Going home

8:30 p.m. Sunday: The Rotaplast team landed in San Francisco, or other cities around the US, a few hours ago. I stayed on in Guatemala to accompany Sulamita back home in the highlands. Dennis Bourassa, our independent filmmaker, Dr. Sibrand Schepel, the surgeon from The Netherlands who performed the miraculous work on Sulamita and I drove her and her father and aunt on the seven hour journey back home.

She had actually gone home following her surgery but returned Saturday for the post op clinic. This was no small effort. Sulamita and her family live about 45 minutes from the nearest town with a bus. They got up early enough to catch a 1:00 a.m. bus in the town for the six hour ride, in order to arrive for the clinic in Guatelmala City. Following the clinic, six of us crammed into Dennis´rented mini Chevy for the seven hour drive back home.

Needless to say, Sulamita, her father and aunt were pretty tired and slept a good part of the way back home. When we were close enough for Sulamita to recognize her part of the world, her faced brightened and she was back in her environment.

Please check back in the next few days and I´ll have some photos and an account of her world.

Guatemalans Helping Guatemalans

8:00 p.m. Thursday: Social safety net is not a term that has meaning in Guatemala. Most children who are born with a cleft lip and/or palate would suffer their whole life if it weren’t for organizations like Rotaplast. I feel compelled, however, to highlight that this mission to Guatemala City would not be possible without the outpouring of generosity and support from the Club Rotario Guatemala de la Asunción and the local community.¨

Jeannette Umaña began preparing for our mission last September, securing dates with the Minister of Defense for use of the hospital and working with Guatemala’s School of Plastic Surgery and Medical School to receive accreditation for our medical team.

The 41 member club holds a jewelry bingo fundraiser to provide over $20,000 toward meals and lodging for more than 100 children and their families. One parent stays with their child the night before and after the surgery and the Rotary club provides a hotel room for the rest of the family who has traveled with them. For the Rotaplast team, breakfast and dinner are provided at the hotel and a caterer brings lunch to the hospital.

Non-cash donations are even more impressive. The owner of the Grand Tikal Futura Hotel donates rooms for the Rotaplast team. Television, radio and newspaper companies donate ads and run news stories to alert families around the country about the clinic. The value of services provided by the hospital exceeds $30,000. At least five local Rotary volunteers are at the hospital each day to assist with administrative duties, patient coordination, providing meals for the families and local arrangements.

Generous contributions from clubs in northern California Rotary District 5130 provide about $48,000 toward the mission. The nonmedical volunteers are also from the district. Rotaplast organizes the highly specialized doctors, nurses and dentist who all volunteer their services. Our team comes from all over the United States and several other countries.

This year is the seventh mission our Rotary district has been able to stage in Guatemala. They have been so successful because, in addition to all that our district provides, more than $100,000 of cash, goods and services are contributed by Guatemalans who truly care about their own children.

2:00 p.m. Tuesday: Flor Maria’s puckish smile was impossible to resist. We traded teasing glances as I looked over from my desk in the pre-op room. Flor Maria spoke little because of her cleft palate, but her expressive face really spoke to me. Her wait in pre-op was long enough for us to have some fun. At one point I went over, she was sitting cross-legged on her bed and I gave her a high-five. It was still another 30 minutes before the anesthesiologist arrived to take her away from her father and into surgery. Twelve year old Flor Maria walked bravely away, hand-in-hand with the doctor. As she passed near me, she stopped, looked up, smiled and threw her arm up to give me a high-five.

Sumalita

4:15 p.m. Tuesday: Dennis Bourassa is an independent filmmaker who is documenting our mission. He arrived two weeks prior to the medical team and drove around the country interviewing children who were planning to come to the clinic. On a six hour drive from Guatemala City, the last hour on dirt, he met 2 ½ year old Sulamita, her parents and six siblings. Sulamita suffers from a bi-lateral cleft lip and cleft palate, but in every other way she is a spunky member of the family.

The family lives in the country, an hour’s drive from the nearest village, although they don’t own a car. They are subsistence farmers growing corn and beans and raising chickens. All work is done by hand as the family owns no tractors, horses or oxen. Mom spins her own yarn and grandma weaves their clothing on a loom.

Sulamita charms everyone who comes in contact with her. A friend learned about our mission on television and Dennis drove the family to the city. The surgery performed by Dr. Schepel is an amazing achievement. When Sulamita’s father first held her following surgery, he lowered his head and quietly wept.

Sumalita before and after surgery

A Rotaplast Vignette

12:30 p.m. Monday: Our 29 member Rotaplast team is becoming well-known to the attentive staff of the Grand Futura Tikal, a Hyatt Regency-style luxury hotel complete with 10-story atrium and glass elevators, so generously donated by our Rotary hosts. Fabiola greets us as we enter the breakfast buffet. She had noticed us bringing in toys for the Rotaplast children when we checked in, so when recovery room nurse Jackie Arata arrived today she asked her where the toys had come from. “We brought them all with us from the U.S.”

Fabiola replied, “Oh,” then paused. Jackie asked if she wanted one. “No, I know the work you are doing. My children have so many toys already, I just wondered if I could give you some for your children.” Then they both cried.

Today I Saw A Miracle

11:00 a.m. Monday: Gloria Esmeralda Elias has bright, black eyes that will catch your attention from across a room. With a tuft of hair tied straight up on the top her head, she was one of the unforgettable “way too cute” kids that came through my photo station on Thursday. On Friday, I wrote this paragraph about Gloria and her family as they awaited her surgery near me in the pre-op room:

Gloria, a 20 month old sweetheart who is completely missing the center of her upper lip, is wearing a skirt of traditional woven fabric. Blues, yellow and green in random patterns. Her dad scoops her up, gently rocking her as he shuffles near the crib. Mom, dressed in a similar skirt, sits looking through the doorway into the recovery room. Within one or two hours Gloria will have a new lip and be able to close her mouth for the first time.

This morning, I stopped at the pediatric ward to greet the children who had arrived last night in preparation for today’s surgeries. Gloria and her family had just been cleared by the pediatrician to go home, after spending an extra two days in the hospital due to respiratory complications. Without her top knot and now with a fully closed lip, I didn’t associate her with the little girl who had captured my heart a few days earlier. I jotted her name and chart number in my notebook so I could retrieve her “before” photo. The change was stunning.

I called doctors, nurses, other team members, anyone who was nearby to come and see the photos. The doctors pointed out that she still has a long way to go. Judging from the smiles on Gloria’s family, I think that didn’t really matter on this day.

Our Rotaplast Mission Team

5:45 a.m. Monday: Following early morning rounds at the hospital, Sunday, our team assembled for our group photo then had a day off to visit Antigua. We explored the cobblestone streets of the colonial capital, shopped and rested. We were treated to an afternoon garden party hosted by the local Rotarians who really make this mission possible with their financial and volunteer help. The Ballet Folklorico de Guatemala entertained us with native dances in gorgeous costumes.

Now it's time for a quick breakfast so I can catch the 6:15 bus and greet the families before the first surgeries of the morning.

Blanca's Story

Hey, that’s my patient. As we walked toward the hospital entrance this morning, Dr. Schepel immediately recognized the baby from Wednesday’s check-in, now cradled in the arms of his sobbing mother. I can’t afford the medicine for my son and he’s not going to be able to have the operation. Oh yes you can, we all thought. We weren’t going to let a few dollars worth of antibiotics deprive the boy of his life altering surgery. Besides, Rotaplast already provides follow-up meds. There was more to the story.

Through Blanca’s tears we heard that her mother had just died yesterday, she has five more children at home and she and her husband have no money to take their son back there. We went inside to see what we could do. I learned that her son, Jesus, has scabies and was scratched from the surgery schedule. Rotary volunteers paid for the scabies medication and also provided bus fare for them.

I told a few other team members about the family’s misfortunes and a surgeon who overheard me said that scabies is really not a problem that would stop him from doing surgery. I was concerned there had been some miscommunication. Did the pediatrician know that? Was the family still here?

Feeling conflicted about getting involved in medical decisions, I went down to pediatrics to find out if there was yet more to the story. As if the family didn’t have enough problems already, it turned out that Jesus is also suffering from severe anemia and that’s why the surgery was cancelled.

The good news is that another cleft lip and palate clinic is scheduled for Antigua in July. Blanca told me it’s a six hour journey to get there. They have to walk from their home to catch an early enough bus to bring them back to Guatemala City, then catch another one to Antigua. I only hope there’s enough money for Jesus to get the food he needs to build up his iron.

In just about an hour, Carmen-Alicia's smile will be as beautiful as her eyes.

Mom waiting for her daughter to wake up in recovery.

Dr. Schepel from the Netherlands and his surgical team.

Here's one young man who is definitely ready for his operation.

Dr. Solis, Guatemalan surgeon, and his team in action.

Dr. Johnson explaining how the surgery will go to the mom.

Tom Andrews, ward coordinator, catching some z's during a long day.

In recovery following surgery.

At the end of the first day, this mother is waiting to hear if her daughter will be admitted to receive an operation.

Mother and daughter waiting to enter the pre-op clinic on the first day.

First day of surgeries

12:05 p.m. Friday: The pea green-tiled walls of the surgical suites have been filled since morning. More families continue to arrive today, hoping we can somehow make room for them, too.

Getting to hospital from our hotel is an education in patience. The streets of Guatemala City are mere inches from total gridlock. I was sitting in the front seat of the van, chatting with our driver, rapidly using up all the Spanish I could muster. How long do you think it’s going to take us to get through this intersection? Five minutes, he answers, without a trace of assurance. It took ten, likely because the traffic cop was standing over on the sidewalk, staring off into the smoggy haze.

Once we finally arrived, all 29 members of our team donned their scrubs and spread to their assigned posts to begin performing miracles. I’m ensconced in the corner of the pre-op room, sharing a rickety plastic picnic table with the medical records. I look over my left shoulder to three blue metal cribs. The children are spending their last minutes before surgery more in the reassuring arms of their parents than in the beds.

Gloria, a 20 month old sweetheart who is completely missing the center of her upper lip, is wearing a skirt of traditional woven fabric. Blues, yellow and green in random patterns. Her dad scoops her up, gently rocking her as he shuffles near the crib. Mom, dressed in a similar skirt, sits looking through the doorway into the recovery room. Within one or two hours Gloria will have a new lip and be able to close her mouth for the first time.

Nelson, a tall blonde 14 year old, lies on his bed eyeing the surgical leggings covering his feet and legs up to his knees. Two month old Elisa is wheeled in and is clearly letting us know that she is the least happy person to be in here.

5:20 p.m. Friday: Two more children are still awaiting their turns in surgery. The team has hours to go before the last will be out of recovery. A local Rotary volunteer steps in bearing a heft tray of thick, nut-covered chocolate brownies. Despite the rule against food in the OR area, we are all offered a late afternoon pick-me-up. Nelson’s parents savor their brownies; no such luck for him, minutes before surgery. His good fortune will come in about an hour.

Mission director Frank Leake just stepped in to us know that the first bus will leave for the hotel at about 8:00. He’s requesting that the hotel restaurant stays open for us. There’s no estimate for how late the second bus will be.

Pre-op clinic

4:00 a.m. Friday: The view from the sixth floor window of the Grand Futura Tikal Hotel is one of silence and scattered street lights. Neither bird songs nor diesel break through the high-rise of our change of venue. Only the hum of the air conditioning that belies the awakening chaos in the predawn. Through the sheer curtains of our luxury, the double rows of razor wire encircling the tops of lesser buildings below are unseen. As unseen as the children who shyly turn their heads to hide the gaps in their lips.

Yesterday by 7:30, 137 of them were already assembled outside of the Centro Medico Militar Hospital, some sleeping in slings of colorful native fabric, others standing close by their parents, all patiently waiting with hopeful eyes for the chance to change their lives.

First stop upon entering the building was medical records to get vitals before heading to pre-op surgical screening. A surgeon, anesthesiologist, nurse and interpreter evaluated each child. Those who have not had any previous surgery are given priority, with safety and the likelihood of a quality outcome as additional factors.

The child’s general health is evaluated by a pediatrician who can overrule the surgical screening if there is too great a risk to withstand surgery. Vital signs are recorded, including weight, a critical factor for pediatric anesthesia. A three year old boy was so happy to be there he was running around, clapping and singing.

The older kids who have been living with their clefts into the always difficult teen years were shyer, a bit intimidated, but excited to be getting their smile. One young man who sells flowers has lived his sixteen years without any previous repair for his lip, a surgery that can be done as early as at two months. He is now beyond the age for palate repair because his father wouldn’t let him have the operation. God made him that way.

Finally, all children received a dental evaluation followed by the photo station. By the time they reached me for their chart portrait, many of the babies were sound asleep. The older ones stood proudly with their arms straight down at their sides. By the end of the day, 101 children had green dots on their charts, approving them for surgery and nine more had provisional blue dots. Fifteen surgeries are scheduled for today.

A large banner at the entrance to the sprawling hospital grounds welcomes our Rotaplast mission. Dr. Francisco Javier is president of the Club Rotario Guatemala de la Asunción that has very generously provided our accommodations, meals and transportation. Two local television stations were here, interviewing local surgeon and Rotarian, Dr. Milton Solis. The Rotary club ran advertisements in the local newspaper to spread the word about the mission. Several moms told me they heard about it on Telemundo, local TV.

Arrival

5:00 a.m. Guatemala City: The roar of diesel is just getting underway in the city, drowning out a chorus of birds in a nearby tree who are singing their hearts out, no doubt ecstatic over the arrival of our band of 39 physicians, nurses and non-medical volunteers. At this moment there are about 250 children and their families beginning to assemble on the grounds of the military hospital awaiting our arrival this morning to begin the process of interviewing and deciding on which lucky ones will qualify for the miracles we are anxious to offer.

Our travel day, yesterday, was a bit of organized chaos as we transported 35 unwieldy cardboard cubes of medical equipment, each weighing up to 70 pounds, through check-in at San Francisco and finally onto the awaiting truck late last night in Guatemala. We were met by our Rotarian hosts who, with extraordinary ease and efficiency, transported us to our hotels.

We are meeting this morning at 7:30 for a formal greeting ceremony, then we get down to work. We can hardly wait…

Welcome from our Mission Director

Welcome teammates to the 7th annual Guatemala City Rotaplast mission.

Thank you for donating your time and valued efforts to this worthy humanitarian endeavor. High praise and a BIG thank you to our Rotary partners, Club Rotario de la Ascensión of Guatemala City who have done much of the heavy "lifting" over these many years of service above self!

Well over 500 children have received multiple operations for cleft lip/palate defects, along with genetic counseling, lab analysis and case prevention at no cost. Our District-5130 has formed strong bonds of friendship with the local community that we highly value. We look forward to another successful mission with their help. Thanks for sharing our passion.

In these troubled times of war and religious conflict, projects such as these may be the best outreach between different cultures and other countries.

Yours in Rotary service, Frank Leake, Mission Director

Introduction from our Medical Director

Rotaplast Team members Guatemala City 2007,

We will soon meet in Guatemala City to start our 2007 Rotaplast project. Previous teams have done a wonderful job there and their experience will make it easier for us to organize our team and accomplish as much as possible in helping the poor children of Guatemala who have congenital deformities. I am very pleased to see experienced people returning to volunteer their time and effort in order to make this project a success and particularly want to thank those of you making your first trip. We will be working in the Military Hospital which has been used on several previous Rotaplast projects. It is an excellent facility and the staff has always provided enthusiastic support.

The local support has been the best that I have experienced. Jeannette Umana is again in charge of local arrangements and support and has had extensive experience working with Rotaplast teams, providing unbelievable help with her team of volunteers. I have worked with six organizations over many years and have found that the Rotaplast model has been by far the best that I have experienced. We again have a complete team where every member will have a vital role in the success of the project.
We can all expect long hours of hard work but the satisfaction for a job well done should be a special reward for each of us. I'll never forget the father of child bringing tears to our eyes when he told us "God will pay you".

We are fortunate to have Milton Solis on our team. He is an exceptional Guatemalan plastic surgeon with excellent training and extensive experience in repair of cleft lips and palates. He is a veteran of our previous trips to his country and has been critical to the smooth operation of Rotaplast in Guatemala. Frank Leake has been a member of all the previous Guatemala City teams and his experience as the director will be a great help. Ann Bailey is perhaps the most important member of our team. Ann is an experienced pediatric anesthesthiologist who improves everyone's performance by making every procedure with a small infant safer.

I recently had a long conversation with Diane Mahan, who was head nurse in Guatemala City last year and will have the same role with the team this year. Her experience and enthusiasm have made me eager to get started. There inevitably will be some confusion during our screening of patients and the initial organizing of the team, but I expect that we will be able to keep it to a minimum and, with everyone working together, this should be a project of which we can all be proud.

I'm looking forward to meeting all of you on the 18th and want to thank each of you for volunteering.

Frank Virnelli
Medical Director

Greetings from your photojournalist

I’m Jerry Meshulam and I’ll be chronicling in photographs and words the Rotaplast mission to Guatemala, April 18-29, 2007. I’ve created this blog so I can post during the mission for friends, family and all mission supporters to follow along with the incredible work we’ll be doing at the Centro Medico Militar Hospital, Guatemala City.

Although this is my first Rotaplast mission, I’ve been meeting with Mission Director Frank Leake and other volunteers, many well-seasoned, for the last seven months. I’m really getting excited now. Sharon Landon, last year’s photojournalist, captured amazing images showing a full range of emotions - apprehension, contemplation, fear, joy, love, elation to name a just a few. I’ll be watching for decisive moments to document this year’s experiences.

Participating in this mission also has a deeply personal aspect for me. I am fortunate to have had early medical intervention for my own cleft lip and palate, but I still have a sensitivity to the psychological issues faced by the children we’ll meet. When I see photographs from previous missions, I feel like I am every one of those children. My goal is to reach out to each of them and their parents, even if just through a comforting smile. I’ve been searching for ways to make that connection and I’m grateful Rotaplast is providing this opportunity.

About Rotaplast

BUILDING BRIDGES OF PEACE THROUGH SMILES AROUND THE WORLD SINCE 1992

OUR VISION

The goal of Rotaplast International is to eliminate the incidence of untreated cleft lips and palates in children worldwide by the year 2025. Rotaplast will employ the following strategies to reach this goal:

Facilitate medical missions to provide surgical intervention for children who are not able to receive treatment or who are in need of more complicated medical procedures than can be provided by local physicians.

Counsel families about ways of reducing the incidence cleft palate anomalies through diet, vitamin supplementation, and life style changes.

Collaborate with local health professionals on follow-up care and on development of comprehensive cleft palate programs where feasible.

Learn about the incidence and causes of cleft lip and palate anomalies, including both genetic and environmental factors.

Educate local physicians and specialists by urging them to work with our teams to broaden their skills in treating cleft anomalies.

Foster international goodwill and fellowship by working with Rotarians as well as with health officials in host countries.