Honduras Day #2 - First Day of Surgery!

The morning came quickly. We had breakfast at 6 & a team mtg at 6:30 & left for the hospital at 7. I realized at breakfast that I didn't do a very good job of packing food on this trip especially when the eggs & beans for breakfast weren't really looking that great. I do have protein bars & peanut butter but usually I pack more. No worries I wont go hungry!
We set up the recovery room & surgeries started by 8:15 - it all went really smoothly. I was told that most of these patients are from the Western part of Honduras which is the poorest part of the country. We are at the top of Honduras very close to the Guatemala border. There were 15 cases today 7 lips & 8 palates plus some dental procedures. Almost all of the kids here have teeth that are rotted out - it is so sad. We just take dental care for granted in the US. The hospital is VERY old & dilapidated but they have some very strict rules that we have to follow - one is that we are not allowed to bring the parents into the recovery room after surgery to see their kids & comfort them. That makes for alot more crying in the PACU & also is a bummer to me because one of my favorite things is seeing the parents see their child with a beautiful new face for the 1st time. We had some tension as we started just different ways of doing things but it all settled out nicely by the end of the day. Our Pediatric Intensivist has flight problems & got here at 2 pm - she is fabulous & totally mended the local & international team communication challenges.
2 of my favorite kids from yesterday had surgery today a 5 year old dwarf boy with a large bilateral cleft lip - his transformation was nothing short of miraculous. He was all smiles yesterday - not so happy today but looks amazing!!! Also a little girl from yesterday who was such a cutie.
We were told it was the rainy season here but that is a bit of an understatement - it started raining about 3 pm & 8 hours later really hasn't stopped - thunder, lightening, torrential rain & power outages have been the theme of the day. In the recovery room we had a few leaks but the were manageable. Some part of the hospital were fully flooded & the store room in the OR has a tin roof & in there you cant even have a conversation. Also we were supposed to have 3 OR's but we only have 2 because last Sun the roof caved on on the other one...
We finished at 8:15 - not bad for the 1st day & it was still pouring & we had to walk a few blocks to the bus. I decided to use a black trashbag as my rain gear (picture to follow) so I put my very large backpack on, made a hole for my head & put it over me - I am not sure why I didn't make arm holes I just want thinking but I definitely provided evening humor for both staff & families as I walked thru the hospital & for the most part I stayed dry! Sadly there were people sleeping on the wet floors of the hospital hallways...again a reminder of how blessed we are.
I am on call tonight so no sleeping aids for me in case I have to wake up & function but typically that isn't the case. So I am off to be excited for 6 hours of sleep!

A LONG but WONDERFUL Day & Night!!!

The day started early with our 4:30 wake up call & we loaded the bus at 5 for our 7 hour bus ride to the mission site at Santa Rosa de Copan. We actually left closer to 5:30 & I slept until about 7:30 when we stopped for breakfast at what is normally a roadside fired chicken restaurant. They served us beans, eggs, fried plantains & tortillas...not the road trip breakfast I had imagined & my first reminder that this is a mission not a vacation :) Also the guard with guns outside the restaurant that was only serving our group was another reminder.
The drive was nice, the countryside is very green & lush but the poverty is very evident everywhere. There are little huts along the side of the road with people selling fruits just to survive & these little stands are all selling plantains, watermelon, pinapple & are all right next to each other - I dont know how you decide who to buy from? Small "shacks" that people live in varied from pieces of metal to wood or brick or cement. Laundry hung on lines & I am certain there was no electricity in most places. I did see 2 missionaries on the side of a small village we drove thru & that made me smile.
We also drove by some Mayan ruins, a lake & a national park. At those times I wish I had just a few of my sisters geography expert genes to know more about the area.
Our 2nd pit stop was at a gas station with a convenience store think Circle K by my house with the exception of a guard with a gun who opened the door to allow you in. That was at San Pedro where w had a fork in the road & we went to Copan & not to Sula (the murder capital) The guard was actually a nice young man& I took a photo op with him & my Coca Cola Light!
We had box lunches on the bus and arrived at the "hospital" about 1:30. Patients had been there since 7 am & all their photos were taken & paperwork completed. I thought it would be less chaotic but it want there were children & parents everywhere. 80 were screened and this time I did something I havent done before (typically because someone else does it) but the 3 of us from PACU drew all the labs on all the patients. Lori could get all the hard sticks & we got them all done. Basically we were the place that made every child cry - not the best for photo ops!
There were so so many precious children about 30 palates & we will only do maybe 20? Several lips & some revisions to be done. The people were so gracious & sweet. I didn't really get to interact or get "their stories" because we were bringing them in our tiny closet room 2 at a time & poking them - not the best for pleasant conversation. I am sure I will learn more as we go thru the week. There were 2 nuns there with 2 babies & I did go out towards the end of the screening & talk to them. Sister Paula is my new BFF - she is from Spain, has been in Italy, Haiti, Bridgeport Conn. USA & now Honduras. She with 4 other nuns have a home where they care for 28 babies from age 3 weeks to 4 years. Many are babies who have clefts or for other reasons are extremely malnourished. They also "pay" for 5 assistants to help them some very poor women who need to support their own families. She took us over to the "hospital" to see one of her babies who was sick & getting an IV that they cant do at their home. Th baby was a year old & weighed 8 lbs - it was heartbreaking. I was so touched by her happy spirit & love. I asked her how I could help her help the children. She said that the hospital has no medicine & they ask the sisters to get it for them when they need it & right now there was a baby with a temperature over 104 who was convulsing & they needed tylenol...REALLY...TYLENOL??? I asked to see the baby, taught them some cooling measures & immediately gave Sis Paula $$ to go get tylenol. She had to wait for her driver (so I guess it is dangerous here - I was hoping she could walk to a store real quick) Once we had that done I asked her what she needed & she said right now they were low on milk & powder (formula). I told her about my friends the Smiths & Coles Compassionate Community & that yesterday was his ANGELversary & since I wasnt there for the candles at the beach I promised I would do something else & I knew this was what I was supposed to do - help Sis Paula & the children she was caring for. So I gave her money from me for Cole & from a sweet friend who gave me money before I left. It was not hundreds of dollars but would take care of their needs for a month she said... a month of milk and formula to help these children get fed. She said the goal is to get them to thrive and maybe give them back to their parents but she said in addition to not having food "some people have poverty of the mind & cannot care for these children so God needs us to help"
Needless to say my hour or so with Sister Paula was the highlight of my day...if I do nothing else I will have made a small difference here; but hopefully there will be more to do - for certain the surgeries that start tomorrow....as in my wake up call is in 5 hours so I need to get to bed.
The internet was out all day today so I didn't get texts or emails on wifi and didn't think I would be able to blog then 45 min ago my phone made some noise as the internet came back on. A little tender mercy so I could let my family & friends know about my day via my blog & a few other FB posts & instagrams. I am so blessed to be here & know when I serve others I am only being an instrument in Gods hands to do His work for His children. Off to bed - tomorrow is a busy surgery day & we haven't even set up the recovery room yet!       

Made it to Tegucigalpa

Well I arrived in Honduras safely after my flights. I was able to sleep about 3 hours on the SLC-ATL flight but since we arrived at 6:20 it was really 4:30 am Utah time so I was still a bit tired. I made my way thru the ATL airport - its HUGE & has been awhile since I was there - it seems more like a GIAN Mall....I landed in terminal a & took the train to terminal E & since it was about 3 hours before my flight there was no one at the gate so my backpack became my pillow & I napped a bit (airport sleeping tips from Ryan & Kya). There were 4 other Op Smile team members on my flight to TGU. The flight was pretty empty - I was in an exit row by myself & after watching 2 movies we arrived! I got thru immigration & customs without any problems - I do think the Op Smile Bag tags help! Met up with our group, exchanged money & we were at the hotel by about 1 or so.
When they say "it's a nice hotel" you have to take it in context...nice in a 3rd world country. The rooms are what I would guess the inside of a motel 6 is like (I haven't been to one recently & thankfully) - not bad but the property is actually quite nice with patios & a pool area. I ran into & visited with Lori (4th mission) & Valerie (on her 7th mission) the other 2 Recovery Room nurses, so we have great experience for our area. Afterwards I came up to my room & took a good hour nap, shower & felt like a new person for our 5:45 pizza dinner & Pre Screening meeting.
We drove a short way to the Honduras Operation Smile Surgery Clinic that was opened here in 2007 - the 2nd fully operational clinic in Latin America. It is very nice & they do 2-3 surgeries here every Wed. Dr. Oscar Sarmiento is the surgeon at the clinic - I have been on 4 missions with him - he's great. The REALLY nice thing about the clinic is that those heart breaker patients that we see at screening & have to turn away wont have to wait 6 mos or a year until the next mission here they can go & get care in the clinic. That is the sustainable change the OSI establishes in may countries.
There are about 18 of us "international volunteers" at the hotel & the rest are from Honduras or neighboring countries. Its a small team compared to others & that will be nice. Since I have been on 5 missions in South or Central America there are familiar faces & reconnecting is always fun. The goal is 40-50 patients or about 15 a day - 5 per table/surgeon.
On arrival we were told again that unlike other missions sites we may have been to Honduras is not safe for tourists even for us to go out in groups - so we will be a little bit hotel bound except for team events which is fine with me. Every building has barbed wire on it. The mission site in Santa Rosa de Copan is actually a 7 hour bus ride away!!!! I think it could be 6 hours but we have to go the "long way" as there is a bridge that our bus can't pass over. That town is safer but still we aren't to go out. I guess the airport in San Pedro Sula is only 3 hours from the mission site but hey had us flu in here because San Pedro Sula has the highest murder rate in the WORLD!!! Things not to tell your mom....
My roomate Therese should be here anytime. Her flight arrived at 9:40 & then I am quickly going to bed cause we have a 4:30 a.m. wake up call & a 5 am departure & start to our bus ride. We will stop for breakfast, eat lunch on the bus & then go straight to the hospital to start screening at noon. Some of the local team is already there starting the paperwork, photos & labs & when we arrive we will set up all the other screening stations & move people thru. Then in the evening we will set up the hospital. So we are planning on a long day/night & arrival at our next hotel close to 10 pm or so.
That is all I know for now...I am happy to be here & excited to see the precious children of Honduras tomorrow!

Headed to Honduras...like right now!

I am sitting on the floor of the Salt Lake City airport waiting for my 1:07 am departure (yes that is not a typo) to Atlanta on a full flight (really!) that will then connect to my flight to Tegucigalpa Honduras. I am so excited & feel so blessed to be going. My new responsibilities at CHOC have made my schedule & life quite a bit busier the past 3 months. I was so busy that I forgot to even "sign up" or give availability for any fall missions. Typically mission teams are configured and organized 2-3 months in advance and for every mission there are MANY volunteers for each nursing position. I finally signed up on line but alot of the teams were already finalized. I reached out to some of the Program Coordinators & they said they would circulate my name. Miraculously I was offered the opportunity to return to Guatemala in Nov. & was so excited as the Op Smile Guatemalan foundation have alot if input on the team selection & they remembered me from when I was there & offered a spot to me. I tentatively said yes but when I asked my boss - she reminded me that we had our HUGE Unannounced Joint Commission visit sometime in Nov. I was devastated...these missions are what connect me to "WHY" I became a nurse...a pediatric nurse...to have a positive impact in childrens lives. I know I make a difference at CHOC but as an executive it isnt the same as giving direct care. Having to turn down that mission was really hard for me - I understood I was needed at CHOC but my heart was broken. SO I asked again if there were any needs & I was invited to go on "rotation" to Rwanda where they dont do alot of surgeries but they do alot of teaching - which is right up my alley. That was in Oct so I was hopeful BUT...it was 2 weeks & it finished just as I needed to go to Dallas to speak at a conference & I knew I couldnt be gone for 3 weeks. I asked that my name be put as available for "last minute needs" & a few days later got an email for this mission to Honduras. I called 2 hours later & in the 1st come 1st served approach - the position was already filled. Just about the time I was ready to give up on being able to go on a fall mission I got an email the next day that they needed one more Recovery Room nurse in Honduras & was I still interested...YES, YES a 1000 times YES. I already had most of this time off to be with my sweet friends on their sons "Angelversary" and move my girsl to BYU so I called all of them & independently but unanimously they all said GO!!! So I called my boss & asked her for a few more days off & she said ABSOLUTELY. That was all on Aug 13th. So here I am 12 days later packed & ready to go. When we are ready & willing God finds a way to use us to bless others - for me right now I get to bless others in Honduras.
This was supposed to be a "local mission" with all the volunteers coming from Central & South America. The unrest there has causes some of the volunteers to not be able to go there so now they have about 20 volunteers from the US & other countries coming in to complete the mission. It will be a smaller mission than I am used to. Only 3 surgical tables (instead of 5) and only 3 days of surgery. But for me it is PERFECT. One of the OR nurse & I were together in Kenya on my 1st misison and the OSI photographer was with me on a few missions & one of the plastic surgeons from South America is familiar too...so I will have a few old friends & make some new ones.
I didnt read the fine print in the information they sent us that mentions Honduras isnt really a very safe place & that we should "not leave the hotel premises without the Op Smile Program Coordinator". Guatemala was dangerous & I didnt fully realize it. I guess Honduras may be a little more dangerous? But OSI is always ver cautious & I have never felt unsafe..so I am not worried & I know I will be watched over & protected.

They are calling us to board right now...next post will come from Honduras!

    

Friday in Paraguay

How embarassing is this....months later I am finishing up my blog from Paraguay. Luckily I write notes as I go throughout the day so I can blog later. As I read the notes now I am amazed at the recall of these people whose lives mine crossed for a brief moment but they have changed my life forever.

Fridays or the last days of missions are usually less busy, typically no palates as the team would not be there for any potential problems in the next 48 hours. We got our T Shirts & took our team pictire in front of the hospital. As the most "senior" nurse in the PACU I did evaluations on all the local nurses. I got input from Brooke & then sat down with each of them. After things settled down we all worked quite well together & really they could probably do an "in country" or local" mission next time.

We did 17 patients total today & 5 cute babies. I took a photo of another sweet, sweet dad with his baby girl 8 months old Dani. This was another situation where the mom had rejected the baby wheb she was born with a bilateral cleft lip & the daddy took her & cared for her. The mom was not at all involved. He was so sweet - he told me he has to be the mom & the dad & that she is such a blessing to him. Well that of course made me teary. I hugged him & in my broken spanish told him he was a "papa muy bueno". He works an hour away from where he lives & his sister helps him with Dani. It was such a tender scene.

We also did a little spitfire 3 year old with a cleft lip - her name was Luana but we called her "little blondie" she was beautiful. She was atwin & her sister had a cleft lip & palate repair at this mission site last year but Luana was sick at the time & couldnt have surgery...but...good things do come to those who wait & she got her surgery this year. Her mom was very teary when she saw her & said "now she is pretty like her sister" :)

One of our last patients was #348 Victor a 16 year old who was just screened YESTERDAY after someone told him OSI was here & he got surgery today - talk about great timing! His mom called him a "blessed boy" & tolsd us "gracias para todo" & "you are Gods hands". He woke up very quickly & was super hungry - just as any teenager would be!

At the end of the day we packed up & all of a sudden I noticed a bunch of LDS missionaries helping us pack & move the boxes. Apparently 40-50 of them were here the 2 days before we arrived unloading all the cargo...the locals said they had a "Mormon Army of Missionaries" I took a photo of the 2 Elders helping us - one from Utah & one from Idaho & emailed the photo & a quick note to their families.

When we got back to the hotel I took Elaine to the Paraguay temple to check in - yes my VERY BAD & VERY BROKEN Spanish got us a cab, got us there, we found the temple patron apartments where she will stay, dropped her luggage then went over & wa;\lked around the temple grounds. Its amazing that no matter where you are in the world you can feel the beautiful spirit of the temple as soon as you set foot on the grounds - it was wonderful & a swwet reminder to me that these missions are part of Gods plan for my life.

We gor back just in time to change for the final party - it was at a "clubhouse" an hour away - it was nice but I was tired so after about 2 hours of fun a few of us took a cab back. My flight in the morning us super early so I have to be on the 5 am bus back to the airport - it is still going to be a short night!

I continue to be so grateful for these opportunities to serve these sweet wonderful children of God in different parts of the world...I am blessed!

Thursdays aka VIP Day

So today was VIP visitor day - I really wish I had known & I would have put on makeup & done something with my hair besides the permanent pony tail/bun just to stay cool. First there was a Press Conference with the Medical Director & Colonel? or commander of the hospital. It was right outside the PACU & I saw it all set up but totally missed it. Then there were 2 news crews & YES I was on the national Paraguayan news (as the nurse in the background seen in the PACU caring for a patient - no speaking part for me since yo no hablo espanol). Then we were told the Vice President of Paraguay was coming & his 40 or so security (think secret service, dark suits & earpieces plus attache bags I was told either had weapons or kevlar?) Anyway he came in & shook our hands - the Paraguay nurses were awe struck & took pictures with him - me & Brooke not so much! Later the Cammandante 4 Star General & commander of the Armed Forces of Paraguay came thru with a giant entourage of army men....He asked me where I was from & then if he could come visit??? All of this really created a little chaos & all we were trying to do was work :)

It was a nice steady day & being a bit more rested made ALL the difference in the world. Before we started a mom & dad brought an 8 day old with a cleft lip in for evaluation - he was too young for surgery but they got connected with all the local resources so that was good...he was so so sweet & I held him for a bit.

We had a good mix of lips & palates. The palates came out of anesthesia a little "wild" so Plinio our Intensivist from Spain had us give them his cocktail (3 drugs) to "reset their brain" - it seemed to work & the next time they woke up more calm.

Today was the day Christain got his surgery...he was the 2nd super star after Ramon. He is 10 with a VERY significant cleft lip & teeth in the wrong places. His mom did not want him to have surgery??? We never really figured out why but he wanted it done & begged his mom to take him so that he would not be teased all the time at school. He LOOKS AMAZING!!! completely different. It was so great & when we showed him his face in the mirror he was so happy!!! I have before & after photos - he looks fabulous.

We had a few patients with some respiratory issues after surgery so they stayed in the PACU almost 2 hours each which kept us busy. Our final 5 patients were all teenagers & all came out at once that was a little crazy.

The students today went to a "public school" in one of the poorest areas here - the kids are there from 7 am-5 pm no mater the age from kindergarten til high school (unless they have had to stop school to work). They leave at 5 pm but its not like their parents come pick them up or have dropped them off - there are some "shacks' in the area where they live & sometimes their parents leave to go away to work for days or weeks & they sort of look after each other. The public school spends about $60/year per child on all the supplies & some food as many of them don't have adequate food. Just listening to all of this was heartbreaking & seeing the photos was even more so. The head teacher (but there were not that many) appreciated what the students bought & told her what they needed. Because of generous friends I was able to connect with her & offer some support for these desperate children. It is nice to get them what they need or give money & know it will go directly to help these children.

As we walked home I looked around, thought of all I have seen & experienced this week I recognized how blessed I am to live in the USA to have all the comforts of food, shelter, healthcare, schools, water, plumbing, transportation, clothing, dental care, & all of our day to day needs that I often take for granted...why was I so fortunate to be born in the USA & not in a 3rd word country & why do these wonderful people here in Paraguay & other places I have been have these challenges...

Then tonight was the polar opposite of those situations. One of the student volunteers from one of the 2 prestigious schools here (the American School & St Annes) has been a local volunteer here on several missions & went to Toluca Mexico as a student volunteer with Joe our coordinator. As a thank you they invited the international team (the 35 of us not from Paraguay) to their home for a traditional BBQ - it was delicious, their home was very large in an area an hour away with their own armed guard out front They had chefs & chauffeurs & all sorts of Crazy stuff but they were VERY NICE people & are obviously teaching their daughters to serve others. More on that fun night later. I didnt get home until midnite so I didnt blog & now its midnight on Friday so its been another day and I fly home tomorrow . 

Surgery Day #3 Hump Day Hooray!!!

Oh my I was SOOOOO Tired most of today - I think the red eye Sat night where I got some sleep but not "good sound sleep" & getting about 5 hours a night the last 4 nights caught up with me today  - so I am writing this post then going to bed. There may or may not be an incriminating photo that was taken of me this morning with my lab coat rolled up & my head on it on a bed rail...early this morning of course before any patient had arrived & I was only "out" for about 15 minutes!!!

It was a very odd day - often there is one like this on missions & maybe it was because i was so tired...We again went to Pre & Post Op to see the kids from yesterday & the ones we would have today. Then it seemed the rest of the day went in slow motion - it felt like a much longer day than it was - we finished at 8:30 pm. Many of the patients seemed to be VERY FUSSY in recovery - LOTS of CRYING & LOTS of pain meds given - probably more than the prior 2 days combined!
For some today was a really good day & for others a day of disappointment

Early in the morning we went to the area where the parents & kids wait before going in to surgery & saw all the 1st "little ones" ....fairly quickly after that little Bruno was brought to us because after they started anesthesia & before the actual surgery began he had too many secretions in his airway (probably from an undetected cold) & they thought the risk was too high. He was 1 year old & his mom was COMPLETELY Devastated...she traveled quite a ways & had been her the last mission 6 months ago but he was too small & needed to gain some weight - which he did & now this. The thought of him living with this bilateral cleft lip for another 6 months was too much for her to bear. I think we truly don't realize how blessed we are to have access to healthcare pretty much whenever we want or need it. They are in the midst of finalizing an Op smile Supported clinic here in Asuncion that may be open by August & they will do some surgeries - hopefully he can be one of their first cases - still that is a 5 month wait - it was so heartbreaking :(

Another 3 year old palate repair was also canceled as she had gotten sick also in the past 3 days.
A  bigger heart breaker was a 16 year old girl who had a repair when she was little by another organization but it never healed quite right & was still really impacting her life - she felt ugly & wasn't attending school etc. She was seen in screening & placed "on hold" then called to come for a "recheck today". after further review they decided she really needs her lip revised & also her nose - they thought about just doing the lip as the "combo surgery" wasn't something we could add to the schedule but the risks of 2 surgeries & 2 anesthesias is too great - it needs to be done as one big case but again not on this mission. She was in tears....like floodgate tears in the recovery room because that is where the exams & discussion took place. She is actually a beautiful girl & what she sees as horrifically ugly really is fairly minor but being a teenager is hard enough in any country & this added "scar & past surgery" is something she just cant get past.  I was so sad for her & her mom who brought her & was also in tears...again I thought I have 3 daughters...that could be me & I would want to do all I could for my child but sometimes all you can do still wont "fix things". they actually have a wonderful psychologist here so they sent here there & I never herd anything further - hoping they can help her next mission.

Later in the afternoon there was a patient another nurse was caring for & she came up to me & in spanish mentioned that the little 1 year old David had a single dad & no mom & did I have clothes for him?  I did & found the right size & the dad was very sweet & hugged me :) I found out later that the mom had rejected the baby when he was born with a cleft lip & left him on the dads doorstep (they were not married) so the dad kept him, lives outside the city but has brought him to the clinic in Asuncion, gotten the special cleft lip feeder for him & gotten him to the weight he needed to be for surgery & now today David had surgery!!!!  a HAPPY story after the sad ones. The dad is young probably under 20 & he has done all he can for his baby son...all by himself - SUCH GREAT LOVE!

One of my last patients was a 16 year old boy with a revision of his lip...he did great & as I talked to the mom I found out she had 12 CHILDREN!!! and he was her youngest - her oldest was 40 & she had him when she was 15!!!!Just thinking of that made me tired - she was so sweet!

One other very funny thing - 3 of the girls who are student translators came up to me & asked if I would take a photo with them because I looked like one of the nurses on Grays Anatomy?  I have never watched that show so I have no idea what they were thinking & no one else has ever mentioned it so I am thinking they just have a case of mistaken look alike identity - but I did take the picture with them!!!

We did 25 or 27 cases today I am not certain - and tomorrow is our last LONG DAy - it always goes by fast  after "HUMP DAY"