“Una Sonrisa Para Todos” – A Smile For Everyone

by Adrianna Stanley ’18

Hands shaking and mind racing, I took a deep breath and walked through the door.  As my eyes adjusted to the bright overhead lights, I began to take in my surroundings. Metal cabinets filled with gauze, syringes, and vials of medications lined the right wall of the room.  I shivered as I felt a cold breeze coming from the single-unit air conditioner – a stark contrast from the 80 degrees I had felt right before entering.  A rhythmic beeping in the back left corner of the room drew my gaze to a bright blue machine riddled with knobs, tubes, and monitors, all of which were gracefully handled by the pediatric anesthesiologist in the room. I turned my attention to the amazingly courageous and beautiful 4-month-old little boy lying on the somewhat out-of-date operating table in the center of the room.  I thought about Carolina, his mother, who traveled five hours from her village to seek help for her son.  As tears streamed down her face, she hugged me tight, and whispered “God bless you” just as I was about to walk into the operating room.  “Suture please.” I quickly snapped back to reality as the surgeon stared at me in anticipation. “Sutura por favor,” I instantly translated to Dina – our Guatemalan surgical tech who spoke no English.  For the next three hours, I circulated throughout the room, translated and retrieved materials for Dina, discussed the case with our anesthesiologist, and ultimately became entranced by the intricate artistry of the surgical procedure.  It was not until little Jose Miguel was safely awake and in the post-operative care unit that I sat down and thought to myself, “Okay, so that is what it’s like to be in an operating room for the first time.”

Geisel medical student Adrianna Stanley with one of patients and their mother in Guatemala.

Geisel medical student Adrianna Stanley with Antonia and her granddaughter Perla, one of Free to Smile patients in Guatemala.

My trip to Guatemala was a medical immersion experience like no other.  I traveled with Free to Smile – a non-profit organization dedicated to improving the lives of the world’s most underserved children through cleft lip and palate surgeries. As a first-year medical student on the team, I was guided by Dartmouth alumnus, Dr. Frank Virnelli, and asked to help with Spanish translation and any other auxiliary services they may need – whether it was in administration, nursing, dentistry, anesthesia, or surgery.  From the moment we stepped off the plane in Guatemala City, we hit the ground running.  A whirlwind of faces, backgrounds, and professions to keep straight – I’ll admit, I was intimidated at first.  On our team of surgeons, anesthesiologists, dentists, nurses, technicians, assistants, and administrative staff, I was by far the youngest and most inexperienced.  It was not until I started conversing with the locals, meeting our patients and their families, and translating for our team members that I finally felt I could connect with the community, contribute to our team, and truly make a difference.

The week began with triage day.  Stepping into the clinic, we encountered a large group of very scared, nervous, excited, and grateful families.  The vibrant colors of traditional Guatemalan dresses combined with the intricate slings in which the children were carried swiftly caught my attention as we moved through the crowd.  Many of these families had never been to Guatemala City, let alone seen a group of foreign faces before.  Free to Smile works with a local Guatemalan organization called Compañeros Para la Cirugia (Partners for Surgery) that sends health promoters into very rural communities of Guatemala to seek out potential candidates for surgery.  They arrange all accommodations and transport for patients and their families to the city, and they provide post-operative follow-up care and monitoring of patients after our medical team returns to the United States.  On our triage day we screened over fifty pediatric patients for surgical eligibility as well as provided dental consultations for each of their family members.  By the end of the day most of the nervous looks of anticipation that had greeted us in the morning had melted into quite a few toothless grins that really warmed my heart.

Over the next five days, I ran to wherever I was needed or could learn something new.  In the pre-operative care unit, I worked with our nurse to take patient histories and vitals.  With anesthesia, I learned about the process of intubation, inquired about the various anesthetics involved, and even assisted in stabilizing patients during the sedation process.  On the surgical team, I scrubbed in, passed instruments, and am eternally grateful to the surgeons who spent countless hours explaining their techniques to me.  Supporting the nursing team, I had a wide array of roles from circulating in the OR to changing diapers, placing suppositories, and drawing up medications for the patients post-operatively.  Most emotional for me, however, was my role in conducting interviews of patients’ families.  Learning about Carolina’s economic hardships, the lack of nutritional and pre-natal care for Perla’s mother, the community’s heartless reaction to the birth of Maria Jose’s daughter, and the physical abuses rampant in these Guatemalan villages truly broke my heart.  Hearing their stories also made me think critically about the social and economic disparities that lie at the foundation of these medical problems and their role in shaping the way we deliver global health effectively.  I appreciate the work of Free to Smile for their continual presence in Guatemala, their cohesive partnership with local Guatemalan organizations, and their vested interest in improving all aspects of the lives of the underserved.

Ultimately, I am honored to say that over the week we successfully completed 41 surgeries – 12 cleft palate and 29 cleft lip repairs.  The lives of these children will be changed forever, as they now have the capacity to develop their speech normally, go to school without ridicule, grow up with confidence, and bring the option of a better life to their families.  Being a part of this team, connecting with the patients and their families, and reflecting on my own family’s struggles with poverty in Central America has truly reminded me of why I chose to become a physician in the first place – something often forgotten by medical students constantly buried in textbooks and exams.  I look forward to many more global health experiences in the future and a life-long career of giving back to my own underserved Latin American community so that they can achieve the human right to health that they deserve.

A huge thank you to Stacy Henry and the Free to Smile Foundation, Compañeros Para la Cirugia, Dr. Frank Virnelli, Dr. Lisa Adams, Dartmouth’s Center for Health Equity, the Geisel School of Medicine, and everyone on my team for supporting me and providing me with the experience of a lifetime in Guatemala!

Urban Health Scholars Spring Break 2015 – Pt. 6

In March 2015, six medical students in Geisel’s Urban Health Scholars program went to New Orleans for spring break to experience and learn about the city’s challenging and distinct health care delivery system. They are sharing their experiences in several posts here on the Geisel Med Blog. You can find all their posts here.

Shadowing Dr. Jefferey Long at Slidell Memorial Hospital

By: Brendin Beaulieu-Jones ’18

UHS-Nola-6Having been provided an exciting glimpse into the field of organ transplant, half of the group headed to Slidell Memorial Hospital (SMH) in Slidell, Louisiana, about 35 minutes northeast of New Orleans. SMH is a 229-bed acute care community hospital that has been working to enhance the health of the local community for the past 55 years. We were fortunate to be able to spend the afternoon with Dr. William Jeffrey Long, M.D., FACP, FACC, a cardiologist who graduated from Dartmouth College in 1976.

A former U.S. Air Force fighter pilot and physician, Dr. Long has a storied history and was eager to share his experiences and insights with our group. Dr. Long was an interventionalist for many years prior to retiring from the cath lab. Our experience shadowing Dr. Long exposed the different aspects of cardiology, and we were fortunate to have the opportunity to interview and conduct a physical exam on a new patient. It was a fun experience to work collaboratively to apply our On Doc skills to interview the patient and complete a physical exam. Like any good teacher, Dr. Long asked us to present the patient and then challenged us to determine the differential diagnosis.  We also joined Dr. Long on his rounds through the hospital and ICU, which highlighted another component of his work.

In addition, Dr. Long arranged for us to meet with Bill Davis, who serves as SMH’s Chief Executive. Having joined SMH as its CFO in 2001, Davis described how he had helped lead the facility from a precarious financial and operational situation to being a healthcare leader and important resource to the community. It was valuable to hear how Davis responded to an evolving national health care sphere as well as an ever-changing local landscape. In addition, it was valuable to learn how Davis advanced existing health care services and collaborated with community support agencies to prioritize preventative medicine.

The afternoon provided valuable exposure to both cardiology and hospital administration, which opened all of our eyes to new possibilities within health care. We greatly appreciate the time we were able to spend at SMH, and wish we could have accepted Dr. Long’s invitation to search for some alligators on his riverboat in the swamps of Louisiana. Hopefully, the class of 2019 will be able to plan accordingly.

Urban Health Scholars Spring Break 2015 – Pt. 4

In March 2015, six medical students in Geisel’s Urban Health Scholars program went to New Orleans for spring break to experience and learn about the city’s challenging and distinct health care delivery system. They are sharing their experiences in several posts here on the Geisel Med Blog. You can find all their posts here.

Dinner with Dr. Elizabeth Sack

By: Brendin Beaulieu-Jones ’18

On Monday evening, we had the pleasure of having dinner with Dr. Elizabeth Sack, DMS ’10 at Domenica’s restaurant in downtown New Orleans. Dr. Sack recently finished her residency at Tulane University School of Medicine, where she served as chief resident in outpatient pediatrics. We were very excited to hear that Dr. Sack and her husband have since welcomed their first child to their family.

UHS-Nola-4At dinner, we learned that Dr. Sack was selected as a Schweitzer Fellow during her time at Dartmouth. Her project focused on increasing awareness of end-of-life care among medical students and the community. Elizabeth took additional time off during medical school to travel to Lambaréné, Gabon as part of the Schweitzer program, where she served as a junior physician in pediatrics at a primary care clinic. It was wonderful to hear Dr. Sack describe how these experiences enriched her medical training and professional goals.

After spending the past few months with her newborn daughter, Dr. Sack will be joining a private practice outside of New Orleans. Interestingly, the practice serves a majority of patients who are either uninsured or insured through Medicare and/or Medicaid. It was very valuable to learn about Dr. Sack’s residency experience and her process of selecting her first job, as we are all eager to learn about the different possibilities of incorporating our interests in serving vulnerable populations in our future work.

We thank Dr. Sack for making the time to meet with the Urban Health Scholars, and wish her the best as she transitions into her new position.