Mission Summary

Nicaragua

Managua, Nicaragua: February 4- 14, 2009

Julieta was a hungry ten month old. Her eyes bulged out of their sunken sockets, and she had a fiendish, desperate expression when she tried to feed. She had a cleft lip, a “v” shaped fissure extending from her upper lip to her nose. “Her mom just dumps food in her mouth with a spoon, and then the baby spits it up,” said one of the volunteers.

I met Julieta during screening for Operation Smile in Managua, Nicaragua. During screening, a medical team of surgeons, anesthesiologists, nurses, speech therapists, pediatricians and dentists examine kids brought in from around the country. Every child receives a full medical evaluation. About one in four are selected for surgery to repair cleft lips or cleft palates. Julieta was too small and weak.

“She’s a good candidate for surgery,” we told her mother, “but she needs to grow first and put on some weight. “ Her mother cried. She was by herself, and looked like a teenager. Julieta looked hungry and frail, but she was wearing a pretty dress and a yellow ribbon in her hair. “It’s not your fault,” I told her mother. “You need some help with her.” The speech therapist brought a special nipple that would help her feed Julieta. Her mother sat in a circle of encouraging women as her daughter began to nurse.

Sometimes during screening you have to put your feelings on hold. There are children who need surgery who aren’t selected because of time constraints or safety. As a parent I have a hard time explaining these reasons to desperate and hopeful mothers and fathers, who have sometimes traveled for days for their child to have a chance for surgery.

As I watched Julieta’s mother feeding her, I remembered the pure pleasure of feeding my children – we’d cuddle, they would grab the bottle with both hands, and they would grunt and coo and close their eyes. It felt perfect. I couldn’t imagine what the last ten months had been like for this mother – the shock of having a child with a cleft lip, and the fear and shame of not being able to feed her, of watching her waste away at meal times, a time that should be one of the best for parents.

But you have to put those feelings on hold in order to have safe surgeries. Julieta and her mother at least got some help that day – none too soon, because she probably wouldn’t have survived the next childhood illness that hit her. Maybe she’ll receive surgery next time.
This Operation Smile mission was based at Hospital Mascote (Hospital of Pets) – Managua’s largest public pediatric hospital. The hospital was surrounded by a nearly empty parking lot. On one side there were shade trees, where families waited in tents and on hammocks for their loved ones inside.

I worked in pre-op and post-op. Our job was to get children ready for surgery, care for them after, and get them ready to go home the next day. The rooms were hot and crowded – eight or nine beds per room for kids and parents. The hospital was spread out, walkie talkies didn’t work, and phones were usually tied up. So I spent a lot of time walking between pre-op, the Operating rooms, recovery, medical records, the hospital lab, and post-op.

My day started in pre-op. I’d walk in, usually get a kiss and a joke from the nurses, and check on the patients. We’d get out Nicaraguan medical charts and Operation Smile charts and put them together, and Aggie, the resident who worked with our pediatrician, and I would get the kids in line, check vital signs, NPO status, listen to lungs, and make sure everyone was safe and ready. It had the feel of leaving for a vacation as families lined up together holding bags belonging to their giggling and smiling kids. We’d walk in a group to the pre-op area, where they would meet with the child life specialist. There usually weren’t any tears until it was time to go to the operating room, and even then, not always.

After surgeries there was the adjustment of seeing kids who were happy and carefree before their surgery but now somber as they recovered. Children who had cleft lip surgeries would be thrilled to see their new face, and they had less pain. The children who had cleft palates surgeries had a bit rougher recovery ahead of them. Post-op is loud, hot, and tiring, but it is also where you see kids change back into their real selves again. For me there is no better place.

We usually stayed until 8 or 9, when the night shift came in. Many of the Nicaraguan nurses worked 24 hour shifts. We left sweaty, thirsty, hungry and tired, and still needed to eat, shower and wind down. The good thing was that the next day tongue stitches would come out, kids would smile again, and this time, get in line to go home. By the end of the week, over one hundred kids were treated.

Every day brought some special moment. It could be as simple as a warm greeting that stopped me in my tracks as I rushed from one place or another, a game in the hallway, or holding a child’s hand as they walked in to meet the anesthesiologist, but in the midst of all of the grinding poverty and hard work, Nicaraguans showed me again and again to stop and just appreciate and enjoy other people.

Places you go and people you meet become a part of you. I hope what I keep from Nicaragua is being able to stop and smile, and appreciate the hope and possibility and beauty of simple everyday things. You learn to work in a tough place with overwhelming problems and focus on making some things a little better, even if you can’t fix everything, or even most things.

Nursing – wherever you are – is about building. For Julieta, and countless others, we have a lot to build.

- Michael Felber, Operation Smile volunteer, pre- and post-op nurse

Since 1993, Operation Smile medical volunteers have provided more than 4,300 Nicaraguan children with free physical examinations and more than 2,100 have received life-changing surgery during international medical missions.

First international mission: 1993

International mission sites: Chinandega, Managua

Local mission sites: La Mascota, Managua