In front of zebra pelt at Johannesburg airport

preop cleft palate

preop unilateral cleft lip

cleft palate surgery

OR scene

preop cleft lip

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Grace captured our hearts when we met her on Sunday. She is so cute and playful. Don’t you love the hat? Here’s a brief photo journal of her time with us. Grace is four months old and has a bilateral cleft lip. She has a cleft palate as well. She’s just the right age for lip repair, and will return next year for her palate repair. The last photo shows Grace still asleep in the OR. She has orange tubes sutured in her nose to keep her nose open overnight (in case of swelling). Babies this age are obligate nasal breathers. We’ll remove the tubes tomorrow. Now that her lip is repaired, her teeth will come in much better and more in proper alignment. And, as mentioned above, she’ll return for palate repair next year.

Grace, preop bilateral cleft lip

Grace with Dr. Tshoma on the way to the OR

Getting ready for anesthesia

Immediate post op, still intubated in OR

Jimmy in screening clinic

Jimmy came to screening clinic yesterday with his father. We don’t often see the fathers of these children, and it seemed even more notable that this young boy was named for his father. Here are some photos of Jimmy and his father throughout this journey. Jimmy has an incomplete cleft lip. These are typically easy to repair, but because he is eight years old, he’ll have some permanent tooth issues. Note that the right upper incisor is almost perpendicular in orientation. Had this been repaired at 3 months of age, that could have been avoided. In the post op photo below, Jimmy is just waking up from surgery. I’ll try to post a better photo later in the week, with him fully awake. I did see his father on rounds after surgery and dad was all smiles to see the improvement for his son, Jimmy.

*update: At the bottom is a photo of Jimmy two days post op. He’s still a bit swollen, but you can already see the improvement. He went home today.

Jimmy Jr. and his father in prep waiting area

Immediately post op, still asleep. This is our view as we do the surgery. We sit at the head of the table and work “upside down”

Jimmy 2 days postop

Today was our screening clinic, a time for meeting new patients and seeing return patients for follow up examinations. Screening clinic is also a time for rekindling friendships with physicians and staff that we see only once a year. It is always fun and a bit hectic.

Our team this year consisted of Dr. Clawson, me, and my daughter, Madeleine. Alongside us were the indispensable nurses, who also serve as translators, as well as the CURE hospital CEO, Tim Ebbers, and his wife Melissa. We were able to schedule 16 children for surgery, and will be seeing more as they trickle in throughout the week. Below are some of the darling faces that greeted us today.

Grace, preop bilateral cleft lip

Grace is a beautiful baby with a bilateral cleft lip. She is 4 months old and the perfect age for this surgery.

 
 
Friday is 15 months old now. We repaired his lip last year and he was just here for a check up. Mom was very pleased with his result and so were we.

Friday preop, 2013

Friday postop, 2014

Jimmy is scheduled for cleft lip repair this week. Ideally, he would have been treated at 3 months of age. Having the lip repaired at an earlier age helps the teeth come in properly. Nonetheless, he’ll gain a significant improvement in his appearance later in the week.

After screening clinic, we went on a “bush hike” with friends from the hospital and caught a peek at an African sunset. All in all, a great start to the week.

Pre-op Cleft Lip Patient

I am really excited for this particular trip as it brings five non-profits that I love to support together into one trip. First, I’ll be doing cleft lip and palate surgery as part of Dr.Clawson’s Foundation. This will be our fourth annual trip to Lusaka, Zambia.

Second, we are operating at a CURE hospital. CURE has ten hospitals around the world, providing life-changing surgery to children with congenital deformities.

Third, friends and acquaintances with World Vision are helping spread the word about our cleft lip and surgery clinic and also they have provided transportation to bring some children from very distant villages in order that they might have the surgery.

Trading balls in Zanzibar

And fourth, my daughter is bringing soccer balls to distribute on behalf of One World Futbol, a non profit that distributes nearly indestructible soccer balls to disadvantaged communities where play and sport are used to foster social change.

Oh, and I should mention a fifth non profit, WaterAfrica, which is our second quarter charity. I’ll miss the event this year, but maybe you’d like to attend the 7th annual Walk for Water on Saturday April 12th. Our office is helping sponsor the event to raise money to put clean water borehole wells in Zambia. Follow this link for details.

Zambian woman collecting “water.” Imagine having to drink this or worse yet, give it to your baby.

I am a strong believer in community service and these are examples of the types of organizations I like to support. I am so excited that they are all coming together in this one trip! If I had tried, I couldn’t have planned this. It just happened. I’ll look forward to sharing my stories with you when I return.

Most of our patients are infants and young children. Occasionally we see someone who has suffered with a cleft deformity for many years. Gift is just such a man. He was born with a bilateral cleft lip and palate. At some point, he had his bilateral cleft lip repaired, but now he is 27 and still has a very large cleft palate. His speech is very difficult to understand, though he is very intelligent and is deliberate with his speech.

Wide cleft palate. Note disruption of anterior teeth

Technically, we knew this would be a very difficult case and might require a second procedure to be done simultaneously–a pharyngeal flap. Our other challenge was that he is an adult. Through some negotiations and creative funding, the CURE hospital (mainly a pediatric hospital)  welcomed Gift and we were able to treat this man. What a gift to all of us, not just Gift. When I think of the mother who named her infant child Gift, despite the very obvious congenital deformities that would have been evident at birth, I think of Unconditional Love. It is indeed a gift to all of us to know and experience this type of love.

The surgery was done yesterday and it will be a painful recovery. On rounds, Gift does not complain. He only mentions pain when we ask him. This morning, his mother was with him and got to hear his improved speech! That surely was a gift to her. He will require speech therapy and some hard work on his part to continue to improve his speech, but the anatomy is much improved and we are glad to have helped this man.

Below I’ll include a photo of Levis, a child who we treated last year and repaired his bilateral cleft lip. He returned this year for repair of his bilateral cleft palate. So, he had an identical situation to Gift, but for the fact that he was able to have this surgery at the appropriate age–he is just over a year old now. He will have a much better chance for good speech development and a normal exterior appearance. I hope and pray that some day, all children will have access to the gift of medical care.

Levis and mom one year ago pre op, he was 1 month old, bilateral cleft lip

Levis in OR last year. Has small catheters in his nostrils to keep airway open while healing the first few days after surgery

Levis in Dr. Tshoma’s (a superb anesthesiologist) arms immediately post op last year

Levis sleeping on ward, post op day one last year

Levis 2 days post cleft palate repair this year. Note his well-healed upper lip one year after lip repair. He is now 13 months old.

One of the many things I enjoy about traveling in Africa is the interesting names I learn. This story is about Friday, a darling baby boy who is being treated for a cleft lip. On my trip to Kenya in 2011 I met a Sunday. Jokingly, I wonder if I’ll meet the rest of the week eventually. But for now, I’ll take you on a photo journey of Friday’s treatment. We met Friday in Screening Clinic, and I think you may fall in love with him also…
Despite the near 80 degree weather, many babies, like Friday, are bundled in sweaters and knit hats. Here he is seen with the tongue depressor I had just used to examine his mouth and palate. The little notebook with the number on it is used to keep track of the patients. L stands for Lusaka, the site of this mission trip. 05 means he was the 5th patient scheduled for surgery. And, 13 indicates this was the 2013 Lusaka mission trip.

Screening Clinic photo. The number is our mission serial number for this child so we can coordinate pre and post op photos per patient.

Close up, pre op photo

With mom after surgery. She is very happy with the result! Mom sleeps with baby in a hospital bed. There are no cribs. Mom also wears a hospital gown and a robe. Meanwhile her laundry is hanging out to dry behind the hospital. The dry, sunny weather makes this an ideal way to dry her clothes.

Friday is going home today.

I didn’t post one photo, which shows Friday breast feeding immediately after surgery. This is truly the best pain medicine for these little ones–being with mom and nursing. They calm down immediately and then take a nap. Our use of tissue glue on the incisions makes the wounds “water tight” and reduces the risk of infection, allowing immediate oral intake despite the suture line in the mouth, lip and nose.  I’m going to miss my boy, Friday. He was a happy little guy and we all enjoyed seeing him on rounds.

It is fun to share the journey of a few patients, and though we love them all, a few just stand out. Here is the story of Choolwe.

The first child we saw in screening clinic on Sunday was this darling little girl. She is 3 1/2 months old, which is just about the perfect age for undergoing a cleft lip repair.

Pre op

We did her surgery today, and here are two photos post op:

In the recovery room, immediately post op

On the ward a few hours post op

What a beautiful baby! Once her incisions heal and the absorbable sutures disappear, it will be hard to tell that there was ever a cleft. To make things easy for the patient and family, we use absorbable sutures and then cover the incision site with tissue glue. That way, the babies and children may breast feed, bottle feed or eat immediately upon waking up from surgery. Typically they go home the following day after cleft lip surgery, and two days post op from cleft palate surgery. The lip repair is done around 3 months of age if possible and the cleft palate is repaired between 12 and 18 months of age. Sometimes children have both congenital deformities and they have two procedures. Choolwe only has a cleft lip and it was not as severe as some. Once healed from this, she will likely not require further intervention.

We settled back into the routine quickly today. There were a few new faces and names to learn, but there were many familiar smiles as well. Happily, some of the familiar faces were children returning for one year post op visits. This was a joyful experience. A few children were returning for a second procedure, having had a cleft lip repair last year, and now coming in for a cleft palate repair. It is very satisfying to see how good they look and to know that they’ll soon have an easier time with eating and speech development as well. We also saw several patients who had had cleft palate repairs last year–what a joy to hear their mothers tell us that they are eating easily now, without food and liquid spilling from their nostrils as happens with a cleft palate.

We saw fewer children in Screening Clinic yesterday than we did during last year’s clinic, though several patients did arrive today and were seen. Perhaps more will trickle in this week. Four procedures were scheduled for today, though one was delayed until tomorrow due to a lab abnormality that required further blood work.

What sticks in my mind most about today however, is the number of people volunteering their time to help these children. There is a visiting nurse from Nasheville who is spending six weeks here. A medical student from New Zealand joined us in the OR today and helped with writing orders, intraoperative photos and other tasks. The hospital director’s wife also seems to be a full time volunteer and is helping with filling out forms to get further funding for the cleft lip and palate program, and joined us in the OR to take photos. Several people volunteered in the Screening Clinic yesterday as well. And, of course, we are also here as volunteers. It warms my heart to know that there is still much good in the world, as I can see it at work at this hospital. I much prefer this view of humanity–people helping people who are complete strangers–as compared with that which I see on the evening news. (I wrote this blog before the tragic bombing in Boston was on the news…my heart goes out to all affected by this tragedy).

Here are a few preop photos from Screening Clinic. (I surely miss my photographer who is studying hard in school right now and couldn’t make the trip).

April is a busy month for my family. We have three birthdays, a spring break for one school, taxes are due, Easter is usually in late March or April. And, my annual trek to Zambia fits in as well. The weather is perfect in Lusaka in mid April. Highs of around 80 and lows near 60. I’m not sure it ever rains during our time in Zambia. But that’s not the main reason we go, just a nice coincidence.

Dr. Joe Clawson and I are going for our third annual cleft lip and palate medical mission trip. We’ll be at Beit Cure hospital in Lusaka. It is starting to feel like going for a trip to visit family as we look forward to seeing Tshoma, Giorgio, Lucy, Irene, Judy, Victor, George, the list goes on. They are an amazing group of people that make this mission trip culminate in 25 or more children going home with repaired cleft lips and palates. It is the most rewarding week of my year. I never tire of looking at the pictures of the children we’ve treated in past trips, their parents and the smiles of gratitude that speak volumes in a people whose language I can’t otherwise understand.

We arrived late last night after three long flights (and over 24 hours of travel) and rolled our six large suitcases, mostly filled with medical supplies, and 4 carry-ons out into the parking lot and were greeted  with…No, not the eight passenger van we were expecting, but with a four door sedan. And our dear Victor had brought a friend with him to the airport. That made four people who also needed to fit into said car. I know I’ve matured as a person because I didn’t raise my voice, cry, curse, stamp my feet or even roll my eyes. Instead, I helped organize the luggage, stacking three of the large (I’m talking 28″ or more) suitcases in the middle of the back seat. We then stuffed three pieces in the trunk and found a piece of twine lying on the parking lot and tied it to the car to “hold” the luggage in the completely open trunk. The two women in our group sat, one on each side of the large luggage, in the back seat. I barely got the door closed against my hip and put one piece of carry on behind my neck and one on my lap. We then drove very slowly to our hotel, thankful that it was 1:00 AM and the roads were deserted.

I would not be completely truthful if I didn’t mention that this very thing had happened last year! So, I was sort of prepared, but for the fact that Victor had promised us he would not do this again. Last year we had 5 people in this situation, including my teenage daughter who sat on my lap and held the carry-on luggage. What can I say…I returned, so I guess I may deserve it! Now it is time to get to work…

Now at home, I was able to combine all of the animal photos from our safari in one post.

https://drvessely.com/640/

It has been a great mission trip. Now we are on our way home and we are sitting in the Nairobi airport. We were fortunate to work with great staff in the OR, clinic and hospital ward. These folks at the Beit Cure Hospital in Lusaka dedicate their lives to treating poor children with congenital deformities or disabilities year round. They are good at what they do, and they are so pleasant and kind to work with. We will miss them and look forward to returning in the future. We couldn’t get a photo of everyone, but here is a good bunch of us on our last day rounding in the hospital. In the lower photo you can see Madeleine (and her camera) and her friend Makupa. Makupa is Victor’s daughter. You might remember my stories of Victor last year. He has spent some time in Portland with his work with the Forestry Center, but lives in Lusaka and is an immense help in coordinating this mission trip. His daughter is thinking of becoming a doctor and wished to join us one day to watch surgery.