Nicaragua Day 4

Today the medical staff of La Merced arrived at the hospital to find patients already lined up in the waiting area. The schedule for today included a baby with a cleft lip, a girl presenting with an early stage of a neurofibroma, a boy with webbed fingers on one hand, and Ivan, the young man with the hairy nevus.

The baby with a cleft lip was only 2 months old. Having delivered three beautiful children myself, I cannot imagine the conflicting feelings a mother must feel when she discovers her newly born child is disfigured. After my experience today, I can only surmise the stress and frustration must be heavy. Once the surgery was complete, I showed her mother the photo of her baby with her fixed lip. She burst into tears, so relieved and happy to see her child whole for the first time.




The second patient, a very sweet, quiet, and happy young girl, presented with the beginnings of a neurofibroma in the back of her head. It's a sobering condition, as there is no guarantee that, after removal of as much damaged tissue as possible, the tumor will not return. It's heartbreaking to think that such a sweet child, without access to regular checkups, could face a future of severe disfigurement if the condition isn't kept in check. This case proved particularly interesting, as once Dr. Perrotta had excised a good portion of the tumor, he discovered two tubes protruding from deep along the spine. Consultation with the neurosurgeon confirmed that they were indeed feeding the tumor. She said an MRI would be needed to confirm the exact location of their origin, and then she could operate along the spine to remove them. Dr. Perrotta took out the tumors growing along her skull, then closed up. The staff of La Merced later conferred and decided to apportion some of their funds allotted to hospital diagnostics to the fee for a private MRI so she could get one as soon as possible. Otherwise, she would be added to the months-long waiting list of government-provided health services.





The next surgery was fascinating. Dr. Perrotta had to separate three fingers of a young boy which had grown fused together at the base. He deftly demonstrated the zig-zag cuts necessary to assure the best healing for minimum scarring. Where the fingers were cut apart, extra skin was needed to graft between them. A doctor from the hospital worked alongside, cutting the graft from the boy's groin area while Dr. Perrotta prepared the fingers to receive it.





Then finally, Ivan. He and his mom had left at 5am for the hour-long bus ride to the hospital, and he wasn't even scheduled until end of day. He was understandably stressed and anxious by the time he was allowed into the waiting area. As mentioned yesterday, a skin expander is necessary to fully excise the hairy nevus with minimum scarring. Already, his face bears evidence of early attempts at removal with extreme scarring as a result. The skin expander, over time, slow stretches out the surrounding skin, so that a graft is not needed from elsewhere, the nevus can be cut out, and the clean tissue can be stitched together with only a minimal scar left. Because we did not have one, all Dr. Perrotta could do was a face lift to remove as much as possible without overstretching. To Ivan's frustration, he would once again leave the hospital without his hoped-for result. But this time, we could give sound assurances to him and his mother that we would remain in touch and actively work to get the equipment necessary for that one final procedure which would change his life.





It was an exhausting day with only a short lunch break eaten in the hallway outside the operating rooms. The La Merced crew left for the ride back to the hotel with a mix of feelings from the elation of giving concrete results to some patients, while having to leave others with still more work to be done and no guarantees. Even tracking down the skin expander for Ivan won't be an immediate solution for him. The first OR and physician availability for him to have it installed isn't until next July.