Medical Missions Foundation

Moises' Journey

 The last patient of Monday was a double cleft lip and palate, 2 ½ year-old Moises Antionio Sivala-Vega. Today, he was in the recovery ward with his mother, Ruby Vega-Almengo. His 3 hour surgery placed him in recovery after 9:00 p.m. Mrs. Vega Almengo said they did not return to the ward until after 3:30 a.m. this morning. Their journey has been arduous many times, but Vega-Almengo has been comfortable with the challenge because when Moises was selected, she knew he would be well taken care of. They live in the mountains in Herrera province above Santiago in the village of Los Llanos (the Hills). Moises’ father is a farm hand on a finca owned by someone from Panama City. He tends the cattle and fences. The father is home taking care of a 9 year-old sister, and two brothers, 7 and 5. The family heard about the screening through the local hospital.

Vega-Almengo, her husband and Moises traveled by horseback over the mountains before walking an hour into Santiago to catch the transportation bus for the 2 hour trip to Aguadulce. She packed clothes for the stay   but little else. She had great hope and happiness for her son during Sunday’s re-screening. But the long wait yesterday was trying. Moises was brought from the auberge to the hospital at about 3 p.m. and Vega-Almengo stayed at his bedside all day. She then had a three hour wait after leaving him in the OR atnabout 6:30 p.m. During the day, she cried some and worried about him dying and prayed a lot. But she was calm and confident. Today her worry is more mundane; a change to clean clothes (which are under her cot at the auberge.) Their journey is still arduous, more recovery time here and a reverse bus ride, walk, horseback trip back to Los Llanos.

Manic Monday - The Start of a Busy Week

Breakfast is at 7 AM, bus at 7:30 AM and 8:00 AM work starts - that is the schedule for the week.

Monday’s are always hectic.  “Who is where?”  “I can’t find...”  By lunch time kinks were identified and patients were flowing through four OR’s and two mobile surgery vans.  Several cases were long and involved. Drs. Cusick and Koranda reconstructed two ears from flaps of transeferred skin.  The incidence of microtia or malformed ears, appears to be much greater here than in the U.S.  In the van there was a discussion of the impact of genetics and nutrition on microtia.

In the hospital in Aguadulce, the parents can stay with the children in pre op and recovery. They dress in green scrubs like the OR team and stay with their children until they fall asleep.  This is especially calming for the little ones. Beenie babies help with the fear and tears too.  The long waits were trying at times.  The surgeries lasted until 9:45 PM.  By days end the team completed 8 orthopedic and 20 plastics cases.  All were quite weary.

Sunday - On the Ground

We arrived in Panama about 9:30 Saturday p.m.  After we went through immigration and customs, we were   greeted by Marta Picota, the president of AEP. We then boarded our “trusty 12 passenger van” and drove to downtown Panama City and finally checked into the hotel around midnight.   By 8:30 a.m. we were on our way to the hotel in Peronome, to leave personal luggage.  The trip west along the Pan American Highway took us past teak forests and cane fields for about 2 1/2  hours.  Another 25 minute drive took us to Aguadulce   and the hospital and auberge or dormitory.  Just before we arrived at the hospital, our “trusty van” blew a tire.  We first supervised the situation, documented it, then while Carlos the driver worked in 90 (degree) heat to switch to the spare, we schlepped the supply bags to the emergency entrance. 

 The AEP women have set the dormitory for the children and chaperons in a school.  It is summer vacation time in Panama and the Minister of Health, Franklyn Vergara, arranged for us to have the space, including a large kitchen, for the week.  Drs. Cusick and Koranda checked the plastics patients while Dr. Alejandro Arango rechecked the orthopedics patients.  

Since August, Dr. Arango and teams of AEP women and seven or eight Panamanian doctors have conducted seven screenings all over Panama.  They initially trimmed 300 patients to the 150 children chosen for this mission. They were again trimmed to 125 because some required specialized equipment or were sick at the re-check.  Some traveled by foot for hours before catching a bus to Aguaduce.  All are fed and housed and have a recovery team at the auberge.  

After screenings, we gathered for a team dinner with AEP and the Panamanian doctors.  Arroz con pollo (rice with chicken), ensalata fiesta( beets and potatoes), cerviche (fish salad), puerco (roast pork), and galleta (cookies) and meringues.  Panamanians produce a variety of good ceviche (beer) but no wine at all. On the way home, we drove by Santa Maria la Antigua, in Nota, Cocle.  It is the oldest surviving church in Panama and is nearly 500 years old.  

Small, But Skilled - Team Panama 2010

 The 2010 MMF mission to Panama is small in terms of team members, but large in scope.  Two doctors, one CRNA and four non-medical volunteers are joining for the fourth year with teams in Panama.  The Association de Empmpresaras y Professionales (AEP), group of business and professional women and Panama doctors have been screening patients since August for the surgeries this week.  They have scheduled 127 surgeries in orthopedics, opthomology  and plastics.  The hospital, Dr. Raphael Estivar Regional Hospital, in Aguadulce, Colcle, in Panama is providing the nursing staff and many supplies through Dr. Franklyn Vergara head of the Ministry of Health and the hospital staff.  The new First Lady of Panama, Marta Linares de Maitinelli, has arranged for the transportation of children from all provinces of Panama.

Aguadulce, about three hours west of Panama City is centrally located.  For the fourth time, Drs. Douglas Cusick and Frank Koranda will join a team of plastic surgeons from Panama City to perform cleft palates, scar revisions, ear reconstructions and hand surgeries.  Dr Alejandro Arango of Panama has led the medical effort and will do orthopedic surgeries.  There is a team of pathologists to complete the team. 

Reidun Fuemmeler a CRNA from Colombia, MO will provide anesthesia for Drs. Koranda and Cusick.  She has participated in MMF trips to Guatemala and Romania. Cerner has again generously provided a volunteer from the ReACH program, Allen Latham, sales director for ICU and ED Solutions, who will provide tech support and record keeping.  The Panama mission is truly an Intercambio - a collaborative sharing of effort and ideas. We have all joined together for this "Mission de Amore".

After leaving a freezing cold Kansas City on Saturday morning, we were greeted at ten o'clock p.m. at the Panama airport by a humid 82-degree temperature.  Jackets were traded for short sleeves as we checked into a small hotel in downtown Panama City. Sleep was welcome.