Presentation

We're planning a presentation Sunday, March 27th at 1:30 pm at Federated Church for anyone interested. There will be lots of pictures, stories and question and answer period for the community. This is to give a big "Thank you" to everyone who supported us!
Dean and Carolyn are presenting at the Methodist church for the missions committee, March 20 along with another presentation about a medical mission to Jamaica. NN

Team pictures

Chana before 2010, After 2011

I was very happy to see Chana, whose cleft I did last year. She came in for a picture.

Pictures

I've spent the last few days flooded with thoughts about the mission to Puerto Cabezas. I appreciate all the followers and comments and am sorry about those who tried to comment, but couldn't. Somehow the blog makes it tricky to post comments, but some of you managed to make it through the mazes. We're all home, back to work and regrouping. I've spent many hours already looking through the pictures (about 3,000 combined). I thought I'd post a few of the clefts. They make the biggest visible lifechanging statement, although we did a lot of surgery that is of great benefit, but not so obvious on the surface. We worked 14 hrs a day on average and were all pushed to our limit. I don't believe they've ever had a team do as much surgery. All the members worked incredibly hard, each with their own gift. The surgical crew included Dean and Sandra (PC) with anesthesia, Sue T. and Connie M. scrubbing. Kevin (CA) and Keveta circulating, Dr. Morin and Ashley in clinic doing lumps, bumps and misc, Carolyn and Rene (CA) on instruments, John & Karl on handyman crew, Melissa, Sarah & Suzie (CA) in pre and post op, Peggy in pharmacy, Jerry, Linda and Tami in ministry. Dr. Taylor (PC) and Dr. Salas (PC) were on hand to help in many ways as well as the PC nursing staff, anesthesia and scrub techs. I can't thank them all enough. NN

Home to Columbus!

Yes, as Dean said earlier, we are home! After many days of cold showers, boy, did a hot bath feel good!! Again, what a trip! Lots of sadness in Nicaragua. So heartbreaking to see all those people and especially the children, in such miserable conditions. You'll never see any more beautiful children (except for my grandkids!!!) anywhere and it just breaks your heart knowing that their future holds very little promise of anything better than what they have now. We saw newborn babies born during the week with birth defects, one that needed immediate recusitation after birth, another 2 month old who, up till now, had only been fed Kool-Aid and rice water and still looked like a preemie and was probably going to die soon without better nourishment, and on and on and on. Friday evening when we were finished at the hospital and were packing totes to leave the hospital, we saw a group of young men bringing a casket in to pick up a body of a young man who had just died from AIDS. Earlier in the day, we saw a newborn baby delivered by C-section. As Sue said this afternoon at the airport in Houston, we saw the full circle of life that day. As was the case last year, there are soooo many stories. It's a very humbling experience to work down there and see how people live in other parts of the world. It truly makes a person recognize how much we have and how lucky we are to live where we do. It was a pleasure to work with all the people on our team as well as the members of the California team. Here's hoping for safe travels for the rest of our team as well as the California group. Thank you to all who have followed our blogs and for your prayers.

Made it home

I am happy to report that the Atheys and the Tillinghasts have returned to the great state of Nebraska however the totes with the surgical instruments have not. I am sorry that I have not blogged more. The surgical schedule left me exausted and I chose sleep over blogging. We spent last night at the hotel across from the airport in Managua with Karl and Sue. It was great to spend some time relaxing after a very long week. The hotel is nice and the showers were hot. I am still quite tired but I feel our time was well spent and we were able to provide care to a large number of people that otherwise would not have received it. I want to thank all of you for your thoughts and prayers during our time in Nicaragua. The need in this area is just huge.
Dean Athey

Finished

We are all exhausted, but finished with a very busy week. I don´t have any pictures I can post right now because internet is limited, but thought I´d put in some statistics.
Surgery with General Anesthetics- 53, includes 4 cleft lips, 2 cleft palates, 17 tonsils, thyroids, nasal masses, etc, etc, etc.
Local Anesthetic procedures by Dr. Morin - 50
Clinic patients on the first Saturday - 87 (NMN), 130 (PM)
Clinic patients during the week in Dr. Morin´s clinic -75
We figured we averaged 14 hr days.
The last day is always bittersweet since we all go our ways and we say goodbye to the missionary´s in Puerto Cabezas and the California team members that we worked with.
No words or even pictures can truly describe all we did and saw, the people we met, the trials, heat and many struggles we went through. We appreciate all your prayers and interest and will be glad to tell all the stories you care to listen to when we see you at home. NN

worm

Our lady with the trach threw up a 8-10 INCH WORM!! Will try to send picture! Mike, you will understand when I say "There are NO words!" to describe this experience! I got to scrub on a 6 hour neck case with a Nicaraguan doctor and both of our doctors--amazing!! Connie
Pictures- Suzie holding the worm. Cleft bath. NN

Greetings from Nicaragua

Hello to all my family and friends-can not believe we are starting our last day of surgery. It has been hot!!! It has been really hard work! But oh my how rewarding. Thanks for all your thoughts and prayers they have lifted us up. XOX to M and J, K,L, and OT. SUE

Post op cleft, Washing our clothes for us

Wednesday surgery

Late night

There is an adventure at every turn.
We had a difficult thyroid, neck dissection, 6 hours that we started at 6 pm and needed a tracheotomy at the end. I had good help with Dr. Salas and Dr. Morin. It's really interesting to operate w/ another surgeon, especially from another country. We ended up putting in a tracheotomy and Dean rigged up an oxygen system in the ICU. The nurses there looked worried that we weren't all staying the night. By 2 am we were out by the ER entrance looking for a taxi to get home and the ER nurse saw us, so called the Ambulancia to take us home for free. It's only a few minutes away. Dr. Morin has been doing all kinds of interesting ditzels, scar revisions, etc. and we are both working with the med students who are enthusiastic and very interested in everything.
We have more to do today once again than we can possibly do, so I'm going to offer some to Dr. Salas. Dr. Morin offered to open, take a look and decide it's inoperable, then close and give the bad news to the family.
The cleft child from last year showed up hoping to get her palate done and looked as good as I could ever have dreamed (considering I spent the last year worrying that her lip got infected, fell apart or healed badly).
Dean is the best anestetist you could want and Connie and Sue are the best scrubs I could have. Lionell is teaching me instrument names in Spanish. We are all healthy, but tired.
Everyone is working their heads off. NN

Sink

I put the scrub sink on to point out the two faucets on the sink on the right. The silver faucet is from the hospital tank. When the tank is empty for the day, the water is done. The red faucet is the sterile (?) water from condensation off the AC. There's a little stash of that. Yesterday it was all gone by the end of the day. I brought my own soap and left it by the sink. Today I'm bringing more. John and Karl got a toilet seat for us and put in lights in the hallway. Among many other fixit things from their 'honey do' list in the recovery room. NN

Pictures

Tuesday

I was all reaady to admit that it wasn't as hot as I claimed after John and Karl fixed the AC in the OR on Monday. Something happened to the condenser and there were actual flames outside apparently. All we noticed was a smell that I hoped was freon going to work, but was actually the condenser blowing up. Somehow Dean came up with a temperature around 100F, then add in gowns and overhead lights and a 2 hour cleft. I got a wet hand towel around my neck, then later this special cooler padded wrap Karl brought from Linweld. It worked reasonable well and soaked my shirt, but still......
We had more to do yesterday than we could get done. An 89 yo w/ a malignant melanoma. I'm bringing a bit back because pathology has to go to Managua and won't be back for a month. Tell Dr. Lacey. Today are 2 thyroids. Don't tell Sandy, but I'm not going to mark the site. So far I haven't written and op note or clinic note or any note of any kind except for my own cleft notes. It might catch up with me, but so far it doesn't seem like anyone has noticed. NN

The long day

Sorry I hit enter rather than tab. Those killer weekends on call at home don't seem quite as long now. They have a new Dept. of Health regulation that there is to be two anesthesia providers in the OR at all times so no sitting in the Recovery Room getting fanned by our Pharmacy Tech. Peggy. When I get back I want to here no whining about how hot the OR is. This makes the summer temps in the old hospital OR seem down right frigid. We were able to serve a lot of people and that is what this is all about and now we know we can do it in what ever conditions we find. No trouble sleeping last night and now back to work. We hope all is well at home. Stay warm, we are.
Dean Athey

BUSY Day!!!

Hi, friends & family!
What a long day. I was in the first crew to come back at 7:30. The rest just got back a little bit ago just before 9:00. Lots of surgeries. AC off all day and there were a few rain showers during the day. Hot & humid! (Not complaining though!!!) Had a short tour through the hospital and saw several departments we hadn't seen last year. Lots of sadness but fortunately we also have seen several improvements. One big improvement that was very noticeable was that there was a lot less garbage strewn around the grounds. I didn't see the buckskin horse yet from last year but the vultures are still circling! Have a good night and there will be other posts to follow. We're doing great!! Carolyn

Karl - Feb. 8

It is 8:00 and there are still 6 or 8 at the hospital. John and I had a great day - we didnt get sick and are having an exhausting time at the hospital. We are having trouble with the air conditioner at the hospital in the OR. It is old rusty and is not set up right in the first place and no one can find the breaker so we unhook the live wires at the air conditioner. Safe!!!! The opeating room is 80 or 90 and is wearing the OR staff out. We have been busy with fans- doors - suction machines - water faucets - washing machines - lights - and what ever else they ask us to look at plus being the gophers for the team.
This trip and team is so good. We are getting alot of good work done with more to come. We have a plan for the AC tomorrow so wish us well.
Thank you all for all your kind thoughts and prayers.
Have seen alot of the town on our supply runs around town and it is an eye opener but everyone is so appreciative and helpful even with the language barrier.
Thanks again for all your support. Love Karl

Cleft, forehead

The mole was too big to take off completely, but I got about 3/4 of it. The child is 3.

Monday, Surgery

We rode to the hospital, about 10 minutes, in the back of the truck. It reminds me of my days on the farm. We had a wild first day in surgery. 6 tonsils, a cleft, a gigantic forehead mole, 1 tonsil bleed. It turns out the cleft had already been repaired by Operation Smile in Granada last Oct, but got infected and fell apart, but mom didn't tell us because she was afraid they would get turned away. I kept commenting he looked like he had surgical scars, but I was reassured it hadn't. At any rate enough tissue had been removed so things didn't match up as well as they should have, but I did my best and now we all have to prey it doesn't get infected and fall apart again. If it could happen to Operation Smile, it could happen to me. A girl showed up, 16 with a wide... very wide open cleft palate and waited all day hoping we could do it yesterday, but we couldn't, so she is coming back today. I don't thing I can get the whole thing closed, but again will do my best.
We are giving away our sewing kits the 4-H kids made.
They are a real hit. The gowns the Federated women made are perfect. The mother of the cleft baby had the shirt on her back, no place to stay, no money and no food. We're keeping the baby (and mom) in the hospital so they have food and a place to stay. We've got bags of rice, beans and powdered milk to give her when they leave.
They have a rule to feed babys by cup at 2 months of age since they don't wash the nipples on bottles, but they they feed them Kool Aid and rice milk so the little ones can be extremely malnourished.

February 8th

Buenos Dias de Nicaragua! This trip has been amazing, just like we experienced last year. Yesterday we mainly worked with children, so I was in heaven. Working with all of these lovely spirits that want help and are willing to do anything for it, blows me away. Yesterday I believe Nila was able to do 10 or 11 surguries....it was a loooong day. It's wonderful to decompress in the evenings. The hospitality at Pastor Earl's is top notch! We are eating breakfast now and headed out for another long, wonderful day. Thanks to all of you who are thinking and praying for us!

Adios!
Melissa

Clinic

Today's cleft, forehead, hauling stuff to hospital

Ready to go

We organized at the hospital and are as prepared as we can be.
Today I have 6 tonsils, a large black forehead hairy nevus to partially remove, a nasal mass and a cleft in a child 1 1/2. I'll see if I can get pictures on.
The "uprising" was a local political party (?) who shut down the ferry about 1 1/2 hrs toward Managua from here. The truck with our totes couldn't cross so guys in dugout canoes (who belong to the ferry blockers) can then carry your stuff across in many trips and make some money. We sent a truck from our side with John and Karl so they brought it back. The totes got here a few hours late, but that's all. They are protesting the government.
We all smell strangely of bug spray. The heat hasn't been as bad as I remember, but they OR air conditioner wasn't working yesterday. John and Karl are on that detail and putting a window in the OR door, and on the hunt for a toilet seat for the OR bathroom. :) Can't wait! NN

Monday AM

Up early to see the first group off to the hospital (Carolyn is in the first crew). We spent time at the hospital yesterday to prepare for today. I feel much more organized than last trip. We will be much busier than last year. We have about twice as many cases scheduled and that is before WALK-INS. Either I am getting used to them or the airways we saw in clinic are not near as scary as last year. The weather is great. We have been getting good sleep and are very well fed. Pray for us as we start to do our surgical procedures. The uprising is of a peaceful nature and does not affect us at all. It is more of a strike than uprising so do not worry.
Dean Athey

Hello, faamily & friends back home! We have a little down time till we start packing up to take totes to the hospital. Nice to be back and recognize people from last year. We have been very busy since we arrived. The visit to the dump in Managua was undescribable. You can't imagine thousnds of people live in such conditions in a community. Pictures will surely follow for you to see.

In just a year, we have seen so many improvements here at Pastor Earl's compound where we are staying. From our houses to the orphanage. That is truly a blessing for them.

Clinic yesterday was interesting. I joined the ranks of "pharmacist" in the Athey family now. Move over Dave & Paul!!! Hundreds of people came through yesterday and there will be lots of work this week at the hospital. Medical students were at the clinic observing all day. I was so happy to see several girls as students. They obviously have goals and will have such an improved lifestyle compared to most of the women we see here.

Hope the weather has improved for everyone from when we left. It certainly improved for us once we arrived. Time to go! Keep us in your prayers.
Carolyn Athey

Getting the totes across country

There was a local uprising along the road from Managua to Puerto Cabezas, and at a point in the road, there is a ferry. The ferry was shut down by the locals, so the totes had to be canoed across the river. This was on Friday/Saturday. Karl and I went with some locals from Puerto Cabezas to get them on Saturday.

Showing totes at Omaha airport and then after they made them over the river. Continental Airlines does not check them all the way, for obvious reasons. :-)

Doing fine otherwise, everything actually made it, and we are getting ready for surgery tomorrow.

John

Clinic pictures

Clinic

It was an incredibly busy day. Melissa finally got here!!! Woo Hoo!!! We put her right to work. We (Dr. Morin and I) saw 200+ patients in the clinic and turned away I don't know how many. We don't have an exact count, but we've amazing nurses and others helping. There were 100 in line at 6:30 am for good reason. Those last in line were too late to get surgery so they are on the waiting list and can come to the hospital to check on Wed or Thursday OR they can take a paper to be first in line next year. There were only a few of the worried well. Clefts, huge thyroids, nasal masses, ear deformities, lots of tonsils for me. I'm not sure what all Dr. Morin saw, but also not many worried well. The food is delicious, the weather hot, but not unbearable and it rained on us on our way home, so could almost be called cool now at 7:30 pm. I used more Spanish than I've ever known and had some good medical students who taught me how to say sneeze, lymph not and hyperthyroid. I'll post some pictures of clinic, etc. NN

La Chureka in Managua

Puerto Cabezas, Day 1, Friday

We made it to PC after getting up at 4 am. We took the 6 am flight and got here w/o any trouble. We had a GREAT breakfast w/ the usual fresh fruit, then later lunch after getting our rooms organized. Rice and beans w/ plantains. We went to Jeff & Chris' new home across the street for delicious ice cream and to cool off a little. We're totally pitted out now after spending the afternoon sorting through all the supplies they have stored here. Our own supplies are supposed to arrive by pickup early in the morning. We sorted out stuff for our clinic in the morning. We expect 100-200 patients. That's a wild guess only.
Yesterday afternoon in Managua we toured La Chureka (the dump). I will try to post pictures, but even that doesn't really explain it. You can only get the full effect w/ the smoke wafting by continuously. There was a guy w/ a fractured femur and an external fixation device on in one of the homes in the dump. Dr. Cimple will have to look at the picture. If I can't load pictures now, we will later. We have limited access to the internet, but will try to blog every day.
Keep in mind .... it is HOT HOT HOT. But not hot enough to wish we were back home just yet. NN

Arrival

We arrived on time in Managua and sailed through customs. The only problem is that Melissa´s flight got cancelled and we don´t know when she will arrive in Managua. We toured La Chureka and Villa Esperanza. We had a great supper tonight and are really tired, so going to bed soon. NN

Travel

We are leaving early Thursday morning from Omaha. Since there is a raging blizzard across the midwest Melissa's flight was cancelled from NYC to meet us in Omaha. She is now headed straight to Managua and will get there about 6 hours later than us, but will still travel with us to Puerto Cabezas. There are patients there who have already been waiting 2-3 weeks. NN