Arrival in Nanyang
I’m working on adjusting to the 12 hour time difference – this part of China is 12 hours ahead of Northampton so right now though my brain feels like it’s about 3:30 am last night, I’m functioning as though it’s 3:30 pm “tomorrow.” Amazingly, I don’t feel that tired. I slept for a couple of hours in the afternoon and then woke up and was AWAKE until about 8:00 pm China time. I fell asleep again about 8;30 and was really out when my roommate, a Filipino nurse who lives and works in the UAE arrived at 11:30. Though she tried to be quiet, I woke up and it was about 1:00 am before I slept again. The problem, however, is that she snores, loudly. I did manage a bit more sleep before giving it up at 3:30, and this morning she apologized saying she does mark the box on the Op Smile form that asks if you snore. Usually there are enough people on the missions that they can room the snorers together, but with so few of us, that wasn’t an option. So, Marilyn and I are roomies for the week. We’ll see how it goes. She is very nice and funny which goes a long way to mitigating the snoring.
We had to leave the hotel at 5:30 in order to check in for our 8:10 flight from Beijing to Nanjang, so the plan was to get coffee and donuts or bagels at the airport Dunkin’ Donuts to hold us until breakfast on the flight. We soon realized there was a major problem with our plan. Although we flew into the main airport in Beijing – huge and modern and filled with restaurants and cafes, we were flying out of Beijing from a small airport that used to be for military planes only. It’s still on the base and still mainly staffed by military types. It has no Dunkin’ Donuts, no cafes, no breakfast. The security screeners were very serious and emptied out the bags of five of the six of us. The woman checking my bag first made me demonstrate the otoscope, and then examined the little pink rubber guy whose eyes and ears and nose pop out when your squeeze him, turning him over and over in her hands. She finally gave him to me with a gesture that clearly said, “What the H--- is this???” I squeezed him and she actually jumped back, knocking over a pile of empty trays. I DIDN”T laugh (self preservation at work,) but pantomimed examining the ears of a child and using it to distract him. She called over two other screeners and had me repeat the demonstration, and the three of them conferred before waving me on.
The anesthesiologist had to take out his laryngoscope and pantomime using different size blades on various team members to put in paper covered endotracheal tubes without choking us. He too was cleared. The Bio-med was not so lucky. His lithium batteries were confiscated along with two really nice extension cords. One of the students had to give up gel markers and tiny vials of bubbles.
We finally made it to the plane, the only six non Chinese passengers. We buckled in and watched the safety video, and then we waited. After awhile, the captain came on and said something in Mandarin, loud and clear for those who could understand the language. This was followed by a translation into English, given by one of the female flight attendants in heavily accented, barely audible English. In addition to the public speaking challenged translator, we had to contend with the Chinese passengers who indulged in the natural tendency to resume your normal conversations once your part of the announcement is over. None of us could hear a thing. The explanations were repeated every 10 minutes or so, completely incomprehensible to us. After about an hour and a half on the tarmac, the flight attendants decided to serve breakfast. The handed out boxes containing packets of pickled cabbage, a dried out roll filled with dried out bean paste and a chocolate cookie. They also provided hot water, as in tea without the tea bag. As soon as the last box had been handed out, the captain came on again, but this time, perhaps because the flight attendants were busy and he gave both the Chinese and the English announcements and perhaps because everyone was eating and therefore the Chinese passengers didn’t start talking,, we actually heard the announcement. He said, “ The flight controllers wouldn’t let us fly for many many reasons that we can’t tell you. Be grateful we are now number three for takeoff. Thank you for your patience.” What a hoot. I actually like it better than hearing about maintenance issues delaying takeoff. That always makes me wonder what’s broken. Anyway, the poor flight attendants began scurrying around, gathering up half eating breakfasts and “tea” cups and trying to get passengers back in their seats and ready for takeoff.
Once we were in the air, the flight went fine, and two hours later we were in Nanyang. Two things about the passengers that were a little disconcerting: One man carried on a very loud cell phone conversation for about an hour of the flight, totally unmolested by the flight attendants, and another hacked up phlegm and spit it on the floor in front of his seat for most of the flight. Yuk!
After lunch at a noodle restaurant and about an hour to relax, we walked to the hospital where the mission will be and met the rest of the team. They seem very enthusiastic and the hospital, which is a specialized ear nose and throat surgery center looks fine. There are already about 50 patients there, ready for tomorrow’s screening. There are lots of babies needing primary surgeries, so it won’t be like my previous China experience. On the other hand, there is an opening ceremony and I’ve been asked to make a short speech about how honored we are to be there helping the people of Nanyang etc. My interpreter, Zoe Zhang will repeat my words for the “masses.”
The interpreters for the mission are from an international auditing company, KPMG that does auditing and other services world- wide. Zoe is an auditor and majored in language and business in college. She is doing some sort of graduate program sponsored by the company and is required to take another language in addition to English, so she’s in her third year of Spanish. She and I spent some time practicing our Spanish this afternoon. After touring the hospital, we had a team meeting and I talked with the surgeons about their preferences for fluid management and feeding pre and post op. There are Op Smile guidelines, and on international missions, the Field Director of the mission can insist that they be followed. However, on a local mission like this one, the country can modify them and that often means reverting to older, more restrictive rules.
The Op Smile guidelines are that a breast fed baby who just has a cleft lip is allowed to start nursing in the recovery room, as soon as she is awake. The early feeding soothes the baby and the pursing of the lips helps pull the incision together. Bottle fed babies have to be fed by syringe as the hard artificial nipples can damage the suture line, but they also get milk as soon as they are awake. The palate repair patients get clear liquids the first day and then milk, etc and advance to a soft diet in a few days. Here, they don’t allow nursing until four hours after surgery and the palate patients have to maintain a liquid diet for two weeks. The more lenient guidelines have been tested and have been found to not cause problems with recovery or outcome, so keeping to the more restrictive plan only causes more misery for the kids. Bletch.
Dinner tonight was at a “Hot Pot” restaurant where each person sits in front of a bowl of spicy broth on a little built in hotplate. On a lazy Susan in the middle of the table there’s a mountain of various foods to cook in the broth and eat. If the broth doesn’t burn your mouth then the boiling broth does. I’m ready for some oatmeal.
Finally, they were unable to find an international pediatric intensivist for this mission on short notice. They will use a newly credentialed pedi intensivist from the hospital here in Nanyang, but this will be her first Op Smile mission. The pediatrician and the intensivist are usually a team, with the intensivist taking care of the child directly from the OR and releasing him to the pediatrician when he’s stable. I rely on the intensivist to back me up if a child gets into trouble or to advise me if I’m not able to control a child’s pain or agitation. On this mission, though the intesivist has the knowledge and skills for the position, she will be looking to me for direction, and the surgeons want me to write all the orders. I’ll just keep my fingers crossed that there are no crises.
Tomorrow is screening – more notes then, and photos will begin to pile up. Since I’m home in a week, I think I may just wait and post them on Picasa rather than trying to figure something else out here.
I’m working on adjusting to the 12 hour time difference – this part of China is 12 hours ahead of Northampton so right now though my brain feels like it’s about 3:30 am last night, I’m functioning as though it’s 3:30 pm “tomorrow.” Amazingly, I don’t feel that tired. I slept for a couple of hours in the afternoon and then woke up and was AWAKE until about 8:00 pm China time. I fell asleep again about 8;30 and was really out when my roommate, a Filipino nurse who lives and works in the UAE arrived at 11:30. Though she tried to be quiet, I woke up and it was about 1:00 am before I slept again. The problem, however, is that she snores, loudly. I did manage a bit more sleep before giving it up at 3:30, and this morning she apologized saying she does mark the box on the Op Smile form that asks if you snore. Usually there are enough people on the missions that they can room the snorers together, but with so few of us, that wasn’t an option. So, Marilyn and I are roomies for the week. We’ll see how it goes. She is very nice and funny which goes a long way to mitigating the snoring.
We had to leave the hotel at 5:30 in order to check in for our 8:10 flight from Beijing to Nanjang, so the plan was to get coffee and donuts or bagels at the airport Dunkin’ Donuts to hold us until breakfast on the flight. We soon realized there was a major problem with our plan. Although we flew into the main airport in Beijing – huge and modern and filled with restaurants and cafes, we were flying out of Beijing from a small airport that used to be for military planes only. It’s still on the base and still mainly staffed by military types. It has no Dunkin’ Donuts, no cafes, no breakfast. The security screeners were very serious and emptied out the bags of five of the six of us. The woman checking my bag first made me demonstrate the otoscope, and then examined the little pink rubber guy whose eyes and ears and nose pop out when your squeeze him, turning him over and over in her hands. She finally gave him to me with a gesture that clearly said, “What the H--- is this???” I squeezed him and she actually jumped back, knocking over a pile of empty trays. I DIDN”T laugh (self preservation at work,) but pantomimed examining the ears of a child and using it to distract him. She called over two other screeners and had me repeat the demonstration, and the three of them conferred before waving me on.
The anesthesiologist had to take out his laryngoscope and pantomime using different size blades on various team members to put in paper covered endotracheal tubes without choking us. He too was cleared. The Bio-med was not so lucky. His lithium batteries were confiscated along with two really nice extension cords. One of the students had to give up gel markers and tiny vials of bubbles.
We finally made it to the plane, the only six non Chinese passengers. We buckled in and watched the safety video, and then we waited. After awhile, the captain came on and said something in Mandarin, loud and clear for those who could understand the language. This was followed by a translation into English, given by one of the female flight attendants in heavily accented, barely audible English. In addition to the public speaking challenged translator, we had to contend with the Chinese passengers who indulged in the natural tendency to resume your normal conversations once your part of the announcement is over. None of us could hear a thing. The explanations were repeated every 10 minutes or so, completely incomprehensible to us. After about an hour and a half on the tarmac, the flight attendants decided to serve breakfast. The handed out boxes containing packets of pickled cabbage, a dried out roll filled with dried out bean paste and a chocolate cookie. They also provided hot water, as in tea without the tea bag. As soon as the last box had been handed out, the captain came on again, but this time, perhaps because the flight attendants were busy and he gave both the Chinese and the English announcements and perhaps because everyone was eating and therefore the Chinese passengers didn’t start talking,, we actually heard the announcement. He said, “ The flight controllers wouldn’t let us fly for many many reasons that we can’t tell you. Be grateful we are now number three for takeoff. Thank you for your patience.” What a hoot. I actually like it better than hearing about maintenance issues delaying takeoff. That always makes me wonder what’s broken. Anyway, the poor flight attendants began scurrying around, gathering up half eating breakfasts and “tea” cups and trying to get passengers back in their seats and ready for takeoff.
Once we were in the air, the flight went fine, and two hours later we were in Nanyang. Two things about the passengers that were a little disconcerting: One man carried on a very loud cell phone conversation for about an hour of the flight, totally unmolested by the flight attendants, and another hacked up phlegm and spit it on the floor in front of his seat for most of the flight. Yuk!
After lunch at a noodle restaurant and about an hour to relax, we walked to the hospital where the mission will be and met the rest of the team. They seem very enthusiastic and the hospital, which is a specialized ear nose and throat surgery center looks fine. There are already about 50 patients there, ready for tomorrow’s screening. There are lots of babies needing primary surgeries, so it won’t be like my previous China experience. On the other hand, there is an opening ceremony and I’ve been asked to make a short speech about how honored we are to be there helping the people of Nanyang etc. My interpreter, Zoe Zhang will repeat my words for the “masses.”
The interpreters for the mission are from an international auditing company, KPMG that does auditing and other services world- wide. Zoe is an auditor and majored in language and business in college. She is doing some sort of graduate program sponsored by the company and is required to take another language in addition to English, so she’s in her third year of Spanish. She and I spent some time practicing our Spanish this afternoon. After touring the hospital, we had a team meeting and I talked with the surgeons about their preferences for fluid management and feeding pre and post op. There are Op Smile guidelines, and on international missions, the Field Director of the mission can insist that they be followed. However, on a local mission like this one, the country can modify them and that often means reverting to older, more restrictive rules.
The Op Smile guidelines are that a breast fed baby who just has a cleft lip is allowed to start nursing in the recovery room, as soon as she is awake. The early feeding soothes the baby and the pursing of the lips helps pull the incision together. Bottle fed babies have to be fed by syringe as the hard artificial nipples can damage the suture line, but they also get milk as soon as they are awake. The palate repair patients get clear liquids the first day and then milk, etc and advance to a soft diet in a few days. Here, they don’t allow nursing until four hours after surgery and the palate patients have to maintain a liquid diet for two weeks. The more lenient guidelines have been tested and have been found to not cause problems with recovery or outcome, so keeping to the more restrictive plan only causes more misery for the kids. Bletch.
Dinner tonight was at a “Hot Pot” restaurant where each person sits in front of a bowl of spicy broth on a little built in hotplate. On a lazy Susan in the middle of the table there’s a mountain of various foods to cook in the broth and eat. If the broth doesn’t burn your mouth then the boiling broth does. I’m ready for some oatmeal.
Finally, they were unable to find an international pediatric intensivist for this mission on short notice. They will use a newly credentialed pedi intensivist from the hospital here in Nanyang, but this will be her first Op Smile mission. The pediatrician and the intensivist are usually a team, with the intensivist taking care of the child directly from the OR and releasing him to the pediatrician when he’s stable. I rely on the intensivist to back me up if a child gets into trouble or to advise me if I’m not able to control a child’s pain or agitation. On this mission, though the intesivist has the knowledge and skills for the position, she will be looking to me for direction, and the surgeons want me to write all the orders. I’ll just keep my fingers crossed that there are no crises.
Tomorrow is screening – more notes then, and photos will begin to pile up. Since I’m home in a week, I think I may just wait and post them on Picasa rather than trying to figure something else out here.
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