For the patients and their families the Rotaplast journey is one of joy and the hope of having life changing surgery through to the anxiety of going through the assessment process needed to ensure the surgery is right for them and that they are fit enough to undergo surgery. Then if surgery is feasible going through the anxiety of the pre-op, surgery and then recovery.
The patient journey, after often traveling several hours to reach the hospital involves arriving in the clinic on day 1 they have their details taken to start a medical record, they are then photographed before having their vital signs taken – weight, height, temperature, blood oxygen saturation, blood pressure, pulse, respiration, and finally a finger prick to test for hemoglobin level. Once past that station they move to the next where they are seen by the pediatricians who ensure they are fit enough for surgery before being seen by the surgeons to assess what can be done. Then finally they are assessed by an anesthetist to ensure they are fit for an anesthetic. Once that is completed the medical team then decides if they are either a suitable candidate for surgery and if so put on the surgery schedule, or a maybe to be done if there is surgical time available, or regrettably not a suitable candidate or surgery is not an option. For some they are too young for surgery and are told to see their 
own doctor when they reach the appropriate age, or in the case of this mission because we had several local surgeons return to see one of them when the time is right, or that they could be considered for a future mission.
On the day of surgery the patients are seen by one of the pediatricians to check they haven’t an infection and are still fit enough for surgery. In the picture you can see Dr Bryan Stamm seeing a patient on our first day of surgery. There were two pediatricians on this mission, Dr Stamm and Dr Elizabeth Humphreys.
After being cleared by the pediatrician they go through to wait in pre-op before being placed in the care of one of anesthetists – on this trip we had four: Dr Stephen Layne was the missions lead anesthetist, working with him was Dr Dulce Anunciacion, Dr Harohalli Vijayakumar (a.k.a. VJ) and David Rowen, CRNA.
Once asleep under the anesthetic the surgeons can start their work. For cleft lips it starts with using a temporary ink to ‘tattoo’ the incision lines for the repair. This has to be done with great precision to
Cleft Lip Incision tattooing
ensure the cleft repair to the lip is as seamless and anatomically normally as possible. It is not only important to get the lip lines accurately aligned but also ensuring the nostrils are equal in size and aligned. A millimeter out can make all the difference in obtaining the perfect result. The operations on cleft lips if straight forward take around one hour, for more complicated cases and repairs to the palate, these can take up to 3 hours.
The mothers are often worried about the lip opening after surgery, but they are closed in 3-layers: the inner mucosal layer, the muscle layer and then finally the outer skin is closed. Young babies need regular feeding so it is important that they feed shortly after surgery – breast feeding is preferred but if the mother cannot breast feed feeding via a cup or gently being fed with a syringe.
Burns cases can be more complicated especially when they have had a Z-plasty – an operation where Z shaped incision are made is a scar revision technique that rearranges skin tissue to improve scar appearance or function, such as by releasing contractures or reorienting scar lines. Maintaining function and range of movement is critical post-op and during the recovery phase, and on this mission we had Linda Zellerbach a Physical Therapist who specializes in maintaining and improving
function post burn injuries and after burn surgeries. She would also instruct the parents on what physical therapy was important to do when they get home.
The PACU team ensure the patient fully recovers from the anesthetic and surgery before they are either sent to the ward for further observation or if appropriate sent home. The PACU roles are critical as they have to be ready for any unexpected emergency (we had none) but also carefully monitor the patients in their care, sooth anxious babies and reassure anxious parents.
In the pictures you can see one of the Rotary quilts made for ‘Wrap-a-Smile’ by International Quilters – a Rotary Project. Each child is given one of these to keep when they leave. They are also given a Beanie Baby and for the young babies a crocheted beanie hat.
A busy day for the patient but one that will transform their life.