Guatemala--Days 1-4

Written by Jeff:

Guatemala Days 1-3

At the request of some friends, I have decided to write about my experience in Guatemala.  I was graciously sponsored by a former OHSU anesthesia faculty and her husband, The Thompsons, to travel to Santiago, Guatemala with SmileNetwork International to provide anesthesia for children with cleft lips and palates who would otherwise be unable to get surgery.  I am traveling with one of my pediatric anesthesia faculty, Dr. Berklee Robins as well as a medical student going in to anesthesia Luis Salseto (who is also sponsored by The Thompsons).  

After spending five days with my family at Disney World and getting home from the park at midnight, I woke up at 3:30am and Jill took me to the airport in Orlando (she and Jenna stayed with the family for the remaining vacation) for my flight to Houston where I met my OHSU team.   In Guatemala City we met the rest of the team which included volunteers coming from Minnesota where Smile Network International is based (plastic surgeon, four nurses, one CRNA, two high school students, and three SNI staff including the founder of the non-profit) as well as a plastic surgeon from Chicago and a pediatrician from Mexico.  We were all greeted by a local woman and her family (husband and 3 kids) who is serving as our in country hosts during our stay, coordinating what has so far been a great trip.   From Guatemala City we headed by bus to the Lake Atitlan region where our hospital is based.  The drive was supposed to take about 3 hours but due to traffic, bad roads, horrible weather causing three accidents on our way (two with semi trucks hauling sugar cane) and very winding roads the trip took 5.5 hours.  By the time we arrived at our lodging in Santiago, Guatemala (Hotel Bambu) it was after seven and dark, so we all quickly ate dinner and went to bed.  

When I awoke for our team breakfast at seven the next morning the place was amazing.  After the long drive through very rural Guatemala with poverty that is unbelievable,  I found myself in one of the most beautiful places I have ever seen.  While the poverty in this town is no different then the areas we traveled through on our way, the natural beauty of the area is amazing.  A lake surrounded by four volcanoes at about 5000 ft elevation would be my home for the next week.  

To describe the level of poverty, think villages comparable to Slumdog Millionaire. While I cannot even begin to detail every eye opening thing I saw, things particularly memorable included one of the first people we met outside the airport who had no legs and was riding on a skateboard trying to sell us pens, a one year old child sleeping on the sidewalk while his mother was wandering through traffic selling fruit, and multiple people selling various refreshments to the long lines of backed up vehicles due to what was undoubtedly a fatal car accident due to the bed conditions during our bus travel.  Closer to Lake Atitlan I frequently saw young children out working in fields or helping their parents make a living (most without shoes).

 Our first day of work on Saturday we went to the hospital to meet patients who had been identified by a Guatemalan agency needing our help.  They had been working with these patients for many months to improve their nutrition so they could undergo surgery (poor feeding is a common problem with left lips and palates).  This amazing team went around to villages to find these patients in preparation for our arrival, and arranged for them to travel to Lake Atitlan and stay in a local hotel (an absolute luxury for them, more like a place on Aurora Ave in Seattle to us).  We had one family travel 20 hours with their child just to be evaluated by us with no promise for surgery.  Another mother quit her job to come with her child because she wouldn't be allowed the time off, even though she wasn't even able to support her family on what little she was making.   Because of the isolation of these villages, many of these families were for the first time seeing another child that looked like theirs.  They have often faced ridicule by others in their community for the appearance of their child, and thus this was an opportunity to forever change their child's life.  One mother arrived with her child (who previously had his cleft repaired by another mission team) just so that she could bring all the families a meal while they were waiting in the long line for evaluation. 

The evaluation process included multiple stations including the surgeon to see if the defect could be repaired, a visit with a pediatrician to evaluate the overall health of the child (cleft patients can have syndromes with other serious medical problems including their heart), and a visit with the anesthesia team to evaluate their appropriateness for surgery.  I believe the local team had found 38 patients, two never arrived so we screened 36.  They were all ranked based on a priority scale and at this point (aside from a couple minor health concerns) we hope to be able to operate on all of the children and not turn any away.  It was more then the 25-30 we had planned for, but it would be heartbreaking to turn these families away so we have opted to work long days.    One we decided to add on was a 73 year old man who showed up after hearing we were coming.  While our primary goal is operating on children (the other 35 patients are between 3 months and 11 years), this sweet man told us that his only wish before he dies is that he can get his cleft repaired.  The team decided that there was no way we could not do this for him as long as we could be safe, and after a more thorough work up we hope to do his surgery this week.  He just repeatedly told us how thankful he was for allowing him this chance.  

Right before we were leaving the hospital we were asked to quickly come to the small ER.  We were totally unprepared to find a 3-4 year old girl with a softball sized mass growing out of her eye-socket that was covered with flies.  It was heartbreaking to see, and a disease that I am positive I will never see such a severe case of again in my life (retinoblastoma).  It is the disease the pediatrician is looking for when they shine the bright light in to a young child's eye.  The child had signs that it had already metastasized to her other eye and likely her brain.  We all pooled our money so she could get an ambulance back to Guatemala City for help, although the outcome is unlikely to be good.  It was an emotional and tiring day, do we finished with some shopping in town and a great team dinner.

Sunday was our one free day during the mission.  After breakfast we all headed out on a boat around Lake Atitlan to Panna where we shopped and had lunch.  Five of us (including the 73 year old surgeon) went zip lining through a natural reserve with a gorgeous view of the lake, a waterfall, and a collection of animals including monkeys.  

We just got back from dinner in town, and I write this as I head to bed in preparation for our first day of operating.  We have six kids scheduled, surgery starting at 7:00AM, to begin what will be a very fulfilling, challenging, tiring, and I'm sure emotionally draining experience.

Guatemala Day 4 - First Day of Surgeries

 We did 6 surgeries today (4 cleft lips and two cleft palates) all on kids between 5 months and 14 months of age.  Things went great in the operating room given the different environment and minimal technology that I have come to rely upon in the OR back home.  There were a few flies landing on the s drapes....but we will ignore that.  It was a long day as I awoke at 5am and didn't return from the hospital until 7pm but it was all worth it to see how good the kiddos looked after the surgery and how happy and grateful their parents were.

The story of the day goes to a little girl who woke up, coughed, and had a 6 inch long worm come out of her mouth.  Guess it now makes sense why she was 14 months old and only weighed 12 pounds.  I'm pretty sure I won't ever see that again in my life.