Hirsche Smiles Foundation
Guatemala February 17-26, 2012
Friday February 17, 2012
Dr. Hirsche was a plastic surgeon from Provo
who around 16 years ago started the Hirsche Smiles Foundation which provides
surgeries free of charge to the people of Guatemala and Mexico. There is a special
emphasis on maxillofacial plastic surgeries such as repair of cleft palate and
cleft lip. Julie Musselman, a nurse that
I work with in the PACU at UVRMC, has
been more or less in charge of the PACU on this trip each year and has been
coming to Guatemala from the infancy of it’s mission.
Last year I was invited to be part
of this medical mission lasting for 10 days in Guatemala with the Hirsche
Smiles Foundation, but the timing didn’t work out since we had just had our
fourth child around the time they went.
Long story short I was invited again this year and this has already been
a great start to a very wonderful mission.
I awoke this morning at 4am to get dressed and make some last minuet
preparations. Julie had made
arrangements for her, her daughter Amy and myself to ride with Dr. Wilson and
his wife Lola Dawn. We didn’t leave Orem
until about 5:07 and we were supposed to be at the airport at 5:30 to begin checking
in. We got there, checked in and made
arrangements to get through security without any problems. Julie was nice enough to buy me a Cinnabun
and gave me a Guatemalan wallet with one quetzal and some change in it. We boarded the plane and we flew to Dallas/Fort
worth. Once there we wandered around to
find something to eat. I decided that
since we were in Texas I should go for the whole cultural experience and get a
barbecue pork sandwich. We sat down and
ate lunch with Brook (one of the nurses that will be working in the PACU),
Julie, Amy, and Dr. Moreno Robins. We
had the most interesting conversation with Dr. Robins, a retired pediatrician, about some of the history of Pediatric
medicine in Utah Valley and about some of his experiences from being a mission
president over the MTC here in Guatemala.
What a truly interesting person to talk to. He told me that he has spent 10% of his
entire life serving as a missionary for the church. He is a very interesting person to visit with
and I am sure there will be more visits later this week.
Ever since we arrived at the
airport we have been treated like royalty.
We are now here in Guatemala City and are spending the night in a very
fancy hotel called the Barceló. I was
the odd man out so I get my own room.
It is nice not having to share the T.V. remote with anyone J We ran next door and ate dinner at McDonalds
and then I came back and took a shower/bath.
I then read a chapter out of my Libro De Mormon. I read 3rd Nephi 11 in memory of
my mission. I remember we had a printout
of that chapter to give out to people.
If they would read that printout then we would give them a Book of
Mormon the next time we were through. I
actually brought a Book of Mormon and plan on giving it away this week when the
opportunity arises.
It is now 1am and I am going to go
to sleep in order to wake up and go for a run downstairs on the treadmill.
Saturday February 18, 2012
Well, today was an adventure. I woke up and went downstairs and ran on the
treadmill for 35 minutess in the gym there at the Barceló Hotel which was very
nice. Staying at fancy places like this
while helping people who are so absolutely poor is a little difficult. I feel like I have been so extremely blessed
in my life to have been born to the circumstances that I have. I live in a very safe area of the world and
take a lot for granted. Being here is
like having a flashback of my mission in Paraguay even though I have been home
for nearly 11 years. If I forget to lock
my doors at home it’s no big deal, but for example, this morning Sandy set down
her notebook and turned around and it was gone.
Someone had stolen her notebook that had all the information for the
trip logistics in it. Fortunately this
is not her first rodeo and she brought back up copies of everything in her
other bag. Well, we had a little team
meeting about safety which we were informed to absolutely not leave the
premises of the hotels or hospital in order to be safe. There are people in this country that will do
anything for money.
We all loaded our stuff into a
large moving van type of truck and then we loaded ourselves onto what I’m not
sure what to call. I guess you could
call it a very large van, or a very small bus and we crammed 28 people into a
27 people van. We have had a full
military escort the entire time. They
was a truck loaded with soldiers with machine guns who followed us all the way
here from Guatemala City to make sure we got here safely. The bus ride was supposed to last just over 4
hours but with a traffic jam it turned into around 6 hrs. to get out here to Retalhuleu
(Reu pronounced Ray-oo) for short. We
drove straight to the hospital in order to off load the operating room
gear. Today when we drove in from
Guatemala City we brought with us a member of the church and her 17 month baby
who we will do surgery on on Monday. I
couldn’t help but get a photo with her.
She had the biggest smile that was so cute. She has a bilateral cleft lip. I know this is going to be a moving
experience this week starting tomorrow.
We have around 75 people coming to the hospital to be screened for
surgery tomorrow to see if they are candidates for surgery.
We settled into our rooms and then went to dinner. I ate something called chilequiles. I had a small taste of this food this morning
for breakfast and it was very good. It
is kind of like a tortilla, enchilada, chicken, cheese, green sauce, onion
thing that I squeezed lemon all over the top of. The price was 40 quetzals which was around $6
which for what I got was a deal. After
dinner Julie showed a couple of us around the resort here. There is much to do, but it seems we will be
so busy that we will not be able to do it all (which would have been fun but at
the same time I’m not too upset because that isn’t why I came here anyway).
Sunday February 19, 2012
Today was a great day. Since I could not be in church today there is
no other place I can think of to be than here.
This morning we met at 7am to have a buffet breakfast. I ate all the different authentic foods. They have the most wonderful orange juice and
eggs. I had plantain fried bananas with
cream on top which were wonderful. After
breakfast we loaded the bus and headed for the hospital. We kind of had a meeting and then just
started in with screenings. I was
interpreting for two of the plastic surgeons who will be working together Dr.
Sidiki and Barbu as well as for the anesthesiologist Dr. Wilson. The children
were so beautiful. The majority of the
them have had or are having surgery to repair their cleft palates and
lips. In order to repair a cleft lip and
palate it is a three surgery process.
The first surgery for the children here happens when they are at least 6
months old and is a repair of only their lips.
We saw many children that have come back this year for the surgery on
the palate which happens at least one year after the surgery on their
lips. The third surgery, if they need it
happens at least one year after that but no earlier than age 6. It is a bone
graft from bone taken from the top of their hip (iliac crest). The hard part of that is that it hurts very badly
and we don’t have the ability to control pain here with epidurals or have pain
management teams to work with them. We
are not doing any of those this year I think.
We also had a few we had to turn away that had issues with ears etc.
because they have a team that specializes in prosthetic ears coming in 6 months
that will be better for that. We
finished the day after the screenings were done by setting up the OR’s but we
couldn’t set up the PACU yet because it was locked. We traveled home and ate dinner at the same
place as last night. I had a chicken taco meal that was quite nice.
I was talking to one of our
volunteers named Will who is a very generous man from Alpine who doesn’t have
any medical background but is the best help at keeping the kids entertained and
he also takes such good care of us as well.
Today we had a little miracle with our lunch. Will went out and ordered enough pizza to
feed us volunteers which was 12 pizzas from Domino’s. After he finished paying for the pizza the
manager informed him that it was two for one day so he gave us 24 pizzas for
the price of 12. The miracle in that is
that we were able to feed all the hungry Guatemalans that had traveled many
hours to get here and were starving. I
don’t know how often they are able to eat pizza from Dominos but I would
venture to say that for many of them it was their most expensive meal of their
lives. It was in all honesty a fish and
loaves miracle right here in Reu Guatemala.
Monday February 20, 2012
Well the first day here at work was
just amazing. We did 10 cases with five
in each room. The pictures tell the
story perfectly but I had one experience that shows me that Heavenly Father
knows we are here and He is helping us.
We had a problem in one of the
operating rooms when the suction machine accidently filled completely up and
the blood was sucked into the machine.
Sandy looked at me and asked me if I could fix it. Well, the four screws to take the thing apart
were star shaped and we didn’t have the right tools to remove those
screws. I said a little prayer as I
stood there looking at this machine knowing there was no way in the world that
I was getting this machine open. Well, I
am quite stubborn and I was very determined.
I found a star shaped screwdriver that didn’t work well but I was able
to get three of the four screws out but because the fourth one was very deep
and the tool I was using wouldn’t reach the screw I couldn’t get the last screw
out. I was on a mission to fix this
machine. I went to find someone who
might have a tool that could help me. I
went down to their maintenance department and asked them if they had a
screwdriver that would work and they said no and just kind of stared at
me. Then when they could see that I
wasn’t going anywhere without solving this problem their brains started to
move. One of the guys brought a flathead
screwdriver, and nut, and then we put the star shaped attachment into the nut
and with some convincing we got the screw out.
I then went and told Sandy how Heavenly Father was watching over
us. She told me how often those kinds of
miracles happen to them on these trips. I
was not surprised. I also was able to
watch a Guatemalan woman have a c-section in the OR next to ours. They are able to do epidurals here in order
to help these mom’s be more comfortable.
We asked how many babies they deliver each month and it was quite a
few. They deliver around 300 c-sections
and 400-600 natural births. One thing
that stood out in my mind about the people here is that they don’t complain
about anything. The women here just
labor and recover in the PACU in complete silence. Very stoic.
Well there will be many pics and I
will tell you about the children later. For now I am beat.
Tuesday February 21, 2012
Well today
was very hot to say the least. We got to
the hospital and they normally don’t have ac in the patient care areas but in
PACU we have ac and especially they have a huge beautiful ac unit in all the
OR’s. The OR is a place that needs to be
cool because of all the clothing and cover gowns that the surgeons and nurses
have to wear in there. They said that
the power was out and that it would be back later this morning. Well we decided to start the day and see how
many cases we could get done. The ac
ended up turning back on toward the end of the last cases around 6pm. The patients just deal with the heat. I felt bad for the families that had to sit
in the hall in the heat and humidity. It
is very humid here in Reu.
I feel like
my Spanish is finally back to normal. It
only took a couple of days. One of the
things I have been doing in the PACU is holding the children that are a little
bit bigger because they are most of the time going a little crazy. All the children that are around 2 years old
and older I have been holding. I love
holding them and trying to calm them down a little. We do have to keep them a little bit longer
in the PACU than we would if we were back in the states because the nursing
care they receive and the resources, oxygen for example, are not
available. The post op nurses that are
here with us are great. Margaret and Cecily
both speak Spanish very well.
I have been
the only one that is back in the OR/PACU that speaks Spanish so Sandy has been
using me as an interpreter for her. I
feel like I am a valuable part of this team.
They are already hinting that I will be invited to come again and that
makes me so happy. This is an incredible
team to work with.
The staff
here has been great. We do have an
amazing team. We have someone for
everything. We have 4 plastic surgeons,
1 pharmacist, 3 anesthesiologists, 2 scrub techs, 2 circulators, 4 PACU nurses,
2 post op nurses, 1 pre op nurse, office staff, and several non medical
volunteers.
Each morning
I have been trying to keep up with my exercising by running. The resort that we are staying at is very
nice and very big. We have a running
group of Dr. Wilson, Lola Dawn Wilson, Angela, Ann, Josh and Me. We have been running either 2 or 3 laps
around the inside of the resort and each lap is about 1.15 miles. It has been a great group to run with and it
was a welcomed surprise to actually be able to run while I am here.
Today for
lunch we had chicken from a place called Pollo Campero which is a food chain
that is very popular. They have chicken
and fries. I have also been drinking a
couple of Cokes and Pepsi’s each day. I
think that the cola helps my stomach and calms it. So far I have not been sick; in fact no one
in our group has been sick either. Apparently
it can be quite miserable if you get the great gumba while here.
Wednesday-Friday February 22-24
The pictures are just a glimpse of
what my experience was like.
Tuesday-Thursday has been about the same. We did many cleft palates and lips. Along
with those types of surgeries we did some palate revisions to help these
children speak better. Sometimes when
the palate is repaired the children are still left with fistulas, which are
small holes in the palate where food still goes into their nose when they are
eating through the roof of their mouth.
Remember that when the palate is open prior to surgery, the entire roof
of the mouth (palate) is open into the nasal cavity. After the first surgery to repair the cleft
lip the palate is still open to the nasal canal (until the repair of the palate);
and even after the healing of the repaired palate they can have an incomplete
repair just because of the way it heals and they are left with these fistulas
or holes where food goes into their nose through the roof of their mouth. Plastic surgery is a very delicate
process. I continue to find myself
commenting to the parents how amazing it is that they are able to have this
caliber of surgeons working on their children.
They truly are artists. They know
exactly where to stitch in order to have minimal scaring etc. It is simply
amazing.
Thursday night we had the
opportunity to have dinner with the governor of the department, a congressman,
a female member of the government, the medical director of the hospital, his
secretary and a couple other staff members from the hospital. One thing that touched me most was when the
female government member stood up. She spoke quite well in English. She congratulated us on a very successful
week of work and stated that Gods most beautiful creations were the smiles of
these children and He was using our hands to finish his wonderful work. She said that we had done more than bless the
lives of these 52 children . . . we had
given them the opportunity to grow and be providing members of society. They will grow up and get married and have
families of their own now. It was very
obvious on Sunday as we were screening these children that it was hard to get
them to answer some of the questions. They had obviously been beaten down their
entire lives by people around them and had become accustomed to not socialize
with anyone.
In fact one of the boys that I
visited with on the PEDS ward after his surgery demonstrated that. I asked him what grade he was in and the
mother told me that he had not been going to school for about a year. He was in second grade. The children would constantly make fun of the
way he spoke. She said that just in the
24 hrs since his surgery he is speaking better than he ever had and that he was
excited to go back to school. These are
the kinds of stories that make this trip all worth it. It has been hard on me financially as well as
being away from my family for these 10 days but it has been all worth it.
Friday we did all Same Day surgery
cases so that we could have all of our patients discharged from the hospital
before we left the area the next day. We
did 10 frenulectomies, one rhinostomy and an eye scar revision that they had
been working on over the past couple of years when they come. The frenulectomies are where they go in and
clip that piece of skin that holds the tongue down when it is lifted up. These children were “tongue tied” because
that little piece of skin wouldn’t stretch making it hard for them to speak
well. This is a very short surgery and
is done with very little sedation. In
the states this surgery is done mostly in the doctor’s office or small surgical
center. Sometimes they don’t have to
place any stitches. They just do a
little snip and they are done. We were
done with surgery by around 1:00 in the afternoon at which time about half of
our group left to drive back to Guatemala City and fly home Saturday. I stayed with the group that planned on flying
home on Sunday. We went back to the
hotel and did what we had been waiting all week for. We swam at the pool (which was very fancy)
and enjoyed the warm air ( which was around 90 degrees with quite a bit of
humidity). In the evening we went to a
nice place for dinner and ate outside.
The temperature was amazing.
Imagine being outside in shorts and a t-shirt and not feeling cold or
hot. That was the typical evening
temperature that we experienced there.
After dinner we went down to the spa and I enjoyed my first spa
treatment of my entire life. Julie, Amy,
Angela, Barbu and I went and got a 45 minute massage and it was pretty much wonderful. I now know why they have that hole in the
massage table. It is for your face but it has a duel purpose which is to let
the drool not pool under your face. I
sat in the hot tub for a while and then went home and went to bed.
Saturday February 25
This was a day of travel. I woke up and ran with Angela and Dr. Wilson
for almost an hour, got cleaned up and packed. I then cruised down to a
restaurant where I got some oatmeal (avena).
I’m going to let you in on a secret.
Guatemalan avena is to die for.
It tastes kind of like horchata mixed with tapioca. It is very runny so it is not at all like the
oatmeal I have learned to choke down (and have gotten pretty good at choking
down) over the last 31 years. If I ever
get the chance to come back to Guatemala I am going to eat a lot more avena.
We loaded the bus van thing and
headed back to Guatemala City by way of a town named Antigua. Antigua is the old capital of Guatemala and
is now home to the largest market in the country. We did some shopping where I picked up some
small trinkets and jewelry for my wife and family. We then went to an old hotel called the Hotel
Santo Domingo. This is one of the coolest
places of the trip. This
hotel/restaurant is built inside of an old monastery and is now one of the
nicest places to stay at in the entire country. I chose to eat at the buffet in order to
experience as many different foods as possible.
Given the chance to do it again I would do it in a heartbeat. My favorite dish was a crunch corn tortilla
with black beans and guacamole on it with pork and cheese on top. I had three of them as well as a couple of tamales. The drinks were amazing and I loved every
moment. You can eat at these very fancy
places in this country for around 10-15 bucks depending on if you get frozen
lemonade. After dinner we got back on
the bus and headed back to the Hotel Barceló in Guatemala City which was about
a 45 min. drive from Antigua. One other
note is that on our way to Antigua we drove past several huge volcanos. One of them actually had a large puff of
smoke/ash coming out as we were driving by.
I am sure this is a regular occurrence for these people but I thought it
was very neat to see.
Once at the Hotel Barceló I went
for one last swim and then headed back to my room to pack for the trip home
because we would be leaving for the airport at 6 am.
Sunday February 26
I woke up early at 5am in order to
go downstairs and eat my last Guatemalan buffet breakfast. The Barceló hotel has a very fancy buffet
that is free with your room charge. They
have many different fresh squeezed juices, granola, yogurt, a made to order
omelet, all different kinds of breads, black beans, and chilequiles just to
mention a few. This trip has truly been
a blessing. I have been able to remember
how much I love my Latin-American family.
I grew to love them while serving an LDS mission 14 years ago. The language came back to me fast and it has
helped that I speak Spanish almost every day as a nurse at the hospital. These people live such simple lives and take
the time to enjoy their families.
We boarded the plane in Guatemala City
and headed for Dallas/Fort worth which was about a 3 hr flight. Once there we ate some lunch at Dickies BBQ
(you can’t go to Texas and not eat BBQ can you?). After about a two hour layover we boarded
another plane for another 2hr 45 min ride headed to SLC. We drove home with Dr. Wilson and his wife Lola
Dawn and now I am back with my beautiful wife and children. We all made it safe and sound. I have to put in a plug for my wonderful
wife. I tried to make it clear to her (and
I’m pretty sure she understands) that she has had a huge part in helping these
Guatemalan children by letting me go and her staying home to take care of our
children (not to mention some of my nieces and nephews as their baby brother
has been in the hospital). Thank you so
much Mary for letting me experience this trip of a lifetime!!!
I need to express one last thank
you to Julie Musselman and Dr. Patterson for inviting me on this wonderful
mission. I cannot thank you enough for
giving me this opportunity to serve my brothers and sisters of Guatemala. You truly have vision and I see the
inspiration that the Lord has given you.
I was amazed at how well the trip went and how well organized it was. Thank you so much!!
