LIMA PERU 2012 BLOG #5
I’m on my way home after two of the most interesting weeks I’ve known in recent years. When I was invited to participate in the 2012 Lima Rotaplast Mission, I had a small idea about what was ahead. I knew that volunteers, under the auspice and financing of Rotary, traveled to strange places around the world to provide surgery for children who were born with cleft palates and lips. Two members of our Rotary Club had participated in the past and have given talks about their experiences. What I’ve learned from my experience in Lima is that there are some truly awesome individuals in this world and that I’ve had the privilege of knowing and working with a number of them.
Most of the twenty six members of our team had served on several Rotaplast missions and nearly all were already signed up for future missions. With rare exceptions, the professionals left full time practices to serve with Rotaplast. All of the nonmedical volunteers, with the exception of the Mission Leader, paid their own expenses with the exception of their hotel accommodations. One of the local Rotary clubs in Lima provided morning snacks and lunch each day as well as serving as host for a farewell appreciation dinner. Dinner each day was at the volunteer’s expense
I had heard our club members who had participated in previous Rotaplast missions speak of long work days but I didn’t realize what that meant. Our team’s work day began with a bus pick-up at our hotel each day at 7:00 am. We rarely returned to the hotel before 7:00 pm and on several days the return was after 9:00 pm. The surgeons were on call each night in the event that a patient was having difficulty. Each day was followed by a “happy hour”, to which participants contributed, where the team anjoyed relaxing and sharing the events of the day.
It was amazing to me to observe the medical volunteers and the endurance they displayed. I never once heard anyone mention fatigue or the stress of the busy day. Each day I saw these medical volunteers intensely involved in the skilled work they performed, bustling about seeming always to be on the run. If one of the medical folks completed his or her surgery assignments for the day, he or she always seemed to find some supportive involvement with surgeries yet completed. And all of this tireless effort accompanied by smiles. I was amazed.
In all, the team completed approximately ninety surgical procedures. While cleft palate and lip repair was the primary function, several patients received surgery of the nose that related to his or her deformity. The vast majority of patients were very small children; many less than a year old. A small number of older children and a few adults were also treated. One patient, a lady, was seventy-four years of age and had lived her whole life with her birth defect. One of her sons had heard a radio broadcast reporting on the Rotaplast Mission and decided to try to get surgery for his mother. He drove several hours to pick-up his mother to bring her to the clinic where she was interviewed, evaluated and accepted for surgery. The lady seemed frightened but patiently went through the process. On the final clinic day she was seen looking as though she was afraid to smile with her new lips but a twinkle in her eye showed the joy in her heart. One boy of about eight years of age was evaluated and found to have club feet and clubbed hands along with his cleft palate and lip. A decision was made by the surgical team to see if something could be done. After a study of X-rays, it was determined that it might be possible to make the boy’s thumbs functional. I watched much of the surgery and was amazed at what was accomplished. The boy went home with the potential for being able to grasp something with hands for the first time in his life.
The smiles of joy on the faces of parents and the hugs of appreciation received by volunteers perhaps explains in part why some volunteers have been serving on Rotaplast missions every year for dozens of years. Accounts are related by these veterans about 19 hour flights followed by eight or nine hours of auto travel over rough roads to remote places where one can’t eat the food safely and one needs to share a thin mattressed bed with another. Now I know why they return to do it again.
Rotary is all about “Service Above Self” and I witnessed first hand on the Lima 2012 Rotaplast Mission what that really means. The team of volunteers, only a few of which were actually Rotarians, demonstrated to me how our motto really works. Their tireless devotion to people in need left me with an indelible memory of their service and a personal challenge to devote my few strengths, time and resources in a more significant way as I attempt to fulfill my obligation to place “Service Above Self”.
Incidentally, each Rotaplast Mission, of which there are a half dozen or so a year, costs approximately $80,000. Rotaplast has been in existence since the eighties and has provided tens of thousands of youngsters around the world with a new look and new life.
Love to all,
Bill, Grandpa Bill, Dad
Sunday, January 22, 2012
Thursday, January 19, 2012
LIMA PERU 2012 BLOG #4
LIMA PERU 2012 BLOG #4
Imagine getting ready for a Sunday drive. You get the kids in the car, load in the picnic lunch(there aren’t many McDonalds outside of Lima) and the fishing rods (just in case you pass a promising looking stream or lake) and then you get the tank of oxygen and place it conveniently where all in the car can reach it. This is real life according to an account shared with a new Peruvian friend. Less than two hours east of Lima the road climbs from sea level to over 12,000 feet and even the locals admit to having problems with altitude sickness. The sudden change of altitude does strange things to most of us and the tank of oxygen is the most effective means of saving the day. I recall our recent trip to Macho Pichu w here we found “oxy-shots” available at the airport and at our hotel.
Not many of the nine million residents of Lima would make such a trip. As a matter of fact, there’s not much to be seen or do if you do make the drive. There’s plenty to do in town and if you’re a Lima resident you’re too spoiled by the weather to chance getting cold for nothing. Limans are used to two seasons; summer and winter. Since Lima is situated in the desert (Lima is the second largest desert city in the world. Do you know the largest?) , one would expect high temperatures in the summer. Actually, summer temperatures range between a high of 89 and a low of 69. Winter on the other hand is wet. Locals complain about the constant “rain” although no one owns an umbrella or a raincoat. The “rain” consists of an almost constant fog that locals call a drizzle. Now that sounds pretty wet but in actual measures the drizzle amounts to an annual average of 2.4 inches. And oh yes, the winters are “cold”. The daily highs and lows are about ten degrees lower than summer readings.
By the way, L:ima is the fourth largest city in South America. Can you name the other three. If you you add Mexico City, Lima is the fifth largets city in Latin America.
Lima, and this part of the world, has a long history of devastating earthquakes. Historical accounts list some major quakes that “leveled” the city on several occasions. One local friend told me that “…we know that every four years there will be an earthquake” with a certainty that made me a believer. The city center has many buildings that appeared to be built in the middle to late nineteenth century suggesting that something big must have happened th. No one tell me what happened and all seemed not to care. The hospital where we are working is one such building. It is old and not in good repair but it does provide the primary source of health care for poor people in the area. Several modern hospitals exist where services are available for those who can afford it. Patients in “our” hospital spend the night in open wards with forty or more beds side by side
While I was impressed by the number of cars on the streets, I was surprised not to see a parking lot for patients’ cars at the hospital. I was told that most who are served by the state operated hospital don’t own cars. Some of our patients came from homes that were hundreds of miles from Lima; usually by bus
Archeological studies indicate that the Lima area was inhabited as early as 14,000 BC. On Sunday I visited an archeological site that once was a city built of mud bricks dated somewhere around the 5th or 6th century. Spanish explorer Francisco Pizzaro sailed into Callao Bay in 1535 and named what was the beginning of Lima “La Ciudad de los Reyes”, the city of kings. Pizarro immediately defeated the Inca leader Atahualpa and took over his empire. Spain ruled the country until 1821. During the next several centuries, Lima played an important role in supporting the sea trade routes from Europe and the far east. Because of the valuable cargoes carried to and from the city, pirates and privateers roamed the coast attacking ships at will. The problem was of such an extent that the Spanish built a wall around Lima in 1687-89 to protect inhabitants from attack from the sea.
Peru is another of the South American countries that gained its independence from Spain in the 19th century. In 1820 a group of Argentine and Chilean patriots, led by Jose de San Martin, decided that Peru should also be free so they traveled to Peru. Fearing the worst, the then Spanish Viceroy invited San Martin into Lima hoping to save his loyalist guards from harm. What the history books call the War of Independence drifted along for several years but was officially ended on July 28, 1821. The next several years where unsettling but the new country got its feet on the ground by 1850. About that time, guano exports became a big thing and Peru’s economy was off to a good start. Why guano? Guano was an excellent source of nitrate and an important ingredient in gun powder.
Lima is the home of the oldest higher learning institution in the new world. The National University of San Marcos was founded on May 12, 1551 and is the oldest continuously functioning university in the Americas.
I had an opportunity to spend some time at the Museo Nacional de Arqueologia, Anntropologia e Historia del Peru. Well organized and maintained exhibits tell the story of Peru and its people from its known beginning in 14000 to the present. Artifacts are displayed that show the growth of skills and products as the country grew. A book I recently read hypothesized that when people became farmers instead of hunters and gatherers they had time to devote to things artistic and political. The pottery displays effectively demonstrate this idea as household pottery changed from functional things made to do a particular job to jugs and bowls that were intricate in their design and color. The concept I read about seems proven by these exhibits.
Like almost every place in the world, there is more to see and do than time permits. The few days I’ve spent in Peru were a marvelous learning experience that I found very enjoyable.
Love to all,
Bill, Grandpa Bill and Dad
Imagine getting ready for a Sunday drive. You get the kids in the car, load in the picnic lunch(there aren’t many McDonalds outside of Lima) and the fishing rods (just in case you pass a promising looking stream or lake) and then you get the tank of oxygen and place it conveniently where all in the car can reach it. This is real life according to an account shared with a new Peruvian friend. Less than two hours east of Lima the road climbs from sea level to over 12,000 feet and even the locals admit to having problems with altitude sickness. The sudden change of altitude does strange things to most of us and the tank of oxygen is the most effective means of saving the day. I recall our recent trip to Macho Pichu w here we found “oxy-shots” available at the airport and at our hotel.
Not many of the nine million residents of Lima would make such a trip. As a matter of fact, there’s not much to be seen or do if you do make the drive. There’s plenty to do in town and if you’re a Lima resident you’re too spoiled by the weather to chance getting cold for nothing. Limans are used to two seasons; summer and winter. Since Lima is situated in the desert (Lima is the second largest desert city in the world. Do you know the largest?) , one would expect high temperatures in the summer. Actually, summer temperatures range between a high of 89 and a low of 69. Winter on the other hand is wet. Locals complain about the constant “rain” although no one owns an umbrella or a raincoat. The “rain” consists of an almost constant fog that locals call a drizzle. Now that sounds pretty wet but in actual measures the drizzle amounts to an annual average of 2.4 inches. And oh yes, the winters are “cold”. The daily highs and lows are about ten degrees lower than summer readings.
By the way, L:ima is the fourth largest city in South America. Can you name the other three. If you you add Mexico City, Lima is the fifth largets city in Latin America.
Lima, and this part of the world, has a long history of devastating earthquakes. Historical accounts list some major quakes that “leveled” the city on several occasions. One local friend told me that “…we know that every four years there will be an earthquake” with a certainty that made me a believer. The city center has many buildings that appeared to be built in the middle to late nineteenth century suggesting that something big must have happened th. No one tell me what happened and all seemed not to care. The hospital where we are working is one such building. It is old and not in good repair but it does provide the primary source of health care for poor people in the area. Several modern hospitals exist where services are available for those who can afford it. Patients in “our” hospital spend the night in open wards with forty or more beds side by side
While I was impressed by the number of cars on the streets, I was surprised not to see a parking lot for patients’ cars at the hospital. I was told that most who are served by the state operated hospital don’t own cars. Some of our patients came from homes that were hundreds of miles from Lima; usually by bus
Archeological studies indicate that the Lima area was inhabited as early as 14,000 BC. On Sunday I visited an archeological site that once was a city built of mud bricks dated somewhere around the 5th or 6th century. Spanish explorer Francisco Pizzaro sailed into Callao Bay in 1535 and named what was the beginning of Lima “La Ciudad de los Reyes”, the city of kings. Pizarro immediately defeated the Inca leader Atahualpa and took over his empire. Spain ruled the country until 1821. During the next several centuries, Lima played an important role in supporting the sea trade routes from Europe and the far east. Because of the valuable cargoes carried to and from the city, pirates and privateers roamed the coast attacking ships at will. The problem was of such an extent that the Spanish built a wall around Lima in 1687-89 to protect inhabitants from attack from the sea.
Peru is another of the South American countries that gained its independence from Spain in the 19th century. In 1820 a group of Argentine and Chilean patriots, led by Jose de San Martin, decided that Peru should also be free so they traveled to Peru. Fearing the worst, the then Spanish Viceroy invited San Martin into Lima hoping to save his loyalist guards from harm. What the history books call the War of Independence drifted along for several years but was officially ended on July 28, 1821. The next several years where unsettling but the new country got its feet on the ground by 1850. About that time, guano exports became a big thing and Peru’s economy was off to a good start. Why guano? Guano was an excellent source of nitrate and an important ingredient in gun powder.
Lima is the home of the oldest higher learning institution in the new world. The National University of San Marcos was founded on May 12, 1551 and is the oldest continuously functioning university in the Americas.
I had an opportunity to spend some time at the Museo Nacional de Arqueologia, Anntropologia e Historia del Peru. Well organized and maintained exhibits tell the story of Peru and its people from its known beginning in 14000 to the present. Artifacts are displayed that show the growth of skills and products as the country grew. A book I recently read hypothesized that when people became farmers instead of hunters and gatherers they had time to devote to things artistic and political. The pottery displays effectively demonstrate this idea as household pottery changed from functional things made to do a particular job to jugs and bowls that were intricate in their design and color. The concept I read about seems proven by these exhibits.
Like almost every place in the world, there is more to see and do than time permits. The few days I’ve spent in Peru were a marvelous learning experience that I found very enjoyable.
Love to all,
Bill, Grandpa Bill and Dad
Sunday, January 15, 2012
LIMA PERU 2012 BLOG #3
LIMA PERU 2012 BLOG #3
After several days experience, I now know what a “sterilizer” does. It goes something like this. Surgeons use trays of instruments that are fitted out with the specific instruments needed for a particular procedure. Each tray is exactly like all others designed to support the named procedure. The instruments used in the operating room are sterile as is all else, as much as possible, that comes in contact with the patient. My job as sterilizer is to insure that the instruments delivered to the operating room are clean, sterile and that the tray has all of the instruments expected.
As each surgery is completed, the tray of instruments used in the surgery is delivered to the area where I work. A Peruvian lady specifically trained for the purpose washes the returned instruments and delivers them to me. I examine the instruments to determine that all of the instruments that need to be on the tray are present. Some of the instruments need to be reassembled; a task for which I have been trained. I count and recount the instruments and note the number on a card that is placed on the tray. The tray is then placed in a machine, an autoclave, that is designed to create steam and maintain a temperature of 270 degrees Fahrenheit for a minimum of three minutes. The process takes about thirty minutes per tray except when the washed instruments brought to me doesn’t include all of the instruments that are supposed to be on a specific tray. This leads to a search that may include a return to the operating room where the tray was last used, an examination of other trays that may have been used at the same time as the incomplete tray and an occasional search of waste cans in the area where the missing item may have been inadvertently tossed. If the missing item cannot be found, a replacement must be taken from a supply of “extras” so that the tray will be complete for the next surgery. When a surgeon calls for a specific instrument during a procedure, he or she needs to know that the needed item will be available.
Since most of our days so far have been 10 or more hours long, I have had the opportunity, when no trays need my attention, to walk freely among the operating rooms to watch the surgeons at work. My presence in the OR area requires that I wear scrubs at all times, a hat and covers on my shoes. Whenever I enter an operating room while a patient is present I must wear a face mask. A number of times the operating surgeon has invited me to put my head next to his or her head so that I could look directly into the mouth of the patient’s mouth. This was a totally new experience for me and one that I found fascinating. Often there were Peruvian doctors and/or doctors and nurses in training gathered around the operating table observing the procedure. The surgeons often kept up a continual dialogue explaining everything that was happening. In some instances, two of our team’s surgeons worked together on a single patient. Most often, the “scrub nurses” supporting the surgeon were Peruvian nurses who normally assisted Peruvian doctors in the operating room. Our surgeons each took the time to train the Peruvian nurses in the techniques that were expected by the American doctors. I found our surgeons to be very patient with the training process that they found necessary.
This was my first experience working closely with a group of medical professionals. Many in our group had served on pervious Rotaplast missions. I was impressed with several qualities that were present among the medical professionals. Although we worked long hours each day, starting early and ending late, none of the professionals ever seemed to tire. Each moved rapidly from one task to another never slowing down. Everyone smiled and joked even after a fourteen hour day. Most of all, each demonstrated an intensity of purpose that I imagined was the product of knowing that what was being done would be a significant benefit to the patient being served. My first few days as a part of the Rotaplast team gave me a new understanding and appreciation for those who choose to serve as medical professionals.
Love to each and everyone,
Bill, Grandpa Bill and Dad
After several days experience, I now know what a “sterilizer” does. It goes something like this. Surgeons use trays of instruments that are fitted out with the specific instruments needed for a particular procedure. Each tray is exactly like all others designed to support the named procedure. The instruments used in the operating room are sterile as is all else, as much as possible, that comes in contact with the patient. My job as sterilizer is to insure that the instruments delivered to the operating room are clean, sterile and that the tray has all of the instruments expected.
As each surgery is completed, the tray of instruments used in the surgery is delivered to the area where I work. A Peruvian lady specifically trained for the purpose washes the returned instruments and delivers them to me. I examine the instruments to determine that all of the instruments that need to be on the tray are present. Some of the instruments need to be reassembled; a task for which I have been trained. I count and recount the instruments and note the number on a card that is placed on the tray. The tray is then placed in a machine, an autoclave, that is designed to create steam and maintain a temperature of 270 degrees Fahrenheit for a minimum of three minutes. The process takes about thirty minutes per tray except when the washed instruments brought to me doesn’t include all of the instruments that are supposed to be on a specific tray. This leads to a search that may include a return to the operating room where the tray was last used, an examination of other trays that may have been used at the same time as the incomplete tray and an occasional search of waste cans in the area where the missing item may have been inadvertently tossed. If the missing item cannot be found, a replacement must be taken from a supply of “extras” so that the tray will be complete for the next surgery. When a surgeon calls for a specific instrument during a procedure, he or she needs to know that the needed item will be available.
Since most of our days so far have been 10 or more hours long, I have had the opportunity, when no trays need my attention, to walk freely among the operating rooms to watch the surgeons at work. My presence in the OR area requires that I wear scrubs at all times, a hat and covers on my shoes. Whenever I enter an operating room while a patient is present I must wear a face mask. A number of times the operating surgeon has invited me to put my head next to his or her head so that I could look directly into the mouth of the patient’s mouth. This was a totally new experience for me and one that I found fascinating. Often there were Peruvian doctors and/or doctors and nurses in training gathered around the operating table observing the procedure. The surgeons often kept up a continual dialogue explaining everything that was happening. In some instances, two of our team’s surgeons worked together on a single patient. Most often, the “scrub nurses” supporting the surgeon were Peruvian nurses who normally assisted Peruvian doctors in the operating room. Our surgeons each took the time to train the Peruvian nurses in the techniques that were expected by the American doctors. I found our surgeons to be very patient with the training process that they found necessary.
This was my first experience working closely with a group of medical professionals. Many in our group had served on pervious Rotaplast missions. I was impressed with several qualities that were present among the medical professionals. Although we worked long hours each day, starting early and ending late, none of the professionals ever seemed to tire. Each moved rapidly from one task to another never slowing down. Everyone smiled and joked even after a fourteen hour day. Most of all, each demonstrated an intensity of purpose that I imagined was the product of knowing that what was being done would be a significant benefit to the patient being served. My first few days as a part of the Rotaplast team gave me a new understanding and appreciation for those who choose to serve as medical professionals.
Love to each and everyone,
Bill, Grandpa Bill and Dad
Thursday, January 12, 2012
LIMA PERU 2012 BLOG #2
Lima PERU 2012 BLOG #2
Our first day of real activity involved the registration of potential candidates for the kind of surgeries we will perform. About 75 victims of cleft palate and/or cleft lip answered the advertised call for patients who wished to undergo surgery to change their particular problems. Potential candidates appeared at 8:00 am to begin the process of evaluation and selection for the process. Candidates lined up outside the clinic door with full anticipation of waiting most of the day to be interviewed and evaluated. Only one or two adult candidates came alone. All of the rest came with a family member or two and began the waiting for a call to be interviewed.
The first step involved registering. Clerks were waiting at a table to get specific information from candidate. Name, age, address, telephone number and specifics about how far they had traveled were duly recorded on data sheets that became a part of the medical record for each. Following registration, candidates were evaluated by a surgeon who took notes on each candidate’s problem and possible strategies for its correction. Next, each candidate was interviewed and evaluated by an anesthesiologist to determine if each could withstand anesthesia and its potential complications. Then a pediatrician examined each candidate to determine wellness in terms of the demands of the planned procedures. A dentist examined each patient to determine the implications for dentistry following corrective surgery. And finally, the candidates’ vital signs were determined and made a part of the patient’s record. At every station, several photographs were taken for future reference.
At each evaluation station, the doctor and the other professionals responsible for the examination made a crucial decision regarding the patient’s eligibility. Green dots were awarded those patients that showed signs of profiting the most from corrective surgery. Blue dots were awarded patients who showed and need and potential for success but with a lesser degree of need than those awarded green dots. These would be scheduled for surgery if time permitted. Red dots were given to those candidates that the medical professionals deemed unsuited for corrective surgery. Poor health, problems too serious to be corrected, lack of an obvious need for corrective surgery and/or a combination of some of these usually denied the corrective surgery being sought.
After the evaluations began, one wall of each examination room began to display post-its with notations regarding the patient and a colored dot denoting the decision resulting from the examination. The post-its were arranged in order of acceptability with those deemed worthy of surgery on the left and those least able to profit on the right. Each candidate was evaluated at each station with consultation following disagreements by evaluators. The final selection was evaluated by surgeons and the administrative nurse who made the final decision about scheduling surgeries.
All of this was accomplished on Wednesday, the second day of the team’s presence in Lima. Some experienced volunteers recalled such days when 150 or more potential candidates were evaluated with the process beginning at 8:00 am in the morning and ending at 10:30 at night. Our day of evaluation was completed by 4:00 pm.
Following the completion of the evaluation process, Parents and their children gathered in the courtyard outside of the building we used to wait for the announcement of candidates that had been chosen for surgery. Hope was written on the faces of parents in the crowd as names were read. Wide smiles were seen on the faces of parents when the name of their child was read. These parents who had been waiting since before 8:00 am showed no sign of weariness, just eager anticipation that their child might be chosen for a new look and a new life.
Surgeries are planned to begin on Thursday; our third full day in Lima. When we arrived we found that the surgery rooms were being painted. Everyone knew that we were going to be needing the rooms six months before our arrival. For some reason yet explained, the maintenance was scheduled making it impossible for our team to begin surgeries as planned. The first surgeries will probably not begin until noon rather than 7:30 am as planned. None the less, the team will be prepared and on the job at the earliest possible moment. Some of our team expressed disappointed with the lack of cooperation exhibited by the hospital. There seemed to be little regard for the fact that each team member had paid more than $1500 for a plane ticket to come to Lima plus the cost of meals and such would add. Additionally, most team member were either losing earnings from their individual practices or vacation time that was being used for the trip. There was no griping from team members but rather regret was expressed that the limiting of the use of facilities simply meant that fewer children could be scheduled for surgeries.
My role on this second day was to assist the registration desk. I spent several hours setting up file folders that would later be used to record all of the patient data necessary for the evaluation and eventual surgeries. I spent an additional three and a half hours recording patient data in a computer data bank that would eventually list the procedures used with each child.
During the remainder of the day I was able to observe the evaluation process in operation. One surgeon showed me a one year old child that exhibited a classic cleft palate. Looking into the child’s mouth I could see the hole on the top of the child’s mouth that allowed one to see the inside of the child’s nose. The child was chosen for surgery.
At our second night’s cocktail hour get together, one of the surgeons gave a talk, supported by a computer generated set of pictures, that described the surgical process used to repair cleft palates. We were also given some information about the causative factors leading to such conditions. Heredity, environmental factors (ie pollution) and cleanliness were described as known contributors. Some countries have a greater incidence than others. Africa, India and South America have a high incidence of cleft palates while Europe and the United States have relatively few. The U.S. has about 7500 cases a year. Peru has about twice that number. The presence of a cleft palate begins to show in infants as early as the 6th week of gestation.
I’m learning a lot and meeting a number of wonderful, dedicated and interesting people.
Love,
Bill, Grandpa Bill and Dad
Our first day of real activity involved the registration of potential candidates for the kind of surgeries we will perform. About 75 victims of cleft palate and/or cleft lip answered the advertised call for patients who wished to undergo surgery to change their particular problems. Potential candidates appeared at 8:00 am to begin the process of evaluation and selection for the process. Candidates lined up outside the clinic door with full anticipation of waiting most of the day to be interviewed and evaluated. Only one or two adult candidates came alone. All of the rest came with a family member or two and began the waiting for a call to be interviewed.
The first step involved registering. Clerks were waiting at a table to get specific information from candidate. Name, age, address, telephone number and specifics about how far they had traveled were duly recorded on data sheets that became a part of the medical record for each. Following registration, candidates were evaluated by a surgeon who took notes on each candidate’s problem and possible strategies for its correction. Next, each candidate was interviewed and evaluated by an anesthesiologist to determine if each could withstand anesthesia and its potential complications. Then a pediatrician examined each candidate to determine wellness in terms of the demands of the planned procedures. A dentist examined each patient to determine the implications for dentistry following corrective surgery. And finally, the candidates’ vital signs were determined and made a part of the patient’s record. At every station, several photographs were taken for future reference.
At each evaluation station, the doctor and the other professionals responsible for the examination made a crucial decision regarding the patient’s eligibility. Green dots were awarded those patients that showed signs of profiting the most from corrective surgery. Blue dots were awarded patients who showed and need and potential for success but with a lesser degree of need than those awarded green dots. These would be scheduled for surgery if time permitted. Red dots were given to those candidates that the medical professionals deemed unsuited for corrective surgery. Poor health, problems too serious to be corrected, lack of an obvious need for corrective surgery and/or a combination of some of these usually denied the corrective surgery being sought.
After the evaluations began, one wall of each examination room began to display post-its with notations regarding the patient and a colored dot denoting the decision resulting from the examination. The post-its were arranged in order of acceptability with those deemed worthy of surgery on the left and those least able to profit on the right. Each candidate was evaluated at each station with consultation following disagreements by evaluators. The final selection was evaluated by surgeons and the administrative nurse who made the final decision about scheduling surgeries.
All of this was accomplished on Wednesday, the second day of the team’s presence in Lima. Some experienced volunteers recalled such days when 150 or more potential candidates were evaluated with the process beginning at 8:00 am in the morning and ending at 10:30 at night. Our day of evaluation was completed by 4:00 pm.
Following the completion of the evaluation process, Parents and their children gathered in the courtyard outside of the building we used to wait for the announcement of candidates that had been chosen for surgery. Hope was written on the faces of parents in the crowd as names were read. Wide smiles were seen on the faces of parents when the name of their child was read. These parents who had been waiting since before 8:00 am showed no sign of weariness, just eager anticipation that their child might be chosen for a new look and a new life.
Surgeries are planned to begin on Thursday; our third full day in Lima. When we arrived we found that the surgery rooms were being painted. Everyone knew that we were going to be needing the rooms six months before our arrival. For some reason yet explained, the maintenance was scheduled making it impossible for our team to begin surgeries as planned. The first surgeries will probably not begin until noon rather than 7:30 am as planned. None the less, the team will be prepared and on the job at the earliest possible moment. Some of our team expressed disappointed with the lack of cooperation exhibited by the hospital. There seemed to be little regard for the fact that each team member had paid more than $1500 for a plane ticket to come to Lima plus the cost of meals and such would add. Additionally, most team member were either losing earnings from their individual practices or vacation time that was being used for the trip. There was no griping from team members but rather regret was expressed that the limiting of the use of facilities simply meant that fewer children could be scheduled for surgeries.
My role on this second day was to assist the registration desk. I spent several hours setting up file folders that would later be used to record all of the patient data necessary for the evaluation and eventual surgeries. I spent an additional three and a half hours recording patient data in a computer data bank that would eventually list the procedures used with each child.
During the remainder of the day I was able to observe the evaluation process in operation. One surgeon showed me a one year old child that exhibited a classic cleft palate. Looking into the child’s mouth I could see the hole on the top of the child’s mouth that allowed one to see the inside of the child’s nose. The child was chosen for surgery.
At our second night’s cocktail hour get together, one of the surgeons gave a talk, supported by a computer generated set of pictures, that described the surgical process used to repair cleft palates. We were also given some information about the causative factors leading to such conditions. Heredity, environmental factors (ie pollution) and cleanliness were described as known contributors. Some countries have a greater incidence than others. Africa, India and South America have a high incidence of cleft palates while Europe and the United States have relatively few. The U.S. has about 7500 cases a year. Peru has about twice that number. The presence of a cleft palate begins to show in infants as early as the 6th week of gestation.
I’m learning a lot and meeting a number of wonderful, dedicated and interesting people.
Love,
Bill, Grandpa Bill and Dad
Tuesday, January 10, 2012
LIMA PERU 2012 #1
Lima 2012 Blog #1
On January 6, 2012 I received a call from fellow Rotarian Tom Fox who was quick to explain that as “Mission Director” for the ROTAPLAST 2012 mission to Lima, Peru he had a big problem. Due to a heart attack with one of his volunteers, he was short two positions for a ROTAPLAST mission to Lima, Peru that was scheduled to leave on the following Sunday night. He asked if I would be interested in becoming a member of the mission team as one of the non-medical participants. After discussing the idea with Dottie, I called Tom and told him I would be glad to volunteer.
ROTOPLAST is a little known program operated by Rotary International that focuses volunteer effort to help children who suffer from cleft pallet. Rotary volunteers visit foreign countries and perform operations on children for whom there is no other opportunity to recover from the abnormality they were born with. Volunteers pay their own expenses to third world countries where need exists and no other programs are available to meet the needs. Rotary International pays for the surgical supplies necessary for the project but the rest of the costs are covered by volunteer participants. Visit the website rotaplast.org to see what has been accomplished over the past decade. It is truly amazing.
My Rotary friend, Tom Fox, has participated in 16 missions to date. Another member of our Pleasanton Rotary Club is currently the President of the ROTAPLAST board of Directors and has devoted her vacations for the past half dozen years as a volunteer visiting dozens of countries in the process. When we had our introductory meeting, as we waited for a connecting flight in Miami, I was impressed with the number of our 26 member team of volunteers who were repeat volunteers; many who had served on a half dozen or more missions in the past.
Our Lima, Peru Mission follows the pattern established some years ago. A local Rotary club does what is necessary to recruit children who have cleft pallets and are appropriate candidates for corrective surgery. The local effort takes at least a year and includes doing whatever is necessary to make facilities available for the surgeries. The ROTAPLAST information states that it takes about seventy volunteers to make the program work. Our team from the United States usually consists of 27 volunteers. The Lima 2012 Mission Team had 26 members.
The team I will be working with has the following make-up; 1 Medical Director, 3 Surgeons, 4 Anesthesiologists, 2 Pediatricians, 6 Nurses, 1 Speech Pathologist, (non-medical) 1 Mission Director, 1 Interpreter, 1 Medical Records Manager, 1 Post-operative Assistant, 1 Photo Journalist, 1 Quartermaster, 2 Ward Coordinators and 1 Sterilizer. I was the “Sterilizer”; a position that has yet to be defined to me but one, I am told, is very important.
The schedule for our mission begins on the first day after our travel with an orientation at the hospital where we will be working and training for our respective jobs. The next day will be devoted to interviewing the potential patients to evaluate their needs and determine what procedures will be helpful. We have been told that some cases will be rejected because of conditions beyond the scope of the mission but most will be treated. Seven days of surgery are planned and it is expected that approximately 100 children will leave with repaired pallets and lips.
Our flight from San Francisco, via Miami, was a 12 hour affair, plus a two hour lay-over in Miami, that provided an opportunity to catch up on sleep, for those who caught the 6:00 am flight out of SFO and an opportunity for team members to begin to get to know one another. Our Mission Director asked us to travel in khaki slacks, navy blue blazers and white shirts so that we could identify one another. It was interesting to me to learn that our team, while mostly from California, has Rotary volunteers from six other states.
I’m really excited about this new experience and the opportunity to work with the dedicated individuals in our mission group. A quick look at the group makes it obvious that I am the senior member of the group. I hope I can keep up and do my share.
Love to all,
Bill, Grandpa Bill and Dad
On January 6, 2012 I received a call from fellow Rotarian Tom Fox who was quick to explain that as “Mission Director” for the ROTAPLAST 2012 mission to Lima, Peru he had a big problem. Due to a heart attack with one of his volunteers, he was short two positions for a ROTAPLAST mission to Lima, Peru that was scheduled to leave on the following Sunday night. He asked if I would be interested in becoming a member of the mission team as one of the non-medical participants. After discussing the idea with Dottie, I called Tom and told him I would be glad to volunteer.
ROTOPLAST is a little known program operated by Rotary International that focuses volunteer effort to help children who suffer from cleft pallet. Rotary volunteers visit foreign countries and perform operations on children for whom there is no other opportunity to recover from the abnormality they were born with. Volunteers pay their own expenses to third world countries where need exists and no other programs are available to meet the needs. Rotary International pays for the surgical supplies necessary for the project but the rest of the costs are covered by volunteer participants. Visit the website rotaplast.org to see what has been accomplished over the past decade. It is truly amazing.
My Rotary friend, Tom Fox, has participated in 16 missions to date. Another member of our Pleasanton Rotary Club is currently the President of the ROTAPLAST board of Directors and has devoted her vacations for the past half dozen years as a volunteer visiting dozens of countries in the process. When we had our introductory meeting, as we waited for a connecting flight in Miami, I was impressed with the number of our 26 member team of volunteers who were repeat volunteers; many who had served on a half dozen or more missions in the past.
Our Lima, Peru Mission follows the pattern established some years ago. A local Rotary club does what is necessary to recruit children who have cleft pallets and are appropriate candidates for corrective surgery. The local effort takes at least a year and includes doing whatever is necessary to make facilities available for the surgeries. The ROTAPLAST information states that it takes about seventy volunteers to make the program work. Our team from the United States usually consists of 27 volunteers. The Lima 2012 Mission Team had 26 members.
The team I will be working with has the following make-up; 1 Medical Director, 3 Surgeons, 4 Anesthesiologists, 2 Pediatricians, 6 Nurses, 1 Speech Pathologist, (non-medical) 1 Mission Director, 1 Interpreter, 1 Medical Records Manager, 1 Post-operative Assistant, 1 Photo Journalist, 1 Quartermaster, 2 Ward Coordinators and 1 Sterilizer. I was the “Sterilizer”; a position that has yet to be defined to me but one, I am told, is very important.
The schedule for our mission begins on the first day after our travel with an orientation at the hospital where we will be working and training for our respective jobs. The next day will be devoted to interviewing the potential patients to evaluate their needs and determine what procedures will be helpful. We have been told that some cases will be rejected because of conditions beyond the scope of the mission but most will be treated. Seven days of surgery are planned and it is expected that approximately 100 children will leave with repaired pallets and lips.
Our flight from San Francisco, via Miami, was a 12 hour affair, plus a two hour lay-over in Miami, that provided an opportunity to catch up on sleep, for those who caught the 6:00 am flight out of SFO and an opportunity for team members to begin to get to know one another. Our Mission Director asked us to travel in khaki slacks, navy blue blazers and white shirts so that we could identify one another. It was interesting to me to learn that our team, while mostly from California, has Rotary volunteers from six other states.
I’m really excited about this new experience and the opportunity to work with the dedicated individuals in our mission group. A quick look at the group makes it obvious that I am the senior member of the group. I hope I can keep up and do my share.
Love to all,
Bill, Grandpa Bill and Dad
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