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Making children smile

"Making children smile" Continued...

Issue: "The death of discipline?," June 26, 1999

The gathered supplies for each trip are packed a month ahead of time into 26 boxes and 18 purple-and-turquoise crates. Everything the team will need in El Salvador, except for operating tables and anesthesia machines, is shipped from Austin. It's the equivalent of packing to move a large home three times a year.

In El Salvador, Austin Smiles works with La Familia (the El Salvadoran equivalent of Health and Human Services) and the military. La Familia makes sure that the 44 crates and boxes are cleared through customs and received at the military hospital in San Salvador where the surgeries take place. By the time the Austin Smiles team arrives, the military and La Familia will have publicized the visit through ads placed in newspapers and on TV and radio. The military through its bases gets the word out even in isolated villages.

The group leaves Austin on a Saturday and returns the next Friday. The doctors operate from Monday through Thursday, doing as many as 20 operations per day.

Early Monday morning potential patients are sorted by problems: cleft lips here, palates there, burns and other problems here. Though the parents wait patiently, the line is noisy. Some of the hundreds of babies scream. Doctors and translators go down the line, evaluating each patient for surgery. Some are too young. Cleft lips can be done at three months, but palates need to wait until about three years. Some are too sick. The young and the sick are sent home with the promise that "we will be back." That's one of the reasons that Austin Smiles operates primarily in El Salvador. Doctors know if they can't operate during one visit, they will be back in four months for the next.

While the plastic surgeon is evaluating patients on one level, a family practice doctor is making another kind of evaluation: Is the patient healthy enough to undergo surgery? Carolyn Hardwick says it is difficult to get good medical histories from many of these patients, but a family practice doctor is able to detect children who may not make it through safely because they have asthma, infections, or dehydration.

Once the first four patients are chosen, the action moves upstairs where three operating rooms are ready. One of the rooms has two tables in it, so four surgeries are often taking place at the same time. The rooms have been fitted with the supplies brought from Austin. Cameramen from the military are everywhere, poking their cameras from above and below, trying to capture every surgery and every emotional moment for posterity and public relations. Austin Smiles has brought a great deal of positive press to an unpopular military. For the most part, the volunteers are able to ignore the cameramen, maneuvering around them like mere pieces of furniture.

Surgeries take place one after the other, with just enough time in between to prepare the table for another patient and sterilize the equipment. It is a scene of constant motion, interrupted frequently by emotional moments. Mothers have to hand their children to strangers who, in many cases, speak a foreign language. Carolyn Hardwick says, "It's a terribly frightening thing for these parents to do. I don't know if I could just hand someone my child." And yet they do.

The babies stare with big-eyed wonder at the strange foreign-speaking adults who hold them, and the machines, lights and cameras that clutter the operating rooms. They scream and struggle when the anesthesiologist places the plastic mouthpiece over their noses and mouths. Administering anesthesia to these young patients, who often have airway problems related to their deformity, is not easy.

Dr. Wayne Porter, chief of anesthesiology at Children's Hospital in Austin, says that cleft lip and palate surgery poses special problems for an anesthesiologist. Not only are the children young-in the case of cleft lip they may be just three months old-but the anesthesiologist is dealing with the babies' airways. "You're in the middle of their airway, in the back of their throat. You're operating on it. You've got bleeding and swelling, and the airways are not all that normal to start with," he said. The challenge is even greater in El Salvador. While the military hospital is new and modern, it lacks the standard back-up equipment found in good U.S. hospitals. He says, "Everything has to go perfectly in a less than optimal circumstance.... There is very little margin for anything going wrong." Experience is essential: "If I've done tons and tons of children, but I haven't done El Salvadorian lips and palates with their anesthesia, then I'm a novice."

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