(This is my travel journal that I kept during a medical mission to Paraguay; part one can be found here)
October 1, 2015. 15:30
Havana Café, ASU Gate 2 / TAM JJ8141, Seat 24A
Recollected from September 29th & 30th surgery day.
There is a nervous excitement in the breakfast room. Even though we have all had breakfast here for the past few days, collectively we are clueless and tentative with our selections. Not quite aphasic, but not decisive either. It is an early start, despite recovery from jet lag, six thirty feels too soon to rise. Clive and I stand at the toaster conveyor, flipping bread, several times without toasting it. Our attempts prove useless; we settle for disappointing warmth. The fruit looks great, but the thought of diarrhea does not. Instead I see a few biscuit treats next to the coffee. They are calling for me.
Darcy, Bernie, Mafe, Vivi, Nina and I (part of the J&J team) decide to walk to the hospital. It is quite straight forward now, and even though the streets do not look like home, the area has been safe to us. The pavement, when present, is musically uneven, undulating and pitching. Where patches are neglected, the missing layer reveals a past of tiled or cobble stone craftsmanship; evidence that the city has been neglected for some time. Dirt, stained by oil and excrement, among other municipal secretions, tend to fill the patchwork and add a red brown hue to the ground.
Twisted metallic shards and rebar, rounded from years of traffic, project out of the pavement. Maybe a railing once stood here containing a sidewalk café. Contrasting is the oblong holes into the ground revealing knobs recessed in the depths. Comparisons are inevitable as I remember from my days living in Philadelphia; certain objects are coveted and stolen for metal recycling and the cash prize which comes with it. Such objects made from brass or copper, like flashing, rain gutters, and grounding wire, and the Iron, mainly castings for covering holes in the ground like the one missing from the oblong hole. I suspect the poverty in Asunción has dictated such a recycling program. The fragmented ground rises up on the edges to formulate equally colorful buildings. Their drunken facades project upwards, slathered in Technicolor swatches with parasitic crumble. Blues, yellows, and reds are faded from years of weathering. Clearly, past the grime and delaminating plaster, one might deduce the architectural elegance of former times.
A colorful Mercedes bus, from 1950 perhaps, whooshes past us, inches from the curb. I was not sure these buses remained actively running today. The multi-color stripes with large, oversized wheels and dancing lace hung at the top of the windshield. Someone sticks their hand out stopping the bus to board. It seems like an unscheduled stop, or at least there is no board indicating it should. All the stops appear to be like this.
Across the street from us is a bright yellow restaurant. It is small and very local, with an oil drum grill out front, constantly burning some kind of meat. A Mercado for basic needs and little space sits discreetly in a doorway opposite the yellow restaurant. On one corner a man offers empanadas from his rust colored food stand on one corner of a busy intersection, a block or two from the hospital. Three, lonely empanadas lay in a covered transparent box while a Coca-Cola wave encourages a drink. Across the street, two Policia stand in front of a drab, run-down building. The roof is missing. Window gates hang ornately and hold back framed rubble. The third corner holds a busy gas station clad in blue and orange. Cars jockey for pump positions, at times congesting the street and retarding traffic. The final corner holds a restaurant which appears to be more bar than restaurant. Its passionately painted blue façade attracts locals, and cages them within the black painted rebared windows. At least until the football game is over. There is a parking lot in the back, in case you were wondering.
Sitting in the stoop of the doorway next to the Mercado are two little girls. Dirty. Barefoot. Probably four and five. One of them takes a bite of a banana, peeling back the speckled tawny skin. Her hair, chaotic, is in need of a thorough washing. The second girl giggles, waiting for her share. The Mercado offers bread, several loafs sit on a rack in the doorsill balanced on three legs, rusting. Inside, picnic table and chairs are illuminated in the dim room. Two doors down and across from the military hospital is a pharmacy. We cross the bus busy street and pass the armed militia. On either side of the entrance, sandbags faded green and weathered, ooze red dirt toward the center of its half-moon embankment. Clearly they are not used or currently necessary.
We navigate to the “cosina” for the morning meeting and last minute reminders before everyone eases into their workflows. The J&J team finds its way up two levels to the pre-op ward. Children cry their hungry cry; having not eaten since the prior evening. The parents tensely wait for their child’s name to be called. A few comforting “hellos” from our team connect us to the familiar. Rooms rendered near useless as the hallway crowds with the families. A few picnic chairs are lined up and roll call begins.
The pediatrician checks the vitals and charts for each child in the lineup. One little boy fails the checkup because of diarrhea. He will not have surgery this time; the risk is too high. It is heartbreaking to see this family travel so far, endure so long and prepare for so much, only to relinquish their hopes for today.
The first group is sent to the child life area. Darcy relieves a mother by holding her child. In the child life area, the kids play while parents become educated on what to expect before, during, and after surgery. Some children look for a favorite stuffed animal, a rattle, cars, balls, or build puzzles. Lilian swings a large stuffed, pink caterpillar at Bernie, hitting him in the backside. One boy is throwing around an inflatable t-ball stand. These children have an idea of what is going on, and the stress reduction appears acceptable. The distance between parent and child minimizes the stress. Avoiding its contagiousness, Bernie and I leave. We head down the half green painted hall to the Medical Records staff and into the stock room. Boxes and boxes and boxes line the hallway to the surgical area; a drop-and-go operating room. We are greeted by “the twins,” Nina and Vivi, complete with matching scrubs. You would think they were related. Vivi humors us and suggests calling “their” dad to let him know that they found each other.
Bernie and I return back to the child life area and continue down the hall to the change into scrubs. Once changed, we declare ourselves at the OR board and get taped, adhering our name to our forehead for identification among the team. In OR two, miracles are happening, and I join on of them at table one. Dr. Alvarez is in the beginning stages of crafting a work of art. He is a master, in the midst of educating younger colleagues, giving tips on the incision, scar tissue trimming, muscle release, fascia, dermal, and cartilage placement. What seems like minutes, the sutures are started. Thirty seven minutes. This child has a closed lip and appears completely normal. A result everyone smiles about. The morning continues like this; evolving stages of success. The pros are in a rhythm. “I’m an Albatraoz” plays on someone’s iPhone; the back beat accompanying the beeps and boops from the patient monitors. Fourteen or so people working three separate tables in only one of the two rooms, with over twenty-five patients for the day. The impact is palpable.
Lunch is grabbed when possible, sometime between the 3rd and 4th patients depending on the OR table, with two or three patients per table remaining. The afternoon continues steadily, but little Mariana, Paula’s little sister, from what we hear, was not cleared for surgery. She was one of the children who really needed it; she developed an acute lung infection, common in cleft lip and palate patients; I was told by Francesco, one of the pediatricians. Her mother is quite upset and nearly ready to leave. It is past six in the evening and several of us travel back upstairs to post-op. It is a level of controlled chaos. Babies are adjusting from their changes after surgery, parents comforting and smiling, and nurses circulating. Paula is sternly walking the hallway. She loves her little sister and is quite upset. Their mother is at the other end of the hall, I’m guessing, discussing options with the nurse. There is not much we can do here, and remains a difficult part of the story after a long day. I pray that this family can get a break from their long string of hardships and hope for their daughter’s victory. It is an intensely emotional day full of heartbreaks, but mostly success with twenty two children having surgery.
We leave the hospital. It is about seven thirty in the evening. We navigate the dark streets back up the hill towards the hotel. Headlights race by, old buses rumble, and a game play on the TV inside the blue restaurant bar on the corner with patrons surrounding it like moths to light. We cross the street to our hotel; on another corner a security guard manages the door to the bakery. Damn, that must be some good pastries! Several of us begin to wind down at the hotel bar sharing our stories. What was planned to be an eight o’clock meet up for dinner turns to eight thirty and then nine. Different people keep rolling in. Finally we head to the restaurant. The Spanish place down the street. A second row of tables are built and we all sit down just about too tired to decide what to eat. Whatever the other table is having looks tasty, so we all order that; soup.
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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!