In October 2005, I joined a Rotaplast International mission to India. The Mission of Rotaplast International is to provide free reconstructive surgery and treatment for underprivileged children worldwide, to provide education, and to advance research in the prevention of cleft lip and palate. Part 1 can be read here.
Thursday – Day 3
Today the real work begins. The opening day clinic is held where potential patients come from far and wide to be evaluated and ultimately accepted or rejected for treatment. A huge line forms outside the hospital, ranging from young to old, from minor to massive medical issues. Stations positioned for the most optimal patient traffic flow. Many of the team has experience gained from multiple previous Rotaplast and other international medical missions, others are brand new. Many of the younger team members have never had an opportunity to see many of the conditions that will present. The line of patients begins to wind its way through each of the stations, registration, pediatrics, anesthesia, surgery, dental, photo identification leading to an overall evaluation as to their suitability for surgery. Sweet faces of little children marred by obvious facial deformities and the parents who cannot speak our language but are literally begging with their huge eyes to help their precious child.
Adults covered with a scarf that when removed reveals devastating burns. One man is so badly burned that only by checking his chart can one even decipher his age. The heartbreak is overwhelming but the pace of the evaluations must move swiftly. One little girl of 7 months, referred to the program by a local Rotarian, screams at the top of her lungs during her photo and then breaks into wreaths of smiles that last the rest of the day. Her name, surprisingly, is Jennifer, a decidedly non-Indian name. As situations change, team members quickly sense places to fill in, tasks they can accomplish to facilitate the process, and even design some improvements on the fly. And finally the combined effort and experience and sheer will of the team begins to effect progress. As a purposeful buzz fills the air, the line that this morning snaked seemingly forever begins to gradually shorten. 
At the end of the day we have registered 219 patients, with additional registrations expected each day at the walk-in clinic. Almost a half are put in the top category and should receive surgery during the week. Another twenty percent are in a “time available” category. The remaining, unfortunately, cannot be helped by the team. Some are rejected due to anemia, other illnesses or low birth weight, or surgeries that are simply too extensive. Some could well be candidates on Rotaplast’s next mission to Karaikal. In parallel, all the equipment has been set up and sterilized for four surgeons to begin work early tomorrow morning on the twenty patients who have been scheduled.
Friday – Day 4
Surgeries are to start at 7:30AM. Breakfast is served starting at 5AM to allow those who are involved in pre-op to leave the hotel no later than 5:30AM. Any delay will mean one or more patient who will not get an opportunity to receive a life-altering surgery. This is motivation enough to rise early.
For the next several days, the success of the mission will be based almost completely on the strength and dedication of the team. Mabel Mattos, a dentist from Uruguay, typifies the extremely high quality of those who have chosen to be a part of this effort and why there is no doubt the mission will be extremely successful. Mabel is just completing her twentieth international medical mission, several of them working with Rotaplast. She often spends several weeks prior to each mission volunteering her services in country. Prior to Karaikal, Mabel worked for seven weeks in Chennai providing free dental services. She was provided with a house with one room to be used as an office, and a driver who would take her out to schools and community centers and even to the fields. During that time, she saw more than 1,700 patients, completed 378 extractions and fillings. Her plan was to finish up her work in Chennai and then join the Rotaplast mission in Karaikal. Finding out that her son was seriously ill in Uruguay, Mabel flew back to Uruguay, satisfied herself that her son was stable, and turned back around days later to join the Rotaplast mission in Karaikal. Mabel spends much of her time abroad spreading her professional skills, her quiet competence and her enormously generous heart. When asked what her two adult sons and three grown grandchildren think of her escapades, she admits with a smile, “They think I am crazy.” “But”, she continued, “I can’t do this for ever. So for as long as I can, maybe the next 3 years or so, I am going to do as much as I possible can.”
The services she provides to Rotaplast are enormously important adding considerably to the favorable outcome of a surgery. She is the icing on the cake. Sometimes, there is only icing and no cake. But that icing, in terms of extractions, a prosthesis, and other tricks that Mabel has learned over the many years of working with cleft patients, can make a significant improvement in the lives of her patients. Scheduling her dental procedures around the surgical procedures seems a daunting task. “Oh, no,” she says, with great humility, “you see, I have had a lot of experience making up schedules.” As patients came through on clinic day, many having already been told that for various reasons they would not be able to have surgery, Mabel would often find something she could do dentally to improve their situation. “They come from so far away,” she said, “I want to give them something”. An apt quote from one who comes from so far away and has so much to give.
As she sits in her office, parents bring their children to check on the prosthesis she is making that will fill in the huge gaps that the cleft palette has caused. She shows them the progress and then patiently but firmly tells them to return in a few days. A mother brings a baby with a piece of gauze bandage that Mabel has fashioned to hold his clef lip together to make the job easier for the surgeon later in the week. She talks easily as she surely and deftly moves that bandage a little tighter. It is easy to see that the parents have huge confidence in the skills that she brings to their children. And the respect she shows for each and every one of her charges and their families is inspiring. 
Mabel dreams of owning a mobile unit that could be shipped from place to place and would give her much more capacity. “We could work more than double if we had a mobile unit and it costs less than $4,000.” We, of course, is only Mabel. And she wants to include education. “If I had toothbrushes to give away, I could teach the parents how to take care of their children’s teeth. But first I need to teach them that the cleft is not attached to the brain and that brushing the teeth will not damage the brain.”
Mabel played a big role for a little girl on the first day of surgery. When we were rounding up the patients for surgery, one, a 9-year-old girl was missing. We thought her parents had failed to bring her. A few hours later, Mabel saw the girl and her father on the lower level of the hospital. She quickly made the connection and rushed her upstairs. Luckily, we were able to make time at the end of the day’s schedule. That evening in the recovery ward was a girl with her father sitting next to her bed with the broadest smile in the world. He would tell each team member who approached, “Happy, so happy. Thank you.” That’s Mabel, making a difference one child at a time.
Another interesting aspect of this team is that three of the four anesthesiologists are from the same practice in Little Rock, AK. At the opening evening ceremony, with much of the Karaikal medical school staff and faculty in attendance, the names of the Indian members of the Rotaplast team drew loud cheers. One of these members is Shailesh Ravindra Shah, an anesthesiologist. Shailesh emigrated from India to the United States six years ago, soon after he had finished his medical training. This is the first time he has returned to India in a professional role. “I wanted to come back and see how far things had progressed in India from a medical standpoint,” he explains. He is the only one of his family to have moved to the United States, so he will take the opportunity to spend some time with relatives after the Karaikal mission is ended. When asked whether the dialect he speaks, which is different from the Tamil used in Karaikal, helps him in communicating with the patients he has seen in the clinic, he confides, “the two dialects are so different that I am in the same boat as the rest of the team, struggling to make myself understood in English to my fellow Indians.” It points out starkly how large this country of India is.
The patients for the first day’s surgery are located on the lower floor and brought up to the second. As the day progresses, they are brought into pre-op in sets of four, with one parent accompanying them. As the surgeons and anesthesiologists await, each patient is brought down to the operating room suite, some in the arms of the Rotaplast team members. 
The first patient comes around the corner, and a smile lights up her face – it’s Jennifer, the smiling baby we all remember from the clinic. It seems an apt choice for an organization whose tag line is Saving Smiles – Changing Lives. As the first set of four surgeries are completed, one that involves a very complicated skin transplant – additional work on a burn patient from last year – they are transported to post op. Each patient, no matter the age, is provided with a quilt, made by Rotary volunteers, that comforts them after surgery and that they can take home when they leave. Once stable, they are transported to the recovery ward and watched. One interesting phenomenon, and maybe something that the US should consider, is that in this hospital, and many others Rotaplast works in around the world, patients are allowed into post op to comfort their children.
Their presence has an instant calming effect. And seeing the look on a mother or father’s face when they first see their child with a repaired lip makes this whole mission worthwhile to those who volunteer.
As Jennifer comes out of surgery, the post-op nurses and the pediatrician jump into action. And her beautiful young mother is brought in to hold her groggy baby. But within the half hour, Jennifer is at her mother’s breast, seemingly quite content. The mother is concerned that the nursing will open the lip back up, but she is assured that it is fine. During the day in the recovery room, where Jennifer occupies in the bed marked 1, she quickly returns to her old self and pretty soon she is full of smiles again. 
An adolescent boy with extensive burns on whom we operated last year is back again for additional work. Dr. Capozzi performs a skin graft on the inside of his upper arm. Tedious, microscopic work. Later in the day, the boy is in recovery with his mother at his side, obviously in a great deal of pain, but always ready to come back for additional assistance when the Rotaplast team comes to Karaikal.
Working the recovery ward is Neilu Golshanara, a fully-fledged pediatrician in her native Iran, but now that she lives in Sacramento, California, she must get re-certified. Her desire to put her skills to work has led her and her husband to meet up with Dr. Capozzi to understand more about Rotaplast. Using the motivation that came from the meeting, they assisted in raising the requisite sponsorship money from the local Sacramento rotary clubs to underwrite this mission. As a tribute to his wife, Neilu’s husband, Ted, has stayed home with their 5-year-old daughter and sent Neilu on her way. During the trip, Neilu will celebrate her 40th birthday doing what she loves – working with sick children. 
And so the pace continues throughout the day. By the end of it, the team has operated on 20 patients. Visiting the recovery room at the end of the day and looking at all of the lives that have been changed for the better forever is a very gratifying and emotional experience. As Neilu and some of the team members discuss the changes that have been made in just a few short hours in so many lives, we try to hide the tears welling up in our eyes but finally allow them to run shamelessly down our faces. This is definitely something to get all chocked up about. And the parents, sitting by the bedside, so completely grateful for the new chance on life that their precious children have been given. If our emotions are at their peak, imagine those of the parents who live with these children day in and day out.
Back at the hotel, we meet for dinner and a team meeting where we review our day and get instructions for the next. We fall into bed exhausted with our heads full of things to come tomorrow.
To be continued
Gillian Parrillo
The Sacramento Executive
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