Day 4 of Surgery: A Shift in the "Routine"

There will be no pictures with this post. I just can't do it.

The first few days of surgeries were more or less what we expected: cleft lips and cleft palates. These surgeries are major game-changers for the patients. In the U.S. we do not see a lot of these cases. If they occur, the babies are repaired right away and don’t live years with the problems that come with the deformities.

For those who do not know, a cleft palate is a split down the roof of your mouth. Run your tongue across the roof of your mouth and imagine a large gap there. This causes significant breathing and speaking problems for patients; for infants, it makes it difficult to breastfeed and often these babies are undernourished and underweight. A cleft lip is when there is a split from the nose down through the lip; often in the U.S. this is referred to as a hair lip. For these patients, speech is a problem also but more times than not they are mocked for looking different; in some cultures they are hidden away as the deformity is considered shameful for the family.

With the more “routine” surgeries behind us Day 4 of surgery took an interesting turn. I had seen a number of burn patients during the pre-clinic but honestly it was such chaos I did not have the time to fully take in the extensive nature of each case that approached my desk and what each situation meant for the patient.

As we checked in the patients for the morning on this day, it was clear that the surgeries would be vastly different. As the patients stepped forward I began to take in their realities: a 6-year-old boy with one side of his head missing hair where he had been badly burned. The scars followed down the right side of his face across his chest and down both arms. He had fallen into a fire. They were going to revise a scar by performing a skin graft (removing healthy skin from another area of his body and putting it on his face).

A 31-year-old man with fingers crumpled up into claws burns and burn scars everywhere from the neck down. His total disfigured body he kept covered with a blanket probably from embarrassment and/or to keep people staring. We didn’t know his story or why he was this way, only that he had been like this for more than 10 years. He was getting his foot released from a contracture (when the scar heals in a way that the foot is left in an unnatural flexed position).

Then there were several women with a variety of facial, neck, body and limb burns – all supposedly from "kitchen accidents." While none of them will speak of it openly with us, it is known that in several of these cases that we saw today and the many we will see on other days are pre-meditated and motivated. As I studied the faces of each of these women and see their grateful attempts at eye contact and smiles at me, I wondered what could have motivated another human being to inflict such pain on them. Upon asking more questions of the translators and my team mates, who have seen these kinds of situations before, I was told that family members will soak one’s clothing in kerosene and set them on fire or push them into a stove when they have displeased or shamed their husbands or families. It’s hard to imagine doing this to someone you love. And what results is nothing less than tragic.

If you want to feel for a moment what some of these women are living with try this: hold your chin to your chest and try and do any normal activity for two minutes. Forget Zumba or yoga. Some women are raising children and running a household like this. Then flex both feet upwards so only your heels touch the floor and walk to the mailbox and back for a few minutes of another person's experience. Just try it. Finally, fold your arm in half (forearm to bicep) and hold your hand into a fist (don't allow your fingers to move) and try and wash the car or clean the house or go grocery shopping.

Just basics are so hard for these people and the scarring is very hard to look at. So much so that I could not bring myself to take pictures of these people and treat them as if they are some kind novelty. It’s just one more potential embarrassment or a reminder of how bad they look, and I won’t be part of that. You'll just have to use your imaginations and multiply it by ten to get an idea of just how bad it is.

The mission has changed. And it's breaking my heart.