Azogues, Ecuador Fall 2007

Helping Heal Disabilities from Burns

  Helping Heal Disabilities from Burns 
  Originally uploaded by interplast

From Dr. Michelle Spring, Interplast Webster Fellow (September 15):
This is a photo of a beautiful girl who was burned on her legs as a young child. She had a contracture of her right ankle, which made it hard for her to walk normally. Shafquat operated on her and released the contracture and covered the wound with a skin flap. She is here with her mom. They have to stay in the hospital until next week, because they have to take two buses and walk for three hours just to get home.
We have seen many burns, and a lot of the patients have been operated on before by Interplast surgeons. These patients require many surgeries to correct their contracture deformities, and it is nice to be able to continue to help them. There are some children who have been burned in fires, but many are from gasoline, hot milk or hot water burns. Many have very bad scars around their lower face and neck, probably from their clothing starting on fire.

Here is a little more information to understand how a burn becomes a disability from our chief medical officer: Most burn-related disability is due to permanent tightening or contracture of the skin as the burn wound heals, which occurs when there is no immediate access to adequate medical care. Such burn contractures can severely limit mobility and may damage the underlying nerves and muscles. For example, without adequate acute burn care, a burned foot may attach to the shin as the wound “heals” and the skin contracts, consequently eliminating the ability to walk. By releasing contractures, we restore movement and function to the afflicted areas.

Eight children and one strong woman

From Ashifa Kassam, volunteer nurse from Los Angeles (September 14): Yesterday, I recovered a 6-year-old boy who had a cleft palate repair.  When he was awakeFning from anesthesia, I asked him if he´d like to have his mother be with him.  He would not answer, he lay in the gurney, not asking for anything.  Quiet. With tears running down his cheeks.  The children here have a great tolerance for pain.  They also suffer in silence, it seems.  I hugged him and consoled him.  He was receptive.  We called the family member in who was the boy’s aunt.  She explained to me that the young boy´s mother had passed away in a boat while she was attempting to come to the United States for better opportunities.  The patient has three other siblings. They all live with this aunty who has four children of her own.  The woman is 29 years old and is the sole supporter for the eight children. She makes hats and also receives financial assistance from the government for the children´s school supplies and some food. When I asked her what was the best part about having all those children in her home, she stated, simply, "everything.”  Then she offered, "The saddest part is when they get sick.”  If it weren´t for Interplast, there would be much sadness for this woman.  Seeing her nephew after the surgery made her very happy. I was humbled by this woman´s courage. She gave permission for me to share this story.  The young boy is doing great after surgery and has been discharged from the hospital.

"Usually we think that brave people have no fear.  The truth is that they are intimate with fear. "             --Pema  Chodron

The Strength of a Child

From Dr. Michelle Spring, Webster Fellow: It is always surprising to see how strong even the youngest children are.  They rarely cry, and they often do not have much pain after surgery.  They let the doctors exam them over and over again, even if it causes discomfort. We operated on a little 9 year-old boy with a cleft palate and found out postoperatively that his caretaker in the hospital is his 13 year-old brother.   On the ward, there are 6-8 children in each room, each with a member of his or her family.  When we visit the ward and even when we leave the hospital, the families and even the townspeople tell us over and over again that they are very grateful for us to be here.

Lost in Translation

From Ashifa Kassam, volunteer nurse from Los Angeles: The staff for Azogues is absolutely amazing and talented. We have a surgeon from Bangladesh, an anesthesiologist from Vietnam, a pediatrician from Canada and the remainder of us are from various parts of the United States. Quite an eclectic and international team.  I am learning so much from everyone.  What a great experience for personal growth. Not to mention the friendships, which are a welcomed side effect of trips like this. I have to mention something hilarious which happened on clinic day.  Our team nurses and anesthesiologists were collecting information regarding blood transfusion policies and protocols in the hospital.  Our team nurse attempts the conversation in Spanish.  The lab staff chuckled and laughed. Knowing we were missing something, we returned to the lab with our interpreter and found that the our nurse was inquiring about "sangria" and not "sangre” (Spanish for blood).The lab staff thought we wanted wine... not blood!  So funny!

Baby with Cleft Receives Free Surgery

  Baby with Cleft Receives Free Surgery 
  Originally uploaded by interplast

From Dr. Michelle Spring, Webster Fellow :
This photo is of a little boy with a bilateral cleft lip that I repaired with Shafquat. I will take a picture of him when he returns next week for follow-up.
I am finding that the days are so busy and I am in the OR all the time. We also took care of the little girl, Gloria, who has been cared for by Interplast in the past. We did another skin graft on her face for the burns she sustained as an infant.

Azogues: Narrow steep hills and cobblestone roads

From Ashifa Kassam, volunteer nurse from Los Angeles: The trip to Azogues has been absolutely amazing so far.  The town itself is beautiful with narrow steep hills.  Many roads are made of cobblestone, which get quite slippery after the rain. The views are breathtaking. The town goes to bed around 10pm and all is quite at 6am when I go for my walk. By 6:30am the town is bustling with kids going to school, shops opening for business, and people getting to their jobs. The major mode of transportation seems to be walking or driving. Surprisingly, there are many cars in Azogues. The butter, bread, coffee and the exotic fruits are delicious. People are kind and soft.  I´ve noticed how patient the parents are.  They come from far away, often traveling for days to arrive in time for clinic day.  We had more than 150 patients to see on clinic day.  Families continue to arrive everyday to be evaluated for surgery.  The Interplast team is well known in town, as there was an article in the paper about the organization and our goals and Interplast has been here many times before. Three of our team members and I went to a local restaurant for dinner.  The meal was absolutely delicious! Complete with fresh pineapple juice.  The woman who owned the restaurant was generous and kind.  She inquired about our plans, as she thought we were tourists.  We explained why we were in town. She had tears in her eyes.  She is familiar with Interplast.  She thanked us profusely for the work we do and said God would bless us in return.  I share this because I know that there are many individuals involved in planning and executing a trip.  Not only the ones who make the trip to physically be here, but all that give of their time, energy and share resources to make these trips happen. Know that what we do effect not only the patients and their families, but their towns. There is a ripple effect .... touching everyone.

Operating in Azogues, Ecuador 2007

  Operating in Azogues, Ecuador 2007 
  Originally uploaded by interplast

From Dr. Michelle Spring, Interplast Webster Fellow:
This is a photo of me and Dr. Shafquat Knundkar, Interplast surgical outreach director in Bangladesh and the chief surgeon for this trip. We are performing a cleft lip repair on a little baby boy. I am learning a lot from Shafquat and Dr. Joe Benacci, the other volunteer surgeon (from Wisconsin - my home state!). They both have a lot of experience with clefts, and we have seen many patients for very complicated revision surgeries, as well as burns. The anesthesiologist, Dr. Nguyen Thi Hein (shown sitting at the left), is from Vietnam and is a very active Interplast partner. It is so interesting and rewarding to work with medical people from other countries, as one team.

I am starting to mix up Spanish (very poor Spanish, I might add) and English when I speak, which probably happens to everyone. Esther has been great as the translator - she and Maggie have worked very hard, as has everyone else. I bought a headlight from REI before my trip, hoping that it would be bright enough to operate with, but unfortunately the battery life is too short and it is only bright enough to read with. The lights in the operating room leave a lot to be desired, but we are getting along fine.

So Far So Good

From Maggie Loya, team leader and coordinator/translator:

Tonight was the first time we all had to get into town to the internet cafe.  All is going very well.  The team is great. We have more than 50 surgeries scheduled so far with people coming in every day.  Today, there were 20 more who showed up for evaluation; we already saw more than 150 people in clinic and it was very successful, with a very good mixture of lips, palates, burns, etc.  Everyone at the hospital is very helpful.

International Partners from Asia in Ecuador to Help Team

International Partners from Asia in Ecuador to Help Team
Originally uploaded by interplast

Azogues marks the first surgical team trip of the fiscal year for Interplast. It should be an exciting trip, as two of Interplast’s key international medical partners will be working side by side Interplast’s new Webster Fellow Dr. Michelle Spring and volunteer medical staff from the United States and Canada. Dr. Nguyen Thi Hien, pediatric anesthesiologist and Interplast's leading partner in Vietnam (shown in photo), will serve as anesthesiologist in Ecuador. Dr. Shafquat Knundkar, plastic surgeon and Interplast’s surgical outreach director for Bangladesh, will serve as chief surgeon. This gives all of the medical professionals on the trip an opportunity for advanced medical education and cross-cultural dialogue with other doctors from around the world. Please visit this blog in the week to come for more updates from the field.