Mission Trips

MMFC just returned from two very successful missions to Peru, both led by MMFC Medical Director Helen A. John-Kelly, MD.  The first mission to Cusco took place from May 20-28th. Our  22 member team  completed 38 surgeries including cleft lip, palate and microtia procedures. Our dental and speech team members also provided services to over 100 patients. The second mission to Cajamarca took place June 17-26th. Our 16 member team performed 41 surgeries. Our dental and speech teams provided services to 95 children. In total, MMFC screened and provided  care to over 300 children in Peru. MMFC sends missions to both Cusco and Cajamarca in order to reach children in both both southern Peru (Cusco) and in the northern highlands region (Cajamarca).

For the very first time, a father in Peru scheduled an appointment for us to screen his four month old daughter and her cleft lip for possible surgery on MMFC’s Facebook page. Imagine that!

Thank you to our extraordinary local coordinators Ani Forsyth and Ita Gamero whose work year round ensured the success of these missions. We also appreciate  the warm welcome and partnership with the medical and administrative professionals at both EsSalud Hospitals including Dr. Ocania, Dr.  Cabello, Dr. Guzman, Dr. Farfan, Dr. Diaz and Dr. Bueno, as well as Jorge Idrago and scrub nurse Juan Carlos. All of our esteemed Peruvian counterparts either scrubbed in with us and worked side by side with our  surgeons and anesthesiologists, or trained with us learning the English names of all the surgical insruments,  and/or agreed to provide the necessary follow-up care care for our patients during the next year until we return in 2012.

MMFC and the children who received the life-transforming surgeries are forever grateful for the financial support of the Children of Peru Foundation,  Smile Train, Inc. and our local Peruvian sponsors, Asociacion los Andes de Cajamarca (ALAC) Secretaria Tecnica del Programa Minero de Solidaridad con el Pueblo de Cajamarca (PMSC).

Mucho gracias!

MMFC is grateful to the families who entrust us with their care of the children.  Mostly, and as always, it is the children we meet and the stories we hear that enliven and embolden us to keep marching forward in our quest to help each and every child around the globe who suffers from a congenital facial deformity and is denied much needed medical treatment. Here are some of the stories collected by our hard-working volunteers, Marianne Ruelle and Susan Ruggera.

Luz, age four months.

Luz Angelica is a four month old girl with a primary cleft lip deformity. Her family lives in Cuzco, but her father works hours away from their home. When Luz Angelica was born, her mother had to lose her job to take care of her; she needed extra care because of her malformation. Since then, the family has been living in extreme difficulty. Luz also has two sisters, aged four and eight. Neither of them has a cleft lip or palate. This year, after she heard about the mission, Luz’s mother brought her in for treatment. “I just want my girl to have a normal childhood,” says the mother with tears in her eyes.  MMFC operated on Luz and repaired her cleft lip.

Ivel, age five months.

Ivel, a five month old boy, was born with a bilateral cleft lip. His family lives just outside of Cuzco, in San Jeronimo. His mother is dedicated to him and to her two other sons, aged four and nine. His father, an architect, travels constantly around Peru to try and find a decent job to support the family. Ivel is the only one in the family with a cleft lip. When he was born at EsSalud hospital, Dr. Gustavo Bueno told them about the MMFC mission. 5 months later, his mother brought him in to get surgery. “I just want Ivel to have a better childhood than I did. I am so thankful for what these people are doing.” says Ivel’s mother. MMFC repaired Ivel’s bilateral cleft lip.

Rachel, age fifteen years.

Rachel has an ear deformity (first stage microtia). She is from Arequipa but has been living in Cuzco with her parents since 2006. Last June, she came to the hospital with her mother and learned about the MMFC mission. Rachel goes to an institute to learn english. She also dances at school when she has spare time but she doesn’t want to put her hair in a bun like the other girls because she doesn’t want them to see her ear; she is afraid they will make fun of her. She hopes that this surgery will give her new opportunities. Rachel also does very well at school. “When I’m older, i would like to be an architect or a lawyer, but I also love math and science fiction.” she says

Jose Antonio, age ten years.

Jose Antonio is a ten year old boy with cerebral palsy. He goes to a school of children with special needs located in Cuzco. This year, the founder and coordinator of the school brought her students to MMFC to be treated. A lot of children had never seen a dentist before, so many of them had dental rehabilitation, including Jose Antonio. Jose lives with his mom just outside of Cuzco. They live in extreme poverty but this year, his mom got a job at his son’s school. She also has another son with cerebral palsy, Deyvis, who was treated during the mission by the MMFC Dental team like Jose Antonio. This year, their mom participates in parent support groups to try and help her two special needs children. She is so thankful to be able to work at the school and to be with her two boys, and now to have the care of MMFC.

Henry David, age 13

Henry David is a 13 year old boy with both cleft lip and cleft palate deformities. He lives with his parents and 6 siblings in the village of Tallambo. The family heard about MMFC coming to Cajamarca on radio Lider.  In order to get to EsSalud in Cajamarca, Henry David and both his parents walked 3 hours to the nearest city Cruzconga in the province of Celindin. They then took 2 buses for a total of 6 hours to Cajamarca. There are no other clefts in Henry David’s village.  Henry David is very lucky. He has been raised by a supportive and loving family in a supportive and loving community, which is not the case for many of the children we treat.  In fact, many local Peruvians believe that a child is born with a cleft deformity because the mother did not care for herself properly during pregnancy. Another local belief is that while pregnant, the mother was struck by lightning during a thunder storm.  In either case, there is a social stigma attached to the family. Not in the case of David Henry, though. His parents and siblings have worked with him on his speech and comprehension.  He attends 6^th grade and while he struggles academically, he has been able to remain at grade level due to the support of his family and community.  Most important, Henry David is a happy, secure and well-loved boy who was never made to feel different or less special as a result of his facial deformity. He has many friends and loves to play futbol with them. He loved having his picture taken even before surgery, and easily and happily made friends with MMFC’s Junior Volunteers, Nell Franchek and Dan John-Kelly. MMFC performed a cleft lip repair on Henry David this year.  He then consulted with MMFC’s speech therapist Audrey Hivner and MMFC’s Pediatric Dentist Dr. Tony Vinciguerra. We scheduled an appointment for him to come back to Cajamarca in a few weeks to see the Director of Dental Services at EsSalud, Dr. Josef Guzman who will fit him with an obturator at no cost to his family. This will help Henry David with his speech and eating. Next year, he will return to Cajamarca and a determination will be made as to whether he needs to have his palate repaired, as well.

Lenin, age 15 months

In 2010, the MMFC team was met at the Cajamarca airport by a band and the parents of newborn named Lenin. The parents made such an impression on all of us.  On Wednesday of that surgical week, we repaired the newborn’s cleft lip. We later learned that the parents had not heeded our discharge instructions and had taken Lenin’s  arm boards off thereby allowing Lenin to pick at the stitches in his lip.  Lenin did in fact tear out his stiches the following Saturday. This year the parents returned to Cajamarca and promised that if MMFC fixed their son’s lip again, that they would follow our discharge instructions to the letter, and of course, we did.  Our dentist Dr. Vinciguerra made an appointment for Lenin to see Dr. Josef Guzman, the Head of EsSalud Dental services who has agreed to fit him with an obturator at no cost to his family. The obturator will help Lenin’s feeding and speech until he is ready for cleft palate surgery, in 2012.

Lister Segundo, age 7

This year our very first patient was Lister Segundo, a 7 year old boy who suffered from a severe lip and palate deformity that required two surgeries. Last year, Lister Segundo walked 2 hours from his village of Calvario –Cortegana to the nearest bus stop. He and his mother then took traveled for 6 1/2 hours by two buses to EsSalud Hospital.  Unfortunately, Lister Segundo and his mother were too late and missed the MMFC Screening Day and Lister Segundo could not be scheduled for his much needed surgeries in 2010. Undaunted, Lister Segundo and his mother came to EsSalud every day last year hoping for a cancellation. He stopped eating or drinking water after midnight every night (as all surgical patients are required to do) hoping the next morning he would be notified of a cancellation and would be ready for surgery, but there was no cancellation. Lister Segundo could not receive his surgeries in 2010. We promised Lister and his mother that if he returned to EsSalud this year, we would perform our first surgery on Lister, and we did. MMFC performed both a primary lip repair as well as a primary palate repair on Lister this year. He and his mother were overjoyed.

Sanchez Bacilio, Merly Nathaniel, age 4 mos.

On June 16, the day before our Cajamarca Team of Volunteers headed out to Cajamarca, a father named Oscar Sanchez Jara posted this on Medical Missions for Children’s Facebook page “Good morning friends, I am told that this weekend June 18, 2011 will be in Peru, right in the city of Cajamarca, true information. If so tell them that I have my little baby to be operated, but the same date also operate in other parts of our country. Please confirm if traveling to Cajamarca to register my little 4 months old.” I wrote back to Mr. Jara and informed him that we would indeed be in Cajamarca and would be screening patients for surgery and that he should arrive at EsSalud on Sunday June 19^th by noon. He did, and his his daughter Merly had his cleft lip fixed on Tuesday June 21^st. Imagine that … and appointment scheduled from Peru via Facebook. On Monday, June 27^th, back at home in the States, MMFC  received this email from Mr. Sanchez:

I want to extend my gratitude to all members who visited doctors on 19 June this year in Cajamarca – PERU, with the aim of carrying out the operations of cleft lip and palate, we extend our heartfelt thanks for support, for his humanity, for the love they have shown towards our children, we carry in our hearts to all of you who took pains all week to benefit our children.

On a personal level, my wife and my family, we send our infinite gratitude for my baby Merly operated, we will take forever in our hearts and thought life, thank you, will always welcome to this beautiful land of Cajamarca – Peru.

No names but I can describe briefly. Infinite thanks to the doctors, nurses, anesthesiologists, everyone in general, the doctor in the recovery room for the patience and love for our children.

Cordialmente,

Oscar Sánchez Jara

Shugar Leonard, age 1.5 years

Shugar Leonard is the third of three children. The family does not  live in this district they live Bolivar in La Libertad. Shugar’s Father has a cousin who lives in Cajamarca and the cousin called him and told him about MMFC. There is no public transportation between these districts so they arranged for a ride in a van. Shugar got his name because his Father was watching a fight of Sugar Ray Leonard and thought the name was cool. The Father says his family knows of one other child with a cleft lip who was lucky enough to be able to afford a private physician to perform the surgery. Shugar Leonard’s Father stated that “[I]f it were not for MMFC, Shugar would never be able to get this surgery,” and he is eternally grateful.

Earlier this month, MMFC completed its 12^th annual mission to the Ukraine. During the most recent mission, volunteers from MMFC and AMCU (Advanced Medical Care for Ukraine) worked at three different hospitals:  the Regional Specialized Children’s Hospital of L’viv; the Pediatric Burn Hospital of L’viv; and the City Hospital of Chervonohrad.

This year MMFC teams performed a total of 37 surgical procedures, donated needed equipment and supplies and continued to provide hands-on teaching to the Ukrainian surgeons and anesthesiologists.

MMFC Ambassador-at-Large Janette Barber and Board Member and Producer Barry Brown accompanied the team and shot some great footage. Check out the video clips on Janette’s Blog.

When MMFC began sending missions to Ukraine in 1999, the dedicated and talented surgical and anesthesia staff were severely lacking in specialized training, technology, equipment and supplies.  In response, MMFC has donated a number of anesthesia machines and OR monitors. MMFC installed the HINARI medical literature electronic library at both The Regional Specialized Children’s Hospital and the Pediatric Burn Center, and also installed a microvascular lab.  MMFC and AMCU donated a Storz endoscopic intubation system to the Pediatric Burn Center and  medical supplies to the City Hospital of Chervonohrad including an endoscopic surgical tower, surgical texts, anesthesia laryngeal mask airways and endotracheal tubes, Sevoflurane and other general anesthetic medications, facial plastics sutures, alloderm, dermabond and tissue expanders.

Since its first mission 12 years ago, MMFC has screen approximately 1200 children and has performed life-saving surgeries on approximately 500 children. MMFC successfully completed the first free flap tissue transfer procedures ever performed in the Ukraine. Both operations were on burn injury victims with chronic, non-healing wounds. These two patients have both made a full recovery. Other surgeries include: thyroidectomies, thyroid lobectomies, advancement/rotation flaps for repair of burn scar injuries-neck and scalp, full thickness skin graft auricular burn scar, revision of neck burn scar with multiple Z-Plasty, revision facial bum scars with advancement/rotation flap, burn scar reconstruction with tissue expanders, Nissan Fundoplication, and cleft lip repair.

Thanks to the hands-on-training that Dr. Dennis Snyder, Dr. Gary Ruggera, Dr. Val Atanassov and Dr. Roman Dashawetz have provided to their Ukrainian counterparts, most notably Dr. Ostap Mohylyak and Dr. Vasyl Savchyn, the vast majority of the surgical procedures originally only performed in the Ukraine when MMFC teams were present, are now being performed year round solely by Ukrainian surgeons and anesthesiologists. MMFC lead surgeons and anesthesiologists remain available to Dr. Mohylyak and Dr. Savchyn on a year round basis for consultation and support both via telephone and the internet.

The most significant training by far involved teaching their Ukrainian counterparts to use tissue expanders to help treat children with severe burns.  Physicians use tissue expanders to intentionally grow excess skin so that it can be later harvested for transplant to another site where skin was lost or severely scarred due to trauma, extensive wounds, surgery and burns.  The Ukrainian surgeons now routinely use this procedure.

During MMFC’s recent mission, Dr. Igor Stoyanovsky remarked to MMFC Ambassador-at-Large Janette Barber that “they have not lost a burn patient since MMFC began coming to work at the hospital 12 years ago.” To all of us at MMFC, there is no greater measure of our success.

To more about MMFC’s recent mission to the Ukraine, listen to Janette Barber’s radio interview of Dr. Dennis Snyder on Sirius’ Rosie Radio. Click here. Rosie Radio – Janette Barber Interviews Dr. Dennis Snyder

In March, MMFC traveled to Gitwe for the fifth time.  Dr. Jag Dhingra and his team performed  25 thyroidectomies. Under the auspices of the MMFC Dental Program, Dr. Alaleh Zadmehr performed dozens of dental procedures, several under general anesthesia and donated dental equipment allowing for the expansion of the services offered at the Gitwe Dental Clinic.  Dr. Dennis Snyder and his surgical team operated on 37 patients with cleft lip and palate deformities.

MMFC Executive Director Liz Desmarais was invited to meet with the Minister of Health in the capital city of Kigali to present the wonderful work being done at Gitwe Hospital, and to voice support for Dr. John Streit’s efforts to build Kigali Medical University and expand Gitwe Hospital into a teaching hospital. MMFC was the first international cleft organization to go to Rwanda five years ago to provide free reconstructive surgery. Appearing before the Minister of Health to recount MMFC’s history of surgery at Gitwe Hospital was a proud and humbling moment for MMFC.

MMFC would like to thank the following individuals and foundations whose financial support made this mission possible and provided much needed equipment for the operating room and dental clinic:  Dr. Jag Dhingra and Dr. Meera Mahalingam , the Hellman Family Foundation, the Smile Train, Inc. and Anonymous.

One of MMFC’s volunteer team members is Dr. Faye Evans, a pediatric anesthesiologist at Emory University and Children’s Healthcare of Atlanta.  She is also an Assistant Professor at Emory School of Medicine.  Among her many humanitarian alliances,  Dr. Evans serves as an advisor to MMFC regarding its Global Education and Training Program. Dr. Evans can be reached at fmazo@emory.edu.

Dr. Evans and MMFC are both committed to fostering collaboration between visiting physicians on short-term surgical missions and local physicians and physicians in training especially in the areas of anesthesia and surgery.  In fact, during the fall 2010, Dr. Evans spent two weeks traveling in Rwanda under the auspices of The Harvard Humanitarian Initiative (HHI).  As a representative of HHI, Dr. Evans and her colleagues assessed the current surgical and anesthesia capacity, and measured the needs of the health system in Rwanda .  HHI is conducting this ongoing survey in 10 countries in east and West Africa.  The purpose of this effort is to inform the international community, including donors and humanitarian agencies, on the growing surgical services crisis and the need for physical infrastructure, education and training for surgical and anesthesia providers, adequate equipment and medications. The results of Dr. Evans’s work under the auspices of the Harvard Humanitarian Institute (HHI) will be published this fall in the World Journal of Surgery.

In March of this year, Dr. Evans traveled with MMFC to Gitwe, Rwanda to perform surgeries removing large goiters and correcting cleft lips.  Prior to the mission, Dr. Evans contacted the Rwandan Anesthesiology Residency director Dr. Theo Twagirumugabe to coordinate an opportunity to work with the Rwandan Anesthesiology Residency Program.  This four year program leads to a Master’s degree in Anesthesia and was established in Rwanda in 2006.  It is a collaboration between the National University of Rwanda and the Canadian Anesthesiologists’ Society and the American Society of Anesthesiologists Overseas Teaching Programme.    Each year 5 new residents are accepted into the program.  Dr. Evans and MMFC were fortunate to have Dr. Alfred Mugenshuro , a third year anesthesiology resident from the Rwandan program spend the first week working with the MMFC team.  It was an incredible experience for everyone involved.   After the trip, Dr. Mugenshuro wrote to Dr. Evans, “I have really appreciated to be with the team even if the time was too short. I have learnt some technical skills, but apart from that, I have also experienced your team work, empathy, situational awareness, etc.  Even if the next year I will be busy in preparing my final exam, let me be informed when you return to Gitwe, because I will be glad to work with you again.” MMFC and the Rwandan Anesthesia and Surgical residents will continue to work together on all future missions to Gitwe.

Dr. Andrew Patterson and Dr. Ana Crawford teaching Dr. Alfred Mugenshuro to use the glidescope.

The US Ambassador to Rwanda, W. Stuart Symington visited Gitwe Hospital during this mission to thank MMFC for its tremendous work in both caring for patients and providing needed education and training to Rwandan medical residents and other medical professionals.  It was a rewarding and exciting visit.Ambassador Symington  met with Olivier Urayeneza, MD, a native of Gitwe who is the son of Gerard Urayeneza, the individual who built Gitwe Hospital.  Dr. Urayeneza has been in the United States attending medical school and is now in his residency at Bassett Heathcare in Cooperstown, NY, US. He traveled back to Gitwe with MMFC during the March mission as a surgical resident. He will move back to Gitwe as a surgeon when he completes his training in the United States. He intends to use his knowledge and skill to help his homeland.

Finally, we had the pleasure of having Amber Webb of Smile Train, one of the Rwanda mission sponsors,  visit Gitwe Hospital during cleft week. Ms. Webb delighted in meeting and spending time with so many of the children who received surgeries because of the financial support Smile Train provides.

Amber Webb, Smile Train Program Administrator is welcomed by the children of Gitwe

There were so many children and patients whose stories humbled all of us. Ms. Webb was particularly moved by Alice’s story and she recounts it for us here.

“Last March, Alice Mukanyongera, walked eight hours with her mother to Gitwe Hospital from her village of Ruhango in order to have her cleft lip repaired.

A year later the two made the long journey again, this time with Alice’s four month-old son, also born with a cleft lip.

The two, strenuous journeys to the hospital were the least of the small family’s hardships though.

Now her mother’s only child, Alice at one time had been the proud older sister to three siblings, all of whom passed away. Her father, who, upon seeing her cleft lip, gave Alice the surname Mukanyongera, meaning “What God gives to you, you receive it; you do not change it,” is now in prison for genocide crimes.

Before her cleft repair last year, Alice had no friends, was called ugly, and was often referred to as inhuman. So when a young, male family friend showed interest in Alice one day before her cleft repair, she enjoyed the attention. As the day progressed he bought her beer and asked her to come to his home so he could tell her a secret. Alice went. It was then when Alice was raped and became pregnant with Joshua.

Although many people in the village has begun to gossip about Alice’s pregnancy, she refused to admit to her mother that she was with child. Finally, after becoming fed up with the rumors of her neighbors, Alice’s mother confronted her daughter. Overwhelmed, Alice was unable to speak so her mother cornered her in order to lift her shirt, revealing a 5-month pregnant stomach.

After discovering the pregnancy and the identity of the child’s father, Alice’s mother decided to confront the mother of her grandchild’s father, who also was her best friend. The father denied he was responsible for the pregnancy and said there could be many other potential fathers. His mother agreed, ending the friendship between the two families.

Four months later Joshua was born. Despite the circumstances surrounding Joshua’s conception and his cleft lip, mother and grandmother were happy to welcome the newest member to their family. Even months after his birth, Joshua’s grandmother’s eyes widen and her speech becomes loud and rapid when talking about him. Her lips, previously held in a sullen position immediately turn to a smile. When Joshua’s mother holds him she never takes her eyes away from her baby.

Now, a year after her repair Alice not only has many new friends, but also a family. She is happy that her son also soon have the same opportunities she is just now beginning to experience.”

And finally, a dedication and farewell … to our dear friend and devoted colleague, Greg Feldman, MD.  MMFC’s  mission to Gitwe, Rwanda in 2011 is dedicated to Greg who understood the Power of One  in  helping to heal.  A part of his spirit will always sleep in the land of a thousand hills.

Dear Mr. Allan Pineda Lindo, Jr.,

My name is Tracey O’Keeffe and I am praying this letter finds you.  I am a nurse and I work full time at Memorial Sloan-Kettering Cancer Center in New York City.  I recently returned from my second medical mission to Angeles City, Philippines.  It was a wonderful, unforgettable experience that I am grateful for.  I know you were born and raised in Angeles City and remain devoted to your homeland.  I am touched by your life story and am hoping I can touch you with my story… and the story of some of the children whose lives we transform with a one-hour surgery.

Tracey O’Keeffe, RN sharing some fun

For the past five years I have been volunteering with a non-profit medical group called Medical Missions for Children (www.MMFC.org).  MMFC is a nonprofit organization dedicated to correcting facial deformities of under privileged children and young adults around the world.  We specialize in correcting cleft lips and palates, ear deformities, severe facial injuries and burns.  Our medical team consists of surgeons, anesthesiologists, nurses, dentists and speech therapists from well- respected hospitals in the U.S. and abroad.  Each team member volunteers his or her vacation time to participate.  On average MMFC completes 15 to 20 missions world- wide each year, including  Angeles City and Leyte, Philippines.

Our recent trip to the Philippines was very successful.  With the help and dedication of the Filipino volunteers and, in particular, Holy Family Academy Batch 83,  we were able to provide life altering surgery to 40 deserving children and young adults at the Dee Hwa Liong Foundation Medical Center.  In particular we had the pleasure of meeting the De La Cruz family.  The De La Cruz family consists of 7 children, three of the children have a cleft lip and palate.  Being an impoverished family from a small community outside of Angeles City, the De La Cruz’s had no hope of receiving medical attention for their children.  The three children were under weight for their age, had permanent speech impediments and were social outcasts as a result of their deformities.  Fortunately, MMFC had the ability to help.  We performed 5 surgeries to correct the lips and palates of these children. They will now have the ability to eat and grow properly, their speech impediments can be improved, and our hope and belief is that their self-esteem and social status will improve as well.  Seeing the radiating smiles from the faces of these children along with the appreciation of their familes is priceless.  There are no words to describe the gratitude felt at the end of our work week.  It is why we continue to do what we do.

The Filipinos are the warmest, most hospitable culture of people I have had the pleasure to work with.  The city of Angeles, the history and most of all the people have left a lasting impression on me.  I have committed to returning annually as a volunteer.

I chose to write to you Mr. Pineda because you are an inspiration for young adults.  You have overcome many obstacles to become a musical icon.  You remain dedicated to your Filipino roots and I believe you will appreciate the work we do for your people.  I also feel that with your support we can continue to treat the underprivileged children of Angeles City.

I know that as the Black Eyed Peas band member apl.de.ap you have been appointed  special ambassador to education by the Ninoy and Cory Aquino Foundation named after two of the Philippines’ democracy icons, and that you have helped to launch school projects in Angeles City that aim to increase literacy and develop the musical talents of young Filipinos.

Volunteering with Medical Missions for Children is a true passion of mine, I absolutely adore this work.  I would love to share the many stories and pictures I have of the Angeles mission if you have further interest.  I hope that you will consider expanding the reach of your charitable work in Angeles City and support the medical care that MMFC provides to the Filipino children and young adults.

Thank you for your time,

Tracey O’Keeffe, RN

info@mmfc.org

978-387-2749

The MMFC Cleft team returned last week to the small town of Phalodi in the northern state of Rajasthan, India. The nine person team traveled for over two days to reach this remote site which graciously hosts the team each year.

Upon arrival at the hospital, the team immediately set out to screen the many cleft lip and cleft palate patients that had been anxiously awaiting the team’s arrival.

The surgeries were completed at HBS Hospital and Medical Research Institute which is a privately run charitable hospital.

The HBS hospital is run by Dr Kanti Jain (pictured below, on left) who also serves as MMFC’s local coordinator.

While the surgeries are a significant aspect of each mission, it is also important to make note of the innovative ways our patients find out that we are coming to their region and arrive at the hospital steps.  Families travel many miles and many days to reach the hospital.  The efforts of Dr. Kanti Jain and her staff to recruit patients are notable.  In anticipation of our visit, Mr Devi Singh Rajpurohit (pictured above, on right), the hospital’s outreach coordinator, travels the region for four months and visited local villages, farms and schools announcing the expected arrival of the MMFC team.

As part of his outreach effort, Mr Rajpurohit had installed an enlarged photograph of a previous cleft patient on top of his vehicle.  This was a way of educating the community on what type of surgeries the team would perform.  He also worked closely with the local midwives to educate them on how to identifycleft patients.  Mr Rajpurohit did an incredible job at screening each patient to ensure that the mission would be successful.

As a result, the MMFC team had a fully booked surgical schedule.  These grassroots efforts are vital to the medical mission in Phalodi and without the help of our local team, our trips would not be as successful as they have been.

We thank our “family” here in Phalodi for your continued support of our work!

During our one week mission, MMFC team members performed 75 surgical procedures, 50 of which were cleft lip and palate procedures and 25 of which were microtia (re-construction of the outer ear). Our dental team headed by Dr. Charles Badaoui (pictured below with a patient) also provided free dental care to 63 patients in the clinic at Hermano Pedro Hospital and donated much needed equipment. 

Dr. Cindy Weller, an Anesthesiologist from California created this wonderful 3 minute video during our January 2011 mission to Antigua Guatemala.

Dr. John Pook is a Consultant Anaesthetist at the University Hospital in Lewisham, London and an Honorary Senior Lecturer at the King’s College London School of Medicine. Nicole Cromwell, RN is a ICU and Recovery Room Nurse at Stanford Hospital in CA. Both volunteer on multiple MMFC missions each year, and both are active members of the MMFC Board of Directors.

A new site for MMFC.    An exciting prospect – an invitation to work at the Huiyang People’s Hospital of Huizhou City.     Most MMFC sites are old friends – this was different.

Tradition, history, culture, language, politics and protocol?     And our patients?  And the hospital?  A tough or an easy week?   Our thoughts while we wait in the spacious calm of Hong Kong International for our small (but also great) team to arrive.   Denny and Russell – surgeons, Nicole and Heidi – PACU, David – OR, Marc and John for anesthesia.

And then it started.    A whirlwind week, unforgettable and absorbing, hectic and hugely enjoyable.

Most important, we did what we came to do and treated 25 children.    There was a lot of teaching and discussion with our local colleagues and they provided us with some fascinating insights into their surgical management of cleft together with demonstrations of Traditional Chinese Medicine.

Huiyang People’s Hospital is impressive.    Big and very well equipped.  Workmanlike and comforting.

The staff are proud of what they have and have ambitious plans for the future.

Clinically and technically the mission was quite straightforward.   The children were well prepared, the operating department spacious and comfortable and the postoperative care well managed.

Some patient stories.

Yupeng Shi is a one year old boy from North West China.  It took his mother and grandmother two days to get to the hospital by bus.

When his mother found out that MMFC was coming to China to perform cleft lip and palate surgery, she moved here several months ahead of time to fill out all necessary paperwork and to prepare her child for surgery.  He is her only child and she is so happy with the results of the surgery.  She looks forward to moving back home to show her family and friends how her child’s life has changed.

Qihua Tang is a 10 year old boy with a cleft lip.  He travelled 3 1/2 hours by bus with his family to have surgery.  This is the 3rd surgery on his lip. His first two surgeries left him with horrible scars.  He is in primary school and his mother tells us he is very smart and brave.  People have asked her why she doesn’t have more children and she tells us that she wants to focus all her attention on him and give him a good life.  She tells us that the other children make fun of him but she hopes that after this surgery, his life will be much better.

Song Hui is a 4 year old orphan with a cleft palate.  We learned that the orphan children get their last names by the first three letters of the province they live in. Song is from Huiyang, hence his last name of Hui.  Song was abandoned on the street at about 6 months old.  Someone took him to the police station where he was then taken to the orphanage where he has lived ever since.  His nanny hopes he will be adopted someday.  She says she will be very sad to lose him but happy for the prospect of a better life for him.  He plays with the other children but is very shy and doesn’t talk very much.  His nanny wants to say thank you to MMFC for coming to China and caring about the orphans.

All the orphans together!

For the 2010 MMFC mission to Huiyang there is one more thing that must be said.     Worldwide we are very lucky to have great support wherever we go.    But in China this was truly exceptional.      The team must record our most sincere thanks to the local governor and her deputy, the groups who did all the fundraising, the hospital staff, the organising team, our translators, the cleft specialist group from Hong Kong and the visiting medical team. Everyone showed us exceptional kindness and hospitality – everyone was energetic and professional – everyone was engaging and entertaining.

The hospital has three explicit strategies.    One of them is to upgrade through a spirit of “love, unity, quality, devotion and initiatives”.  And that’s precisely what we experienced during our inaugural mission to Huiyang, and it is exactly what we expect to experience when we return in 2011.

Farhad Sigari, MD is an Otolaryngologist who has been working in the Kenosha, Wisconsin area for the last 4 years and is now in the process of relocating to Southern California. He completed his training at the University of Chicago where he began volunteering for medical missions in 2003, and started volunteering with MMFC in 2005 on the Cusco, Peru mission. He recently returned from MMFC’s inaugural mission to Cajamarca, Peru.

The MMFC physicians, coordinators, and volunteers worked hard for the last two years to make a first ever trip to Cajamarca, Peru a reality. This hard work and dedication came to fruition when the MMFC crew landed in Cajamarca, Peru on August 28. The efforts ultimately resulted in a full week of surgical and dental procedures for children born with cleft lip and palate deformities.

Our arrival had been discussed, advertised, and anticipated by the regional community, newspapers, and radio stations, and because of this, we were met at the airport by the local coordinator, potential patients, and their families.  Even a traditional local band welcomed our arrival to Cajamarca with much fanfare.  It was a warm and welcoming reception.

We were overwhelmed with the hardship each family endured just to have a chance to seek medical care for their children. One of the most compelling stories was of a beautiful 13 year old girl named Erlita who had been born with both a cleft lip and a cleft palate deformity. Previously, when Erlita was age 4, her family had saved and borrowed from their local village community to travel hundreds of miles to seek medical care, only to be turned down. Her family was devastated and since had given up all hope for any possible treatment. However, thanks to the MMFC outreach efforts, they heard that there was the possibility of receiving surgical treatment any 13 year girl old with her deformity would wish for. Again with the help of family, friends, and community, Erlita and her father traveled a day and half (including 4 hours by foot) in hopes to make her dream a reality.  And this time, it did.

Luckily for Erlita and her family, the MMFC team was able to coordinate the proper surgical and dental treatment she so desperately needed.  Erlita and her father were overjoyed with the result. Her father shared with the MMFC team that 5 other families with children with similar deformities in surrounding villages had also given up hope for any possible treatment. He was excited to return home with the news that such medical treatment was possible and was being offered by the MMFC organization to the people of Peru. MMFC is already coordinating treatment for those children and others like Erlita for next year’s mission!

On its inaugural mission, MMFC performed a remarkable 40 surgical cases during a one week, one operating room schedule, 30 of which were cleft lip/palate procedures. On behalf of the children and families of Cajamarca, Peru, we would like to thank the Children of Peru Foundation, Smile Train, and our many kind-hearted and generous donors, without whom this mission would not have happened.

Dr. Cindy Weller, Nicole Cromwell, RN and Wanda Hartigan, RN surrounded by the sweetest children in Tanzania

Nicole Cromwell RN, Lead Recovery Room Nurse on our recent mission to Tanzania shares the stories of several of the 38 patients whose lives were changed on this mission.

Upendo Nibigira is a 6 year old girl with a bilateral cleft lip deformity.  Her family fled Burundi in 1972 and has lived in a refugee camp in Mpanda, Tanzania ever since.  They traveled by bus for 3 long days for to get her surgery.  Upendo is a very quiet, shy, and reserved little girl because of her deformity.  Her mother tells us that the other children made fun of her and teased her all the time.  Now that her lip is repaired, her mother says that she will be accepted by other children. She hopes for a better future for her child.

Nicole Cromwell RN, Lead Recovery Room Nurse on our recent mission to Tanzania shares the stories of several of the 38 patients whose lives were changed on this mission.

Tanzania is located on the coast of East Africa and is one of the poorest countries in the world.  There is an enormous shortage of doctors and health care- only ONE doctor for every 26,000 people, a staggering statistic.  The life expectancy is only 51 years old.

We work at a hospital called CCBRT, or Comprehensive Community Based Rehabilitation in Tanzania (www.ccbrt.or.tz).  This facility is incredible- they repair club feet, insert shunts for hydrocephalis, perform much needed VVF surgery, and do extensive rehab therapy for children born with spina bifida.  The staff is incredibly efficient and do about 20-30 surgeries a day, despite the fact that the equipment is basic and antiquated.

Our typical day here starts with the pick up at our hotel at 7 a.m. sharp.  We have a short ten minute drive down the side streets to the hospital where we are always warmly greeted by staff and families.  We start right away by checking the children from the previous days’ surgery, making sure everyone is recovering well and isn’t in too much pain.  The CCBRT nursing staff does an incredible job monitoring and caring for our patients.  Next, we consult with the Doctors and nurses to plan the day’s schedule.  Weights, blood levels, and general health are discussed.  Each patient is then examined thoroughly by our Anesthesiologists and then prepped for surgery.  Our operating nurse extraordinaire Wanda Hartigan, RN is already hard at work setting up the OR for the day.  Dr. Denny Snyder soon goes in, works his magic, and before you know it the patient is ready for me in the recovery room!  After the child is sufficiently recovered, they are off to the ward to be comforted by their family.  The parent almost always stands back to admire the results with their hands clasped together over their heart.  One of the nurses told me that when they do this it symbolizes extreme gratefulness.  You cannot imagine the shock, joy and tears these parents display seeing their child for the first time after surgery.

Kibula Nibizi is an 8 year old boy who also traveled from the Mpanda refugee camp.  Like Upendo, his parents also fled war torn Burundi in 1972 and have lived there ever since.  Kibula is extremely shy and hides his face every time we approach him.  His father tells us that he was very scared to come here for the surgery but now, although still very shy, is very happy to have his new lip.  He is one of 8 children- there were 10 but 2 have died.  His father is very happy and grateful for the work that we were able to do and is also hopeful for a better life for his son.  Kibula opened up a little more each day and by the last day of our trip, he was smiling, made new friends, and even helped us pack our bags!  The transformation was amazing…

By our second week most of the children from the first week of work were still there.  At most other sites the children go home after a day or two so to be able to see them one week post op was a real treat for us.  They are well on their way to healing by then and everyone is pretty happy with new smiles everywhere.

Perhaps our most famous patient from Tanzania is Tobias.  He has a type 3 cleft deformity and was profiled in our video from last year.  We were all surprised and happy to see him here for a one year post op check.  His mother reports that the surgery has completely changed not only Tobias’ life, but her own and every other member of their family.   When Tobias was born, his mother thought for sure he would die from his defect.  Her family shunned her and just didn’t understand why he was born this way.  Tobias’ mother brought him to a hospital in the countryside of Morogoro.  By chance, there was a woman there that had heard of us and told his mother to come to CCBRT.  She was unsure if we could really help her son but now is so incredibly grateful for what we have done for him.  Tobias is a very different child than he was one year ago.  His mother tells us that he is able to eat better, has gained a lot of weight, crawls and has even starting to walk.  She says he’s a much happier child and is now treated the same as other children in his community.

The difference in these children’s lives not only affects them, but their families, and the community around them.  These children, however poor they may be, now have a chance at a better life because of Medical Missions for Children.

Nicole lives in San Jose, CA and hosts a fabulous west coast fundraiser for MMFC every spring.  If you would like more information, or can help by attending, donating or joining her committee, please contact her directly at nicole.cromwell@mmfc.org.

This was MMFC.org’s 8^th annual, consecutive mission to Cusco, Peru and it was a success on every level. Despite the challenge of working at an altitude of nearly 12,000 feet,  MMFC.org volunteer team members screened 108 patients and performed a total of 68 procedures, 32 of which were cleft lip and/or palate surgeries. The dental team performed 91 procedures including 6 under general anesthesia. MMFC.org worked closely in training and education with the local surgeons who participated in all aspects of our mission and whoparticipated in screening, pre and post operative care and the surgical procedures themselves. We worked side by side and trained local OR and PACU nurses. Our Speech Therapist and Nutritionist provided one-on-one training to the hospital staff and directly with the patients’ families. Thank you to our volunteer team members, our local coordinators Ani Forsythe, Monica and Rafael Ferrer, our kind donors and our generous mission sponsors,  The Smile Train and The Children of Peru Foundation.

Estrella Del Carmen Olivera Menacho, age 5  (cleft lip/palate)

Estrella, an only child, lives with her mother and grandfather. After she was born, the father abandoned the family and never paid child support; the grandfather has served as a father figure since she was little. Estrella loves school – she is very social with her classmates. Her mother is worried because a lot of people cannot understand what she says because of her cleft palate. She’s been in speech therapy for a while, which has really helped her. Last year, her mom heard about the MMFC.org program, and she brought her in for treatment. This year, she is getting her second surgery. “I am very grateful for what everyone has done for us; I want to help in anyway possible and thank everyone for their love and care,” says Estrella’s mom.

Luis Carlos “Lucas” Vera Infantas, age 12 (microtia)

Luis Carlos, also known as Lucas, is the first born in his family. He has a little brother who is a month old. He lives with both his parents and brother. The family owns a restaurant in Cusco. Lucas goes to a school with people who have special needs. He cannot go to a normal school in Cusco because of his long hair. He lets his hair grow because he doesn’t want people to see his ear; he is afraid people will make fun of him. He loves to play soccer in his spare time. Microtias are a recurrent malformation in the family: Lucas, his cousin, his mother, his grandpa, and his great great grandma all have ear malformations. This year, he is being brought in for surgery (1^st stage microtia). His mother, Maria Isabel, is also being treated. “Next year, I want to help the people of MMFC.org; what they are doing is absolutely incredible,” says Isabel.

Luciano one year ago, age 6 mos., prior to first cleft surgery

Luciano this year, age 1 1/2, before his cleft palate surgery

Sebastian this year, age 1 1/2, before his cleft lip surgery

Luciano & Sebastian Ripa, 1 ½ years old twins (cleft lip/palate)

Luciano and Sebastian are identical twins. Luciano underwent surgery last year for his bilateral cleft lip, and he was brought in again this year for his cleft palate. The parents heard about the MMFC.org program in  March 2009, and brought the twins in for treatment. Last year, Sebastian couldn’t be operated on because of his cough; but this  year he was a safe and viable candidate for surgery. Their mother, who is a teacher, is so happy for her twins’ surgeries. Both parents work a lot, so their uncle lives with the family to take care of the twins. “Luciano is the calm one. Sebastian is always running around and playing, he has a lot of enrgy,” says the uncle. The family lives 8 hours away from Cusco; they came here to EsSalud Hospital specifically for the surgery.

MMFC.org returns to EsSalud Hospital in Cusco, Peru next May 20, 2011. If you are inspired by the stories of these children, or the tireless dedication of our volunteer surgeons, dentists, doctors and nurses, please consider making a contribution. We are only able to accomplish what we do and help to change the lives of these children, because of your financial support. We accept donations online at www.MMFC.org or by telephone at 508-697-5821. MMFC.org is a 501(3)(c) charitable organization and donations are tax deductible to the fullest extent of the law.

Plain and simple, MMFC volunteer team members ROCK!  Their incredible passion, professionalism and pumped-up-personalities came together to create an amazingly productive two weeks in Gitwe, Rwanda. During our two week mission,  MMFC performed 38 cleft lip surgeries, 27 thyroid surgeries and a dozen miscellaneous procedures for a total of 77 surgical procedures!  Our surgeons held several lectures and hands- on workshops for the local surgeons, including “Care of the Cleft Patient”,  “Suture Materials” and “Knot Tying Techniques.”  And the IT System implemented at Gitwe Hospital under the auspices of Stanford University and the Hellman Family Foundation is beyond unbelievable in the impact it will have on patient care in this remote central African village and beyond.

The MMFC dental team donated a portable dental unit and reference books to the one local dentist practicing out of Gitwe Hospital.  Using the new equipment, the MMFC dental team and the local dentist performed fillings and extractions on over 100 children and adults in just one week’s time. During the same week, the dental team visited the village elementary school,  provided screenings and education on oral hygiene and dental care , and distributed toothbrushes and toothpaste to over 750 students. 

We are inspired by the people of Gitwe and the work we were able to accomplish there.  And we are inspired by you, our dedicated donors and supporters. We are also grateful to the Hellman Family Foundation, the Smile Train and the American Society of Plastic Sugery’s Educational Foundation, without whom this mission could not have happened. All of you are an integral part of this success story!

And the Gitwe success story continues. As many of you might remember, MMFC had the privilege and honor to have six-time Emmy Award winning writer and producer Janette Barber and producer Barry Brown join us on our annual mission to Gitwe in 2009.  During that mission Janette and Barry spent time with our volunteers, our patients and their families. This dynamic duo also took lots of amazing photos and raw video footage. A year later, here is the amazing result.  Three MMFC stories that will bring you right smack dab into the middle of the village of Gitwe where we work for two weeks each year.  Watch all three episodes right here on the MMFC Blog (see next 3 entries below).   Like you and our volunteers, they ROCK!

So watch these videos, and send them along to a friend or two. And please, donate to MMFC today!

Let the Healing Begin …

“Individually, we are one drop. Together, we are an ocean.” Ryunosuke Satoro

MMFC’s inaugural mission to Angeles City, Philippines was an enormous success in every way imaginable! We are incredibly grateful to our generous financial sponsors who made this mission possible: The International Foundation; Authentic Dental Lab; Pam Lundgreen; Nancy Taft and Tanya Zamora. MMFC would also like to extend its gratitude to its local hosts and sponsors: Dee Hwa Liong Medical Center (Angeles City); the Holy Family Academy, Batch ’83 and Dr. Fortuna Alapag Vardeman.

During our mission, MMFC screened 96 patients and performed a total of 48 surgical procedures, 36 of which were cleft lip and/or palate. The stories of the children and families we met and cared for continue to inspire us. Here are some of their stories.

Names:         Anthony De la Cruz, 3 years old and Bernardo De la Cruz, 8 years old

Address:       Sta. Isabel, Cabiao, Nueva Ecija

Anthony and Bernardo were born with cleft lip and palate to parents Lualhati and Augusto De la Cruz. They are both farmers and have 7 children.  Their eldest, Angeline, 17 yrs old, had her cleft lip surgery when she was 7 yrs old, but still suffers with a cleft palate that needs repair.  Their mother Lualhati told us that when her eldest Angeline was born she thought it was a case of “paglilihi”… the Filipino myth that the wishes or cravings of a pregnant women would affect the physical appearance of a child at birth. But after Angeline came Bernardo, then Anthony. She said it must be in their “lahi” or genes since she has nephews and nieces with cleft lip or cleft palate and many of them died at age 7.

A neighbor who was operated on at Dee Hwa Liong Medical Center heard about the free cleft lip and palate surgery being offered by Medical Missions for Children.  This neighbor knew that the De la Cruz’s could not afford bus fare from Nueva Ecija to Pampang, so she drove them herself.

On February 16, 2010 Anthony and Bernardo underwent cleft lip surgery. Lualhati hopes for her eldest daughter to have the cleft palate surgery on the next medical mission in 2011.

Name:               Jason David

Age:                   42 years old

Address:           ACLI Resettlement,  Pampanga

Job:                    Laborer

Jason was born in Visayas. He was orphaned at age 2 and was taken to Pampanga by a distant relative named Aling Puring.  Jason is now 42 years old and takes care of Aling Puring who is now 65. Jason works as a laborer at ACLI resettlement area in the Filippino village of Mexico. He is known to the people of ACLI as kind, honest and very trustworthy. Mrs. Juanita Razon, a Barangay Kagawad in the area heard about the free surgery being offered by Medical Missions for Children and immediately thought about this long trusted laborer Jason. There was hesitation on the part of Aling Puring to let Jason go. He thought if Jason underwent the surgery he would need time off to recuperate and therefore, be unavailable to take care of Aling Puring’s daily needs. Mrs. Razon promised Aling Puring her full support if and when Jason was accepted as a patient.

On February 15, Jason did undergo the cleft lip surgery.  He hopes to have the palate surgery next year.  At 42 and single he is now more than excited to face his new life and as Mrs. Razon said, she hopes Jason can now find a girlfriend.

Name:              Chan Leo Simbulan

Age:                   2 years old

Address:          ACLI Resettlement, Mexico, Pampanga

Chan Leo is the youngest of 2 children. Upon seeing at birth that Chan Leo had a cleft lip and palate, his father abandoned the family. The young mother of two is now left alone to tend to the needs of 2 young children. The children are now being supported by their maternal grandfather.  Mrs. Juanita Razon, a barangay kagawad of ACLI , Mexico took them to the Dee Hwa Liong Medical Center where Medical Missions for Children was offering free medical and surgical care. On February 16, 2010 Chan Leo underwent the cleft lip surgery.

Name:              Romel Pajares

Age:                  2 years old

Address:         Lapinig, Northern Samar

Romel hails from Samar, an island in the southern part of the Philippines. His father is Romy Pajares, age 30, who works intermittently in a plantation carrying sacks of copra from the field to the warehouse. Romy also has a cleft lip and so does his other son, Randy, age 4.

Romy found out about this medical mission from his aunt, Lina, who works in Angeles City as a domestic helper.  Lina heard about it from a friend who also heard about it from someone who worked at the local Department of Social Welfare and Development Office (DSWD).

Romy and his wife borrowed some money, about P5,000 (US $109) for fare and food so they could take their son to Angeles City. While Romy needs the operation, too, he would rather see his children have the surgery so that they will have the chance for a better life. Also, having an operation might mean he could have to stop working, something his family can’t afford for him to do right now.

Romel underwent a successful cleft lip surgery on February 18, 2010. Romel’s father plans on bringing his other son Randy in for surgery next year in 2011.

PS- MMFC would like to thank all of our patients and their families for trusting us and for sharing their stories with us. The grace and dignity we saw in each of your faces, and the love we felt from each of your hearts, was the most precious gift we brought back from the Philippines.

PPS- To Fortune, Candy and Judy and all the women of Holy Family Academy Batch ’83 –  you gals rock! Salamat! See you next year.

Sue Matthes Hadden has been a pediatric nurse for 34 years with 24 years in pediatric PACU and 2 years in ambulatory pediatric otolaryngology. Dr. Jenn Kim (3 year MMFC volunteer and University of Michigan Otolaryngologist) asked a peer pediatric otolaryngologist if he knew any pediatric PACU nurses who would be able to attend the Guatemala mission. When asked, Sue jumped at the chance to volunteer for MMFC. Her friend and colleague Rebecca (“Becky”) D’Agostino also volunteered to join her on their first mission trip. Becky has 36 years experience in pediatric nursing with 28 years in pediatric PACU.  Sue and Becky hope this was the first of many MMFC trips. As Sue’s journal entries so aptly illustrate, it is the people involved in every aspect of an MMFC mission- and their perspective on patient and family centered care – that ensures the success of each mission.

What a great way to start the New Year.  The first day in Antigua we had dinner with some of the team. One of the returning operating room nurses said that we would leave Antigua changed. She said that the experience was hard to describe but life changing.  I thought, “Ya, ya, we’ll be doing meaningful work, the team seems to have great mojo and I’ll be working with my buddy Becky.  This will be a good week.”

Half way through the first day, I totally understood what she meant. Working with a focus on the patient and family is why we go into medicine. The doctors, nurses and support staff had a vision with one purpose: to help these kids and families.  The Obras Sociales Hermano Pedro Hospital staff created a template that supported the task. The families were appreciative and the children stoic.

It is hard to put to words how the patients, families and staff touch your heart, but they are all heart. No language barrier can hide what was deep inside. With or without an interpreter, you could tell what was in their hearts; love for their children and appreciation that we were trying to help.

Patient and Family Centered Care (PFCC)

Patient and Family Centered Care (PFCC) at Hermano Pedro Hospital is amazing. As soon as it was clear that the patient was stable, the local staff would invite the parents in to be with their children.  In the United States, there are legitimate reasons why parents are not allowed into the recovery room directly after surgery, such as confidentiality, lack of space (crowding) and parents fainting. At Hermano Pedro Hospital we had all three “issues”: there were no curtains, very little space and 2 moms who fainted.

I would not change the timing of the parents’ arrival to PACU. I would have liked more space, more privacy and no fainting, but we live in the imperfect world. These children are not ours. I know children and I know a lot about waking them up. But I don’t know these children. Their parents do. They know their cries, their preferred methods of comfort and all the intricacies every parent inherently knows about their own children. Their children do not know me. I might be comforting but their parents are much more likely to be the postoperative antidote. PFCC was at its best in Antigua. They do not have the money, resources and research that we have access to. But we have a lot to learn from them.

Our Interpreter Miriam

Part of the reason we were able to do Patient and Family Centered Care in Antigua was in large part due to Miriam. Miriam was our interpreter for four days. She functioned as interpreter, nurse, social worker, child life specialist and confidante. Her Mayan village suffered from genocide when she was six years old. Her family fled to Guatemala City where she still lives. When her four children were in their teens, she raised enough money to go to Canada to do an intensive English program. She now works at the Embassy in Guatemala City interpreting. When she can take time off, she travels to Antigua (1 to 2 hour commute) to volunteer her time at Hermano Pedro.

Miriam had a great sense of compassion. When not busy she would find out each family’s story. She would tell us the compelling stories of the parents’ struggles to bring their children there for surgery. She helped us discover the struggle of one mom who had been working for six months to help her failure to thrive infant gain enough weight to be able to be a candidate for surgery. She shared the story of one mom who sold all of her turkeys to afford the arduous trip from the mountains to Antigua. There were many stories. She helped us to get to know the Hermano Pedro staff better. She helped us speak with Otto, one of the nurses whose wife had had a baby on day 2. This was Otto’s first baby and he was handsome and looked just like him.

Our experience and the experience of our patients was enhanced due to Miriam. We marveled at our luck to have her volunteer week be the same as ours. Thank you, Miriam.

Patsy Donlan, RN

Just a few words about Patsy, the team leader of PACU:  She has great clinical skills, compassion, leadership, sense of humor and an incredible work ethic. She shared her wealth of knowledge and yet was open to suggestions. Despite a little local gastrointestinal infestation she was a workhorse all week. When it came picture time she had us surround her so no one would see her IV.

Nancy Natalie

We met Nancy Natalie in pre-op. She had already had her IV started and her eyes looked nervous. We asked her if she wanted to blow bubbles to entertain the crying babies who were also waiting for surgery.  She gladly took the bubbles with a sparkle in her eye and a smile that melted your heart. She was pleased as the babies were distracted and stopped crying.

The next time we saw Nancy Natalie was after her surgery in recovery. Her chest was sore where the rib graft had been harvested for her microtia surgery. She gave us a sweet smile despite the “dolor” (pain).  Her father had a quiet nurturing presence. Dad comforted her as we administered medicine and she slowly reached comfort.

Each morning we poked our head in the ward where Nancy Natalie stayed. Each day she looked a little better, first not getting out of bed, then sitting at her bed to eat breakfast, then out of PJs and in her clothes.

The last day of our work, Friday, we walked into the hallway adjacent to the ward and Nancy Natalie saw Becky and ran into her arms. Nancy Natalie hugged Becky, patted her back and softly said gracias, gracias, gracias. She would step away with a smile, then again hug and thank Becky over and over. Her dad gave a quiet nod. Muchas gracias.

We are praying that we meet again next year when she comes for her second stage repair.

One day we took care of a sweet two-year old girl who had had a cleft palate repair.  Her mom was comforting but like most children who have palate repairs, this little one was unhappy. Despite pain medication and mom’s presence, she was difficult to console and her bleeding difficult to control. She was taken back to the operating room to assess and treat the source of her bleeding.

Upon arrival to recovery she was reunited with her mother. Her bleeding had stopped and she was finally sleeping peacefully in her mom’s arms. Her mom began to cry and I asked the interpreter what was wrong. I interpreted that mom had told her that she didn’t know how she was going to pay us.

The interpreter said that I had misunderstood. “ Mom and her family do not know how they will ever repay you. They are so appreciative of everything you and the doctors and everyone have done for them. They will never, ever be able to repay you.”

So mom was crying, the interpreter started crying, I started crying and the 3 other recovery nurses started crying. Because of course no payment was due or necessary. This child will have a chance in life now – to smile, be happy and productive.

Denny Snyder, MD and Noah Siegel, MD (Dr. Siegel is pictured above)

Dear Dr. Snyder (“Denny”),

Becky and I started hearing about you as soon as we hit the ground in Guatemala City. We heard your name, what a force you are, how fun, inspirational, great leader, what a bummer you were not here this year, what a great surgeon, how this trip would have never started without you and most of all, what a good heart you have.

Well, Denny, you left the Antigua trip in capable hands. Dr. Noah Siegel, our team leader, would have made you proud.  This capable, talented surgeon nurtured everyone from colleagues to patients to parents (I believe he was a nurse in a previous life).

And the buck stopped with Noah. He took responsibility for all problems, questions or concerns.

The first day the OR ran longer than anticipated. This is rarely anyone’s “fault” and is a multifaceted problem that we deal with everyday at home. We took it in stride firstly because we had no expectations and secondly because we know that hospital time is different than real time. It is just the nature of the work. But Noah killed us with the saddest puppy dog eyes ever. He felt so bad for making us work later than he would have liked.

What Noah (and the entire OR staff) didn’t realize was that PACU had the best job. We had the privilege of witnessing the incredible expression of joy when the parents caught first sight of their child. The gifted talent of the surgeons, anesthesiology and OR staff were appreciated beyond words.

Noah had an appreciation for the work that everyone did. He looked outside his job and appreciated all roles. Noah validated what we did, no matter how small the task. Jon Kabat-Zinn describes how Noah treated us. Kabat-Zinn says “Most of us feel better when we are seen and met with authentic presence and regard, without condescension or contrived intimacy. We feel good when we are treated as capable, when we are related to as if we have the capacity to actually undertake the hardest work in the world, when a lot is being asked of us, but in ways that build on our own intrinsic capacities and intelligences.”

Noah led the ship with amazing humility and grace.  Everyone knew that all they had to do was concentrate on our job.  He made an incredibly hard task look easy.

So Denny and MMFC ………. well done.

N.B. – While in Antigua, Guatemala, MMFC screened over 100 children and performed 81 surgical procedures. Dr. Charles Badaoui and the MMFC dental team also provided care and treatment to 71 children and young adults. MMFC wishes to thank Smile Train, Jill and Darius Bikoff Foundation, Mary E. Fox, Dr. Robert Feinstein, Paul Sawler and the Lefkofsky Family Foundation for sponsoring this very successful mission.

MMFC Executive Director Sonia Pasters began her journey at MMFC as a volunteer in 2004. She has traveled on numerous missions during the last five years. Under her auspices, MMFC has significantly expanded its programs and deepened its impact on the global communities it serves. The number of annual missions has grown from 5 to 11-13. MMFC now has an established administrative office and medical storage space in Woburn, MA, with full time staff.  Sonia lives with her husband, Erik and their two boys, Evan, age 2 and Gaven, age 1, in Westford, Massachusetts. This September, she returned to Quito for the fourth time.

Dear Friends,

Quito, ah, Quito. It is a mission I know well, my home mission, as I would put it. This year was my fourth mission to Quito. I have taken a hiatus from traveling for the last two years as I have had babies of my own. We are finally out of the proverbial “woods” of my youngest’ first year and I felt the need and calling to start going on missions again. What better choice than to go home again.

Our team flew in over the familiar twinkling lights in the mountains of Quito and I couldn’t help but become excited at the events of the week to unfold. How many children would we screen tomorrow? How many surgeries could we do? How many lives could we help to heal?

I was greeted by familiar faces and new- all smiling and happy to be here in this city, on this mission, in this moment. I was warmed by the embraces of people I consider family, especially Mary Kay Dassum, who is a major driving force behind the success of this mission- and not just while we are here, but all year long.  Quito, ah, Quito.

Screening day- it is the most intense and sometimes chaotic day of the mission. There are families lining the long hallway to our screening room and they are spilled out and completely fill the large waiting room outside. As we walk by- I connect with parents and children alike- smiling and greeting, amazement in my head and heart that we are really here, we continue to be here, and we will be able to help many of these children this week.

Our team is ready to go and the screening process has begun. As each child sees the triage nurses, then surgery, then anesthesia, pediatrics, speech therapy and dental, I am deeply respectful of the relationship we have with Fundación Tierra Nueva, the people who help us year round, and our team. The organization is outstanding. It is a true testament to the long term commitment of both organizations to work together to help the children of this beautiful city.

I am helping however I am needed. I help guide patients through the organized chaos, run for equipment and supplies, help obtain needed translation, make sure our team is staying hydrated and well and I observe the evolving process of screening clinic. There are still lines, but everyone waits patiently. This process has come a long way.

I am taking a lot of pictures this time- the process is so smooth, I am afforded a small amount of luxury of trying to capture, impossibly, the magnitude of hope and bravery of these families, and the love and care of our team. I am trying my best.

Screening day ends with an enormous success and many, many children are scheduled for surgery this week. We have screened approximately 150 children today for surgery and dental procedures that will help to change their lives. We will not be able to work with every child, but we will be able to help many of them.

This is my first mission since becoming a mother – and I feel the difference.  When I look into the eyes of each parent, I can feel their hope and fear- and their bravery for coming- for trusting in our team to do what is best for their child. I am lost in the deep pools of their children’s eyes- the comfort they take in their parents’ arms amidst the noise and novelty of the scene here today.  I melt with their smiles, despite deformity and I ache when they cry.

Too often I think that I am caught up in the daily routine of my life, of schedules and sleep (or lack thereof), of work and traffic and everything else that takes over the minutes of my days. I pause and remember that the details of my work have a greater meaning and purpose. I see this in the face of a brave mother who has just given her child, crying and scared, to our anesthesiologist to go have surgery.

I am on a plane home now to my own babies. I have not come for the entire mission as I have to be back and work on our first four missions of the coming year and to maintain the operations of our organization. Our team is still now working hard, intense and rewarding hours at Fundación Tierra Nueva and I am proud. I am wishing I could have stayed. I know it will be a hugely successful week.

Warm Regards

Sonia Pasters

NB – Indeed, the entire Quito Mission was an enormous success. The surgical and dental teams were able to help heal 114 children and young adults.

Anne Bonner, RN has worked in an operating room for 28 years, first as a surgical technologist and then as a nurse.  She lives in Massachusetts and works at the Beth Israel Deaconess Medical Center (BIDMC) in Boston.  She has been a volunteer with Medical Missions for Children (MMFC) since 2002.  This was Anne’s first mission to Gitwe, Rwanda. Her observations are keen and the images she evokes with her words are vivid. Enjoy!

February 26

I am finishing my packing for the mission.  When I decided on this career path at age 18, I never dreamed it would take me to Africa!

February 27

We are leaving Logan Airport in Boston.  We will meet up with the rest of the team in Washington D.C. They are coming in from Stanford, California, Chicago IL and Saratoga Springs, N.Y. We will all fly out of the states together.  We are aware that in a little over a month, just after we return from a mission that we have just now begun, it will be the 15th anniversary of the genocide.  We feel humbled and honored to play a small role in the healing of Rwanda and its people.

March 1

After multiple plane rides (Boston to DC; DC to Italy; Italy to Ethiopia; and Ethiopia to Kigali, Rwanda) and a 2 1/2 hour van ride, we arrive in Gitwe.  The entire travel time door to door is just over 24 hours. Gitwe is a tiny and remote village – and as visitors we were noticed immediately and met with intense curiosity, even though most of our team has been here before. 

We went immediately to the hospital and I was surprised to see that it was a three story building.  When I entered the hospital, though, I realized that it was nothing like the health care facilities we have back home. I was shocked to see that the hospital pharmacy had less medication than most of us have in our medicine cabinets.  There was a laboratory technician, but he couldn’t always run basic blood tests because his equipment sometimes worked and sometimes didn’t.  The x-ray technician told me that until last year, when MMFC brought her one, he never had a lead apron. In Gitwe, it is strictly no frills.  Patients are brought to the O.R. by stretcher even when it is an emergency.  There are no IV poles. There are no big teams of medical personnel. When laundry needs to be washed at the hospital, it is hung on lines outside to dry.  Despite their limited resources, though, the nurses were proud of their work and eager to discuss issues such as how to prevent HIV transmission in newborns and methods of birth control.

March 3

It is a busy work day.  One young boy had a keloid (an overgrowth of tissue) over his left ear.  The keloid was the size of a small child’s fist.  He’s had it for an unknown length of time and one of surgeons, Dr. Craig Roberts was able to remove it in about 20 minutes.  This boy just stared in awe into a mirror in the recovery room. He couldn’t believe it was him.

Rwandans are friendly but not effusive in expressing their emotions.  A raised eyebrow or a handshake lets you know how deeply our presence is appreciated.   

I put up a piece of paper on the wall and asked the translators to write down words or phrases they think we can use.   I’ve learned how to say the word for yes, no and good morning.   I’m off to a good start.  

March 4

It is another busy work day.  One patient was a woman with a cleft lip who was between 40 and 50.  No one here knows for certain how old they are, let along what day of the year they were born. That is because in Rwanda, a person’s birth date is neither recognized nor celebrated, and so there is no reason to remember it.  It didn’t matter, though. She looked amazing after Dr. Denny Snyder operated and repaired her lip.   

I learned how to say “Do you have pain?” in Kinyarwanda. I’m getting the knack of this!

A group of children have taken to following us at the end of the day when we walk back to our host’s house.  The entire time they laugh with us and shout to us, “Give me a pen” and believe it or not, a pen or pencil really is a big deal for these children.  With it they can go to school, do the lessons and learn.  Without one, they can’t. It is as simple as that.

March 5

Samuel, a patient from yesterday, stopped by before going home to give us a note he wrote thanking MMFC.  A hug and a note and we’re happy.  

In the afternoon we give up the operating room to the local physicians so they can perform a C-section. While a number of C-sections are routinely performed here by local physicians, there is no neonatal unit.

March 7

It is a memorable day.  There is one patient who is a young woman around 20 years old who said she wanted to be a nurse.  Her mother told us how it broke her heart when she recently learned how badly her daughter had been taunted and isolated growing up.  She never knew because her daughter never told her.  She did not want to make her mother sad.  We had finished the surgical reparation on the daughter’s lip and repaired her cleft and when I stepped out of the O.R., I saw her mother in the hallway crying and staring at the recovery room door.  When she saw me, she pointed to the door and said “[t]hat’s my daughter”.  I said “I know. She is beautiful.” The mother hugged me and said “[n]ow others will see what I see.”  They certainly will.  

March 8

We are in our second week. After lectures, Dr. Snyder invites the hospital dentist and the medical students (many of whom serve as our translators) to observe and participate in the surgeries.  They are as eager to learn as we are to teach.

March 10

It is an extremely busy day.  The word has spread quickly that we are here.  Yesterday a man named Emmanuel came to us and we performed a cleft lip repair on him.  Today, a friend of Emmanuel’s came to us.  He told us that after Emmanuel had recovered from his own surgical procedure, he went straight home, found his friend and said to him “Don’t eat anything. Go straight to the hospital in Gitwe, they will fix your face like they did mine.”  It’s not always as simple as that but fortunately he listened and he was an eligible candidate for surgery. 

I learned how to count to ten in Kinyarwanda today.  

March 11

Vianney Ruhumuliza RN, an MMFC volunteer who now lives in Michigan, is originally from this part of Rwanda. So tonight, we had the pleasure of celebrating our few remaining nights in Rwanda at his parents’ home for dinner.  It was lovely.

March 12

This is our last working day here in Gitwe.  After finishing the last of our surgical cases in the morning, we pack our belongings.  We have brought with us some wonderful equipment that has been donated to the hospital and the rest of our supplies and equipment will either be stored at our host’s home, or brought back to the states with us to be used on our next mission.  Before heading home to the states tomorrow, we will spend our last night in Kigali, Rwanda. 

“Imana yirirwa ahandi igataha mu Rwanda.”

“God spends the day elsewhere, but sleeps in Rwanda.”

Rwandan Dictionary (Kinyarwanda-English)

Simran Kaur recently returned from Phalodi, Rajasthan, India where she provided administrative support to the MMFC surgical team. She resides in Fresno, California and manages the Patient Safety program at Children’s Hospital in Central California. Simran holds a Master’s Degree in Public Health and is pursuing a vocation in Global Health. We are excited to share Simran’s story.

Day One: Sunday January 25^th 2009

After traveling by plane for over 24 hours, we arrive in Rajasthan to be greeted by garlands of marigolds! At the airport we gather our luggage – medical equipment, toys, and clothes that have traveled alongside us.  The team is excited for the upcoming week – many have visited this site before but for some of us, including myself, this will be a first.

This mission is meaningful to me for many reasons.  India is where my parents were born and raised, so this mission brings me that much closer (geographically and emotionally) to my history.  Growing up speaking Punjabi, a North Indian language, it was a great privilege that I was able to use it to communicate with the patients and their families. I strongly believe that all of us in this world should have access to quality health care regardless of our financial means, and so I feel honored to be part of MMFC, an organization that espouses the same core value and makes a real difference in the lives of so many children.

As Claire, one of our nurses, notes – arriving in Rajasthan is like coming home!  And that’s exactly what it feels like.  Rajasthan is definitely one of India’s unearthed jewels and it’s easy to be struck by the contrast of colors between the sandy dunes and colorful saris. Everything is welcoming – the people, the sights, the smells, the sounds.

Screening Day: Monday January 26^th 2009

When we arrive at the hospital, the patients and their families are already waiting for us. In anticipation of our visit to Phalodi, our local site coordinator, Dr. Kanti Jain, and her team traveled into the surrounding communities to let families know about MMFC’s  upcoming visit. By doing so, Dr. Jain and her team were able to locate many children with cleft lips and palates and were able to educate their parents on the work of MMFC and our ability to correct their children’s deformities. What is also incredible about this site in Phalodi, Rajasthan is that patients are offered room and board at the hospital throughout the week – this type of support is incredibly valuable to our team and to the success of the mission. It allows MMFC to help more children from the most destitute and rural areas of Rajasthan.

Our screening process runs smoothly and we manage to schedule four surgeries for the same afternoon.  Our first day at the site also happens to fall on India’s Republic Day – and since we already feel like part of the family in Phalodi, we are invited to participate in a flag ceremony at the hospital.  It is a good feeling to be surrounded by our patients and to participate with them on this special day.

Mid Week

We continue to work efficiently and tirelessly during the week, but we are also reminded how challenging it is to provide medical care for an entire community in a developing country. Today, we had a problem with the oxygen tank making it almost impossible to run two beds simultaneously.  We were able to fix the problem, but not without delays and a bit of frustration.  The lesson, I think, is to accept the fact that when you are working in a developing country, not everything will go as planned.

Dr. Jain informed us that the operating room had not been used since our last visit here, a year ago. All the more reason it was a meaningful and fitting tribute when we dedicated the operating room to Mr. Alfred Z. Solomon, a benefactor, humanitarian and supporter of MMFC whose foundation helped to make our trip back to Phalodi possible.  We know the patients and their families are grateful to Mr. Solomon and his charitable organization.

End of Week: Friday January 30^th 2009

Our small team of ten is pleased that we have been able to complete 30 surgeries this week. At the end of the week, Dr. Jain and her team planned a wonderful reception to bring everyone together.  It was a wonderful way to end the week and Dr. Jain provided an opportunity for parents to share their thoughts with the team.  It was heartwarming to hear about the impact that we’d had not only on the patients but also on their parents.  One of the families in attendance had two daughters who had undergone corrective procedures last year for their cleft lip and palates.  This year, we treated their older brother.  It was amazing to see how an entire family was affected by our missions to Phalodi.  You can’t really describe such an impact.

The entire experience reminds me of a favorite quote of mine by Che Guevara, “Let the world change you, And you can change the world.”

Back Home

Upon returning to the US, I heard about an Oscar-nominated film called Smile Pinki that chronicles the story of eight-year-old Pinki and her journey from being a social outcast in her village in India – to her acceptance, and even deification, by her society.  Pinki was born with a cleft lip in an impoverished family and the first few years of her life were spent in abject unhappiness.  Pinki and her parents dealt with her stigmatization and wondered how she’d ever get married.  A few years ago, a plastic surgeon spotted Pinki and was able to perform surgery on her lip.  The film is about the change that came into Pinki’s life with this surgery and the transformation, not only physical, but an emotional transformation in this young girl’s life.  This film may be about Pinki – but as those of us who have been involved with MMFC know – there is a Pinki inside each and every one of our patients.  We do the work we do so that every child born with a devastating congenital deformity can have the same opportunity for a happy, healthy and productive life, just like Pinki.

One Month Later:

Congratulations Smile Pinki for winning Best Documentary Short at the Oscars! Our heartfelt appreciation goes out to Director Megan Mylan and Smile Train for telling the story of Pinki and for bringing awareness to the world of all the children who suffer from cleft lip and palate deformities and whose lives can be changed in such a beautiful way by a surgery that takes less than an hour to complete and costs approximately $250.00.

Antigua, Guatemala – January 3-10, 2009

Obras Sociales del Hermano Pedro Hospital

Dr. Adele Evans is a Pediatric Otolaryngologist who resides in Winston-Salem, NC with her physician husband Jerry, two- year old daughter Cora, and dog Grady.  She works at Brenner Children’s Hospital and is an assistant professor of Pediatric Otolaryngology – Head & Neck Surgery at Wake Forest University School of Medicine.  Adele began volunteering with Medical Missions for Children (“MMFC”) on the Antigua, Guatemala Mission in 2005 and returns annually.  She is grateful to all of her supporters and the donors who sponsor her annual mission.  These are some of her journal entries.

Pre-mission

It is a month before the mission to Guatemala but I am already preparing.  It is always difficult to think of leaving my family and especially my 2 year old daughter, Cora, for an entire week.  It is difficult, but there is never any question that I will go.  I grew up in a medical household, with a surgeon-father and a nurse-mother. My mother always taught us to take good care of our things and to pass them along when they could serve someone else.  In essence we were taught to share, whether that meant our material goods, or the skills we possess, or both.  Now that I am a mom, I want to teach my daughter the same simple but powerful lesson.  So I teach Cora to share by putting a quarter in the Salvation Army red-bucket at Christmastime and to send the toys she doesn’t need anymore to the babies in Guatemala. And I teach her to “share” her mom with other children in need when I go to Guatemala each year to share my skills as a surgeon.

Day 1: Travel

The vast majority of our team members arrive in Antigua from Guatemala City and the airport today. Our team is comprised of anesthesiologists and nurse-anesthetists from Boston, NYC, St. Louis and San Diego; nurses from Boston and NYC; otolaryngologists from Boston, NYC, Winston-Salem and San Diego, and support staff from Boston. All but two bags arrive as scheduled; the others are scheduled to follow tomorrow when the next daily flight from the US arrives.  We are all traveling with bags of supplies and equipment for the hospital and patients.  My bags are filled with gloves and sutures and instruments, and beanie babies collected by colleagues and staff.  Oh, and this year, I took Cora’s bear, named “Travel” with me. I plan on sending Cora photos all week of him: Travel in the airport, Travel in the hotel, Travel on the plane, Travel in the hospital!

We arrive at Porta Hotel, Antigua by 4:30pm and eat a quick dinner at MonoLoco, a local dining establishment.  It is an early night to bed for everyone.  We are all excited about the work ahead.

Day 2: Welcome

The Team went to the hospital first thing in the morning after a breakfast at the hotel. As usual, we received a truly generous and warm greeting from Dolores, the head RN who runs the operating rooms at Obras Sociales del Hermano Pedro Hospital. Dolores knows all too well our ability to keep working … and working …all day long and into the evening.  With a smile on her face, she asked us to please stick to the scheduled operating hours as much as possible  because the nurses and technical staff live “lejos de aqui,” “far from here” and need to be able to catch their buses and at a safe hour in the evening. 

Dolores also informed us of a new and exciting initiative at hospital. The Obras council has decided to establish an intermediate-care unit.  This intermediate-care unit would have 3 adult beds and 2 pediatric beds with some capabilities for short-term ventilation. It would be a tremendous benefit to the hospital and the surrounding community.  Great news!

 “Proximo! (Next!) How do I say it in K’iche’? Or Kekchi? Or is it Cakchiquel?”

Instead of proceeding with the usual tour, we offer to get started immediately. In 3.5 hours we screen over 90 patients, the vast majority of whom we are able to offer surgical treatment.  We see babies from 3 months old, who still weigh less than 10 lbs, to a man 47 years old. 

The most touching case today, the one that brought tears to the eyes of everyone around, was Deisy. She is an 11-year 6-month old girl no taller than a 7-year old child in the States. The anterior hard palate had a large cleft present and she had a marked nasal deformity, with her nasal septum practically lying flat across the floor of her nose. She entered the room with her hand over her mouth and stood in the center of our tiny exam area and began to cry.  I asked her father and grandfather, who had accompanied her, “Is she nervous?” And they said she was very nervous. I rubbed her back as I sat her down in a chair and told her we were going to help her and everything would be okay. We sat a few minutes as the others drew the curtain around our area to give her some privacy.

Deisy eventually calmed down and removed her hand, showing us what was bothering her the most… the teeth sticking forward and impossible to be covered by her lip. We decided to give her a full redo of the lip and augment it with mucco-buccal flaps, folds from other parts of her mouth to improve her lip size. And next year we will plan to completely redo her palate repair with repair of the naso-alveolar clefts that persist and even to repair her septum. By this time next year, the reason for her fear, shame and isolation will be on its way into a distant memory.  We will make sure that happens for her.  It is why we do what we do, Deisy and the thousands upon thousands of children like her.

The fruits of our labor become evident …                                                                                                                                                                                                                                   It is common for many patients to travel 8 hours to the hospital to be present on the day they know we are scheduled to arrive. What is different this year, in contrast to years past, is that parents are relaxed and smiling when they arrive. There is much less fear of the surgery and much less fear of the hospital. The parents have always been gracious at the end of the week, but there has been an underlying sense of fear and anxiety about what happens at the hospital. I attribute this change to the good work done at the hospital, to the hard work done by MMFC and to our repeated annual presence with a core of strong surgeons and medical support staff.  It is truly one of the things that sets MMFC apart and is a source of particular pride for all of us: we continue to return to our host sites and more importantly, to our patients, year after year after year.

As a result, our efforts are evident to all.   Our young patients, once ostracized and kept at home, are being sent to school now. Parents who speak Mayan dialects are learning Spanish and teaching it to the children to help them succeed professionally and academically. This is a new era here in old Guatemala. The families here are expressing excitement about the future. And they are starting to self-advocate. 

Day 5: Mid-week self assessment

We now have three days of operating behind us and two more to go. We are averaging 6.5 cases per room per day in each of the two cleft lip and palate rooms, and we are averaging 4 cases per day in the microtia room.  We have been able to accomplish some impressive primary surgeries in the younger children. Everyone is pleased!

Each day consists of heading to the hospital around 7am, rounding on the previous day’s surgical patients, and then getting changed into scrubs to start the new operative day. There is no heating or air conditioning; the hospital is a fresh-air facility and the climate here is perfect for it.  Temperatures are crisp and cool during the night and warm and comfortable by day.

The nurses, who are generally graduates of a 9^th grade education and 18-years old or older who have finished a clinical practice equivalent of a technical school, record the milk and formula intake of the babies. They administer the medicines with the moms. And each mom, who has stayed at the bedside, learns how to feed her child with “una heringa,” a syringe with a little rubber tip on the end.

The cleft-palate repair patients all have a rescue suture, running from their tongues forward and taped on the cheek. The safe and ready-to-go patients get their suture snipped and removed, and the patients are sent home with amoxicillin and Tylenol.

Back to Basic Needs

Yesterday, we had to make a difficult, but correct decision, to postpone surgery on an infant in need of a cleft lip repair.  She was nearly 4 months old, meeting the age requirements. But she weighed in at a mere 6 pounds, falling 4 pounds short of the general criteria for a safe surgical repair. This was sad for everyone, but the safe decision to make.  We had the infant evaluated at Obras by a nutritionist where she was admitted to the hospital for failure to thrive. At 4 months old and 6 pounds in weight, she is the size of a small newborn child in the States. She will receive nutritional supplementation which will hopefully increase her body weight to allow for the surgical repair later in the year when the next team arrives.

MMFC always seeks to address these issues on two levels.  First, what can we do for this patient right here and now, i.e. surgery; and what can we do to eradicate the underlying causes of the prevalence of these congenital deformities in this community, i.e. malnutrition and clean water.  MMFC continues to invest its resources on both fronts.

Final Day

Today is the last day.   I am sad to leave this little town even though I miss my daughter and family and am excited to see them again. But by now I understand that Antigua and the people who live here will be here next year when I return.  MMFC will return, and I will return.

Final Thoughts

The water is running in my bathroom back home in North Carolina.  I am thinking about the dirt-floor homes in Antigua and the little babies we treated.  My daughter is brushing her teeth.  I am thinking about the little babies and their teeth. And Cora says, holding her toothbrush in her hand, “Can we send these to them?” And I am shaken out of my memories and brought back to the present by her sweet voice.  I look at her, and say “What, Cora? What did you say?” And she looks up at me and answers, “Yes, let’s send these to the babies next time … the babies in Gua-te-ma-la, okay?”