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 and Part 2 can be read here.
Saturday – Day 5
Another heavy schedule lies ahead. An early breakfast is in order. We have asked for the kitchen to provide scrambled eggs supplementing the usual menu. A very Indian version is forthcoming, which some people actually find quite appetizing. The team members who brought peanut butter and packages of instant oatmeal are very much in favor as breakfast partners. These staples, accompanied by toast and the wonderful little local bananas have become the breakfast of choice for most. Sandi, an attorney in real life, but Medical Records Keeper for this mission, has brought a coffee press with Peete’s coffee beans much to some of our envy.
We are transported daily by 5 SUVs that run a constant morning and evening shuttle between the hotel and the hospital. We have learned that the most admired drivers in India beep the loudest and squeeze through almost imperceptible gaps between trucks, cows, goats, dogs and people, all at top speed. Sitting in the front passenger seat is not a big favorite for our team.
Today, we meet the 13-year-old boy who was burned practically from head to toe when he was 11. He has no hair, no ears, no lips. His skin is taut on his skull. He saw a movie on TV where a stuntman ran through fire and emerged uninjured. He thought it would be a fun trick. Unfortunately life, unlike the movies, has real consequences.
His father shows a picture of the boy before he was burned.
It is hard to even imagine how much his life has been changed by one moment of boyish zeal. But even so, he has a sense of calm about him. He gives a shy grin as we bring him in. The surgeons perform a skin graft, taking skin from his hip and covering an open place on his side – a little relief for such a tragically wasted body.
The parade of babies, young children, adolescents, and adults with cleft lips, cleft palates, huge lip tumors, scars from accidents that have left noses and eyes in other than their original positions. They are led, or carried, to the operating room, and the surgeons work with deft precision to put back to right what is wrong. And outside the operating room, the family members wait with enormous expectation to see the beloved face of their family member. Sometimes the change is so profound that when we go in the evening to check up on a patient, we cannot find anyone who looks even vaguely like them and we have to find the ID picture from clinic day to locate their bed.
As the patients wake from anesthesia, one of the parents is located and brought to the post-op area. This is a practice much more common in countries outside the US and much applauded by our professional PACU nurses. One of them, Joanne Gillespie, was so impressed with this practice on a previous Rotaplast mission that she went back home and lobbied until the hospital where she works changed the policy. Young children, who wake scared and in pain, are much more easily comforted by their parents than by a nurse. We encourage the parents to pick up the young children, IV and all, and rock them. And we note with interest that in India many of the fathers choose to be the primary parent accompanying the child.
At the end of the day, the surgeons have completed 22 cases. The first week has ended well and we will now get a day off to recharge our batteries (internal and external) and go on a trip planned by the local Rotarians. Saturday night is celebrated in our dining room with Bacardi Breeze’s (cranberry or lemon), which is the closest we can come to red and white wine, and some excellent Kingfisher beer. The Rotarians are concerned we are not eating enough and ask us what else we would like to see for our meals. Fruit is the consensus – oranges, apples, pineapple – things we can peel and eat. Team members go down to the local Internet café and re-discover dial up (broadband has not yet made it to Karaikal), and make calls home (which requires a trip to the lobby and one person at a time).
Sunday – Day 6
Our one day off and the Rotarians have planned a sightseeing trip.
Some strike out on their own; others decide to relax at the hotel. But the majority load into SUVs, with bottles of water in hand, and head for the Shrine Basilica of Our Lady of Good Health in Vailankanni, an hour’s drive away. The huge white shrine dominates the town. Pilgrims come from miles around, often shaving their heads and covering it in a thick yellow paste made of turmeric to give thanks for receiving a blessing for which they have prayed. Many of the pilgrims make the journey up the aisle on their knees. We buy jasmine garlands at a local stall and, following the lead of the pilgrims, we present them at the altar. They are placed on the altar in huge stacks along with coconuts and candles. We follow the crowd and are given back a small piece of the jasmine to weave in our hair. Leaving the church, we walk down the street that leads to the beach. On each side are stalls selling every sort of religious item imaginable. Children mill around us trying to get us to buy religious cards, women carrying small babies beg for money. This is obviously much more of a tourist mecca than Karaikal, where the people are friendly and never pushy. We also see the places where people are having their heads shaved. And down at the edge of the ocean, many are mixing the paste to put on their heads. Many are also in the ocean fully clothed. And there is even an amusement ride filled with small children. We learn that more than seven thousand people were killed by the tsunami in a 10 square mile area surrounding this town. One can imagine the wall of water coming up the street and sucking everyone and everything in sight as it recedes. There appears to have been no changes made to ensure that next time it would be any better.
Purchases made, we have worked up an appetite for lunch. The Rotarians take us to the MGM Resort. We sit at small tables and almost cheer as a plate of French fries with ketchup is delivered as an appetizer. This is the first non-Indian food we have seen in a week. After lunch, we pile back in the SUVs and drive back to Karaikal on the beach road stopping every few miles to view the devastation that has been caused by the tsunami. It looks as if a nuclear bomb has gone off. Roads have disappeared, bridges gone forever. In one place, a new bridge of more than 50 feet is being constructed. It towers over the village, but we are reminded it is only just slightly higher than the wall of water that devastated this area. Temporary housing is everywhere – even more rudimentary and crowded than normal living conditions. The government has promised to rebuild homes within the next few months, but much is left to be done to meet this deadline.
We return back to our hotel full of the horror that hit this area the day before Christmas and has changed, and will continue to change, hundreds of thousands of lives for years to come.
Some decide to visit the local temple, Lord Saneeswara (Saturn) at Thirunallar, 5 kms away from Karaikal. It is the only temple in India dedicated to Lord Saturn in India and is well known throughout India. We have read that this is an ancient Siva temple probably constructed in 7th Century A.D. When we arrive, there is a tall thatched column that looks very unimpressive and we think we might have made a mistake. But then we meet up with the Rotarians and they lead us into the temple, with bright intricate carvings, many worshippers, shrines, priests, and the offerings brought by the people. It is fascinating. The Rotarians have arranged a special tour for us. We remove our shoes and follow the holy men. We receive various blessings, with spices being placed on our foreheads, and foods to taste. We are shown the most valuable article at the temple – a giant emerald that most tourists do not get to view. A ceremony ensues where all of the men are given turbans to wear. The women in the crowd successfully moderate their behavior and go with the local cultural flow.
The day off is winding down. Tomorrow we begin our last week of the mission. We have much still left to accomplish to declare this mission a success.
Monday – Day 7
After our day off, things get off to a slow start. First there’s an anesthesia monitor that stops working. Then an oxygen tank explodes sending everyone running to see what has happened. Luckily no one is hurt. But this is not a good day for delays. There are some very difficult burn cases to be undertaken along with the usual heavy schedule of facial surgeries. Jim Galloway, Head Nurse on this mission, takes command, as he always does. He is everyone’s go-to guy in the operating theater complex. He moves from crisis to crisis, the calm in the eye of the storm. He has done it so many times before, for Rotaplast and other international medical missions. Over and over, he gives up his personal vacation to provide his dedication and expertise around the world. Jim, who comes from Chico, California, is married with two daughters. One is finishing up her studies at Chico State and the other is a teacher in Mountain View. This is the guy that you would want with you in an emergency. And Jim has recruited a local anesthesiologist that he works with, Ray Yip, to come on this, his third trip.
Back in the pre-op area, the sound of a perfect little English voice, wafts to our ears. Who is this 13 year old that speaks the best English we have heard in a week? We use her to translate the backgrounds of some of the waiting patients. How did they burn themselves so badly? How old are they? Are they married, kids? She perfectly translates every detail making these patients even more personal to us. And then we ask her, why are you here? “Oh”, she says, “I am having surgery.” With a closer look, we realize that she has some abnormality of her nose. So, we make a deal. She has to come back every time that we return to Karaikal as our official translator!
Meanwhile, also waiting in the pre-op area are two young females, sitting close together. One we remember from the opening day clinic. She had arrived appearing completely normal. Her beautiful face shone out from a scarf that was artfully draped around it. Only when we went to examine her did we discover the horrendous burns to her neck, upper torso and arm. In fact, her arm was completely fused to her side. Through the “translator” we learned that she was 17, had been married for two years and had two children. She told us, without prompting, that her husband had married her after her burn. We never really did understand exactly how she was burned – some sort of explosion we believe.
The second young girl had an obvious double cleft lip with very prominent, misaligned teeth. From her chart, we learned she was sixteen and also needed a cleft palate repair. She had a sweet smile and trusting eyes. Both girls were brought to the operating room at the same time and will, no doubt, meet in the recovery ward and hardly believe their own eyes at the difference they will see in each other.
Suddenly there was a lot of noise and activity in the hallway. The walk in clinic for the day had begun. A replay of the opening day clinic, but as the time grew shorter that the Rotaplast team would be here, the atmosphere was becoming more desperate. Several of the children we recognized from previous days, their parents running out of time to get them help. The surgeon quickly divides them into two groups; those that we could help and those we could not. A sweet little girl in a lavender tunic peeks from behind her mother’s skirt and finally we coax her into giving us a radiant smile. Pictures are taken, charts are made up, and the wait for those who have passed the initial screening to find out if they can fit in the remaining schedule begins.
Back in the operating room, the schedule is rapidly moving ahead. A little boy with a very wide horizontal mouth, a syndrome known as macrostomia, literally large mouth, comes to post-op. His father is brought to comfort him. His father looks with amazement at his boy and then thanks us from the bottom of his heart with his eyes. The nurse brings a mirror for the boy to see the results of his surgery. When he sees his reflection, his eyes light up and he turns to the nurse, “Thanks,” he says. We share a tear or two.
Another young man has been burned badly and allowed to heal with his lower thighs fused to his upper calf. He can barely walk. Nan Madden, the Pediatric Nurse Practitioner on the mission declares this case to be the most heartbreaking of the trip. Dr. Capozzi frees the fusing and takes grafts from his back to cover the affected areas. When he walks for the first time after surgery, he will have grown several inches because he will finally be able to stand up straight. Who says this isn’t gratifying work?
At the end of the day when we go to see our patients one last time before leaving for the day, we look for the translator girl. She is nowhere to be seen. We check with the pediatric nurse practitioner. Where is the translator girl?? Unfortunately, the schedule slipped and she is asked to come back tomorrow. After we recover from our disappointment, we realize we will have the services of this wonderful girl one more day to help us explore the stories behind the patients. And she, we are not surprised to hear, took the news with great stoicism.
Meanwhile, Mabel is dealing with the Indian culture of arranged marriages in the dental clinic. Earlier in the week she is chatting with one of her orthodontists and she asks him if he is married or has a girlfriend. He says he has neither. Two days later he comes to her to tell her he must leave early tomorrow because he must go to his engagement party. She is astonished and wants to know how this happened so fast. It seems he has received a call from his father to say that he has arranged a marriage for him. Later we raise the subject with some of the interns. They explain that marriage is not about two people, it is about joining two families and, in India, marriage is seen as a business. One of the interns tells us, “My wife will spend a lot of time with my Mom, so I want my Mom to pick someone she will get along with.” One would hope that he would get along with her too!
A late night – surgeries are still ongoing at 7:30PM. The planned shopping trip for some of the team to the sari shop is cancelled. Instead, one of the Rotarians brings shawls to our dinner and we snap them up gratefully. Twenty cases are completed today.
To be continued
The Sacramento Executive