May 26, 2011 § 2 Comments
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 ….
Annu Sharma, MD