On Tuesday, May 18, we woke up at 5:30AM, ate breakfast, then boarded a bus to the Hospital in Retalhuleu.  We were greeted by the hospital staff, who gave us a tour.  More interesting than talking to the hospital staff, was witnessing the mass of people waiting for our arrival. There were over 250 people outside waiting – our patients and their parents, all hoping that they might be among the ones added to the week's operating schedule.  "Corrective surgery" is a medical term used by doctors to describe what they do, but the term is an inadequate description of the profound effect this surgery has on our patients and their families.  The severe facial clefts and dental distortions repaired will allow our patients to function in society without being ostracized and discriminated against.  Closing their palates allows them to better articulate their speech, to drink and eat without aspirating food, and to be able to eat more and take in the nutrients that are needed for growth and development. This is the hope of these people who wait to hear if they are chosen to receive surgical care.

We started this morning with set-up for the opening day clinic. We organized the medical records station, which follows each child through the entire treatment process and ensures our patients quality care. During pre-operative clinic, patient's basic information is taken down by the medical records keeper at the registration station. The patient is given a medical record number, and a photo is taken of each child.

Next, at  another station, the patient has his or her vital signs checked, and undergoes a quick blood analysis. The pediatrician checks the patient for overall health. The patient then visits one of several triage stations, each includes a surgeon, an anesthesiologist, an operating room circulating nurse, and an interpreter. Lastly, the patient also visits a dentist and an orthodontist, where they undergo an evaluation of what can be done for dental disease, missing teeth or other dental problems associated with cleft lip and palate. It  is critical to screen every patient, both for safety and to be sure that we are doing everything that we possibly can for every child who walks in the door.

By the end of opening clinic, the number of people waiting under a make-shift tent swelled to about 400. The doctors, nurses, and non-medical volunteers joined together to take care of these patients and their families. The day was hot, humid and intermittently rainy – we worked as quickly as we  could.
After evaluation, each patient's chart is marked either GREEN (Surgery is a go), BLUE (Surgery is possible, but depends upon time and the patient's health), RED (The patient is not cleared for surgery because other medical  problems, such as  malnutrition and/or infection, make surgery an unsafe option). At the end of a long day in near darkness, Medical Director, Ron Gemberling and Lead Anesthesiologist, John Lee struggled to see as many of the remaining 50 to 60 families as possible. As the rain came down, those waiting hugged the hospital wall to stay dry.

Turning a patient away is a heart-wrenching experience, even if it is done for a very good reason. It is very difficult to deliver this information to the parents. Some of the families who come to us for help have traveled long distances at great expense of time and money. It is so hard to look upon their crest-fallen faces in the cases where surgery is not an option. It is also difficult to deliver the news of a pending status to the families who remain in limbo – perhaps their child is recovering from a cold, or maybe their bus arrived late and now they must simply wait to learn whether or not there will be room. When these families are from far away, they must stay overnight, hoping. The accommodations available to them are sometimes little more than a tin roof covered area. They may, despite their patience, still be told "nothing can be done at this time". The pain of delivering such disappointment is counterbalanced by the look of joy on a mother's face when her child has been cleared for surgery. It also firmly cements in my mind how important it is that we are here, and how important it is that Rotaplast teams return to sites year after year. For the moment, we must focus on the good that we are doing right now, and the sheer quantity of people that we are helping this time. When we have finished the work we are able to do, that is the time to remember those who will wait for next year.

The last few children were evaluated for surgery after 7pm. We returned to the hotel in darkness, and prepared for another long day.

Until tomorrow!