Changing Lives, One Patient at a Time

Sunday January 10th – Monday, January 11th, 2011. Comunidad de Ruiz, San Juan, Sacatepequez, Guatemala. On Saturday, January 9th, a 17-person team of surgeons, nurses, operating room technicians, translators and support staff - calling themselves Team Renova – walked out of Guatemala City International Airport. Upon arrival, they were met by Partner for Surgery (PfS) staff members Christine Record and Felipe Sutantri and shuttled northwest to the complex of facilities we commonly refer to as the Centro de Salud Bárbara (CSB) – a modern surgical center and a pre- and post-operative residence facility for patients and their families located in this small town on the outskirts of San Juan. PfS jointly shares and operates the surgical center at CSB with our Guatemalan partner organizations Compañero en Salud (CenS) and Asociación Compañro para Cirugía (ACPC). At about the same time as the surgical team was arriving, so too were 67 surgical candidates who had been identified during our rural medical “triage” missions over the last several months. In addition to the patients themselves, in most cases entire families made the journey together in support of their ailing loved one. Men, woman and children of all ages traveled up to eight or more hours in search of the life changing, sometimes life-saving surgery that the volunteer surgical team can provide. Yesterday (Sunday, January 10th), I made the hour long trip from Antigua to the CSB.

One of the patients that immediately caught my eye was Lucia Pop, a 16 year old girl who was here at the CSB for the second time. She’d traveled the over 180 kilometer, eight hour journey with her parents in November 2010, but was turned down because the reconstructive facial surgery she needed was beyond the expertise of the team of volunteer surgeons who staffed that mission. November’s surgical mission had been organized by Dr. Joseph Giordano. Recently retired, Dr. Joe had worked as Emergency Room Director, and more recently Chief of Surgery, at The George Washington University Medical Center in Washington, DC. One of the organizers of Team Renova, Dr. Philip Iorianni had trained under Dr. Giordano, and Doctor Phil was determined to deliver the surgical care that Lucia needed and so desperately desired.
As a result of a condition that first presented when she was a week old, Lucia arrived Saturday with what looked like a severely swollen black left eye. In fact, she had a naturally occurring sac of blood corpuscles under the eye – a disfiguring condition that worsens if untreated, but which could have routinely been corrected when she was a small child. Unfortunately, access to routine medical care for those who live in remote areas of this nation, not to mention the specialized care Lucia needed, is in nearly all instances a non-existent luxury.

While her parents had accompanied her in November, on Saturday, Lucia had to travel the eight hours alone because her mother went into labor as they were preparing to leave. So, unable to speak a word of Spanish (she is from an area where the Mayan dialect of Keachí is spoken) she set off alone, determined to break free of a condition that, according to Lucia, caused great shame, often kept her out of school, and isolated her inside her home and away from friends. Essentially, it was robbing her of the childhood she deserved. Upon her arrival, Lucia reported that her condition made her “feel ugly,” and that she was depressed and sad about the way she looked. “Before I learned I could receive treatment,” she said, “I did not want to go on living with my face like this.”

On Monday morning, I had the privilege of speaking with Lucia, through two interpreters, just a short time after she had been wheeled out of surgery into the recovery room. According to Dr. Iorianni, the surgery was a smashing success. Check back to this site in the coming days to see post-operative pictures of Lucia and an interview with Dr. Iorianni. (Brian Carome is Director of US Operations at Partner for Surgery, a not-for-profit organization based in McLean, VA and operating in Guatemala.)

Let me introduce you to Santiago, age 5-months

Saturday, January 8th, 2011. Near Chiché, Quiche Guatemala. At 6:20 am on Saturday, Frank and I drove out of Antigua, and began a trek designed to orientate me to our Infant Nutrition Program (INP). At just after 9 am, we arrived in Santa Cruz del Quiché, the bustling commercial capital of the Department (State) of Quiché. Twice along the way the four lane highway was reduced to two where repair work was underway to replace 500 yard stretches of roadway that, following heavy rains, had plummeted into the valleys, and in some instances, the homes below. In Santa Cruz we were joined by Diego Aurelio Cordova Toma, a Guatemalan nursing student who is one of the Rural Coordinators of our INP. It would be Aurelio who would introduce me to the families of two infants – Santiago Isaias (age 5-months, shown at left with his mother Josefa Morales Guarcas) and Mely Tzalam (age 4 months) – both of whom were born with clef lips and palates so severe that their mouths were unable to latch on to their mother’s breast. As a student at Boston College, I had frequently spent long afternoons at the Kennedy Library. There I had seen the archival footage of Bobby Kennedy’s journey into the heart of Appalachia, used to demonstrate his awakening to the shocking condition that some American families lived in. Today, walking into this remote Aldea (small village), I too was startled by the poverty around me. I will write more about Mely in the March 2011 edition of our newsletter. Here I will share a little bit of the Isaias’ story.

The Isaias’ home is five kilometers from the nearest paved road and over 300 yards from the small adobe church where we parked our car. It’s about 300 yards from the well that serves the surrounding area. Their home is constructed of mud, stick, cardboard and plastic. Their “kitchen” consisted of an open fire on the packed mud floor. The Isaias family, like the other families in this tiny rural enclave, are without work because of the dry conditions that currently exist in this agricultural region. I was startled by the poverty. I was also struck by the wealth of spirit, generosity, pride and playfulness I witnessed (pictures of my visit will be posted to this blog upon my return to the states next week).

I was immediately drawn to Santiago, noticing at the same time his beautiful, brightly alert eyes and what looked like the tip of a pinky finger protruding out of his mouth. Often thought of as an unsightly facial deformity, the severe form of clef lip and palate that Santiago was born with can be a death sentence because he cannot latch on to his mother’s breast. The survival rate for children like Santiago is grim. Market rate formula, let alone the supplies needed to prepare and serve it, are financially out of reach. Partner for Surgery’s INP offers Santiago and children like him their only chance for a normal life.

Santiago was born at home with the assistance of a mid-wife. Once he came to the attention of Aurelio in December, when he was four months old, he and his family were entered into our program and immediately brought, for the first time ever, to a hospital where he was evaluated against standards of healthy infant development. He was then sent home with the same chart that parents of children in the U.S. receive during their child’s first healthy-visit to a pediatrician, usually on or around the third day after birth.

The goal of our INP is to perform the facial and respiratory passage surgery needed to close the palate and nasal cavity and construct a full upper lip. Even infants who survive into childhood remain at risk of respiratory infection if the palate is not closed. An underweight child will not survive the reparative surgery that a volunteer surgical team can provide. Aurelio’s job is to work with Santiago’s parents to usher the child toward nutritional stability and normal weight benchmarks, providing them with low or no cost formula and the skills they need to use it effectively.

Aurelio began by teaching Santiago’s parents how to properly prepare and serve the formula. During each return visit – one to two times a month – he’ll weigh Santiago and chart his overall growth. He’ll also continue to instruct the family in safe preparation of the formula. I look forward to the day when I meet the post-surgery Santiago and he returns my smile with one as beautiful as the dark bright eyes that followed me around as he sat peacefully in his mother’s lap on Saturday. In my next posting, I will be sharing my first ever observation of a surgical mission in action. (Brian Carome is Director of US Operations at Partner for Surgery, a not-for-profit organization based in McLean, VA and operating in Guatemala. He will be writing here about his visit to Guatemala through January 12th.)

The Fire is Lit, Now for the Real Guatemala

Friday, January 7th, 2011, Antigua, Guatemala. I think the legal term for what happened is “spontaneous utterance.” Whatever it’s called, when, with the advantage of sunlight, I was able to take in my immediate surroundings yesterday morning (Thursday, January 7th), I exclaimed “oh, my God” at the spectacular sight of Mount Fuego, one of the many active volcanoes that stand out as exclamation points in this culturally rich and beautiful nation. Spewing ash into the blue sky above, Fuego, I now understand, foretold the fire of passion, respect and awe that would be lit inside of me as the hours of the following two days unfolded.

As you may have come to expect, my days begin with a run. The Antigua morning rush hour I now know is a mix of bicycles, buses, pedestrians, diesel trucks, mopeds, motorcycles and SUV’s. In opting to put in a morning run, the choice is often between glancing downward to navigate the cobblestone streets and rutty paths beside the roadway, or upwards to avoid the rush of oncoming traffic on the paved roads. What’s obvious is that at 6:30 am, this nation and its people are already hard at work.

Since my arrival at Partner for Surgery last November, I’ve developed a growing appreciation for the hard work that our staff here on the ground are engaged in day by day. Yesterday, I spent 9 ½ hours with our leadership team here – Director of Rural Operations Jessica Momberg, outgoing Director of Operations and External Relations Felipe Sutantri and Director of Operations and External Relations (In-Training) Christine Record. With their front-line service and office support staff, these faces of Partner for Surgery blanket a wide swath of this predominantly rural country with the systems, structures and caring expertise needed not only to deliver quality, life-saving medical care, but the training and knowledge that the Guatemalan people need to respond to their own community health care needs. During this all day staff meeting, we evaluated our successes and challenges and created renewed vision for evolving our approach and focus in the hope of expanding our impact in the year that lies ahead. This evening, we met in Guatemala City with the leadership of our Guatemalan partner organization Compañero en Salud, and mapped out an exciting new vision of cooperation between our two organizations to meet even more of the existing need in the years to come.

Tomorrow morning the focus of my orientation switches to what our staff here refer to as the “real Guatemala.” At 6:00 am, Frank and I head out of the city of Antigua into the rural heart of the country where we will visit with some of the families being served by our Infant Nutrition Program. I imagine that the long journey from Arlington, Virginia through Guatemala City to Antigua might in retrospect seem like a scenic stroll once I’ve seen life outside of these two cities. (Brian Carome is Director of US Operations at Partner for Surgery, a not-for-profit organization based in McLean, VA and operating in Guatemala. He will be writing here about his visit to Guatemala through January 12th.)

Meeting Good People Along the Way

6:00 am, Antigua Guatemala. After yesterday’s pre-sunrise run, I completed some frantic last minute packing and began my journey with cab ride to the McLean, VA home of Partner for Surgery (PfS) founder and President Frank Peterson and his wife Linda -- my seasoned colleagues, travel-mates and guides on this, my first ever trip to Central America. Like the night prior to so many of their previous missions to Guatemala, the Petersons had been kept up Tuesday night deftly squeezing essential medical supplies and equipment – including an Ohmeda Anesthesia Gas Monitor, a sophisticated medical device essential to surgery – into the six oversized suitcases we were transporting down with us. We boarded the first of our two flights for the day at 11:20 am. Skipping forward over a day of both pleasurable and educational conversation for me, at just before 8 pm local time, I was getting my first glimpse from the air of the lights of Guatemala City – a scene not unlike my first-time arrival in other major cities. Temperature on the ground – lower sixties after what the pilot said was sunny afternoon in the mid 70’s. Gracefully we breezed through customs without having to pay any unexpected or burdensome import taxes for the donated medical supplies we were carrying and met our driver Jorge – a Guatemalan citizen who once taught driving lessons in Annandale, VA – at about 8:30 pm. In the airport at baggage claim, the Petersons had an unexpected but welcome meeting with Ricardo Umana, former Chief Justice of the Guatemalan Supreme Court and a longtime friend of the organization. Our bags were quickly thrown on top of Jorge’s tourist van and we joined about seven other international travelers for the one hour drive to Antigua. (La Antigua Guatemala ("The Old Guatemala") served as the capital of all Central America from 1543 until 1773 – source: http://www.mayalandia.com/guatemala/colonial-history.php.

As we approached the center of Antigua, paved roadway turned to cobblestone streets and I got my first quick look at local businesses – restaurants, small hotels, a gym, a sushi bar, a gas station, a local market stocked floor to ceiling with provisions of daily living – in this quant and cosmopolitan small city of 31,000 (source: http://en.wikipedia.org/wiki/Guatemala). I spent the entire drive chatting with two American Peace Corps Volunteers (PCV’s) both of whom were returning from holiday visits home – Alicia Swift from Oregon and Aliyya Shelley from the San Francisco Bay area. Both know Jessica Momberg, PfS’s Director of Rural Operations, a former PCV herself. Alicia talked of her work in the Peace Corps Healthy Schools Program evaluating and monitoring the delivery of curriculum in Guatemalan elementary schools that introduces concepts of everyday best health care practices to school children in rural communities. She also spoke about her familiarity with international volunteer engineer missions working to improve access to affordable, accessible water. Aliyya, a third year PCV, now supports the work of over 30 first and second year volunteers who work with teenage girls and young women to promote behaviors and decision making that create economic opportunity and sustainable family planning. Alicia, a graduate of the University of Oregon, reflected on how her experience in the Peace Corps and rural Guatemala was challenging her to grow personally and professionally, reminding me of the early years of my own career working in a shelter for homeless adults in Washington, DC in the mid 1980’s. Their lives and career choices deeply impacted by the work in Guatemala, both talked about their plans to pursue degrees in public health or a similar field.

Finally, a few minutes before 10 pm, Jorge dropped us and our luggage at the Peterson’s home in Antigua. Just before the van departed with the remaining passengers, Aliyya generously advised me on a suitable route for my Thursday morning constitutional run. At the house, we settled in, Frank orderly arranged the medical supplies we’d brought and, after a quick snack, we said good night and called it a day.

Memories of the journey and the conversations I’d had throughout the day, great wonder about what beauties and treasures that sunrise will reveal, and anticipation for the 8:30 am staff meeting and the new introductions it will offer are the thoughts crowding my mind at the close of this exciting day. During our layover in Dallas, I learned that a last minute glitch was threatening to disrupt our long planned and painstakingly arranged training of Guatemalan Ministry of Health nurses later this week in Fray Bartolomé de las Casas. Trouble shooting? Brainstorming improvisational solutions? Adjusting expectations for this important effort to detect and treat cervical cancer. Which blend of these activities will greet me in the morning? (Brian Carome is Director of US Operations at Partner for Surgery, a not-for-profit organization based in McLean, VA and operating in Guatemala. He will be writing here about his visit to Guatemala through January 12th.)

A World Away or Closer than I Imagine?

6:50 am ET, Arlington, VA. In just a few hours I’ll board a plane at Dulles International Airport and begin my journey to Antigua, Guatemala beginning a new and important phase of my orientation as Director of US Operations at Partner for Surgery, an organization I came to work with on November 1st, 2010. I am just back after my daily morning run along the Custis Trail. The temperature in Arlington this morning was in the mid 30’s. Even at 6 am, the hum of rush hour traffic on I-66 was already buzzing. I wonder how that will compare to rush hour in Guatemala City. Along the run, I tried to assess my expectations for this trip.

I’ll be meeting the staff and leadership of our independent Guatemalan partner organization, Compañero en Salud (CenS), as well as my colleagues at Partner for Surgery’s Guatemalan headquarters in Antigua. There will be lots of new names, faces, stories and languages – both Spanish and the many Mayan dialects spoken by our patients, staff and many translators. I’ll have a chance to see a team of volunteer surgeons and other health professionals from Montgomery County, MD at work in our surgical center in San Juan, Sacatepequez starting next Sunday. And as a husband and father of four daughters, I am particularly interested in hearing about the success and challenges of the training we are sponsoring this week of Guatemalan Ministry of Health nurses in the use of an innovative protocol to detect and treat cervical cancer among women in remote Mayan villages. I am told that during the training we’re expecting upwards of 1000 women, all of whom are coming in to be screened for cervical cancer.

What other images might I encounter as I step off the plane in Guatemala City later this afternoon and head west to Antigua? For the last 25 years, I have worked locally here in the DC metro area with children, adults and families who were homeless. How different will those experiences prove to be when compared to the medical and health education services Partner for Surgery delivers in Guatemala? I am about to find out. (Brian Carome is Director of US Operations at Partner for Surgery, a not-for-profit organization based in McLean, VA and operating in Guatemala. He will be writing here about his visit to Guatemala through January 12th.)