Cusco, Peru 2007 Surgical Trip

Camila After Cleft Surgery

  Camila After Cleft Surgery 
  Originally uploaded by interplast.

Cusco, Peru - Sheila Wolfson, coordinator / translator:  Here is Camila a few days after her surgery.  Even though she isn't smiling anymore, she will one day realize the gift she has been given through Interplast.

Camila Before Cleft Surgery

  Camila Before Cleft Surgery 
  Originally uploaded by interplast.

Cusco, Peru - Sheila Wolfson, coordinator / translator:  Camila has a unilateral cleft lip.  Even though she was about to have surgery, she still had a smile on her face.

Unstoppable

  Gonazalo making paper doll 
  Originally uploaded by interplast.

Cusco, Peru - Sheila Wolfson, coordinator / translator:I think Gonzalo was the friendliest,most outgoing and affectionate child we saw during our two weeks in Cusco. Gonzalo was there to have a revision on his cleft lip surgery that was performed by our host, Mario Cornejo several months prior to our visit. During their wait, it was obvious that he and his mom had a very loving relationship. Although Gonzalo was missing an arm from birth, he did not let it stop him from accomplishing what he wanted to do.

I'd like to add a special thanks to Klutz, the children's publishing company, for donating many of the arts and crafts supplies used to occupy the kids while they waited for their life changing surgeries. They are the best!!!

Julio Eight Days After Cleft Surgery

  Julio Eight Days After Cleft Surgery 
  Originally uploaded by interplast.

Cusco, Peru - Sheila Wolfson, coordinator / translator:  This photo, taken just eight days after the surgery, does a much better job of showcasing the power of reconstructive surgery to change lives.

Julio Right After Cleft Surgery

  Julio Right After Cleft Surgery 
  Originally uploaded by interplast.

Cusco, Peru - Sheila Wolfson, coordinator / translator:  On most Interplast trips, the only "after" pictures we get of patients look like this.  One can see that Julio's cleft lip has been repaired, but the dried blood, surgical tape and stitches don't highlight the impact of Interplast's work.

Miriam Overcomes Challenges, Eats Celebratory Banana

  Hungry Miriam 
  Originally uploaded by interplast.

Cusco, Peru - Sheila Wolfson, coordinator / translator:  They treated her with the necessary antibiotics and several days later Miriam was feeling much better. It seemed like a miracle to us. Although she still would need several skin grafts and time for healing, we actually saw her smile for the first time and she thanked the doctors. Later in the week, the doctors were able to perform a skin graft on her and we were thrilled to hear her say afterwards "Tengo hambre" (I'm hungry)!!! Although we have left Cusco, I know Miriam will still be in our thoughts.

Burn Victim Suffers From Infection

  Miriam 
  Originally uploaded by interplast.

Cusco, Peru - Sheila Wolfson, coordinator / translator:Miriam was on everyone's mind while we were at the hospital. When we arrived, our host had asked our doctors to see if they could help her, as she had been in the hospital for over three months due to burns she suffered all over her body from falling into a fire after a seizure. When we first saw Miriam, she was in total agony both physically and mentally. We truly did not know if she had the will to live, as she was suffering with pain. During the early part of our trip, our doctors brought her to the operating room to change her bandages and observed she had an infection throughout her body.

Bicyclist Hit By Car Still Smiling

  Bicyclist Hit By Car Still Smiling 
  Originally uploaded by interplast.

Cusco, Peru - Sheila Wolfson, coordinator / translator:She had been in the hospital for more than a month and finally was able to be released. For the next week, she would be lodging at her sister's place in Cusco so she could return for follow up care. Then Sara would travel 8 hours by bus to return home. If there was a Miss Congeniality award, Sara would receive it for her kindness to the other children and adults in the hospital.

Bicyclist Sustains Head Injuries After Being Hit By Car

  Sara having head shaved 
  Originally uploaded by interplast.

Cusco, Peru - Sheila Wolfson, coordinator / translator:Sara wasn't a complainer, not even as nurse Barb was shaving her head so the doctors could perform rotation flap surgery on her. She was 17-years-old and was recovering from a terrible head lesion she suffered when she was hit by a car while riding her bike.

Where The Children Have A Home

  Sheyla at the orphanage 
  Originally uploaded by interplast.

Cusco, Peru - Sheila Wolfson, coordinator / translator: Rosa Maria and I were very impressed with the bright, cheerful and clean social areas in the orphanage as well as the lovely dormitory rooms organized by age groups. These children, although separated from their “birth” families, truly had a family at the home.

Jhon Ready For Cleft Palate Surgery

  Jhon waiting for surgery 
  Originally uploaded by interplast.

Cusco, Peru - Sheila Wolfson, coordinator / translator:  Jhon, age 1½, was also there for a cleft palate repair, an optimal age for the surgery to be done since he would just be developing speech.

Hoping To Be Adopted

  Omar and Social Worker 
  Originally uploaded by interplast.

Cusco, Peru - Sheila Wolfson, coordinator / translator:  Omar, an adorable 7 month old baby, needed a bilateral cleft lip repair. When his parents saw that he was born with this deformity, they left him at the orphanage. The social workers hoped that after his surgery, he might have a chance at being adopted.

Turned Away Last Year, But Not This Year

  Sheyla waiting for palate surgery 
  Originally uploaded by interplast.

Cusco, Peru - Sheila Wolfson, coordinator / translator:  Sheyla, a child who needed a cleft palate revision (yet could not be treated the year before due to an upper respiratory infection), was accepted for surgery this year.

Return to Santa Teresa Orphanage

  Jhon and social worker at orphanage 
  Originally uploaded by interplast.

Cusco, Peru - Sheila Wolfson, coordinator / translator:  On the last day of our stay at the hospital, Rosa Maria (our local invaluable helper) and I took a 20 minute taxi ride to visit the Santa Teresa Orphanage in Cusco. We were eager to see “El Hogar” or The Home, as the children called it.

The orphanage was affiliated with the nunnery and was the home to more than 90 children, many with special needs. In fact, most of the children we saw were severely handicapped, as the healthier children were off at school.

Every year, we operate on children from El Hogar.  Check out the blogs from previous Cusco trips in 2005 and 2006 to see more of this collaborative, mutually beneficial relationship.

Over 30 staff meet the needs of these children, and it was obvious that they received excellent care. A lovely social worker brought several children to the Interplast clinic for evaluation the first week we were in Cusco.

Burn Victim David, One Year Later

  David trying to lift his arms 
  Originally uploaded by interplast.

Cusco, Peru - Sheila Wolfson, coordinator / translator:   The nearest hospital where he could be treated was over two hours away. In 2006, David and his father came to Hospital Regional to have the Interplast team release some of his burn contractures so he would have more movement in his head.  This year, he was back again, looking much better than he had in the posts on the blog from the year before.  In the photo he is shown trying to lift his arms above his head.  As you can see, he still has a way to go.  Hopefully, David will gain more and more flexibility after each skin graft.

Burned On His Face, Chest and Arms

  David 
  Originally uploaded by interplast.

Cusco, Peru - Sheila Wolfson, coordinator / translator:  In David’s case, the breakfast room was quite busy and no one saw him when the boiling pot of water fell on him and then somehow he managed to fall in the fire. Not only was he badly burned from the water, he was also burned on his face, chest and arms by the fire.

David Chino coloring

  David coloring 
  Originally uploaded by interplast.

Cusco, Peru - Sheila Wolfson, coordinator / translator:  It was no surprise when we heard that 4-year-old David was badly burned by hot water while his family was cooking breakfast. Because many of the kids we treat do not have electricity in their homes, cooking with open fires on the floor is quite common.

Here he is coloring with crayons and coloring books donated by Ronald McDonald House Charities (RMHC), whose generosity made this trip possible.

A True Hero: Marco the Fireman

Marco Antonio Alfaro, our hero
Originally uploaded by interplast.

Before we even heard Marco’s story, our team could sense this man’s gentle and good nature. His heroic tale only reinforced these perceptions.

Marco is 26 years old and had been at the hospital for three months after he was badly burned by a forest fire in 2005. He was working as an educational assistant in a school when the fire broke out in the area surrounding the school. Being selfless, Marco saved two students (a 16 and 17 year old) from the flames, yet was badly burned on his arms in doing so. When I went on the ward to talk to him, his mother, with her toothless smile, beamed with pride as she confirmed his story.

Marco has had a couple of surgeries since his first stay in the hospital and was back again for another skin graft on his hand. He's hoping to go back to work at the school during the week and continue to help his family in the fields (where they grew corn, cocoa beans and fruit) on the weekend. Marco is also a dedicated son, as his family lives 6 hours from Cusco and several hours away from his home.

He was truly our hero.

Worth A Thousand Words

  Father and Baby 
  Originally uploaded by interplast.

Cusco, Peru - Dee Fuchs, support staff:  They say a picture is worth a thousand words, so I leave you with this one.

Why I Work So Hard To Support RMHC

  Cute Interplast Patient 
  Originally uploaded by interplast.

Cusco, Peru - Dee Fuchs, support staff:  After a full day of surgery, the weary team returned to the hotel for a light dinner and a good night’s sleep. We will board a bus early tomorrow morning for the first train to Machu Pichu and a little rest and relaxation over the weekend. The team will return Sunday evening, rejuvenated and prepared to begin again Monday morning.

Amy and I will return to the US after the weekend but the rest of the team will continue working throughout the week.

I will return having a greater appreciation of why we all work so hard to raise money for Ronald McDonald House Charities, which is a longtime supporter of Interplast. I have been blessed to be a part of this medical team, to make new friends, and to leave behind brighter smiles and futures for many children in Cusco, Peru.

Amy's Birthday

  Happy Birthday Amy 
  Originally uploaded by interplast.

Cusco, Peru - Amy Laden, Interplast staff:  It was my birthday yesterday, and the team surprised me with a wonderful book that they had made for me, as well as a vase of artificial tissue flowers that Nidia and Sheila had stayed up until midnight to make. They gave the gifts to me at the restaurant where we had dinner, and they had bought a cake. The waiters turned out all the lights so that the two taper candles on the cake were the only lights. All the diners sang happy birthday to me. I was overwhelmed. I’m going with the team to Machu Picchu this weekend and leaving for home on Monday. I’m already missing them. They are really great. So many of them are strong experienced Interplast team members, and the new ones are extraordinary.

Focusing on Cost Effectiveness

  Lunch at the Hospital 
  Originally uploaded by interplast.

Cusco, Peru - Amy Laden, Interplast staff: Our lunches: after Gilda and I spent two mornings shopping for lunches for the team, the hospital nutritionist, Ana Maria, appeared to offer her help. She brought us sample menus, and we selected several. We began on Thurs., with a delicious local dish called causa (mashed potatoes, shredded chicken, lime, mayonnaise, and avocado shaped like a little round layer cake). We had been spending about $50 a day for lunches and drinks, and we’re now spending about $15 to feed 20 people (the local scrub nurses and helpers are eating with us). Jose is our cook and he shops for ingredients too, so that we’re relieved of the hours it was taking to shop each morning.

Problem Solving

  Problem Solving 
  Originally uploaded by interplast.

Cusco, Peru - Dee Fuchs, support staff:  Speaking of problem solving, the team performed surgery on a young mother whose propane cooking stove exploded. Both hands needed skins grafts and the doctors then wanted her hands to remain elevated, so slings were a necessity. The hospital provided slings that were cumbersome and not desirable in this situation, so our recovery room nurses went to work preparing a prototype sling, which Gilda then took to the hospital laundry. The laundry was then able to sew several slings using the nurses’ design from a piece of left over fabric. It is our hope that they will continue to use this sling for future needs as well.

Purchasing Medicine Locally

  Gilda and Amy 
  Originally uploaded by interplast.

Cusco, Peru - Dee Fuchs, support staff:  Once at the hospital, we quickly got up to speed and headed back out to the surrounding streets to purchase much needed medications that were unavailable at the hospital pharmacy. Our local nurse, Gilda, was invaluable, assisting with directing us to the pharmacies with the best prices first and negotiating the purchases. She was a kind, caring woman who worked tirelessly assisting with the internal procedures of the hospital, directing patients and their families before and after surgeries, and helping solve problems as they arose.

Recovered and Ready

  Interplast Nurse With Patient 
  Originally uploaded by interplast.

Cusco, Peru - Dee Fuchs, support staff:  My roommate and I spent the night ill, so we were both excited to be feeling better and ready to begin our day. After a light breakfast in our warm and friendly hotel, we visited the business district of Cusco to elicit a reduction in fees from Lan Peru for the excess baggage of the team that was filled with medical supplies being utilized in the hospital.

Won't Choke On The Bottle Much Longer

  Baby and Grandma
  Originally uploaded by interplast.

Cusco, Peru - Amy Laden, Interplast staff:Though I found myself under the weather and having to remain at the hotel, the rest of the team was back in the hospital before 8:00am, prepared for another full day of surgery. Here’s one very interesting case story:

Sheila Wolfson, coordinator / translator: Sitting in the rather dark and damp waiting area outside the operating room today was a family of four. Mom and Dad were on the young side and looked rather nervous as Amy and I greeted them. Grandma was carrying her 2-month-old grandson inside her native colorful shawl that was tied over her shoulder. At first we had heard that the family had come to Cusco from Bolivia, but when we spoke with them we were told they traveled many hours by bus from Ayaveri, a town near Puno, Peru to seek help for Jharol. A friend of theirs from Cusco had called them on their cell phone the day before to inform them that the Interplast team was in Cusco. Rather than bring the entire family on the long journey and possibly experience disappointment, grandma traveled ahead to confirm that Interplast was in fact in Cusco. The adorable baby had a unilateral cleft lip and tended to choke when he drank from a bottle, a typical side effect of having a cleft lip. This was the young couple’s first child and they were still questioning the reasons for the cleft lip. Much to the delight of the family and our team, we were able to schedule Jharol for surgery that very same day and he did beautifully.

One of the goals of Interplast is to train surgeons and set up outreach centers in various locations around the world so the local surgeons can treat their own people. In Puno, Peru that has become a reality and we have a wonderful outreach surgeon, Percy Rossell, who will be available to provide follow up care for this family as we obtained contact and internet access information for them.

No Longer Hiding Under Turtlenecks

  Yesenia 
  Originally uploaded by interplast.

Cusco, Peru - Sheila Wolfson, coordinator / translator:  A 14 year old girl with a lovely disposition was waiting in the hallway for her surgery today. As I walked past her, I recognized her from my visit to Cusco in 2002. When I smiled, she smiled in return and it gave me a warm feeling inside.

Yesenia was burned in an alcohol fire many years ago and was not able to receive medical care after this tragic accident. Her mother tried treating her burns with herbs, but to no avail. She developed burn contractures on her wrists, hands and neck and had practically no range of motion in her neck, as it was fused to her chest.

In 2002, Yesenia and her mother came to Hospital Regional in Cusco when they heard the Interplast team would be arriving. She was eager to have the first of her skin graft operations to release these burn contractures.

When I saw her today, she had the ability to lift her head and her range of motion was greatly improved. It was touching when she said she no longer felt compelled to wear only turtlenecks to hide her thick scars from her classmates.

Former Interplast staff member Archana Sridhar was in Cusco in 2005 and saw firsthand how Yesenia hid under her turtlenecks.

What teenager would not feel self-conscious? Her favorite subject in school is art so we kept her occupied with art activities while she waited for her surgery. This year the surgeons will be releasing the scar contractures on the sides of her mouth allowing her even more mobility.

Recycling and Reutilizing

  Interplast Doctors Examining A Patient 
  Originally uploaded by interplast.

Cusco, Peru - Dee Fuchs, support staff:  I'd like to expand on the creativity and teamwork by this group of wonderful individuals. They have utilized both the balloon packing material from the crates and our empty water bottles for wound elevation, the empty plastic containers from gauze packs for containers, etc. Nothing goes into the trash until all possibilities for recycling/reutilizing have been explored.

By the end of this first day of surgery, our group of highly qualified individuals has become a cohesive team, supporting each other, and helping these wonderful children.

Magical Intern

  Intern Alex Jaramillo 
  Originally uploaded by interplast.

Cusco, Peru - Dee Fuchs, support staff:  Today a young intern magically appeared at our door and asked to speak with one of the doctors. He offered his time, following his shifts, to work alongside our surgical team to learn from the best. It was exciting to see the potential in this young man, Alex Jaramillo, and to know that the team is leaving behind their knowledge and skills.

Moving Forward and Doing Well

Cusco, Peru - Terri Patrin, PACU nurse:  A fair amount of chaos this morning but this group really worked well as a team with good humor and good spirits. I think we thrived looking for alternatives for everything we couldn’t find, didn’t have or that didn’t work. We are moving forward and doing well.

Things Are Looking Good

Cusco, Peru - Alice Truscott, pediatrician:  Clinic went amazingly well yesterday.  Not as many patients as expected, but I imagine as these things usually go, we will have multiple walk-ins as the days go on.  Happy, healthy babies are always a joy, but it breaks your heart to have to turn away otherwise healthy children for anemia.   Here in Cusco, the cutoff is 12 for the Hemoglobin given the elevation and chronic hypoxia.  There's an interesting mix of indigenous and city folks.  Today we put together all of our resources and ingenuity into creating the operating and PACU environment that would work for all in the basic area provided.  The hospital has given us a most beautiful and inviting pediatric ward of eight beds in a sunny, clean room of our own.  So far by 11AM things are looking good.

Patient Close-Up

  Close-up of Cleft Baby 
  Originally uploaded by interplast.

Cusco, Peru - Dee Fuchs, support staff:  Here's a close-up of one of the cuter patients scheduled for surgery this week.

Finalizing The Schedule

  Cute Baby With Cleft 
  Originally uploaded by interplast.

Cusco, Peru - Dee Fuchs, support staff:  The day passed rapidly, and before I realized, we had finished the day’s screenings. It took about an hour for the doctors to then process the approved patients and prepare the schedule of surgeries while support staff completed the necessary documentation ensuring that all charts were ready for the following morning.

Waiting Patiently

  Clinic Day 
  Originally uploaded by interplast.

Cusco, Peru - Dee Fuchs, support staff:  Patients and their families patiently waited in the hall the full day for the final results, the mothers anxious to hear if their child had been accepted for surgery by the kind and skilled hands of our surgeons.

Evaluating Patients

  Evaluating a patient on clinic day 
  Originally uploaded by interplast.

Cusco, Peru - Dee Fuchs, support staff:  Once ready, the patients were welcomed one by one into the clinic, interviewed by the doctors (utilizing a translator if necessary) and decisions were made by the doctors if the patient was a potential candidate for surgery. If approved as a patient, they were then screened by the pediatrician and routine tests performed, i.e. hemoglobin.

Setting Up For Clinic Day

  Unpacking Boxes 
  Originally uploaded by interplast.

Cusco, Peru - Dee Fuchs, support staff:  The morning began with transportation at 7:15 am from the hotel to the hospital. We were welcomed by Dr. Mario Cornejo and escorted in for a brief but heartfelt reception. We then immediately walked through the halls, filled with Peruanas and staff, to find both the clinic and surgical areas. Then the work began. The surgeons, anesthesiologists and OR nurses unpacked and setup the surgical room with two sets of tables and equipment while the PACU nurses unpacked and setup the recovery area. The rest of the team, (the pediatrician, one anesthesiologist and the support staff) began the setup of the clinic while future patients lined the hallway outside.

Arrival In Cusco, Peru

  Unloading boxes in cusco 
  Originally uploaded by interplast.

Cusco, Peru - Dee Fuchs, support staff:  After a long but uneventful overnight flight from Miami to Lima, Peru, we arrived in Cusco. As we descended below the clouds, the Andes mountains magically appeared, in all their glory, green and moist following a recent rain.

The terminal welcomed us with a three-piece band playing typical Quechua music. All the luggage and boxes arrived in good condition with the exception of two of the team’s personal bags. In Lima they advised that they had been sent straight through to Cusco, but in Cusco they were nowhere to be found. Hopefully, they will arrive on the next flight in.

As Cusco sits at 11,000 feet, our hotel welcomed us with Coca matte to help alleviate altitude sickness. It has a very pleasant taste and complimented the alfahores cookies. The hotel is colonial in design with a central courtyard. The stone patio frames a central fountain and the walls display many pieces of antique Peruvian artwork. It is very quaint and inviting to us weary travelers. Cusco is damp and about 50 degrees, but the sun came out shortly after our arrival to everyone’s delight.

After receiving our room keys and placing our luggage in the rooms, the team gathered in the dining room for lunch. Though we all look a bit worn and tired, we enjoyed a delicious lunch and jovial conversation.

Since we were not expected at the local regional hospital until tomorrow, we were left to our own devises for a few hours. Many team members rested while others utilized what is probably their only free time this week and explored some of this beautiful, colonial town.

At 8:00 pm the team found a small restaurant close to the hotel and had a light meal, enjoying music played by a young man, before calling an end to this very long day.