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San Francisco Plastic Surgery

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Dr. Roy Kim's Medical Mission with Operation of Hope, Malawi 2012

21
Jun

Map of Malawi, Operation of Hope, Malawi 2012, Dr. Roy Kim

In early June, I flew to Malawi to do cleft lip and palate surgery with Operation of Hope, a charity based in LA.  This was my first trip to Africa, so I was excited to see what it was like.  The blue dot is where we went to-  Blantyre, Malawi, the economic powerhouse of Malawi. 

 

Malawi from the Air. Operation of Hope, Malawi 2012, Dr. Roy Kim

Here’s a view from my flight from Johannesburg to Blantyre.  It was only 2 hours.  Then again, it took me 30 hours to get from San Francisco to Johannesburg, with a connection in London.

Siri, Operation of Hope, Malawi 2012, Dr. Roy Kim

Siri was not much help to me in Blantyre, Malawi

Blantyre Airport Code and Name Tag, Operation of Hope, Malawi 2012, Dr. Roy Kim

The airport code for Chileka International Airport, in Blantyre, is “BLZ”.  Operation of Hope gave me a nice name tag for my time at the hospital.

BEIT Cure Hospital, Operation of Hope, Malawi 2012, Dr. Roy Kim

We operated at the “BEIT Cure Hospital”, which is run by the charity Cure-  www.cure.org.  They do mainly orthopedic surgery there, and were kind enough to host Operation of Hope for a week.

BEIT Cure Hospital Staff, Operation of Hope, Malawi 2012, Dr. Roy Kim

Some of the members of the OR/ operating room staff, at BEIT Cure Hospital in Blantyre.  They were awesome, were really helpful and efficient, and I would totally trust them if I needed surgery there!

 

Surgical Supplies, Operation of Hope, Malawi 2012, Dr. Roy Kim

Here’s a shot of most, but not all, of our surgical supplies.  We had to bring a small truck of stuff in our checked-in luggage from the USA for our surgical trip. 

Screening Day, Operation of Hope, Malawi 2012, Dr. Roy Kim

Let’s get going!  This is screening day, where we met 25 patients, and booked 19 surgical procedures.  Shenazz was our translator, and it was a lot of fun! The 2 official languages in Malawi are Chichewa and Engligh.  All of our patients spoke Chichewa, and spoke very little to no English

Cleft Lip Patient Before Surgery, Malawi 2012, Operation of Hope. before surgery, Dr. Roy Kim

This is an interesting story-  a grandmother brought in her daughter and her grandson.  Both the daughter and the grandson have a unilateral (1-side only) cleft lip.  The daughter’s reaction to her surgery touched me the most. 

 

WARNING- the images in the following pictures show before and after shots of cleft lip patients, and some may consider them graphic.

Of course, to me, it’s only plastic surgery, but you’ve been warned. If you’re squeamish, don’t look at these photos!

 

Cleft Lip Patient After Surgery, Malawi 2012, Operation of Hope, Dr. Roy Kim

Right after her surgery, she looked at herself for the first time in her life with her cleft lip repaired.  Marike, one of the members of our team, is on the left.

 

Cleft Lip Patient After Surgery, Malawi 2012, Operation of Hope, Dr. Roy Kim

This patient actually started crying tears of joy in the recovery area.  I almost started crying too.  The whole story is here-  http://www.drkim.com/2012/06/18/ive-been-guilty-taking-things-granted-my-plastic-surgery-trip-malawi/

Courtney and Esther Recovering a Patient, Operation of Hope, Malawi 2012, Dr. Roy Kim

 Courtney and Esther, our recovery room nurses, are shown here recovering a patient. 

 

Judith and Martha, Operation of Hope, Malawi 2012, Dr. Roy Kim

Judith is on the left, and Martha on the right.  Judith is one of the outstanding ward nurses at the hospital, and Martha is a nurse from Zimbabwe who helped our team in Blantyre.

 

Ketilina, Operation of Hope, Malawi 2012, Dr. Roy Kim

Ketilina is a young girl who has lived her whole life with a right cleft lip.  They’re wearing winter coats, because it’s cold at night.  When we were in Blantyre, it dipped into the 50’s Farenheit at night!

Ketilina, Immediate Pre-op, Operation of Hope, Malawi 2012, Dr. Roy Kim

This is Ketilina, in the operating room, right before surgery.  You can see that her lip does not fully unite.  This is an “incomplete” cleft lip, because there’s still tissue connecting the right and left sides.  Also, note how here right nostril is distorted.  This is very common with cleft lip patients.

 

Ketilina, Immediate Post-Op, Operation of Hope, Malawi 2012, Dr. Roy Kim

This is Ketilina, immediately at the end of her surgery.  I think this is an excellent result.  I have to repair the inside lip, the muscle of the lip, the outside lip, the skin above the mouth going towards her nostril, the nose skin and cartilage itself, and the inside of her nose.  It typically takes me about 1 hour to 1 ½ hours to do this procedure.

 

Kevin and a CRNA intubating a patient, Operation of Hope, Malawi 2012, Dr. Roy Kim

Dr. Kevin Healy was the anesthesiologist for this case.  Here, he’s watching a CRNA intubate a patient.  Or maybe the CRNA is teaching him how to intubate-  I’m not certain.  (Inside joke there).  His blog is at -  http://havelaryngoscopewilltravel.blogspot.com/

Matriarchs of Malawi, Operation of Hope, Malawi 2012, Dr. Roy Kim

These are the matriarchs that ordered me around while I was in Malawi.  From left to right, it’s Marike, Martha, Jennifer, and Kristie.  Marike was our logistics, PR, photographer, and all around nice person.  Martha is a RN from Zimbabwe, and helped us a lot with the hospital staff, logistics, and rounds.  Jennifer is the President of Operation of Hope and our fearless leader.  Kristie is a RN, and took care of supplies, medications, dosage, taking care of patients, recovery, and tons of other stuff.

Mwatyesi, Screening Day, Operation of Hope, Malawi 2012, Dr. Roy Kim

Back to surgery!  Mwatyesi is shown here on screening day with a right cleft lip. 

In general, cleft lip is associated with poor pre-natal nutrition, especially lack of folate.  Also, it is slightly genetic, and is known to run in families.  However, cleft lip tends to be an isolated anomaly, and usually most patients are completely normal in every other way-  development, growth, and everything else. 

Mwatyesi, Screening Day, Operation of Hope, Malawi 2012, Dr. Roy Kim

This is Mwatyesi post op after surgery.  ALL of the families in the hospital ward after surgery insisted on photos with the team members.  It was very touching and moving to be asked to be in their family portraits!

Precious, Operation of Hope, Malawi 2012, Dr. Roy Kim

This is Precious, on screening day, before surgery.  She was our very first patient that we operated on, and had a great result.

Percious, Pre-Op in the OR, Operation of Hope, Malawi 2012, Dr. Roy Kim

This is Precious in the OR, right before her operation.  Note that she has a right incomplete cleft lip, with a decent amount of tissue between the right and left side.  Also, notice that her right nostril is not that distorted.  Cleft lip conditions can vary, so all procedures have to be tailored to the individual patient. 

Precious, Post-op  in the Ward, Operation of Hope, Malawi 2012

This is Precious in the hospital ward after surgery.  She had a great result, probably because her cleft lip wasn’t that bad, she’s an infant and has great healing capacity, and her nutritional status is pretty good-  look at those cute chubby cheeks.

Tsanzo, Screening Day, Operation of Hope, Malawi 2012, Dr. Roy Kim

This was my toughest cleft lip case.  Tsanzo has a central cleft-  note that there is NO tissue in the central lip, underneath his nose.  He actually has a little tissue, but it’s pretty sparse. 

Typically, the fetus develops on the right and left sides of the face, and meets in the middle over time in the womb.  In Tsanzo’s case, the tissue under his nose and in the middle of his lip didn’t quite reach.

Tsanzo, Pre-op in the OR, Operation of Hope, Malawi 2012, Dr. Roy Kim

This is a close up of Tsanzo in the operating room, right before his surgery.  Note the vast amount of missing tissue in the central portion of his lip, and the lack of cartilage in the middle of his nose to support the bridge of his nose.

Tsanzo, Post-Op, in the Ward, Operation of Hope, Malawi 2012, Dr. Roy Kim

Victory!  Tsanzo’s case went smoothly, and his lip is united.  I did some surgery to his nose as well to try to re-shape his cartilage to give him some “bridge of the nose” to correct his lack of tissue. 

I’m glad that Tsazno looks like a cute little boy!  He’s 12 years old, so I can’t imagine what it must have been like before his surgery. 

Tsanzo, Post Op in the Ward, Operation of Hope, Malawi 2012, Dr. Roy Kim

Family portrait of Tsanzo in the hospital ward. 

Pemhiro, Post Op in the Ward, Operation of Hope, Malawi 2012, Dr. Roy Kim

This is Pemphiro, after surgery.  She’s doing great!  Surprisingly, cleft lip surgery actually doesn’t hurt that much after the procedure, so most patients are able to talk and eat pretty quickly.  She has a left nasal stent in, the bit of white gauze that you see on the left.  This is done to reshape the left nostril cartilage to give it a more normal shape.  The stent and the sutures are removed about 1 week after surgery. 

Recovery Room, Operation of Hope, Malawi 2012, Dr. Roy Kim

A little baby with Kristie in the recovery room.  The patients and nurses were wonderful on this trip, and a lot of hugs, snuggles, and gifts were given to all of the patients.

Makes me want to be a patient!

Family Portrait, Operation of Hope, Malawi 2012, Dr. Roy Kim

This is Marike, Pemphiro, and me, in the “family portrait”. 

I really felt that I was honored to be allowed to operate on these patients.  Despite the language and culture barrier, I think that all of the families could tell that we took their pain and surgical problems seriously, and that we would fix them to the highest standards possible. 

Family Portrait, Operation of Hope, Malawi 2012, Dr. Roy Kim

This is Mywatyesi and me, in the “family portrait”. 

Family Portrait, Operation of Hope, Malawi 2012, Dr. Roy Kim

Yikes!  Let’s get the whole extended family in the portraits!  This is Martha, Kevin, Me, Marike, Courtney, and Esther.  Ketilinia is in the front with her Dad.

Family Portrait, Operation of Hope, Malawi 2012, Dr. Roy Kim

This is a baby with bilateral cleft lip.  There’s no way the Mom is going to snuggle her-  Martha snatched her for the extended family portrait!

Prayer in the Operating Theater, Operation of Hope, Malawi 2012, Dr. Roy Kim

BEIT Cure Hospital is run by a Christian organization, and they usually say a prayer after the patient has been intubated, but before the surgical case starts.  Here, Kevin is leading the entire operating room staff in prayer. 

Kuche Kuche, Operation of Hope, Malawi 2012, Dr. Roy Kim

The pride of Malawi-  Kuche Kuche beer!  This was a pretty good anesthetic at the end of the day, after operating for 8 hours.

Lunch in Malawi, Operation of Hope, Malawi 2012, Dr. Roy Kim

Typical food in Malawi.  There’s a variation of Nsime, which is cornmeal.  There’s cabbage, which is a vegetable.  The protein is a fish, and I think it’s a small Chambo, which is a fish indigenous to Lake Malawi.  Chambo is a cousin to Tilapia. 

You are a Blessing, Operation of Hope, Malawi 2012, Dr. Roy Kim

The BEIT Cure Hospital had tons of artwork made by the kids.  Here’s one of my faves-  just to remind you that by merely reading this blog post, YOU are a blessing!

Come Back Soon, Operation of Hope, Malawi 2012, Dr. Roy Kim

So, this is a small slice of the entire surgical output in Malawi.  We operated on 19 patients, so this is sort of the “greatest hits”, but we all had a blast.

If you would like to donate money to Operation of Hope, and probably get a tax deduction as well, just click here-  http://www.operationofhope.org/donate.php

Don’t worry-  more blog posts about food, technology, and me making fun of the team are yet to come!

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