Lip Service: Orphanage Babies

May 29, 2011 § 1 Comment

Dr. Nichter, last day of making rounds.

I will never forget several of the children and infants I was privileged to care for in Armenia. Many were from the orphanages. Despite the hub-bub of activity and cacophony of background noise including languages foreign to their ear they seem delighted to have stimulation to the otherwise presumably sterile existence in the orphanage they know as home. One 6-month-old baby, Narek Mkrtchian, with a cleft lip was set aside in her plastic baby carrier against the wall. She did not cry but lay still for the moment. Every few minutes she would kick her legs rhythmically to set the carrier rocking for several seconds. Her understated smile seemed to indicate satisfaction as if she was rocked purposefully to soothe her. Her self-surrogate’s actions somehow soothed her loneliness.

2-year-old Nver Grigoryan before surgery

After surgery

Another 2 year old child with a pleasant demeanor was a charmer to all; Blond curly hair, wide cleft lip which became enormous with his frequent smile. His large forehead was from stable hydrocephalus and he was actively engaged in all activities. He reminded me of my nephew when he was young. Though both were too young to understand the significance of their surgeries at the moment, both following their surgeries did not complain of pain. On the contrary, they smiled at us with normal lips for the first time in their lives on morning rounds following their surgeries which must have caused discomfort.

Arzuman after surgery.

Arzuman before surgery.

Arzuman Ghazaryan,a 14 year old boy, with an almost identical brother except for his largevascular benign tumor of his upper lip, a lymphangioma which distorted his upper lip making it huge, unsightly and purplish.  He was brought in to the Operating in clear view of another patient undergoing surgery of her head and neck by our team. Instead of showing distress, he grinned knowing that whatever the physical cost of undergoing surgery he had a shot of being normal again. The surgery only took about 45 minutes to correct the deformity that haunted him lifelong. I spied him looking in a mirror with a satisfied look that evening  on rounds. When he spotted me he smiled and gave me the thumbs up sign and the first look of confidence he has probably experienced and just in time for the tumultuous adolescence period ahead.

I feel so privileged to have played intersected in a meaningful way in their difficult lives and the chance to train qualified surgeons who will now perform this surgery after I have returned home.

Larry Nichter, MD


A great accomplishment

May 28, 2011 § Leave a comment


Our time in Armenia has come to an end. I feel incredibly fortunate to have been a part of the Plasticos group, and I am proud of the work that we have done for the children of Armenia.  We pre-screened over 250 children before we came, and additional 91 in on site. We completed 60 surgeries – all with successful, dramatic results. Although the numbers are impressive, they are not what define the trip for me. The impact that that this mission has had on everyone involved goes beyond numbers.

One of my happiest moments on the trip happened on our last day of post-op clinic, when our doctors made their final check up and recommendations for the children who have had surgery. Zohrab, at 5-year -old boy who had syndactylys on his right hand walked into the room and lay down on the clinic bed.  Now I’ve grown fond of Zohrab, and I know that how talkative, energetic and funny he is – always spitting out 100 (Armenian) words a minute, but whenever doctors are in the room, he tenses up and becomes deathly quiet because – let’s face it – doctors can be pretty intimidating and scary to a child, especially to one who has recently had surgery and whose hand is still healing and hurting. On previous follow-ups with the doctors, he stared wide-eyed with a serious expression that made it look like he was thinking, “What the heck are they going to do to me know?” But on our last day, he did something surprising and utterly adorable: When he got up form the clinic bed, he said – in perfect English – “Thank you.” The entire room cheered and clapped. I nearly died. Then he stood next to his mother and refused to leave the room because he wanted to stay with us.  And earlier that day, when we made rounds to check up on all the children, I couldn’t help but notice all the smiling faces. The children were feeling better and they were beginning to understand what were have done for them.

Linda and Zohrab

It’s always interesting to observe how our group works with the Armenian staff. For some, like Monica, our recovery nurse who is fluent in Armenian, it’s second nature. She was completely in her element, even though this was her first trip with Plasticos. I watched her talk to and comfort mothers before, during and after surgery, care for children post surgery, and interact with the Armenian nurses like she was one of them. To watch her work is to see love, passion and compassion in action. Others, like myself, who have a limited Armenian vocabulary, rely on facial expressions and body language to communicate, but the warmth and love of the Armenian staff were not lost in translation.

Monica in the recovery room

Watching the doctors communicate in surgery is always a learning experience. Aside from operating, the teaching that they do is highly technical, but it is also an art form. They carefully choose their words to communicate a sharing of information, and they ask questions that often require out-of-the-box thinking. And the Armenian staff is highly receptive. In fact, another trip-defining moment for me was watching the incredible work that Dr. Hovakimyan (Armenian Maxillo-Facial Surgeon) did on his first cleft lip surgery.

Dr. Nichter assisting Dr. Hovakimyan in surgery

One of the greatest things about my job on this trip is that I get to see all aspects of the child’s care – from screening, preop, surgery, recovery, follow-ups — I have been there through all of it. I’ve had a great time working with Joanne Horowitz, who has been documenting the trip, and has also seen the entire process of caring for a child who is having surgery. She shared with me a truly moving story. On our third day at the medical center, we screened a 14-year old boy named Arzuman Ghazaryan, who had a lymphangioma in his upper lip. He walked into the screening room ashamed of who he was – and I don’t mean “of the way he looked” but who he was.  It is amazing how, for many children, abnormalities can be thing that defines them. Arzuman had trouble letting himself connect with others; he could not make eye contact with anyone.  A couple days after surgery, he was a completely different person – confident, happy, and actually really funny.  While snapping post-op photos, Joanne said he was ready for the cover of GQ magazine. And I completely agree.

Joanne Horowitz

I leave Armenia not fully recovered from the impact that its people have had on me, but I am proud of the work that our team has accomplished. That we transformed Arzuman’s life is enough for me. But the fact is that we have helped many children – many of whom are orphans, and we leave Armenia confident that the Armenian staff is capable of continuing the types of surgeries we have done during our stay.

Plasticos Team, from left to right: (back row) Dr. Larry Nichter, Linda Nguyen, Rachel Russell, Dr. Annu Sharma, Brenda Drake, Monica Karamian, Irene Landry, Ruth Ann Burns, Dr. Robert Burns, Dr. Mohamad Iravani. (Front row) Dr. Jed Horowitz, Joanne Horowitz, Susi Gertmenian, Dennis Gertmenian, Jessica Bonthius, Dr. Ani Kalfayan.

Linda Nguyen

Trip Coordinator

From our Coordinator and Team Leader

May 28, 2011 § Leave a comment

Dr. Burns carrying Valia to the recovery room.

Our Armenian heritage was a prominent factor in instituting Plasticos’ mission their country. Grandparents on both sides came from eastern Turkey/Armenia over a century ago. Friends and family told us of children placed in state run orphanages because of congenital anomalies. Some had parents, some not. Correction of these abnormalities could result in either return to their families or adoption as we have witnessed.

We have completed 60 surgeries, many on orphans, all successful. The changes have been dramatic. Photos only partially depict the life-changing events we have helped to create.

The Armenian people have been warm, loving and supportive. We feel like family, which we are.

We cannot wait to return to continue what we have started.

Ruth Ann and Dr. Burns

Robert Gertmenian Burns, MD (Team Leader) & Ruth Ann Burns (Trip Coordinator)

A Sucessful Trip All-Around

May 28, 2011 § Leave a comment

Three heads are better than one.

On Thursday afternoon we completed our last surgery.  We did over 60 surgeries on 33 patients. With some patients, our surgeons operated on several parts of the patient’s body at one time.

On Wednesday, our Medical Team tackled their most challenging case which included a series of operations on one patient that lasted 8 hours. Dr. Nichter and Dr. Horowitz had several of  S.t Grigor’s doctors participated in different aspects of the operation.   To my amazement (less than 24 hours latter) I saw this teenage girl walking the hospital hallways!

It is important to note that Plasticos  success is  measured in several ways:
1. How many surgeries completed.
2. How many doctors and nurses are trained.
3. Difficulty of surgery
4. Ability of Plasticos Team members to work with the Hospital staff regardless of their abilities and communication skills.
5. Donation of needed surgical supplies to the Hospital
6. NO Fatalities since ever surgery has a risk factor!

As we prepare to depart  we have had only one post operation complication.  Our team of Doctors reviewed the current circumstances of this patient and  there are no immediate threats to her long term well being.

Finally our team hosted a celebration where we gave out awards to 33 members of the Hospital Team who played critical roles in our over all success. At the same time we donated thousands of dollars of medical supplies to the hospital so they could carry on our work.

The consensus by all is that this has been a more successful trip than we ever thought possible. Plasticos plans to return in approximately 1 year because the need is overwhelming.

Dennis Gertmenian

Team Member

Traveling with Plasticos

May 26, 2011 § 1 Comment

Irene Landry, RN

Working in an OR in a foreign country can be challenging, but is always interesting. Our practices differ, and we have varying ideas of how-limits the OR should be and what one should wear in it. But ultimately, we are there for the patient, and that is what unites us.

The language barrier is one problem we face. We have learned to make “flash cards” with the help of an interpreter for the basic information we need to share: “Is this sterile?” “saline”, “hello, my name is…” etc. Trying to learn each other’s language is fun, and by the end of our stay, we all know a few phrases. An observer remarked that it appeared as if I understood Armenian and my scrub nurse understood English, as she asked me for supplies during the procedure. Even though I didn’t understand a word of what she said, I knew the procedure and what suture was next. Although we don’t speak the same language, we both speak OR. The scrub nurses here in Armenia were top-notch, and by the end of our first day of surgery, they were able to anticipate exactly what came next.

Sterilization of supplies is another consideration. In a modern OR in the US, supplies are readily available and instrument trays can be cleaned and sterilized in a short time. In the countries we visit, this is not always so. Many hospitals do not have conventional autoclaves and sterilize with heat or other methods, which can take much longer. We get creative in stretching our instruments to the last day.

The challenges of doing surgery in foreign lands were many, but they are not worth dwelling upon, because that is not our purpose for being there – we are here for the children and adults who need our services and we love every minute of it.

Armenia is a lovely country, the city of Yerevan very cosmopolitan. The people we have met at St. Grigor’s Medical Center are amazing – never before have I met warmer, a more welcoming of people. As we busily unpacked our supplies on day one, they made us stop for “coffee.” We were then led to the dining room of the hospital, where the table was lad with fruit, pastry, and of course coffee was served. We were overwhelmed, and so touched by their consideration and heartfelt thanks for coming.

The rest of our visit consisted of 12 and 14 – hour days of surgery, clinics and follow-up. Although the days were long, our Armenian nurses were cheerful and worked just as long and hard as we did. Each day, the Armenian doctors and residents became more skilled in the procedures, and at they end of the week, they were doing the surgery with Dr. Horowitz and Dr. Nichter assisting.

And then there are the kids – beautiful, big-eye, children, some of them orphaned, some given up by their parents because they were born with deformities. all of them adorable.  I love seeing them playing in the hospital corridors or being carried by their mothers, especially a day or two after their surgery when you can really see the difference in their smiles. Their parents will sometimes give a nod of thanks, too shy to address us directly, but there is an understanding between us that their child – every child – is special and deserves our best efforts.

Irene Landry, RN

OR Nurse

From our Anesthesiologist

May 26, 2011 § Leave a comment

Ani Kalfayan, MD

What shall I say? Words cannot adequately express my feelings about this mission. It was my first, and it sure will not be my last. Placing my extensive responsibilities at home aside, I left for what would be one of the most memorable experiences of my life.

Our team was formed of members from all walks of life yet we were there with one vision, one heart and one purpose, and that is to make a difference in the lives of children who stood no chance in life to live as dignified human beings, and by the end of our mission, I feel we were able to achieve that goal.

I would like to extend my sincere thanks to the Lazarians and every individual who played a part in making this possible, for no individual’s role was less than the other, We functioned as a healthy body, and I am humbled to be a member such a body.

Ani Kalfayan, MD


Pediatrician’s Perspective

May 26, 2011 § 2 Comments

Dr. Horowitz & Dr. Sharma making morning rounds at St. Grigor Medical Center

A fifteen minute brisk walk in the morning gets us from the hotel to the hospital.  It’s a beautiful day in the city of Yerevan; the weather reminds me of our weather back home.    l get greeted by “ bare luis”, “bare luis “ as I walk in, staff and patients smiling even though I do not understand their language or they mine, we seem to have a special bond as our eyes meet.  Mothers and their babies, some in their arms and some by their side throng the hallway. Each is anxious to be seen. Some fathers pace up and down and press against the doors. These mothers have the same aspirations for their offspring as any other mother in the world. They all wish their children to reach their full potential.

I sit down at my desk to see a child with a cleft lip, then a cleft palate, then both, a syndactyly , some in the hands and some in the feet,  polydactyly, and then badly healed burns with keloids, then worse ones with contractures and then  a series of rare syndromes.   I see a milieu of patients one after the other,  trying to determine their overall health status, respiratory, cardiovascular and nutrition, to see if they would be a safe candidate for Surgery. I feel the mothers’ pain as I turn away some, denying them the chance of being normal like everybody else.   The Armenian Pediatrician from Saint Gregor Lusavorich Medical Center comes in and joins me every day.  She evaluates patients with me, interpreting Armenian at the same time and we look at syndromes and congenital anomalies together, both advocates for children.  Treacher Collins, Pierre Robin , Congenital Familial Ptosis, Phocomelia  were some of the rare cases we spotted.

There are several orphanages in the vicinity that brought in children with cleft lips and palates. These children have uniquely adapted to their environments by developing self-soothing and self-comforting behaviors that are very interesting to observe.  One child in a seat rocker is able to rock herself at will every so often.  These cases are high priority for correction.

A messenger from the operation theater hurries in. The anesthesiologist needs my opinion on a patient’s rash. The patient is ready for induction and he wants to know if it is safe to proceed. On evaluation and taking a short history and physical exam, it appears benign and they are able to proceed with surgery.

15 month old Avdalian had palate surgery and was transferred to the recovery room. He was having a difficult time with breathing. The general surgeon came looking for me in the clinic; they needed me to evaluate this patient. His airway was inflamed after extubation.  He developed stridor and retractions which is upper airway difficulty.  This proved to be a good time to collaborate with the local Pediatricians to see what local injectable and inhalant medications were available. Avdalian was put on inhalation treatments and his oxygen status was maintained.  With the help of our experienced recovery room nurse he was successfully transitioned to the general floor.

A few distraught looking Armenian nurses came up to me.  Vlad a little 4 year old boy on the floor was in very bad pain. He had extensive repairs for post burn keloids.  I ordered  more pain medications so he could be comfortable and had Suzi our helper take crayons, coloring books and toys to do play therapy with him. All was calm but only for a split second…

Then back to clinic ….

Dr. Sharma in clinic.

Annu Sharma, MD


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