Cusco, Peru Surgical Trip

Michael: Safety Issues

There was a small challenge during Joel’s case when an anesthesia machine at the local hospital malfunctioned and we had to improvise oxygen supply in the middle of the surgery. Everyone leapt into action to help, just as we had discussed earlier this week when we “ran the scenarios.” Interplast is very conscious about safety issues, especially with the unpredictability of working in operating rooms in developing countries.  As a result, our medical committees have come up with various emergency scenarios that we discuss as a team before we begin surgery on the first day. Every single member of the team is at this important meeting, where we create a plan of action for just such a scenario.

I was so proud of the team today. It was amazing to see how everything went so smoothly, and Joel’s surgery went perfectly as planned. He’s resting tonight. Soon, he should be able to fully extend his arm and move his neck to look at his father and point to the goal he just scored…

Archana: Doing What We Can

Today was a full day of surgery, and everything is really beginning to fall into place after a somewhat chaotic first day in the OR yesterday. Now we know more of the local physicians and nurses, and have an established schedule with all of our supplies unpacked. The team seems to have great morale, and I continue to be so amazed by their dedication and sense of humor. Kay Neal, our fearless team leader, even brought a supply of Hershey’s Miniatures for the team to enjoy during breaks.

An entire group of children and their parents showed up outside of the operating room today, hoping to be seen by the surgeons for treatment during the trip. Unfortunately, because the surgery schedule for the next two weeks is so full, we are not able to help many of them this year.  The surgeons decided that we could take a couple of new patients for surgery next week.

Archana: Ocdulia 24 Hours Later

  Archana: Ocdulia 24 Hours Later 
  Originally uploaded by interplast.

This morning, I went on rounds in the pediatric wards with the two surgeons (Dr. Simone Topal and Dr. Del Mount) and the pediatrician (Dr. Kathy Gallagher) to check out the patients we treated yesterday. Here is a photo of Ocdulia, who we told you about yesterday. She seems to be doing great, but Dr. Topal decided to keep her in the hospital for another night since she has to walk so far to get home.

I wondered aloud whether it was hard for the surgeons to say goodbye to their patients since they may not see them again. Much of the follow-up care for Interplast patients is done by local surgeons and physicians, who monitor their progress after the teams depart. Del said, “The best thing about being a pediatric plastic surgeon is watching them grow up, so we do miss that part. But, with these patients, it is incredible - I can only imagine how their lives must change after these surgeries.” And Simone added, “I really wish I could see them in three weeks and again in three months, just to know how they did after surgery.”

I wish I could see them too. I never thought I would get so attached to them after a day or two, but they’re all so adorable, it’s hard not to…

Simone Topal: Ocdulia With Her Mother

  Ocdulia With Her Mother 
  Originally uploaded by interplast.

I’m Simone Topal, the other plastic surgeon on this Interplast trip. Around 3pm today, I was called aside by Archana between surgeries. I went out to meet Ocdulia, who was waiting with her mother outside of the operating room. She has a cleft lip.

Ocdulia is nine years old, and it took her 10 hours to get here -- five hours walking, and another five by truck. She and her mother only speak Quechua, so one of the relatives of another patient (who was in the operating room for a burn procedure) helped us translate from Spanish. I explained the operation to her and obtained her mother’s consent to operate. Ocdulia has two brothers and two sisters, and attends school in her village. She had never left her village or met a doctor before, so she told the translator to tell me that she was very scared.

Simone: Ocdulia's Mother and Michael Flynn

  Ocdulia's Mother and Michael Flynn 
  Originally uploaded by interplast.

The level of her mother’s trust to be able to give over her own daughter to us without ever having been in a hospital before is amazing to me. Michael Flynn, the anesthesiologist I worked with on this case, observed that she went to sleep without crying, even though she had revealed how scared she was.

Simone: Ocdulia on the Operating Table

  Ocdulia and Mike Fallon 
  Originally uploaded by interplast.

Normally we aren’t able to take last-minute patients like this, but since Del and I had set a rather light schedule for our first day of surgery, it was possible to add Ocdulia on. We felt like it was important, especially because she and her family had come such a long way and it would be difficult for them to return next week or even next year.

Simone: Pure Campesino

I bring my iPod on trips so that I can listen to music in the OR – the “Girl from Ipanema” was playing as I completed Ocdulia’s surgery. It reminded me of what a lovely little girl Ocdulia is, and I hope that she will be fully accepted into her community when she returns home later this week. Although when you look at her, all you hear is “El Condor Pasa”—she is pure campesino.

Simone: Ocdulia Before Interplast

  Ocdulia Before 
  Originally uploaded by interplast.

I’m grateful that I was an Interplast Webster Fellow last year – it was the best year of my life, and now I feel confident doing surgeries like Ocdulia’s.

Simone: Ocdulia After Interplast

  Ocdulia After 
  Originally uploaded by interplast.

I’m so appreciative that I can give back in this way. I remember visiting the Dibner Fund in Connecticut, and thanking them for sponsoring the fellowship for the past five years – it is generating plastic surgeons like me, who will be dedicated to Interplast’s work for the rest of our lives. Good night from Cusco, Peru!

Archana Sridhar: Big Blanket

  Archana: Big Blanket 
  Originally uploaded by interplast.

It was an incredible experience to witness clinic today. The halls were crowded with families, just hoping for a miracle. By the time the night is over, we will have seen over 90 children, and most of them will receive free surgery over the next two weeks. What struck me most was the children’s constant laughter. They loved my Easter stickers, and our translator Maya’s hand puppet of a bright green dragon! Many of the women were in the traditional dress of the Quechua people, with their babies wrapped up in colorful blankets, just like this little guy. It was amazing to hear how far they had traveled. Several people I spoke to traveled three full days from the rural districts in the Andean highlands outside of Cusco to get here - on foot, by horse, and then by bus.