"Life consists with wildness. The most alive is the wildest." -Thoreau
I once heard a story about a candle.
Went something like this: The candle knows that by itself it’s just a skinny piece of wax that’s not good for much of anything at all—the truth is that if the candle wants to help anybody, well, it’s going to have to get burned a time or two. It’s got to be willing to let the flame in close, and it’s not pretty. The candle is going to melt. It’s going to get worn and disfigured. It’s going to have to give way to the flame, and in the end, the candle will inevitably be consumed for sake of the light it gave to others.
I thought about melted wax as I looked in the mirror this morning.
Kathmandu is broke.
We drive from our hotel to the hospital in the morning, and most of the buildings look like they’ve been hit with a combination of dynamite and an earthquake. You see entire fronts of apartments just fallen away, and then you see people living inside of them. The place is crowded. There’s something like two and a half million people here and they all are on the streets that are far too narrow to support a city that refuses to stop growing.
Surgery days move pretty fast.
Operation Smile’s “The Journey Home” campaign has provided cleft lip and palate procedures to over 1,200 patients during their most recent missions in the Philippines, and with eight different mission sites happening more or less simultaneously, things go quick.
As a volunteer, you get used to seeing people coming and going. You meet volunteers from every corner of the map coming together for a common good to help as many people as possible. You see family after family whose children with facial deformities find a new sense of happiness when they see their little boy or girl emerge from the recovery room with a freshly closed cleft.
You see this all again and again and the more you see it, the faster it all gets. It seems like you land in some strange country one day, and suddenly your team has done 120 surgeries and you’re headed back to whatever place it is you call home.
Well it starts like this: Robyn and I needed to get from Bohol to Cagayan de Oro.
Of course this sounds simple, but from what I’ve seen nothing about the Philippines is simple as far as travel goes. Trying to get from one place to another is a mess with virtually no exception. None of the airlines jive with each other to link up your flights. The cabbies argue with you when you try to catch a ride to almost anywhere. The jeepneys breakdown in the middle of the road, and the inter-island ferries, well, let’s just say the ferries aren’t exactly a spectacle of seaworthiness.
All the flights that could have gotten us from Bohol to Cagayan were too late in the day, and that means we would have missed post-up checkups entirely. And post-op is important. It’s almost the only chance many of these kids who just received cleft lip or palate surgery have to get any treatment for infections they’ve developed. There are surgeons there giving out amoxicillin to those who need it, nurses who clean and dress crusty incision sites, and Robyn and I document the surgical procedures for future operations and techniques. The problem was we had no way to get there.
Except for the boat.
This place has been a blitz.
I’ve been here a week and just now have the time to sit for longer than a few minutes in one place to catch my thoughts. Getting into the Philippines was one lesson in close calls after another and when I finally I got in country, the sensation of getting kicked around and pushing through never really stopped. I should back up:
There have been only three times in my life I have vomited from physical exhaustion. Once was after one of the best sparring matches I can recall with a man named Adam Palmiotto—which for a lack of a better term I’ll call a mentor. The second was when I was invited to train with Augustana College’s wrestling team during their drive for the national title. The third, of course, was when I was on a Boeing 777 after sprinting across the entire Minneapolis airport with 40 pounds of gear in order to make a flight to Manila.
We screened 231 patients.
As a medical records volunteer, that means I see 231 names in my entry log. I watch them all walk through the doors of Guadalajara’s Institute for Reconstructive Surgery hoping to receive treatment from Operation Smile, and I watch each and every one pass from my desk praying that they would be one of the 116 chosen for surgery.
There’s chart number 21: Age 1 year. Male. Born 4/28/11. Priority 1. Proposed procedure is bilateral nose repair.
Chart number 180: Age 5 years. Male. Born 5/22/07. Priority 4. Not cleared for surgery due to current infection.
All day I sit at the hospital in a wing without air-conditioning and stack red medical charts into piles of those who get surgery and those who don’t. Around me there’s sounds of children scampering around, passing the armed guards in bulletproof vests standing near the building’s entrance. I’m tired from long days working and few hours sleeping. It all turns into this long, stuffy grind and if you’re not careful, the names on the page stop turning into names at all. After a while they’re only numbers that get sorted into different schedules and priorities. Number 152 in this pile. Number 15 in that.
But yesterday I stumbled across a number that I remembered.
Chart number 146.
Ramirez Medina, Lizbeth Guadalupe. Age 13 years. Female. Born 11/6/98. Proposed procedure is lip scar revision and rhinoplasty.
The reason I remembered her was because of all the kids that came through the doors for screening, she stood out among the others. During screening, you see everything: Children with holes in the roofs of their mouths. Two-week-olds with little gaps in their lips where flesh is supposed to be. Babies with clefts in their palate so bad that they cough and sputter whenever their mother tries to feed them because the milk that enters their mouth is forced out through what should be a nose.
But Lizbeth, she was different.
Lizbeth was accompanied by who I can only assume was her grandmother, no mother or father to be seen. She stood behind her grandma and meekly peered at me behind my desk through her pink glasses. Both of her hands were missing their first two digits and her feet fit terribly in her sandals because of the large cleft that ran down the middle of her feet until her ankle. She had marks at the edge of her eyes from a previous surgery, and grotesque scars that ran like crooked white rails from her nose to the edge of her upper lip that was a result of a botched surgery that was intended to fix her bilateral cleft lip.
Her nose, flat.
Her shoulders, thin.
Every part of her seemed to speak of poor nutrition and even lower self-worth. I couldn’t understand why the girl wore glasses if she never looked at anything besides the floor.
After I took her information, her grandmother stood up and thanked me and they went off to continue the screening process with the outcomes department, doctors, and dentists. I remember thinking she would be a likely candidate for surgery because of the work that needed to be done on her lip from whatever previous surgeries she’d had. However, Lizbeth’s chart was sent to the pile marked “Standby,” which more or less means the only way a candidate gets surgery is if one of the cleared patients somehow cancels. As many of the chosen patients come from long distances for the chance to receive treatment from the international team of doctors, few standbys get accepted. I filed her number between numbers 145 and 147 and expected not to see her again.
That was the last of I saw Lizbeth until I was called to the pre-operation ward the following week. Apparently one of the admitted patients had come down with a fever and was unable to have surgery and Lizbeth was called back and they needed her chart. I walked into the room and saw her in a hospital gown sitting on the edge of her bed with mismatched sheets and talking quietly with her grandmother who she called “mama.”
Lizbeth’s grandmother introduced herself as Ruperta, and tears welled in her eyes as she wiped them with her wrinkled hands and explained she’d been taking care of Lizbeth since she was a baby. Her birthmother had abandoned her when she was only one month old and wanted nothing to do with her ever again. No Christmas cards or birthday presents, Lizbeth doesn’t even know what she looks like.
Ruperta took Lizbeth on a bus from their hometown of Culiacan—nearly 10 hours away—and said that Operation Smile was the only chance Lizbeth had for the procedure she needed. The surgery necessary to correct her lip scars and repair her nose would be relatively cheap here in Mexico, but because they are so poor they were unable to afford it. Instead, they took what little money they had to come to Guadalajara and stayed at a shelter with free meals and a place to sleep.
“I know I will not be here to take care of Lizbeth forever,” Ruperta said, “but I want her to be healthy so that someday she will be able to take care of herself.”
But as a 13-year-old girl, Lizbeth just wants to feel normal. She told me she wants to look prettier like other girls. She told me that the “friends” she has at home call her names like “monster face” and “leper lip.”
I looked at her chart and saw that her surgeon, Dr. Victor Ledezma, was one of the best in Guadalajara and assured her she had nothing to worry about. She was scheduled as the last surgery of the day and the sun had long set. She kissed her grandmother and got on the gurney to head to the operating room. She took as deep and heavy a breath as her small frame would allow and I realized that for the first time all mission I’d put a story to a face. Before, all I knew that the number on the chart needed a lip scar revision to fix a previous surgery and a rhinoplasty intended to improve breathing function. Chart 146 was a Priority 4 on standby and not much else.
I didn’t sleep well that night, and I suspect Ruperta didn’t either. For many people, a rhinoplasty is simply a nose job because they don’t like the way their own is a little too rounded instead of being perfectly pointed. They get scar revisions because they don’t like the way that old cut doesn’t let their leg tan evenly when they’ve been laying in the sun. But for Lizbeth, the outcome of her surgery would directly dictate the way her life would unfold. It would change the way she interacted. They way she lived. This relatively simple operation would change the way she took each and every breath.
Today, I woke up early to get to the hospital in time to see Lizbeth before she was discharged. I walked to her room, which she shared with four other patients, and I saw Ruperta standing in the doorway, crying. I turned the corner and understood why. Lizbeth was sitting in bed looking at herself in a mirror for the first time and was crying too. Her nose, while a little swollen from surgery, now had nice round nostrils and a pointed tip. Her lip was revised properly and the muscles realigned so she—for the first time since I’d met her—showed me a smile.
She was beautiful.
Ruperta hugged me and said, “Gracias a dios” over and over and then went and hugged the doctors and everyone else in her general vicinity until Lizbeth told her to help her get her clothes on so they could go home. She moved close to Lizbeth and told her very quietly, “You are beautiful, just like I always knew you always were.”
The last I saw of the two was them holding hands as they walked out the front doors of the hospital toward the bus station to Culiacan, and it was then that I started to realize that even though I’d been on other missions with Operation Smile, each one is new and unexpected and that if you’re willing, they’ll change the very fabric in the quality of life throughout the world.
This is not just some late night 1-800 sob story ad on TV looking for your pennies.
This is not just some processing of people for a greater cause.
This is Carlos Benitez, a four-year-old boy who loves wearing plastic vampire teeth to scare his brothers when he plays tag.
This is Samuel Saldivas, a kid with more knowledge about Ninja Turtles than is generally expected of someone who’s six and is immovably convinced he’s learned how to become one.
This is Lizabeth Ramirez, a teenager who wants to go to school to be a secretary when she grows up in order to take care of her grandmother.
And so when you get it—when the name on the chart stops being just a number but a child with hopes and a future—then you start to understand that what these kids actually receive during surgery isn’t just a closed palate or a corrected fistula. What they actually get is a chance.
And that is something you’ll never be able to put a number on.
I sometimes begin to worry that I’m becoming jaded, at least around these parts. The streets of Guadalajara look like the streets of Chinandega look like the streets of Guatemala City except with fewer shotguns. The crumbling streets of one could just as well be the crumbling streets of another. Street vendors hocking pirated DVDs. Crooked politicians smiling on billboards. It all seems the same, and even though the name of the town has changed, nothing else has.
Robyn and I landed in here in Mexico and started the first days of screening for the Operation Smile mission in Guadalajara. Started the day tired and only thinking of the job. Still working for the medical records department. It is a constant processing. Patients and their families come to my station and get their name stamped in a record log, then over to Robyn to get pictures taken for research, then off to get weighed, measured, assessed, examined, poked, prodded, checked and rechecked, and then told to wait until after the other 230 patients have been screened to see if they will be selected for surgery. This mission they’re hoping to perform surgery on 100.
If you’re not careful it turns into a grind, these screening days. Pretty soon you stop seeing the clefts at all. The scars on the faces from previous surgeries. The wide holes in the roofs of young children’s mouths. The 2-week-old infants with little gaps of nothing where their upper lip is supposed to be. Some smile. Some cry. Some play with their brothers and sisters and some just sleep in their parent’s arms.
But for some reason today the desperation of the situation here hit good and hard just the way it should have. As I flip through the charts and write down information from the 230 people that passed through screening that say they’ve traveled for 8 or 10 or 12 or 48 hours to get to a rundown hospital in central Guadalajara, it occurs to me that this is the only chance these parents have to help their kids. It is, after all, a unique sort of love that causes a parent to endure long rides in dirty buses that are crammed beyond capacity and stuffed with the hanging scent of body odor in the Mexican heat only to stay in shelters step up the the in-country medical organizations here.
And still only half will receive treatment.
We finished screening today and tomorrow the surgeons will announce which patients will be eligible for surgery. Many will receive help and the majority of patients who will are so young that the only real memory they’ll have of their cleft lip is a small scar that runs from their nose to the edge of their mouth. But there are many who will return home on long stuffy bus rides with medical issues that are still very much unsettled. They’ll still have difficulty eating and will be cast as freaks and those parents who put so much effort in getting their children to Guadalajara for this mission will be turned away with nothing more than some antibiotics and nutritional advice to help their child reach a healthy enough condition to receive surgery.
It is with that understanding that one comes to realize that nothing is the same. There isn’t just a simple processing of humans from one station to the next, and this isn’t just some gig that punches a time card where you watch for the clock to tick past 5 o’clock. Each entry in my log book today was a different testament to the concept of hope, and one that is not to be undermined or accepted as commonplace.
The second you forget the things that make you breathe is the second you forsake your humanity and turn to stone. When you forget why you do the work you do, then you’ve already quit. Find a new job. When you look at your partner and forget the reason you fell for them is the moment you’ve forgotten them in your life. This day—as always—is only an opportunity. We can choose to be turned into stone and grind out a life void of challenge or we can take each morning we open our eyes as a true awakening and see that there are so many stories in the world.
So many people and things that need tending. So many reasons to see that the world is a wild, wild place and should be curiously explored as such.
Back in the States.
There’s always that strange reeling sensation of walking through the polished concourses of Houston International, past all the neatly folded “USA” T-shirts in the gift shops, the overdose of dining options, the phone charging stations, and the LCD screens running ads about airport security. There is a foreignness here, and I cannot help but think that the place Robyn and I have just been with the dirty floors and the trash-filled ditches makes much more sense than my point of entry into America.
The Nicaraguans are slow, and I say that with a considerable amount of envy. It’s not that they are a brainless people. It’s not that they are somehow lesser humans because the vast majority don’t have three flat screens in their houses, Roth IRAs, or couldn’t tell you where the nearest touchless carwash is. They are slow in the sense that the pace at which they live is deliberate. They are some of the most genuine people I have known. Some of the most devoted parents and careful thinkers. They smile because there’s no reason not to, which is more than many of us can say.
There are plenty of problems there to be sure. Inadequate health care. Governmental corruption. The capital is a dangerous city at night in the wrong neighborhoods and there are plenty of children who fall asleep unfed. But when you think about it that’s really not too different than what we’ve got here in the States. We just have central air and more asphalt.
I think that one of the worst things anybody could do is feel sorry for the people of Nicaragua, feel that somehow by being an American that I am innately the one administering aid to poor foreigners in need. In the end, I was just as in need as they were and they were just as capable of healing me as I was of them. It is possible that I may have contributed some small part to helping those people, but it is certain that they put my head back on my shoulders. It’s too easy to drive my nice car in my nice neighborhood to my nice grocery store in my nice clothes and forget that I am as frail as anyone else. A place like Nicaragua makes you humble if you let it. Reminds you that people are at the center of it all. Sounds idyllic, I know, but something about it has to be true.
It doesn’t mean we have to abandon our high tech hospital systems of adopt a Nicaraguan or Guatemalan or Spanish or Moroccan or Italian or English style of living. All it means is that we have to be open to the ride. The wilder the better. These days it’s only the weird who survive, because rigidity is only fear that will snap under pressure. The more willing we are to jostled around by the experience other people have to teach us, the less frightening the world becomes, or at the very least you have a better understanding of the things that are actually worth being afraid of. When you take the time to understand the bits of the world around you the boogeymen start to disappear, and in their wake stands a new generation—equally as bizarre, thank God, but not no longer fearful of the shadows. Plenty of problems out there to be tackled, but I shudder to think of our certain failure if we meet them with old tactics and rigid thinking.
The world is changing, and as I stand the moving sidewalks in this hulking metal leviathan of an airport looking at all the dirt under my fingernails, I can’t help but think that somewhere along the line after sinking my head into all of this that maybe I did too.
Today was the last day of surgeries. Of the 192 that got screened, 109 received surgery. Not bad shakes for doing it all in four and a half days.
Robyn and I are both tired, as is the rest of the team and they were all great. Even through they came in from all corners of the globe: Iceland, Egypt, Scotland, Nicaragua, The States, Canada, they all managed to come together and do some incredible things.
The conditions in which we worked were certainly less than savory by most sterilized U.S. standards. The hospital was rundown and cracking, and the flies that zipped around the operating rooms were shooed out by the anesthesiologists so they wouldn’t land on the patients or surgical equipment. Trash was scattered about the courtyard area, which was more or less just a dirt space filled with dying trees. And trash. Air conditioning was hard to come by, and the rooms that were reeked of freon and mold. The recovery rooms were crowded and stuffy, the days were long, but people made due. Because the important thing here isn’t that we were sore from working in cramped spaces or trying to keep our paperwork from sliding off the tilted tables, but because in a world that often looks like it’s falling apart we were actually doing something good. Something worthwhile.
I’ve heard a lot of people say that you should live every day like it’s your last, and from what I can tell that’s all just one big smelly load. If everybody lived every day like it was their last then we’d all be speeding down interstates in Maseratis and squeezing every last drip out of our credit line on every swan song guilty pleasure the mind could conceive. One of the best pieces of advice I’ve ever got is that instead of spending every day like it’s you last you should at the very least make every day worthwhile. Doing something besides wasting our time on things that will eventually yield nothing in return.
All I am looking for is a chance to eventually die without having to think “God. I wish I would have ________.” It’s not that I’m scared of dying without any stories or scars. Maybe more than anything I just want a chance to participate in something more important than myself. Lord knows I could use some humbling. This mission isn’t going to change the world. Our actions won’t sway elections or global policy. But these 109 people have new smiles, and most of them are so young that they will grow up and not even remember a time they had a facial deformity. Certainly won’t remember my name or anyone else on this team. What Op Smile did for those 109 people will not change the world, but it was at least something. And that’s a start.