So No Child Must Wait

Jerzee

Jerzee
Originally uploaded by interplast

Dr. Joyce Chen, Interplast Webster Fellow.

Running into our surgical consultation room was a rambunctious and adorable little girl named Jerzee. She is 14 months old and has an unrepaired cleft palate. After an appropriate examination and counseling to Jerzee’s mother regarding her daughter’s cleft palate, Jerzee was scheduled for surgery the next day. Just as she came into our lives, Jerzee left, running out of the room after her mother.

Surgical Team Evaluation

Surgical Team Evaluation
Originally uploaded by interplast

Dr. Joyce Chen, Interplast Webster Fellow.

Pictured here is Dr. Kristen Stueber examining a patient with a repaired cleft palate, alongside Dr. Gary Fudem (pictured wearing glasses on the right) and I (pictured middle in blue). The patient’s palatal repair appeared intact but with his hypernasality caused by a shortened palate, the surgical team decided to schedule this patient for a palatal lengthening procedure to improve his speech. Amy Laden (pictured far right) helped us with the Spanish translation during this and other consultations throughout the day.

Rickshaw Racing

Rickshaw Racing
Originally uploaded by interplast

Dr. Joyce Chen, Interplast Webster Fellow.

At the end of our clinic day in Pucallpa, our tired but jovial team joined our hosts from EsSalud Hospital at a local restaurant. Transportation was quickly solved when we saw a line of motorized rickshaws waiting outside the hospital. After evaluating patients and/or setting up our operating rooms, everyone was hungry and eager to reach our culinary destination. We all shared rickshaw rides, racing and blending with the other motorists on the streets towards the promise of savory Peruvian cuisine.

Clinic Day

Clinic Day
Originally uploaded by interplast

Dr. Joyce Chen, Interplast Webster Fellow.

Our patients waited patiently to be seen in clinic. In the meantime, the adults passed the time conversing with one another, while the children enjoyed coloring with crayons. Fans overhead in conjunction with a slight breeze through the open windows helped cool everyone in the tropical Amazon climate of Pucallpa.

Meeting Our Hosts

Meeting Our Hosts
Originally uploaded by interplast

Dr. Joyce Chen, Interplast Webster Fellow.

After arriving at our hospital, our team was introduced to some of the surgeons and nurses with whom we will be working closely at EsSalud Hospital. They were introduced by Dr. Esly Vicente Anderson Motta, a pediatrician and medical director of the hospital (pictured left). He’s also been our main liaison and has been instrumental in preparing for our team’s arrival at this new site. Sitting next to him is Amy Laden, Interplast’s director of international services, who flew out to Pucallpa ahead of time to help with the preparations. Special kudos need to be given to Amy as she was able to make this inaugural team trip a reality with only two weeks notice, as our original intended Peruvian site was cancelled due to a dengue fever epidemic.

The Inaugural Pucallpa Team

The Inaugural Pucallpa Team
Originally uploaded by interplast

Dr. Joyce Chen, Interplast Webster Fellow.

In front of a banner announcing our arrival, the inaugural Interplast team to Pucallpa, Peru, posed for a group picture, already appearing to be a cohesive group, less than two hours after our bay area team members joined the rest of the team. As typical of Interplast team trips, the master itinerary had everyone arriving together in Peru. However, due to mechanical problems of their original plane, the bay area team members missed their connection in Miami and arrived in Pucallpa 8.5 hours after the rest of the team. Despite the travel delays, everyone was excited to see and evaluate patients on clinic day at our new site near the Peruvian Amazon.

Is there a doctor on the plane?

Is there a doctor on the plane?

Dr. Joyce Chen, Interplast Webster Fellow.

An hour into our red-eye flight from Miami to Lima, on Interplast’s inaugural team trip to Pucallpa, Peru, a flight attendant announced over the loudspeaker that they needed medical help at the front of the cabin. I, along with two Argentinean physicians, a cardiologist and a critical care physician, responded.

The flight attendant had watched a passenger collapse in front of the bathroom. She was immediately laid down on the floor with her legs propped up above her heart to facilitate blood flow to her head (this is called the Trendelenburg position). The patient was diaphoretic (perspiring heavily) and pale but had a nice, steady pulse. My years of general surgery and trauma training suddenly rushed back to me, and my examination and assessment of her were very second nature. With diabetes, cardiac disease, and head injury ruled out, we learned that this passenger had high blood pressure and had last taken her blood pressure medication during her layover in Miami. The Argentinean cardiologist checked her blood pressure which turned out to be low. In order to increase the amount of fluid circulating in her system and thus increase her blood pressure, we asked her to sip orange juice from a straw. After two full glasses, she pinked up, looked and felt much better. Her blood pressure had already improved!

As we were watching our patient recover, I was able to enjoy a conversation with my two new Argentinean friends. They had attended an international meeting of cardiac-lung transplantation in Chicago and were heading back home to Argentina. They had missed their Dallas, TX connection and were rerouted via Miami, FL and Lima, Peru to Argentina.

Before we left our patient and headed back to our seats, I asked her to see a doctor the next day at home in Lima to have her blood pressure checked and to make sure she was OK. She agreed and then graciously told us “grazie mille” with a genuine smile. Both she and the Argentinean cardiologist were of Italian descent, and I had mentioned to them that in college, I had taken some Italian and studied in Florence, Italy. My last thoughts as I drifted off to sleep…tiramisu, Michelangelo, Vivaldi, BUONA NOTTE!

Khia

Originally uploaded by interplast

Jane Chen, Interplast trip logistics coordinator.

Fifty-three-year-old Khia had already had five operations, some performed by earlier Interplast teams, before she came to clinic day this year in Cao Lanh. Years ago she had filled an old gas tank to light a lamp, and it had promptly burst into flames. She was home alone at the time, and, because her clothes were made of satin, the fire quickly spread, and she sustained severe burns all along her arms, chest, neck and face. Until her first operation in 2007, she was not able to move her arm or to raise her head. It was a terrible time for her, and this past Thursday, the day of her surgery, Khia still teared up when she spoke of those years. However, even as she spoke of her hardship, you could see the strength and pride in her face. She raised her hand to her chest as she told our volunteer translator that even though her scars still pain her at times, she is very strong, and she is glad to be alive. Her husband of 18 years accompanied her to the hospital for her operation. He himself has issues with his eyes and high blood pressure. The mutual love they have for each other was incredibly apparent over the course of her surgery and the days afterward while she waited to have her bolster and sutures removed. She asked our doctors several times when she could be discharged, as her husband would not leave without her, but she worried that his condition would worsen if he waited. In the end, she left a couple days earlier than scheduled, with the promise to return for a follow-up on Friday. They both came back on Friday as promised, and our surgeons found that her graft was doing well. After this surgery, Khia will be able to move her neck much more freely and to raise her head. It hasn’t been an easy road for Khia, but she has come a long way.

A Different Kind of Partnership

Originally uploaded by interplast

Sandi Walsh, Interplast volunteer OR nurse.

Hello from Vietnam! After a lengthy trip here (as I missed my connecting flight in Detroit, and therefore missed the group flight), I traveled a day later by myself and finally made it to Cao Lanh. Thanks to the team for setting up O.R. without me!

It is extremely hot. It feels like it’s 100 degrees. If it weren't for our air conditioning in the O.R. and the PACU we would not be able to work as efficiently as we do. Over the past seven days, we've done over 60 cases.

Each morning we are greeted by a “than lan” (gecko) in our wash up room. I call him “ban” (my friend). He eats the insects and helps keep us bug free. Works for me!

Cao Lanh

Cao Lanh
Originally uploaded by interplast

Emma Phan, Interplast volunteer coordinator/ translator.

Cao Lanh is a quaint city and the people here are very kind and easy going. You just have to make sure you eat dinner before 8:30pm because the restaurants all close after that. The hospital staff feels like they are old friends. I’m glad to be here helping out and seeing children and their parents smiling.