Most Operation Smile missions have one screening day during which the team sees 200 to 250 patients in order to find 100 to 130 who are eligible for surgery. When there are two screening days scheduled, you know that it is a really big mission. This is just the fourth Operation Smile mission in Guatemala, so they are still playing “catch-up,” trying to treat a backlog of patients who didn’t have access to surgery in the past. In the first couple of missions that meant there were lots of older kids and adults in addition to infants, and now it means that the missions are still larger than usual as they continue to try to meet the country’s needs. The team shirt is even different from the others I’ve received. They usually say something like, “Operation Smile Managua October 2012,” but this one says, “4th Maratón de Sonrisas.” (marathon of smiles.)
Despite all the hype, we had a pretty calm screening day. We only saw 86 kids, so unless tomorrow is huge, this will likely be a more normal mission. The surgery will be done at the children’s hospital, a change from previous years when they used the military hospital. The hospital administrators and nurses seem very excited about hosting the team and it’s a great facility. Its name is Hospitál Infantíl Juan Pablo II after Pope John Paul II. Tomorrow morning at 7:00, the hospital is conducting a Mass for us before screening. It’s a great honor so we’re all going and we Catholics will take it as a cultural experience.
There are several student volunteers from the Guatemala Montessori School, an English immersion school that goes from preschool through 12th grade. They sound like native English speakers and of course also are native Spanish speakers. Our VIP’s this time are Johnson and Johnson employees from Canada who won a company wide contest for raising the most money for Operation Smile over a three-month period. There are three of them here and the “top” one explained to me that she raised enough for 24 smiles (at $240 per smile,) and the other two for 20 smiles each.
There were a few interesting patients today. There was a six day old baby with a small unilateral cleft lip and normal palate. His Dad brought him in on the off chance that we could fix it, even though he’d already seen two other surgeons who told him the baby needed to be about 10 pounds and 4-6 months old. He was very sweet and a bit chagrined about the whole thing, and I think after seeing some of the babies with severe clefts, he calmed down and realized that it was OK to wait. Nevertheless, seeing a parent in that situation really brings me back to the fact that this deformity is a huge shock for most parents and having to wait even one day to have it repaired is excruciating. I also saw two 3 month olds who will have to wait a couple of months – again a big disappointment.
There was a very blue 8 pound 11 month old with a single chambered heart and cleft lip and palate that we also had to turn away. He was so bright and alert and needs the surgery so that he doesn’t have to work so hard to eat. However, it must be done somewhere with a pediatric ICU and pediatric cardiologists available and I don’t think, realistically, that it will happen. What he really needs is a heart transplant.
Finally, we evaluated five kids today with complex syndromes that included clefts. All were severely developmentally delayed and would have trouble tolerating surgery, so they won’t be on the schedule. It’s always hard to be objective in deciding whether or not to operate on a severely delayed child. If it will help with nutrition or breathing then it may be worth it, but particularly in the case of cleft palate, it’s not clear that the benefit is worth the risks of surgery or the painful recovery in a non-verbal child.
The internet at the hotel is currently down, but if it comes back up, I’ll post a few photos. There are a couple pictures of a young man in a Dr. Seuss hat playing with a little girl and later holding a baby. He’s one of the volunteer students from the Montessori school and plans to be a plastic surgeon so he can volunteer with Op Smile.
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