Hear the description of our service and our 2007 China Mission.

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Another of our desired goals for an operation like this is to not only provide cleft lip and palate repair, but to also interact with our colleagues to providing an educational experience. It’s naïve to assume that our surgical colleagues lack the necessary skills to perform these operations and that we can “show them” the “right way” to do the operation.

In fact, many of them are accomplished surgeons, and the reasons they might not routinely perform reparative cleft operation has little to do with their skills, experience and available facilities. For these and many other reasons, we encourage the local surgeons to become more involved with our effort – this not only helps engender a more collegial training atmosphere, but ultimately benefits our patients as well.

The challenge is that some of our Chinese colleagues aren’t fluent in English (and we’re certainly not anywhere near conversant in Mandarin, or Cantonese) and so rely on interpreters to guide us while they or we assist during surgery. Not surprising, when you operate with colleagues as experienced as they, you realize the unspoken language of surgery needs no interpreters and procedure move along fluidly…. . It transcends the approach of “we’re doing something for you, because you aren’t able” to become “we’re doing something together because we both are able and have a common goal”…

Ask any surgeon: “is it possible to perform safe surgery without “good” anesthesia?”. The answer is: NO. When I discuss these types of missions with the anesthesiologists back home, I tell them of the great anesthesiologists I have the pleasure working with.

Whether they’re academic or private office or surgicenter based, I know I can trust them and work with them as team members. None of that nail-biting (mine) wake up and extubation – especially in those post-op palatoplasty patients. They all have a great understanding of the pediatric airway and anesthesia and share my enthusiasm and concern with our patient’s welfare. I hope I have earned their respect and friendship as much as I do theirs.

During the last week of August, the Governor of Shandong Province paid us a visit. Of course, the hospital was all a buzz, and the governor arrived with the usual contingent of press corps and bodyguards. He toured the Operation Sunrise ward, visiting ALL the patients and their families, asking questions about where they’re from, etc. – all what you might expect from a visiting guv. I’ve seen a few of this type of visit during previous surgical missions, and this format is essentially the same. This time however it was different.

While I can’t say I understood all the translation of his words, the governor showed very palpable warmth towards the families of our patients. Through his questioning, I learned that at least one of our patients was from a farming community at least 60 miles away and took nearly 5 hours transportation to the hospital. While on “Governor rounds”, Tim and I acted through an interpreter asking questions and sharing our feelings about the goals of the mission. At one point, Ann thoughtfully introduced David as the surgeon of one of the patients – the look on the mother’s eyes when she learned exactly whom the surgeon was who brought new life to her child was priceless. Moments like these cannot be put to words.

I could write volumes about how well team members worked. While I spent most of my time in the operating room – with some time in the recovery room and on ward rounds, I’d have to say that this was one of the best groups with whom I’ve ever worked. It’s the kind of situation where everything is working so well (of course with the occasional tweaks needed to improve efficiency) that don’t know just how well it’s working. It amazes me how, never having worked with my scrub nurse Sue, she was able to learn not only the sequence of a cleft lip and palate operation, but also all my idiosyncrasies. Together we kept refining our “game plan”, with Sue half joking, “there’s still room for improvement” so that even on the last two days of the mission, we improved the efficiency of our work – things as seemingly insignificant as the room set up (i.e. OR instrument stand table relationship, etc.). I’m lucky to have worked with her – she’s one of those persons that as a surgeon you can always rely upon to make any given operation run smoothly.

For the first few days in the OR, things are a bit disorganized – all to be expected after making such a long trip and setting up in a room where you often wonder if there will be a regular source of electricity. Everyone takes responsibility for their own role and takes the initiative to “cover the gaps” in service. I’ve thought long about how it is that such a disparate group of people, some never having worked together, are able with a minimum of time be able to coordinate such a complex set of events. Justin (surgeon from Australia) and I agreed that by definition, all team members want to be there and will do the best “to make it work” and that there’s really no consciousness of “it’s not my job” or failure to take initiative, learn new skills, etc. I often think of how the same sentiment could be instilled in my co-workers back home.

I guess as much as any one person can create a supportive work environment, it’s really up to the individual to make it happen and no amount of incentive/coercion can ultimately drive this to effectively happen.

Missions like this run on so much “behind the scenes activity”, that it’s often easy to overlook and give credit where it’s due. Sure, it’s easy to see the tangible results of great surgery and superlative patient outcomes as a result of quality nursing, but less obvious and underestimated are the important contributions by support staff. Every time I went to the ward to check on patients, I was greatly impressed with the work done by Elaine, Val, Heather, Rosie, Ann – Elaine who I first met in the Hong Kong airport even before the mission began as she was busily working on the patient database, and preoperative screening forms. Quietly working on the ward, Elaine orchestrated tracking vital patient information. Many others like her, especially our nursing staff in all sectors of the mission, created the safe, efficient working environment that’s remains our primary goal. The same goes for all the administrative staff and their assistants. Somehow they appeared out of nowhere whenever we needed supplies or had some vital question that needed to be answered. I could go on and on mentioning names, and I know I’m forgetting to mention a few (sorry !), but I would like to say a very special thanks to Walter, Washington (thanks for the diagrams !), Anita and Brianna, Hong Mei, Jackie, Penney, and the others, who without these people, we clearly couldn’t function in any meaningful, patient safe and centered way.

Linyi People’s Hospital is much larger than I imagined. Because there were no readily available Internet hospital images, I anticipated an institution that might have been smaller in scale. In fact, the hospital is a 2000 (as in two thousand) bed, state of the art facility. Since we were in the “older” part of the hospital, it wasn’t until the formal opening day ceremony that I realized the full size grandeur of the hospital. The images from this ceremony show you the towering atrium extending up to five or more floors from a polished marble foyer. All departments have well-organized signage and while I haven’t directly seen it, I suspect that the hospital (like others in China I’ve visited) is “wired” – using with credit card like patient ID cards and electronic medical records issued to inpatients and outpatients alike. As someone with this interest, Id like to have a long conversation with someone in the hospital IT department to see if this is the case, how records are stored, what their concerns are for privacy, etc. A cross-cultural analysis of sorts. We may have much to learn from them.

The separation of OR and hospital ward doesn’t permit much time with the patients and families pre and postoperatively. While I can easily fulfill the morning obligation of making rounds, it’s all the more difficult to drop into the ward to chat with other team members, see how I might be able to help, answer questions, and spend some time with the families and patients. If the OR and ward were closer, this wouldn’t be the case. One of the unfortunate aspects of this arrangement is that you can’t spend long amounts of time learning from the families of where they’re from what their expectations are of the surgery, how they feel about us, their thoughts about this type of mission, etc. I’d love to learn more about them, much as I do my patients back home. It not only adds a new dimension to the work I do, but adds to the magical bond between physicians and patient/family. Otherwise, it sometimes feels like just “doing surgery” (which for all it’s artistic and technical aspects, is admittedly what many of us crave). I’m lucky that our ward team has a passion for the patient and family relationship. Through this they can provide a technical level of care well balanced by an abundance of personal supportive care. I can see also how for many ward-based team members share this sentiment – like when I witnessed Sharon sharing a very emotional moment with one of the mothers in the preoperative holding area. When I see and feel this, I know that so much of what we do back home in our medical practices is so mechanical, and while the ultimate goal of superior patient care is realized, I wonder if somehow we couldn’t provide just that much more in the way of “care”. Maybe it’s easier for us here in China as we’re not being distracted with the myriad phone calls and mundane activity of calling the pharmacies, insurance companies, etc.

Each day consists of rising early for the 6:30 AM breakfast and then off to the hospital for a hopeful first incision time of 8:30 AM. Patients who were screened on our first day are either kept on the ward the hospital so generously provided to us. Thus far, we’ve had little problem with parents maintaining their children NPO (prior to surgery nothing to) for 6 hours prior to surgery.

While a minor geographical inconvenience, patients are housed on a ward apart from the main hospital, but only a minute or two walk away. From this ward, the patients are then escorted to the main hospital, and then up the elevator to the OR. We’re we provided with 4 very modern operating rooms, outfitted with ample storage space, good lighting and local nursing assistants who have been very helpful in providing all manner of support.

Each surgeon has between three and four cases per day with the case mix of cleft lip and/or palate. On this trip, there are a significant number of cleft palates (both in- and complete) and only scant few more cleft lips. Since the full functionality of a cleft palate repair should usually be performed before 12 – 18 months of age, it doesn’t really do the patient much good to perform the repair for the children greater than 4 years of age. Furthermore, some of these palates would subsequently require additional more extensive or adjunctive surgical procedures, palatal obturators with long term follow up and speech therapy, so that attempting to repair these palates would be only marginally successful.

It’s disheartening to both patients and families to travel so far and not be able to provide the gift of a palatal repair. It’s even more difficult to explain through an interpreter why it’s not in the patient’s best interest to surgically repair the defect and that an obturator is probably a better option. Like other experiences gained from a mission like this, one realizes (again) the uncontrollable limitations imposed on your ideal of how things should work – often just like what happens at home.

While I thought I’d be able to add to this blog on a daily basis, it turned out not to be the case. First, reliable Internet access was near impossible, with the hotel server being only able to allow brief periods of connection, between competing guests. Finally on day three after our arrival, the Riverside Holiday Hotel IT specialist, the elusive “Mr. Go”, was able to get us a (semi) reliable network connection – I had to manually reassign the IP address every 15 minutes or so – quite a problem when you’re trying to FTP files to a website! Following that, by the time we finished with surgery, rounding and returning to the hotel, it was all I could do to finish resizing, re-labeling and then uploading images, before reviewing the next day’s schedule – making notes for future improvements, etc. before collapsing on my 5’2” bed (I’m 6’4” – Ha!).

I will begin however by saying that by all measures, the Operation Sunrise 2007 China Mission was a clear success. Any more words beyond that are just icing on the cake, and the blog that follows only hopes to give greater depth to our daily mission life and to thank those who made this success possible. I know that I’ll never be able to thank each and everyone of those that participated in the mission, so please accept my most sincere thanks to all of you, even if you’re not directly mentioned in this blog. I encourage our members to submit to me your thoughts about the mission, and I’ll post them on this site. Through this, the mission will go on for as long as we add to it, and hopefully will merge with other Operation Sunrise future missions.

After the 15+ hours flight from Chicago, we landed in Hong Kong. Leaving Chicago wasn’t as painful as in the past – something I attribute at least in part to taking the upgrade to Business Class. This afforded us direct passage to the oversized baggage section we were checked in quickly and without delay and then onto a sympathetic TSA inspection. Because we pack three large footlocker sized bags filled with medical equipment (cautery unit, suction machine, three full sets of surgical instruments, gloves, gowns, masks, shoe covers, scrubs, electrical transformers and connectors, etc. etc.) it’s desirable to have these inspected in our presence so that the trunks can be not only locked but duct taped closed on both ends. TSA goes out of their way to accommodate us and allows the additional taping at the end of their inspection (even thought the trunks were subsequently opened elsewhere in the depths of O’Hare and re-inspected – but not re-taped, oh well). Each trunk weights about 70 pounds, so we’re carrying a total of about 350 lbs of medical equipment as well a small amount of personal effects. Going to the gym pays off here as you get a workout lifting these trunks on and off the trolleys in each of the three airports prior to our final destination. I consider myself lucky however, as the San Francisco team manages a collective 40 + trunks containing all other medical supplies that comprise our complete mobile operating room.

After arriving in Hong Kong, we spent the night in the Regal Airport Hotel which, in connects directly to the airport proper and made for a flawless transition. The hotel may have been a bit pricey, but the convenience was well worth it after the long haul and with the abundance of luggage. Moreover, the hotel offers many amenities making for a very pleasant overnight stay – a club lounge with a wonderful breakfast overlooking the South China Sea and staff who define the phrase “superlative service”. We reunited with some of our colleagues (others arrived 2 days later) and spent the night discussing the planned mission, defining logistic details, and taking the tine to get reacquainted as many of us had not seen each other since the 2005 China Mission. That night Tim (our founder), Peter (Director of Anesthesia for Operation Sunrise), Heather and I had a light dinner in the hotel – after beginning our time honored regimen of daily Peptobismol tabs (which Craig contends that the CDC recommends taking 6 (!) tablets daily to prevent routine traveler’s diarrhea).

The following day, we boarded DragonAir to Qingdao after other group members met us in the airport (who had just arrived from both San Francisco and Australia). After a brief reunion, we then boarded the 2 hour flight to Qingdao and after clearing customs (without any problem whatsoever), loaded the bus to our final destination of Linyi City – about three hours bus ride to the northeast. So far:
Chicago – Hong Kong – 15 hours
Hong Kong – Qingdao 2 hours
Qingdao – Linyi City 3 hours
TOTAL: 20+ hours in transit (can you say “jet lag”)

After the 3-hour bus to Linyi City, we checked into the Riverside Holiday Hotel and quickly off loaded personal belongings. Walter designed specially colored tags that differentiated medical supplies from personal belongings, so that the medical supplies could be taken directly to the hospital the very same day. After arriving at the hotel and following a brief check in, we proceeded to the hospital to set up the operating room.