Antigua, Guatemala | 2010 by Sue Hadden, RN

Sue Matthes Hadden has been a pediatric nurse for 34 years with 24 years in pediatric PACU and 2 years in ambulatory pediatric otolaryngology. Dr. Jenn Kim (3 year MMFC volunteer and University of Michigan Otolaryngologist) asked a peer pediatric otolaryngologist if he knew any pediatric PACU nurses who would be able to attend the Guatemala mission. When asked, Sue jumped at the chance to volunteer for MMFC. Her friend and colleague Rebecca (“Becky”) D’Agostino also volunteered to join her on their first mission trip. Becky has 36 years experience in pediatric nursing with 28 years in pediatric PACU.  Sue and Becky hope this was the first of many MMFC trips. As Sue’s journal entries so aptly illustrate, it is the people involved in every aspect of an MMFC mission- and their perspective on patient and family centered care – that ensures the success of each mission.

What a great way to start the New Year.  The first day in Antigua we had dinner with some of the team. One of the returning operating room nurses said that we would leave Antigua changed. She said that the experience was hard to describe but life changing.  I thought, “Ya, ya, we’ll be doing meaningful work, the team seems to have great mojo and I’ll be working with my buddy Becky.  This will be a good week.”

Half way through the first day, I totally understood what she meant. Working with a focus on the patient and family is why we go into medicine. The doctors, nurses and support staff had a vision with one purpose: to help these kids and families.  The Obras Sociales Hermano Pedro Hospital staff created a template that supported the task. The families were appreciative and the children stoic.

It is hard to put to words how the patients, families and staff touch your heart, but they are all heart. No language barrier can hide what was deep inside. With or without an interpreter, you could tell what was in their hearts; love for their children and appreciation that we were trying to help.

Patient and Family Centered Care (PFCC)

Patient and Family Centered Care (PFCC) at Hermano Pedro Hospital is amazing. As soon as it was clear that the patient was stable, the local staff would invite the parents in to be with their children.  In the United States, there are legitimate reasons why parents are not allowed into the recovery room directly after surgery, such as confidentiality, lack of space (crowding) and parents fainting. At Hermano Pedro Hospital we had all three “issues”: there were no curtains, very little space and 2 moms who fainted.

I would not change the timing of the parents’ arrival to PACU. I would have liked more space, more privacy and no fainting, but we live in the imperfect world. These children are not ours. I know children and I know a lot about waking them up. But I don’t know these children. Their parents do. They know their cries, their preferred methods of comfort and all the intricacies every parent inherently knows about their own children. Their children do not know me. I might be comforting but their parents are much more likely to be the postoperative antidote. PFCC was at its best in Antigua. They do not have the money, resources and research that we have access to. But we have a lot to learn from them.

Our Interpreter Miriam

Part of the reason we were able to do Patient and Family Centered Care in Antigua was in large part due to Miriam. Miriam was our interpreter for four days. She functioned as interpreter, nurse, social worker, child life specialist and confidante. Her Mayan village suffered from genocide when she was six years old. Her family fled to Guatemala City where she still lives. When her four children were in their teens, she raised enough money to go to Canada to do an intensive English program. She now works at the Embassy in Guatemala City interpreting. When she can take time off, she travels to Antigua (1 to 2 hour commute) to volunteer her time at Hermano Pedro.

Miriam had a great sense of compassion. When not busy she would find out each family’s story. She would tell us the compelling stories of the parents’ struggles to bring their children there for surgery. She helped us discover the struggle of one mom who had been working for six months to help her failure to thrive infant gain enough weight to be able to be a candidate for surgery. She shared the story of one mom who sold all of her turkeys to afford the arduous trip from the mountains to Antigua. There were many stories. She helped us to get to know the Hermano Pedro staff better. She helped us speak with Otto, one of the nurses whose wife had had a baby on day 2. This was Otto’s first baby and he was handsome and looked just like him.

Our experience and the experience of our patients was enhanced due to Miriam. We marveled at our luck to have her volunteer week be the same as ours. Thank you, Miriam.

Patsy Donlan, RN

Just a few words about Patsy, the team leader of PACU:  She has great clinical skills, compassion, leadership, sense of humor and an incredible work ethic. She shared her wealth of knowledge and yet was open to suggestions. Despite a little local gastrointestinal infestation she was a workhorse all week. When it came picture time she had us surround her so no one would see her IV.

Nancy Natalie

We met Nancy Natalie in pre-op. She had already had her IV started and her eyes looked nervous. We asked her if she wanted to blow bubbles to entertain the crying babies who were also waiting for surgery.  She gladly took the bubbles with a sparkle in her eye and a smile that melted your heart. She was pleased as the babies were distracted and stopped crying.

The next time we saw Nancy Natalie was after her surgery in recovery. Her chest was sore where the rib graft had been harvested for her microtia surgery. She gave us a sweet smile despite the “dolor” (pain).  Her father had a quiet nurturing presence. Dad comforted her as we administered medicine and she slowly reached comfort.

Each morning we poked our head in the ward where Nancy Natalie stayed. Each day she looked a little better, first not getting out of bed, then sitting at her bed to eat breakfast, then out of PJs and in her clothes.

The last day of our work, Friday, we walked into the hallway adjacent to the ward and Nancy Natalie saw Becky and ran into her arms. Nancy Natalie hugged Becky, patted her back and softly said gracias, gracias, gracias. She would step away with a smile, then again hug and thank Becky over and over. Her dad gave a quiet nod. Muchas gracias.

We are praying that we meet again next year when she comes for her second stage repair.

One day we took care of a sweet two-year old girl who had had a cleft palate repair.  Her mom was comforting but like most children who have palate repairs, this little one was unhappy. Despite pain medication and mom’s presence, she was difficult to console and her bleeding difficult to control. She was taken back to the operating room to assess and treat the source of her bleeding.

Upon arrival to recovery she was reunited with her mother. Her bleeding had stopped and she was finally sleeping peacefully in her mom’s arms. Her mom began to cry and I asked the interpreter what was wrong. I interpreted that mom had told her that she didn’t know how she was going to pay us.

The interpreter said that I had misunderstood. “ Mom and her family do not know how they will ever repay you. They are so appreciative of everything you and the doctors and everyone have done for them. They will never, ever be able to repay you.”

So mom was crying, the interpreter started crying, I started crying and the 3 other recovery nurses started crying. Because of course no payment was due or necessary. This child will have a chance in life now – to smile, be happy and productive.

Denny Snyder, MD and Noah Siegel, MD (Dr. Siegel is pictured above)

Dear Dr. Snyder (“Denny”),

Becky and I started hearing about you as soon as we hit the ground in Guatemala City. We heard your name, what a force you are, how fun, inspirational, great leader, what a bummer you were not here this year, what a great surgeon, how this trip would have never started without you and most of all, what a good heart you have.

Well, Denny, you left the Antigua trip in capable hands. Dr. Noah Siegel, our team leader, would have made you proud.  This capable, talented surgeon nurtured everyone from colleagues to patients to parents (I believe he was a nurse in a previous life).

And the buck stopped with Noah. He took responsibility for all problems, questions or concerns.

The first day the OR ran longer than anticipated. This is rarely anyone’s “fault” and is a multifaceted problem that we deal with everyday at home. We took it in stride firstly because we had no expectations and secondly because we know that hospital time is different than real time. It is just the nature of the work. But Noah killed us with the saddest puppy dog eyes ever. He felt so bad for making us work later than he would have liked.

What Noah (and the entire OR staff) didn’t realize was that PACU had the best job. We had the privilege of witnessing the incredible expression of joy when the parents caught first sight of their child. The gifted talent of the surgeons, anesthesiology and OR staff were appreciated beyond words.

Noah had an appreciation for the work that everyone did. He looked outside his job and appreciated all roles. Noah validated what we did, no matter how small the task. Jon Kabat-Zinn describes how Noah treated us. Kabat-Zinn says “Most of us feel better when we are seen and met with authentic presence and regard, without condescension or contrived intimacy. We feel good when we are treated as capable, when we are related to as if we have the capacity to actually undertake the hardest work in the world, when a lot is being asked of us, but in ways that build on our own intrinsic capacities and intelligences.”

Noah led the ship with amazing humility and grace.  Everyone knew that all they had to do was concentrate on our job.  He made an incredibly hard task look easy.

So Denny and MMFC ………. well done.

N.B. – While in Antigua, Guatemala, MMFC screened over 100 children and performed 81 surgical procedures. Dr. Charles Badaoui and the MMFC dental team also provided care and treatment to 71 children and young adults. MMFC wishes to thank Smile Train, Jill and Darius Bikoff Foundation, Mary E. Fox, Dr. Robert Feinstein, Paul Sawler and the Lefkofsky Family Foundation for sponsoring this very successful mission.