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