Miles of Smiles in Guatemala

Our Final Thoughts

2011-02-26T06:09:00.001-08:00

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:

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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

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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.

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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

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Sharing the Blessings

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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

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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

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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

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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

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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

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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

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The Story of Mario, February 17, 2011

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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

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A Few of our MOST Children

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A Happy Family

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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”.

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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.

New Emergency Vehicle from Rotary

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Firefighters designed and engineered the inside of the emergency vehicle given to the Huehue Bomberos by Rotary District 6000 of Iowa. Their first emergency response was this week, to a call for a crash between a truck carrying deisel fuel and a coca-cola truck.

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Over the years of MOST we have seen several individuals come back for additional procedures. Luis was first seen by MOST dentists, Steve Aquilino and Bill LaVelle, in 2007 when he was 13 years old. He came with a repaired cleft lip and with the hopes of surgery to repair his cleft palate. Sadly the gap in his hard palate was too large to be repaired, but a prosthesis was made to cover the roof of his mouth, making it possible for him to eat and drink without food going up into his nose. He also now would have the potential to develop his speech. He had no front teeth so 6 teeth were included in the prosthesis, another life changing procedure. Luis still had some baby teeth and his mouth was transitioning so he would be able to use the new prosthesis for a limited time. An accident caused the usability of his prosthesis to be even more limited when Luis fell face first off a balcony damaging the prosthesis. Local orthodontist, Rita Morales, had seen Luis and did some repairs to last until the next MOST mission. Luis came back to MOST in 2009 to have his prosthesis adjusted. Now, in 2011, Luis returned to MOST to have a new prosthesis, appropriate for the size of his mouth. We may not see Luis again. His life has been changed.

Another returning patient is Deniss. He was first seen by MOST in Huehue in 2007 when he was 2 years and 8 months old. Traveling from their home in a small village in the area of Cuilco it was a difficult several hour trip. At that time he had a cleft lip repaired. In 2010 Deniss and his family traveled to Xela, an even longer trip, with the hopes for a palate repair, however his mouth was too infected with bad baby teeth. Instead it was first necessary to have 18 of his baby teeth extracted and allow his mouth to heal. We saw Deniss again this year for the third time and now he will have surgery on his palate. After three visits we expect Deniss to be onto a life of being a normal, happy young boy.

Surgery Photos, February 15, 2011

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There are moments when the value of our mission strikes at our hearts. That moment happened this morning when Carolina and her mother were ready to leave the hospital and return to their home. Carolina had cleft lip surgery yesterday. Mama holding her precious one-year-old baby came to say her thank yous and good-by. With tears in her eyes and running down her cheeks, she emotionally shared her feelings. "I did not want to take my Carolina out in public. People were cruel. There had always been so much sadness and now there is no sadness. May God grant you many blessings. May God bless you. Muchas gracias..." and again and again and again. And we cried tears of joy with her.

Happy Valentine's Day from Huehuetenango Rotarians

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Iowa MOST members were surprised and delighted by Valentine roses, badges and tasty treats. Muchisimas gracias, amigos!

Second Day of Surgery, February 14, 2011

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Four of the children who had surgery yesterday were kept overnight, evaluated this morning and released. A parent and the patient checked into the hospital yesterday afternoon for today's surgeries. Space can be at a premium when the patients from yesterday are in the same area as those waiting for today's procedures. There is a strange juxtaposition of anxious parents whose children are awaiting surgery and joyful parents whose children's surgery is completed. The surgeries today tend to be more complex and time consuming, cleft palates and multiple procedures such as baby teeth extraction along with cleft lip repair. Many children come with so much tooth decay and infection that a palate surgery is not safe for the child until the mouth has healed. One child had 16 teeth extracted today.

Adjustments were made to allow for a power outage and recovery had to take place in the operating room where a generator kept the power going, a little snag in an otherwise successful day.

Second day of surgery photos, February 14, 2011

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First Day of Surgery, February 13, 2011

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The first day of surgery and we are all anxious that things go well. The procedures will range from tooth extractions to insertion of ear tubes to cleft lip repair, all less complicated than cleft palate repair. Today the team gets in the flow of things, getting used to the setting and adjusting to working as a new team. Tomorrow will begin the more delicate cleft palate procedures.

Nervous parents, confused and curious children at the beginning and through the surgery. After the operation, dazed children and parents who are still concerned, but exceedingly happy to see their child's face without the disfiguring cleft lip.

MOST photos from 1st day of surgery, February 13,2011

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Screening Day, February 12, 2011

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The roosters start crowing at 3:15 am, the dogs start barking soon after and we are up for breakfast at 6:15 and off to the Hospital de Especialidades. The thoughtful planning by the local Rotarians proves to be essential for the day of screening. Drivers bring families over in workable size groups. Patients are registered and given a number for the order in which they will be seen. Local Rotarians assist with translating. They also provide a morning snack and lunch for the waiting families and lunch for MOST workers.

Screening Day always begins in a chaotic manner, but out of the chaos comes the desired result -- a schedule to accommodate those patients old enough and healthy enough to have a life-changing operation. In the morning nerves are a little raw, anxiety is high and many things are out of place. Since this year's mission is in a new hospital and it is on more than one level, the flow of the process hasn't been clearly established and that creates even greater confusion. Patients and their families move through the various stations to be processed at in-take and then see surgeons, anesthesiologists, dentists and pediatricians. At the end of this day, however, as always, the process meets its goal.

February 11, 2011 Travel to Huehuetenango

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We leave Guatemala City for a long, but beautiful bus ride up into the mountains to Huehuetenango. At times we are escorted by the Huehue volunteer firefighters in emergency vehicle purchased through a Rotary matching grant. MOST arrives at the home of Dr. Ocsar Marroquin for lunch and a celebration with the local Rotarians. Dr. Marroquin has been the instrumental force in Huehuetenango behind MOST since its start. He has arranged for us to be located this year in the hospital he and hs partners operate.

We learn there are around 100 applicants ready for screening tomorrow. They range from babies to the oldest of 56. Some families have traveled over 200 miles, a 10-12 hour trip to reach the clinic. The Catholic Church will provide a shelter for the families. They can take up to 300 and will generaously provide meals. Dr. Marroquin has 50 of his hospital staff ready to help including the night nurses.

Following mutual expressions of appreciation we say good by, leave to check-in at the hotel and walk to the hospital to prepare for tomorrow. Supplies stored from last year and recently shipped supplies are located, unpacked, sorted and delivered to the various stations. Traffic flow of patients is layed out for the screening day tomorrow. Dr. Canady's parting words for the evening are, "Be kind to one another."

Huehuetenango, Guatemala

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Huehuetenango, Guatemala

Guatemala is in Central America and is about the size of the state of Tennessee. She has many neighbors including Mexico to the west and north; Belize, The Gulf of Honduras and the country of Honduras to the east; El Salvador and the North Pacific Ocean to the south. Huehuetenango is in the western part of Guatemala, along the mountains of Sierra de los Cuchumatanes. Some of the families coming to the MOST mission will travel from this mountainous area where they have limited medical services.

Huehuetenango can be very cold or very hot and humid. We anticipate warm and moderate weather in February to make easier travel for the families and so that the team can deal more with the mission at hand and not the possible extremes in weather.

More than half of Guatemalans are descendants of the Mayan civilization. There are several Mayan ethnic groups around Huehuetenango with the Mam being the majority in the area. Identifying dress and indigenous languages are characteristic of each ethnic group. While Spanish is the official language it is not universally understood among the indigenous populations when vocabulary is also a descendant of the Mayan culture. From experience of the past years we know that there will be times when several language translators will be needed to gather medical information on the child in need of cleft surgery.

As many as 50% of Guatemalans are based in agriculture, often at the subsistence level. The families that come to the MOST mission are generally farmers who cultivate corn, potatoes, wheat, barley, coffee and sugar cane or shepherds who tend sheep and goats. Another large group are artists who create textiles, guitars, fireworks, pottery and baskets.

The predominant religion in the country is Roman Catholicism, but the main religion for the families we will see in Huehuetenango is a mixture of ancient Mayan beliefs with Christian elements.

Guatemala gained independence from Spain in 1821, was briefly a part of Mexico and then became part of the United Provinces of Central America. The country has struggled through difficult and unstable political powers and transitioned to become a constitutional democratic republic in 1985. MOST will arrive in the capitol, Guatemala City on Thursday, February 10^th, our first stop on our way to our mission in Huehuetenango.

MOST mission count-down

2011-02-08T11:43:00.000-08:00

MOST mission count-down, February 3, 2011

We are on count-down to our departure on February 10^th for the 2011 MOST (Miles of Smiles Team) mission to Huehuetenango, Guatemala.

Iowa MOST is a Rotary District 6000 initiative, which provides surgical repair for cleft lip and palate to individuals living in the western highlands of Guatemala. Guatemala has significantly higher incidence of cleft lip and palate than the US. Individuals served by Iowa MOST do not have access to such surgery, due to proximity of limited surgical sites and family financial limitations. Some families travel well over 100 miles to the clinic on rough, steep mountain roads. Some come by bus and even need financial assistance to pay for the transportation. All come with the hope that this surgery can give their child a better life.

This is the sixth mission to Guatemala and the fourth to Huehuetenango. This mission’s genesis was from the Iowa City Rotary Club and has been nurtured through the relationship between Rotary District 6000 and the local Rotary Club in Huehuetenango. It works and thrives because of this partnership. Local Rotarians inform families in the mountainous locations of western Guatemala about the MOST mission. They do so by word of mouth, posting fliers throughout the area, contacting health services to let families know of this help, and advertising on local TV and radio. They provide assistance to families traveling to Huehuetenango and as the families stay for the duration of the surgery and recovery. Local Rotarians support the visiting team with our needs, including in-country transportation and lunch on the days that the clinic is doing in-take, surgery and recovery. Returning team members look forward to seeing Guatemalan friends. Those of us new to the mission anticipate a common bond with local people who share the ideals of the MOST mission.

The 2011 Miles of Smiles Team has 33 members from the US, mostly Iowans; 24 are medical personnel: surgeons, anesthesiologists, medical students, pediatricians, dentists, bio-medical engineer and nurses. The rest are volunteers to assist in various capacities. In addition, we will be joined by two Guatemalan doctors and a local translator/organizer. All of us come with a sense of service and dedication to the cause of helping to make life better for many children and their families.

Funding is through District 6000 Rotary Clubs and from individual donations, which covers additional equipment, medical supplies and expenses for the medical team who donate their time and professional skills to the mission. MOST volunteers perform a variety of needed duties and pay for their own expenses.

Equipment and supplies were generously donated for the mission from many sources and are handled through FAMSCO. FAMSCO is an ongoing program of the District 6000 Humanitarian and Education Foundation that channels used, usable medical and emergency equipment and vehicles to needy communities in developing countries. One example is anesthesia machines donated to FAMSCO by Mercy Hospital of Iowa City and the University of Iowa Hospitals and Clinic that have become a necessary part of the MOST mission in Guatemala. DHL has generously coordinated and picked up the majority of the cost for shipment of FAMSCO items for the MOST mission. The FAMSCO partners in developing countries, like Guatemala, are Rotarians who act as stewards for donations received through FAMSCO and accept these items to recycle valuable surplus in lifesaving ways. Other corporations donate their products that are needed for surgery, such as Johnson and Johnson’s Ethicon and Dermabond divisions that have provided suture and surgical glue since the first year of the mission. Local businesses such as Hills Bank and Technigraphics have also been supportive.

Planning for this mission started about a year ago. Supplies were shipped to Huehuetenango several weeks ago. We have had an orientation meeting about the 2011 trip and have had the chance to meet fellow team members. We are making arrangements at our homes to be gone for 10 days and we are starting to pack our bags. We are ready to go.

Why MOST in Guatemala?

2011-02-08T11:08:00.000-08:00

Why Guatemala? Why Huehuetenango? The answers start with Rotary International and two of it’s objectives:

to encourage and foster the development of acquaintance as an opportunity for service;
to foster the advancement of international understanding, goodwill and peace through a world fellowship of individuals united in the ideal of service.

“Acquaintance as an opportunity” is key. In the over 100 years since it was founded Rotary has developed a system that works to provide humanitarian service and sustain the benefits. The system is to work with the people, to form a partnership and for Rotarians to give of themselves along with financial assistance. The acquaintance with Rotarians in Huehuetenango started almost 10 years ago with a Central American Project Fair held that year in Guatemala. This is a match-making event where local Rotarians in Central American meet to discuss their needs and suggest projects as they talk with American and Canadian Rotarians who are looking for the “opportunity for service”.

The Rotary in Huehuetenango partnership with Rotary District 6000 started in 2004 with a clean water project at a small village in the mountains. While checking on that project and meeting with some of the leaders of the community it was noticed that one gentleman had a cleft lip. Our Rotary District 6000 Governor, Gary Pacha, asked him if any others had a lip like his. The reply was, “Many”, and the seed for Iowa MOST was planted. The partnership between Rotary clubs in different countries that started as an “acquaintance” grew to a “fellowship of individuals united in the ideal of service” as several projects followed and expanded.

The need of the people of Guatemala matched with what we in MOST can give is important in answering why MOST is in Huehuetenango. Guatemala has a significantly higher incidence of cleft lip and palate than the US and the families don’t have access to medical facilities where that surgery can be performed. The families served by MOST have very limited financial resources. There is a need and we have a gathering of individuals skilled in many ways who can help. Addressing this need is life-changing for the individuals. Cleft lip and palate results in difficulties in eating and verbally communicating ideas and being involved in many social interactions. Most of the individuals who come for surgery are children, many of whom have limited personal contact outside of their homes. A new and happier world is open for these children with the surgeries that MOST provides. The big answer to the question of why MOST is in Huehuetenango is because MOST can and does make a difference.

We are in Antigua

2010-02-27T05:42:00.000-08:00

Yesterday afternoon we arrived in Antigua, and are staying at a very nice hotel. It is a welcome respite after a week of long, yet rewarding days. Some of the group are going zip lining today, others are hiking a volcano, others are going to attempt to play golf, and others are touring a small village with weaving and jade factories. We leave late this afternoon for Guatemala City, and then off early Sunday morning for the airport and our trip home.

Steve Aquilino, Prostodontist

2010-02-26T07:33:00.000-08:00

Steve Aquilino is a Prostodontist at the College of Dentistry, and is one of two dentists on this mission.

"I became involved in Iowa Most through Bill LaVelle, my mentor at the University of Iowa from 1982 on. Four years ago I went to Huahuetenango with Bill and it was my first mission trip. I had always wanted to do something like this, and I jumped at the opportunity. It's a type of dentistry I don't do in my practice at the University. I returned to Huahuetenango two years later, and this is my first time in Quetzeltenango.

The overall highlight for me (there are many more individual ones) is the MOST team. It is an amazing thing to come down here and see how this team melds together to work in such an efficient way toward such a positive outcome. It would be great if the whole world could work this way."

Ayman El-Sheihk, Pediatrician

2010-02-26T07:25:00.000-08:00

Ayman is one of two pediatricians on this misison. This is his first year, and he responded to an email put out by John Canady, telling about the MOST trip. Ayman was on a medical mission to Nigeria 16 years ago, and wanted to be part of one again. He has so enjoyed experiencing the appreciation and satisfaction from the families of the children seen by MOST, knowing that we are making a difference in the life of the children. Ayman has a new appreciation for the simple things that we in the States take for granted--good medical care, availability of sub-specialities, even transportion.

Mindy Bowen

2010-02-26T07:13:00.000-08:00

Mindy is a Post-op Recovery nurse at the Universityof Iowa Hospitals and Clinics , but on this mission she worked on the Pediatric floor in post-op. She was recruited by Pat Wehrle 4 years ago to be a part of this mission, and knew instantly she wanted to be a part of this team. The best part of the trip for Minday is seeing how grateful the parents are for all that has been done for their children. In America, Minday notes, we expect our children to receive palate treatment, but in Guatemala the parents hope that something will be done. Mindy also is touched by the loving chidren, who are happy despite their troubles speaking and eating because of the cleft lips and palates.

Kristopher Day

2010-02-26T07:03:00.001-08:00

Kris is a medical student at the University of Iowa Hospitals and Clinics, and is one of two scholarship recipients from the MOST mission. He has wanted to go on a Medical mission since he was in college. He wanted to be part of a team, and witness all that is involved in making something like this happen. This mission has offered him the opportunity to play a significant role in surgery in a foreign country. Kris is so grateful to have the change to make an impact on the lives of kids.

Karin Franklin

2010-02-25T06:03:00.000-08:00

I became involved in Iowa MOST since 2006 through my local Rotary club. I was involved on the first mission as a recovery room assistant, and I had no medical experience prior to that. On the next mission I got involved in supples, and became increasingly involved in the organization in 2008, 2009, and 2010.

This year's highlight for me was a a delightful 11 year old boy named Christopher. He came to feel very at home in the hospital, running all over and stopping in with a smile on his cheery little face. He asked for a stuffed animal (something we usually save for post-surgery) and I wondered if it might be a problem for the other patients, but I gave him a black teddy bear. He gave it a huge hug and walked back to the ward. It was then that I learned he was an orphan and........(tears indicating she won't forget him).

Lucia de Leon, Quetzaltenango Rotary Member

2010-02-24T15:17:00.000-08:00

Lucia de Leon is an invaluable member of this Iowa MOST mission. She has been a Rotarian in Quetzaltenango for 35 years, and has volnteered her time during this mission by acting as translator between the medical staff and the families of the patients. She and her other Rotary members have also provided much needed lunches for all the medical staff. She is shown her with her friend, Judy Estrada, who has also volunteered her translating skills. Both Lucia and Judy are so happy to be a partner with Iowa MOST, because they know that this mission is changing the lives of all these children. They know that the lives of the children will be improved by how they look, how they talk and how they eat. But most importantly, their self-esteem is improved.

This mission would not be possible without the joint partnership between the District 6000 MOST Rotary Clubs and the Rotary Clubs of Quetzaltenango and Huehuetenango.

Diane Miller, OR Nurse

2010-02-24T14:33:00.000-08:00

Last year was the first mission trip for Diane. She too was encouraged to be a part of the Iowa MOST mission by Pat Wehrle, her co-worker at the University of Iowa Hospitals and Clinics. Diane was anxious to be a part of Iowa MOST. She had already been on one medical mission through the Army Reserve, and was so glad to be able to offer her talents on another one. Diane is so pleased to be making a difference in somebody's life.

Riley Stringham, Anesthesiologist

2010-02-24T14:25:00.000-08:00

Riley Stringham is a Resident in Anestesiology at the University of Iowa. As a resident, he was able to apply for this Iowa MOST missio. and was excited to be accepted. He views this as an opportunity to experience the practice of medicine in another country. The highlight of this mission for Riley is the experience of seeing the faces of the families as they view their little ones after surgery. He is especially touched by their appreciation to the team.

Dennis Wilson, Biomedical Engineer

2010-02-24T13:10:00.001-08:00

This is the third year on the MOST mission for Dennis Wilson. As a Biomedical Engineer, his skills are invaluable to ensure the each machine is operating correctly in the operating rooms. If something is not working, Dennis is right there to get it back on track. Dennis became interested when his supervisor was a part of the mission, and Dennis jumped at the opportunity three years ago to become a part of MOST. Dennis is somewhat familiar with the culture, as his wife is of Mexican descent.

Helping kids is the most important reason for the trip, and being able to contribute to this cause leaves him with a good feeling. Dennis also enjoys the opportunity to travel and experience another culture. In Dennis' words, "the best day is a quiet day, because it means nothing has gone wrong."

Ruben Zuniga, Sterialization Technician

2010-02-24T12:55:00.000-08:00

This is the second year on the Iowa MOST mission for Ruben Zuniga. He is a Sterialization Technician at the University of Iowa hospitals, and speaks fluent Spanish. In 2007 his collegue, Pat Wehrle, recruited him to become part of the mission. Pat has been on these missions since 2005, and she thought he could fulfill two needs: his occupational skills and his fluency in Spanish. Ruben was excited to be a part of this because he would be helping those less fortunate than others. He takes real joy in seeing kids return with happy faces. And he especially likes the closeness of the team that he experiences every year.

Trudy Wright, Recovery Nurse

2010-02-24T12:39:00.000-08:00

Trudy Wright is one of the 2 recovery nurses that are a part of MOST. This is her first year on this mission. Trudy is actually a cardiac recovery nurse at Mercy Hospital in Iowa City, and general recovery is not her speciality. Hence she thought her skills were not needed. But in fact Trudy was "recruited" by Pete Wallace, one of the pediatricians of the group. Her children have gone on missions before, and she so wanted to be a part of one. For Trudy, the most rewarding part of this trip is her chance to see the success of the surgeries, and be able to see the joy in the parents faces when they are reunited with their little ones.

Our Team

2010-02-24T12:34:00.000-08:00

There are 35 members of the MOST mission here in Quezaltenango. 29 of us flew in from Iowa City/Dallas, and we met up with the other six here in Guatemala. Everyone's job is important, but in the next few blogs we wanted to feature of few of our volunteers.

Mateo's story continues

2010-02-23T16:15:00.001-08:00

This is part 3 of a story. Please read the previous two blogs first.

...Mateo Hernandaz had a good night, and was discharged by the MOST pediatrician. The other three children in the group were also discharged, and all of their things were packed up for the trip. It was quite an entourage that lef the ward this morning. Four moms and their babies, each with beautiful new smiles, marched down the hallway and down the steps out of the hospital, and made their way to the truck that was taking them back to their village.

The dads laid down a foam pad on the bed of the truck, and everyone climbed in and settled down. Then a tarp was tied on the supports of the truck bed to provide shade and protection, and the group was on its way. There were about 15 people who were making their way to their village, a day and a half trip covering 150 miles of very winding, steep and extremely rutted roads.

Mateo's mom and dad left two very happy people, carrying their beautiful child. It was the most rewarding feeling for everyone, knowing that this small child had experienced big, positive changes. This story is just one of dozens that are happening this week, and have happened since 2006, thanks to the joint efforts of the Iowa MOST and the Rotary Clubs of Quetzaltenango and Huehuetenango.

Catherine Lane and Kathryn Wallace

Mateo Hernandaz, continued

2010-02-23T15:58:00.000-08:00

Mateo Hernandaz was number three on the surgery schedule. He was wheeled from his room and his mom waited patiently at the doors of the operating hall, standing against the wall.

Mateo's surgery was straight-forward. He was going to have his cleft lip repaired now, and his parents were encouraged to come back in a year or two to complete the palate repair. But other children's repairs require more steps. Because good dental hygiene is uncommon for folks living in these remote villages, many children who need cleft lip and palate repair first need to have decayed teeth extracted, in order to provide the surgeon a disease-free mouth. On this particular MOST mission, there is one youg child who is scheduled to have 18 teeth removed. (Children typically have no more than 20 teeth).

After spending time in the recovery room, Mateo Hernandaz was wheeled back to the post-op ward, where the two earlier patients were also recovering. Both his mother and father were there to embrace their son. Throughout the course of the day in post-op, Mateo would be joined by three other young children who were all from the same area of the country. All four families came to Xela together, and all four wanted to leave together.

Sometimes, if everything goes well, if the surgery isn't complicated, and if the child is robust, he or she is able to leave the same day as the surgery. In the case of Mateo, and in the case of the other three from his village, he spent the night. This was partly due to his low weight, and partly due to the distance that needed to be traveled to his village.

More continues in the next blog...

The story of Mateo Hernandaz

2010-02-23T14:35:00.000-08:00

Monday, February 22, 2010

Mateo Hernandaz went home today, his future made brighter thanks to the donation of time, talents and money from many people both near and far. He was born ten months ago in Los Angeles, a very remote village in the area of Xoxlac, in the western mountains of Guatemala. He was born with a cleft lip and cleft palate, and his feedings were going to be very tedious and time consuming.

His mother, who is 18, already had several small children at home, and at his birth was overwhelmed with the time involved with his feedings. It was suggested by a local clinic that she swap babies once per day with other nursing mothers in the village, in at attempt to stimulate her own milk production. The couple agreed that they would try this. Then, 10 months later, Mateo was referred to the Iowa MOST program in Quetzaltenango.

The history of Iowa MOST begins in 2005 when folks from Iowa went to explore a relationship with a Rotary Club in Huehuetenango, Guatemala, in order to repair cleft lips and palates. In 2006 a joint Medical Mission entitled "Miles of Smiles Team", sponsored by the Rotary district 6000 Clubs of southern Iowa and the Rotary Club of Huehuetenango came to Huehue to repair cleft lips and cleft palates of the children in western Guatemala. This mission was made up of surgeons, anestheologists, dentists, and nurses, all from Iowa. They volunteered their time for a week, and changed the lives of many.

This mission was so successful that it has become a annual event for the past 5 years. In 2008 the Rotary Club of Quetzaltenango, also located in the western mountains, became a partner in this, and so sites are now alternated between Huehue and Quetzaltenango, (also known as Xela).

In 2006 Juan Francisco Fernandez, or "Paco," who lives near Guatemala City, joined the team as translator and in-country coordinator. It was through Paco's involvement with this MOST mission that the family of little Mateo Hernandaz became aware of help for their little son.

Two or three months before the MOST mission arrives in Guatemala, the Rotarians of Huehue and Xela advertize through various venues. Radio and television ads are placed and targeted to those living in the mountains; flyers are printed and placed throughout the region; local clinics are asked to let their patients know of this help; and Rotarians spread the news by word of mouth.

This year, on February 18th, 29 persons traveled with the Iowa MOST mission to Xela, firm in their commitment to this cause and anticipating the week of service. The first day of clinic was Saturday, February 29th, and the MOST members were greated by patients and their extended families lining the walls of the waiting room. Some had traveled 1 1/2 days through the mountains to get to the hospital. Mateo Hernandaz and his parents were part of this group. Others were local residents of Xela. All were happy to see us.

The MOST mission group began the day be setting up all the stations necessary to evaluate each potential patients, ad the order in which each patient would be evaluated. The stations included registration, vitals, surgery, anesthesia, dental and finally pediatrics. To impose some sense of order, it was initially decided that those who had traveled the furthest would be seen first. And so, Mateo Hernandaz was one of the first to be seen. Mateo Hernandaz and his parents worked theirway through the evaluation process. He was diagnosed with aleft unilateral cleft lip complete and a cleft palate. It was also noted that he had poor weight gain in his short 10 months of life, and so nutrition was discussed with his family. He was cleared for surgery, and he would be one of the first to have surgery the next day.

He was admitted to the hospital the same day as his evaluation. This was not true for everyone. MOST members were going to perform surgeries for 5 days, and so some would have to come back to be admitted. But Mateo Hernandaz was assigned a bed in the pre-op room, where he and all the other surgery patients, along with their families, spent the night in one big room.

The story continues in the next blog.....

Order Out of Chaos

2010-02-23T13:48:00.000-08:00

What we want to share with you today is a little about what we call Comnmand Central.

Command Central is a room of 317 square feet on the third floor of this hospital. In this small room the following takes place:

Coffee

Lunch

Storage: Countless necessary bottles of water for all staff; all office supplies; some of the medical supplies; one printer; one photo printer; 22 chairs; one tiny cupboard; one large box/crate turned upside down to serve as our only surface area from which to work.

Traffic: Every member of the team enters and leaves this small room at least a dozen times a day. People meet to deliver and pick up supplies, exchange communication, learn about admissions/discharges, and to change and re-change schedules. Local Rotary members also visit frequently with food, encouragement, and interest. (It is their project, too.)

Noise: The guesstimate for numbers of conversations (of varying lenghts) per day in this room is 120, with as many as four going on at once.

Out of this comfortable chaos comes the results that are being described in this blog.

Kathryn Wallace

Another Way Most has Changed A Life

2010-02-23T09:53:00.000-08:00

Today a young boy, Anderson (age 1 1/2) was scheduled for surgery. Anderson had spent the night at the hospital in preparation for today's surgery. While doing his last minute checkup, the nurse heard a heart murmur. This was verified by the pediatrician. For his safety and health, Anderson's surgery was postponed. But MOST feels a responsibility for follow-up to this problem.

Our pediatricians worked with local resources. Local doctors arranged for Anderson to be seen by cardiology at another hospital. A cardiologist at this hospital recommended that Anderson be placed on a Holter monitor for 24 hours. There were two problems with this: (a) financial and (b) how to get the results of the tests. After much help with translation and with MOST agreeing to finance the monitor (the cost in Guatamala is a fraction of what it is in the U.S.), Anderson went to the other hospital to pick up the monitor. He will return to the hospital where MOST is working and spend 24 hours here as the monitor tracks his heart.

Anderson has not received what he expected from the MOST team; he has, however, received important information about his heart which will hopefully be followed; and he will return for cleft work next year. The MOST team considers this a very positive outcome.

Kathryn Wallace

We did feel the earth

2010-02-23T08:26:00.000-08:00

This is just a quick note. For those of you who may have heard through the news, we did feel tremors from an earthquake today. The first tremor we felt woke some of us up about 5:00 a.m., and then two more forceful ones were felt about 9:00 a.m. and 9:15a.m.

Obviously we were scared, and have since heard that there was indeed an earthquake, with it registering about 5.0. Everyone is fine. Catherine Lane

2010-02-23T06:54:00.000-08:00

The day started out on a happy note. Oscar, the gentleman who wasn't able to make his appointment yesterday because he couldn't afford the bus ride, was able to find the funds to make the trip today. We were all elated, but especially the dentists. In the morning they made an impression of his upper teeth for the purpose of make an obturator, which is a speech appliance. It will fit around his teeth like an orthodontic retainer, with an extention to the back of his throat. The obturator will close a defect between his soft palate and the back of his throat, thereby enabling him to speak clearly for the first time in 65 years.

Oscar will have to come back in the afternoon, at which time the portion of the appliance which will help correct will be formed. That will then be converted to plastic, and will be inserted in his mouth on Thursday. Funds will have to be found for him to make that bus trip.

2010-02-22T18:33:00.000-08:00

The motto for this trip, which is posted on the door to our "Mission Control" is the phrase, Blessed are the flexible, for they shall never be bent out of shape." Adherence to this motto was certainly important today.

This was a wonderful day of surgery and recovery. The children all left the operating room with their futures bright. Their moms were all aglow, each enjoying showing off the beautiful new faces of their little ones.

But flexibility was important, because schedules for the next few days were changing. For example, one gentleman who was scheduled for dental work didn't show up because he could not afford the bus fare. Another family canceled the child's procedure because due to hospital policy, no more than four people per patient are allowed in the room, and this meant grandma could not come along.

The language barrier is always there, because many of these people speak the Mayan dialect, which necessitated two translations. And directions and explanations get lost in the translation. But this group of professionals handles challenges very well, and tomorrow brings another bright and sunny day. Catherine Lane

First day of surgery

2010-02-21T18:49:00.000-08:00

This was the first day of surgery, after evaluations and scheduling yesterday. 7 surgeries were done today, with ages of patients ranging in age from 7 months to 15 years. Everything went well.

Six stayed overnight because of the distance from home. Four of these all came together in one truck, and these four were traveling home the same way. Each family is provided with a "before" and "after" photograph, a momento of this life-changing experience.

The Rotary Clubs in this area have been so supportive. Not only have they provided lunch for us, but they have provided many amenities for the patients and their families. They have been invaluable to us with their translation skills, and sensing a need, have promised to provide food for all the families of the patients tomorrow.

This has been a very long day, hence this day's posting is somewhat short. More details will follow tomorrow. Catherine Lane and Kathryn Wallace

Screening Day, February 20

2010-02-20T15:18:00.000-08:00

Today was "seeing patient" day! The group was very enthused and energetic, and the walk to the hospital went very quickly. Patients were already patiently waiting to be seen. To those of us who are new to this mission, it is humbling and amazing to see the trust that these people place in us.

Out of the organized chaos of setting up work stations at a site that hadn't been used before, the patient faced the following steps:

1. Registration

2. Surgical evaluation

3. Anesthesia evaluation

4. Dental evaluation

5. Pediatric evaluation

6. Scheduling for appropriate procedure

Patients who have been scheduled for surgery then needed to meet with a medical student from this local hospital to complete their registration. (Educating these students is also part of this medical mission,)

It was a long day for each of these patients, and their extended family. Some have traveled long distances to be seen. I was so impressed and in awe of their patience and graciousness. I left at 4:30 p.m. because my job was done, and many of these families were still waiting for their surgical schedules.

At the end of the day 71 patients were assessed. Some were directed to physicals at the hospital for admission tonight for surgery tomorrow; some where scheduled for surgery later in the week, with the local Rotary Club assisting with housing for those who needed it; and the remainder, who were not appropriate candidates for surgery at this time, were sent home with the possibility of being seen next year.

Kathryn Wallace, Volunteer

fFrom Guatemala City to Quetzaltenango

2010-02-19T15:06:00.000-08:00

We arose early this morning and started out to Quetzaltenango (Xela) about 7:30. It was a long, slow bus ride. We initially fought rush hour traffic, and discovered just how close two vehicles can actually get without pulling off a rear view mirror.

Our trip went along the Pan American Highway, or Central American One. Once outside of Guatemala City, we were into farming country, with many small plots of farming, each one tilled by hand.

Xela is located in the western hill country of Guatemala, and our trip took us through some beautiful countryside. These small farms used every inch of land, with many plots of planted vegetation along some pretty steep slopes.

We finally arrived in Xela about 12:30, and had a nice lunch of sandwiches provided by the Rotary Club of Quetzaltenango. And then we were off to the hospital to get ready for tomorrow.

We walked to the hospital, which is about 1/2 mile from our hotel. For those of us who are on this trip for the first time, it indeed is a sobering picture to see the facilities. People are camped outside on the steps, probably waiting to be admitted. There is no heat, nor air conditioning in the hospital. It is what I would think a U.S. hospital would look like in the 1920's.

Tomorrow is a big day, with screening and physical evaluations to be done. We expect to screen between 70 and 90 patients. Some of these young folks are traveling 1 1/2 days for this treatment. Some are coming from Hue Hue. These kids will be evaluated and a surgical schedule will be set up for the week. Catherine Lane

MOST team arrives in Guatemala City

2010-02-18T21:14:00.000-08:00

Greetings, it is about 11:00 p.m., and the team has arrived at the hotel in Guatemala City. All of our connections went well, there is a wonderful spirit with the group, and we begin another day tomorrow very early. We have about a 5 hour bus ride to Xela tomorrow, and then the work begins. Will keep you all posted. Catherine Lane

2009-02-19T20:09:00.000-08:00

Continuity of Care

What are the chances that a team like us, who has traveled thousands of miles to do surgery, would see a boy with a cleft lip and cleft palate born, then return a year later to repair his lip, and THEN return another year later to repair his palate? That is what happened with the young boy named Yeremi Heraldo Carrillo Pascual. In 2007 the team was in Huehue for the second mission in that town. Yeremi was born while we were there. Deb Strike, who works with kids with cleft at home, talked to the parents about ways to feed their baby. We took pictures and marveled at the coincidence that a child who would need our help in the future was born virtually right before our eyes. It’s a great feeling to know we have been here to help him for two consecutive years as he grew to a size to be able to have these progressively more complex surgeries. Hopefully he won’t need us again.

Submitted by Jody Meyer

2009-02-19T19:21:00.000-08:00

We did it!

Thursday, February 19, 9:28pm. It doesn't seem possible but we have just culminated a very successful mission here in Guatemala. Access to the Internet has been spotty so you will see some catch-up posts when we return.

The team completed surgical procedures on 39 people, often with multiple procedures on a single individual. This doesn't even count the work done by the dentists on a number of patients who came in for obdurators (a fabricated plate that covers the fissure in a palate) and other strictly dental work. Surgery closed about 3:00 pm and the remainder of the day was spent packing our supplies and equipment for storage until our next visit to Huehuetenango in 2011.

This team was one of the best I have worked with. Comments from some of the team members, old and new, will be posted on this blog. Below are just a couple~

Susan Adamson (left), a nurse at UIHC, is one of our recovery room nurses. Here she is caring for one of our patients and teaching one of our Guatemalan friends, Margery(rt).

This is my second mission and the first in Hue Hue. I am truly amazed and inspired by the teamwork that happens all around me everyday. Most everyone from Iowa Rotarians, Guatemalan Rotarians, physicians, nurses and ancillary personnel has a “can do” spirit. It’s what makes our missions so successful!

I’ve spent the last two years as a Recovery Room nurse and one of my observations is that there is a huge difference in how the post-op patients differ in their experience/expression of pain. It would appear the Guatemalan people either have a high pain threshold or it is in their culture to hide it.

The experiences I have had here are some of the most rewarding of my life. I hope to be able to continue mission work at the same level and am so thankful I have been given this opportunity.

Susan Adamson
Huehuetenango-2009

Mindy Bowen is also a nurse at UIHC and works in
the Recovery Room.

Huehuetenango is now my second mission with the MOST team. These missions have been one of the most rewarding and fulfilling things I have ever had the pleasure of being involved with. As a nurse you give so much of yourself everyday at your job with little or no words of thanks from the patients or families. Here in Guatemala the thanks are non-stop. I believe it was stated very well last year by Dr. Jodi Jones; she said she believed the difference was “expectation vs. hope”. In the US, we expect that our children’s lips will be repaired. In Guatemala they hope they may have the chance to get their child’s lip and palate repaired. With the MOST mission we are able to answer some of those dreams of hope and the gratitude is overwhelming.
I would recommend to anyone interested in doing something like this to get involved and pursue that interest because you will never regret it. I would like to thank my family for being so understanding of the importance of my being here.
Love you and miss you all
Mindy Bowen

2009-02-18T04:44:00.000-08:00

Monday, February 16, 2009. Today was our second day of surgery. We started at 7:30 am with our first little one in Dr. Canady’s room, Maricela Perez Morales. This is the second time we have seen Maricela. Last year in Xela (Quetzaltenango) the team repaired Maricela’s cleft lip. If you scroll down on this blog, you can read her story from 2008. This year in Huehue we were delighted to Maricela again and fix her palate. Now she will not only have her sweet face whole, she will be able to eat and drink and talk without the difficulties presented by her palate.

“Our kids” ranged from 15 months to 9 years old. Although four palate repairs were planned, not all were accomplished. A number of the children we have seen have serious dental problems. Infection permeates their mouths so the diseased baby teeth are removed to enable the mouth to heal. Then the structural issues of the palate can be addressed safely with a much greater likelihood of long-term success. One of our little palate patients needed 10 teeth extracted so his palate repair was cancelled; the trauma would have been too great. Our hope is this patient will come again to Xela or Huehue when we are here, so we can fix his palate. As with Maricela, one goal of Iowa MOST, through our repeat trips, is to fully address the multiple needs of these kids. In the last two days, we have been able to help 24 children and their families.

Our day wound up with the last of the team leaving the hospital at 9:00 p.m. All are hoping for a slightly shorter day tomorrow…….

2009-02-16T19:31:00.000-08:00

Passing It On~

Sunday, February 15, 2009 – First day of surgery. This was a very busy day, as most first days tend to be, with new surroundings and new team members getting accustomed to a new setting. One of the very special moments occurred when we were able to have our lead surgeon Dr. John Canady achieve a very important goal of Iowa MOST. That is to educate others. So… today 20 month old Angel Francisco came to us with a wide left cleft lip in need of repair, and was the lucky recipient of the surgical skills of Dr. Canady (in John Deere cap) teaching Rotarian Doctor Amilcar Estuardo Pinetta the intricacies of the surgical procedure. Sterilizing Technician Ruben Zuniga (in USA cap) translates Dr. Canady’s training from English). Canadian plastic surgeon and MOST volunteer Dr. Murad Husein also helped in the operation. This training will be of great benefit to Dr Pinetta in his role of general surgeon here in Huehuetenango.

Submitted by Gary Pacha.

2009-02-15T20:20:00.000-08:00

Arrival in Guatemala

We have arrived! The entire team came together in Huehuetenango on Thursday, February 13th, another beautiful day in Guatemala. The Club Rotario de Huehuetenango hosted a wonderful luncheon at the home of Dr. Oscar Marroquin. The Rotarians and their families have provided us with a grand welcome and are true partners in this effort to help the children of Guatemala.

Similarly the Hospital Nacional has worked hand in hand with us. The advance team members received incredible assistance from the staff of the hospital as two sturdy lads manually lifted the skids filled with our supplies onto a cart to move them into the hospital area which serves as our “headquarters”. Our shipment of seven skids

arrived with no problems, thanks to the hard

work of our friends at DHL in the States and

in Guatemala.

On Saturday, translators from our Rotary friends helped us with screening of patients, reassuring parents and children, and reassuring us that our Spanglish was understood. Screening progressed extraordinarily smoothly; of over 76 people screened we scheduled 40 for one or more procedures including repairs of cleft lips and cleft palates, dental work and ear tubes. Our hope is always to make the lives of these children easier. Pictured here are (left to right) Patricia Minera, Emilio Mayen Roldan, Orquidea de Marroquin, Dr. Oscar Marroquin, Sofio Moto Garcia, and Julia Maria Arias de Velasquez--some of the many wonderful people we have met in Guatemala.

VAMOS A GUATEMALA

2009-02-05T12:59:00.000-08:00

On January 25th the Iowa M.O.S.T. team for 2009 met at Mercy Hospital in Iowa City to be briefed by team leader, Gary Pacha, on their upcoming trip to Huehuetenango.

The team has spent the last two months collecting supplies and equipment and readying the 7 skids of materials in a frigid warehouse in Coralville for shipment to Guatemala.

The shipment arrived in Guatemala on Jan. 22nd and has been making its way through customs. Today we heard from our contact at DHL, who has been a partner in this project, that the delivery to Huehuetenango in the western highlands of Guatemala was expected by this weekend.

And just in time, as the team takes off next Thursday to arrive in Huehue on Friday, Feb. 13th!

Set up will occur in the Hospital Nacional on Friday and Saturday, and the pandemonium of screening patients will begin on Sunday. Until then~~~

Huehuetenango 2009

2009-02-05T10:10:00.000-08:00

For those following this blog, I am Team Leader and we are finalizing our trip to Huehuetenango, which is coming up in just one short week - February 12. Just got word today that our supplies should clear customs today or tomorrow, so we are hopeful that this year for a change our supplies will be there before the team. Karin Franklin and Rick Borchard as Supply Clerk and Biomedical Engineer respectively will be going one day early and get a head start organizing and checking out our supplies and equipment. We are anxious to see and work with old friends in Rotary and the community to help those less fortunate get a new "smile" thanks to the dedicated medical professionals who will be working to correct cleft lips and palates.

Gary Pacha

Team Scores Smiles & More in April 2008

2008-05-28T13:12:00.000-07:00

Iowans & Guatemalans & Rotary!

Teaming up to make a difference!

On April 5, 2008, the Rotary 6000 Iowa MOST (Miles of Smiles Team) began its journey to perform cleft lip/palate and dental surgeries in the highlands of Guatemala. The 30-member Iowa team included many mission-experienced medical personnel from the University of Iowa, who worked with hospital personnel at the Hospital Regional de Occidente San Juan de Dios, Quetzaltenango (Xela).

The Iowa Miles of Smiles Team was capably augmented by Guatemalan doctors Juan Carlos Garcia Moran and Antonio Rosal Alvarez, and nure Viki Lopez Gutierrez from Huehuetenango. Two generous benefactors, Sal and Maru Danial, worked as translators for the project, and Dr. Bill Olin, who originally inspired the Iowa MOST mission, joined the team for screening and the first morning of surgeries in Xela.

During its week at Xela, the team of surgeons, nurses, pediatricians, anesthesiologist, dentists and non-medical support volunteers screened 69 patients, primarily Mayan children, and completed 55 medical procedures, including 16 cleft lip surgeries, five cleft palate surgeries, three fistual surgeries and dental placement of six obturators as well as multiple teeth extractions.

A great deal was accomplished medically under sometimes trying conditions, and through it all, Dr. John Canady, lead surgeon, continually cautioned the team: "We need to proceed slowly and safely, just as if we were at home making medical decisions for our own children," Canady said, and added, "These children in Guatemala are our children." And, the team met his goal of leaving with more than 30 children and even a few adults restored -- to smile without shame, and to be able to speak and eat more normally. No one was less well off due to the team's efforts.

The Iowa Miles of Smiles Team, who volunteered their time and skills, were amply paid with tears, smiles and hugs of gratitude from thankful families, and the knowledge that many lives had been improved due to their cooperative efforts as a team and the magnanimous support of the Rotary 6000 members in Iowa and the Quetzaltenango Rotary in Guatemala.

Jan Ahlberg Remembers.. & Says, "Thank You."

2008-04-27T14:54:00.000-07:00

A big thank you to Iowa MOST 2008 for giving
me the opportunity to participate in the Cleft Lip & Cleft Palate Repair team trip to Quetzaltenango, Guatemala.

It was a week of inspiration as well as learning for me. The care and attention given to each child and family by team members was heart warming, and an example of how dedication to an ideal can bring life changes to others.

The posted pictures and stories bring back wonderful memories. I have told lots of friends about my week in Guatemala, but the pictures really describe it.

Sending heartfelt thanks to all. Jan

Jan Ahlberg served officially as the record keeper for Iowa MOST '08. She was especially commended for her work as translator & assistant for dentists Steve Hedlund & Bill LaVelle.

Emily Remembers Victor Victorino

2008-04-23T19:20:00.000-07:00

It was the morning that Victor would have his surgery. I was documenting vital signs on all of the kids, when I heard an "Emily." Victor wanted to show me the coloring book page that he had just colored. He was so very proud. This fun went on all morning. Victor was very chatty with me and full of hugs.

Victor left for the OR (operating room). His mother waited patiently. When Victor's mother heard that Victor was ready to return to the pediatrics room, she skipped out of the room with excitement. Their reunion was heartwarming. Victor's mother cried as she and Victor left the hospital. So very happy, they hugged nearly the entire team goodbye.

Emily Berglund served as a pediatric nurse in Quetzaltenango, April 2008.

Post-Op Family Reunions at Xela

2008-04-16T07:02:00.000-07:00

Last Night in Guatemala

2008-04-16T06:26:00.000-07:00

Iowa MOST gathered in Guatemala City for a farewell dinner on Monday, April 14, 2008... a joyous occasion filled with expressions of gratitude for a good mission and continued team spirit.

The next morning -- a 5:45 a.m. wakeup call, a quick van ride to the airport, checking in & changing gears for leaving Guatemala & re-entry to the USA & our 'regular' lives... Safe arrival home with fond goodbyes to team mates & happy hellos to loved ones who came to meet us.

The 2008 Iowa MOST mission is completed, but the Miles of Smiles postings on this blog site will continue as team members send in their photos & stories of their perspectives and insights of our time in Quetzaltenango. We hope you will stay tuned as the valuable story of Iowa MOST continues to unfold...

Last Day for Surgeries in Xela

2008-04-12T12:41:00.000-07:00

The team finishes its mission in Xela on Friday, April 11, 2008, with a full schedule of surgeries & post op & pediatric care.

Photographs feature ~

* Deb Strike, Chandra Beals, Pat Wehrle & Jodi Jones in surgery.

* Team members Ruben Zuniga, Mindy Bowen, Pat Plohman, Bill LaVelle, Robert Forbes & Susan Adamson taking a welcome break!

* Oscar Gomez, Dee Grems & Pete Wallace in the pediatric room.

* Emily Berglund & Viki Lopez Gutierrez attend to a patient in the pediatric room.

* The team's translator, guide & facilitator Francisco (Paco) Fernandez, takes time to flash his winning smile.

* Ruben Zuniga demonstrates how he steralizes instruments for the surgical teams.

* Lael Stander looks on as Jim Schuh & Jody Meyer prep a patient for surgery.

* Tom Cannon, John Canady, Jim Schuh & Jen Oliver prepare for surgery.

* Natalie Freed, Jodi Jones, Gary Pacha & Deb Strike in surgery.

Mucho Gracias a Rotario Quetzaltenango

2008-04-12T11:46:00.000-07:00

Not enough thanks can ever be given to the Rotarians of Quetzaltenango for their generous hospitality & support to the Iowa MOST medical mission. Without their extensive efforts, the medical mission could not have been accomplished. Since July of 2007, when the second oldest Rotary Club in Guatemala said, "Yes" to team leader Gary Pacha's proposal for local Rotarian partnership with the mission, members here in Quetzaltenango have worked arduously to prepare for and ensure the success of the cleft lip/palate medical mission.

Rotarians of Quetzaltenango, Guatemala pictured in this post are among the many local Rotarians who were instrumental in partnership with Iowa MOST in April 2008:

Dr. Fredy Barrios, Sofia de Barrios, Christina de Cifuentes, Miriam Richter, Dr. Raul Cordon, Jorge Cifuentes & John Diehl.

John Diehl, who served as the main contact in Guatemala for Iowa MOST, said from the beginning, the Rotary Club in Quetzaltenango worked to involve the hospital administration with the medical mission, so that it would be a cooperative effort. He noted that Rotarian Raul Corden worked diligently before and during the mission as a liaison with the administration and medical staff of Hospital Regional de Occidente San Juan de Dios. In the fall of 2007, Cordon was instrumental in arrnging for an Iowa delegation's tour of the hospital facilities, meetings with hospital officials and staff, and securing needed rooms, equipment and staffing assistance. Cordon also put the requested drug list from Iowa into Spanish and took responsibility for ordering the necessary drugs for the medical mission. He also secured the loan of critically needed medical equipment from Dr. Schele in Totonipican to enable more surgeries to be conducted. Jorge Fuentes, Rotario Quetzaltenango President, dealt with overall organizational support with Dr. Oscar Marroquin's guidance based on Marroquin's experience with previous Iowa MOST missions in Huehuetenango, Guatemala.

Diehl said the biggest hurdle -- getting the impossible done -- that is, getting the shipment of Iowa medical supplies and equipment through customs in a matter of a few days, proved not to be a hurdle at all. He credited DHL's working with Caritas in Guatemala as making the vital difference. He noted that a Rotary committee led by Efrain Figueroa worked to ensure that temporary medical licenses were issued to enable the Iowa medical team to practice medicine in Guatemala. Diehl headed up the group that made passport and customs clearance of Iowa MOST members entering Guatemala run smoothly. Luis Lopez coordinated another Rotary committee's efforts to provide Iowa MOST mission patients and their families shelter and food during their stay in Quetzaltenango.

Fundraising efforts, including a play (Cavrona a Bruta), auctions, a raffle and donations from area Rotary Clubs, were undertaken by the entire membership of Rotario Quetzaltenango under the leadership of Salvador Aguirre. These funds were used to provide generous support for Iowa MOST, including noon meals, bottled water, transportation, countless supplies, logistical assistance, an excellent restaurant meal (with hosts Hans & Marina Vielman) and an evening farewell part at the Tennis Club in Quetzaltenango.

Fredy Barrios led a committee that did extensive publicity (news media, posters, contacts with priests, pastors and clinic personnel) to identify and get the word out to potential candidates and their families about the opportunity for cleft lip/palate surgery and dental work during the Iowa MOST 2008 mission in Quetzaltenango. Others helped with hotel arrangements, and all of these efforts wer ably and graciously assisted by the Women's Rotary Auxiliary, the Comite de Damas Rotarias.

Pat Plohman Says Thanks to Iowa MOST

2008-04-11T20:40:00.000-07:00

As a first-time volunteer with Iowa MOST, I struggle to find words that adequately describe my experiences so far. From the moment we arrived, our very dedicated team has been welcomed and recognized in ways that extend far beyod what I could have expected. The courtesies of food and support as well as expressions of gratitude are so deeply heartfelt. The Rotarians and families of Quetzaltenango have words, smiles and gracious gestures that so genuinely convey their appreciation for all of our efforts here.

On a very personal note -- I have been able to witness the initial patience and pleading hope with which families passed through the screening process. The children greeted us with smiles and the parents smiled, too, but they also looked deep into our eyes hoping for the confirming "yes" for surgery. Those for whome surgery was scheduled responded with even broader, more grateful smiles. Being a part of this screening process meant that on surgery days, I got to recognize, hug, hold and love the precious smiles of the children afterour amazingly skilled team members had completed their work.

As if that wouldn't be rewarding enough to witness such a life-changing event for these special children. I was able to carry the children out of recovery and place them safely into the arms of their trusting parents. Exchanging hugs and glances with tear-filled eyes, we would say our farewells with those precious moments imprinted in my heart forever.

Thank you Iowa MOST for including me on such an invaluable mission that provides the surgery with the tender love and care for these children that we as parents all want for our children. I am also particularly grateful to John Canady and Gary Pacha for allowing me to share this once in a life-time opportunity with my daughter Jodi, who is one of the surgeons! I will leave Guatemala realizing what an incredible difference a relatively small group of compassionate people can make when the primary purpose has been motivated by the desire to do "good" where it is most needed!

Pat Plohman is shown on the right in the picture in this posting. She lives in Winnepeg, Canada.

Miracle of Maricela

2008-04-10T08:55:00.001-07:00

Here are photos showing four-year old Maricela with her mother on screening day, Monday, April 7, 2008, & on the very next day: Maricela's operation in progress & being completed by surgeons Drew Dillard & Antonio Rosal Alvarez, Maricela being held by Pat Plohman in recovery and then reunited with her parents while Emily Berglund checks her vitals in the pediatrics room.

But, pictures tell only a small part of the story...

Maricela's becoming part of the Iowa MOST 2008 story begins in a remote village ten hours travel ~ some on difficult, narrow dirt roads ~ from Xela. Francisco (Paco) Fernando, the Iowa MOST medical mission translator, explains that a non-profit humanitarian organization, Casa Colibri, established a medical clinic near Marciela's home in 2004.

On a medical mission to this rural clinic in November 2007, Paco served as a translator for the doctor conducting examinations. Paco's association with Dick Enders, Father Gerald Hagen and Rotarians Ulie Liechti, and Linda and Dr. Jay Eastman, all who have worked toward the development and management of the clinic, led him to become involved with Casa Colibri on a deeper level than as only a translator. The second patient to arrive at the November 07 clinic was Maricela. Paco saw the severe deformity of her cleft lip and was immediately convinced that he personally needed to ensure reconstructive surgery for Maricela.

Paco had served as translator for an Iowa MOST mission earlier theat year (February - March 2007) in Huehuetanango, and had witnessed the dramatic improvement for children who had undergone cleft lip/palate surgery. He said, "Last spring when I worked with Gary Pacha and Iowa MOST, I found a part of myself that I didn't know existed, that part of me that is deeply a human being, when I saw the change in the children who had surgery. It was almost as if their souls had been healed." He added, "It takes weight off the parents, too. So many of these people don't have access to medical services and no expectation of help, so providing it is important, and one feels in the gut, the enormity of it."

So, Paco told Maricela's parents to do all they could to keep her well and to be patient until the Iowa MOST mission came to Xela. He arranged through Casa Colibri for Marciela and her family to come to Xela on the weekend before the MOST screening. He felt certain, and the clinic doctor concurred, that Maricela would be a good candidate for surgery. She was accepted and had surgery on the first day that surgeries were performed at Xela.

The surgery transformed Maricela's appearance. Surgeon Drew Dillman used a specific type of surgery that Dr. John Canady had taught him. He was able to repair Maricela's severe cleft lip and open palate, and also keep her nose appearance normal. Drew smiled as he said of the surgery, "It's like being a baseball player, who normally has strong single base hits. Maricela's surgery was a home run."

Paco noted that a big problem in the rural mountainous regions of Guatemala is that parents often hide their children who have physical defects. They feel ashamed, and the children come to believe that their deformity is their fault. Some of the rural people feel that it is a spiritual thing, too, something to be accepted fatalistically. He said, "It is difficult to trespass this cultural barrier. Hopefully, with this example, others in Maricela's rural area will try to help their children and will overcome their mistrust."

Gratitude in Guatemala

2008-04-10T07:04:00.000-07:00

Wednesday, April 9, 2008 ~ A Story from the Dental Team

Perhaps the most difficult part of the Iowa MOST medical mission in Xela has been having to make decisions to turn people away; to say no to their requests for reconstructive surgery, because they are too young to undergo anesthesia, have respiratory problems that could compromise the patient during surgery, or require a procedure that is too complicated and lengthy to complete in the time the team has available in Xela.

The latter condition applied to Severiano, a young man, who needed extensive dental surgery for a wide open cleft of the whole hard and soft palates. He had been scheduled early on Tuesday morning, because dentists Bill LaVelle and Steve Hedlund knew it would require four, possibly five days to complete the two impressions needed, the surgery, and the post-op checks to be certain that the appliance fit correctly so that it didn't cause a major sore and allowed a sufficient opening for appropriate speech sounds.

Unfortunately, when the dentists began work on Tuesday, they discovered they were in the midst of a hospital remodeling project that started that morning in the dental offices. Equipment, chairs, lights and supplies were removed, and a water pipe broke with a brownish water spreading across the floor. The Iowa MOST dental appointments had to be cancelled for the rest of day. The Severiano's appointment was moved to 9 a.m. on Wednesday morning, but then was cancelled due to the length of time needed to complete his procedure. The time available was shortened even more, because painters would be arriving on Friday afternoon to paint the dental offices.

Severiano arrived at 9 a.m. on Wednesday morning, even though he knew that his appointment had been cancelled. He pleaded to have surgery. He asked, "Could you do even part of what is needed and then finish the rest when you return another year?" Jan Ahlberg, who was translating, reported, "He begged, really begged for over half an hour, because he wanted desperately to be able to speak clearly." The answer was sadly, but firmly given: no.

That afternoon, the young man returned and sat quietly in the waiting room. When Jan asked him why he was waiting when he had no appointment, he said he had a gift to give. Jan invited Severiano to come into the dental office and he began to pull beautiful Guatemalan weavings from his sack to present to Bill, Steve & Jan with thanks from his heart. He kept putting his hand to his chest and saying, "Thank you from my heart." Then he added, "Even though I know you can't help me this time, you are helping others. Thank you from my heart." It was an incredibly humbling, deeply touching moment in the life of the medical team at Xela.

Tuesday, April 8, 2008 ~ First Day of Surgeries

2008-04-09T08:49:00.000-07:00

Surgeries were done throughout the day... then the patients were taken to the recovery room & soon reunited with their families. Watch for details ~ coming soon ~ especially, the amazing story of Maricela.

Monday in Xela ~ April 7, 2008 ~ Screening Day

2008-04-09T08:15:00.000-07:00

With no opportunity to set up supplies & equipment on Sunday afternoon, the Iowa team rose extra early and trekked along the bustling street filled with hurtling, colorful, crowded buses, vans & other vehicles spewing diesel fumes, then up over the pedestrian overpass, past tortilla stands, and through the hospital grounds gates and a maze of hospital corridors to set up for a long day of screening candidates for cleft lip/palate and dental surgeries.

A quiet crowd of intensely hopeful parents & their mostly smiling children, as well as a few adults seeking surgery, waited patiently in the lobby. But then, they began lining up, pushing insistently toward the door of the intake office, as the team worked quickly to set up the records and medical equipment needed for screening.

Then all was ready for the patients to be 1) charted, 2) examined by the surgical team to see if they would be candidates for cleft lip/palate surgery, and if they were, to be assessed by the 3) anesthesiology team. All the children, whether or not they were candidates for surgery, received examinations by the 4) pediatricians and 5) dentists. Support staff, including the vitally-needed translators, positioned themselves with the medical teams. Others on the Iowa Miles of Smiles Team worked throughout the day getting supplies, equipment and rooms ready for the upcoming days of surgery.

Screening Day Begins with Information Charting

2008-04-09T07:48:00.000-07:00

April 7, 2008 ~ Screening Day in Xela

As families crowded around the door of the intake room, the staff began inviting the prospective candidates for surgery in to have their photos taken (Mindy Bowen), have weight & height checks done (Dee Grems), be checked for fever and respiratory problems (Emily Berglund), and get information (names, place of residence, etc.) recorded (Jan Ahlberg). Other staff assisted with this process throughout the day. All of this information was charted quickly and cheerfully... all the while providing assurance to the families before directing them to the surgical team.

Screening includes Height & Weight Checks

2008-04-09T07:38:00.000-07:00

April 7, 2008 ~ Heights & weights are checked by the intake staff.

Charting Information, Checking Respiration

2008-04-08T19:39:00.000-07:00

April 7. 2008
Screening Day in Xela

Surgeon's Evaluation

2008-04-08T11:50:00.000-07:00

April 7, 2008 ~ Screening Day in Xela

Each prospective candidate (almost always a child brought by family) was examined by the surgeons John Canady, Drew Dillman and Jodi Jones. Sal Danial provided invaluable assistance translating the surgeons' assessment to the parents.

Anesthesiologists' Assessment

2008-04-08T11:29:00.000-07:00

April 7, 2008 ~ Screening Day in Xela

If a child or an adult was determined by the MOST surgeons to be a candidate for cleft lip/palate surgery, the family was directed to the anesthesiologist team of Jim Schuh and Chandra Beals, who were well-assisted with translations by Lael Stander.

Pediatricians' Examination

2008-04-08T11:13:00.000-07:00

April 7, 2008 ~ Screening Day in Xela

Pete Wallace and Oscar Gomez examined patients for their overall health, and in one case, admitted a severely malnourished baby into the hospital for immediate care. Maru Danials provided skillful translating assistance for this team.

Dentists Make Determinations

2008-04-08T11:05:00.000-07:00

Screening Day in Xela ~ April 8, 2008

Bill Olin, Bill LaVelle & Steve Hedlund teamed up for dental examinations, and were ably assisted with translations by Ruben Zuniga and Francisco (Paco) Fernandez.

Waiting to Hear

2008-04-08T10:38:00.000-07:00

April 7, 2008 ~ Screening Day in Xela

Many families waited all day to be seen and then waited to hear whether their loved one would be selected to receive surgery, and when that surgery would take place. As the time between examinations and the announcement of the surgical schedule lengthened (as needed surgical equipment was secured so that more surgeries could be performed during MOSTs' time in Xela), a quiet, but stoic tension grew among those who were waiting. One father sat rigidly, tears streaming down his face. Some mothers and fathers, their faces a mix of hopeful determination and stress, would suddenly hold their child close to them and kiss that child tenderly on the top of the head. The tension was broken when huge bags of beanie babies and other stuffed animals were brought out for the children. Smiles and laughter and playfulness eased the tension a bit.

And then the announcements were made. Joy and relief were obvious as most were included for surgery. A young father came to the door of the office and asked a question. No, no, he said, his little daughter had been selected for surgery. It wasn't that he wanted to know. He wondered how much he would need to pay. He was assured by Deb Strike that he would not have to pay anything for his daughter's surgery. An enormous smile grew on his face. In Spanish he said, blessings, blessings, thank you, thank you. Deb told him that his smile was more than enough payment for us. It was one of the many payments of grace and gratitude the team received during the day of screening -- before surgeries had even begun.

Children Waiting on Screening Day

2008-04-08T10:28:00.000-07:00

April 7, 2008 ~ Children waiting through the day for news of whether they would have surgery scheduled during the week that the Iowa Miles of Smiles Team would be doing lip/palate & dental surgeries in Xela.

Children in Waiting on Screening Day

2008-04-08T10:16:00.000-07:00

April 7, 2008 ~ Children spent the day waiting with their families for their screening & then waiting to hear whether they would be selected for surgery.

Sunday Drive in the Mountains of Guatemala

2008-04-06T18:29:00.000-07:00

Patchwork quilts of vegetable fields... onions, cabbages being harvested on the steep slopes & in the narrow valleys... Small villages with poor housing... Bananas, sugar cane, fruit stands... misty valleys of conifers... so many eco-systems on the long winding drive to the highlands of Guatemala. In mid-afternoon, the team arrived in Quezaltenango (Xela) & then enjoyed a late lunch at the Hotel Arizona before a tour of the nearby (within walking distance) hospital.

Tomorrow, the team begins a day of screening for cleft lip/palate surgery candidates.

Sunday -- Team Enroute to Xela

2008-04-06T18:10:00.000-07:00

Sunday breakfast with our generous benefactors, Sal & Maru Danial, Trustees of the Samir D. Gergis Charitable Trust. And then, the Miles of Smiles Team boards the bus for the long, scenic drive to Xela.. . viewing high mountains & breathtaking steep misty valleys along the way.

Miles of Smiles Team Leaving Iowa - April 5, 2008

2008-04-05T13:25:00.000-07:00

Meeting & greeting & reuniting & boarding... Cedar Rapids to Dallas, then Guatemala City... ETA 8 p.m.! Tomorrow, the team will arrive in Xela for unpacking & getting set up for surgery screening on Monday. Go Team!

Iowa MOST in Operation ~ 2006

2008-04-01T19:07:00.000-07:00

2008-04-01T18:53:00.000-07:00

Don Ambrosio

~ (84 yrs. old) ~

after his surgery.

He said thank you for himself & also for the children who would never have to live their lives in isolation as he had been forced to do, because they had the opportunity for corrective surgery.

CARMELINA

2008-04-01T18:38:00.000-07:00

Carmelina & her husband after
her surgery in 2006.

Carmelina before surgery

ADOLFO

2008-04-01T18:32:00.000-07:00

Adolfo came back to visit & say thanks in 2007...

AMELIA

2008-04-01T17:56:00.000-07:00

Medical Mission to Guatemala

2008-03-30T16:57:00.000-07:00

On April 5, 2008, the Rotary 6000 Iowa MOST (Miles of Smiles Team) begins its journey to the highlands of Guatemala. The 29-member team will work with local partners at the hospital in Quetzaltenango (known locally as Xela) to perform cleft lip/palate surgeries for both children and adults.The Iowa Miles of Smiles Team will be joined by Guatemalan doctors Juan Carlos Garcia Moran and Antonio Rosal Alvarez, and nurse Viki Lopez Gutierrez from Huehuetenango. Two generous benefactors, Sal and Maru Danial, will meet the team in Guatemala as volunteers for our project. Dr. Bill Olin who originally inspired the Iowa MOST mission will also spend a few days in Xela. Iowa MOST members looking forward to working with local Guatemalan Rotarians and hospital staff include:
Surgeons ~ John Canady, Drew Dillman & Jodi L. Jones
Anesthetists ~ Robert Forbes, Jim Schuh, Chandra Beals & Tom Cannon
Dentists ~ Bill LaVelle & Steve Hedlund
Pediatricians ~ Oscar Gomez & Pete Wallace
Medical Students ~ Natalie Freed & Lael Stander
OR Nurses ~ Pat Wehrle, Deb Strike, Jody Meyer & Jen Oliver
RR Nurses ~ Mindy Bowen & Susan Adamson
Floor Nurses ~ Emily Berglund & Dee Grems
Nursing Assistant ~ Ruben Zuniga
Biomedical Engineer ~ Rick Borchard
Team Leader~ Gary Pacha
Supply/Quartermaster ~ Karin Franklin
Tranlator ~ Francisco Fernandez
Photo Journalist ~ Melody Rockwell
Record Keeper ~ Jan Ahlberg
Pediatric/Rec. Room Assistant ~ Pat Plohman

Children in Guatemala~Before/After Smiles Surgery

2008-03-30T15:53:00.000-07:00

MAYNOS!
in 2006 & 2007

DORCAS! Surgery in 2006 ~ See her 2007 SMILE!