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