Mission Accomplished

Well, this was one amazing opportunity and something I will remember forever. Our final "unofficial" tally was 144 surgeries / smiling faces. It is difficult to explain the sense of gratification one feels after completing an Operation Smile mission. Performing cleft lip (and palate) repair is the most gratifying surgery I have performed as a plastic surgery resident. And to be able to perform this surgery on less fortunate patients and see their immense happiness is something I will always cherish. I was amazed to meet and work with fantastic individuals both in the operating room and outside the medical environment. We have bonded over such an incredible and intense experience that I know we'll be friends for life. The opportunity to see the world, perform gratifying surgery, and meet amazing people is what I call "living the life." I cannot wait to go on another mission and relive such an experience again.

Postoperative rounds....mothers and babies waiting for us.

Nightlife in Fes.

Kia, the most amazing mission coordinator!

Dr. Bellamine, a Moroccan (Casablanca) plastic surgeon, demonstrating his cleft lip repair to me.

Our mentors. (Clint, Dr. Bellamine, myself, Dr. Kelly)

The infamous Chowara tannery. Medieval style leather making at its best. (Foreground- mint to mask the decaying flesh/ammonia smell)

It wouldn't be a true Moroccon experience without some rug shop shots.

Proof that I have conquered Fes' medina.

Fes Gastronomy

My indoctrination into Fes cuisine was splendid...it's a multi-ethnic history of the landscape. The Berber influence (indigenous people of North Africa) is noted by the use of tagines and couscous. There's also a Roman influence with the use of ceramic for cooking. Arab influences brought spices from the East-- cinammon, nutmeg, tumeric, ginger. Even Jewish influences are noticed with preserved vegetables and fruit dotted throughout the medina. Most dishes always combine some form of sweet and savory flavor profile that when you eat once or twice taste well, but even with my adventurous eating style I had palate exhaustion.

Enjoying a great Moroccan dinner.

Enjoying the view of the medina from Les Merinides Hotel.

 

The Imperial Room where we had a fantastic Moroccan dinner.

 

Myself doing preoperative marking for a cleft lip repair

My preoperative moment with the Operation Smile Morocco poster child, Khalid before we operated on his cleft lip.

The Official Operation Smile Blog

Fleur and Veronica have put together an amazing blog with great pictures and "tug on the heart strings" stories that sound much better than my blog rendition. If you'd like to see the patients we're treating check out this link:

http://www.operationsmile.org/living_proof/from-the-field/2011/fes-morocco-april.html

The Hidden City

The more time I spend in Fes, the more it remains a hidden city to me. We take a bus the the hospital each morning where we view high windowless walls and narrowed passages flowing with Arabic scripts, unidentifiable to us outsiders. At the hospital gates, many men are hooded and many women veiled holding their child waiting for their surgery. Each morning we round on the patients we operated on the day before and only then do we really discover their profound happiness and excitement.  The mother's lie in their bed holding their child. We get to witness the child's happiness when they look at their new smile. The families are so thankful to all of us and despite the language barrier we know their appreciation and that drives us to keep on operating the rest of the week.

An "enchanted labyrinth sheltered from time," was the assessment of the writer Paul Bowles, whose book, "The Sheltering Sky," has introduced me into the Moroccan world. He states that Fes speaks in symbols. There are buried meanings in the patterns of hand-knotted carpets; in the tattooed faces of Berber peasant women; in the swirls of carved plaster in its architecture; in the techniques of expert craftsman; in the ingredients of its cuisine. The latter being my favorite way of learning the culture (stay tuned in a later posting).

We are fortunate to have several peace corp volunteers who have spent the last 2 years in Morocco being our guide/instructor/interpreters. They tell us the secret to figuring out Fes is called the rule of five. This sacred number threads through daily life. Five calls to prayer. There are five pillars of Islam to observe. Each neighborhood had five main institutions-- a mosque, a school, a shared fountain (for water), a communal bread oven and a hammam (i.e. spa/bath). Even the designs on the buildings follow this rule.

Bryn, our amazing circulator nurse.

Entrance into the hospital.

Our operating room. Each room houses two tables. We have a total of 7 tables running each day. 5 general anesthesia and 2 local anesthesia tables.

Dr. Michael Kelly from Miami Plastic Surgery. One of the 4 plastic surgeons we operate with on this mission. He was trained under Dr. Millard, the god-father of cleft lip surgery.

Mothers waiting in the waiting room.

Fes' Medina and First Operating Day

We finished a fantastic day of operating....our tally for the week is 184 cases. I can't post the patient pictures but all of my 4 cases turned out really well barring some minor anesthesia problems. It's really late here in Fes, so I'm going to be brief and hopefully chat more tomorrow. However I'll post some of my Bourdain-style medina pics and today's Operation Smile approved pictures.

Ma'assalama (Go In Peace)

Bab Abi Lgeonad: Entrance into the medina (11th century)

Camel head for lunch?

It seems that Moroccans have Joel Robuchon beat with the "organ meat" fad.  From left to right--pigeon sausage, camel kidneys, camel tongue, followed by unknown animal lung (hanging on the wall and on platter)

Rare shot of Coke Donkey sponser. You had to watch out or they would run you over due to narrow alleys and aggressive drivers (who made you pay for the picture...if you're caught.)

My other partner in crime....Clinton getting to do his own case. Both of us did our own cases with supervision from US and Moroccan surgeons. I wasn't able to get a picture of myself operating.

The daily congregation around the "board." Julie, our charge nurse, the slanted hat rules the OR thrown...nicely.

Second Pre-screening Day

We were back at it again screening another 120+ (total 300+) patients. The flow of patients went smooth and effortless. Most of the patients were operative candidates with the exception of a few patients that were determined too difficult to perform in a "mission setting." They had severe airway issues or congenital heart problems associated with their specific syndromes and will end of having their surgeries at local hospitals within the area with the Moroccan plastic surgeons associated with our mission. Conjointly many volunteers prepared the operating rooms, recovery rooms, and patient wards for Monday's operating day. Meanwhile the patients that have been pre-screened are staying in local riads tonight awaiting tomorrow's announcement of whether they get to have surgery. Sadly, only 30-50% of patients we pre-screened meet the priority status to get their operation this coming week. The remainder will stay within the Operation Smile system and local Moroccan missions and eventually get their surgery later.

Tomorrow is the "team day off." The team organized a guided tour/lunch in Meknes (one hour away from Fes), the third ancient walled city of Morocco. A tour of Fes' medina (ancient walled city), markets and local festival are in store tomorrow. Hopefully an "Anthony Bourdain- No Resevervations style" food and cultural experience will be the blog topic tomorrow?!!

Operation Smile "Team Surgeon" pausing for photo break

First Pre-Screening

The first day of screening went well. It was initially seemed like organized chaos, but somehow everything married into a well-oiled machine cranking out 153 patients both very young and old. There are two surgeon stations staffed by the Opsmile US surgeons with assistance from the Moroccan observers. My co-regan fellow, Clinton, and I evaluated several straight forward cleft lip and palates plus several children with Tessier clefts, Pierre Robin sequence. One particular patient traveled 8 hours via camel and will be posted this week for her bilateral lip repair...she was ecstatic and teared when we assured her we would be able to fix her lip. This is just one of the many stories I experienced today. Our stations provide a unique mix of training from Europe, Italy, and the classic US surgeons who trained under Dr. Millard. Each patient provides a discussion of 2 to 3 different, and equally effective means to fix the defect equaling a fantastic learning experience. Tomorrow will be another pre-screening day with another predicted 250 patients. Stay tuned....

This is the Hospital that graciously shut down for the week for us to perform all our surgeries.

 Operation Smile- Morocco banner that is posted all of the country attracting the majority of patients.

 Operation Smile Regan fellows: Clinton (Brown University), Alladin (Morocco Plastic Surgeon), and myself

 Entrance into the medina (old Fes) adjacent to our hospital.