Posted on November 13, 2016
Nelida had been a challenge for me since our last trip. We consider the Latin saying "primum non nocere" to be the first law of medicine. This means "first, do no harm". I was not sure we had lived up to that law as we left last time, because I thought the skin graft might not survive, and then she would have been worse off than if we would have done a smaller release operation. When I realized on this trip that she could hold her head up and still close her mouth, I felt the relief of the trip. There are doctors who are critical of missions that operate and leave without provision for follow up and I was wondering if my self- criticism was warranted. It wasn't and I am happy to report of this success.
Cuchiela was the 10 month old with the lip/palate. As all of you were aware, I was a bit rusty going into the lip/palates because it had been a long time since my last. Plus, with Amy not present, I knew these fell to me to complete. In this child, we did her complete palatal repair including a vomer flap. These are small kids and tight spaces to work in and I was gratified to see her in the hospital lobby the day after surgery in her Manta on her mommas back, snug as a bug in a rug. The palate was intact at weeks end as we followed her and this was physically and intellectually my toughest case of the week. I had to review some chapters before the case, but it went perfectly. Nobody gave me grief about reviewing a book before the case. Cilia and Amber were champs while I mumbled and grumbled.
The third highlight of the trip for me was making postoperative rounds on the floors. Leonel had the nurses under a spell and although I don't much like hospital rounding, this trip was far easier. The best moment was watching our post op cleft lip baby feed with a syringe feeder by her proud and thankful mother. Miguel got some good photos 1 week later when he returned and the lip looks like it's going to turn out great. Thanks to him, I could use removable sutures.
We took care of another neck burn patient on this trip. Miguel got surgical time harvesting a groin graft and doing the closure. This patient stayed the week in the hospital and did well with his release. He wanted cosmetic improvement, but we told him no, just functional results. Even in the third world we deal with lots of vanity issues. He will likely have an excellent cosmetic improvement, but his functional improvement surprised him. He saw us on the street after discharge and knew how to say thank you!
One of the biggest desires of mine is to teach. Sue and I got a chance on this trip to spend an hour with one of the local doctors discussing how to care for keloids. Their technique is to shave them off and then do steroid injections. They have very weak steroids available and their patients don't come back for injections, so they end up worse. We discussed our technique and more importantly, why we do things the way we do to get reliable results most of the time. Obviously, the patients did not understand our technique, and some were disappointed that we "only" did injections. Nonetheless, we had a teaching opportunity.
The other opportunity was to teach our young volunteers about the elaborate dance we call surgery. This includes being in an operating room and gowning and gloving. Cutting suture, being close to the sacred and religious experience of the purposeful cutting of living human flesh were lifetime experiences. Everyone learned how to do a jaw thrust and why you would want to thanks to Kevin. Seeing how air moves or does not move depending on the jaw position in unconscious people is an important life lesson they could see and I hope help saves a life sometime!
One of my most reluctant cases came as my day as a dentist. Florence, Sal and Nick went looking for cases up at a school. They found an 11 year old with a dental abscess. Florence offered to pay for her dental extraction. The abscess went from the wisdom tooth to the front of her chin where her nerve exited her jawbone. According to Florence, dental abscess and sepsis are a leading cause of death in children in the third world. If we did nothing, the child would die. I became a reluctant dentist. Thanks to some dental friends in Wisconsin on Whatsapp and Carol finding some local dental extraction tools I have never seen before, we got the teeth out without breaking the roots and could see the pus off the bottom of the tooth. She had to have been in pain. We gave her 6 weeks of antibiotics and a chance.
My worst decision of the week was using dermabond over permanent sutures. Not being terribly accustomed to mission work, nor the use of dermabond, I used it on someone we needed to take the sutures out of days later. Amber and Cillia had their chance to grumble about my bad decision as they slowly got lots of sutures out.
We took a team building hike with Julie, Miguel, Amber, Nick and I up along the opposite side of the valley. The path was closed, probably because dislodged rocks would go down into people's living spaces. We got up close with children, chickens, goats, pigs and dogs of many dispositions. Miguel had to bribe some kids to hold back an aggressive dog. We survived sharp obstacles as a team, crawled up-and down hills on all 4s. Julie and I did some couples wall climbing trying to get down. We were told we were going to die by passersby. Unlike team building in the states, there was no safety net, little bloodshed and a great time to remember.
One of my favorite parts or the trip was interfacing with the locals. The children loved seeing us and having their picture taken. Most adult women enjoyed looking at their own photos. The kids all said "whiskey" when having their picture taken. Although we learned that culturally, some believed we were there to steal their blood (when asleep) or their soul (by capturing their image), most were great to us. The road construction process was a lesson for all of us. The fear of water or showering was a lesson in privilege we all learned and our volunteers Richard, Tess, Nick and Ian lived through. Like washing the feet of the reluctant disciples, it is difficult to believe that we took care of people who have never taken a shower before in their lives, and may never do so again.
I considered it an honor to work with a team of people who not only want to do a mission, but do so at great personal cost. I know what the economic costs of this trip were, but there was a physical cost as well. It started with altitude sickness. Fevers, nausea, vomiting and diarrhea were the norm. The refrigeration was virtually nonexistent, and I had fears early that we would get sick, after I saw how our future food was handled. We also paid an emotional cost that was equally challenging as we questioned ourselves existentially. The cultural challenges added to the challenges we faced as a group. I want you to know how much I respect your commitment to attend this trip. I hope you learned something about yourself, as I did. We took care of each other as we did our work.