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First-year medical student Adrianna Stanley writes about her experience working with the Free to Smile Foundation in Guatemala, where the group helped to put smiles on the faces of many children and their families.

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 I turned my attention to the amazingly courageous and beautiful 4-month-old little boy lying on the somewhat out-of-date operating table in the center of the room.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!

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During his surgery clerkship, Inyang Udo-Inyang ('16) finds that learning a new field of medicine can be like learning a new language.

By Inyang Udo-Inyang

"How many of you have experienced moving to a new culture?” I sheepishly delayed raising my hand until I saw most of the hands in the room were up.

Chris Navas, Inyang Udo-Inyang, and Khushboo Jhala
Inyang Udo-Inyang (center) with his fellow medical students Chris Navas and Khushboo Jhala.

I was joined by 13 other classmates seated in one of the conference rooms at DHMC. The air in the room was filled with excitement and nervous energy. Today was our first day on surgery, our orientation. Fresh off our board exams, we would finally be on the front lines. Taking care of patients. The very thing we had come to medical school to do.

Dr. Andrew Crockett, co-director of the surgery clerkship was explaining what the next eight weeks were going to look like. “You are now joining a new culture, one where we speak a completely different language. One you are going to have to learn to speak.” Anyone who has had the unfortunate pleasure of learning a foreign language is all too familiar with the beginning painful phases of hand-waving and facial contortion that occur before becoming comfortable with said language. True to his analogy, my initial foray into surgery would be much like assimilating into a foreign culture.

I had been assigned to my first choice, the orthopaedic surgery department. On my first day, I walked into the operating room (OR) with an almost unhealthy amount of enthusiasm, primed to take on whatever task I was assigned, only to find that everyone and everything in the OR already had a very specific role. The OR was a well-oiled machine with seamlessly moving parts, and I stuck out like a sore thumb (no thanks to my 6’ 7” frame).

As most people eventually discover in the process of integrating into a new environment, the acceptance and guidance of the “locals" is essential to feeling comfortable in the new surroundings. That has certainly held true in my four-week journey in orthopaedics. The residents whom I got a chance to work and interact with have been unbelievable. They fashioned an inviting environment of support, teaching, and mentorship replete with extensive suturing sessions, World Cup games, evening barbecues, lessons on spondylolisthesis, and much more.

It would be very remiss of me not to mention the incredible amount of help and support I have received from the nurses, from guiding my wandering attempts touse a Foley catheter to helping untangle me from my OR gown (yes, it happened), they have been very gracious and kind.

In the meantime, I have become enthralled with the world of orthopaedics and eagerly await the next time I can submerse myself in this new culture. With these kinds of people in my new environment and a whole career ahead of me, I have no doubt I will settle into this environment just fine.

Inyang Udo-Inyang ('16) is a medical student at Geisel and a member of the Urban Health Scholars. He is originally from Lagos, Nigeria, and graduated from Oberlin College in 2012, where he majored in biochemistry. Read all posts by him here.