Our Final Thoughts

This is the last posting of MOST mission 2011. Some of the team would like to share their thoughts about this amazing experience. It is appropriate to post our thoughts with a photo of one of our MOST children.

“Although every mission has it’s standout patient story, what keeps me coming back is being a part of this amazing group of talented individuals that every year comes together as the Miles of Smiles TEAM. If people could work together like this on an everyday basis, this world would be a much better place.” Steve Aquilino, team dentist

“My title on the MOST mission is Pre/Post Nurse. I have the opportunity to meet the families the day prior to surgery, get them ready for their surgery and then take care of them following the procedure. My job is very rewarding in so many ways.

This is my fourth mission trip with the MOST team and each year I find myself feeling a more personal reward than the previous year. When I arrived home this year I was asked by several colleagues if we changed the lives of those we helped, I honestly believe that we did change the lives of those we helped but most importantly the mission changes my life!”

Mindy Bowen RN, BSN

“This satisfies my soul.” Nancy Pacha

“ It has been an honor for me to serve as the author and photographer for this mission. I have been witness to a quality of character in this traveling medical miracle that I will not forget.” Nan Mercier

“If I had the stamina, I’d work 24 hours a day at our mission in Guatemala.”

TrudyWright, Recovery Room Nurse

“Everyone that hears about the Rotary MOST trips says "Oh, that is such a great thing for you to do." But I feel like I am the lucky one: it is such a wonderful experience to be a part of this team; and the happiness/warmth/gratitude of the parents is so touching, it makes me feel so blessed and grateful that I can help. I wish everyone could have a chance to do this.”

Truly, BJ

“A mission such as this truly does make a difference in the life of an individual and their family. The impact of this medical mission is unbelievable.”

Rachel Litwiller

“Happiness is helping others, or... Service above self.” Gary Pacha

“To see so many kids helped with life altering surgeries was truly amazing. I feel blessed to have witnessed the professional and dedicated work of the MOST team and the strength of the children and their families. What we take for granted here at home is only a dream for them. As someone penned on the trip, it was truly soul food for the heart. “ Keith

MOST Thanks:

MOST wishes to thank the following for their valuable support in our mission to help the people of Guatemala:

DHL

Experts in specific transportation solutions. Air, Ocean or Land.

Dermabond

A topical skin adhesive that protects wounds while they heal.

Ethicon

A Johnson & Johnson company. For over 80 years Ethicon has been at

the forefront of innovation to advance the practice of surgery.

Hills Bank and Trust of Iowa City

Your community bank since 1904.

Serving thousands of customers…one at a time.

Technigraphics

Serving Eastern Iowa with printing and copying since 1977.

Friday in Antiqua

Many of the families that come to MOST travel great distances to Huehuetenango. Such is the case of four of the families from the remote Mayan communities of Northwest Guatemala that traveled to be seen by MOST. They were first seen at Casa Colibri, a nonprofit organization in partnership with Rotary International and the Gerard Health Foundation. It serves over 3000 families in the rural communities of Barillas. One of the connections between Casa Colibri and MOST is Paco Fernandez.

Paco‘s history with Iowa MOST started before MOST began. Rotarians on an exploratory mission needed a translator and local networking led them to Paco. The second year of the MOST mission Paco joined as translator and in that process became the go-to guy in dealing with the on-sight problem solving. Then he started to help with pre-mission, non-medical details and continues in those roles today. We, the team of MOST, greatly appreciate him, his efforts and his skills.

Paco has also transitioned into a leadership role at Casa Colibri, House of the Hummingbird. In the beginning, a collaboration of local individuals and those from Iowa, Minnesota and Wisconsin sought to identify the needs of the local population and bringing relief and hope to those in greatest need. In 2008, Casa Colibri built a clinic that provides the villagers of the area access to basic health services and facilitates follow-up care for those who need further medical treatment.

Casa Colibri serves the people in the rural area of Barillas in the rain forest, about 8 ½ - 9 hours from Huehuetenango. Paco says, “It is remote…and then some”. People will walk up to 12 hours to reach the clinic or multiple families will ride in one car or truck to make the trip. Individuals come to Casa Colibri for basic medical care, children’s vaccinations, training for the village health providers and training for midwife skills.

Other areas of focus for Casa Colibri include goals to build roads, schools for a quality learning environment, and water collection and filtration to provide safe drinking water.

Education is a third focus of the House of the Hummingbird. There are programs to provide textbooks and library books for rural schools, and an early literacy intervention program for families. For more information on Casa Calibri go to www.casacolibri.org.

On Friday of our mission, MOST traveled to Antiqua and attended a fundraising dinner that Rotarians in the area organized to benefit Casa Colibri. The entire MOST team attended this very elegant and festive occasion held at a 16^th century cathedral archeological site. The evening included recognition of those helping to sponsor the event with Paco translating and the wonderful Ballet Folklorico. We were pleased to be a part of this fundraising effort to benefit the people of Guatemala. In Paco’s words,

“It is sharing the same possibilities.”

Congratulations, Thank you and Good-by.

Thursday morning, February 17^th, was the last day of surgery. After the patients were safely in recovery and post-op it was time to inventory supplies for the next mission and say good by to our hosts and co-volunteers at the Hospital de Especialidades. We all returned to where the mission had started on screening day, the courtyard of the hospital where just a few days ago the families had gathered to be seen by the doctors, dentists and nurses in hopes of being able to have a surgery that would improve their quality of life.

It was a time for visitors from the United States and the local hospital staff to congratulate each other on a successful mission. In the photo we see team leader, Gary Pacha, joined by our medical team leader, John Canady, and pediatrician, Oscar Gomez, present a defibrillator to Dr. Oscar Marroquin as a gift of thanks from MOST. The defibrillator is the first one in his hospital and a much needed and appreciated piece of medical equipment.

The tally of the medical mission is finalized. The most important statistic is that all surgeries were safe. SIXTY FIVE PROCEDURES WERE SUCCESSFULLY COMPLETED ON 52 PEOPLE.

MOST Photos

Sharing the Blessings

The parents of the children must think that it is some kind of magic when their child is taken away for surgery and returned to them in a form that they had only dreamed about.

The child and a parent check into the hospital the afternoon before the procedure and stay in the pre-op area where the child is monitored by the nurses and pediatricians. The next day one of the anesthesiologists comes to the ward to take the child to the operating room.

The team of anesthesiologist prepares the child for surgery and carefully monitors their vitals during the procedure. The operating room team of nurses and medical students assist as the surgeons perform the magic that the parents consider to be a miracle. When the surgery is finished and the child is breathing on his/her own and stable, it is time for the anesthesiologist to take the child to the recovery area. The child will still be quite sleepy. Their vitals are monitored closely as they emerge from the anesthesia. When the child is conscious of their surroundings and usually asking for their mama, they are ready to go the post-op area and meet their anxiously waiting parents.

The parents see through the drowsiness of their child and beyond the swelling and stitches to a new beautiful face that they will no longer have to hide. At this point the child is again cared for by the nurses and pediatricians. A translator helps to reassure the parents and communicates to them about healing care. The child and parent stay in post-op over night and are examined to be released the next morning. That is usually when the blessings start. While it is the post-op team that receives the blessings from the families, they are meant for all in MOST. The blessings are to be shared.

One father said, “I don’t have anything to give you or money to pay for what you have done for my child. My wish is that the gift you have given to us be returned to you in multiple blessings.”

Julio’s father when saying good by became so emotional that he sobbed uncontrollably and was finally able to say, “When I now see how beautiful my child is I will always remember what you did for him. I can’t find the words to give you proper thanks. Bless you.”

Some parents repeatedly ask for photos of the team so that their children will remember “the angles who helped them”. Others want pictures to take to their church or to put in a shrine and offer daily prayers for us.

The last patient to be discharged on Friday morning was Pedro, an 11 year old boy who had lip and other corrective surgery the day before. As he was getting ready to leave he started to cry. He was questioned about his tears for concern that he was in pain, but he shook his head no, no pain. Pedro was realizing so early after surgery that his life had changed. His tears of great emotion flowed so freely and continued uncontrollably. They were tears of gratitude and ones of blessings to be shared.

Education: Our Physicians

The first and foremost reason for MOST is to provide a safe surgery for cleft lip and palate to the people of Guatemala who do not have access to such procedures. Another major objective is education, an objective that expands each year of the mission.

Built into the first MOST mission was the inclusion of physicians in training. Don Solomon was a Pediatric Otolaryngology Fellow at the University of Iowa and joined MOST for the first time last year. Dr. Solomon finished his fellowship in 2010 and started a pediatric ENT practice in Philadelphia. Don returned to MOST this year, “for the unique hands-on medical educational opportunity that is unlike any you can get back in the States during training. You do more cleft palate surgeries in a week with MOST than trainees do in two months. Not only is the clinical experience robust, but it is an opportunity to serve those in need. It is an opportunity to make a difference in the lives of these children and their families.”

Dr. Ben Cable joined the MOST mission for the first time this year. He had been a Fellow with Dr. Canady, our Medical Team Leader, before MOST began. Dr. Canady invited him to join the team this year and he jumped at the opportunity. He is a Lieutenant Colonel in the Army and is currently serving as a Pediatric Otolaryngologist at Tripler Army Medical Center in Honolulu. He is also the current Chief of the Cleft Team at Tripler. Dr. Cable says:

“Although you can learn the science of cleft surgery over a finite period of time, you never stop learning the art. Every child is different and no single formula applies. I don't think there is any other surgical procedure where experience is more important. Having the opportunity to train with John Canady was a privilege. Being able to work with him again during this trip, after working on my own for the last 8 years, was invaluable. The benefits of this trip will certainly be brought back to help other children well beyond those served in Guatemala.”

Education: Our Guatemalan Doctors

Guatemalan doctors and dentists are an important part of MOST. Two Guatemalan doctors, Juan Carlos Garcia and Antonio Alvarez Rosal, joined the team the first year. Juan Carlos heard about MOST through local Rotary when his cousin was president. He recruited his long-time friend Antonio. Dr. J.C. Garcia is an Oral and Maxilofacial Surgeon. Dr. Garcia says:

“I do this for my heart, to help the needy children in our own country. Families from the mountains will not come into Guatemala City where I have my practice, but they will come to Huehue. I have the blessing of being a professional in my country. The thing that touched my heart the most is being able to help make the children presentable so they can be out in public. Parents keep cleft children at home to protect them. The opportunity to work with John Canady, who is a highly educated person in the field and learning new techniques from him makes me a better doctor. I learn from the whole team. I feel part of the team. They make me feel welcome and I hope we are together for many years to come. This is not my first medical mission, but I have never been more involved than I have with MOST. Sometime I would like to come to Iowa to study so that I can come back to my country be to able to help more.”

Dr. Rosal says: “I do this because I have two sons and thank God they are healthy. All parents should have the right to have healthy children and have them out in public. Because of these missions there is an opportunity to improve the lives of these children.” As far as the educational value to him, he says: “ LOTS! It is a great experience to be a part of this whole team. I love the interactions with this team to help the children of my country. I would like to thank everyone for coming to help the children and thanks for having me be a part of the team of MOST that makes millions of more smiles.”

Education: Medical School in Huehuetenango

The new medical school in Huehuetenango, Universidad Mariano Galvez de Guatemala, is less than two years old. Dr. Carlos Salorzano, an ophthalmologist in the area, invited our Dr. Canady to give a guest presentation at the medical school. Dr. John Canady is a professor at the University of Iowa College of Medicine in Plastic and Reconstructive Surgery and is highly respected in his field. He is one of the “founders” of Iowa MOST and is the Medical Team Leader of our group.

Dr. Canady was honored by the invitation to speak at the medical school. He feels that Dra Annette Morales De Fortin, Dean of the College of Medical Science and Health, is a future-thinking dean. Dr. Canady was pleased to start to develop a relationship between the medical school and the MOST mission and looks forward to positive possibilities that may come from this connection.

Congratulations to Dr. John.

Education: Research

The first research project conducted during the MOST mission took place this year. Ryan TerLouw, a medical student at the University of Iowa, gathered information on beliefs and understandings of cleft conditions. With the help of his interpreter he interviewed 39 of the families of children with cleft lip and/or palate issues who came to the MOST mission. The interviews were done when the families were screened for surgery. The main theme of the study was to assess the beliefs surrounding causation of clefts in Guatemala.

Out of the 39 interviewed, almost a quarter attributed the eclipse or the pull of the moon to their child’s cleft. In some cases the mother could describe in detail the event of looking at the eclipse. When asked about their religious beliefs, over 50% of those interviewed identified themselves as Protestant. Of those saying they were Protestant, many still believed the eclipse caused their child’s condition.

There were a number of the families who had previously sought care for their child. Those families had some ideas of cleft conditions related to vitamins, nutrition and folic acid. The researcher says:

“This research opportunity was great and allowed me to see how culture effects Guatemalan’s choice and the follow-up on their healthcare.”

Education: Parents and School

Too often parents will bring a child to MOST with hope of a cleft lip or palate surgery only to be disappointed when the procedure is denied because it cannot be preformed safely due to massive decay of existing teeth and resulting infection. Instead, many of the baby teeth are extracted, the mouth will heal and the child will need to return for our next mission, waiting another year for the hope of the surgery. Team dentist, Bill Gates and team pediatrician, Pete Wallace stress that preventative dental care is what is needed. They note the lack of preventative care is a great problem in the United States, but even much worse in Guatemala.

Educating the Guatemalan parents is a preventative treatment that is no cost to the families. An appreciation for the value in caring for teeth, even baby teeth would be a major step in a no cost treatment. Helping parents understand what sugar does to teeth would be significant. Dr. Gates has repeatedly seen mothers adding sugar to their baby’s water bottle. He states that such a practice is just not appropriate for the health of the child. The general acceptance of candy and sodas as food and drink also contributes to tooth decay. While the education of parents is no cost to the families, in Guatemala as in the rest of the world, there is a higher cost for healthy practices. That includes the next level of prevention, purchasing toothbrushes and toothpaste, which is an added expense for many of the families in the area who are living at extreme poverty. A third level of preventative dental care would be fluoride treatments.

MOST is about safe cleft lip and palate surgery for those who do not have access to the procedures, however, it is difficult to always separate the surgery from the overall general health of the child, including dental care. Rotarians, dental care professionals and local Guatemalan dentists are looking at ways to start to address these levels of preventive care. Three Rotarians traveled to a school of about 150 elementary students and gave the children coloring booklets about teeth brushing. The students learned a song about brushing their teeth, which they repeatedly sang for the visitors. All students received a toothbrush and paste.

The Rotarians delivered to the teachers of the school flipbooks on dental care that were developed by Dr. Karen Weber-Gasparoni of the Department of Pediatric Dentistry at the University of Iowa. The flipbooks are printed in Spanish with color photos that illustrate brushing techniques and general care of teeth at many ages.

A wonderful part of dental education efforts is the local Guatemalan dentists making plans to go to the schools and teach children about dental care. All of these efforts are ways to enhance MOST.

MOST Photos

The Story of Mario, February 17, 2011

The story of Mario has become one our favorites on this trip to Huehuetenango. Mario is 16 years old, we think. It has been difficult to get exact facts from him. His severe cleft has greatly impaired his speech and his speech development and his ability to communicate. His actions of a huge smile and hugs let us know what he is feeling. Mario lives a distance from Huehuetenango, somewhere on the border of Guatemala and Mexico. He heard about the MOST mission from friends and maybe a bus driver. He was told that this is a good chance for his mouth to be fixed and that the gringos are so nice. More than anything he yearned to have his mouth corrected. He tried to explain to us, “I want a life. I want a future. I want to be normal.”

Mario lives with his family in extreme poverty. His mother did not want him to come to Huehue as she had no money to send him and she was fearful for his safety on the long trip. Mario had worked cutting firewood for his uncle. He also helped load the top of buses and sometimes sang on the buses for some money. His uncle was able to give him about $6.00 for the trip and he left for the MOST mission in spite of his mother’s objections and fears. It took him more than a week to make the trip, traveling from his home in the warm coastal area into the mountains to Huehue where nights are cold. His clothing was inadequate for the cold temperatures and sometimes he would sleep on the street with little, if any, food or water. From time to time, thanks to the kindness of strangers, he had a safe, warm place to sleep with a meal. His means of travel was to ride the bus when he could, hitch a ride and walk. He reached Huehue about a week before MOST arrived. The police questioned him and after he tried to explain his quest the police kept an eye on him for his safety. He had four more days to wait for us to arrive.

Mario came on screening day. Again it was difficult to understand his background due his extreme speech difficulties. His appearance after two weeks without a bath or clean clothes gave us the impression that he was homeless. Little by little we learned more about his story. Dr. Oscar Marroquin started to get involved in Mario’s story. Oscar met Mario on screening day and being true to his nature of kindness and being a man who knows how to get things done, he began to put a plan in place to help Mario.

Dr. Marroquin made sure that Mario got to the MOST shelter provided by the Catholic
Church, where he enjoyed regular meals, a bath, his own bed, gifts of new clothes, new shoes and he was jubilant. Then on Day 4 of the mission Mario had his operation. He awakened from the anesthetic a different person and with a careful plan in place for future support. Mario will spend time in a home for a week or so until he is totally healed. After that time, Dr. Marroquin has arranged for Mario to be under the care and supervision of a foundation that teaches a trade and he will learn to read and write. Here in Huehuetenango Dr. Marroquin will be able to monitor Mario’s health and educational progress.

He left the hospital today with a new backpack from his nurses and with a new and bright future. MOST leader Gary Pacha reminds us, “Through Rotary good things happen. Mario came for a new mouth and he also has a start on a new life.”

MOST Photos, February 17,2011

A Few of our MOST Children

A Happy Family

The Garcia family – mom, dad, daughter Maria de los Angeles and son Maynor came to us the first year of our mission trips in 2006 because baby Maynor had clefts. They became known as the “Happy Family” because they interacted so joyfully with each other. Maynor’s mother was expecting a baby. What a wonderful happy family the unborn child would be blessed to have!

Maynor’s lip was repaired and he was a handsome little boy. The “Happy Family” went home even happier, but we would see them in the future to repair Maynor's cleft palate.

One year later the Garcia family greeted us again. Maynor looked great, but his baby brother Juan Carlos had a cleft lip and a cleft palate. Juan Carlos was too young to have surgery in 2007, but through the years the family has returned again and again.

Now Maynor’s and Juan Carlos’ lips are beautiful and their palates are whole, but they have some teeth that need the dentists’ attention this year.

There are now five children in the “Happy Family”. And, happily, none of the other children have suffered clefts.

As much as we hate to say a final good-by to this wonderful family, we hope they have no future needs from Iowa MOST, but it would be great if they would stop in each year so we could watch the children grow up and so we might know any new member of our “Happy Family”.

Rotary District 6000 has a long established relationship with Huehuetenango Rotary including an initial water project, our repeated MOST mission and ongoing involvement with Huehue firefighters and emergency responders. FAMSCO shipped a fire truck and a 40 foot container with rescue and fire equipment and fire turnout gear to Huehue. District 6000 leveraged funds via a Rotary Matching Grant to purchase a much needed rescue vehicle.

Members of Iowa MOST whose clubs were involved in securing these vehicles and equipment for Huehue were invited to the fire station for a celebration in recognition of Rotarians' efforts. At the program we saw photos of the firefighters fighting fires and doing rescues. One of the photos showed a firefighter in a fire emergency without a helmet. We were told that would never happen again thanks to Rotary. The first official need for the rescue vehicle was on our second day of our mission and we were able to document the use of and the need for the contributions from this ongoing partnership.