Azogues, Ecuador 2006 Surgical Trip

Mr. Charming Personality

  Victor 
  Originally uploaded by interplast.

Victor and his father came from Santa Marineta to get help from the Interplast team. When Victor was 4 years old he was playing with a machete and accidentally cut his hand. After it happened, he was taken to the clinic in his town and he needed to have one of his fingers amputated. Despite this treatment, he still could not move his remaining fingers very well and it was creating problems for him in school when he needed to write. Our surgeons hoped to repair his tendon, providing him more movement in the hand. His freckles, charming personality, bright smile and cooperative spirit endeared him to everyone on the team.

Napa Valley Register Story About Interplast

The Napa Valley Register in Napa, California just did a story on Interplast volunteers / Napa residents Maureen Cox and Clara Blair. The story talks about their experiences on a recent Interplast surgical team trip to Azogues, Ecuador. If the link goes dead, you can read the pdf from the Interplast website. Thanks to Maureen and Clara for sharing their story!

Christina After Surgery

Christina After Surgery
Originally uploaded by interplast.

Here´s Christina and Mama the day after surgery.

The full sponsor of this team surgery trip to Azogues, Ecuador is Ronald McDonald House Charities (RMHC), a major supporter of Interplast and its service to children around the world. RMHC has helped thousands of children in some of the poorest regions of the globe to receive life-changing surgeries through Interplast´s programs.

Seeing Interplast´s program first-hand for the first time is a profound experience for me, and makes me even more grateful than ever for the support of our donors and sponsors like RMHC. Thank you so much for making this possible!

Christina Looking at Mama

Christina Looking at Mama
Originally uploaded by interplast.

Afterwards, Christina´s mother cradled her in her arms, and they just stared and stared at each other. I wish I could have captured that, but Mama was too aware of my camera, and would look at me and smile every time I raised it. I didn´t want to keep her from looking at her daughter´s new face, so finally I just took this picture. Look at Christina staring at her mother, though, and you should get the idea.

Right after taking this picture, I left the room sobbing.

Unconditional Love

  Unconditional Love 
  Originally uploaded by interplast.

Christina's surgery went very well, and she woke calmly in recovery. But something amazing happened when her mother was brought in. The moment they caught sight of each other, they reached for each other simultaneously. Her mother scooped her up--IV and all.

I'm sorry these photos are blurry, but it happened so fast that I'm lucky I captured it at all!

Christina Before Surgery

Christina Before Surgery
Originally uploaded by interplast.

Do you remember earlier I told you about Christina—I mistakenly called her Christiana. Here she is before surgery, a beautiful little girl just under two years old with a cleft.

Margarita and Dr. Quinde

Margarita and Dr. Quinde
Originally uploaded by interplast.

Another member of the team you haven´t met yet is Maggie Loya, affectionately known here as Margarita. She is pictured here with our host, Dr. Quinde—and I think this is the first time you´ve actually seen his face!

Maggie is incredible. She is the team leader, and I can´t believe all the details she has to juggle. In addition to making sure that all goes smoothly in the OR, Maggie also has to make sure the team gets fed and has transportation when necessary. She procures medications if we need something beyond what we brought with us. She works with the hospital administration, the hotel personnel, and many others. Talk about detail, she even makes sure the team has adequate drinking water! And all of it with the most pleasant good humor.

Famous Dr. Fred Mihm

Fred, Joe and Jan
Originally uploaded by interplast.

Dr. Fred Mihm is the only member of the team you haven´t met yet. He´s another anesthesiologist on the team. All of Azogues has met Fred, as he´s had his picture in the local paper twice now. We joke that he´s a local celebrity, and will have to start signing autographs any minute.

In this photo, he is bringing a patient out of anesthesia after surgery while Joe and Jan observe.

The trickiest times for anesthesiologists are putting the patient under, and then bringing them out. But during surgery it is essential that the surgeon communicate well with the anesthesiologist. Any medication administered by the surgeon can have an effect that the anesthesiologist must deal with. In addition, if there are any post-operative problems, it is usually the anesthesiologist who handles them. For these reasons and more, Interplast always sends one more anesthesiologist than surgeons, so there will always be one who can be available in the recovery room, or to assist in the operating room, should any problems arise.

Victor and Mother After Surgery

Victor and Mother After Surgery
Originally uploaded by interplast.

Here´s a happy Victor and a happy mother.

Video: Explaining Post-Op Meds

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Back in the recovery room, Victor is still a little groggy while the recovery room nurse, through our translator, explains all of the medications to Victors mother.

Video: Hand Must Be Elevated

 

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From this point on, Victors hand must be kept elevated, as Dr. Di Francesco and Dr. Withrell explain in this video. Notice that they comment on his cute freckles, and what a good patient he is.

Victor's Cast

Casting
Originally uploaded by interplast.

Once the surgery is complete, Victor´s hand is well padded, and then a cast is applied.

Video: Victor's Surgery

 

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In this video, pressure is applied through a tourniquet and surgery starts at 10:30. You can see Dr. Di Francesco making the first incisions.

During this operation, the surgeons will harvest a section of tendon from Victor's arm, and attach it in his hand so that the function in his finger will be restored. In spite of his missing finger, Victor will now have a hand that works.

Marking For Surgery

Marking For Surgery
Originally uploaded by interplast.

Dr. Quinde observes Dr. Di Francesco marking Victor´s hand for the incisions.

Maureen Cox Preparing For Victor's Surgery

Maureen Cox
Originally uploaded by interplast.

Operating room nurse Maureen Cox, also my wonderful roommate, preps the instruments for Victor´s surgery.

Nerve Block

Nerve Block
Originally uploaded by interplast.

Victor is a sweet boy, about ten or eleven years old, with the biggest brown eyes. He lost his index finger, and severed the tendon of the middle finger leaving it useless to him. To restore function to his right hand, Dr. Di Francesco performed a surgery which I found absolutely fascinating.

In this photo, Victor has already been given anesthesia and is asleep. But the doctors want further insurance against pain, so anesthesiologists Dr. Heidi Withrell and Dr. Grant Rodney are stimulating nerves in his shoulder to determine which is the one to which they will apply a "block," a sort of local anesthetic which deadens that nerve.

"They Call Me Joe"

Joe talking to a mother
Originally uploaded by interplast.

The pediatrician on this team is Dr. Joe Herbert. He has his medicines and equipment set up at a desk, where he put up a sign that says, ¨They call me Joe.¨

When children are screened the first day, they must see the surgeons, the anesthesiologists, and the pediatrician. Every specialty must clear the child for surgery. I had the pleasure of assisting Joe--if you can call it that, since I don´t know anything medical--while he was screening about half a dozen patients.

Joe has a quiet, gentle demeanor which quickly puts children--and everyone else--at ease, especially since he can also speak the language.

When children come to the recovery room, when they are awake enough, we typically bring in a parent to sit with them and comfort them. Joe is almost always there to answer their questions and explain post-operative care and medications, as he is doing in this photo. He also makes rounds on the ward every morning to check the progress of the children who had surgery the day before, and to do a last minute evaluation of those scheduled for surgery that day.

I accompanied Joe on these rounds the last two days, and I am very grateful that he has been so accommodating with me. He always takes the time to synopsize the exchange with the patient and family for me, since I don´t speak Spanish, and doesn´t seem to mind at all that I´m tagging along.

The pediatrician also doubles as the team physician, and if anyone gets sick, it would be Joe who would evaluate and treat the problem. So far we are very fortunate to all be healthy. Hopefully Joe´s services won´t be needed in this capacity at all on this trip.

Recovery Room

  Recovery Room 
  Originally uploaded by interplast.

The surgeons are brilliant, and truly transform the lives of these children, but even they couldn´t do this without the rest of the team. The recovery room and OR nurses as well as the anesthesiologists all have to collaborate with the surgeons to make everything work.

In this photo, anesthesiologist Dr. Grant is consulting with OR nurses Lou and Jan on the care of one of our patients who has just left surgery. In the recovery room, no patient is ever left without a nurse in the room to make sure all is well. The OR nurses monitor various vital signs and are highly trained to deal with many possibilities. Should a crisis occur, it´s the anesthesiologist who is called in to work with the nurses to deal with the problem.

Video - Smooth, Quick and Quiet

 

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In this video, you can see how efficient Amanda Gosman's operating room is. It's smooth, quick and quiet.

Webster Fellow Teaching Local Medical Student

Amanda and Cookie
Originally uploaded by interplast.

Assisting Amanda in this photo is Cookie, a local medical student who is bilingual. Here she´s learning from Amanda, and next week she´ll be translating for our doctors when they give lectures for the medical students at the local university.

Such Delicate Work

Such Delicate Work
Originally uploaded by interplast.

I had the chance to spend some time in Dr. Amanda Gosman´s OR today, and I was totally in awe. She let me get close to look directly into the mouth of her patient at the cleft palate that she was repairing. It´s such delicate work! In this photo, you can see the apparatus that keeps the mouth open during surgery. There´s also something that keeps the tongue flat against the bottom of the mouth and out of the way of the surgeon.

Happy Family Ready To Go

  Happy Family 
  Originally uploaded by interplast.

Francisco stayed at the hospital overnight, as all of the children do after their surgeries. After being checked out by our pediatrician Joe, Francisco was released to go home. This is one happy family ready to go!

Tamara With Flowers After Surgery

Tamara With Flowers After Surgery
Originally uploaded by interplast.

Tamara seemed very happy that her flowers were waiting for her when she woke up in recovery. She showed them to everyone!

Flowers all done

  Flowers all done 
  Originally uploaded by interplast.

Here you can see Ruth's pretty, finished flowers.

Sheila Wolfson Is So Great

Shiela and Ruth Making Flowers
Originally uploaded by interplast.

Sheila Wolfson is so great with the kids. Here she´s helping Ruth make paper flowers while Ruth waits to be taken to surgery for her cleft palate.

Smooth, Quick and Quiet Operating Room

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In this video, you can see how efficient Amanda Gosmans operating room is. Its smooth, quick and quiet.

Video: Juan is calm

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Azogues, Ecuador - Juan is an adorable teenage boy who suffered an injury to his head that left a large area of scar tissue where no hair will grow. He already had one surgery for tissue expanders so that, in this surgery, the surgeons can remove the scar tissue and close the wound. He very much wants the surgery, and is very calm while hes being prepped on the table prior to receiving anesthesia.

Francisco After Interplast

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When Francisco woke up and went to the recovery room, we called for his parents, who had been so worried. Though they never said much, you could see it in their faces . . . particularly his father, who wanted to be the one to come into the surgical waiting room with him and ultimately hand him over to complete strangers. I´ll try to get a picture of him with Francisco on the ward tomorrow before they go home. Because the operating area is typically crowded already, we can only let one parent in at a time. So it was his mother who came in after the surgery. In this video, she is feeding him. The nurse asks, and the translator communicates the question, when he was last fed. If you can’t hear the audio, the mother responds that it was 10 o’clock last night. By this time it’s two in the afternoon. The nurse’s last comment, at the end of the video, is “give him some more!”

Mommy Comforting Kerly

Kerly and Mom
Originally uploaded by interplast.

Kerly also had surgery today. She was crying desperately for her mommy when she woke up, and we couldn’t get mommy in there fast enough! In this picture, Mommy is in the bed with her, comforting her.

Totally Transformed By Reconstructive Surgery

Drs. Guillermo Quinde and Federico Di Francesco
Originally uploaded by interplast.

Both Dr. Quinde, our local host, and Dr. Di Francesco worked on Francisco’s lip. The surgery lasted about two hours, and Francisco was totally transformed. What’s really terrific is that his cleft is being repaired before he starts to speak, so he won’t develop the speech impediments that are characteristic of children whose clefts aren’t repaired this early. Also, he won’t face the ridicule from other children that is so often the case. He may never know what it might have been to be shunned, denied an education, and have limited opportunities. This beautiful, outgoing little boy is now free to live a full life.

Just Irresistible!

Francisco Before Interplast
Originally uploaded by interplast.

Francisco captured everyone’s hearts. He is a gorgeous 4 month-old, which is not surprising, since both his parents are really good looking. He had a rather severe cleft, as I hope you can see in this picture. He has loads of personality, and is just irresistible! This picture was taken on the ward this morning before he was taken to surgery. If you have never seen a baby with a cleft smile at you, I promise you are missing a real treat!

Too Much For Me

The parents weren´t the only emotional ones. One of our surgeries was a cleft lip for a little adorable girl who I think was about two years old named Christiana. When she woke up we put a gown and hairnet on her mother and brought her into the recovery room. What happened next had me sobbing. Christiana and her mother reached for each other simultaneously. Her mother cradled her in her arms--IVs and all--and they just stared at each other. It was too much for me.

I´m watching this happen for the first time, and I am so grateful to see our program first hand. All other knowledge about it becomes irrelevant when you see these children go into the OR, and two hours later they come to recovery with a whole new life ahead of them.

I have photos of Christiana, but as yet have been unable to post pics. I promise I will figure it out, though, so check back.

Day Two: Scenarios

Our first day of surgery started with rounds on the ward to check on the children. That was followed by "scenarios" which consisted of the chief anesthesiologist posing some potential problems, and our medical personnel along with local personnel identifying what would be available to us to deal with them. But the day ended with successful surgeries, sleepy kids, and emotional parents.

I'm in Awe

It was incredible. Many of these families had traveled many hours, or even days, in hopes of receiving surgery for their children. They were incredibly patient with the long wait, and very attentive to their children, who were so well-behaved.

The team is working together really well, which is impressive when you know that five or six of us are on our first trip--including me.  Imagine fourteen people arriving half way around the world with 29 BIG boxes of supplies and equipment. They wake up the next morning, launch into  action, and within an hour they are unpacked, setting up and screening kids. I´m in awe.

But even that pales in comparison to the hardship and determination of these families who have such hope for their children. I will tell you some of their stories, (and hopefully have photographs) in the coming days.

Amazing Clinic Day

Clinic day was every bit as amazing as I expected it would be. We had so many children and families to see that it seemed impossible we could screen all of them in one day, but we did, and had a full schedule of surgeries for the next day.

But to do that, many families had to wait for hours and hours. I learned early to pay attention to the noise level. When it began to get loud with restless children, I would go out into the waiting area with crayons, and activities books provided by Ronald McDonald House Charities, who generously sponsored this trip. My wonderful mentor, Sheila Wolfson, clued me in to this. Once the children were occupied, the noise level would drop for a time, and I returned to helping Sheila make charts for those scheduled for surgery. That meant that I got to see all of the children that we will be helping in the next two weeks.

Welcome To Ecuador!

Hi.  I'm Karlyn Bennehoof, development director at Interplast. I am accompanying an Interplast surgical team to Azogues, Ecuador, and it is my first trip.  Check back over the next two weeks to see the kids we're helping and hear the stories of the lives we are changing!