Day 6: First Surgical Day

Monday, December 7, 2009 – Surgical Day One


51 new smiles were created today as the surgical portion of the mission began.

The day started at 5:30am with a wakeup call, breakfast, bus ride to the hospital and then a team meeting. We did a quick run through of what to expect and then headed to our stations. I assisted the OR team as a mock “central sterile” tech, teaching the local nurses proper sterile technique, cleaning and processing of instrumentation. I also had a lot of time to observe each surgery and learn more about each procedure and position a person plays in the OR. It was so enlightening!

Working in the OR’s here are much different than any OR in the US. However, it’s amazing what a team can do to pull together to “Make it work Doctor”! Thankfully I’ve experienced some time in foreign OR’s during my time in international marketing at Stryker a few years ago, so I felt somewhat prepared for what was to come. In all, there are 10 OR’s, eight of which are staffed with anesthesiologists and the other two for local anesthesia, which the surgeon administers and is typically utilized on older patients (over 16 years of age is the rule here). Each OR had a wall of windows, which allowed for a lot of natural light. Supplemental lights were brought as well. The team did their best to keep each area as clean as possible. However, the building is old and with the windows cracked to allow the anesthesia tubes to ventilate, it was a challenge. The autoclaves were primitive but the most important part was that they all worked!!!

The whole surgical process was amazing. Many of the young patients were quite scared coming in to the OR, as you can imagine. Leaving mom and dad – being carried off by a stranger who doesn’t look like you and then being surrounded by strange equipment and people wearing masks speaking a different language! I would be scared too! The child life specialist and the students were able to play with the kids beforehand and get them used to the surroundings, which I believe was a huge help!

Next, the anesthesiologist would go and get the patient from child life and bring them into the OR. They would then have a time out with the OR nurse from our team and discuss the chart. After everything was confirmed the patient was “put under” and prepared for surgery. Photos from various angles and measurements were taken of each and every patient for outcomes research and documentation. Now it was time for the magic to happen.

Less than one hour and a child’s life is forever changed! We had a great team of talented plastic surgeons with us, making each procedure look so easy! We began the day with cleft lip cases, which took about an hour each. In layman’s terms, this procedure is all soft tissue work; cutting and sometimes removing skin and muscle then “sewing” it back together in 3 layers. Cleft palates were at the end of the day and went very smoothly. It’s difficult to physically see the results since the surgical site in the mouth. Nonetheless, these kids are much better off. Their speech is bound to improve. The surgeons were assisted by the local scrub nurses. Education is very important on these missions, and the nurses were able to learn a lot from the team and the surgeons about how to do things!

The OR nurses are amazing and should never be taken for granted! They worked very hard to ensure each table was run smoothly, most running 3 tables at a time. The OR nurse was responsible for getting items, such as suture, instruments, gauze, etc for the surgeon. Some of these items are given (on missions) on an as needed basis. They would open the packages on the mayo stand (table the surgical nurses used to hold their instruments) in a sterile manner. For anyone that’s been in an OR, you know how important sterility is. Be nice to the OR nurse!

After the surgery is complete, the patient is woken up and vitals are monitored by the anesthesiologist. Once the patient is stabilized on their own, they are transported to the Recovery or PACU (post anesthesia care unit) room. It’s here that patients are monitored, vitals are taken, meds are given and more importantly, where mom and dad get to see their children for the first time! The smiles on their faces were precious. Many of them seemed stunned and speechless while others were a bit nervous. They’d never seen their baby with stitches and half awake. The recovery room staff was fantastic, ensuring all the patients were well cared for and monitored during the first minutes after surgery.

Once the patients have recovered they are transferred to the post-operative room with their families. They are given fluids and continue to be closely monitored for any problems. Parents were closing holding their child next to them and couldn’t seem to take their eyes of the new smile before them. All patients and their families will spend the night at the hospital and will be discharged tomorrow morning. Did I mention that all the families are staying on one twin sized bed with about 1 foot of space between them and the next family? And we complain about sharing rooms!

The adult patients are taken care of as well and looked amazing! Babies may pull on the heartstrings, but hearing their reaction made me think again. A 22 year old man said after looking in the mirror, “Now I can get married”. Another 18 year old had never been out of his house, not even for school, before coming for screening because his family was ashamed of his cleft lip. Now he will be able to explore the new world available to him. Talk about impact!

We headed back to the hotel at 8:30pm for a quick dinner and bed while the post-op night team will monitor the patients until 7am tomorrow when we arrive back at the hospital.

It was another amazing day and so fantastic to see everyone’s skills put to work. This is better than any gift – the gift of a smile and new opportunity. The best part is, we get to do it all over again tomorrow for another 50 patients!