Jeanette says…

The following post is from our student Jeanette, recently nicknamed JJ by Helen.  She discusses her experiences on our most recent trip from the lens of re-entry to regular life.  Post-mission blues is a serious disorder!  Please enjoy her moving retelling of the mission.

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La gente, the people

In the comfort of my own home, I realize I’m diagnosing myself with my first Medical Mission Trip withdrawal. In retrospect, the mission was life altering and most of the impact was made by la gente, the people, I met on the trip. Small or tall, these people etched each of their names into a special place within me.

To begin, the Healing the Children team was incredible. It was a large gathering of diverse people, all vastly knowledgeable in their own field. From the talented photographers who captured each smile and hug, nurses and doctors who stopped at nothing to ensure each case was a success story. I cannot forget to mention an anesthesiologist who allowed two lowly speech graduate students (myself and Bruna) to overlook amazing surgeries and shadow a case for a day while explaining every step of the process thoroughly. Furthermore, professors became mentors who paved a path of knowledge even deeper within my growing and inquisitive speechie mind. Each client we consulted gave me the opportunity to piece together their individual puzzle, putting what I’ve leaned in the classroom to work, in a real life setting. The education fostered within these days will forever go unmatched and irreplaceable. The bonds shared over delicious Colombian cuisine on a mountaintop restaurant, stories shared between roommates or humbling open- door bus rides cannot be explained.

Being back in America is no treat without UNIMA, a 21 year old organization whose mission is to improve the quality of life and help place a smile back on to children and young people who present genetic problems such as cleft lip and palates. UNIMA helps families whom are among the most vulnerable populations in Colombia, through the coordination of actions with professionals and national and international institutions, such as Healing the Children. This organization is ran by women who enforce the idea that ladies are “poderosa y hermosa,” powerful and beautiful. These amazing ladies catered to our team endlessly, tirelessly and passionately. We each brought snacks from the states, expecting long, hungry days at the hospital. We were pleasantly greeted every single day with coffee, pastelitos,  pastries and lunches fit for kings and queens. They took great care in making sure that even clients who weren’t there for surgeries saw the speech team, because they were aware of how important speech therapy is. Their newest goal for their patients are to enable more access to speech therapy services, which is groundbreaking in Colombia within itself. How I wish to have packed the UNIMA team up in my luggage, but alas, I was only allowed a carry on!

On the frontline of this trip were many parents who fought for their children to be screened and hoped for the surgeries that would ensure a better life. These parents often traveled hours to Santa Marta despite their limited resources, but all with a common goal: to help their children. The parents on this trip often left me speechless, humbled and in tears. The gratitude in their eyes, in the strength of their hugs and in the power of their words will never leave me. One parent wished for God to kiss our toes and hands to help us continue our work in helping children like hers. These parents solidified my thought that my main purpose here on earth is to help as many people in any way I can. The resilience in each parent showed me that no matter where you’re from, anything is possible if you fight for it.

Finally and most importantly, each and every child that I came across had hope, power and love gushing from their bodies. Each hug and every wide eye and smiling face looking up at me motivated my soul.The bright smile that would flash across their faces when we showed them a trick to enhance their speech was such an intrinsic, powerful feeling. I felt super human at times- Jeanette Torres, Super Speechie! In retrospect, it was the children who were superheroes in their own right, not I. I guess that’s the thing with super heroes: they have the ability to make you feel as important as they are.

Para la gente, to the people who involved in all aspects of the trip, thank you endlessly.

 

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10,000 #hscares

The president of HTCNE is Bob Ryan, who joined in on this and many other trips.  Bob is an attorney, a devoted board member and an avid golfer. To make a very long story short, Bob connected with Henry Schein Cares Foundation http://www.hscaresfoundation.org/us-en/sites/HSCaresFoundation/index.asp, and they generously sponsored $10,000 of medical equipment for this trip.  Our Queen of Nurses (ok, that SHOULD be her title, anyway) Debbie Fritz was able to “go shopping” for what we needed in the Henry Schein Medical catalog to spend the money–what an amazing gift!

Below, I’ve included the HSCF mission statement.  It aligns so well with what we do–let’s hope this is the beginning of a beautiful friendship!  Thanks to HSCF for “helping health happen” this week in Colombia.

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The Henry Schein Cares Foundation “helps health happen” by expanding access to care for at-risk and underserved populations globally through the support of not-for-profit organizations, institutions, and communities dedicated to increasing the delivery of health education and care. The work of the Henry Schein Cares Foundation targets those with some of the most limited access to care through a focus on three areas: wellness, prevention, and treatment; emergency preparedness and relief; and capacity building.

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24

Twenty-four hours in a day.

One baby boy, 14 months old, did very poorly in surgery, due to not tolerating anesthesia well.  He ended up in the ICU, with round-the-clock care by Healing the Children, Northeast.  He is a child with many health concerns, some of which were not previously known.  It was up and down, back and forth…in the end, he was fine.

Those who stayed with him all night long, our pediatrician Dave Fenner being one, went back to the hotel in the afternoons to catch a few hours’ nap, and returned again, to spend the night monitoring his condition through the wee hours.

By Friday, when it was time to pack up and go, he was fit as a fiddle, in Mom’s arms.  Nobody would be able to tell by looking at him that there was ever a problem.  The overnight team…they looked a bit worse for wear.  I saw quite a few team members wipe away tears as we said goodbye to this little boy.  He has a sweet little cupid’s bow now, and quite a story to tell.

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Bruna says…

The following post is from our student, Bruna.

As a Brazilian-born graduate student in the field of Speech-Language Pathology, I am so blessed to have been given the opportunity to join this medical mission by Healing the Children to Santa Marta, Colombia. 

This medical mission has been the most gratifying opportunity I’ve ever had to serve others in my life. Giving selflessly is very difficult but when you encounter people who need it and are so grateful, it becomes an easier task. 

I have enjoyed all parts of this trip so far, from some RnR to screening day to therapeutic seasons and counseling. Along with Dr. Berkowitz and Dr. Buhler, Jeanette and I became advocates for speech and language therapy for children with cleft lip/palate. 

It is, however, sad to say that the number of fonoaudiólogos (SLPs) in Colombia are low compared to the United States. Additionally, parents cannot afford to pay for services. Therefore, we needed to train the parents of children with cleft lip/palate in order for them to provide therapy for their children. 

Overall I loved this opportunity and thank Drs. Buhler and Berkowitz, Mercy College Communication Disorders Scholarship Fund, Healing the Children Northeast, and UNIMA for having me be a small part of this immense mission. 

Kind Regards,

Bruna Carbelim Duran

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One

There is always someone with an innovative idea on every trip, and this trip it was Eddie.  Jairo Eduardo Castillo, MD, from Yale New Haven Hospital offered us the chance for our students to follow  a patient from start to finish.  What an amazing idea!  Jeanette and Bruna started in anesthesia intake, through induction (going to sleep), surgery, waking up from anesthesia, post-anesthesia care unit and into mom’s/dad’s arms.

Eddie and his wife, Amparo, grew up in Colombia, and are so happy to have the opportunity to give back.  They are devoted to the children of Colombia, and to Healing the Children, Northeast.  But on this trip, the biggest gift Eddie gave was to our students.

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Two

We have two wonderful students, and a two room suite, so we can break into two teams when we are busy. As always, Helen and I let the students take the lead, and Bruna and Jeanette are doing a fantastic job.  Our office has air conditioning, and wifi…we are feeling very spoiled!

Patients have been coming every day, all day. Most have hypernasality in their speech as a result of their history of cleft palate.  We work with them on getting a better oral flow and on correcting any articulation errors. We have had a few patients with clefts that cannot be fixed surgically, and the wonderful volunteer women of Unima arranged for these patients to have false palates made (like a bite plate), to separate the oral and nasal cavities into two.

In addition to the patients we see in our office, we go up to the post-operative wards and visit with the families.  We instruct the families on how to work with the child until we see them again next year.  These small innovations have made a great difference in the children we have seen over the years in Peru.  I’ll outline two small but meaningful interventions we do.

1.  Babies who have just had the cleft lip repaired, and who have a cleft palate, must return in one year to have the palate surgery.  During this year, we expect all the sounds the baby produces to be coming through the nose (because the nose and mouth are basically one big cavity) and that’s ok.  But, we do not want the babies to produce what we call “glottal stops,” which is the sound in the middle of “uh-oh.”  That is a sound that does not occur in Spanish, but babies with cleft palate are very likely to make them, and then have trouble giving them up once the palate is closed.  We work with the parents on learning the difference between the preferred sounds, which are to be celebrated,  and the glottal, which is to be ignored.   The parents who are able to implement this small intervention find that the sounds are in place and ready when the palate is closed.

2.  For babies and older children who have just had the palate repaired, we work on teaching the parents the difference between oral and nasal flow.  The one cavity has now been divided into two!  Although the kids are tired after surgery, we work with the parents before and after,  and teach and re-teach about how to help the kids along.  Every family gets simple handouts (prepared by alum Lindsay Naylor) and, of course, regalitos (little gifts).

So, it’s been a hectic few days, but the Unima ladies have looked after all the details and the parents are so very appreciative.  Even the security guard and cleaning woman have been so good to us.

As we wave good bye to the children as they are discharged, we know we have done all we can to help them along on their road, to be the best communicators they can be.

Hey, it’s 2 pm.  Maybe the Unima ladies have un cafecito for us!

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One hundred and sixty six

Screening day starts early, and crowd control is key.  Parents have traveled with their kids from six, seven, ten hours away. They may have scrimped and saved to get the bus fare.  People are anxious to be seen and hope to get on the surgical schedule.  

Every child must be examined for their suitability for surgery; for example, babies who weigh less than 10 pounds might be turned away.  So might children with colds or chest infections.  Parents are of course very disappointed when this happens.  They will most likely wait a year to have another chance at surgery, such a very long time for a child.

The speech team sees many of the children on screening day, but not the very youngest.  These families we see on the ward, after surgery most typically.  We also screen many children who are not surgical candidates this time, but need speech therapy.  We take some baseline measures and give appointments later in the week.  Sometimes we will have children return a few times in the week if they live nearby.  We prepare handouts for the parents, because they will be the speech terapists going forward.  We are starting to see some children in Colombia receive speech services,but the majority will not be able to get any follow-up care.

We got on the bus at 730 am, and screened 166 children…maybe more.  We returned to the hotel around 7 and wrote up the surgical schedule for the week.  Then, we quickly freshened up and jumped back on the bus for a wonderful dinner and dancing al fresco at a restaurant high on a hill overlooking the city.  Where did we get the energy to dance?  I do not know, but dance we did.

So, we are ready for a long week of therapy and surgery, take-out food at the hospital for dinner, and interprofessional teaching and learning.  We never quite know what we will experience but we are off and running.

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Greetings from Santa Marta, Colombia

Here we are , back on the road with Healing the Children, Northeast.  Helen Buhler and I are accompanied by  two students, Bruna Carbelim and Jeanette Torres,  to fill out the speech team.   We have a remarkable team of surgeons, anesthesiologists, nurses and administrators, the majority of whom have been here before.  Helen was here twice before–in fact, it was the first trip she went on in 2009!

Santa Marta is a lovely small city on the ocean (Pacific of course) and our accommodations are at the Batallon Córdoba, the RnR hotel for the Colombian military.  In fact, we scored one of the small bungalows on the base..General’s quarters, we hear.  We have everything we need (people can live without hot water, right?) and we will be here until Friday.

The hospital is close to the Army base, Hospital Universidad Fernando Troconis, and this hospital has a secret weapon in patient care and child development. This secret weapon is called Unima, and it is a group of volunteers who are totally committed to the behind the scenes work that makes a trip like this succeed.  They also take great care of the team, providing snacks, logistical support, TLC and inside info on how to get things done.  I wish every hospital had a group like this.  

Our travel down was uneventful, beginning with a Friday night red eye flight and a day to meet or reconnect with each other.  Some swam, some napped, and we all had dinner together with the sound of the surf in the background.

Tomorrow is screening day, so those in the know turned in early.  Screening day is not for the weak.

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Ica, Peru: Speech therapy

Dr. Berkowitz says:  Now we hear from Lesly, a first year student in the graduate program at Mercy College.  She and Ashley were under the supervision of Lindsay Naylor, Mercy alumna.  The hospital at Ica gives us their pediatric auditorium, which is kind of a utility room.  We turn it into a consult and conference room as needed, often carrying on multiple sessions at once.  All part of the fun.  Note:  although the students did not attend surgery on Monday, they did observe later in the week–always a thrill.

First day:  Today was the first day of speech therapy.
The day started off setting up at 7:30 am at the hospital. This included
getting the handouts with information ready in packets for the
parents. Then the parents started arriving with the children at 8:30am
to the speech therapy room. Their faces were filled with eagerness and they
seemed ready to talk to the speech therapists.
There were many different children of all different ages including
little babies and adults. Speech therapy was given either in groups or
in individual sessions. Lindsay lead the team with her expertise and
was completely wonderful. She started with a group session with
parents who had babies with either a cleft lip or cleft palate. We
gave our information to the parents along with directions on how to
feed their baby after therapy. We also gave them background
information on the compensatory errors the child can produce later on
as they grow up because of the cleft palate. Along with feeding
therapy information, we reassured them that everything was going to be
fine and that surgery was going to be a success. After spending time
with the parents of babies we moved on to older children ranging from
the years of 5-9 years old who were going to get a cleft palate
surgery. We explained to them and showed them examples of the
compensatory errors the children were making and why they were doing
it. We explained to them that because of the cleft palate they did not
have separate nasal and oral cavities therefore leading to
insufficient velopharyngeal closure. We demonstrated on one another
taking turns showing them what techniques the parents can use after
the children receive surgery. We demonstrated blowing air out through
their mouth by blowing on a tissue in front of their face while
producing a plosives such as /p/. The parents practiced with us and
the children were listening carefully. The children seemed excited as
we also gave them toys to entertain themselves. That worked as a
motivation for them to pay attention to us and listen to what we were
saying. The parents were so motivated themselves, we haven’t seen
anything like it. They were beyond eager to learn from us and they
were enormously grateful as shown by they hugs and kisses. Parents
even said they were going to bring in treats for us during the week!
How exciting.
The next group we worked with was an adult who unfortunately was not a
candidate for surgery because of of her age and the lack of tissue she
had in her mouth.  There needs to be a certain amount of free tissue for the reconstruction of the palate. However, she did had a prosthetic device that she used to cover the cleft in
her mouth. We gave her a consultation on trying to receive a new
prosthetic device for her that will be able to help her more. She was
more than happy with the help she received.
Then we saw a group of two children who have already received surgery
for their cleft palate last year and were returning for therapy. We
showed them how to blow air on the tissue, and how to blow a tissue
with their mouth using the plosive /p/ across the table. Along with
that, we also showed them how to produce the /h/ sound before a
syllable or a  word. The children were really motivated
and the parents even more. They promised us they would come back for
therapy through out the week.
After, we have a 3 year old boy who’s mother brought him in for an
evaluation for autism. The mother said that the therapist here in Ica
said the child might have autism and perhaps could have epilepsy later
down the road. Lindsay with her great knowledge and skills reassured
her that he was going to be taken care by us and we would help her as
much as we could with information on how to proceed. We recommended language
therapy for now in order to build his language. Also,Lindsay confirmed
some signs that the child shows that indicate he may be on the autism
spectrum. The mom was very supportive and touched our hearts by saying
she was going to work hard to get her child through it. She said she
was going to come back everyday so she can learn the different
techniques to use in order to motivate her child to talk and how
demonstrate to him certain gestures. The mom left extremely grateful
and hugged all of us.
The day concluded by us visiting outside the OR. We did not have a
chance to observe surgery however, we did see the excitement on
parents faces after their children came out with a brand new cleft lip
repaid or cleft palate repair. Pictures were taken with the doctors
and the nurses along with the Peruvian medical students. They were all
beyond grateful.

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Ica, Peru: Screening Day

Shari Berkowitz says:  Screening Day is always hectic, but the team has it down to a science, and many hands make light work.  Speech Team is always the last stop on the many different check-ups the little patients get on screening day. Here is Ashley’s screening day experience:

Our first day in the hospital was screening day. The moment we stepped into the hospital there were patients sitting and clapping for the whole Healing the Children team. All the families are just so amazing and grateful for the work we’re doing. We saw almost 100 patients. It got crazy! However, we kept a good flow despite two rooms ahead of us sending us patients at the same time! Most patients came for surgeries but there also were some for just speech therapy. There were some returning clients from years past, and they were so happy to see Lindsay. She’s another rockstar here. She knows everyone and is super knowledgeable and friendly. We’re learning so much from her. Just everyone here is so amazing. I’m kind of in awe. I’m even learning about some team members that couldn’t make it this trip that are trail blazers. One doctor stays in a certain country for a couple of months and teaches other surgeons from that country how to do the surgeries and then moves on to other countries and continues to do the same.  Another doctor leaves for countries the day that he finds out there has been some sort of catastrophe to help out. Truly amazing. I’m so happy to have this opportunity and be surrounded by so many smart, genuine and fun people. They truly live by “work hard, party hard.” They are all an inspiration to me and I can’t wait to do more missions in the future!

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