Fourth Day of Surgery- Chiclay, Peru

Our blogger and other supportive team members had posted a fine story or two last night and it was completely erased when the power failed. Thus, we´re a bit late with yesterday´s stories but we´ll try to reconstruct them. We visited with Emily and Jason Pope, Mary Johnson and Barbara Wiemann, Clarice Witt. Dan Danahey and Francisco Diez. We were pleased that we were able to operate on about 15 more children and young adults during this busy day.

Our incredible nursing staff keeps us all on our toes with their expertise and senses of humor. We´ve all needed it but the entire team agrees that this is ¨one of the best missions they´ve ever been on.¨ Emily Pope, a Nurse Practioner from Vanderbilt University, is working as a PACU nurse on this mission and therefore is one of the nurses who receives the babies after surgery. Her partner in PACU is the every smiling and capable Doris Osuorah who now lives in Washington, DC. Originally from Liberia, Doris feels fortunate to have been able to come to the US where she graduated from the nursing program at the College of St. Catherine in St. Paul, MN.

Doris and Emily have been having a ball with pediatricians Dave Tetzlaff and Chris Bowron who accompany the patients from the surgery and watch over them as they come out of the effects of the anesthesia. It is truly impressive to see the team of four professionals jump into gear when their young patients arrive. One advantage of the PACU on January 20 was that the staff there were the only people at Las Mercedes able to catch a glimpse of the inauguration of our new President Obama. Emily reports that she and her husband, Dr. Jason Pope, an anesthesiologist also from Vanderbilt, are enjoying this mission (their first ever) very much. She feels that it is something that will stick with them their entire lives because of the hurdles that we´ve overcome and the great friends they´ve made.

Jason is impressed with the Anesthesia Lead Doctor Zipporah Gathuya who came to us from Kenya. Her three day trip was well worth it for all of the anesthesia team because Zipporah has so much experience working in developing nations and is taking our supply shortage in stride. All of the Anesthesia Team, Zipporah, Jason, Dr. J. D. Stamler and Lynn Randall, CRNA, have worked miracles in their job this week. They, along with bio'med tech Dustin Pitlick, feel that this is the most challenging mission they´ve encountered, but ¨it is all worth it!¨

A bit about Dustin who is from Pierre, SD. Most of his electronics training is from the navy and his biomed background was from Southeast Technical Institute in Sioux Falls, SD. He was recommended to CSI by our Board Chairman John Zak and we are delighted that he is here. He has fixed everything from pulse oximeters, suction regulators, to power convertors, and helped to set up the borrowed anesthesia machines and cautery machines as well. When Mary Batinich bemoned the fact that her camera wasn´t functioning, he even fixed that! What a guy! Dustin reports that this trip has been ¨more than enjoyable and that everyone in the group has been excellent to work with. The Peruvian staff at Las Mercedes has been more than accommodating with all of our requests.¨ Dustin would seriously consider taking a trip down here on a vacation but is hoping that we will be back in Peru on a mission when our freight comes.¨¨ç

There is more to reconstruct from yesterday´s blog but we´ll do it after the fiesta tonight where we will enjoy a Peruvian dinner with about 80 people with whom we´ve worked. We´ll try to take pictures even though it will be almost dark when we get together.



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A boy lies on his bed post-surgery, regaining strength in order to take a walk

Dr. Tim Lander and his team in the OR continue to operate despite a power outage

Day Four of Surgery

It is another warm and humid morning in Chiclayo and the two valiant night nurses Tricia Cabrera and Rachel Hovland have just returned to the hotel after a night on duty. The small, cramped ward where our patients spend the night after surgery is very warm most of the time. George Steiner hit the local Supermercado and purchased an "easy assembly " fan, which of course didn't have all the pieces in the box. He fearlessly negotiated an exchange for the correct pieces and got it running in order to provide much needed relief. The two nurses who staff the ward by day, Patience Kankeh and Jan Martland literally do not sit down from 7:30a to 6:30p. One minute they are checking vital signs on an undernourished 6 week old lip case, the next explaining to a recently widowed, jobless father, how to measure the correct amount of medication to give his one year old daughter he has brought in because "I knew it was what my wife wanted." They are adapting to the limit on supplies by fashioning patient wristbands out of red duct tape(thanks to the ingenuity of Lynn Randall), and quickly clean the plastic covered foam rubber mattresses with a blast of Lysol between patients, The hospital, Las Mercedes, is the town's Public Hospital; the place where the most impoverished Peruvians bring their sick. During the time we have been here many mothers and fathers have approached any one of us walking in our blue scrubs (which announce that we are part of the team of los americanos), carrying their sick babies. Many suffer from ailments we are unable to treat, however we have received tremendous support from the staff of the hospital to partner in cases where we can. During the first day of surgery the power went out locally, but team doctors continued using head lamps. We are amazed at the circle of family members that accompanies most patients; mother/father/aunt/uncle/cousin are in tow as the patient comes forward to the screening area staffed by Maria Ferrara. Everyone on the team is multi-tasking in order to do what needs to be done. We have operated on the child of a mother whose husband didn't want her to seek care for the child, forcing her to choose between her husband and the needs of her child. We have helped a 24 year old boy who has spent his life walking with his hand in front of his face to hide his cleft lip, as well as a small boy who is know among his friends as "Cracked mouth." The true joy comes at the end of each day when we had the patient a mirror to take a first glance at themselves post-surgery. Somewhat swollen, but always vastly improved, they glance back at their new faces, and smile.>

checking vital signs

Mom's at Las Mercedes

Lora K., CSI clinical coordinator and Isabel, head nurse Las Mercedes

Las Mercedes Hospital, Children's Surgery Mission to Peru, January 20, 2009

Today is inauguration day in the United States and the team is running around the hospital, wards, operating and recovery rooms, break-out room and administrative offices trying to sneak a peak at this historic event on TV. Unfortunately, there is only one TV around and many of us couldn't see any of the inauguration but kept hearing about it from the excited Peruvians. The press is inundating us with questions about the election in the US and we gently remind them that we are here to help their children and would rather not talk politics. That didn't satisfy them and they kept asking what we thought about an African American being president. We replied that we were excited and hopeful and knew that our nation would continue to adhere to its democratic principals. When they insisted on pursuing the question further, we asked nurse Doris Osuorah, one of our three African team members, to talk about "coming to America" and the opportunity that it gave her in the field of citizenship and education. Her comments were moving, sensitive and we're sure are all over the TV stations in the north of Peru.

Another team member, nurse Patience Kankeh, our official team jogger, is originally from Ghana. Both Doris and Patience have been on CSI missions in Africa. Dr. Zipporah Njeri Gathuya, lead anesthesiologist, flew in from Kenya to be on this team. She is enjoying working with the other anesthesia team members Dr. Jason Pope, Dr. J. D. Stamler and CRNA Lynn Randall. Zipporah trained at Minneapolis Children's Hospital with Dr. Bruce Ferrara and at Gillette Children's Hospital with Dr. Dick Marnach, both CSI Board members. She was housed as a guest of Mary and Alex Batinich and looks forward to returning this spring for our CSI Passport to Smiles Gala to be held at the Millenium Hotel in Minneapolis on April 18th. Invitations are available by logging on to our web site at: http://www.childrenssurgeryintl.org/. That event is co-chaired by Jennifer Rivers and the Peru team's wonderful and ever efficient Lora Koppel. Please join us and hear more about our exciting work.

Not all team members are medical personnel. Logistics chair is George Steiner, a CSI Board member, whose job has taken a new twist since much of our freight didn't arrive. George knows where all of the pharmacias are as well as where one can get ice, water, supplies and diapers! We often hear, "George, could you please get me" (name anything) and it usually arrives. He is also responsible for feeding the team of more than thirty people every day at noon.

Youth representative Tyler Randall often helps run errands and takes pictures for our blog and scrapbooks. Tyler earned his way on the mission by preparing postop bags for patients as part of his Eagle Scout project. A recent graduate of Tartan High School in Maplewood, MN, Tyler is happy that he can share this experience with his dad Lynn and brother Brandon who is a nurse. The second youth representative is Francisco Diez who has been pressed into service each and every day because of his fluency in Spanish. Francisco's parents Claudia and Francisco are CSI volunteers and were born in Mexico, thus helping prepare young Francisco for medical missions such as this. Both young men have done us proud and are under the watchful eye of their youth advisor, Brandon Randall.

Bio-med tech Dustin Pitlick of Pierre, South Dakota has been kept extremely busy because of our special needs in the machinery and equipment department. He also fixes cameras, cell phones and is generally a most amiable team member. "Where's Dustin?" We hear that as often as "Where's George."

Another team member is videographer Masha Petrenko. Her short film resulting from this mission will be edited and presented at our Aprill 18 benefit. She has already taken many hours of footage and her gala film will only be about 7 minutes long, so we all look forward to some future films coming from this fascinating trip. Mary Batinich, another CSI Board member on the trip, is our blogger and Public Relations person on site. She is also doing some homework for possible future Peru sites for missions...................if only we could solve the freight and customs issues. We mentioned the talented Sally Lannin earlier and want to say a bit about her. At last spring's gala, Sally bought the "Mission Spot" and has been put to work taking pictures of our patients before and after surgery. Most of the photo postings on this blog are Sally's and we are all impressed with her ability to calm frightened patients and their parents. She is also a great communicator and hopefully, will post tomorrow's blog when Mary Batinich goes to Lima for a day.

Not all of our time is spent working even though our days and long and hot. Fortunately for us, our very affordable hotel has a swimming pool and many of us jump into it after a long hot day at Las Mercedes Hospital. On some evenings, we walk en mass to a local restaurant if we are not on duty or too tired to do so. Most full dinners cost less than $10 and are delicious. We are having fun trying local delicacies which often includes fish dishes as we are only about 20 miles from the Pacific Ocean. Night nurses Patricia Cabrera and Rachel Hovland miss out on some of that fun but take it all in stride and love their work with the children.

Tomorrow or the next day we'll post more about our amazing and gifted nursing staff. Their jobs are coordinated by Clinical Lead Lora Koppel and we'll tell some of their stories during the next few days. They are the aforementioned night nurses Patricia Cabrera and Rachel Hovland, OR nurses Clariace Witt, Mary Johnson and Barb Weimann, PACU or recovery room nurses Doris Osuorah and Emily Pope, ward nurses Patience Kankeh and Jan Martland and floater Katie Houle.

The entire team misses Dr. Hossein Aliabadi who was to have performed urological surgery but became ill on the way to Peru and had to return home. Get well Hossein and take comfort in the fact that your patients have been operated on by local surgeons who are very happy to be a part of this exciting mission to help their children.

That's all for now. Mary Batinich, Chiclayo. Peru

Monday, January 19, 2009

Today was an exhausting and exciting day. It was our second day of surgery and we still haven't received all of our freight. Thank heavens we brought a lot of medicine and supplies with us when we came. We are trying very hard to get our equipment here but the red tape is overwhelming and we have city officials, regional officials and hospital officials trying to help us. We finally got all of the papers prepared, and of course were done long ago in the states, but "we needed only one more signature." Our freight handler, Alejandro, has taken a week's vacation to help us but to no avail. We still need "the signature." Finally we got it, only to find that the prepared letter, one of four, had 2008 instead of 2009. Back to the drawing board!

The mantra in the OR and on the ward is, "It's in Lima." We're proceeding with borrowed equipment which is declared safe by our bio-med tech Dustin, as well as our anesthesiology team headed by Dr. Zipporah Gathuya. That team of pros consists of Dr. Jason Pope, Dr. J. D Stamler whom I declared a pediatrician yesterday. The other crucial member of that team is CRNA Lynn Randall. Las Mercedes Hospital's Director Dr. Serrano, is opening up the hospital for our use and success. They've found supplies for us, have found a place for us to keep our supplies, have a break, take a rest and let our clients sit while waiting for screening or their children to come out of surgery. Of course, our two heroines are Coty Lazo and Monica Hurtado who are everywhere. They help with publicity, getting patients, housing and feeding those patients and even find diapers and other supplies for them. All of this is in addition to Coty spearheading the effort to release our freight, to no avail.

Some of our patients come from a long way away as Las Mercedes is a regional hospital. One patient whose picture will be posted later is Carlos Cruz Alvarado, age 24, is from a small town near Olmos which is 4 hours north of Chiclayo. Carlos has worked as a field hand most of his life and didn't want surgery in his cleft lip when he was young because he was afraid. His cousin, Jose Gabriel Pupuche of Olmos convinced Carlos that his life would be better if he had his lip repaired, so Carlos finally agreed to come to Las Mercedes when he heard the radio broadcast telling of the CSI mission.

He still feared the surgery but bravely went ahead when he saw how trusting the younger patients and their families were. You can see for yourself how handsome Carlos is now, and how much happier his life will be. Cousin Jose will accompany Carlos back home to the happy relatives awaiting one of their favorite members. Jose came back the morning after the surgry to thank all of us for what we did for Carlos. He promised photographer Sally Lannin that he would keep in touch and asked herto send before and after pictures of Carlos.

Carlos and other patients were "recruited" and transported by a miracle worker named Maritza del Pilar. A nurse, Maritza is responsible for bringing 16 patients and parents from the Puira
area. She pre-screened them and arranged with Monica Hurtado for them to stay at the Military College Dormitory. The only problem was that "the babies were being eaten alive" and needed netting. The only mosquito netting that the team could find belonged to Jason and Emily Pope, a doctor and nurse from Vanderbilt University who are team members. They gladly gave up their netting for the use of the children and we hurriedly found some mosquito spray. Surgical lead Dr. Tim Lander and Clinical Coordinator worked with other surgeons Dr. Les Mohler and Dr. Dan Danahey to rearrange surgical schedules in order to get the babies done early.

Not all of our patients go into surgery with total assurance that everything will be OK. A case in point is 11 year old Ovin from Jaen, a twelve hour ride from Chiclayo. His father was very nervous and became aggitated when the surgery was not "right now!" He said that he was going to take his son home, along with the frightened brother and mother. They started to leave and Juana, the City Hall Social Worker assigned to our mission shouted, "Close the door! Nobody is leaving. Get the Gringas." The security guard blocked the door while pediatrician Dr. Chris Bowron gave Ovin a sedative to calm him down. Then, like angels, team members Maria Ferrara and Brandon Randall appeared and talked the family into staying. Fortunately for us and Ovin, Mariam Brandon and Chris are Spanish speakers and they managed to calm the entire family down. However, it did bring a few smiles to the lips of onlookers when team members had to pry Ovin's fingers from a chair and pull him from under a table where he had sought refugee. " Muy dramatico" said the guard as Ovin went to surgery, which as the picture shows, was a great success. Ovis's family is thrilled and can't thank us enough for insisting on repairing his lip. He was discharged by Dr. Dave Tetzlaff and Dr. Bowron this morning.

After an exhausting and hot day at the hospital, several of our team leaders got together tonight and decided with the approval of CSI Board and team members Lora Koppel, George Steiner and Mary Batinich, that we would not continue to fight for our freight, but would ask that it not be cleared and sent home. Mary will go to Lima tomorrow night to make arrangements for that. We love Peru, we love Chiclayo, we love our patients and in country health professionals and volunteers, but the customs issues are difficult at best. They seem to change every two years or so and if we return to Peru, which we'd all love to do, it would only be if we could bring in most of our supplies and be escorted by a diplomatic or customs representative. Our Children's Surgery International Board Chair John Zak and Administrator Sue Baysden are waiting for a full report before recommending to the Board what our future might be in Peru.
Sally Lannin is coordinating her excellent photos with our blog so that you will be able to see the results of our stories.

Mary Batinich , 19 January 2009, Chiclayo, Peru

Team members Mary J, Lora K, Jan M,Patience K, Barb W and Katie H with Peruvian counterparts and patient

Day 3, January 18, 2009

We missed a day of blogging because of some problems with freight and supplies. However, we´re well n our way with our surgeries and did six today starting at noon. There are many compelling pictures and stories which we´ll send later today as the team is just returning now.

Everyone is working so efficiently and the Las Mercedes staff is stepping up to the plate also. Our supplies have been limited because some of them are held up in customs, but logistics person and CSI board member, George Steiner, seems to be finding whatever is needed. Clinical Coordinator Lora Koppel, also a CSI Board member, seems to be everywhere with screening, arranging nursing duties, keeping track of team members and all. Medical records team members Maria Ferrara and Brandon Randall are putting their Spanish to good use in their interviewing of patients.

Youth members Francisco Diez and Tyler Randall have been busy ¨running around and helping¨wherever needed " because Francisco is fluent in Spanish and Tyler is good with the patients. The third Randall, dad Lynn, is extremely valuable in his work with Dr. Zipporah in the area of anethesia providing. They are working with the hospital to piece together equipment to make the three operating tables work. Pediatricians Dave , Chris and J. D. are everywhere with their examinations, walking babies and parents back to the wards, and generally making everyone feel good. ¨Is this child well enough for surgery"? "Let's get her some meds and reschedule her."

Surgical lead Tim Lander, is scheduling himself and other surgeons Dan Danahey and Les Mohler to do the palates first and then some the more difficult lips. More cases were screened today so need scheduling for the rest of the week. The anestheology team of doctors are all working extremely hard and will be reported on tomorrow.

And then, there is the nursing staff! What a group of cheerful pros! More about them later after we hear their stories for the day from them and Lora. Photographer Sally Lannin and videographer Masha Petrenka are everywhere with their pre and post op pictures which will appear on the blog and in the video scheduled for our April 18th benefit in Minneapolis.

We haven't mentioned the entire team today by name because of time and computer constraints but stay tuned for tomorrow's news and pictures.

We couldn't have made any of this happen without the amazing in country coordination of Coty Lazo and Monica Hurtado who have performed miracles. They arranged a press conference with Walter, PR director of the hospital, which brought in many patients. They have been finding patients for months now and are housing about 25 patients and families at the Military Dormitory in Chiclayo. The Municipality has been very cooperative in providing food and transportation for them.

Whoever is not mentioned above will be soon. For now, it's off to supper in one of the great and affordable local restaurants in Chiclayo. This amazing team is sticking together in everything we do, including heading for meals and/or the hospital where the night nurses are about to go on duty.

Stay tuned.

Respectfully submitted by Mary Batinich, Peru Mission Coordinator and CSI Board Member

One of our happy patients

Maria Ferrara registers one of our patients