27/9/10
Let’s see, it all started back on Sept 4th, the day before I left for Tana. It was the regional foire in Ambato. From what I can obtain a foire is a fair/exposition and it includes everything from fair games and rides, to booths with information and products from all the NGOs, communes and businesses in the region. It was pretty awesome in itself, but on Saturday the president came to give an opening speech. Which means, yes, I got to see the one and only, DJ-turned-self declared-president in real life. It was pretty awesome. We got together with all the French people that night (there are a bunch of 20-30 year old French people working at NGOs in Ambato, a much better group than the old creepy French guys with teenage girlfriends you see in the rest of the country) and had a potluck dinner. It ended up being a lot of fun and I think that we will probably be spending a lot more time with them in the future during banking weekends. It’s a little embarrassing on our part, they all know multiple languages whereas we can only speak English, and there are reasons why Americans have the stereotypes of being loud and obnoxious (we may or may not have started an across the room, throwing peanuts into each other’s mouth contest. Who are we?), but they keep wanting to hang out with us anyways.

Upon arriving in Tana, to help train the new volunteers at Mantasoa, I checked my email and had received a letter from the staff congratulating me on being chosen for the Peace Corps Volunteer Leader (PCVL) position. I was more than a little shocked because after applying I hadn’t heard anything about when or how they would be making a decision, but excited nonetheless. This means that come January, I will be moving to Diego Suarez (google it, or check out my vacation pictures) a beautiful coastal city in the North. There I will be living in and managing the Peace Corps hostel and working as a coordinator for all the volunteers in the north of the country. I’m not entirely sure what that will entail at the moment, but I know that I will be involved in site development, trainings, project proposals and other things of that sort. At the same time, I will begin a new primary work assignment, which I am hoping to do with PSI (Population Services International). It’s going to be a huge change from the village life that I am currently living, and I am really sad to be leaving my community and the group of volunteers in my region, but I am also really excited for the opportunities and work experience that this job will provide.

I then headed to Mantasoa for 3 days to train the new volunteers who were just finishing up their Pre-service training (PST). It just so happened that the stage before them was doing their In-Service Training (IST) that same week. It was pretty crowded in Mantasoa (even though the PSTers were staying with host families) but it was really cool to meet everyone from those two newer stages, and hang out with all the other trainers from my stage or the re-instatement stage. We were pretty short on time because they were trying to fit a lot more into the final couple weeks of training, but I think our sessions went really well and we got to spend some time just answering questions that the trainees had as well. The week was complete with a toga party, in true Peace Corps fashion, with the IST stage. I definitely had a moment where I realized that while many of my friends have ‘grown-up’ and gotten real jobs this year; I was drinking THB, in a toga, dancing, on a Thursday night in Madagascar. I don’t think I need to even say more about that.

As soon as we arrived back in Tana, Operation Smile started up. In case you haven’t heard of it, Operation Smile is an organization that travels around the world and does medical missions to fix cleft lips and cleft palates. I believe it was started in the United States (though I could be wrong) but this mission was out of the South African branch. They regularly invite Peace Corps volunteers to partner with them as translators. I was a little bit nervous to participate, I mean my language is sufficient for my village but I wasn’t sure if I would really be an effective translator for something important like this. Turns out I had nothing to worry about, and didn’t really even have a chance to think about whether I could do it or not; I was basically just thrown right into a crazy day of translating and did just fine.

The first two days were screening days, in which we saw over 400 potential patients. Each patient had to go through medical files, the nurse station, surgeon station, anesthesiologist station, dentist station, speech therapy and finally the ‘gate keeper’ before they could leave for the day and return on the announcement day to find out if they were a candidate for surgery. The first day I spent the day taking vitals with the nurses and asking patients their medical history and the second day I moved into the anesthesiologist’s room and helped them with medical history. For these first few days it was both really fun and really hard. It was really cool to get to meet parents who had brought their patients from all over the country, in the hopes that these doctors would be able to fix their cleft lip. At the same time, when the child did not qualify, because they were too young, too small, too old or would just not make the priority cutoff, we were the ones that had to explain it to the mothers. It broke my heart to tell a mother who had come from far away, probably with all the money that they had, to try again next year. There was one case where a girl would have qualified, and even had a priority card from the previous year, but she had just happened to get an ear infection while traveling. The doctors had to send her home with antibiotics and ask her to try a third time in another year.

At one point a mother and grandmother showed up with 8 months old twins. One twin was healthy and was approved for surgery, but one was very underdeveloped and even at 8 months didn’t make the 4 kilogram cutoff weight. I had to tell the mother that we would be able to operate on the one, but unfortunately his brother would have to wait another year. It was awful. A couple hours later, I was talking with another volunteer about how awful it had been to tell a mother that only one of her children qualified, and they informed me that when the surgeon saw the babies, he also agreed that they couldn’t only do the surgery on one of the twins and had decided to take the risks of the case on himself and would be performing the surgery. It’s amazing how quickly you become attached to certain families, and I followed these kids through the whole process. The mother would come and find me to ask questions, and the smaller of the twins was one of the happiest babies there.

During the surgery days we started at 7am and when I left at 8:30pm the doctors and nurses were often still finishing up for the day. This was an amazing group of people. I have my opinion about short term ‘service’ projects, which I am sure many people reading this have already heard, but op smile is in its own field. It was so amazing to see the ways in which this mission can change an entire family’s life in a few short days. Their child who would have been stigmatized, could now go on to live a normal life. And the kids came back looking so good. The entire staff worked ridiculously long days to try to get as many patients in as possible, and the patients who didn’t qualify for surgery were still treated in other ways. Over 170 surgeries were done, 109 obturators (an orthodontic piece for inoperable cleft palates) were made and patients with other aliments were treated when possible. The staff who had come from South Africa, America, Italy, Egypt, Panama, Namibia and I’m sure many more places; worked together and were all tied together with the same optimism and dedication. Further, as busy as they were, everyone on staff took the time to teach, whether it was a curious peace corps volunteer wanting to understand why one medicine was given over another, a malagasy translator asking about the cause of cleft palates or local staff scrubbing in and learning from these experts from all over the world. I know I learned a great deal about cleft lips, surgery, anesthesia and nursing in general. Not sure exactly what I’ll do with this knowledge, but it made the week so much more interesting.

Working in the pre and post- op area with the nurses was really awesome because I got to follow patients from start to finish. I was there answering nervous mothers’ questions and getting them the things they needed prior to surgery, walked them down to the operating room, and when their babies came back they would call me back to see how beautiful the operation had gone. I had more than one mother stop me on her way out, after discharge to thank me for everything I did. I had to keep telling them that I was not the one who did anything. Women were insistent though, and it made up for all of those families that I had to turn away the first couple days. There was one little 4 year old boy and his dad who I had been talking to throughout the process. The dad was really cute and wanted the doctor to listen to his heart too and had a million questions. When he was discharged the dad called me out into the hall to say goodbye, I bent down to give the little guy a fist pound and he ran up and threw his arms around my neck and gave me a huge hug. I seriously felt my heart melt.

People over 14 years old with cleft lips were candidates for local anesthesia and even though we told them what was going to happen, I don’t think they knew exactly what to expect, and were therefore pretty scared. All of the media had been following this one boy, Alfred, who was 18. He had a pretty intense cleft lip and had never been to school because he was ashamed of it. His dad was this cute little man from the countryside who replied to everything with a smile and encouraging words for Alfred. When it came time for him to go to surgery, his dad had disappeared so I walked him down. Alfred squeezed my hand the whole way and kept asking if it was going to hurt. I kept reassuring him and when we got downstairs he saw the other little boy that had gone before him, and how good he looked. I told Alfred that he had said it didn’t hurt and that he shouldn’t be afraid. And you could literally see him relax a little and get excited for the way he was going to look. I think the whole experience must have been really great for all of the families involved. In their own villages, their child is probably the only one who has a cleft lip and then all of a sudden they are surrounded by hundreds of other families just like them. They were always helping each other when one group didn’t understand what was happening, sharing food, watching each others’ children when they left the room. The local anesthesia patients were old enough to hang out together before the surgery and when one would come back they would all gather around and congratulate each other. It was really amazing.

Along with the incredible interactions with all the families that I got to be a part of, I truly enjoyed meeting the doctors, nurses and other staff. One of my favorites was definitely ‘Bosey’ actually Adrian Bosenberg, a South African, turned Seattle resident who is the Director of the Anesthesiology Department at Seattle Children’s Hospital. We bonded as redheads, well his hair isn’t red so much as gray these days, but he got out his old drivers license to prove it to me. I spent a lot of time that week just joking around with Bosey, and he let me come down a couple times to watch a surgery and even help out a little in the operating room. He explained everything he was doing and tried to convince me to take the med school route after Peace Corps. I told him that that might not happen, but ill at least consider Wash U for my Masters degree. He was great to work with and I hope we stay in contact. Secondly, I got to spend an incredible amount of time with Francesco, an Italian pediatrician; Kathy, an American nurse; and Galima, a South African nurse. They are all absolutely wonderful people and I truly enjoyed getting to know them. It’s amazing how well such a diverse group of people can work together and they were all cheerful and helpful throughout the entire week no matter how tired they got. On the last day they had a big party for all the staff and volunteers, and Galima invited Kelly and I to come take a hot shower in their hotel room and enjoy ourselves. Afterwards she said this was her good deed for the week. Our response was, yeah, that was the only good thing you did this week Galima….

In general I think the entire staff got a pretty big kick out of us. They think we’re super fluent (ha yeah right) and they think we are absolutely insane to be living out in the middle of nowhere alone, but were really excited to learn about what it was like. Everyone on the staff kept sneaking us candy and American snack food, and as soon as they saw how excited we got about it, they only increased the supply. One day we were sitting down during the mandatory tea time break that Galima had each day and JaJa looked at one of the nurse’s socks and said ‘whoa look how white your socks are!’ They then made Kelly show them her socks, which were completely brown, and this started a whole new discussion about our crazy lives. At the end of the week they gave us all kinds of stuff and one of the nurses handed out new socks. Haha the things that we get excited about these days.
I got no sleep for the week and each day did about two weeks worth of site work, not to mention developed a pretty wicked cold probably from exhaustion, but Operation Smile was one of the coolest things I have ever done and I am going to plan my schedule around it again next year.

I conveniently didn’t bring my camera on that trip with me, but you can find pictures at milesofsmiles.org, I think, and I will also post a blog I found about the trip from one of the photographers.