We had a 6:15 wake up call this morning for breakfast at 6:30 and departure at 7:00. It's always entertaining to watch the dynamics around promptness and tardiness at breakfast and morning departure time. As a rule, the pediatrician and ward nurses are first at breakfast and first on the bus because we know we have to have the kids ready for the OR at a designated time. Even though today was just screening, we are habitual go getters. The surgeons are generally last and late as they don't really have to be ready until we've already been hard at work for an hour or so. Now of course that's a giant generalization, and in fact there were two surgeons waiting with the "prompt" group this morning.
Before I continue with a description of the day's events, I need to give a brief summary of last night's team meeting as in at least one sense, it set the stage for our arrival at the screening site. At the team meeting, there were the usual introductions where each team member states his or her name, specialty and country of origin, trying their best to do so in their native language and in Spanish. A few team members don't speak any Spanish and a few don't speak any English, but most could stumble through a couple of words. Of course on missions to China or Uzbekistan, etc, everyone sticks to their own language and the interpreters earn their keep. I really like this team; there was a lot of laughing and everyone seems to be very relaxed. The coordinator from the D. R. is Perla, a large young woman with a buzzed head and a topknot who is "There for you! If you need it, just ask me and I will get it for you!!!" After general information and "team spirit building" from the U.S. coordinator, Ryan, each team leader, surgery, anesthesia, and pediatrics had a chance to say a few words. Usually the pediatrics team leader role is filled by the pediatric intensivist, but he won't be joining us until Sunday. I took the opportunity to give my usual speech about balloons. In case any of you haven't heard (seen) it or know it well but were really hoping I would include it again, here it is: Latex balloons were the leading cause of deaths due to choking in toddlers in the U.S between 1997 and 2011. Toddlers love to put everything in their mouths, and if they bite a balloon and it pops, fragments of the balloon can be blown into their airways, blocking their tracheas. The American Academy of Pediatrics recommends no latex balloons for children under age eight years. After I spoke, one of the pediatric plastic surgeons stood up to add his voice, significantly a Dominican voice to the call for no balloons. Apparently he had recently been part of a futile attempt to revive a child with a balloon aspiration in the local emergency room. With that sobering speech, the meeting ended and everyone headed for bed.
This morning we drove for an hour to a beautiful private park where screening was held. As you will see in the photos, the entranceway and pavilions of the park were decorated with at least 100 balloons. In addition, there were "balloon men" making balloon animals for the kids, including the babies and toddlers. It's not really possible to fight the whole balloon thing here, but I was happy to see a high level of vigilance among the team members, making sure the balloons stayed out of the kids' mouths. My hope is that eventually Op Smile will make it a policy to not have balloons on their missions, but culturally, it's a long road.
Despite working in the shade of the covered covered pavilions, the sun was so fiercely hot and the air so humid that my clothes were completely drenched in sweat within the first hour. I can't remember ever being so uncomfortably hot. The kids, being kids, ran around like little maniacs, oblivious, while the adults all wilted. We screened 112 patients from infants through a 52 year old man. Most were from Santo Domingo rather than small rural villages so the babies were, in general, well nourished. We had two interpreters helping us at the pediatrics/anesthesia table, a young woman who just finished medical school and one who will start in the fall. Both speak impeccable English having gone to an English language school since kindergarten, and both want to be pediatricians. Though I don't need them for speaking with the parents (yay,) it's wonderful to have them ask all the medical history questions while I do the exam when we are really busy. They can also fill out forms and write prescriptions. A couple of times kids had fairly technical medical conditions, and I could explain it to the interpreters in English and they could then give the parents a much clearer explanation than I could have managed on my own. One of them will be with us on the ship, helping on the wards.
We finished the screening about 5:00 and then gathered to make the surgical schedule. Each patient is given a priority based on Op Smile protocols. These have been developed over the years and are designed to be sure that babies who need primary lip closure have top priority along with the one year olds who need primary palate repair. These are followed by other categories such as primary lip and palate repair on older kids and adults, lip scar revisions, palate revisions, rhinoplasties and various other procedures. There is also a balance to the day to consider so there is a mixture of short and long surgeries on each table and so that the babies go earlier in the day, etc. I'm not usually involved in all of this, but again, because the intensivist is not here, I took part.
There is always some discussion of kids who fall outside the wight and age guidelines. For instance, a baby needs to be six months old to have a primary lip repair, and if he is say just five months old but has a good weight and hemoglobin, he might have his surgery if all of the team leaders agree. If even one person disagrees, the surgery is not done. We have six such babies on this mission, all very chubby 5 month olds. One has a low hemoglobin and will wait, but the others will have surgery.
We arrived back at the hotel around 7:00 pm, tired and hoping to head directly to our rooms. However, the man at reception had told us this morning that he would be changing our rooms this evening as many of us had been given single rooms by mistake, and he was waiting for us. So, the first thing I had to do was schlep all my stuff to my new room. The room is quite nice and so far my roommate hasn't shown up. I think she's out to dinner with most of the team at a local restaurant. I decided to skip the restaurant in favor of that long shower!!
Tomorrow is Team Day, and we are going to the beach. That's all I know - more tomorrow. I'll post some photos on Picasa in a bit.
Before I continue with a description of the day's events, I need to give a brief summary of last night's team meeting as in at least one sense, it set the stage for our arrival at the screening site. At the team meeting, there were the usual introductions where each team member states his or her name, specialty and country of origin, trying their best to do so in their native language and in Spanish. A few team members don't speak any Spanish and a few don't speak any English, but most could stumble through a couple of words. Of course on missions to China or Uzbekistan, etc, everyone sticks to their own language and the interpreters earn their keep. I really like this team; there was a lot of laughing and everyone seems to be very relaxed. The coordinator from the D. R. is Perla, a large young woman with a buzzed head and a topknot who is "There for you! If you need it, just ask me and I will get it for you!!!" After general information and "team spirit building" from the U.S. coordinator, Ryan, each team leader, surgery, anesthesia, and pediatrics had a chance to say a few words. Usually the pediatrics team leader role is filled by the pediatric intensivist, but he won't be joining us until Sunday. I took the opportunity to give my usual speech about balloons. In case any of you haven't heard (seen) it or know it well but were really hoping I would include it again, here it is: Latex balloons were the leading cause of deaths due to choking in toddlers in the U.S between 1997 and 2011. Toddlers love to put everything in their mouths, and if they bite a balloon and it pops, fragments of the balloon can be blown into their airways, blocking their tracheas. The American Academy of Pediatrics recommends no latex balloons for children under age eight years. After I spoke, one of the pediatric plastic surgeons stood up to add his voice, significantly a Dominican voice to the call for no balloons. Apparently he had recently been part of a futile attempt to revive a child with a balloon aspiration in the local emergency room. With that sobering speech, the meeting ended and everyone headed for bed.
This morning we drove for an hour to a beautiful private park where screening was held. As you will see in the photos, the entranceway and pavilions of the park were decorated with at least 100 balloons. In addition, there were "balloon men" making balloon animals for the kids, including the babies and toddlers. It's not really possible to fight the whole balloon thing here, but I was happy to see a high level of vigilance among the team members, making sure the balloons stayed out of the kids' mouths. My hope is that eventually Op Smile will make it a policy to not have balloons on their missions, but culturally, it's a long road.
Despite working in the shade of the covered covered pavilions, the sun was so fiercely hot and the air so humid that my clothes were completely drenched in sweat within the first hour. I can't remember ever being so uncomfortably hot. The kids, being kids, ran around like little maniacs, oblivious, while the adults all wilted. We screened 112 patients from infants through a 52 year old man. Most were from Santo Domingo rather than small rural villages so the babies were, in general, well nourished. We had two interpreters helping us at the pediatrics/anesthesia table, a young woman who just finished medical school and one who will start in the fall. Both speak impeccable English having gone to an English language school since kindergarten, and both want to be pediatricians. Though I don't need them for speaking with the parents (yay,) it's wonderful to have them ask all the medical history questions while I do the exam when we are really busy. They can also fill out forms and write prescriptions. A couple of times kids had fairly technical medical conditions, and I could explain it to the interpreters in English and they could then give the parents a much clearer explanation than I could have managed on my own. One of them will be with us on the ship, helping on the wards.
We finished the screening about 5:00 and then gathered to make the surgical schedule. Each patient is given a priority based on Op Smile protocols. These have been developed over the years and are designed to be sure that babies who need primary lip closure have top priority along with the one year olds who need primary palate repair. These are followed by other categories such as primary lip and palate repair on older kids and adults, lip scar revisions, palate revisions, rhinoplasties and various other procedures. There is also a balance to the day to consider so there is a mixture of short and long surgeries on each table and so that the babies go earlier in the day, etc. I'm not usually involved in all of this, but again, because the intensivist is not here, I took part.
There is always some discussion of kids who fall outside the wight and age guidelines. For instance, a baby needs to be six months old to have a primary lip repair, and if he is say just five months old but has a good weight and hemoglobin, he might have his surgery if all of the team leaders agree. If even one person disagrees, the surgery is not done. We have six such babies on this mission, all very chubby 5 month olds. One has a low hemoglobin and will wait, but the others will have surgery.
We arrived back at the hotel around 7:00 pm, tired and hoping to head directly to our rooms. However, the man at reception had told us this morning that he would be changing our rooms this evening as many of us had been given single rooms by mistake, and he was waiting for us. So, the first thing I had to do was schlep all my stuff to my new room. The room is quite nice and so far my roommate hasn't shown up. I think she's out to dinner with most of the team at a local restaurant. I decided to skip the restaurant in favor of that long shower!!
Tomorrow is Team Day, and we are going to the beach. That's all I know - more tomorrow. I'll post some photos on Picasa in a bit.
No comments:
Post a Comment