There will be two teams, each of which will perform four surgeries a day, Monday to Friday. That's 80 surgeries in two weeks. The surgeons set up a screening clinic in a ward with peeling paint the color of iceberg lettuce: The astonishingly energetic 75-year-old Dr. Joe sets the pace for Lisa Buckmiller, MD, a 41-year-old ear, nose, and throat surgeon from Arkansas Children's Hospital in Little Rock. They wear headlamps that look like miner's lights to assess the children, asking them to repeat words like "cake" and "papa" (because k's and p' s test the palate). In the United States, Lisa explains, clefts are often recognized on a prenatal ultrasound and are routinely repaired in infancy. The human face is formed out of three plates that meet in the middle. The ridges above your upper lip are actually the scars left when the tissues join together in the first trimester of pregnancy; a cleft lip results when that fusion doesn't take place. During the same period of gestation, the tongue drops down, and the two segments of the palate "zipper up." A cleft palate is the result of a chink in that zipper. A lot of these children are older than most cleft patients in the United States but look tiny for their age—both poverty and the mechanical difficulty of swallowing has left them malnourished.
It's the job of 56-year-old anesthesiologist Patti Kymer, MD, to clear each child for surgery. She was a cocktail waitress in Colorado when she decided to go to medical school ("I thought I might as well do something with my good grades"), but it wasn't until she specialized in treating children that she found her calling. It's easy to see how well suited she is to caring for young patients and their nervous parents. "I'm going to make sure he's asleep and doesn't feel anything," she reassures the mother of one little boy. "We'll take good care of him, but he'll be mad when he wakes up." Sometimes the parents are crushed to learn that their child is too small or too sick for surgery. A common criterion is the "rule of 10": The child should be at least 10 weeks old, weigh at least 10 pounds, and have a hemoglobin (the protein in red blood cells that carries oxygen from the lungs to the body's tissues) of at least 10. Patti's got a stethoscope and a blood oxygen monitor that fits on the toe, finger, or ear. But with the limitations of language and equipment, she admits, "we're kind of winging it."
Plus she has to rely on a cadre of willing but unskilled volunteers, including two other members of Jennifer Trubenbach's family: 18-year-old daughter Mari, a high school senior, and 48-year-old sister Teryn Bonime, a real estate agent in Portland, Oregon. And then there's me—we're the amateur "info-structure" of this crew, taking histories of the potential patients, often grabbing a passerby who can translate from Shona to English. I'm rather intimidated about getting an accurate body weight since it's an important guideline for administering anesthesia and medicine. But after a while, we're all performing tasks we'd never dreamed of, like mixing powdered amoxicillin with exactly 74 milliliters of water to make a pediatric dose of antibiotics. The modus operandi is the classic role-up-your-sleeves motto: Do what's needed.