Friday, September 30, 2011

El Salvador, part 4- Alegria and Adios

This is Leila, one of the OR nurses.
"This is the only cutting I do!"
Like everyone who was on the trip she's basically awesome-- super nice and really good at her job and obviously cares a lot about what she does.

Leila is also from El Salvador. She grew up in a little village called Alegria. She left when she was very young and hadn't been back for years. She was the one who knew how to eat the interesting local fruits the Ladies of Pediatrics Association brought us for snacks. She also spoke to the patients and I think talking to her helped them feel calmer before their surgeries. She talked to the local doctors and staff members and they would always get all excited when they heard she was from El Salvador.

Our last day in the hospital was Friday. We did rounds and saw all the patients, the doctors changed some casts, the nurses packed up all the equipment, and I went over the care plans for all the patients with one of the our doctors and one of the local doctors. After this we headed to the bus.
We would be flying out on Saturday afternoon so we had about 24 hours to get some R&R at a little beach hotel near the airport.

But! As a surprise, we stopped in Alegria for lunch on our way.
It is a very sweet little town, apparently the flower capital of El Salvador.
We had lunch.
And checked out the restaurant grounds.
There were lots of flowers and also birds.
Including cages that held one rooster by itself as far as the eye could see (so draw your own conclusions about that).

We only had about 30 minutes to explore the actual town of Alegria so Leila took us on a little mini tour and showed us her old school.
Then we walked down the road...
... to Leila's old house!
She used to live there with her grandmother and her grandmother's sister. "We used to have a bench here out front," Leila told us, "and lots of flowers."

We walked around her neighborhood for awhile. It looked like many of the houses on Leila's old street had been boarded up and there weren't many people around.
On our way back into the main square of town we passed by a little house where some people were sitting out front, including a little old woman. Leila called hello to the people and asked if they had known a woman named Gloria Lopez (her grandmother).
The little old woman sitting on the porch squinted at Leila for a moment, then she jumped to her feet and ran down the steps, crying out "Leila!" She reached Leila and grabbed her arm, holding hands with her, hugging her, "Leila Leila Leila!"  She remembered Leila from when she was a little girl; she had been one of her neighbors. Soon the two of them were hugging and crying.
All of us who were watching were crying too.

The woman asked if Leila could stay for a little while but we had to leave. The coordinators wanted us to travel by day, especially since we had a police escort.
El Salvador: Two Thumbs Up

We headed off for the coast, where my dad announced "Drinks are on the docs tonight!"

We only had one day there, one day left in El Salvador, so we wanted to make the most of it. Some of us got up veeery early to watch the sunrise.

But apparently not quite early enough...
Ah well. We still managed to do lots of lounging around and having fun on our last day.
And then we had to go.

I said goodbye to El Salvador.
I said goodbye to the sun and the beach and the heat and the people and the piece of my heart that would stay there.
And I made a wish to be able to go back someday.

Thursday, September 29, 2011

El Salvador, part 3- People

News Flash- The people in El Salvador! They were nice! Shocking, I know.

As I've mentioned, the people on the mission with Operati0n Rainb0w were all volunteers who spent their own money and used their vacation time to come on this trip. They were all incredibly hard working people who were very good at their jobs. The surgeons performed complicated, difficult surgeries and they did it with about half the tools they were used to and they often creatively manipulated the equipment they did have in order to make it work for our particular cases.
That's a lot of plates and pins, yo.
The OR nurses worked side by side with the surgeons, on their feet allllll day lonnnng, handing them equipment, keeping instrument counts (to make sure nothing got left inside the patients), prepping the patients for surgery, getting the cast materials ready, and probably a hundred other things I didn't see.
The anesthesiologists were also in the OR all day long, giving the patients (you guessed it) anesthesia required for surgery. They would also manage some patients' pain with epidurals.
The recovery room nurses took care of the patients after surgery, making sure their vital signs were okay and that they woke up from anesthesia, and then discharging them to their hospital floor.
The physical therapist went around to all the patients post operatively and taught them exercises or how to walk with crutches or a cast shoe.
The translators ran around between everyone, helping the doctors assess patients on clinic day, helping the patients ask questions, telling them not to eat before surgery, going with me up to the floors to see the postop patients and give them discharge instructions, and helping the PT give them exercise instructions.
Notice she's wearing scrubs and a gown? That's because she also had to be in the OR and the preop waiting room. And the recovery room. All the rooms, pretty much.
The medical equipment preparer cleaned and sterilized and re-packaged up the surgical tools over and over again all day long. We used almost exclusively tools that we had brought with us and there was a two hour turnaround time for steam sterilization of equipment, which meant the surgeries had to be scheduled in such a way that all 3 ORs had enough of the proper equipment at the right times.
... Which leads me to the coordinators. One of them was an Operati0n Rainb0w employee and she worked tirelessly to coordinate the whole trip. She worked with the El Salvadorian government to allow us to be there, she coordinated with the hospital to let us use their ORs and their X ray machines, she kept us on schedule and on time and dealt with the hundreds of other things that came up along the way.
She also saw a lot of the postop patients with me, kept a master list of them, and printed out the final copy of instructions that I made with one of the docs.
There was another coordinator who was also an OR nurse so I didn't see her much during the days, but I know that she was in charge of packing all of the equipment we brought-- ALL the tools, the surgical instruments, the drugs, the drapes, the cast materials, the saw, the drill, and on and on and on. Everything was packed into thirty giant duffel bags which were labeled and listed for contents. These two coordinators (plus my dad) also came up with the final OR schedule that allowed the team to perform 42 surgeries in four days. That's... pretty awesome.

But the Operati0n Rainb0w team wasn't the only group of people in the OR area. The El Salvadorian doctors and nurses were there, too. They worked alongside our team, assisting the surgeons, helping coordinate and find equipment, and learning as much as our doctors could teach them. Our being there created lots of extra work for them and they didn't get paid any overtime.
The director of the hospital gave gave us permission to use three ORs and gave us priority use of the surgical sterilizing equipment. The surgical director took on the responsibility of following up with all 42 patients after were were gone.
The Ladies of Pediatrics Association is a group that runs a cafe in San Miguel to donate money to the pediatrics and they volunteered to host us while we were in the hospital. They cooked our lunches at home and brought them to us in the hospital. They made sure our fridge was stocked with water, gatorade, and sodas, and they also brought us snacks like pupusas and pandulces every few hours.
We gave them flowers.
And at the end of the week they threw us a party.
We walked in and thought we were in the wrong room-- it looked like a wedding or something. There was a live band and dancing and lots of speeches and the Ladies of Pediatrics Association gave us all certificates and gifts (El Salvador tee shirts!).
They demonstrated a traditional El Salvadorian dance.
Everyone was so nice to us. So nice and grateful and kind and sincere. I seriously can't find enough words to get this across. I was most amazed by our patients. They were so quiet and stoic and, well, patient. Throughout the day I would go around around to the different rooms and see all the postop patients. I would make sure they knew their care plans and when they would be discharged, that their pain was relatively controlled, and that they had seen PT if they needed to. The patients came from far and wide to see our surgeons. One even rode in on the back of a coffee truck. They never complained. Not when the waited all day long to find out the surgery schedule. Not when they waited all day for surgery. Not when they woke up from surgery in pain, with a giant cast.
There seemed to be no middle ground for their pain. They would be stoic stoic stoic and not complain once until the pain became unbearable and then they would cry. And then they would lay quietly grimacing with tears streaming down their faces until I noticed and offered them medication. They never demanded anything, never even asked. If there was pain medicine they would take it, but if not? They would grit their teeth and wait it out.

When we were leaving everyone thanked us again and again and gave us hugs and took photos with us.

"Will you come back next year?" they asked, "Please?"
"We will try."

Thursday, September 15, 2011

El Salvador, part 2- Patients

Seeing the patients in El Salvador was an intense experience.

There was the three day old baby with a dislocated shoulder.
There was the young man with some kind of growth problem whose radius bone stuck out an inch or so past his humerus in his elbow and his left knee bent the wrong direction.
There was a girl with bone tumors, a girl with bowed legs from Rickets, a baby with club feet, a man with shattered bones in both his legs. These people we could help.
But for every surgery performed I'm sure there were dozens more who needed help. It was completely overwhelming at times.
There were people who needed prosthetic hips or knees, which we didn't have.
There were children who would need surgery in a year or two years instead of right now because their bones needed to grow more.
There was the young girl with little turned in feet who couldn't get an operation because the skin on her feet was too fragile and the risk of infection too great.
We had our big clinic day on Sunday but throughout the week as word spread more people would come and knock on the OR doors or wait in the preop waiting area just for the possibility of being seen. Our schedule was completely booked but the surgeons still managed to find time to see the extra patients. When a worried mother shows up at the OR doors and begs you to look at her child's feet you look at her child's feet, even if you're completely booked and pulling 18 hour days. You just do it.

There was one young girl, about 15 years old, who had surgery on both her legs (for bone tumors). She was in pain and she was also very anxious the first day after surgery so we gave her some Valium and Tylenol with Codeine. The next day she felt better so the PT decided to get her up to walk. She started feeling dizzy so I asked her (with the help of a translator, of course) if she had been drinking water. She said she hadn't. I gestured to her three quarters empty water bottle and encouraged her to drink it. She said okay she would but still looked... doubtful or something. The translator pulled me aside and said "I just realized something-- I think the patients have to pay for their water. She probably doesn't have any more so she's conserving it."
OH MY GOD it it stuff like this that just makes me want to lie down on the ground and weep or start handing out money or SOMETHING I don't know. It was 95 degrees and the patient rooms were 6 to 8 beds with people lying drenched in sweat, fanning their faces and swatting the flies away.
We went downstairs and brought the girl four icy cold bottles of water from our stash in the OR area.

There was a little girl who came to our clinic day wearing a party dress. Her hip joint was frozen. It might look in this photo like she is standing up straight but I can assure you she is not.
Do me a favor, would you? Stand up and bend one hip joint 90 degrees. Now try to walk. It was a little different for this girl because she was a child so her locked bent leg didn't have as far to reach as a full adult leg, but basically she walked with her rear end sticking out and her spine all curved. And a very determined look on her sweet little face. This little girl and her mother had been brought to our clinic by an El Salvadorian missionary who was working to bring people from "very far away" so they could get medical care. I never learned exactly how far they had come, but the little girl had been born on an island somewhere so I suspect it was far.
After the surgery the little girl was put in a cast that went up her whole leg all the way to her waist (a Spica cast, it is called, but I couldn't find a good link). She was discharged from the hospital two days later (after her pain was under control and to make sure she didn't have any surgery complications) and her mother had a lot of questions. I told the mother I would go get the surgeon and he would come talk to her. When I returned with the surgeon, the little girl was wearing another party dress.
Her mother had gotten her dressed up to see the doctor.

There was a little girl who had suffered from Rickets and had bowed femur bones as a result. The surgeons straightened her bones out and put her in casts. When I saw her up in the post op pediatric ward she had tears streaming down her face, she was in so much pain.
It might look like she's smiling in this pic, but she definitely had tears in her eyes.
We found out from the nurses that she had received only Ibuprofen the night before so I gave her a dose of my new best friend, Tylenol with Codeine, then and came back throughout the day for subsequent doses. "Of course she's in pain," my dad told me when I updated him about this patient. "She had major surgery on both femurs. Imagine having a toothache in both your legs."
Oh, I see. MISERY.
Because she was in so much pain, the surgeons came to her room and split her cast (sawed up both sides of her legs and wrapped the casts with bandages so they weren't so tight) and then when she was still in severe pain they took her back to the OR and recasted her. She felt MUCH better after the recasting.
Sitting up and smiling and ready to go home.

We couldn't help everyone but we helped those we could.
That little footsie? Belongs to the girl in the photo below:
She couldn't walk before. And now she will.