“All you need is faith and trust and a little bit of pixie dust!” ~ Peter Pan

The need is great here in El Salvador, but there are only so many patients the Austin Smiles surgeons can squeeze into the four very long days of surgery this week. Most of the spots are allocated on Sunday to the families who are fortunate enough to both know that the Mission Team is coming and have the ability to get to the hospital that day.   As the week continues, word spreads and more parents arrive hoping a child can be evaluated and assisted. Amazingly, no patient is ever simply turned away. Each patient is evaluated and some kind of guidance, support or intervention is provided by the team of specialists including surgeons, a dentist, and a speech pathologist.

Tiny baby Katherine is a patient who arrived early Monday morning with her mother and father, who hoped that Austin Smiles could repair her serious cleft lip and palate. Although she is two months old, Katherine looks like a newborn She is frail, pale and weighs only 9 lbs. The Austin Smiles triage team, Dr. Quint Barnes and Laura Guerrero, learn that Katherine was born premature with an underlying heart condition that will require surgical intervention (scheduled for October).

Katherine needs surgery to repair her cleft lip and palate, but she is so weak and tiny that surgery this week would be too risky. She must grow and become stronger before any type of surgery, but that too is a challenge. The severity of her cleft lip and palate keep her from developing suction to nurse and make feeding a difficult exercise, one which is complicated by her heart condition because Katherine fatigues easily while trying to nurse. The conditions for which Katherine needs surgery are keeping are preventing her from gaining weight and growing stronger.

_-2

Nurse Practicioner Laura Guerrero examines Katherine

They turn to dentist Dr. Tom Sentz, who addresses the frequent dental needs of patients with cleft lips and palates. Tom believes he can create a tiny feeding palatal obturator (a prosthesis to cover the opening in Katherine’s palate) to seal the cleft when Katherine is nursing. Ideally, this will improve the efficiency of Katherine nursing by adding pressure. Tom is optimistic that by improving her feeding efficiency with the help of this device, Katherine can grow and become stronger before her heart surgery.

On Tuesday, Tom welcomes Katherine to his makeshift “workshop” tucked in the corner of the OR area and sets to work to precisely fit the obturator. Alternating between his tools and his delicate patient, Tom is an artist at work – assessing, measuring, forming, fitting, and refining his tiny masterpiece. Creating a device for such a tiny space, the obturator must be fitted to cover the palate, but not to obstruct Katherine’s breathing. As Dr. Tom works, Katherine’s mother leans over her with the refrain of “Mi amor” until the work is complete.

With the assistance of speech pathologist Alisa Baron, Katherine’s parents learn to place it in her mouth. With hugs and words of thanks, Katherine’s parents depart. We say adios with great hope and faith that Katherine will return next June strong and healthy for surgery with the Austin Smiles team.