Dale's blog

Surgery - Day 4 & 5 - continued

2009-11-17T03:03:00.000-08:00

Surgery, Day 4

Four down one to go. Another long day, on the bus at 6:25 pm. Every day gets better as I learn the system. Today I went to the PACU (after the kids get out of the OR, they are monitored here by nursing staff), I then escorted the children to the floor where I work (post-op). This system seemed to work well, I get a good initial look at each patient. If there was someone that didn’t look quite right, I am able to keep an extra eye on them. This worked very well for the first 15 children, then as I got more involved with the care of the children I was unable to escort a few of the last ten children.

Didn’t take lunch today, I sat down for about 5 minutes, had a sandwich which the volunteer kitchen staff (from Paraguay. I had a few coffees on the run as well as some cold bottled water. (I use bottled water for everything, even brushing my teeth at the hotel, don’t want to risk getting sick).
I gave most of my gifts away to the medical volunteer staff (from Paraguay) today. For the nurses I gave out a key chain from Life Lion that has a CPR mask attached. I also gave away some EMS patches that I collected over the years (when I recertify I get a new patch). The volunteers from Paraguay look up to us (USA) and are very grateful for any gifts. They are also interested in any teaching we can share with them and I did my best to share. I felt like there is more I can do, but everyone seemed pleased. The minimum wage here is around $3.00 per hour, I think the nurses are on the low end of the wage scale. Seems hard to believe.
Edgar is a great guy who volunteers on the pre-op ward (before going to surgery), he is not a nurse but went to school for some sort of medical assistant training. He doesn’t speak any English, is a hard worker, shows up every day on time and is ready to help. I noticed him in Paraguayan firefighter gear on when he arrived, then he got changed. I asked another volunteer and found out that he is a volunteer firefighter. I wore some Life Lion t-shirts to the mission. The next day I presented him with not only a t-shirt but an EMS patch from Pennsylvania. He was very happy to say the least. To my surprise he presented me with one of his t-shirts from his fire company and a patch. I gladly accepted.
I’m on the bus back to the hotel , so far, our bus driver got lost twice and made U turns both times. He took one turn on a dirt road with a lot of mud, he had traffic backed up for a few minutes. When is the last time you saw a bus make a U turn? Speaking of driving, it is not unusual to see three on a motorcycle, all without helmets. Passing on the inside lane is very common, and they drive on the sidewalk if traffic is too bad. I tried to snap a picture but was to slow. It would be safe to assume there are no traffic tickets issued in Paraguay. The coke trucks ride around with sides open and the staff holds on hanging out the side of the truck.
I’ll get back to the hotel and have about 30 minutes to jump in the shower and catch a cab.

Surgery, Day 5:
Another 5:45 wakeup call and on the bus at 6:30. Our final team meeting was held at the hotel after breakfast. We only have 14 cases today and all were lips, these usually have minimal complications.
Team picture in front of the hospital went well today. A few serious pictures and a few with star sunglasses that someone on the team picked up. We were all excited to get started. At 8:30 it was 83 degrees and got hotter as the day went on, to make matters worse this was the most humid day of all.
The day went excellent, I first went to pre-op to be sure the patients were ready, since we only had 14 this went pretty quickly. Faith (RN) as usual had the everything under control. Today I hit the wall around 2pm, layed down on the emergency table I set up and took a nap. I was exhausted to say the least. This was the hottest day by far and I work on the second floor which is a lot hotter, no a/c.
Well, here I am sitting in sweltering heat waiting for the bus to pick us up. We were to be picked up at 3:15, it’s now 3:50 but we are having a great time waiting. They just told us the party tonight is at the Sheraton and the bus will pick us up at
8:45. That’s 15 minutes prior to my bedtime. I’m sure there will be a lot of cervaza (beer) tonight.

Had a good time at the party, we had a professional photographer on the mission. Bert is a great guy, he put together a slide show to music. He picked out 500 pictures of the 5,000 that he took. Two of the songs he chose was Santana, the music fit perfect!
In closing: I tried to keep my blog up to date, but with the demanding schedule, I just couldn’t do it. Today is Tuesday, the 16th and I’m just posting for Friday & Saturday. I am now relaxing in Chile with Marisol (foreign exchange student that we hosted in 1999). All is well

This country is very happy to receive our help. I plan to do another mission, words can’t express the feeling I have after helping so many children

She is going home today after surgery yesterday. Her family was very grateful

The last day waiting for the bus to pick us up from the hospital, the volunteer's took burger king hats, turned them inside out, decorated them and made us a Kings & Queens for the day

At the party with the girls

Hemi is from Peru, he set up the OR's

With Dianna, a nurse that worked with me on Post-Op.

Patients and families looking at the surgery schedule

A teen volunteer who translated for me, thank Paula!!

Presented a patch to Edgar, then he had a shirt and patch for me

Faith & Doug (4th yr medical student from Chicago) putting up a paper towel holder made from tape.

Helping in the PACU

Received a gift from a PACU nurse

Picture in the PACU with one of the nurses

The volunteers got this bed ready in post-op (after surgery) for this patient, today is her birthday.

Surgery day 4 & 5

2009-11-13T15:06:00.000-08:00

I have a lot more to post but my laptop is really slow in the hotel. Getting ready for the final party with the team at the Sheraton. Should be a lot of fun, they are going to teach me to dance!! Now I gotta see that. Then a massage at 8am. More to follow

This is Faith, she is a great nurse. Comes to volunteer from a small town by the boarder with Brazel. Her son stayed with her in-laws in town while she worked this misson, he is so cute. Her in-laws work with HIV patents.

This was the most interesting night of all. I went out with Roxy, an OR scrub nurse from Paraguay.

This is something I planned to do this week, she picked me up at the hotel. Little did I know tonight would be an eye opener for me. Although their ambulances were pretty new, they had limited supplies which I am accustomed to in the states. The ambulance is very small and have 2 small 6 inch fans, I don't think there is AC. However, they did have intubation equipment (breathing tubes) and medications. Roxy told me they are government sponsored and no one receives a bill. Up to a few months ago, there were only 5 ambulances to cover the city of Asuncion with a population of about 1.5 million, they now have 14. Roxy works one 24 hour shift a week and gets paid $300 a month. You do the math. She works every day, I think she has 4 jobs plus she volunteers countless hours for Operation Smile. I frankly don’t know how she does it. She is a single mother, with a beautiful child (around 4 or so). After spending the night with her, I am now reflecting on how I spend my life at home.
As we sat in the rear of the ambulance, they received a call via radio and had to leave. The patient was pregnant and had to be transferred from one hospital to another, about a 45 minutes ride. We left and went to the government hospital where the main headquarters was for the ambulances. I asked if I could go inside, and look at the ED. I walked passed security and suddenly the doors to the ED opened. I was astonished at what I saw. This is a public/Govt hospital (they also have private). There were about 5 beds on each side that made a square and were separated by a canvas type army curtain, with very high ceilings. In the middle was what appeared to be a supply station in metal bins, similar to a buffet line in a restaurant. It is hard to explain in words, I wish I could have taken a picture. This hospital is decades behind in technology. I was able to take a picture of CT (cat scan) that they have.

From what I’ve been told the private hospitals are a lot better but not everyone can get treated at them.

Talking with the crew.

This is a hand held suction unit, I have never seen one like this before. We have one that runs on electric and batteries

There is no outside compartments and this is where they store the backboard.

THIS IS WHAT IT'S ALL ABOUT!! This was the last day of surgery, this kid was great. The local newspaper must have taken 100 pictures of us, looks like I'll be in the paper

These were my great teen volunteers, they translated for me every day while I was there, they were wonderful.

The only female General in the military, she is the medical director of the hospital. They keep a very small area of the hospital open

Surgery Day 3

2009-11-11T15:48:00.000-08:00

Surgery, Day 3
I found a way in my busy day to blog. I use my laptop on the bus on the way to and the way home from the hospital, save to a word document then copy and paste.

Last night (Tuesday), we had a storm and the lights went out while we were eating. I was out with Marian (Former foreign exchange student that stayed with us & now Operation Smile Coordinator), Within 5 minutes, Marian’s phone was ringing, the hospital was calling. The power was off, they were calling to assure Marian that everything was fine. They were off for about 45 minutes, the storm continued all night and was pouring buckets when we left at 06:40 the next morning. The hotel security guard escorted everyone to the bus with an umbrella (except me and a few other guys). He was drenched; I sat in the front of the bus today and before the bus pulled away I gave him a $3.00 tip, that’s all I had except for a $20 bill. The water lays mostly in the streets due to the limited number of storm drains, as we drove through the streets to the hospital, multiple Paraguayan’s are trying to huddle under the limited number of bus shelters. Some were standing on the seats of the shelter so they did not have to stand in the water and sometimes mud. In some areas the water was several inches high.

It’s now 7pm and we are on the bus back to the hotel. As soon as I open my room door, I’m going to the fridge for a cold one. Can’t beat the price for the convenience, it’s only a buck a beer. I was so busy today I didn’t get time to take many pictures. The good news is there is a professional photographer on this trip; Bert is a great guy and taking lots of good shots which I will be able to share. Today he took a picture of me, Anne & Marian, Operation Smile may do a story on our family, we’ll see. Sorry to say we had to cancel 3 or 4 surgeries today due to medical conditions the patients presented with today. We may try to do one on Friday, from what I heard tomorrow (day 4) will be very busy.
The family of the one of the patient's was keeping a diary for her son. She asked me to sign the diary, what I do and what country I’m from. In return she gave me a small hand crocheted white hat with a purple ribbon. The photographer was making his rounds and got some good pictures of the gift. Her gift to me ment more than words can express. The afternoon was very busy for me; I only took a few minutes to eat lunch. A student Volunteer, Analia Ruiz was huge help for me today. She translated for me with the patients and their families which made me a lot more efficient.
I had a great day today, I really feel good inside, we are making a difference. I am so glad I’m here. I am totally exhausted but it’s a good type of exhaustion. My goal is to be in bed sleeping by 9:30. Life is good.

This is Heimi, the OR tech from Peru. What a great guy, he is the one who used the machine to shock your heart by testing it with a fluorscent bulb

Diana, RN. I worked with her, she calls me "Daddy", she is a friend of Marian's. Super to work with

This is the great student volunteer that helped me today. I have to buy her a nice gift, I asked Marian to help with pick something out.

This is the famlily that took my picture yesterday after surgery. I gave them some Hershey kisses, everyone is fine

Some of the volunteers taking a lunch break

This is our kitchen staff, both volunteers, the daughter is an accountant, not sure what her mother does. Both are great. Today they sent a few people looking for me, the coffee machine broke and they saved me a cup. I was asked by some, "How do you rate", it's the Hershey Kisses!!

Typical breakfast at our hotel

Surgery, Day 2

2009-11-10T17:09:00.000-08:00

Myself, Marian & Anne (wife) in front of the hospital.

A superstar kid with a new smile being discharged today

Surgery, Day 2; Got up at 0540, breakfast at the hotel with the team, on the bus at 6:35 to the hospital. Team meeting in the courtyard. Day one went fantastic, 25 surgeries, all will be discharged home today. Again the night shift nurses got everyone ready, and started sending patients to the OR at 7:20 or so in groups of 5. Since all well in pre-op, Faith Schmidt, Charge RN asked if I wanted to observe in the OR, so I did. I want to sidetrack for a minute and say again the Faith is an amazing nurse. She talked about visiting the northern US; our house will always be open to her and her family. She told me today her husband in a doctor in a small (12 bed hospital), he does it all from childbirth to taking out your appendix. If something more serious, the patient is sent about 30-45 minutes away to a larger hospital.
I took Faith up and went to the OR, I haven’t been in the OR since my nursing school days. I watched two surgeries side by side. On Table one was my roommate, Walt Peet from Billings, Montana. He is retired after working 31 years as a plastic surgeon. On table two was Dr. Juan Carlos, the plastic surgeon from Columbia. Both are gifted surgeons, enough said!!
When I first arrived at the hospital, I went to visit the 3 y/o that I had my picture taken with the day before, he was sleeping. When I went to his room after spending an hour in the OR, he & his family were already discharged. Marian will try and get a family picture on his follow up appointment for me next Monday. We had a special bond.
Again, a busy day in post op. I tried to be there as every patient was delivered from the OR. My goal today was to keep the IV’s patent (open). We had a few problems with the IV’s on Monday, today was a much better day. I resecured the IV’s with tape and made sure there was no kinks in the tubing.
I was also requested to speak to about 20 high school students who came to the hospital today to learn about Operation Smile. They listened to my every word that was translated. Hopefully, they will become volunteers for this great organization in the near future.
In closing, we made a lot of families happy today. One family requested to have my picture taken with their son. That one moment made this trip worth my time and effort. I ended my night by having supper with Mrs. Wonderful aka my wife, Marian and Regi at the same restaurant we were at last night. It’s now 10:30 and 5:45 comes up pretty soon. Life is good.

Last day of R&R followed by1st day of Surgery

2009-11-09T16:54:00.000-08:00

On Sunday we went to a Country Club about a 30 minute bus drive from our hotel. This place was amazing, someone said it was a 5 star resort, sure seemed like it, just take a look at the pictures. Paraguay opens their arms to us, the owner of this resort allowed our team to spend the day with all you can eat buffet at no charge. What a great day we had

Got up Monday at 5am after getting to bed around 10:30 after our team meeting. Got on the bus at 615 to arrive at 645 for the 1st day of surgery. The patients arrived last night, were given a bath and spent the night in the hospital in the Pre-op area, after surgery they go across the hall to post-op. When we arrived they had the first 5 patients ready to go downstairs for surgery. This was a pretty relaxing time as the night shift nursing staff did a great job.

A family and patient I got close to, I played ball with him and we had a great time. His surgery went great, hopefully I'll have another picture posted tomorrow.

A typical window bed in a room of 4 beds, notice the IV pole on the wall.

I had a volunteer from Peru (biomed), come up and check the defibrillator, I was amazed how he checked it out. Yes, he did charged the defibrillator and lit the bulb.

Emergency room I set up on the 2nd floor

We got back to the hotel at 730, jumped in the shower and went a few doors down to a great french restaurant. I got soup, lamb, potatoes and a beer for under $20, it was yummy. It's now 10:30, gotta get to bed for another long day on Tuesday, all is well. Enjoy life

2009-11-08T04:10:00.000-08:00

Pictures of the house where the party for Operation Smile was. This house is where the gentleman who started the Op Smile Paraguay chapter lives. He works for Mobile and is a great guy!!

Faith enjoying an ice cream cone at the party, she is an amazing person. I will remember her forever. Faith is an excellent nurse and is married to a doctor. Faith & her husband live in a small area of Paraguay by the Brazil boarder. Her husband is the only doctor in a small hospital where he works. Her parents are missionaries and now are working with HIV patients. I will be working closley with her this week and looking forward to it.

Photo after my power point presentation, Faith translated for me, she is an amazing person.

One of our PACU nurses, Chelsea with the street vendors ¨Lets make a deal¨

Out to eat at a private club with the Buzo family.

Marian (my right) and her sister who came to volunteer. I think Marian said it was a three hour bus trip for her

A picture of the front of the hospital

Checking the drug box we will use in pre and post OP.

USA team members in the Operating room.

The food for them was prepared in a large pot for the patients and families by volunteers. The General of the military always tasted the food before it was given to the families.

Picture of where the patinets and their families stayed during the week. Some travelled a long distance, spending hours on a bus (and not the kind of bus we think of in the states!).

Saturday night 8pm my time

2009-11-07T15:06:00.000-08:00

Went out with Marian and her family last night at 830 to a private club. I got to meet Regi´s boyfriend, what a great guy. When he left to get the car for us, I told her I give my stamp of approval. A really nice guy. Got to bed around midnight. Today is the day that the patients find out who is getting surgery next week.

Gave my power point presentation on Life Lion aeromedical operations today and was very well received. A little difficult, I had someone assist me to translate every slide into Spanish (so the program took me almost twice as long). A lot of good questions, had nurses from Paraguay, a doctor from Columbia and multiple other volunteers from multiple conuntries,including the US. There were a total of 6 pp presentations this morning.

We went downtown for lunch and ate a huge meal that we paid for by the pound. I had a 22 ounce beer with my meal, the total cost was $10. We went shopping and saw some interesting street vendors. back to the hotel and got a much needed two hour nap. Now to a party tonight that starts at 9pm (aka, my bedtime).

I´m having problems connecting wireless with my laptop and the 3 computers in the lobby are usually full. I have lots of pictures and more info to post. Hopefully tomorrow I´ll be able to do that. Gotta go to the party.

All is well,

Friday

2009-11-06T14:26:00.000-08:00

My blackberry´s clock reset itself back to EST, so my room mate kocked on my door at 6am, my clock said 4am. Had a little time for breakfast, but just don´t think much of breakfast, lunch meat and cheese. I Opted for fresh juice and yogart.

Not much going on, today was the last day of screening. We will do 125 surgeries next week in 5 days. The OR is all set up and locked. We can´t set up the patinet rooms until Sunday night, there is no way to secure them, I have all my medication locked up in a special room.

I don´t have any photo´s to post, cant get my laptop connected. I´m waiting for Reggi (Marians sister) to pick me up for dinner, going to an all u can eat place per Marian.

I give my presentation at the college tomorrow, a lot of people are excited. I hope I don´t dissappointment them. I made a lot of changes today after talking to two volunteer nurses from Paraguay. I got all my videos to work, we shall see.

All is well. I will try to blog tomorrow and add some more pictures. Next week is going to be great. All is well, enjoy life!

Day Two (I Think)

2009-11-05T15:30:00.000-08:00

When I arrived at the Buenos Aires airport, they opened my suitcase and saw 28 pounds of Hershey Kisses. He had no idea what they were, had a peculiar look. I told him they were chocolate, he cautiously opened one, slicing it up like a fine piece of steak, then moved around most of the kisses, he didn’t smile, so I took that as my cue to leave.

Wow, not sure where to start. Got to the airport in Paraguay and was greeted by the Buzo family (Marian our foreign exchange student from 1995 and now the coordinator of Op Smile) Then a short drive to the hotel with Marian’s family, others went in a van. We got a welcome package with a Operation Smile t-shirt that we will wear on day one. Off to our room that I will share with Dr. Peet, the medical director from Billings, Montana. We got lucky and have two separate bedrooms, each with a shower. My window air conditioner is about 8 feet high and not very cold. No control knobs, good thing I have my small tool, aka Leatherman. I jumped on the bed, it was set to fan, used my tool to changed it to a/c, we are in business. To bed at 1am, slept like a log, up at 6am
Crawled out of bed at 615, to breakfast at 630, time for a cup of coffee, fresh juice, a piece of pineapple and out the door. Bus to the military hospital where we were greated by the Paraguay military at the front gate. For those that don’t know, this is an old military hospital that is not used. It is cleaned twice a year for Operation Smile.
Yesterday it was cool 47 degrees or around 117!!! So here I am at the hospital in long pants (jeans) and a T-shirt (Dr. Peet said we shouldn’t wear shorts). At 730, I was dripping wet. It’s now a little after 8, and I’m using my new laptop (Thanks to my wife), sitting outside in a very cool courtyard in a shaded area. From what I heard, today is screening day with over 300 to patients to be evaluated, for 125 surgeries. Yesterday they were screened briefly by the Paraguan Doctors, if there we any medical issues (Flu symptoms etc) they were sent to the local hospital. Upon our arrival there were approximately 200 families sitting in a grassy area in lawn chairs, some arrived yesterday. If they travelled, they were put up overnight in the military barracks with 70 small bunk beds lined up in two units. I went over there at 6pm to see them making supper for them in a huge pot. The head of the military was the first to try the meal, with his approval, two volunteers took the pot to where the families were staying.

Earlier in the day I was carrying a large trunk with medical records and had my camera in my front pocket. Broke the darn screen, will improvise and use my camera phone. Then Marian came to my rescue and gave me her camera so I’m back in business.
I first started to assist setting up the OR, which is fine with me it’s the only area that has A/C. They had some metal stands but the tops were missing. No problem, Paraguay volunteers are cutting heavy cardboard to serve the same purpose. After my short stint in the OR (an hour), I went to the second floor to set up pre & post Op. Every room needs cleaned as well as two nurses stations. I stocked the cabinets with medical supplies, lining some of the shelves with cardboard that I cut with my Leatherman. I went downstairs and saw the hallway (about 50 yards long), lined both sides with patients . Some were breastfeeding, others were holding loved ones in their arms, each with a different deformity. Words cannot express how I felt, I wanted to take a picture and share with you, but …. I will never forget, enough said, I’m getting choked up. The families went down each hall, stopping in special rooms set up, one for medical records, one for a picture, vital signs taken, meeting with the surgeons etc. Amazing how the process works. One more day of screening, then on Saturday, the families are called in, one by one to see if they were selected. It’s a pretty straight forward process for selection.

I went back up stairs to clean and put on some latex gloves. After about 15 minutes, your hands are so full of moisture from the heat, the gloves gotta come off. Did I mention that it’s hot here!!! Marian came to visit and hooked me up with two pedestal fans, Yippie!! I am so glad I brought my Leatherman (a small multiple purpose tool), I used it more in one day here that I ever did at home in 5 years. I now am proudly wearing it on my belt.

Typical post op room.

One of the student volunteers dressed up, he was great with the kids

Another visit from Marian around lunch, we went to the cafeteria. Yep you guessed it still hot. We packed up our lunch and ate in the OR.

My day started at 6am, got back here a little before 7pm, some were going out to dinner, not me. I’m staying back and relaxing. A one hour massage is $12, I might have to get one every day.

All is well, life is good – enjoy it. We are very lucky!!!

messages posted by Anne from Dale's text messages

2009-11-05T10:52:00.000-08:00

11-5-09

Dale sent me a picture (sorry can't post it from my phone) and said "7:30 and I'm sweating bullets."

Next message said "What an eye opener. I was helping out in the OR for about 1 hour, only place that as ac, very nice. Now setting up for next week on the 2nd floor, pigeons o/s the nurses lounge open window-no screens. Had lunch with Marian and Karen in the OR, remember it has ac. Marian hooked me up with 2 fans and gave me her camera, broke mine"

11-4-09 in Buenos Aires, Argentina

2009-11-05T02:24:00.000-08:00

What an amazing day. Prior to leaving the Atlanta airport, I met three other volunteers with Operation Smile: Walt Peet, a surgeon and team leader from Montanna, Chelsea, a nurse from Seattle and Anesia, a nurse anesthesia from Florida. We were not together on the plane, but met up when we landed in Buneos Aires. I don't sleep well sitting up, so needless to say I'm a little tired. We waited for our luggage on the slowest moving carousel I ever saw. All of our luggage showed up which was a bonus.

I had a LONG layover in Buenos Aires. Some fresh brewed, strong airport coffee was the fix I needed. We were to be picked up by our hotel. We waited, and waited-well you get the point. After about an hour and nothing, Walt made some phone calls. Seems no one reserved a ride for us. So we had to take a taxi. Let the fun begin. The fare should have been about 100 pesos; however since there was 4 of us the price went up. We ended up paying about 228 pecos or $60. Not bad for a 30 minute cab ride. We got to our hotel and it was great. Little did I know there would be no sleeping today. We brushed our teeth and out the door we go. We left around 10:30 and got back at 4:30. Just in time to freshen up and head for the airport at 6:20

We had an amazing day exploring Buneos Aires with the short time we had. We took a taxi ride that took us through demonstrations against the government. You think the cabs in New York are crazy, you need to ride one here!!! We arrived at our first stop-an old cemetery which was totally awesome. We spent about 90 minutes there and then went to this great restaurant next to the cemetery Our bill for 4 was $67, which included steak for everyone, two glasses of wine and a beer. The food was incredible. The same meal in the US would have been double that amount. Below is a picture of Anesia and me having a little fun at the restaurant, the staff was great.

Day One

2009-11-03T08:17:00.000-08:00

Breakfast at the Brownstone (local restaurant)with my wife, then to the airport. Sittin in the airport for flight to Atlanta.

Felt good on my first flight, about 3 rows from the back of the plane. All seats were full except the one next to me, YIPPIE. Then a middle aged guy comes hustling back, stands in the middle of the isle next to me and in a loud voice says: "Is this the first class area". Everyone had a good laugh, I thought this would be a very long flight but he was a great guy, turns out his wife is a RN and he is a minister going to a conference. All is well. Now waiting in Atlanta for my red eye to Buenos Aires. Will arrive around 7am, then a 14 hour layover. Operation smile was kind enough to get a hotel room. More to follow, stay tuned!!

Operation Smile pre planning

2009-10-22T18:49:00.000-07:00

Currently I am about 10 days away from my medical mission to Paraguay. I am finalizing my plans, getting my luggage ready. Still not sure how I'm going to pack the 25 pounds of Hershey Kisses that the Hershey Company graciously donated.