Rosie was one of our stellar team players - I think this mission was her first, and she so thoughtfully shared excerpts from her letters (email) to her family. Now about three weeks out from the mission, it’s nice to read her thoughts and observations. I learn from this many things - how I hope she joins us again and how as a team surgeon, I see only a very small part of the bigger process of our mission (and would like to see more). It’s really a treat to see a similar experience through another’s eyes….

About our arrival to Linyi People’s Hospital:

“Walter told us that they were going to have a little ceremony to welcome us. Well, we drove up and there was a mass of people waiting in the parking lot. There were huge balloons and signs. There were about 20 men dressed in costume playing drums and two chinese dragons dancing with a young woman. The rest of the people lined the way and were locals as well as it seemed just about everyone from the hospital all dressed in white nurses and doctors uniforms. The nurses all still wear hats here. They were all clapping for us as we got out of the bus and they put a good luck necklace around each of our necks as we stepped out. I had goosebumps and it brought tears to my eyes. Iwas just stunned at the welcome. Our main guy, Tim, was given a huge bouquet of flowers and then we were all lead by the dragons dancing to the door of the hospital. Talk about feeling welcomed!”

One of more poignant patient stories (of which there are MANY):
“Heartbreaking story of the day. A middle aged man came in with about a 4-5 month old baby. Obviously totally in love with this baby. He explained that he wasn’t the parent. He said that he found the baby by the side of the road and took him home to care for him. My first thought was “how does this happen? People just leaving their baby on the side of the road.” But then I thought about the teenage Moms in the U.S. that have left them in dumpsters. I guess we’re really not so different. “

…”Heartbreaker story of the day: There was this little tiny old Chinese lady who
brought a child in. I think I told you about her. She found the baby by the side
of the road. Well, it turns out, it wasn’t she who found it. It was her blind son. They took the baby in and today he had his surgery. When he came back from surgery she insisted on holding him and he immediately settled in her arms. Well, he was almost the size of her and was draped over her shoulder. She was perched on a little stool and didn’t want to put him down because he would start crying. That little old lady sat with that baby in arms until sweat was pouring down her face. We finally were able to talk her into putting him on the bed and lying next to him. We found out she hadn’t eaten since 5 pm the previous day so we also fed her.

Here’s something else. We are all sitting in our assembly room which is kind of
like sitting at the nurses’ station and this man comes in with his newly repaired baby. He came to say goodbye and he is just crying, absolutely balling his head off. You can see that he is trying to hold it in but there is just no way. He’s hugging us and shaking hands and just crying away. Of course we were all crying too by the time he left.”

Many Thanks again to Rosie for sharing her thoughts and feelings…..

Justin Curtin is one of the surgeons of Operation Sunrise, and recently sent this to me. What more could anyone say - encapsulates our experience beautifully !

Dear Team members of Operation Sunrise 2007

A tribute to the people who make up the Team :

- that over an intense 9 days there is hardly a word spoken in anger or spite - tiredness and frustration at wanting things to be better maybe,

- that people who have not worked with each other for almost two years can just pick up where they were,

- that those who had not been on such a trip before jumped right , , , and swam, (mostly)

- that those who wondered, ‘what can I do’ , , , were so gainfully busy, and exhausted,

That people can come together, focus, harmonise and put the efforts of our individual selves towards something greater than we can achieve alone.

Without the efforts and talents of each person the goal would not be the same.

Wasn’t it a blast ?

Thank you, all

Justin

Justin Curtin
MB BS, BDS,
FRACDS, FFD RCSIr., FRACDS(OMS), FRCSEd.

The Operation Sunrise 2007 China Mission

Look for additional images of the 2007 China Mission at http://cleftgallery.cleftmission.org

Surgeons
HOWARD K. USA
TIM M. USA
CRAIG B. USA
JUSTIN C. AUSTRALIA
DAVID K. USA

Anesthesia
CRAIG N. USA
PETER M. USA
GARY T. AUSTRALIA
MARK C. USA
JOAN H. USA

Anesthesia RN
MELANIE C. AUSTRALIA

Pediatrician
RENEE H. USA

Patient Coordinator (Ward)
VAL S-0. AUSTRALIA

OR Nurses
MARY H. USA
DANIELLE L. USA
CINDY W. USA
SUSAN B. USA
YIPPI Y. USA

Recovery
JAMES H. AUSTRALIA
MAUREEN W. AUSTRALIA
TIFFANY W. USA

OR Techs
NEIL J. USA
SHARON M. USA
JILL I-B. USA

Ward Team
SHIRLEY R. AUSTRALIA
ELAINE B. AUSTRALIA
LAURA A. USA
HONG MEI K. AUSTRALIA
JIM B. USA

Dental Team
NORMAN C. USA
GREGORY C. USA

Administrative Team
WALTER W. USA
HEATHER B. USA
PENNEY M. USA
ANN K. USA
ANITA L. USA
WASHINGTON W. USA

Other Valuable Team Members
BRIANNA L. USA
HANG Y-C
YUN P-Z
SU Y
CHANG H

As we usually do, our last night was spent hosting a farewell party that included the Mayor of Linyi City, Director of Linyi City People’s Hospital, Chair of Surgery, Linyi Hospital physicians, nursing and OR staff and of course our own team members. Much toasting and of course the obligatory Karaoke rounded out a very festive evening complete with Walter’s polished version of “My Way” (wherein he substituted in “…we did it OUR way” !!), Heather’s striking rendition of Tammy Wynette “Stand by Your Man”, and the Australian team well rehearsed Australian anthem (complete with iPOD accompaniment). A nice addition to the evening was the recognition of three team members September birthdays – complete with gigantic birthday cakes and a resounding sing-a-long of “Happy Birthday”.

After the party, many of us returned to our rooms to repack, while others continued the celebration. The next morning we sadly boarded the bus for the three-hour return trip to Qingdao to make the connecting flight to Hong Kong. That morning we were honored to have members of the hospital staff, our new friends with whom we worked so closely over the past week, see us off from the hotel.

Operation Sunrise was able to successfully complete over 80 procedures on the children of Linyi City, Shandong Province, providing cleft lip and palate repair.

I look forward to the possibility of working again with the staff of Linyi Hospital and others like them in the future, who know no bounds of what an international team can do to improve the lives of those so disadvantaged.

Howard S. Kotler, MD, FACS
Director of Surgical Services
Operation Sunrise

One aspect of a mission like this is with the variety of people working in different areas, you often are never able to get acquainted everyone during the 12 days of the mission. Mostly, you get to know well your immediate colleagues with whom you spend the most time (in my case in the OR or ward personnel).

Otherwise, you only have the opportunity to share ideas with others during the short time you may see them during the day, because by the time we finish and get back to the hotel and eat dinner, it’s time to sleep and prepare for the next day. This is then repeated over and over until the mission’s end. In past missions we had one day off mid-week that allowed for more social interaction but on this short mission, we didn’t have the time

to do so. I hope that this lack of a break won’t deter some of the first-time team members from future involvement. Hopefully, on the next mission we’ll plan for a one-day break of R&R.

Hear the description of our service and our 2007 China Mission.

Click below to hear the audio file or the iTunes or Yahoo! icon to subscribe to the podcast

 

 Operation Sunrise Description [2:02m]: Play Now | Play in Popup | Download

Another of our desired goals for an operation like this is to not only provide cleft lip and palate repair, but to also interact with our colleagues to providing an educational experience. It’s naïve to assume that our surgical colleagues lack the necessary skills to perform these operations and that we can “show them” the “right way” to do the operation.

In fact, many of them are accomplished surgeons, and the reasons they might not routinely perform reparative cleft operation has little to do with their skills, experience and available facilities. For these and many other reasons, we encourage the local surgeons to become more involved with our effort - this not only helps engender a more collegial training atmosphere, but ultimately benefits our patients as well.

The challenge is that some of our Chinese colleagues aren’t fluent in English (and we’re certainly not anywhere near conversant in Mandarin, or Cantonese) and so rely on interpreters to guide us while they or we assist during surgery. Not surprising, when you operate with colleagues as experienced as they, you realize the unspoken language of surgery needs no interpreters and procedure move along fluidly…. . It transcends the approach of “we’re doing something for you, because you aren’t able” to become “we’re doing something together because we both are able and have a common goal”…

Ask any surgeon: “is it possible to perform safe surgery without “good” anesthesia?”. The answer is: NO. When I discuss these types of missions with the anesthesiologists back home, I tell them of the great anesthesiologists I have the pleasure working with.

Whether they’re academic or private office or surgicenter based, I know I can trust them and work with them as team members. None of that nail-biting (mine) wake up and extubation – especially in those post-op palatoplasty patients. They all have a great understanding of the pediatric airway and anesthesia and share my enthusiasm and concern with our patient’s welfare. I hope I have earned their respect and friendship as much as I do theirs.

During the last week of August, the Governor of Shandong Province paid us a visit. Of course, the hospital was all a buzz, and the governor arrived with the usual contingent of press corps and bodyguards. He toured the Operation Sunrise ward, visiting ALL the patients and their families, asking questions about where they’re from, etc. - all what you might expect from a visiting guv. I’ve seen a few of this type of visit during previous surgical missions, and this format is essentially the same. This time however it was different.

While I can’t say I understood all the translation of his words, the governor showed very palpable warmth towards the families of our patients. Through his questioning, I learned that at least one of our patients was from a farming community at least 60 miles away and took nearly 5 hours transportation to the hospital. While on “Governor rounds”, Tim and I acted through an interpreter asking questions and sharing our feelings about the goals of the mission. At one point, Ann thoughtfully introduced David as the surgeon of one of the patients – the look on the mother’s eyes when she learned exactly whom the surgeon was who brought new life to her child was priceless. Moments like these cannot be put to words.

I could write volumes about how well team members worked. While I spent most of my time in the operating room – with some time in the recovery room and on ward rounds, I’d have to say that this was one of the best groups with whom I’ve ever worked. It’s the kind of situation where everything is working so well (of course with the occasional tweaks needed to improve efficiency) that don’t know just how well it’s working. It amazes me how, never having worked with my scrub nurse Sue, she was able to learn not only the sequence of a cleft lip and palate operation, but also all my idiosyncrasies. Together we kept refining our “game plan”, with Sue half joking, “there’s still room for improvement” so that even on the last two days of the mission, we improved the efficiency of our work – things as seemingly insignificant as the room set up (i.e. OR instrument stand table relationship, etc.). I’m lucky to have worked with her – she’s one of those persons that as a surgeon you can always rely upon to make any given operation run smoothly.

For the first few days in the OR, things are a bit disorganized – all to be expected after making such a long trip and setting up in a room where you often wonder if there will be a regular source of electricity. Everyone takes responsibility for their own role and takes the initiative to “cover the gaps” in service. I’ve thought long about how it is that such a disparate group of people, some never having worked together, are able with a minimum of time be able to coordinate such a complex set of events. Justin (surgeon from Australia) and I agreed that by definition, all team members want to be there and will do the best “to make it work” and that there’s really no consciousness of “it’s not my job” or failure to take initiative, learn new skills, etc. I often think of how the same sentiment could be instilled in my co-workers back home.

I guess as much as any one person can create a supportive work environment, it’s really up to the individual to make it happen and no amount of incentive/coercion can ultimately drive this to effectively happen.

Missions like this run on so much “behind the scenes activity”, that it’s often easy to overlook and give credit where it’s due. Sure, it’s easy to see the tangible results of great surgery and superlative patient outcomes as a result of quality nursing, but less obvious and underestimated are the important contributions by support staff. Every time I went to the ward to check on patients, I was greatly impressed with the work done by Elaine, Val, Heather, Rosie, Ann – Elaine who I first met in the Hong Kong airport even before the mission began as she was busily working on the patient database, and preoperative screening forms. Quietly working on the ward, Elaine orchestrated tracking vital patient information. Many others like her, especially our nursing staff in all sectors of the mission, created the safe, efficient working environment that’s remains our primary goal. The same goes for all the administrative staff and their assistants. Somehow they appeared out of nowhere whenever we needed supplies or had some vital question that needed to be answered. I could go on and on mentioning names, and I know I’m forgetting to mention a few (sorry !), but I would like to say a very special thanks to Walter, Washington (thanks for the diagrams !), Anita and Brianna, Hong Mei, Jackie, Penney, and the others, who without these people, we clearly couldn’t function in any meaningful, patient safe and centered way.

Linyi People’s Hospital is much larger than I imagined. Because there were no readily available Internet hospital images, I anticipated an institution that might have been smaller in scale. In fact, the hospital is a 2000 (as in two thousand) bed, state of the art facility. Since we were in the “older” part of the hospital, it wasn’t until the formal opening day ceremony that I realized the full size grandeur of the hospital. The images from this ceremony show you the towering atrium extending up to five or more floors from a polished marble foyer. All departments have well-organized signage and while I haven’t directly seen it, I suspect that the hospital (like others in China I’ve visited) is “wired” - using with credit card like patient ID cards and electronic medical records issued to inpatients and outpatients alike. As someone with this interest, Id like to have a long conversation with someone in the hospital IT department to see if this is the case, how records are stored, what their concerns are for privacy, etc. A cross-cultural analysis of sorts. We may have much to learn from them.

The separation of OR and hospital ward doesn’t permit much time with the patients and families pre and postoperatively. While I can easily fulfill the morning obligation of making rounds, it’s all the more difficult to drop into the ward to chat with other team members, see how I might be able to help, answer questions, and spend some time with the families and patients. If the OR and ward were closer, this wouldn’t be the case. One of the unfortunate aspects of this arrangement is that you can’t spend long amounts of time learning from the families of where they’re from what their expectations are of the surgery, how they feel about us, their thoughts about this type of mission, etc. I’d love to learn more about them, much as I do my patients back home. It not only adds a new dimension to the work I do, but adds to the magical bond between physicians and patient/family. Otherwise, it sometimes feels like just “doing surgery” (which for all it’s artistic and technical aspects, is admittedly what many of us crave). I’m lucky that our ward team has a passion for the patient and family relationship. Through this they can provide a technical level of care well balanced by an abundance of personal supportive care. I can see also how for many ward-based team members share this sentiment – like when I witnessed Sharon sharing a very emotional moment with one of the mothers in the preoperative holding area. When I see and feel this, I know that so much of what we do back home in our medical practices is so mechanical, and while the ultimate goal of superior patient care is realized, I wonder if somehow we couldn’t provide just that much more in the way of “care”. Maybe it’s easier for us here in China as we’re not being distracted with the myriad phone calls and mundane activity of calling the pharmacies, insurance companies, etc.

Each day consists of rising early for the 6:30 AM breakfast and then off to the hospital for a hopeful first incision time of 8:30 AM. Patients who were screened on our first day are either kept on the ward the hospital so generously provided to us. Thus far, we’ve had little problem with parents maintaining their children NPO (prior to surgery nothing to) for 6 hours prior to surgery.

While a minor geographical inconvenience, patients are housed on a ward apart from the main hospital, but only a minute or two walk away. From this ward, the patients are then escorted to the main hospital, and then up the elevator to the OR. We’re we provided with 4 very modern operating rooms, outfitted with ample storage space, good lighting and local nursing assistants who have been very helpful in providing all manner of support.

Each surgeon has between three and four cases per day with the case mix of cleft lip and/or palate. On this trip, there are a significant number of cleft palates (both in- and complete) and only scant few more cleft lips. Since the full functionality of a cleft palate repair should usually be performed before 12 – 18 months of age, it doesn’t really do the patient much good to perform the repair for the children greater than 4 years of age. Furthermore, some of these palates would subsequently require additional more extensive or adjunctive surgical procedures, palatal obturators with long term follow up and speech therapy, so that attempting to repair these palates would be only marginally successful.

It’s disheartening to both patients and families to travel so far and not be able to provide the gift of a palatal repair. It’s even more difficult to explain through an interpreter why it’s not in the patient’s best interest to surgically repair the defect and that an obturator is probably a better option. Like other experiences gained from a mission like this, one realizes (again) the uncontrollable limitations imposed on your ideal of how things should work – often just like what happens at home.

While I thought I’d be able to add to this blog on a daily basis, it turned out not to be the case. First, reliable Internet access was near impossible, with the hotel server being only able to allow brief periods of connection, between competing guests. Finally on day three after our arrival, the Riverside Holiday Hotel IT specialist, the elusive “Mr. Go”, was able to get us a (semi) reliable network connection – I had to manually reassign the IP address every 15 minutes or so – quite a problem when you’re trying to FTP files to a website! Following that, by the time we finished with surgery, rounding and returning to the hotel, it was all I could do to finish resizing, re-labeling and then uploading images, before reviewing the next day’s schedule – making notes for future improvements, etc. before collapsing on my 5’2” bed (I’m 6’4” – Ha!).

I will begin however by saying that by all measures, the Operation Sunrise 2007 China Mission was a clear success. Any more words beyond that are just icing on the cake, and the blog that follows only hopes to give greater depth to our daily mission life and to thank those who made this success possible. I know that I’ll never be able to thank each and everyone of those that participated in the mission, so please accept my most sincere thanks to all of you, even if you’re not directly mentioned in this blog. I encourage our members to submit to me your thoughts about the mission, and I’ll post them on this site. Through this, the mission will go on for as long as we add to it, and hopefully will merge with other Operation Sunrise future missions.

After the 15+ hours flight from Chicago, we landed in Hong Kong. Leaving Chicago wasn’t as painful as in the past – something I attribute at least in part to taking the upgrade to Business Class. This afforded us direct passage to the oversized baggage section we were checked in quickly and without delay and then onto a sympathetic TSA inspection. Because we pack three large footlocker sized bags filled with medical equipment (cautery unit, suction machine, three full sets of surgical instruments, gloves, gowns, masks, shoe covers, scrubs, electrical transformers and connectors, etc. etc.) it’s desirable to have these inspected in our presence so that the trunks can be not only locked but duct taped closed on both ends. TSA goes out of their way to accommodate us and allows the additional taping at the end of their inspection (even thought the trunks were subsequently opened elsewhere in the depths of O’Hare and re-inspected – but not re-taped, oh well). Each trunk weights about 70 pounds, so we’re carrying a total of about 350 lbs of medical equipment as well a small amount of personal effects. Going to the gym pays off here as you get a workout lifting these trunks on and off the trolleys in each of the three airports prior to our final destination. I consider myself lucky however, as the San Francisco team manages a collective 40 + trunks containing all other medical supplies that comprise our complete mobile operating room.

After arriving in Hong Kong, we spent the night in the Regal Airport Hotel which, in connects directly to the airport proper and made for a flawless transition. The hotel may have been a bit pricey, but the convenience was well worth it after the long haul and with the abundance of luggage. Moreover, the hotel offers many amenities making for a very pleasant overnight stay – a club lounge with a wonderful breakfast overlooking the South China Sea and staff who define the phrase “superlative service”. We reunited with some of our colleagues (others arrived 2 days later) and spent the night discussing the planned mission, defining logistic details, and taking the tine to get reacquainted as many of us had not seen each other since the 2005 China Mission. That night Tim (our founder), Peter (Director of Anesthesia for Operation Sunrise), Heather and I had a light dinner in the hotel – after beginning our time honored regimen of daily Peptobismol tabs (which Craig contends that the CDC recommends taking 6 (!) tablets daily to prevent routine traveler’s diarrhea).

The following day, we boarded DragonAir to Qingdao after other group members met us in the airport (who had just arrived from both San Francisco and Australia). After a brief reunion, we then boarded the 2 hour flight to Qingdao and after clearing customs (without any problem whatsoever), loaded the bus to our final destination of Linyi City – about three hours bus ride to the northeast. So far:
Chicago – Hong Kong – 15 hours
Hong Kong – Qingdao 2 hours
Qingdao – Linyi City 3 hours
TOTAL: 20+ hours in transit (can you say “jet lag”)

After the 3-hour bus to Linyi City, we checked into the Riverside Holiday Hotel and quickly off loaded personal belongings. Walter designed specially colored tags that differentiated medical supplies from personal belongings, so that the medical supplies could be taken directly to the hospital the very same day. After arriving at the hotel and following a brief check in, we proceeded to the hospital to set up the operating room.

I was recently cleaning out some old files and documents a few months ago (you know, all the written stuff that collects somewhere in house, basement, office, etc.) and came across an old leather bound journal that somehow I’d completely forgotten about. I recognized it immediately from the grass stain on the book’s edges and the great dent in the back cover leather. It was my journal from a summer journey to Alaska in 1976 where I worked and traveled all over the state for a three and a half month period.

Like rereading any journal, many of the entries were pretty silly, mostly reflections of an early 20’s guy trying to make some sense of college, women, and well, life in general. Scary thing is, I’ll probably think the same of this Blog in the (not too distant) future!

Anyway, the opening page has a quote that I used to carry with me during other travels - Europe, Peru, Mexico, India, etc. I really can’t remember where I lifted it from, but it may have been taken from something as uninspiring as a National Geographic magazine article on traveling to the swampland. Either way, like so many of the things that we assign some special importance (that are seemingly to others are so completely devoid of any meaning or worth), I wrote it on a piece of waterproof paper (I used to work in a lab where all our lab books were made of the stuff) and then laminated it, and stuffed it in my wallet. In retrospect, I still feel the same now about it as I did then. It still really does resonate. It goes something like this:

“In sea travel, there are diaries made, but in land travel with so much to be observed and experienced, they are omitted”.

The mission thus far, has been a great success. As happens on these journeys, the team finally gets into a groove and aside from the occasional glitches, flows along well. It’s really something to see, how so many differing persons with differing talents, skill sets, personalities and little or no formal written instruction (AKA standard operating procedure) can each contribute so much and make it all happen. I don’t know how this spirit of cooperation evolves so easily in a situation like this, but in my estimation it’s a chore to duplicate back home…….

Often during a mission like this, you have these experiences, these epiphanies that literally drive to you to tears. The most obvious reason is because you feel the desperation and the greater social situation that promotes the development of conditions like cleft lip and palate, and of the poverty and the access to opportunity that we take so much for granted.

I was finishing up a long day in the operating room and was making late afternoon rounds when I was asked to evaluate a young girl who in essence, had just come off the street to have her widely clotted lip and palate repaired. Apparently, she had heard about us through the local paper that did a story on our mission (see the images portion of this Web site). It’s a very sad story that follows, and one that I’ve reflected on quite a bit. It tells of a greater injustice worldwide and while is not any great epiphany, it nonetheless grips you tight and makes you face your thoughts for some time to come. The nurses and other support personnel who experienced it directly likely feel the same.
This young girl of about 15 was slight in build from poor nutrition and had a dramatically wide cleft (see the image portion of this Web site). Apparently she “works” as a beggar for a “relative” who collects the money and (I assume) gives her a part of the meager profits in food. As Tim so keenly observed, that despite her destitute situation, she was a vibrant, radiant young girl who when told that she could have her surgery (we made available special space on the already crowded operating room schedule), began happily walking (nearly dancing) around the hospital ward, smiling widely. Her surgery was scheduled for the next day.

On the day of her surgery, the adult who “accompanied” her said that she wouldn’t sign the consent form and allow this young to have the surgery. She wanted to take the girl back to the street, mumbling something that the surgery was too dangerous. Some team members even went so far as to show this woman the other children who were post operative and how good they looked, how well they were doing. That somehow furthered her resolve to not allow the surgery. The young girl was heartbroken, and began to plead with this one person who could, with one operation completely change her life so she could go out in public without ridicule and shame. It seemed so ironic, here we, as Operation Sunrise had come so far to help patients just like her, and now the chance of a life-transforming operation was about to be lost.

The adult companion became further incensed and using her fist, hit the face of this young girl, grabbing her shoulder and trying to literally drag her down the hospital ward towards the exit. Hospital security was called and this woman who was ostensibly a relative was lead out of the hospital. It seems that the woman was in essence her “pimp”, and the cleft deformity only enhanced her value as a beggar. Apparently people won’t give as much if you don’t have some sort of deformity or another and correcting the facial disfigurement meant less income for this violent, abusive woman.

We finally got consent for the operation by another “relative” of this poor little street urchin, and will make arrangements (as best we can) to make sure she doesn’t return to her life on the street. We also fear that if she does go back to the street with this woman, that the woman will tear apart the girl’s surgically repaired lip to increase again her potential as a beggar. Getting the consent was tough, because we have strict requirement for the proper legal documentation. Later as she was being brought into the operating room, Mary asked me who finally gave consent. I replied, “God did”.

The girl underwent a successful image restoring, life transforming operation on the 19th of May by Justin and Tim. All of us hope for her better future.

I never once forget that perhaps if I really want to make great changes in social inequity, that maybe I should better spend my efforts helping people build a water reservoir, teach better farming or crop methods, community sanitation, etc. Something that might perhaps have a truly more global effect, instead of participating in activities that help just one singular person.

Events like what I describe above, lead me to believe otherwise.

After a 15-hour flight from Chicago to Beijing, I was able to uneventfully pass through China customs. As expected they wanted to know why I had: surgical instruments for cleft lip, palate and rhinoplasty operations, a full size suction machine, canister and tubing, ValleyLab electrocautery with 50 hand pieces, 60 pairs of sterile surgical gloves, shoe and head covers, facemasks, electrical transformers, power strips, and adapter plugs, digital still image and video equipment, headlight and light source, tool kit, etc. etc. etc. I spent more than an hour convincing the rather thorough customs agents that I wasn’t going to sell any of it, and that it would only be used in the surgical care of children with cleft lip and palate. In instances like this, I carry a file folder of pre and postoperative images along with my medical credentials. All it usually takes is a brief presentation of the purpose of our mission and the display of the images. It’s a universal response - the understanding of how one operation can dramatically improve a child’s life.

I’m waived through and place my three footlockers of equipment back on trolley cart, each weighing 65 pounds. Once outside the gate I look for a taxi to head over to our rendezvous point. No sooner after I pass the guarded checkpoint am I inundated with those all too familiar shady offers of “taxi? taxi?”. Fortunately, I see through the crowd our coordinator Walter Wong - the “can do” guy who always seems to make things happen. Not surprisingly, Walter already has transportation arranged and we load the trunks. The mission gets underway.

Preparing for a mission like this, one where the team literally brings most all of the supplies (except for IV fluids and other heavy disposables), never feels like it is ever going to get off the ground or that you’ll ever be leaving anytime soon with everything preplanning accomplished. With so many people involved doing so many differing things, you can easily go insane worrying about covering every little detail. Especially when those little details ensure the children’s safety and success of the mission. Somehow however, it gets done, thanks in large part to the tireless efforts of Tim Marten and the San Francisco team.

The team finally convened in at The Third Hospital of Hebei Medical University, ,Shijiazhuang Heibei, after a 5 hours bus ride from Beijing. It’s an intense, brief and welcoming reunion and despite the jet lag and time zone difference (for those of us from Chicago it’s nearly 12 hours difference) we check into the hotel after a brief dinner begin the preliminary team assignments,

If it’s one thing I’ve learned from missions like this, is that every team member is here because they want to be. For most , it’s a tremendous personal and financial sacrifice to be away from family and professional practice. The overall spirit of cooperation is exceptional. While on the mission, team members will roll up their sleeves and take on any additional tasks just to make things run smoothly. I’ve never worked with such a great group of people covering all facets of medical care - administrative, and (especially!) nursing (ward and recovery) and scrub/circulating personnel, and co-surgeons, etc. What’s more, it’s an interesting multinational group comprised of Australians, New Zealanders, Chinese nationals and Americans. The great reward our team members receive is knowing we’ve provided one of the most priceless gifts that come from helping those less fortunate. The value of providing cleft lip and palate service is inestimable, and resonates over time. For many of us, it recharges those original feelings of why we’ve chosen medicine as our lifelong career.

Today was our first day in the operating room, and we performed around 12 cases, all with great success. Not bad for a first day, and as we “get the rhythm down”, our productivity will improve all under the focus of paramount patient safety.

Well, with that brief overview more will be posted tomorrow on some of the interesting cases and observations, about the great interaction with our new Chinese physician colleagues of the University Hospital. Thanks again for visiting the site!

Best-

Howard S. Kotler, M.D., FACS