Vinayaka Hospital - Karaikal, India: Tuesday, January 27

Waking up groggy at nine in the morning in the Post Op ward, twenty-eight year old Ganthimithy Kodamathy looked up to see a big man hovering a few feet from her face pointing a camera, another guy waving a flashing light and someone else scribbling on a notepad. Maybe it wasn’t her best moment – or ours – but after surgery last night, the results were pretty dramatic. She looked 100% better than when we’d snapped her picture and chatted yesterday.

A cruel gap in her face had created a gap in her life; she was illiterate, socially stigmatized and shut away in a small village due to her cleft lip and palate. Last night’s operation by the Rotaplast surgeons closed the physical gap. The rest would be up to her. Wayne promised the groggy girl he’d drop by to get a better picture later today.

Our burn victim was in a more chipper mood. Up and about on his spindly legs with his mother by his side, he greeted us with a big grin and thumbs up. Mom was cheery, too. All around the Post Op wards, kids and young adults were waking up and literally putting a new face on life. For some it was easier than others.

At the mission’s midpoint, with four more days of surgery to go, the results of the Rotaplast mission are adding up:

SCORECARD TO DATE
(values at US rates of donated medical services, excluding hospital costs and supplies)

Friday 17 procedures 14 patients $ 66,900 value
Saturday 27 procedures 17 patients 88,680 value
Monday 28 procedures 19 patients 95,011 value

Total to date: 72 procedures 50 patients $250,591 value

Our other, more serious burn case was in the midst of heavy drama, however. A couple of pieces of equipment are necessary to take care of this kid. They need certain blades for the Dermatone skin grafting machine, among other things. Paula Fillari, head recovery room nurse and one the mainstays of St. Francis Hospital’s burn unit in San Francisco, was working her cell phone.

The cell phone is plugged into the wall of the recovery room. Everybody’s using it, staying in touch with wives, husbands, significant others and offspring, courtesy of Paula’s husband, Gaetano. The Bay Area chef usually accompanies his wife on these missions, but he’s currently sidelined at home due to illness. Picking up the bill is his very generous contribution. Paula’s absence is not easy for them both. She calls him every night. But you could say he’s right here with the team, in an important way, through that cell phone.

Down the hall and around the corner from the recovery room, twelve year old Vijayakumar Barathi was waiting to go into surgery, drawing pictures on a sheaf of paper. His family waited with him – sister, mom and dad. We’d visited their home last week. The boy’s name means “Victory’s Son” in Tamil.

Dad’s with the Karaikal Information Ministry – basically the town PR department. Yesterday’s Republic Day show was one of the year’s biggest workouts for him, herding the journos, looking after the VIPs (including me, Wayne and Jason – he’d given us official passes and front row seats). When Wayne wanted to pose him and his family and joked, “This is the publicity shot,” he knew just what to do. I promised I’d stay with his boy all through surgery later. But first I wandered downstairs into the dental clinic.

The busy dental, orthodontic and prosthetic workshop is an essential stage of cleft lip and palate repair. Dr, Mabel Garcia Mattos from Uruguay, a veteran of eleven Rotaplast missions, and Dr. Chintamani Kale from Mumbai, are running it. Rotaplast non-medical volunteer Nora Manchester from San Jose, California is lending crucial assistance. Local technicians are an important part of the team.

Dr. Kale explained that dental plates close the gaps for many patients with incomplete palates. The devices allow them to eat better, speak more clearly and smile prettier. The plates also keep food from being sucked through the opening in the roof of the mouth and into the lungs, creating potential infections.

Appliances sculpted by the local technician in the workshop for certain patients form the shape of the mouth that the surgeons are working to complete. The missing teeth in a cleft lip and palate are filled in with by the dental plate, so that the surgeon can adjust the lip repair to fit just so.

The dental department also stretches each side of the patients’ gapped lips towards the center with surgical tape or elastic bands before their operations. Over a few days this makes the flesh more pliable when the surgeons need to pull the parts together and stitch them into a solid pair of lips.

After so many missions, Dr. Garcia said this one was as rewarding as the all others, especially “when I see them look in the mirror.” But it’s not always so rosy. “When there is nothing we can do for them and then we have to tell them… that’s the worst.”

Lunches served buffet style in the hospital recreation room feature a menu of Indian standards and Tamil specialties that changes daily. Most of the dishes are pretty tasty; some are puzzling, but the team is well fed on rice pilavs and gobi masala and rice biryani – occasionally chicken. Today’s menu included beef for the first time, prepared in a kind of stew. Resigned to vegetarianism, the team dove in and the pot was scooped clean in no time.

Right after lunch I was in OR 1 watching Dr. Angelo Capozzi work on little Vijayakumar, the PR guy’s son, and trying to stay out of everybody’s way. Capozzi pried the boy’s nose open to show a septum bent like a hockey stick, blocking his right nostril. The remnant of a previously repaired cleft. No wonder the kid was having trouble breathing.

Capozzi got to work as Ambika Chada was suctioning. Carole Hager and a hospital intern were handing over the forceps and other instruments from the tray. Anesthesiologist Alan Andecht kept an eye on the monitor. He looked over and asked me to hand him a towel. It was a blue towel. Alan folded it over a couple of times and tucked it underneath the Endo-Tracheal Tube that was helping the patient breathe. It was the first operation I had ever assisted.

Close to three o’clock, Capozzi gave the thumbs up and in went the sutures. The operation was over after less than an hour. Andecht cut off the sedatives and stood over the boy with the ETT in his hand, ready to draw it out. The boy was coming to, but his body was bucking like a young pony. Andecht was waiting for the cough – a sign that the patient can bring up anything in throat on his own. “Take-offs and landings,” said Andecht. “In flying or anesthetics, they’re the most dangerous times.”

The boy coughed, out came the tubes, and the nurses rolled the patient over on his side onto a gurney, attached to an IV trolley. “One for the road!” Andecht called out.

Mom and dad came to the recovery room to see him. A tear rolled out of the boy’s eye when he saw his folks. Their own faces were tightly drawn with worry and it took some minutes before they were smiling. In a short while, so would their boy.

Just before leaving the hospital for the day, we checked back with Ganthimithy. She was awake now, and recovering well, but still a bit bleary. Not quite ready for her close-up. Tonight, while the Rotaplast team gets some shuteye at the Paris hotel, she and the others patients are all in the good care of the Vinayaka doctors, nurses and teaching college interns. We’ll see how she looks tomorrow.

Rex Weiner
Wayne Schoenfeld