For the first time in many years, Esperance can finally sleep without a large 3.6 pound ball crushing her esophagus. Her goiter has been growing in her neck for over 20 years. This beautiful Wednesday morning in Gitwe, MMFC had the pleasure of checking in with Esperance to see how she was feeling and healing. Many of the patients who come to get thyroid surgery travel over a day by bus and foot to get to the Gitwe hospital for a chance at surgery. The majority of the patients are women, like Esperance, but there are also some men.

When asked how her large growth affected her productivity, she said it made her feel tired and caused her headaches, neck aches, and shoulder aches. She had trouble sleeping at night, since it felt like she was being choked by this massive goiter. The goiter also made her labor much more difficult, having to take many breaks while farming. Since the lifestyle is mainly agriculture for self sustenance as well as trading and selling, being unable to work or having low productivity severely affects the patient’s lives.

Esperance is one of the many whose life has been changed on this trip. She is extremely pleased with the result of her surgery. Take a look for yourself at the before and after images!

-Yuleissy Ramirez

Monday was a great day of surgery for the doctors of MMFC. Although the need for cleft surgeries is low, Drs. Aric Park, Merry Sebelik, and Jeremiah Tracy were hard at work with some slightly complicated cleft lip surgeries. Usually, babies with cleft palates have difficulty eating and breastfeeding. They are often malnourished not for lack of food, but rather because the openings in their lips constantly leak food and liquids. This is why often times babies with cleft lips–especially with two openings rather than one–are much slimmer than babies with no clefts. You can imagine the happiness of not only the nurses and doctors, but also the mother when the little babies wake up from their surgery in the recovery room and are able to finally latch on to the breast and feed. This was the case with little 8 month old Lea.

Lea and her mother had been waiting all day through the other cleft lip surgeries. The hallway was filled with the screams and cries of the little girl who was frustrated she was not allowed to eat before her surgery. Her worried mother skeptically followed directions, since she had seen other cases and babies delayed because they had eaten to close to their surgery time and it was unsafe to induce their anesthesia. The surgery went smoothly, and an hour and half later baby was in mom’s arms desperately searching for the comfort and nourishment of her breast. The smile on the mother’s face was priceless, “this is the first time she has been able to latch on”. We were all watching in peaceful attentiveness as the baby settled into a rhythmic suckling, completely forgetting about the pain as she finally satisfied her hunger.

Not all babies latch on so quickly and easily, others have difficulty using their newly sealed lips because they have never had to use the muscle. Eventually, they will learn how to gain control of the muscles around their mouth and have an easier time feeding.

As mentioned in the previous post, most of the patients that made the long journey from their homes miles away were here to get Goiter surgery. As the messages reached further (whether through radio or word of mouth), more and more patients poured into the room. The most remarkable moment is one picture below where women swarmed Dr. Dhingra and Dr. Sebelik asking to feel their necks in the hopes of being one of the lucky ones to be selected to have surgery. Unfortunately, time, supplies and manpower are limits to how many surgeries can be done. No matter how quickly and efficiently the talented surgeons can work, there is no way they can perform over 50 surgeries in a little under three days. For now the goal is to keep working through as many cases as possible… so far we have had 15 successful surgeries! There are still three days left, stay tuned…

-Yuleissy Ramirez

Days 1 & 2 – Sat., October 8th and Sun., October 9th:

After almost 24 hours of flying, we finally arrived in Kigali, Rwanda. This would not be our final destination, but for many, our first welcome to Africa. On the ride down to Gitwe, we would hear the happy shouts of the children pointing and screaming “muzungu!!”, meaning “white person” or “wanderer/foreigner”. Never had I seen children with smiles so big, happy to just say hello. Their  warm smiles decorated their dark brown faces of the earth, and they, in turn, decorated the brown earth they walked on. They seemed to be one with their surrounding, fluidly strolling between one another on the sides of the dirt roads while cars and motorcycles sped by. Women carried anything on their heads—large pieces of wood, stalks of sugar cane, bags of beans— with their children strapped to their backs. They complemented the warm orange hue of the concrete homes with tin roofs and the lively green of the palm trees, shrubs and bushes all around.

Saturday night was when we first entered the empty rooms that would be our reconstructive and healing spaces for the next 6 days. Immediately, the team began opening the bags and pelicans filled with supplies, medication, and equipment and setting up their stations-P.A.C.U., O.R., Pre-Op,  Anesthesia, Thyroid, Cleft. The dusty empty rooms quickly began to fill with noise and movement, starting to resemble the rooms of a hospital. Shortly after, the patients began to arrive. This was the first and only sign of haste in this region where time does not seem to be a part of their lifestyle. We went down to meet the women with enlarged thyroids and children with cleft deformity. Unfortunately, some of the little “umwanas” (babies) were too small or too sick to be seen this time around. We relied on the translators to relay the difficult message to the mothers, who would shoot dissapointed and pleading looks the doctors way, not quite understanding that sometimes rejection for surgery was really for the well being and survival of their child. Giggles and small talk ensued between those who would stay, their smiles a clear sign of the happiness for the victory of all their efforts. Most of the cases done by MMFC in Rwanda, however, are largely thyroidectomies. Many of the patients that filled the waiting rooms were women in their mid twenties to late fifties with enlarged goiters on one side or the other. Each one in their colorful “ibitenges” or traditional dresses and wraps. Their eyes showed a mixture of fear and hope—fearful of what was to come, but hopeful that their lives would return back to normal.

What is a goiter, what causes it, and why do people have it removed? A goiter is a non-cancerous enlargement of the thyroid. Our thyroids play a very important role in our bodies. By using iodine, a trace mineral, the thyroid produces hormones that play an important role in regulating our metabolism, temperature, and heart rate. Goiters are usually cased by lack or deficiency of iodine in a diet or an overactive thyroid (hyperthyroidism). Goiters can obstruct breathing and swallowing and cause shortness of breath, wheezing, hoarseness. If  linked with hypo- or hyperthyroid, goiters could cause other health problems. Therefore, a thyroidectomy is an important part of maintaining the health and improving the morbidity of the patient. Not to mention, these ladies will have yet another reason to smile a little bigger each day.

We have a surgery packed day today! So far 3 scheduled cleft lips and 6 scheduled partial thyroidectomies… Let the healing begin!

-Yuleissy Ramirez