Day 6: 1/24/20

Today is our last operating day and it definitely started off with a bang. I’ll stop boring you with my excitement over oatmeal when I’m equally excited about a banana for breakfast. My signature hair braid for work has prompted one of our speech pathologists to now braid my hair each morning and she does an amazing job. It’s like summer camp, my friends help me braid my hair. One of our docs is going to fishtail it for the trip home. We become a very tight knit group I do have to say. 

We got to the hospital and started out in our usual fashion of rounding on all the patients. The clefts all looked wonderful and were eating and drinking well. The residents have improved so much on their presentations this year it is so encouraging to see. 

If you listen to some of their stories it is pretty incredible. One of the residents for instance is from a rural region far away where their family are farmers. Growing up  they were told the family job is what they were destined to do so education and schooling was never an option no matter how much they wanted to go. But over the years until they were 9 this Resident would find books to read and learn to teach themselves. They enrolled in a school where they had to walk 1-2 hrs everyday (or something extremely long and laborious) and ended up doing exceptionally well. They were able to skip a few grades rights away so their parents allowed this to continue for one more year, but with the condition they would have to come back to work for the family. Well every year they continued to excel and skip grades until they realized their destiny would be something a little different from their original plan. And now that person is a doctor. Now how inspiring is that?! We really take education and the opportunities we have for granted back home. 

Now back to the morning bang. We had an emergent pediatric airway bump the first cleft lip today in my room. The baby is one month old and likely premature given the weight. She has hydrocephalus, possible vocal cord paralysis although this was determined to not be the case and a neck and mediastinal mass that was biopsied 2 days ago pending final pathology. They attempted extubation this morning and she coded but brought back prompting an emergent airway evaluation.  The airway was fine after the bronch cleared her and she was reintubated prior to going back to the ICU. She has poor lung effort and the issue is there is no way to deliver positive pressure here (aka CPAP) which she will need to be extubated. And the ICU’s here aren’t comfortable handling sedation so it creates an entire world of problem. The diagnosis hopefully will dictate her future plans and the residents here are all over that case.

Once we started the first case, although late making it feel just like home it was my last cleft lip of the trip. Marking out even your incisions for a cleft lip is incredibly intricate and requires lots of measuring and planning prior to the start which has been a lot of fun getting to do and think through. It’s a very fun operation and the outcomes are as I have said a million times so rewarding for everyone. 

Our second scheduled case was a young girl who had developed a terrible, likely untreated external ear infection after ear piercing that led to an abscess and subsequently a cauliflower ear deformity. She had no cartilage over her auricle so we recreated her ear by using conchal cartilage and releasing all the scar bands to smooth out the overlying affected skin and create a new pocket for our sculpted cartilage. It came out really well and she was so happy. Ear cases are tough in the sense that creating all the convexities and concavities that make up the intricate shape of an ear is truly difficult and quite an art.

The last case it was just me and the residents and their opportunity to do a rhinoplasty. A young gentleman that had severe nasal obstruction and deformity from a car accident earlier in his life. And apparently he is a male model in Ethiopia. I walked the residents through a septoplasty and we worked together making osteotomies to reshape the nasal dorsum and straighten his deformity. They did so well and it came out great! The other room also had a cleft case and a rhinoplasty with rib cartilage. I kept popping my head in to emerge myself in everything. 

The end of the day was sad to see come. Our team was truly amazing. The PACU nurses and docs even had a coffee ceremony with with staff there because they were so welcomed and loved and appreciated. The speech therapists really make our trip special with all the things they do for patients. Some of the team had to catch flights tonight home and others on an extended Africa trip with a safari. So I should be hearing the word hyena for a little while longer.  The relationships we form are incredible and words are really tough to describe the impact they have on us just as much as we do them. We cleaned up the ORs and PACU of all our supplies. I donated all my scrubs to staff and residents which they are so appreciative of as well as some of the medical supplies we have to share. We made the residents an academic book of various articles and PowerPoint’s of our presentations so they can continue to learn and have these four references.

We hugged everyone goodbye at the end of a long day. Our bus drivers still came to pick us up one last time even though we got out late again and headed back to the hotel. We went to dinner at a traditional Ethiopian restaurant with some of the residents and ate, drank and watched some amazing dancing one last time. I did not partake tonight, as I have retired from African dancing for now. 

It’s always hard when an amazing trip like this comes to a close but the memories and relationships, and stories that don’t even come close to explaining in words will always be cherished. Tomorrow we get to sleep in a bit before making the long trip back at NYC.
Can’t get enoughCleft lip babyOur honorary team doctorOur PACU beds, decorated by one of our talented docsAuricular repairMy crazy baby
How the mother’s hold their children Repaired cleft lip
Team dinner
Carrying my patient to PACUMy Ethiopian team and aspiring doctor Our beautiful team
Back in the ORTaking a rest 
One of the many braids along my trip

Day 2: 1/20/2020

Good morning Ethiopia

So we got 9 of our bags but 5 are still missing. Sitting in customs in Addis likely because they didn’t clear security. Remember when I said it was the things you don’t expect to happen that should cause more worry. Well our faithful trip coordinator has been trying to sort it out so there is still time. 

I woke up at 3am this morning, completely wide awake and ready to go which was annoying. Heard a few hyenas which was like my lullaby back to sleep but that took a good hour. I tried to ponder my WiFi-less phone and bore myself back into a slumber but even that didn’t do the trick. Eventually when I did I felt like I was waking right back up to the sound of an alarm

We gathered for breakfast in the common main lobby area. The Ethiopians love their carbs and I tried to sneak in a bit of fruit and eggs to avoid going completely Michael Phelps with all my meals. The first plan of the day was to go over to the hospital with all the supplies we did have and start getting set up and screening patients. It is a holiday, the Epiphany to be exact so a lot of things are closed. As we drive to the hospital you could see a sea of white linen dresses and suits which was pretty beautiful. Everyone looked so nice going to the churches. Ethiopia where we are is primarily an orthodox Christian society that takes their holidays very seriously. At the hospital we met up with the familiar faces of the ENT residents of Mekelle who worked along side of us last year. It was so great seeing them again and just like last year they were incredibly helpful at prescreening a lot of patients.

Half of the group stayed back in the ENT clinic to help organize our supply bags. We split things up evenly in case missing bags become a problem but there are a few key surgical sets in the missing ones we do need. Myself, the other surgeons, doctors and the speech pathologists went to screen all of the patients for the OR tomorrow. We had a bunch of cleft lip and palate babies that we plan on doing the repair and having them work with speech to initiate their treatment. A lot goes into their care for many years so our goal is to teach as much as we can to create a sustainable system for them when we leave. One of the little girls that came with her sibling was such a little ham and so precocious. I loved her. And she would lean down and give me a hug and kiss on the cheek. And she was so fascinated by my hair wanting to touch it and see it sway. It’s always so incredible to see the merge of different cultures an our adoration for the things that make them unique. Their hair in Ethiopia is incredible and they style it into these beautiful crown braids that frame their faces. I wish I could do that to my hair. 

One of the most incredible cases was a 6 month old with a huge Capillary hemangioma taking up the majority of his right face. In their culture they have a lot of religious medical practices. One is taking hot coal and placing it on the lesion in an attempt to burn out the disease. This baby was lucky that they didn’t have severe bleeding from this practice as that can happen with Capillary hemangioma even in a careful surgical removal. He did have a central ulceration over the mass that likely   Was from their home medical remedy, but it also blunted the biopsy report that was done.  He is on a medication currently in an attempt to shrink the tumor, and has no deficits from speech and swallowing which is good for his growth and treatment process. We have a few nasal deformities on our list as well which will be great cases and of course the group tradition, a hyena bite injury to the ear.

After the screening and set up we took a look where we would be holding our lectures and courses. I am teaching the residents tomorrow on a topic you’ll have to wait and hear about yourself, and I set up for them a small simulation center. If you know what I like to do, you’ll guess what it is easily. Their lecture area and medical school are very simple with just small rooms and chairs. And they are so motivated which makes it so exciting. 

After we unpacked and somewhat situated and scheduled planned out we went back to the hotel, had lunch and decided to go on a hike up this small mountain in Mekelle that has a large cross. It’s 52 meters tall and 5 wide and let me tell you it was quite a little hike. I for one would say I’m pretty fit, and I am not sure if it’s the altitude, jet lag or both but I FEEL it. Walking up stairs and I’m winded so you can imagine I was exhausted doing this hike. It was very hot too for my pants, but the view from the top was incredible and very worth it. Who know Mekelle was so large! All the small children on our way chased after to say hello, shake our hand and take pictures which was adorable. Everyone has been so friendly and beautifully dressed for their holiday today. Along the rode and hike though we encountered lots of large bones and a few goat heads. It is a delicacy they have and savor just for their holidays. But the animal lover in me can’t help but be a little sad.  

I am for one exhausted. We ate at one of the traditional Ethiopian restaurants and even after being here prior I cannot say I love the food. I may have cheated and eaten their chickpea spread with regular French bread instead of the injera. We did order a turbo for the table (the classic Ethiopian beverage of beer, wine and sprite mixed together) and that didn’t get more appealing either. I stick with the beer I think. We always have a great time out together and were a few drinks away from dancing away. But tomorrow we have a full day or lectures and operating so getting back on the right body clock with be imperative. I am not sure what year I am in let alone hour or day. Excited for tomorrow!

Traditional Ethiopian meal

 Hospital Emergency Room

 Holiday Best dressed

Outside an Ethiopian bodega

Examination of a 5 month old with Cleft Lip 

Bilateral Cleft Lip patient

Capillary Hemangioma Patient

My face after my surprise hug and kiss from this sweet girl

Small children playing and waving to us

View from the top of our hike

Proof I made it to the top

The Cross

Gangs all here!

The gang in our new chef hats.....I mean OR hats

Day 5: 1/23/2020

Oatmeal for breakfast again. It’s like they know I’m coming! I have to say last night was the warmest shower of the trip and I stood in there just embracing this small fortune. Despite waking up bright and early I was convinced the bus drivers quit because they were 30-40 minutes late picking us up. Surgeon time isn’t their thing. When we got to the hospital we decided to be that group fo people to take a big group photo in front of the hospital, embrace the lateness and enjoy the week slowly coming to an end before going to round. 

Our patients from the day before looked wonderful and were so happy. Especially our little boy who likes to taunt the hyenas with his new ear. The babies with the clefts were feeding well and it was a successful rounds before breaking off to the OR. I started my day with 2 palatoplastys and I have to say the start felt pretty good. I really love helping them and operating. It’s such an amazing feeling. And these mission trips to get to help others is really something else. It’s worth occasional cold water showers and roughing it. After the palates I joined one of my attendings in a cleft lip repair that came out amazing and finished the day with a rhinoplasty. The moms in Ethiopia are amazing and seeing them latch to their mothers breast after the repair is so heartwarming. Dear America, please get on the rest of the worlds level with breastfeeding in public. It’s beautiful and amazing. This is what they were made for. I for one loved getting to see that embrace take place after the surgery that helped them get there. 

The gentleman who came in is a priest and I don’t know the whole story but and oxen came between him and ripped the right tip of his nose. He scarred down and lost cartilage and his breathing was comprised so we did an alar Graft, released the scar and he was the happiest person you’d imagine. In the other room some of the residents were repairing a CSF leak through an endoscopic sinonasal approach which turned out successfully. They really make do with the instruments they have and they do it well. 

At the end of the day we gathered back to the bus to head to the hotel for dinner. I can successfully say I have avoided using the hospital bathrooms (aka sqatty holes in the ground) the entire trip. I may be in kidney failure and dehydrated but I am very much a clean freak. I just cannot do it. What if I fall? You just can’t recover form that.

We went to the restaurant across the street to celebrate the day and had way too much of a good time.

Work hard play hard is definitely out mantra. We danced, ate, had way too much turbo and just overall had a blast. I even got challenged by a local to dance and you bet I did. Eventually everyone got up to dance and it was quite the laugh. Tomorrow is our last day and I’ve already had my cold shower tonight (I knew it was too good to be true). Sweet dreams everyone!
Repaired cleft lip
My OR crew

Another repaired cleft lip

RhinoplastyOur ENT resident in Ethiopia: girl power!
In the OR, doing my thing
Our OR againTeaching about furlow palatoplastys

My babiesMy sweet patientThe best team ever 
Your heart willMeltTeaching the residents about Furlow palatoplastys