Today is Monday, the 10th of November, and the second day of surgery. The ward nurses and I left the hotel at 6:30, a half hour before the rest of the team, so that we could get the first eight patients ready for the OR. I've learned that it's essential for the pre-op team to go early because once the surgeons have arrived, the pediatrician needs to go around the ward with them while they do discharge rounds so that discharge orders, which the pediatrician writes, will include their wishes. They also have questions about how the post op day and night have gone and look to the pediatrician to give a report. After they do their rounds, they head off to the OR and almost immediately call for the first two rows of patients. Without advance prep time, it's impossible to have the kids ready, and the whole day is delayed.
This morning, the main team left the hotel at 7:00 and got bogged down in the morning rush hour traffic. The surgery and anesthesia team leaders got together and decided the whole team should come at 6:30 to avoid the traffic. Since the hotel starts serving breakfast at 6:00 and won't accommodate any early diners, that would mean that the pre-op team would have no prep time. I had to do some fast talking and be uncomfortably pushy, but a compromise was reached! The pre-op team will leave at 6:30 and the rest of the team at 6:45. Maybe we'll let a bit of air out of the tires on their bus before we go.
By mid-morning I realized that this is a beautifully run mission, and there are several things that I love about it. First, the Hospitál Infantíl is very happy to have us here and everyone is friendly. The chief nurse is always around and if we ask for something, she provides it at once. The ward nurse, Sandra has worked 24 hours on, 12 hours off for the past 21 years and is one of the more cheerful people I've ever met. She greets us all with a big hug and a kiss on each cheek each morning and can jolly the fussiest kid into taking some juice. The pediatrician, Maritsa has been here 20 years and facilitates medical needs such as labs, medications, appointments and referrals. She's about five feet tall and wears 4 inch heels and beautiful makeup. Kathy, the pre-op nurse who dressed like a princess for screening and in wild colors yesterday, wore a Teenage Mutant Ninja Turtles outfit today, complete with cape. She's done 30-40 missions and has all the details set. On many missions, it's my job to make sure all the small but crucial things happen. These can include making sure all the kids have had their labs done and that the labs are normal, all the charts have the needed pre-op forms, the "code sheet" which has all the code drugs pre-calculated per the patient's weight has the right weight, the kids are truly NPO, etc. On this mission, all those things happen automatically because Kathy has "systems" she follows to get them done without a hassle. She's crazy on the outside but a bit OCD - in a good way. The other Kathy, who works in the children's hospital in Denver, also wears colorful scrubs, and today wore her Ninja Turtle scrubs as this was Turtle Day (see photos for coordinating outfit picture. )
Other things I love about this mission are: Real toilets complete with seats and toilet paper, fruit for snacks at the hospital instead of chips and stale cookies, really nice sheets and quilts on the patient beds, a lunchroom and three meals a day provided for the patient's parents, volunteers who play with the patients while the parents eat, a really great team that doesn't have any members with "issues."
What I don't love about "developing," poor countries: the inequality with which people can access medical care. This morning around 11:00 the team dentist asked me to come upstairs to the clinic to see a two month old who was in for a fitting of an obturator and had a rash. Babies who have cleft palates have a hard time getting a seal to suck, so the dentist can make an obturator - sort of like a retainer - to seal off the connection between the mouth and nose and create a seal. He had seen the baby 10 days earlier and made and obturator and she was returning for a recheck. The baby was dressed in five layers of shirts and pants and one piece pajamas, and when she was finally undressed, I was shocked to see how emaciated she was. She had weighed six pounds at birth and now weighs five pounds. The mom said she had been drinking formula with a special bottle for babies with clefts and that she tried to feed her every three hours but the baby got tired easily. I asked to watch the baby feed, and it was heartbreaking. She was obviously ravenous, but couldn't make a seal on the bottle so she couldn't suck effectively. After about two minutes of effort, she gave up and drifted off to sleep. The mom is poor and the baby hasn't seen a pediatrician. She was given the special feeder at an intake visit by an Operation Smile outreach worker, but didn't realize she could receive services free, so didn't return. For some reason, she knew the dental part was free, so she came for that. The hospital pediatrician came through again and got the nutritionist to see her for free, and now the Op Smile nutritionist will take over, but I couldn't help feeling outraged that this baby would not be getting the care she needs. I just kept thinking, she's a person too. Her mother is poor and therefore she starves while surrounded by excess. It's not right. I know that's naive and that's just the way things are in much of the world, but there was something about watching this tiny person trying so hard to eat that did me in.
The second day of surgery was generally smooth. I took a few post-op pictures and tried to do some pairing and some new pre-ops and post-ops that I'll try to improve on tomorrow. There was one difficult patient right at the end of the day that kept us all a bit late. An 11 month old had her palate repaired and then had some bleeding. Controlling the bleeding meant extra fluids and then she had trouble with her oxygen saturation and became a bit overloaded with fluids. Eventually all was resolved, but it turns out she likely has an kidney problem that caused the fluid overload problems. Tomorrow I'll see if I can sort it out, and if there is a problem, find out if she can find treatment here.
Finally, two sort of funny anecdotes. Because of the way the scheduling went this morning, we had four patients sitting in the hallway for awhile before they could move into the Child Life area to wait for the operating room Since yesterday's patients had been discharged, we let these four patients' mothers go and pick a bed for their child so they could get out of the hall. We didn't consider the consequence which was that every other mother then wanted to rush through the wards and choose a bed. If all beds were equal, this would have been fine, but 11 of the 22 beds are cribs and we have to put the infants in those. Also, there are 3 beds in tiny private rooms that we try to save for the teens or young adults instead of toddlers or school aged kids. Squabbles erupted and we had to move some five year olds out of cribs. For tomorrow, we will pre-choose all the beds. Heh!
Since the political situation is a bit iffy in Guatemala right now, Op Smile has engaged a local group to provide security for the team. A couple of the pre/post nurses and I got a look at the security truck that discretely follows us. It's from the Scorpion Group and has big scary looking scorpions on the sides. Creepy.
More tomorrow.
This morning, the main team left the hotel at 7:00 and got bogged down in the morning rush hour traffic. The surgery and anesthesia team leaders got together and decided the whole team should come at 6:30 to avoid the traffic. Since the hotel starts serving breakfast at 6:00 and won't accommodate any early diners, that would mean that the pre-op team would have no prep time. I had to do some fast talking and be uncomfortably pushy, but a compromise was reached! The pre-op team will leave at 6:30 and the rest of the team at 6:45. Maybe we'll let a bit of air out of the tires on their bus before we go.
By mid-morning I realized that this is a beautifully run mission, and there are several things that I love about it. First, the Hospitál Infantíl is very happy to have us here and everyone is friendly. The chief nurse is always around and if we ask for something, she provides it at once. The ward nurse, Sandra has worked 24 hours on, 12 hours off for the past 21 years and is one of the more cheerful people I've ever met. She greets us all with a big hug and a kiss on each cheek each morning and can jolly the fussiest kid into taking some juice. The pediatrician, Maritsa has been here 20 years and facilitates medical needs such as labs, medications, appointments and referrals. She's about five feet tall and wears 4 inch heels and beautiful makeup. Kathy, the pre-op nurse who dressed like a princess for screening and in wild colors yesterday, wore a Teenage Mutant Ninja Turtles outfit today, complete with cape. She's done 30-40 missions and has all the details set. On many missions, it's my job to make sure all the small but crucial things happen. These can include making sure all the kids have had their labs done and that the labs are normal, all the charts have the needed pre-op forms, the "code sheet" which has all the code drugs pre-calculated per the patient's weight has the right weight, the kids are truly NPO, etc. On this mission, all those things happen automatically because Kathy has "systems" she follows to get them done without a hassle. She's crazy on the outside but a bit OCD - in a good way. The other Kathy, who works in the children's hospital in Denver, also wears colorful scrubs, and today wore her Ninja Turtle scrubs as this was Turtle Day (see photos for coordinating outfit picture. )
Other things I love about this mission are: Real toilets complete with seats and toilet paper, fruit for snacks at the hospital instead of chips and stale cookies, really nice sheets and quilts on the patient beds, a lunchroom and three meals a day provided for the patient's parents, volunteers who play with the patients while the parents eat, a really great team that doesn't have any members with "issues."
What I don't love about "developing," poor countries: the inequality with which people can access medical care. This morning around 11:00 the team dentist asked me to come upstairs to the clinic to see a two month old who was in for a fitting of an obturator and had a rash. Babies who have cleft palates have a hard time getting a seal to suck, so the dentist can make an obturator - sort of like a retainer - to seal off the connection between the mouth and nose and create a seal. He had seen the baby 10 days earlier and made and obturator and she was returning for a recheck. The baby was dressed in five layers of shirts and pants and one piece pajamas, and when she was finally undressed, I was shocked to see how emaciated she was. She had weighed six pounds at birth and now weighs five pounds. The mom said she had been drinking formula with a special bottle for babies with clefts and that she tried to feed her every three hours but the baby got tired easily. I asked to watch the baby feed, and it was heartbreaking. She was obviously ravenous, but couldn't make a seal on the bottle so she couldn't suck effectively. After about two minutes of effort, she gave up and drifted off to sleep. The mom is poor and the baby hasn't seen a pediatrician. She was given the special feeder at an intake visit by an Operation Smile outreach worker, but didn't realize she could receive services free, so didn't return. For some reason, she knew the dental part was free, so she came for that. The hospital pediatrician came through again and got the nutritionist to see her for free, and now the Op Smile nutritionist will take over, but I couldn't help feeling outraged that this baby would not be getting the care she needs. I just kept thinking, she's a person too. Her mother is poor and therefore she starves while surrounded by excess. It's not right. I know that's naive and that's just the way things are in much of the world, but there was something about watching this tiny person trying so hard to eat that did me in.
The second day of surgery was generally smooth. I took a few post-op pictures and tried to do some pairing and some new pre-ops and post-ops that I'll try to improve on tomorrow. There was one difficult patient right at the end of the day that kept us all a bit late. An 11 month old had her palate repaired and then had some bleeding. Controlling the bleeding meant extra fluids and then she had trouble with her oxygen saturation and became a bit overloaded with fluids. Eventually all was resolved, but it turns out she likely has an kidney problem that caused the fluid overload problems. Tomorrow I'll see if I can sort it out, and if there is a problem, find out if she can find treatment here.
Finally, two sort of funny anecdotes. Because of the way the scheduling went this morning, we had four patients sitting in the hallway for awhile before they could move into the Child Life area to wait for the operating room Since yesterday's patients had been discharged, we let these four patients' mothers go and pick a bed for their child so they could get out of the hall. We didn't consider the consequence which was that every other mother then wanted to rush through the wards and choose a bed. If all beds were equal, this would have been fine, but 11 of the 22 beds are cribs and we have to put the infants in those. Also, there are 3 beds in tiny private rooms that we try to save for the teens or young adults instead of toddlers or school aged kids. Squabbles erupted and we had to move some five year olds out of cribs. For tomorrow, we will pre-choose all the beds. Heh!
Since the political situation is a bit iffy in Guatemala right now, Op Smile has engaged a local group to provide security for the team. A couple of the pre/post nurses and I got a look at the security truck that discretely follows us. It's from the Scorpion Group and has big scary looking scorpions on the sides. Creepy.
More tomorrow.
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