Thursday was the final full day of surgery, and Friday was a half day. Both were packed full as the surgeons tried to fit in as many of the remaining patients on the waiting list as possible. All the residents completed one palate and two lip repairs as the lead surgeon with the credentialed Op Smile surgeon assisting, and the anesthesia residents all had the opportunity to manage general and local anesthesia and perform the various blocks under the careful supervision of the team anesthesiologists. On the wards, the nurse trainees from Ghana were amazing. They all work as hospital nurses in Ghana, so their general nursing skills are solid. To be credentialed for Op Smile, they needed to learn about the special needs of post-op cleft lip and palate patients. This includes getting oral fluids in without disrupting their sutures, managing any post-op bleeding from the palate, recognizing and treating breathing problems from airway irritation, bronchospasm or excess secretions. Finally, they learned how to do the discharge teaching about wound care, medications and feeding, and each had a turn presenting this information to the parents.
The parents were very supportive of their young professional countrymen, cheering them on, sometimes teasing, but generally trying to make sure they were comfortable and would succeed in their credentialing. On Friday morning, while I was signing the discharges, it was the turn of a rather soft-spoken nurse trainee to give the discharge spiel to the parents. One of the mothers took her aside and said, “You got to shout out those instructions, girl, if you want to pass. None of that mumbly stuff you usually do.” Though she didn’t exactly shout, the nurse did speak up enough that there were no complaints about not hearing her.
I took Thursday night late call and the last patient didn’t reach the ward until 10:00. The PI had been treating him for post-extubation bronchospasm in the recovery room for two hours, alternating albuterol and terbutaline updrafts, IV steroids and 6 liters of nasal oxygen. He’d also given the boy Benadryl to sedate him as he had been thrashing about on the bed. Unfortunately, as sometimes happens with children, the boy had become more agitated, pulling out his IV and trying to take off his oxygen. When he arrived on the ward, he was asleep, thanks to some clonidine. His IV and nasal prongs were heavily taped in place and his oxygen was being weaned. I stayed around until it was clear he was out of the woods and then left for the hotel.
Friday morning Hans, Kathy and I were on the 5:50 bus to the hospital to prepare the final patients for surgery. I’d gotten to bed at 2:00 so was not at my most perky. Just as we finished the pre-ops, one of the medical records volunteers brought over a four year old boy for me to screen. His parents had driven overnight, hoping to arrive in time for their son to be evaluated. He didn’t have any clefts, but he had never spoken, and they thought maybe a tongue tie or other minor surgical problem might be the cause. My heart sank as I listened to their story because I’d heard it several times before on Op Smile missions. The child was deaf, likely profoundly so. When I asked the parents about their son’s hearing, they replied that he could hear and understand everything. But when I asked his mother to stand behind him and call his name and ask him to tell her his sister’s name, he didn’t respond at all. The father understood before the mother, I think because he was sitting in front of his son and saw the complete lack of response to the mother’s voice. The mother even said, “He hears fine. He just needs to see me.” She paused then and you could see her processing her own words. When they both understood that their son could only “hear” them when he was lip-reading, we talked for a while. There are no services, no formal signing, no hearing aids or cochlear implants for this child from rural Ghana. On the other hand, their son seems very bright and has taught himself to lip-read well enough that even at four years he understands complex directions and all his extended family thinks he can hear. The local Op Smile coordinators and Lions Club will work with the family to see what might be available for the child.
Friday afternoon was spent packing up and getting ready for the Team Party Friday night. Usually the team party is a big event held either in the hotel where the team is staying or a nearby hotel if needed. Dinner is followed by the presentation of certificates and speeches thanking the local sponsors. The photographers on the teams usually make a slide show from photos they’ve taken during the week, including as many team members as possible. Finally, local musicians play and there is dancing into the night. This year, everything felt different. The surgeon’s death still hung heavy over the group, the coordinators were still absent, and the unrelenting 12 hour days had everyone exhausted. After the dinner, most people were ready to head to bed. Some of the younger team members did go out to a dance hall with local volunteers from the team, but I was almost asleep at the dinner table.
On Saturday morning after we discharged the Friday patients, the team would be driving back to Accra, so we had to have our bags packed and in the lobby of the hotel before we went to the hospital. Most of us were flying out of Accra about 10:00 pm, but a few had earlier flights. The drive to Accra takes about 5 hours, so the plan was to leave the hotel at 9:00 am. Dr. Ampomah, the Surgical Team Leader who is from Ghana, Kathy and I went over to discharge the patients, and some of the other team members came to pack up our remaining cargo and make sure we left the wards and OR’s clean. The final count was 157 operations - about 40-50 more than the usual mission. No wonder everyone is exhausted. There is however, exhilaration that goes with knowing we were able to treat so many patients and send fewer home disappointed. The patients will stay another few days at the shelter and then Dr. Ampomah, Ella and a local nurse will do a final post-op visit before the patients are transported to their home villages.
On the way out of Ho, we had a surprise stop at the shelter. The parents and patients were waiting outside for us with a thank you banner and a celebration song and dance that went on for about 45 minutes. It’s hard for me to describe how moving it was. People of all ages were singing, playing bells and drums, swirling and stomping and shaking, all the while moving in a huge circle around the open space in front of the shelter. They all had small white cloths that they twirled above their heads. Babies bounced along on their mothers’ backs and small children danced and sang, imitating their parents. When the dance finally wound down, everyone mingled for another half hour, parents thanking us, asking about our homes, telling about their villages. It was overwhelming.
For most of the parents and kids who come to an Op Smile mission for evaluation, it’s the first time they have seen another child with a cleft or met another parent in their situation. The vast majority live remotely and think their child is the only one in the world to have been struck by this catastrophe. When they come to a mission and stay in the shelter with, in this case, almost 400 families with children with clefts, everything changes. They see other parents and begin to see themselves as more normal and their child’s clefts as a medical problem that can be corrected rather than a curse. The children, who by age three are covering their mouths in public, are suddenly smiling and playing with others who look like they do. Besides the physical healing, a lot of emotional healing takes place here.
I’m going to stop now. This blog has been disorganized and I apologize for that. Much has been written from notes rather than the same day due to my computer issues, so I’m sure I lost some information and spontaneity. However, I also don’t want to ramble on too much. When you go to the photos, the Ho Ghana album is where I’m working on arranging side by side pre and post op photos, but there are still some in “faces” and “crowd” photos as well.
Thank you for following my adventures.
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