was on call & truly thought I would get called in but fortunately I didn’t. Post Op did have some issues w/ the last patient bleeding, but he did not have to go back to surgery, so I was not involved. Days like yesterday remind me I am still an “RN- Real Nurse” & can thrive in the chaos and quickly changing clinical situations that require my brain & my skills. It’s just a nice validation since those are skills that I don’t use every day in my Executive Director job at CHOC and I’m pretty certain all my critical care staff don’t even know I still have these skills…LOL

This morning at breakfast Chris & I were told that Morag was ill. She ate lunch at the hospital -I NEVER eat the lunches provided – it is always a peanut butter sandwich for me but since we were at the hospital so late last night, I was hungry & went up & grabbed a lunch at the end of the day as Morag said it was a good chicken sandwich & brought it back to the bus when we were waiting to go home last night - in general getting a lunch 5 hours after it was brought is a bad idea - I was hungry  not thinking.  Fortunately when I opened it up it was beef not chicken so I offered it to the bus driver & I didn’t eat it ….SOOOOOOO GLADDDDDD when this morning I found out that was the last thing Morag ate & likely what made her sick. Truly feeling like it was a tender mercy. The last thing I needed today was to be sick again. Basically, this week I survived on eggs & bread each morning at the hotel along with a bit of fruit & the rest was my PB sandwiches, protein bars, dried apricots & nuts I brought.

We got to the hospital & made a quick trip upstairs, saw a few patients then Chris & I made arrangements to get IV fluids for Morag & then take a car back to the hotel & the car waited for us. In 20 min we started an IV on Morag, got about a liter of fluid in her, “macgyvered” a way to hang another liter above her bed flowing in, & taught her how to discontinue it when it was done. Amazing efficiency if I say so myself!

We got back to the hospital & had an hour before the 1^st patient came back at 10 am & all the 1^st 5 were in the PACU by 10:20. Of course the 5^th one was a feisty one we had to give meds to hoping he would wake up better the 2^nd time. Typical calm then chaos. My first patient was Kareem – he was 4 years old. His sister who was 23 was w/ him & she is studying to be a nurse. Kareem’s mom is 39 – so she had his sister at 16 & then him at 35…bit of an age gap 😊. He was such a sweet boy but once he was fully awake, he started crying telling his sister all about the surgery…that they “tied down his arms & put the mask on his face” he was very passionate & detailed – it broke my heart! Rebecca our Child Life Specialist said he did all the medical play before surgery but clearly the real thing was different. His sister said Kareem could be a bit “naughty” & he does not forgive easily so no one related to the surgery could be trusted. She also said that she had promised him a trip to the sea after the surgery. When it was time for him to go up to post op he 1000% refused to get in the wheelchair – no way-no how. He wouldn’t even let his sister sit in it & be on her lap. Then he asked for slippers (which he didn’t have) so he could walk. Making no progress his mom came down & he just cried to her & told her the story too…poor Kareem.

We finished up by 3:30 – and ended up with a total of 63 patients who had surgery. That’s 63 children who would have never had this medical care without our team in Cairo – changing lives one child at a time! I was back at the hotel at 4ish & Pres. Marcous had text me that he was in the area with his youth from the branch & wanted to stop in & say goodbye to me. He came & we went to a little café next to the hospital – I had to explain that I didn’t want to eat but would have a soda. He shared with me more info about the church branch. They have 10 youth but today there were 9 others who were friends of the youth – most were Sudanese & they used $20 American form the money I gave him to have this "BIG Youth Activity" and went to Abou Tarek’s (where I had gone) for lunch to celebrate some birthdays after their service activity. He shared with me the video which was so nice to see.  

He had hoped his primary President could join us to tell me the plan for the children's schooling but she was unable to come at the last minute. We chatted and he said many of the church members here walk 45-60 min to come to church & others are as far asway as Alexandria & Aswan. He shared that Egypt as a country is in crisis. 1000 factories have closed & they cannot import products to make items that were made in the past & they are exporting so much food that there is a scarcity of food in the country. They measure inflation by eggs & 6 months ago it was 1 Egyptian pound for an egg (about 5 cents US) & now it is 5 pounds or 25 cents. He said there are shortages with medicines & food/grain. He is diabetic & has to go to multiple pharmacies to get his needed medicine. The churches Bishops storehouse is working with the Egyptian government & supporting many in Cairo from all religions – Muslim, Coptic Orthodox Christian etc. he said that 6 months ago the storehouse gave away $7,000-9,000 Egyptian pounds of food each month. Now with both the inflation & added needs last month they gave away $70,000 Egyptian pounds of food.  He said that in Sept he & other church leaders are scheduled to meet with the US Ambassador & Minister of Affairs – since the church is US based & has given 2-3 million dollars of aid in Egypt. Much of it to widows in the Coptic Orthodox Christian Church; yet that church just worked to write & pass a family law in Egypt that if a spouse changes religion you can automatically get a divorce and the LDS Church is at the top of that list…so odd that on one hand they want to partner to help widows & others with food needs but also I guess are threatened by another church? He also said that the Diplomat Branch is very supportive & caring of the Arabic Branch – they have helped 3 members take classes from BYU online to assist with the goal of more education for church members.  Self-reliance is hard when it is so difficult to survive in general. It was again very humbling to talk to him – he said that he knows God is working in Egypt he has seen what happens when people get to know Jesus and that it is his goal to teach people about Jesus & Jesus will change their lives. Pretty profound & applicable worldwide. He said he hopes to be remembered in Egypt as an “early saint” who helped the church to grow there. I assured him I was certain that would be the case.

By the time we got back to the hotel it was already 6 pm & Chris was in the lobby a bit frantic canceling her debit card that she had lost. Morag was better & the “final dinner party” was starting at 8 & I knew it would go until MN & I had to leave for the airport at 1 am. Knowing how these parties go all 3 of us opted to stay in. I finished packing & tried to get 3 hours of sleep before heading to the Cairo airport & then staying awake for 8 hours until I was on my “long flight” from Istanbul to LAX. My first flight was delayed taking off so my 90 min window between flights turned into 50 min & the girl I sat next to was from Dubai & going to San Francisco for a business meeting. She spoke great English said this was her first time connecting in Istanbul, but friends said you need 2 hours between flights…not ideal. We were only about 4 rows behind 1^st class, so once we landed we rushed off the plane & truly RAN together about 3 miles – we had to go downstairs out of “passport control” then back upstairs into the terminal & run thru 4 LONG terminals. When we started out of passport control the signs said a 28 min walk to terminal A-I was stressed but grateful I was healthy enough to run thru the airport. I got to my gate & there were 3 different security areas you had to go thru to get to the gate. I was in the gate area as they were boarding & went straight on the plan – thankfully I made it! It was a full flight; I had a window seat & once we were in the air I took a sleep aid to be sort of on Calif time. I slept about 6-7 hours of the 13-hour flight then was awake the rest. I was concerned about my luggage wondering if it made the connection but fortunately it did! I got my bag & Doug was waiting when I came thru immigration. What a night & a day & now another day. I made myself stay up until 8 pm to try to get on a Calif time schedule but I had to be at work at 7 am Monday & its been a rough adjustment all week. Finally, by Friday I started feeling like I was rested.

So Op Smile Mission #18 in the books – always grateful for the opportunity to do this work & always amazed at the opportunities I have to connect with church leaders & be a conduit for the generosity of others in ways I could never imagine. What a blessing it is to serve….it was a rough start but a good finish and seeing a bit of Cairo & the pyramids was a nice bonus!

July 21, 2023. Surgery Day #3 – There is always ONE Crazy, Chaotic Day & it was today!

 Since it is always empty in the PACU for the 1^st two hours or so until patients finish surgery; Chris & I again went up to pre-post to check on the kids who had surgery yesterday. Some of the cute 10-year-olds we took selfies with at screening had surgery yesterday so they were excited to see us this morning, since they have had their surgeries & will be going home – more photo ops of course and some sweet hugs – they are all so precious!

Chris & I got matching Egypt scrub hats & wore them today to be “ALL IN” for this Cairo Egypt mission. Little did I know that maybe we bothered the ancient Egyptians because today was “THAT DAY” for this mission; teaching me that even on smaller, complex missions you can have CRAZY & CHAOTIC days & this was ours from start until our 9 pm time back at the hotel – yep, you’d not expect a late night with only 17 cases but we had it! I feel like I was also “the med nurse” today because I am sure I gave over 20 meds on my patients & others. Also, several of my patients must have signed up for the “extended stay package because they were not progressing & stayed way too long!

The first patients again came back starting at 10 am & it was steady all day. My first patient was a very unhappy 2-year-old palate who even with meds was crying. The mom was also distraught & bless Morag she took the baby & rocked & sang to him & after about 20 min of that he fell asleep. But during that 20 min. the mom of Chris’ patient came in & was overwhelmed by the PCU & her baby & decided to go back out w/o telling anyone & fainted on her way out but fortunately was caught by one of the students by the exit door. We elevated her legs & got her juice & settled amid all the crazy.

My 2^nd patient was worse than my 1^st…cute Abdul. Anesthesia said he had a bronchospasm at the end of the case & was having some difficulty breathing so they put a nasal airway in – wonderful makes sense. BUT…he then pulled the nasal airway after he gave me report & the patient immediately crashed as he walked out f the room dropped his oxygen level to 70%, working heard to breath, heart rate up. We found a nasal airway & inserted it, put him on oxygen, gave him a breathing treatment – pretty much all simultaneously & I was just about to assist his breathing when he started to improve. It was a CRAZY 1^st hour with him trying to figure out what was going on keeping him sitting up. Every time I tried to wean the oxygen, he dropped his O2 level – I gave a boatload of meds for pain, plus a diuretic cause his lings sounded a wet & some steroid & FINALLY he turned the corner after some “intensive care” for 2 hours & I was able to wean the oxygen & watch him another hour; Yes he had the 3 hour PACU extended care package. He was REALLY cute though & when he did finally wake up had the cutest smile. I took a pic w/ him & his mom as I took them to post op. By now it was 3:30 as my 2 patients had stayed a total of 5 hours???

As I walked back into the PACU the same anesthesiologist was bringing back another patient this one w/ an oral airway & special needs who was really kicking & having a hard time coming out of Anesthesia – seemed a little bit like ground hog day & fortunately Saben took one for the team & cared for that patient. The post op floor was bringing down a patient who was having some bleeding, so I took that patient & we were able to get his bleeding stopped with a lot of pressure on his palate for about 30 min & thought we were good but watched him another 30 min & he started to bleed again so I added a tea bag on a tongue depressor to my pressure regimen &that seemed to work – Hooray! When I took him back upstairs the post op ward was “drowning” a few kids weren’t doing well plus they were getting all the kids from us & they legit said “we need help”. So, I said I would send people up & when I went back to PACU there was only one pt left to come in so we sent 2 nurses & our doctor up there & Saben & I stayed in PACU. Our last patient clearly knew the theme of the day – “create chaos” & had a rough surgery so the anesthesia team gave him plenty of sedation & he came out sleeping for about 10 min til he woke up & was also bleeding. Thank goodness Morag was with us because he too had special needs & it took all 3 of us to keep him in bed. Secure his IV so we could give meds, and try to stop the bleeding. We sent SOS texts on our team WhatsApp to now ask for help from us after we sent all the help upstairs. I know it sounds comical, but it wasn’t feeling that way in the moment. A surgeon came back & our PACU doc & they did some work in his mouth in the PACU & got the bleeding stopped so he didn’t need to go back to the OR which by now were all being cleaned…when we took that LAST patient up the post op ward was still very busy but they had some help, so I think they at least felt better & supported. BY now it was 8 pm & we needed to wait to fill the bus w/ everyone still at the hospital so that took awhile & then the drive home had lots of traffic on a Fri night that was also Islamic New Year…maybe that is what made this day CRAZY!?  

So yes even missions with less patients can have days like this 😊 The PACU mantra is we are typically pretty chill with intermittent chaos & today was A LOT of chaos & intermittent chill. I can’t believe tomorrow is our last day of surgeries & then I head home WAY TO EARLY on Sunday. My flight is at 4:15 am (I really thought it was 5:15) so I am thinking there will be NO SLEEP & we will have to go to the airport by 1 am or so – we will see. Still, I would sign up for it all over again even with a day like today. Shower, Blog & Bed were all that was on my agenda for the night so off to sleep I go!

July 20, 2023 Surgery Day #2 It was a good day!

 Surgery Day #2 - 16 Cases Completed & a night visit to a CRAZY Bazaar Market

Even though I only slept about 6 hours I woke up feeling the best I have since I left home. It was wonderful & I am 100% good to go! It was as typical morning…breakfast, meeting at the hotel & off to the hospital at 7 am. Yesterday we shared the PACU w/ the hospital staff – they had 3 beds & we had 4. Today we have all 5 OR tables & the entire PACU. We got it all set up & organized exactly how we wanted & it is fabulous. We took a picture of the 4 of us in the PACU once it was “ready”.

Knowing it would be a while before patients got to PACU Chris & I went upstairs to Pre-Post to see the patients. That is always my favorite part of the mission; when you get to see the moms & kids the next day, wide awake & happy, feeling better & their moms are excited to see you again if they had come into the recovery room. We saw that all of todays pre-op patients were in 2 rooms so we went in there w/ a translator & told the moms we would be the nurses taking care of their children after surgery. We hoped that would be reassuring to them.

We are still missing quite a few medications & some supplies so we made a “wish list” for Morag & Rania &t hey went out & got quite a bit of what we needed. There are “medical supply stores” all in this area where 2 hospitals are at. It was our “Christmas in July”  when we got some of the items we needed- just simple stuff like gauze to wrap around IV’s .

We had a rapid fire return of 5 palate patients from every table starting at 10 am & stayed busy all day with our 16 patients. Three of them didn’t receive their own bone grafts so they had a “donor” site in their hip. Fortunately there were no trues “bleeders” – some oozers that needed pressure on their palates but no “true bleeders” perhaps because all the patients are getting Tranexamic Acid which helps with clotting. We did tend to bring more moms back today and it was fun to see them after having met them briefly in the morning.  A few come in very anxious & tearful, concerned if their child still has oxygen on or is restless waking up & the translators assure them for us & I just put my hand on their shoulders for reassurance. So many of them are so grateful, putting their hands together over their hearts & blowing a kiss of gratitude, which always melts my heart. Somehow no matter what country or situation you are in mothers’ hearts even without strong verbal communication are always closely knit together…

Serendipity my lil pt. #19 who had the tearful dad at screening had surgery today & without even knowing he was on the schedule today he became a patient I recovered. He did well & when I took him up it was his mom there with him!

I had my standard mission peanut butter on a sandwich thin for lunch and went into the breakroom to eat. The mission sponsor was in there & I just watched him as he cleared the break table of cups & plates that had been left & saw him making coffee. Clearly, he is a “Servant Leader” & leads by example. I understand that he had canvas bags made for all of the patients & filled them with the typical “Smile Bag Contents” for home care after surgery but alo wanted the age & gender of each child & got them clothes as well…such a wonderful man! Truly all the needs at the mission for thee children & families were being met by him down to the smallest detail; which further confirmed to me that the “sacred funds” I brought were not meant or needed for the mission but for the children in the Arabic Nile River Branch who will now get to go to school & for some adults who needed help in participating in the Don Bosco skill training. It is always such a testament to me to see God is in charge always & a lesson I need to remember in my everyday life not just when I am 7000 miles away from home in a foreign country.

We finished by 6:30 & were back at the hotel at 7 & Chris really wanted to go to this “largest bazaar/market in Cairo” The Khan el-Khalili. It says on line it is a bustling vibrant market that has been around for centuries & is a “must see” for anyone visiting the city. So how could we skip that???? We got a cab at 7:30 & took our lives in our hands getting there – a 15 min drive to go 2 miles. It is in the heart of Islamic Cairo & literally has all sorts of winding “streets & alleys” & even a tunnel that takes you across the street. There were some different sections – spices, LOTS of gold “ish” jewelry shops, handicrafts oils & incense, rugs, clothes and a whole lot of souvenirs made in China 😊 It was super crowded, loud & so so many smells!!! None of the 3 of us bought anything but it was an quite experience-more hectic & chaotic than any other international market I have visited & I have been to quite a few in many countries. While getting there was easy getting a taxi back was 4x the price (mind you that meant $12 instead of $3 to get there – but of course we haggled??/ until I finally said this cab is clean & really girls we are talking about $2 more from what you are trying to get 😊 The car was decent but the driver was another story…as we left the market he pulled by a street food vendor then pulled over across the street  -he was getting himself some food – it looked not appetizing &then offering it to us. I was pretty pleased I was in the back seat! Mostly I was happy we got back to the hotel safety! A few Op Smile friends who know I am her have messaged me about this being the worst place for driving & chaos – I must agree!

We got back to the hotel by 10 & visited a bit then I headed up first to get set for bed & another day tomorrow. I have to say that a “smaller mission” with a goal of 50 complex cases is actually a nice pace…so far no super late nights in the PACU because we are doing 30+ surgeries in a day. I caught up with family via phone, packed my backpack & was in bed by 11 pm!

July 19, 2023 Surgery Day #1 Cairo 9 Patients!

 It was a short night & early morning with a 5:45 wake up call and breakfast at 6:15, then departing for the hospital at 6:45. I wasn’t feeling great this morning but doing ok  - I just think that I had such a busy/active day yesterday I am still getting back to 100%. I did decide to start Cipro for “travelers Tummy Issues” …based on my health history on this mission I would rather be safe than sorry.

We got to the PACU & started setting up. We are sharing the space w/ the hospital patients today which is fine & the space is actually nice – clean beds, monitors circa 1980 but monitors no less 😊 We did find out that all of the “cargo” sent for the mission either did not arrive or is stuck in customs so we are working with very minimal supplies.

At breakfast I met Marag who currently lives in the UAE – she is from England & went there 20 years ago as a teacher & then met her husband who is from Scotland there & they have raised their 2 adult children there. She is part of the OSI foundation in the UAE & brought the generous businessman who is funding this entire mission & he brought personal friends who are volunteering in whatever way is needed. I LOVE seeing very “well to do CEO, multi millionaires” who are just good people…with no pretenses. It is so refreshing to see good people who will help you hold a crying baby with a bloody mouth without flinching 😊

We got out first patient back at 10:15 – we are only doing 9 pts today on 3 OR tables as some of the Egyptian team members are at a training day. It is sort of  nice way to ease into the mission. Today each table started w/ a cleft lip but that will not be the case every day so I appreciated snuggling the babies this morning. We had 6 palates – some did well coming out of anesthesia & others had a rough time. We had not planned on being able to bring parents in but were able to do so for the last 2 as here the PACU is a “clean” but not “sterile” area. On a positive note we did not have any bleeders 😊 Even with only 9 pts we did not finish taking the last patient up until 6:30 pm…hoping it was just a “slow first day” & we will not have super late nights.

While the PACU is really very satisfactory – maybe even in my top 5..the hospital itself (at least the one we are in) is a lil rough…the patient floor is on 7 & we are on floor 2 so we take a lift to get to the floor – it is really a cargo elevator & you have to keep the doors held close as you go up. I choose to take the stairs when I dont have a patient & am returning back down - would prefer not to get stuck or who know what? Today on one trip down there was a worker with a skill saw cutting a strip of metal with sparks flying everywhere, men in the stairway smoking (very common here) & a patient in a wheelchair with oxygen nearby. I waited til the sparks ended & then continued down. Also when I took the last patient to the floor the lovely housekeeper was mopping but quite literally poured a bucket of water on the floor soap & all as we were entering & my nice student was carrying the 6 year old patient….I envisioned a “slip, trip, fall” but we made it thru all the water! On another floor there is part of a crane coming thru a broken window. I promise I am not making this up  

The food at the hospital is not anything I would want to eat especially with my stomach a lil unsettled. They brought in Papa Johns pizza for a late lunch. There are several US fast-food chains I have seen as we have driven around -McDonalds. Hardees (Carls Jr), even a “On the Run” gas & store like we have right at the bottom of the hill at home & apparently Papa Johns!. It is not an Op Smile mission if you don’t eat pizza at some point.

Since Lisa my roomie is a night nurse we just “pass each other either at the hotel (If I get back before 7 like tonight) or at the hospital when she comes in – I get to say hi for a minute. Some people who had been on the team day were going to the pyramids tonight for the light show. I enjoyed them yesterday but the photos of them lit up looked great. Really a different perspective at night.  I opted to stay in shower, have a protein bar & did a lil work on some CHOC emails & updated my blog from my "tourist Day" & “Special Time with a church leader here in Egypt”.

I just realized when we returned to the hotel tonight that in addition to the gate & all the interior security they have a “bomb sniffing dog” that circles each vehicle twice before  you can enter. I’m feeling safe. Good Night!

Tues July 18th Part 2 Two hours that reminded me that God is in the details of ALL His Children's Lives

This post is one really for me and some friends who are generous with their “sacred funds” they give to me when I go on a mission trip. Others of course are welcome to read it but again this is not really about the Medical Mission & the Op Smile kids it’s about an opportunity to “be on Gods mission” and be a conduit for the goodness of others in ways I never seem to be aware of before I leave my home….and will definitely be the most memorable part of this trip to Cairo.

As I mentioned in my first post regarding Cairo I had reached out to the branch (congregation) president in Cairo (Nathan Ayer). He leads an “English” congregation that has existed informally in Egypt for 30 years largely for Americans & foreigners living in Egypt. Mostly people who work in the US or other Embassy’s or large businesses. He connected me to the current president (Marcous) of the “Arabic Branch” which is comprised of about 70 local members 30% Egyptian & 70% Sudan refugees. Before I left the states Pres. Marcous identified some things he would like me to bring & I was able to purchase those & pack them with me to Cairo. He then reached out to me yesterday asking if I could meet him last night at 8:30. I originally said yes then as plans for the team dinner changed asked him if he could come before 7:30 our planned departure time. He said he would be by at 5:30 & after my touring day & my rest I set my alarm to meet him in the hotel lobby. I knew he had some needs for school supplies but did not have the details & honestly was praying & hoping that either thru him or other needs I would be able to appropriately spend the funds I was given in a way to bless God’s children in Egypt.

I told him what I was wearing & waited for him in the lobby. He arrived & we immediately started talking – nonstop for 90 min. He shared with me that until 6-7 years ago the church sent church leaders to Cairo to meet with members but about 7 years ago they formalized the English Branch & the leader at that time was a man named Spencer Penrod who worked at the US Embassy. Brother Marcous was raised by a Catholic Father & Orthodox mother & did not belong to any church at that time. He had worked in Embassy’s in Africa & drove for diplomats & tutored them in languages before he moved to Cairo. This new church leader Bro Penrod hired Mr. Marcous to be his Arabic tutor. He shared that Bro. Penrod had dedicated his life to God and to the Middle East & that thru Bro Penrod God started a huge plan for him personally and Gods children in Egypt.

Bro. Marcous met with Bro Penrod every day for 3 years & in that time Bro Penrod knew he was in the presence of a special man, a man who taught him about God, mentored him in service & changed his life. After 3 years of this influence of Bro. Penrod. Bro Marcous became a member of the Church of Jesus Christ of Latter-Day Saints. Bro Penrod has since left Egypt but his leadership and influence live on thru Bro Marcous. In 2018 the Arabic Branch of the church was formed & a few years later Bro Marcous was asked to lead that Arabic Branch as he does today.  They have 2 couple missionaries who are here to do humanitarian work in the branch & in the country. Church members in both congregations may not contact Muslims. The church is no recognized by the Egyptian Government, but they have a positive non antagonistic relationship. There are 18-20 million Christians in Egypt most belong to the Egyptian Orthodox or “Coptic” Christian Church. As I said their congregation has 70 members & about 150 “investigators” he says he must look for seeds of faith in the investigators to know their heart if about Christ. He said that there are missionaries around the world learning Arabic & they do video lessons with Arabic speaking people throughout the world interested in the church. He also said that there are more & more church resources in Arabic – he feels this is all part of Gods work in Egypt.

We then talked about the needs in the branch…I was tearful the entire time & apologized to him for my emotions that were so tender & raw & on the surface. He shared there are not many opportunities for Sudanese in Egypt as they are discriminated against as refugees & based on their skin color. (FYI there are 7 million refugees in Egypt from many countries). He said that someone working 12 hours a day cleaning or in another labor job might earn $100/month & rent in the poorest areas just above the slums is $150/month so 2 parents working these hours can barely survive w/ their children. They all need help with food & the church supplies rice, oil, sugar & other items to most members. When he recently met with a church leader from Salt Lake he was guided to focus on Education & food for the members to help them attain a better life. So that is where the needs are in 2 ways….first for the children in the branch. They can attend the public schools but are required to wear uniforms (including tennis shoes) and but their own school supplies. To send one child to school may cost $40 a year for the unform, and shoes & supplies. Families with even 2 children can typically not afford to send both children to school. They may send the oldest one or not send any. Pres Marcous wants all the children in the branch to go to school next year & has been praying for a way to make that happen. There are 10 families with 28 children – 7 families have both parents & 3 families are led by single mothers. 28 children required about $1200 for school. He is also trying to get 4 adults into a 3-6 month long “technical training program” to teach them a trade where they can get a higher job & improve their life. The program is led by an organization called Don Bosco (I think it is an NGO?) and is being overseen by a District President in Lebanon who is the self-reliance leader for the church in the middle east.  There are fees to attend. Church members get a 20% discount, church donations can cover 70% & the individual has to pay 10% which is about $300 for the 3 mos of most programs or $100/month – which remember may be all they are earning now to support their family. Plus they have to cut out some work hours.     

Our time was coming to an end. I had exchanged $500 USD into Egyptian pounds that I had for him & gave to him I also mentioned that I had some another $500 in US dollars & he said that US dollars had an even higher rate “on the black market” (sounded sketchy but I let that one go as Hanan said that too yesterday) I gave him all of it without hesitation & knowing this was how God wanted some of his children in Egypt lifted by others…my truly amazing friends. He apologized he could not give me personal receipts due to the situation of the church in Egypt but said that it would all be recorded & accounted for  & registered on the system in the name of “church of Jesus Christ Admin” & said he wanted me to tell Pres Ayer exactly how much I was giving him & they would both be accountable for these sacred funds. Then I asked him to wait & I went to my hotel room & got all the cash I had plus cash from my roommate cause I could pay her back & all together gave him enough money for all the children in the branch to go to school & to support 2 single moms in the Don Bosco program.  I knew that was what I was to do….Yes I had spent money before I left & yes I bought formula for that sweet mom at screening (fortunately I used my credit card on both those purchases leaving more cash that I brought with me). In that moment none of that mattered. I mentioned to the Clinical Coordinator I had funds of there were mission needs & didn’t get a sense that they had big needs as this mission is self-funded by a kind & wealthy man from the UAE who is here w/us…so I am pretty sure if they have a need they would go to him first…his pockets are definitely deep & he is a generous man…Everything I had from others & my own money I brought needed to go to Pres. Marcous. When that happened he got very emotional & neither of us spoke for many minutes. He asked if I could attend the branch to meet these children or families on Friday for church service but I cannot – it’s a surgery day & he asked if he could send me photos in the future of who is blessed by these funds & I said of course…so I will never meet them & neither will my friends but I know someday we may have a grand reunion in heaven & understand how our lives intersected for a brief time in Cairo Egypt…in ways I could never have imagined, with money I thought may have been too much & that I possibly would return partially to my friends but know…our sacred funds were the answer to the faith of the leaders and a group of people in the Arabic Branch in Cairo.

When our time ended & he left & I headed to dinner he sent me these texts…”Sister Nancy there is such unlimited and unconditional love from the saints in your area. May God bless all of their lives & God bless the heart and the daughter of God that was carried here to this country to help us”

Yep more tears….How blessed am I to exercise faith myself as I go into countries blindly praying that God will direct me to where I am to use this money. I also know others pray for me to be led & watched over on my missions. Together we assist with and watch miracles unfold & lives of people we will never know changed for the better….I still have a “full medical mission ahead of me but if I had to go home today I would have fulfilled the purpose for which I was unexpectedly asked to come on this mission back in May when I knew nothing of what I know today.

July 18th A Day of Being a Tourist in Cairo!

 Tues. July 18^th My day to be a tourist! This is  really a Travel Diary not much of a Mission Diary!

In the team emails & packets the schedule was a lil confusing. For today it said “free day” on one & “Team Day” on another. I emailed to see if it was a free day & was told it was so Lisa & I booked a “Tours By Locals” to see some of the Cairo sights. Yesterday they said there was a “Team Day” going to both the oldest & largest Mosque & “Coptic” or Christian Church in Cairo. I explained we had already booked & paid so I was grateful Lisa & I were able to keep our plans. Our guide Ranan & a driver picked us up at 8 am & we first went to the pyramids before it was too hot. The drive was about 30 min & OMG driving in Cairo may be the most frightening place of all I have been, no signals, people just honk & are about 3 inches from the car next to them. Every car you see has dented or scratched areas – literally impossible to not get into accidents & so many “close calls” always. I could never drive here! That being said, we were in a van so a bigger car that the small cars would give deference to & our driver was skilled & we got to the pyramids in about 30 min. Ranan gave us all sorts of info about Egypt on the drive. We passed the area where the protests/revolution against the corrupt government took place in January 2011. She said that the average salary is about $130/month for a family of 4 & right now the cost of housing for a very dilapidated apartment is at minimum $100/month so even people with “steady jobs” very little money in general.

There are pyramids in all 10 areas of the country but the Giza pyramids we went to are the most famous & closest to Cairo. Ranan took us to a specific entrance where we would also connect with our Camel “guide” Mohammed. Since we arrived by 8:30 it was still cool & not too busy which was wonderful. We entered near the Sphinx & she explained the human head or intelligence of a man & body or strength of a lion. I am HORRIBLE with my history knowledge in general & this was not different so the information she shared was “new to me”. The pyramids were made with Limestone from Cairo, Granite from Aswan & Alabaster from Luxor. So 3 different types of stone. I understand why the pyramids are one of the 7 wonders of the world – they were utterly amazing to see and it is so perplexing to consider how 4000 years ago they cut & moved these huge pieces of stone into place without using any other materials simply stacking them & creating these magnificent structures. There are temples connecting some of the pyramids, places where the bodies were taken to be mummified & so many areas or “tombs”. We walked thru the area with Ranan then connected w/ Mohammed &he promptly used my scarf for a proper head covering & I got on my camel Rasmus to ride up to the  “grand plateau” where we could see the 3 main pyramids known as the Father, Son & Grandson & then 2 sets of 3 smaller pyramids known as the Mother, Wife & Daughter. Mohammed was wonderful – he stopped us at several places to take the “fun pics” it was like having a private photographer. He even made a video of us with Egyptian music! Our time on the camels was about an hour riding thru the pyramids & even touching & walking thru them. What a bucket list experience! I am so glad we came early by the time we were done it was getting very busy already & warm.

From the pyramids we went to see how papyrus was made - which was fascinating. And they have used papyrus for thousands of years here to write their history and stories in hieroglyphics. They now also have art on papyrus & I bought the “Tree of Life”. We also went to an essential oils place which was interesting, but I feel like those oils are made in so many countries now each with the unique scents from the country.

After that we took a “Sail in the Nile” on a Feluga. I ALWAYS love being on any body of water so that was relaxing & invigorating & our Feluga guide was this very old sweet Egyptian man who loved taking photos with us. The area of the Nile that is in Cairo moves fairly slow & because of that some small “islands” are created. The water is pretty dirty & I am told no one really swims in it in this area.  After the sail Ranan took us to a very famous restaurant for Koshary – Egypt’s National Dish at a place called Abou Tareks. The owner started on the street corner years ago with this one item & still only serves that one item. It is a  dish with 2 types of pasta, rice, dried chickpeas, lentils, crispy onions. It comes with a tomato sauce & you can season it with Garlic olive oil, a seasoning salt & a spicy sauce (which I did not add to mine), The place was packed they serve this one item at one price per person (about $1.50 US)  & was a great lunch! They told me to google it which I will have to do!   

From there we went to the Egyptian Museum (which is actually right across from our hotel) to see all that was found in King Tuts tomb when it was found in 1922. While my kids studied Egypt for maybe an entire month In 6^th grade my knowledge about pharaoh Tutankhamun “ King Tut” was minimal & seeing all these artifacts was pretty incredible. The tomb had 4 rooms & was filled with over 5000 items. Most impressive was the multiple gold elaborately decorated coffins & all the jewelry & items of royalty. I had no idea he became a king at age 9 & then died unexpectedly at age 20. Also at that museum was a statue that was discovered underneath the site of the pyramid we were at today. Plus it housed the mummies of King Tuts grandparents…those were a lil creepy to see how well they were “preserved” – hair, fingernails – WOW!!! That ended our 8 hours together & we had done SOOOOO MUCH!!! Lisa & I were exhausted so we went for a lil rest. This was the most energy I had expended since I got sick & I was feelin’ it! I got up after 90 min to meet Pres. Marcous from the Egyptian branch & I am going to make that a separate post.

We had a team dinner scheduled at 8 pm at a “famous restaurant” We sat on the floor & they brought out things that I wouldn’t eat even it I didn’t have a sensitive stomach…lots of meat that included liver, beef on bones, lamb & more. The presentation was impressive the food not to my taste so I stuck w/ the saffron rice 😊 Our large area had a 10 pm reservation after us…this late night lifestyle is so foreign to me…as we drove back to the hotel at 11 pm the streets were INSANE – so much that we had a police car help get our large bus thru the streets to our hotel. Lisa had to go into the hospital for the 9 pre-op patients & I got all my stuff ready for our first day. Tomorrow will be a slower start day with only 3 tables as some of the physicians are at a training. I am so thankful I was able to have this day in Cairo & for our wonderful guides! Pyramids - DONE-the rest of the week will be all about the palates

July 17th Screening Day

 * I am posting my travel day & Screening day on the same day as I was not up to blogging yesterday but didn't want to get behind :)

Cairo Mission Day #1…Screening Day & Feeling Better 😊

I slept really well & woke up feeling A LOT better compared to my travel day which with the time change was 2 days ago because today in Cairo it is July 17^th and I left on the 15^th & arrived here close to midnight on the 16^th…so however many hours that is I do feel better! I think I am at 75%. I met Chris at breakfast she was trying to be up when I get here last night but with her travel & time change from Sweden, she was tired.  It was quite an interesting breakfast set up…. lots of meats & cheeses, lost of olives, grains & spreads, some whole fruit, bread, a place where they would cook eggs & a full dessert bar???. I opted for a scrambled egg & a piece of toast & paid dearly for a diet coke to see if that tasted ok.

On the drive to the hospital, we passed the Nile Ritz Carlton, so my bold assumption is we are close to the Nile River. There was more homelessness on the streets than I expected. It was not a long drive to the hospital & per my research it definitely is 40 years old, lots of dirt, broken windows & leaking pipes but it is the largest pediatric hospital in Egypt & they say there is a “new area” I just think we aren’t in it?

At our team mtg we were told to expect this to be a difficult and heavy mission with lots of palates & other cranio facial anomalies. This is on the 2^nd mission in Cairo but throughout Egypt they do “local missions” without international volunteers every 2 mos mostly correcting simple cleft lips & international missions quarterly – a recent one was in Alexandria. If only I had that geography gene because I have no idea re. Egypt as a country. They also are planning on about 60 patients in 3 ½ days of surgery with 5 operating tables so 15-20 pts/day. The patients were all waiting on the 7^th floor of the hospital so as to not wait in the outside heat & screening was on the 2^nd floor but first they had to be registered HOLY MANUAL PROCESS….paper & pen with white out for 6 pages of questions, I am sure it is the same registration at all mission but this seemed rough. Chris is a Nurse Coordinator” in Sweden & we both were unsure how long the day would be with 3 registrars & each one taking 30-45 min at best so she started “coordinating” & I was her biggest support. We recruited 2 other “volunteer guests” businessmen from the UAE who spoke Arabic & were happy to help – that almost doubled our workforce to 5 registrars. The we brought 5 patients/parents down – had them start the process & brought down 5 more to be in the queue when a spot opened. It still was a lengthy process, but Chris was “on it” other wise we might still be there! By 11 am only 1 pt had fully gone thru all the screening stations but by 3 pm things were humming & we had 51 registered & 28 thru screening. Literally almost EVERY PATIENT was a palate. There was one cute baby girl w/ an easy lip repairs I got to hold the entire time her dad was getting registered & of course the Mimi in me LOVED that!  It was apparent that several of the children had syndromes or other anomalies. All of the “moms” women had head coverings & the majority were in Burkas but you can see their “Smieyes” – “Smiles w/ their eyes” a term we used in Covid where everyone was masked 😊 There was one very tearful dad with his 4 year old son, he just was teary, I gave him tissue & water & thru the translator he said he simply wanted “help for his son” – he broke my heart every time I saw him during the process (he was pt #19 so I am anxious to see if his son has surgery)

The morning snack at the hospital was lot of random pastries that I wasn’t quite up for but I did have a banana & my epic fil was that I didn’t bring my Tums & my saltines. I am always careful about what I eat on missions but right now I am VERY Cautious! And the “hamburgers” they brought in for lunch would have been a no-go even if I was healthy. I did pack a trail mix that worked for me but need to pack more going forward. Also, I gave one of the students money & he went to a street vendor across from the hospital & bought me 6 Diet Pepsis to take back to my room so that was nice!

There was a baby that had a primary cleft lip I had hoped would be repaired & I helped the mom thru the process. The baby had a feeding tube to help her gain weight & I thought she looked an appropriate size for surgery. About 4:30 pm as she finished, I saw her crying deeply…it turns out her baby has a small ASD (Atrial septal defect or hole in her heart) & that eliminates her ability to have a surgery without a cardiology clearance & there is not a pediatric cardiologist in Cairo. This young mom was devastated & certain her baby would die without the surgery…I had no words. I asked Malika what could we do? On past missions we referred them out to the WHO or another NGO for the Cardiac care & then they came back on another mission.  That did not seem to be an option – what about an obturator (like a retainer that closed off her opening in her palate & helped her to eat, also not an option. I felt totally helpless. They did say if she had a higher calorie formula that would help & she could be scheduled to come back for a recheck in 2 months (I wasn’t sure how that mattered since she needed the cardiologist piece) but I asked if I could provide funds for the formula. They said we could not give them money but could get the formula & give her a 2-month supply… I was “all in” financially but had no capacity to do this & fortunately one of the local volunteers was as moved as I was & went to a 3 pharmacies to get the formula. Truly what I hoped for was a surgical repair & I was reminded of my PICU Mantra as a bedside nurse – “when you can’t cure you can always provide some care”

Later in the afternoon when everyone was thru registration & waiting to be screened Chris & I were in the hallway with them & were a “big hit” with the 6-10 year old crown who wanted us to take selfies with them on our phone cameras – I am unsure if they wanted to see themselves, if it was our blonde hair or they just thought we were nice…anyway that was our 1 min of Egyptian “fame” LOL. Screening ended about 6 pm (which seemed like an eternity for 60 patients) & we had our pre-surgery meeting so that we didn’t need to have it tomorrow night. They confirmed that 85% of the cases are palates & yep that does cause me some anxiety. We have a strong PACU team 3 of us were together in Morocco & one it's her 1^st mission plus we may have a local RN but it may get a lil crazy….but that is what I signed up for & why I am here. These kiddos would never ever get this surgery unless tis team was here for them. them. It was after 7 when I got back to the hotel, then showered & fully enjoyed my peanut butter sandwich! Now I am 100% which is good because I have pyramids to see tomorrow! The team day option was to go to 2 old churches which I am sure would be nice – they are concerned it is too hot to be outside at the pyramids but this is my “Palates & Pyramids Mission” so the pyramids are a must…lots of sunscreen, our private local guide & the high is only supposed to be 101 at 3 pm & we are leaving at 8 am so I think we are good – just a lot like Palm Desert right??? Good Night From Cairo!!!

Travel Day to Cairo - NOT ideal :(

Egypt Travel Day – Not Ideal ☹

I was 80% packed by 9 pm last night, even watched a Hallmark movie (my guilty pleasure) before I went to bed. At 4:30 am I woke up feeling nauseous & thought I just hadn’t had a decent dinner as I was busy & might have part of a protein drink. Within 10 min of doing that I began vomiting & continued to do so for 2 hours….food poisoning I presumed from the lunch I had eaten at a not to be named restaurant. At 6:30 I took Zofran (& every 4 hours after that x3) & prayed I would feel good enough to travel. I couldn’t keep anything down. With a plan to leave for the airport at 10 am I slept until 8:30 showered, dressed & stayed upstairs for Doug & a dear friend to give me a blessing that I would be okay & able to travel. Getting into the car I had a variety of potential food & the only thing I managed to eat by 11 am was applesauce. I used the luggage cart as a walker to get into LAX while Doug parked the car, He met me & I headed to the gate…longest walk ever! I managed to eat half of a banana before the flight at 1 pm but I was pretty miserable. There was an empty wheelchair near the gate that I sat in & the wheelchair man scolded me until I told him I felt unwell then he not only let me stay there but took me down the jet bridge. Fortunately, they changed my seat so there was an open middle seat & the woman I sat by was so kind. I explained I was not ill just had food poisoning. I took a sleep aid & slept off & on during the 12-hour flight. Turkish air served 3 meals none of which I ate or could eat. I did manage apple juice & a roll Doug packed me. I had a 4-hour layover in Istanbul & still was not great. I walked for what seemed like a mile to the “information desk” to get an idea of what terminal my next flight would be in. The man there asked if I was OK? I assume I didn’t look it? He brought me water & took me to a waiting area nearby where I promptly laid across 3 plastic seats & slept for 2 hours…in that area you had to give them your boarding pass & they would escort you to your gate so that happened & now 18 hours later I was a lil better at the start of that flight. I did eat the white rice in that meal & more apple juice, more rest & felt better by the time I landed in Cairo.

I was met by a nice Travel Agent w/ an Operation Smile placard & he whisked me thru the Visa process & immigration, currency exchange & baggage claim. It was a very nice service & I am pretty sure it is my preferred method of travel & not just because I was sick 😊 I am not adventurous like Ryan who figures out all of his international travel on his own. The agent had met 3 other mission members who were waiting & 2 of them were from my Morocco missions in 2018 & 2019 Malika the clinical coordinator plus an OR nurse & an anesthesiologist I just met. Somehow in my frenzied week I missed the team composition page in all the attachments with the Team Packet. I looked at Malika’s & was SO EXCITED to see that I knew 2 of the other PACU RN’s – Chris from Sweden who I was with in Ethiopia & Morocco & Sager who is Egyptian but was also with us in Morocco. It is like an unexpected reunion with dear friends who you share this unique bond with,

It was after 11 on our ride to the hotel & the streets of Cairo were buzzing as if it were noon. Little kids, families having food & treats on the street. The hotel is definitely safe… a gate to get in, metal detector & man with a gun seated near the front. It is also a very Noce lobby while the rooms are a step up from Motel 6 with small twin beds. I unpacked, called Doug, ater some saltines & my last applesauce & went to bed at 12:45 am knowing there was a 6 am wake up call, 6:30 breakfast & team mtg at the hospital at 7 am. Let the mission begin!!!   

Headed to Cairo Egypt -Operation Smile Mission #18

 Tomorrow I will head to Egypt....yes I was supposed to be a "Champion" in Guatemala for the next 2 years but they decided that you truly needed to be" bilingual" in order to effectively teach there which I totally "get". My Spanglish was not going to be enough & I did not in the last 6 months have the ability to take a month long 5 night/a week Spanish language intensive course. So I was a little disappointed as I made a lot of sacrifices to go to Guatemala last year with the idea it would be a place I would go back to...but clearly there was another plan :). In May as we were en-route to Maui I got an email in flight asking if I would go on a "Complex Palate Teaching Mission to Egypt" This too would require some sacrifices as it was the same dates as my mission last year meaning I would miss Drew's 1st Bday (we share a Bday) & I missed his birth last year -so I have some making up to do...but Sarah graciously said "yes mom go" & so did Doug so then I text my boss to ask if I could goon an Op Smile Mission & as a bonus see the pyramids for my B-day. My boss is also very supportive & said yes. So I was confirmed on the team from 35,000 feet in the sky!  

Fast forward 8 weeks & I am leaving tomorrow for the Abo El-Rish Mission in Cairo Egypt. There are only 8 US volunteers going - it will be a small largely Egyptian team and those of us who are going are there to help train the Egyptian team members on these more complex Cleft palate cases that will require bone grafts as they are too large to be "closed" in other ways. That does give me a few concerns- historically the palate cases can have problems with bleeding. There are always a few "bleeders" every mission & often they have to go back to the OR. As I have said the Recovery Room (PACU) on a mission consists of times of "boredom" before patients come out & then many moments of chaos - the bleeding is the worst chaos so it will be interesting to see how this all goes... The goal of the mission I believe is 60 cases over 3 days of surgery. We may do some simple lip repairs as well I am not 100% sure. It will depend on who they are "planning on for the "complex repairs" & who also comes to the screening day. I am excited as the night post op nurse Lisa who is from NY is a friend of mine from past missions. It is always nice to have a familiar face :) 

We got our "final team packet on Monday but this week at work was a doozey with 12-14 hour days Mon-Thurs so I am just looking at it now!  As I understand it there are some "well to do people" in Egypt but 60% of Egyptians live near or below the poverty line. The average salary in Egypt is about $300 USD/month & I think that is for people who have "real jobs" like the nurses we will work with so the majority live on much less than that. There are 1100 slum areas in Egypt & about 350 of them are around Cairo where we will be. These slums lack the basics such as electricity, running water& sewage. So I am anticipating some poverty similar to other part of the world I have traveled to. 

I was excited & hopeful when I heard we will be at the Cairo University pediatric hospital but I looked it up & it was built 40 years ago in 1982 with funding from Japan. So we will see what has been "kept up" in the last 40 years - it may be great :) and heck I've been in Africa a lot (while my geography knowledge is minimal at best I do know that technically Egypt & the Middle East is considered part of Africa) but I am thinking it will be better than the places in Africa "proper"...like Ethiopia! 

As I typically do I reached out to my church contacts in Egypt- what a blessing it is to belong to a worldwide church & be able to connect with strangers who share your Christian faith & desires to help however I might be able to during this short time in Egypt. Nathan Ayers in the Branch President there & he said there are 2 congregations - his is the English speaking one that has mostly diplomats & others working in Egypt & all of those families are very well off & many are back here in the US for their summer vacations. There is a 2nd Arabic speaking branch that for reasons of privacy & security is not "public" The members are mostly refugees from South Sudan & areas where there has been unrest in the region. There are tremendous needs there & the church helps with support but there is a fine balance between helping them to be "self reliant" and  providing for all of their needs, he is going to see what specifically they are challenged with & get back to me as I told him I did have "sacred funds" from wonderful friends who want to provide humanitarian aid. The only missionaries in Cairo are "adult couple missionaries"  providing humanitarian service so they may be aware of needs & he will reach out to them too. I leave on these missions trusting in God that whatever "service opportunities" I am to assist with will always present themselves to me while I am there either thru my church contacts or thru Op Smile and it always works out....I am blessed to be "on the Lords errand" both in the medical care I will give to His children in Egypt and in any other ways I can be used as a conduit for the generosity of others who send me with their sacred funds. 

So I am calling this mission "Palates & Pyramids" - not a bad way to spend my Birthday! And we did get to have an early family Bday for Drew with Ryan's family & our neighbors so we celebrated Drew early with his 3 Kraus girl cousins & had FUN. Kelli is headed to Utah w/ her 2 littles to be at the BIG Bday party as a follow up to her being there last year for his birth when I was in Guatemala & arrived 2 days later, I am so grateful to her for being there while I am gone & Doug is in CA with Clark - our family is "moving in all directions this month" to be together at different times. I sill need to finish packing & Ryan has been here this week w/ his 3 girls escaping the AZ heat so I have tried to get some "FUN" in with them at night & we had a donut trip this morning but I still owe them a trip for french fries. As is always the case I truly appreciate & feel the support that comes thru the love, prayers & positivity from family in friends. I am hoping for travel blessings (I go LAX to Istanbul then have a 6 hour layover & a flight from Istanbul to Cairo arriving Sunday at 9 pm Cairo time (which is 10 hours ahead of Calif). Alos hoping that our team will be able to meet the needs of these complex patients & their families. So I welcome all that you have to offer! My next post will be from Cairo!