I just re-read and edited yesterday's post. I wrote it after about four hour's sleep and it needed a bit of cleaning up. Today was my last day as I am leaving tomorrow so that I can be home in time to Chair the board meeting for Clarke. (www.clarkeschools.org for those who'd like a look.) The airport was closed yesterday due to winds, so I hope it's open tomorrow.
Today was a slower day for the ward because the surgeons had scheduled fewer but more complex and therefore longer cases. We only had 22 as opposed to 33 patients today, and it was nice to have a slower pace. Jen went to the ward to check on the boy who was cancelled because of his respiratory infection and wheezing yesterday and brought back a photo of his chest X-ray on her cell phone. It turns out he has a big pneumonia so she felt vindicated. Perhaps she'll email it anonymously to the PI. There was an 18 month old with a history of asthma and developmental delay who had his palate repaired today. After surgery, he had a very hard time recovering. He spent most of the day in the PACU on oxygen, getting various drugs IV and by nebulizer. He finally stabilized enough to come to the ward and looked well on room air by the time we left tonight. It brought up a big discussion of the screening process, how cases are chosen, which kids should be excluded, etc. Here's my opinion: One should try to do the lip repair on almost every child. I say this because even if the child has very little function, making their appearance more "normal" helps their parents and other family members bond with them and in certain countries and villages helps the family be able to be included in the village again. With palate repair I find it more difficult. The recovery from palate surgery is difficult and painful. The main benefits are better speech quality and less regurgitation of food through the nose, and perhaps less choking while eating. If a child has profound cognitive deficit and no language, I would find it hard to recommend putting the child through palate repair unless their were major feeding issues that the speech/feeding therapists felt would be helped by the surgery.
OK, now to stories and brief thoughts before it gets too late.
On the light side:
There are generally no paper towels or electric blow dryers in the bathrooms in the hospital. The action is, wash hands, shake off the water, wipe on pants. Everyone has the remnants of water handprints on their pants.
There is never any toilet paper in the bathrooms. Everyone tries to remember to bring some from their hotel room, but paper napkins from breakfast, paper towels, any little bit of relatively soft paper is gold. People are on the lookout and pick it up and stuff it in their pockets as they go by.
Most babies with cleft lips go right to the bottle here. I only saw three breast feeding babies and they are allowed to go right to the breast after lip surgery. Bottles are not allowed for six weeks. As you might imagine, the nursing babies are in heaven on the ward and the rest are very jealous.
If a parent takes off work for their child to have surgery or a child misses school to come to the hospital for the sibling's surgery, they have to have a letter from the treating doctor,(or colleague,) to get back into work or school. I can't write the letters as I'm not licensed in Honduras. Parents line up outside the OR for hours,waiting for a surgeon to come out to sign the form letters. They have to be signed on the day of discharge and then date stamped at the main office of the hospital. They can't be pre-signed.
I can't remember if I mentioned that the women who mop the corridors have to wash out their mops by hand in outside stone basins (photos on Picasa.) Perhaps the sheets are also washed by hand in another part of the hospital??
There is lots of construction going on at the hospital with open pits of gravel, rebar sticking out of the ground, big and small holes everywhere. I find I have my eyes on the ground at all times.
When we had to transfer a child from the post-op ward to the inpatient ward, we discovered that the child's hospital chart (as opposed to our Op Smile chart,) had been left in the pre-op ward when the child went to surgery. All the kids have the two charts as they are considered in patients of the hospital while they are on our "service." I went to get the chart, but they wouldn't give it to me. We had to take the child back to pre-op, and the pre-op nurse could then release the child AND the chart to the nurse from the inpatient ward. SHEESH.
One of the team nurses who comes from Bolivia arrived at the mission feeling a little bit feverish. She got joint pains and fatigue and it turns out she has Dengue fever. Now one of the Swedes also feels bad and had her blood drawn today. I haven't seen any mosquitoes and no bites. I think they don't like the taste of me.
I'll finish today with the story related by LiDeny, the Honduran pediatrician who has been working with us this week. She is trying to finish her credentialing as an Op Smile pediatrician, and the last step is to work on an international team and be evaluated (by me.) Anyway, she works three different jobs adding up to 60-80 hours per week, and her husband who is an OB Gyn does the same. They have two children, a 19 year old son and a 15 year old daughter. LiDeny explained that just as the poor of Honduras save every penny to make sure their kids can rise out of poverty through education, the more well-to-do like she and her husband work and save to send their kids to school outside of Honduras. They do it, she says for two reasons. The first is safety. She said that a well off boy, in particular is a target for kidnappers who think they can get a big ransom. If they don't get enough money, they kill the boy as an example for other parents. Her son had two friends who were killed by kidnappers. He is now in university in Plattsburgh, NY where he is studying economics and business. He is fluent in English, French, Mandarin and Italian from his private grade and high schools and has a $3500 a year scholarship. She and her husband have to pay $10,000 twice a year which they consider a great deal for this public education in the US. He earns pocket money tutoring other students and maintains a 4.0 grade average. If he keeps his 4.0, he gets monetary bonuses each semester of Amazon or store gift cards that help with expenses. If it drops below 4.0, he doesn't get the bonuses. Her daughter has been going to a French immerse school at the French Embassy since age three and is fluent in French, English and is working on Mandarin and Italian. They love the US because they feel the US people value educated people who know languages and will provide good jobs for her children when they are done with school. Meanwhile, they will be safe from kidnappers.
That's all for now. I'll do some wrapping up in a day or two
Today was a slower day for the ward because the surgeons had scheduled fewer but more complex and therefore longer cases. We only had 22 as opposed to 33 patients today, and it was nice to have a slower pace. Jen went to the ward to check on the boy who was cancelled because of his respiratory infection and wheezing yesterday and brought back a photo of his chest X-ray on her cell phone. It turns out he has a big pneumonia so she felt vindicated. Perhaps she'll email it anonymously to the PI. There was an 18 month old with a history of asthma and developmental delay who had his palate repaired today. After surgery, he had a very hard time recovering. He spent most of the day in the PACU on oxygen, getting various drugs IV and by nebulizer. He finally stabilized enough to come to the ward and looked well on room air by the time we left tonight. It brought up a big discussion of the screening process, how cases are chosen, which kids should be excluded, etc. Here's my opinion: One should try to do the lip repair on almost every child. I say this because even if the child has very little function, making their appearance more "normal" helps their parents and other family members bond with them and in certain countries and villages helps the family be able to be included in the village again. With palate repair I find it more difficult. The recovery from palate surgery is difficult and painful. The main benefits are better speech quality and less regurgitation of food through the nose, and perhaps less choking while eating. If a child has profound cognitive deficit and no language, I would find it hard to recommend putting the child through palate repair unless their were major feeding issues that the speech/feeding therapists felt would be helped by the surgery.
OK, now to stories and brief thoughts before it gets too late.
On the light side:
There are generally no paper towels or electric blow dryers in the bathrooms in the hospital. The action is, wash hands, shake off the water, wipe on pants. Everyone has the remnants of water handprints on their pants.
There is never any toilet paper in the bathrooms. Everyone tries to remember to bring some from their hotel room, but paper napkins from breakfast, paper towels, any little bit of relatively soft paper is gold. People are on the lookout and pick it up and stuff it in their pockets as they go by.
Most babies with cleft lips go right to the bottle here. I only saw three breast feeding babies and they are allowed to go right to the breast after lip surgery. Bottles are not allowed for six weeks. As you might imagine, the nursing babies are in heaven on the ward and the rest are very jealous.
If a parent takes off work for their child to have surgery or a child misses school to come to the hospital for the sibling's surgery, they have to have a letter from the treating doctor,(or colleague,) to get back into work or school. I can't write the letters as I'm not licensed in Honduras. Parents line up outside the OR for hours,waiting for a surgeon to come out to sign the form letters. They have to be signed on the day of discharge and then date stamped at the main office of the hospital. They can't be pre-signed.
I can't remember if I mentioned that the women who mop the corridors have to wash out their mops by hand in outside stone basins (photos on Picasa.) Perhaps the sheets are also washed by hand in another part of the hospital??
There is lots of construction going on at the hospital with open pits of gravel, rebar sticking out of the ground, big and small holes everywhere. I find I have my eyes on the ground at all times.
When we had to transfer a child from the post-op ward to the inpatient ward, we discovered that the child's hospital chart (as opposed to our Op Smile chart,) had been left in the pre-op ward when the child went to surgery. All the kids have the two charts as they are considered in patients of the hospital while they are on our "service." I went to get the chart, but they wouldn't give it to me. We had to take the child back to pre-op, and the pre-op nurse could then release the child AND the chart to the nurse from the inpatient ward. SHEESH.
One of the team nurses who comes from Bolivia arrived at the mission feeling a little bit feverish. She got joint pains and fatigue and it turns out she has Dengue fever. Now one of the Swedes also feels bad and had her blood drawn today. I haven't seen any mosquitoes and no bites. I think they don't like the taste of me.
I'll finish today with the story related by LiDeny, the Honduran pediatrician who has been working with us this week. She is trying to finish her credentialing as an Op Smile pediatrician, and the last step is to work on an international team and be evaluated (by me.) Anyway, she works three different jobs adding up to 60-80 hours per week, and her husband who is an OB Gyn does the same. They have two children, a 19 year old son and a 15 year old daughter. LiDeny explained that just as the poor of Honduras save every penny to make sure their kids can rise out of poverty through education, the more well-to-do like she and her husband work and save to send their kids to school outside of Honduras. They do it, she says for two reasons. The first is safety. She said that a well off boy, in particular is a target for kidnappers who think they can get a big ransom. If they don't get enough money, they kill the boy as an example for other parents. Her son had two friends who were killed by kidnappers. He is now in university in Plattsburgh, NY where he is studying economics and business. He is fluent in English, French, Mandarin and Italian from his private grade and high schools and has a $3500 a year scholarship. She and her husband have to pay $10,000 twice a year which they consider a great deal for this public education in the US. He earns pocket money tutoring other students and maintains a 4.0 grade average. If he keeps his 4.0, he gets monetary bonuses each semester of Amazon or store gift cards that help with expenses. If it drops below 4.0, he doesn't get the bonuses. Her daughter has been going to a French immerse school at the French Embassy since age three and is fluent in French, English and is working on Mandarin and Italian. They love the US because they feel the US people value educated people who know languages and will provide good jobs for her children when they are done with school. Meanwhile, they will be safe from kidnappers.
That's all for now. I'll do some wrapping up in a day or two
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