It will Get You in the Feels

The week is over, and it's true we did a lot for these kids and their families. Their quality of life will be improved. Their parents' worries will be soothed. We provided them with an opportunity to receive care that would otherwise be too costly or completely unavailable.

I know that we did a lot for them, but I can't help but think of what they did for us - for me.

Every year when I travel with Project Perfect World to Ecuador I'm reminded of something that I don't see often in my competitive, quick-moving, American life.

I think the word is humility - a willingness to receive help. These people have it, and they receive help with such lovely grace. They embrace their dependence. They allow us to help them. Serving in that kind of environment - an environment where my help is welcomed and appreciated is a rare and heart-changing experience.

I had a couple of experiences this week that will stay with me for a long, long time.

Seven-year-old Allison woke up in the PACU surrounded by strangers all of whom were speaking a language she didn't understand. She was terrified. We sent for her mom, but her mom couldn't be found. I stood for 45 minutes holding her little hand, stroking her fingers where they stuck out of the bandage around her IV. If I tried to talk to her she cried; if I even looked at her she cried. But if I just held her hand she was quiet and content. I didn't know I had the power to do that.

Saturday morning I took one last trip upstairs to our inpatient unit. I said my goodbyes to the patients. We had photos and many hugs and kisses. As I was heading back downstairs I ran into the grandmother of one of the patients. She stopped me, held my hand, and looked up at me with tears in her eyes for the longest moment. I wanted to tell her that it wasn't me who helped her granddaughter. I didn't do anything! I'm not a doctor! I knew she was trying to thank me; but honestly, I wanted to thank her for allowing me to play a small part in their lives, for so thankfully receiving what I had to offer.

Project Perfect World offers me the opportunity to give of myself.

Quote of the Day: Sage advice from a medical student, translator, and dear friend of mine, Bianca, "It can take two people to be upset, or it can take one. I think I'll let her be upset by herself."

Next Up ... more about our staff!

Orthotics are Fun to Do

There are two members of Project Perfect World’s team who we don’t see very often, but we know are

indispensible. Brian is a certified orthotist and Jamie is a orthotist/prostetist. They also happen to be brothers.

Together Brian and Jamie see 120 patients in clinic of which they treat 90. They asses and treat the physical and functional limitations of children resulting from illnesses and disabilities. In other words, they create and modify braces to address very specific mobility, function, and correction needs.

A usual day for Brain and Jamie starts at the hospital around 8 am and ends when they take the last bus back to the hotel at 11 pm or midnight. The hospital provides them with a shop where the can work and see patients. Their shop was once a shed behind the hospital, but they have really moved up in the world. They now have an air-conditioned room INSIDE. They are kind of spoiled.

Jamie and Brian have worked with a young lady they affectionately call “Stubby” for a couple of years. When Stubby was 1 year old, she had surgery and suffered an allergic reaction to the anesthesia. She developed a systemic infection, and her body responded by shutting down circulation to her extremities. Eventually her limbs began to die. Both her legs and most her fingers had to be amputated.

Stubby’s parents brought her to Brian and Jamie’s clinic to see if there was anything that could be done to her with mobility.

After some trial and error, Brian and Jamie found a solution they thought would work. From a cast of her legs, they built her a prosthesis made of lightweight foam and copoly plastic. The battle was not won just yet.

Stubby’s skin is very sensitive. Her legs are a mass of scar tissue; she could barely tolerate being touched, let alone the contact of a prosthesis. Brian and Jamie delivered the prosthesis to Stubby’s parents and instructed them to help her build up a tolerance for it. She should wear it for as long as she could – increasing the time as much as possible.

When Brian and Jamie saw Stubby in clinic this year, she was wearing the prosthesis. Ok. She was not only wearing the prosthesis, she was also walking and running!

With the help of Brian, Jamie, and her parents, Stubby is now a mobile, happy, beautiful little girl.

As part of Project Perfect World’s education efforts in Ecuador, two of our physicians spoke to a crowded auditorium of local doctors. We learned more about scoliosis and spinal cord injuries. Their talks were translated by the ever present, kind, and tenacious Cesar.

Quote of the day: When beginning his talk on scoliosis, Dr. Riely asked the crowd to: “Raise your hand if scoliosis is your favorite thing!” No one did. Tough crowd.

It's a Surgery Thing

This week Project Perfect World will do 20 surgeries (including 5 scoliosis surgeries) in 5 days. The

kids are all impressive, but I had the opportunity to get to know 3-year-old Katy particularly well.

I met Katy in clinic on Sunday. She came up to the administrative group running the clinic from a makeshift table; sat down on the bench next to us; and said, “hola!” For the rest of the day she participated as if she was one of the staff (sometimes we wished she wasn't quite so helpful). We were immediately charmed.

I ran into Katy again when she came with her family for surgery on Wednesday. She had hip dysplasia (a dislocated hip) that caused her to walk with one foot on her tippy-toe. Project Perfect World’s Dr. Schwend planned to surgically put the hip back in the joint and cast her in a spica cast.

Katy’s surgery went well, and she came to the Post Anesthesia Care Unit (PACU) with an epidural. The local nurses who take care of our patients on the patient floor are not trained to maintain epidurals so we kept Katy in the PACU for six hours to allow her to take advantage of the pain medication as long as possible.

It was in the PACU that I really got to know Katy – she is a charming, patient, savvy young lady.

When we told her she could only have a little water for now, she rationed the water she had. She lifted her sippy cup to visually measure what she had left before she took a sip – only a sip. She had remarkable self-control.

We gave Katy a stuffed unicorn to play with, and she asked if there was a toy she could take to her sister. Initially we thought she was the sweetest thing ever, but her father quickly set us straight. He said that she had figured out that if her sister had a toy too, she was less likely to try and play with Katy’s. Pretty smart for a 3-year-old.

Katy’s parents expressed their deep gratitude to Project Perfect World for helping their child. I too was grateful to get to know such a great kid and to be a part of her care.

We also had a heroic rescue today by one of our OR nurses, Lisa. The OR teams were working away when they heard a loud CRASH. Lisa ran out into the hall and saw a man’s legs hanging from the ceiling. He had been doing some maintenance work and had taken a fall. Dust and debris was everywhere.

Lisa quickly wheeled a gurney under to catch him and yelled, “drop!” Somehow he understood her command in English, and let go. He dropped onto the gurney. Lisa saved the day.

Only in Ecuador. 

Quote of the day: A local Resident serving as a medical translator was telling us that there is no call system for physicians in Ecuador. He said that if you are shot on the weekend, the laws prohibit a surgeon from caring for you until Monday morning. He summed up the problem by stating, "It's really easy to die in Ecuador."

Below are more photos from Roberto. They are far more descriptive of this experience than my words.

Hitting the Ground Running

Bienvenidos a Ecuador! The Project Perfect World team made it to Ecuador Saturday night, and spent

Sunday seeing patients in our most busy clinic day of the week and setting up for surgery. From the patients seen on Sunday, we make our surgery schedule for the week.

Clinic is an emotional roller coaster ride. The families come with infectious hope. When the Project Perfect World surgeons determine that we can help a child, we rejoice with the family. When the surgeons decide that the time is not right or the surgery too dangerous for the situation, we empathize with a mother's tears.

Patients and their families show up at clinic early in the morning and wait to be seen by one of Project Perfect World's surgeons. They wait in a loud, hot, crowded waiting room. I am always impressed with their comradery. They arrive in the morning as strangers, and by the evening they seem to have known each other all their lives.

One of the last patients we saw Sunday evening was a young man, Jose, who had been assessed for surgery for the last ten years. His foot had turned due to a neurological problem following meningitis, and he walked on it's side. He is a tall, strong 17-year-old. I can only imagine the pain he must have felt when he placed his weight on his foot with every step. His mom brought him to the Project Perfect World clinic last year without an appointment and was turned away by local staff. She said that her biggest regret is leaving without being seen by one of our doctors. 

This year they came to clinic again without an appointment. They waited patiently all day, and politely insisted to the local staff that they would like to be seen. When the surgeons saw Jose's foot, they knew immediately that surgery could greatly improve Jose's quality of life. 

Jose had the surgery to correct his foot today. It was a very emotional experience for him and his family. After 10 years of waiting, a lot of pain, and even more patience - Project Perfect World was able to help Jose make a new start.

We also spent a lot of time preparing for the week. An advance team comes a few days early to get a jump on the work. Project Perfect World has such a great relationship with Roberto Gilbert la Hospital de Ninos in Guayaquil, Ecuador that they allow us storage space in the hospital year round. Preparation includes unpacking, sorting, and organizing a staggering amount of supplies.

Operating room nurses and techs set up the ORs, and an intensive care team prepares the Pediatric Intensive Care Unit for the week of work. In addition, Project Perfect World brings an instrument tech who must organize all the instruments and prepare them for use.

Quote of the Day: One of our scrub techs described the coming week with the statement, "It will be long, and we will be tired, but we'll have fun."

Below are some photos taken at clinic by the talented Project Perfect World photographer Roberto.

The Project Perfect World team will be traveling to Guayaquil, Ecuador June 1 - 8, 2014.