Patients and Patience

(This is my travel journal that I kept during a medical mission to Paraguay; part one can be found here)

September 26, 2015. 19:15

Hotel Internacional, Room 1004

Last evening, I almost overslept the team meeting at 18:30. The jet-lag was actually worse after I had napped. The meeting room was swamped with about fifty various local and international surgical staff. Pre-op, Surgical, Post-op, Records, Laboratory, Anesthesia, Dentistry, and Speech Pathology are all represented, to name a few.   Of the fifty, eight of us are from J&J. They cover a lot of things, do’s and don’ts, changes to the policies and documentation, forms, workflow, team introductions, and more.

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We ate empanadas and shared stories and expectations. We will be working out of the Paraguay Military Hospital down the street from the hotel. There was some work being performed, facility upgrades to the electrical system, but while this had been taking place, there was a bee infestation. I was still very tired from traveling and can’t remember falling asleep.

The sun must have raised at five or five thirty because I got out of bed close to that time, to shower and to eat. I tried texting home a few times, but the texts were missed or bounced to the wrong phone (frustrating Apple ID). Needless to say, I was unable to connect home.

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We arrived at the Military Hospital down the street in less than five minutes, just before 7am. The compound was filled with personnel with side arms and green and khaki fatigues. We were directed to the back of the building, through a parking lot and past a small football (soccer) field, where, already, a large waiting area had begun to formulate. We took a brief tour where the stations would be, about nine in total: registration, vitals, photographic identification, surgical, dental, speech, laboratory, and records. Station one and two had already begun to fill with patients and parents by seven o’clock.

We disperse to our respective locations and our group (the J&J team) is tasked with playing with the kids. Everyone seemed to notice this one boy, Bryan. His mother had brought him here hoping that he could receive surgery as a first time patient. He looked like he had just learned to walk in the last few months, had a bilateral cleft lip and palate, and a contagious smile; the whole team was gunning for him. He seemed to warm hearts everywhere he ran.

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Many of the team members brought bubbles, coloring books, crayons, chalk, and Darcy had brought a Polaroid and a ton of film; this was a huge hit. People would walk up to her and ask her to take their picture. For some, it was the first time they had ever had a physical photograph. Nina, Vivi, Beth, Bernie, and I sat with a bunch of kids drawing, and coloring on Dora coloring book pages.

I tried to communicate in my nearly non-existent Spanish. This one little girl, still in diapers, took a liking to me and would not leave my side. She was too cute! From time to time she would run off, but always came back with another coloring page, another handful of crayons, or stickers. She, very quietly, would take most of the crayons and systematically use each one, in her own special order, to scribble lines, probably to check the color. Her older sister was there for a follow up visit, I could only notice a speech impediment.

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I started talking, actually each of us did in broken Spanish and English – with the help of Maria (Mafe) to translate – to a man named Arnaldo. His nephew, perhaps two or three years old, was there for a follow up surgery. Arnaldo told us he was a missionary and is changing to become a priest. He knew some Italian and English, but we mostly communicated in Spanish. He was as curious of us, the volunteer foreigners as we were to be there. His nephew, I cannot remember his name, was everywhere, playing, coloring, stacking Jenga blocks, sitting on my lap, kicking footballs, and chasing bubbles. His father, Carlos, took a photo of the three of us. They disappeared when their name was called.

Before I knew it, the little girl returned and wanted stickers more than the mariposa (butterfly) hair bow someone had tried to give her. After about fifteen to twenty stickers, she started to put some on me, my shoes, a poster and on the scribbled coloring book page.

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I noticed a very serious girl guarding her two year old sister, ensuring she had crayons and something to draw on. Her persona was well beyond her years, and she looked like a tough older sister; sadly, who appeared to trust very few people. Through translation, I had heard that her family had traveled five hours to get to Asunción. They mainly spoke Guarani, the indigenous language of Paraguay, so some of the Spanish was lost in translation. Their mother, who looked quite indigenous, was rather shy. Paula, is the older sister who is twelve and Mariana was the little one with a unilateral cleft lip and palate. They were all beautiful people. From what I had heard, there were three other siblings at home, all from different fathers.

I decided to go inside to see how things were going throughout the various stations and help myself understand a bit more of the process which the parents and patients go through. Inside it appeared to be a bit like controlled chaos. People triaged in queues outside each room (station). Hallways packed. It was only eleven thirty and I noticed the patient charts which were being reviewed in room four were between numbers forty through fifty; not even twenty-five percent! Quite a lot going on and I had little thought of how I could help. Already some of the kids looked past the point of playing. This was going to be a long day.

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I mostly observed the process for the surgery, dental, vitals and PIT rooms. I went back outside again to blow some bubbles and kick the ball around. We took a break around one thirty for lunch. I was a bit surprised to find Chinese food, but more surprised by how good it was. Perhaps not particularly healthy, but it was cooked, fried and tasty.

The afternoon brought a lot of the same, and also my own helplessness. I wanted to do so much more, but I am not a doctor; I am not even part of the process. As I am going through this I am realizing how much I suck at playing with kids. It’s that, despite having my own kids whom I play with, I am completely inhibited by other people’s kids, and here it is compounded by a massive language barrier. On top of it, people are snapping photos, selfies, etc. while I am somewhat paralyzed by it. It’s not normal to photograph other people’s kids, let alone patients. I am at conflict. These people’s stories should be told, and others should see the pride in modern medicine being made accessible to those who really need it and will benefit from it. From the entire day, I took nine photos, mostly of the crowds of people. I let others take photos of me before I did. I really need to evolve. Not that I need to let others in, but rather to let myself out.

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I ran into another boy who was kicking the ball outside. He had lost his balloon and saw some in the courtyard outside the window; it appeared inaccessible. Not knowing the limits of our work at the military hospital, I jumped through the window to get the balloons, twice; because it floated back through the window when I came around the corner to meet up with him. Silly boy, he was laughing, holding a Hot Wheels emergency vehicle.

Stations one through four had begun to close for the day and I met up with Anii, an anesthetist from a children’s hospital in Boston. We were talking about where to grab dinner; no one had plans and it was already seven thirty. The total patients for the day totaled two hundred and seventy eight, Anii mentions that in clinic (at his hospital) it would have taken four days to see this many kids.

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We are stopped by a lady, who came up to us, saying something in Spanish. She asks if she could get her picture with her four year old son. Another team member offers to take the photo for her so that she can also be in the photo too.

Victor Hugo is the boys’ name, his mother is Wilma. I had to ask for a translator because I think she asked us if we had kids, and I showed her my kids on my phone. She was trying to tell us her story. When Victor was born, her husband left her and moved to Mexico while blaming her for Victor’s cleft deformity. She was left alone to raise him and Victor’s older brother who is ten years old and has Down’s syndrome.

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Victor is an active boy, with a strong personality. He seems quite smart and at four is well aware of the situation around him. Since he was born, Wilma had learned about Operation Smile, and brought him to Asunción when he was eight months old. She had never been to Asunción before, and she thought Victor was the only child like this. She arrived in the large city, almost lost, but had asked where the clinic was located and found her way there early in the morning. Tired, she slept with victor outside of the clinic, when she awoke; she was surrounded by parents and kids with similar cleft deformities. She said it was such a comfort to find a group which was supportive throughout her experience with Victor. Because of this, she has offered support to mothers who were new to the process.

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Despite her hardships while being a single mother, she showed such caring, dedication and gratitude. It was the end of a very long day, and she and Victor were towards the end of the queue. Through a translator, I told her she had great patience and had raised a wonderful family with good spirit. She said thank you in English.

General Disclaimer:

The views expressed on this website/blog post are mine alone and do not necessarily reflect the views of my employer or Operation Smile. The author encourages your help and support by donating to support medical missions by Operation Smile via this link: http://support.operationsmile.org/goto/schoutens

#JNJ #MyCompany

This blogpost-series are pages of my personal journal leading up to and during my first medical mission to Asunción, Paraguay. I hope this series encourages you to serve global communities and/or donate to a wonderful organization that improves the lives of children and families around the world!

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