Today was the day we began the adventure of ear nose and throat surgery in the Dominican Republic. We started our day at the hospital in Perralta about 8:30am, and thankfully having Oscar as our anesthesiologist, who knows the lay of the land, we started pretty quickly. We kicked things off with a full palate repair. You've heard of kids with cleft lips and palate? This little guy had already had the first procedure, which was initial repair of the lip, and we were the first ones to start fixing his palate. It's a fairly complex procedure, separating the muscle and mucosal layers, and crossing them over in a z-like pattern to close the gap and create the palate that you and I are so very accustomed to, that allows us to do things like swallow, talk, and eat without food coming out of our nose. It took a couple hours, but the result was definitely a successful one, and we can only hope that all the post-op instructions are followed and no fistulas form. Fistulas, or small holes, can happen in the palate between the hard and soft palate, and apparently studies have shown that it is more common in countries like this than in America. Maybe because of some misunderstanding for how to care for the kids after surgery....but we aren't sure. In addition to the palatal reconstruction, we had two palate revisions today, which was fixing these fistulas that had formed over time.....again, not sure why, but it happens. Peter is a great surgeon, and a wonderful teacher. He has walked me through every step of the surgery, and it has been amazing to see how this works. Even more amazing to see the final outcome with these kids. We also repaired another cleft lip, which had already had an initial repair, but over the years as the child grew, he needed another surgery. I can't wait to post the before and after picture for you, because it is tremendous. We also did a revision on a lip for one of the palate kids too. So, overall we did 4 surgeries today, 1 palate reconstruction, 1 stand alone lip revision, 1 stand alone lip revision, and 1 lip revision and palate revision. The kids afterwards were doing great, and we will keep them at least overnight to make sure everything goes well. It's a cool surgery to take part in because there is definitely immediate gratification. Seeing these kids with gaping holes in the top of their mouth, affecting their daily ability to communicate and eat, and the deformed lips, which I'm sure affects how others treat them in some way.....it's just cool to be part of fixing that and giving them a new way of living. Overall we did surgery from about 8:30am until 7ish-pm, so it was a good long day. Tomorrow we have several tonsillectomies and adenoidectomies, which is going to be a little bit quicker each surgery but a long day nonetheless. I'm really glad I came on the trip, especially as there is only one ENT surgeon and no one else to assist.....Dr. Wang has her hands full with everything else going on, and though I'm sure she could handle it with pre-op and assisting in the surgeries, I think it's helping to take a load off and make things flow more smoothly. Peter has had me assist on some of the operations as well, and I've been doing a lot of just the nuts and bolts of getting things set up, moving along, and "scrub nursing" for the operations (making sure he has everything, passing the instruments and all that, etc.). It's nice to get to play all the roles in medicine, especially when you have to set things up from scratch that are normally just "done" in the hospital setting. It teaches you quite a bit outside the normal. Anyway, time to turn in for bed as we have a long day ahead of us tomorrow. I'm trying to take some more pictures on this trip and have some to show you when I return. It's hard to get some with me in them, but I have some of the patients and the surgeries we are doing, which is more important I think. Thanks for reading.
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