Stories From Nicaragua

“A NIGHT IN MANAGUA”

In the middle of the night when everything was calm, Mario and I had a few minutes to look around Hospital Infantil Manuel De Jesus Rivera located in Managua, Nicaragua. Mario was a Nicaraguan physician who participated with the in-country Operation Smile missions and had volunteered to spend his night translating for me in the Post-Op Unit. We wandered out to the hospital lobby, and what I saw before me simply stopped me in my tracks. There were approximately twenty people sleeping on the ground right outside the locked doors to the front entrance. Mario explained that many of them are people who live in very remote areas and travel far to bring their children here. Since only one family member is allowed in a Post-Op room at night with their child, any other family member often sleeps outside.

Meanwhile, inside our Post-Op Unit, for every child sleeping in a bed or crib, there was a person attempting to sleep in a chair next to that bed or crib. Yet, despite this discomfort and other conditions that we would find difficult to bear, the parent remains patient with their child as he/she squirms or cries, sweating in the warm room, possibly febrile, and desperately seeking sleep in the strange, new environment.

As the sun was rising several hours later and we rounded from room to room, the same exhausted family members graciously accepted our repeated suggestions to push fluids for their child and smiled in return as we wished them the best.

-Amy Braun, Post Operative Nurse, Operation Smile Managua
November, 10-17, 2007

The children who needed an operation but weren’t quite ready for surgery are the ones I remember and think of. “X” was one of the last to be seen in screening, brought by her mother after we had begun to clean up for the day. She was one and a half years old and brighter than one might expect. She had a facial cleft, either Tessier 3 or 4 with additional clefting of her ear and lateral eyelid. She had cleft hands and an unusual skin condition with patches of firm, hypopigmented spots throughout her body. Although they looked like scars, her mother said that she was born with them. She had a head of thin, sparse hair and her skin was dry. We suspected that she had the ectrodacytly-ectodermal-dysplasia-cleft palate syndrome, also known as EEC. Her mother suspected that this was all due to moon rays from an eclipse that occurred the night she gave birth.

In addition to her hands, face, and skin abnormalities, “X” had a non-seeing eye and strabismus. The eye looked empty with no iris and just a bright white reflection. Her ear was thin and knobbly in appearance. She had anteriorly projecting teeth from her malpositioned, clefted alveolus. In spite of her appearance, there was a bright, feisty girl inside.

“X” came back the next day for bloodwork, but the overall sense from the team was that she was too small and undernourished to undergo a surgical procedure.

What will happen to her? How will she eventually look? Who will she eventually be? She will see a local ophthalmologist and will return to the next international mission screening in less than a year. Her mother is caring and attentive. She is a bright little girl. Who will she grow up to be?

Raymond Tse, MD, FRCSC, Plastic Surgeon, Canada
Team Nicaragua, Operation Smile World Journey of Smiles 2007

Saturday, 8AM – the day that all of the children will find out if their lives will be changed. Hundreds of people anxiously gathered around the hospital, awaiting for the lists to be posted.

Finally…the lists went up.

I recognized one of the mothers, whose daughter I screened for cleft lip surgery. I distinctly remembered her story – 14 hours of travel just to get to Managua, in the hopes of obtaining cleft lip surgery for her daughter. Hours and hours by foot, boat, and bus – and now they finally made it.

She walked away from the wall – crying. I didn’t know what to say. Did her child not make it on the schedule? Was her daughter too malnourished? Was she denied surgery for health issues?

Then, I felt a tap on my shoulder. It was her – with her daughter. As I spoke to her in the small amount of Spanish that I knew, I did understand her say, “Thank you”. Through a translator, she told me that today was the first day that she saw her daughter smile – she said that she didn’t know that her daughter could smile with a cleft lip, as she never saw her do it in the past year. Monday, her daughter would have cleft lip surgery.

I then realized that those were tears of joy.

-Albert Andres

I looked after one boy who was about 14 and mentally disabled. That day I was the only non-Nicaraguan in the OR and the only person who didn’t speak Spanish. As the Nurse, it was my job to help Anesthesia get the boy off to sleep. Unfortunately, because of his age and size, he needed an IV before he could off to sleep. The girls had tried in pre-op but he became very agitated and somewhat aggressive. The Nicaraguan Anesthesiologist elected to bring him back to have the IV started in the OR and warned me that me might have a fight on our hands. The boy was terrified and at first was very agitated but the Anesthesiologist and myself calmed him down and eventually got him to lie down. He grabbed my hand and I held his hand and re-assured him in what must of been the most horrible Spanish he had ever heard. He just looked at me and smiled. He had his IV started without so much as a flinch and went off to sleep without incident and the surgeon repaired his cleft lip. It showed me that caring for another person crosses all language and cultural barriers. My trip to Nicaragua with Operation Smile has been the highlight of my Nursing career.
Thank you

-Quinn Sharkey RN, CNOR

Blues from the green eyed baby

Green eyes stared at you from the tiny 5 month old tot. Her 16 year old sister was her sole companion on her visit. With the child in one arm and an old diaper bag in the other,
she came from afar with little money and lots of hope. The child was cute, chubby and smiled at you at every opportunity. She smiled at our giggles, bubbles, and perhaps even freckles. Her mother was with her other sister who had been admitted in a distant hospital with pneumonia. The 5 month old could not be cleared to undergo surgery as she had congestion and fever. We told her sister that we could not operate on her lip now but will definitely do it after 3 months when she is healthy again. Her hopes dashed in one quick moment, sorrow rolled as tears from her cheeks. The sister was uncontrollable for 10 minutes. Then she looked up, looked at the baby and smiled again.

Her journey will continue and her hopes have been renewed. Again will come another opportunity and she will be back. Her little sister will have her lips repaired hopefully in the next few months. The green eyed baby’s smile will be complete soon.

As Dr. Magee and hordes of volunteers travel on this world journey, not only are they accumulating countless miles ( frequent flier for some), they are also spending many more smiles throughout the world.

-Pradeep Padmanabhan, M.D, Pediatrician,
Operation smile – Nicaragua mission November 07