2/16/11 Tata

The second mission was different then the first, but went well. I hear in total between the two missions, 509 surgeries were completed. I think Minh and I interviewed close to 200 of them. The power would go out mid-surgery and even one operating table was shut down due to this gastroenteritis thing that was going around. Recovery room set up a “power nap” station for those who needed to rest. Minh and I were back there one morning. Otherwise, things went smoothly. Minh and I had a good system going to integrate ourselves within the mission structure. We also took over Stephanie’s speech project she worked on developing with the speech therapists. We arrive early in the morning and interview those we didn’t get a chance to the day before a few hours before their surgeries. In the afternoon we interview those arriving for surgery the following day. Our goal for each operating day was 25. Also, patients were coming for one week follow-up. We surveyed them about surgical satisfaction and their overall experience at Op Smile for internal evaluation. On top of all of that, we interview those patients over 7 with cleft palate before surgery about how speech has effected their lives and take speech recordings. The team wants to investigate whether cleft palate surgery actually improves speech if the patient is over 7 because there’s debate if it does or not and whether surgery is worth it. The other option would be an obturator, which is a molded piece to cover the palate. So they will do follow-up speech recordings at 6 months and speech therapists will see.

The research meeting went really well with Alex, Carolina and Justin. Stephanie, Minh and I found a lot of great articles and have some good ideas. I was reading that basically not much work has been done in establishing “normal” growth curves and measurement of malnourishment. WHO completed one, but Indians aren’t “normal” compared to that curve and I think it’s because their phenotype is just on average smaller either due to diet, environment, genetics or a combination. So first, some type of growth curve will need to be established in Assam using anthropometric measures (body measurement ratios). Ultimately Alex and his team want to be able to define which patients are too malnourished and at too high of risk for surgical complications so that Op Smile can treat them until they’re ready. Currently, Gary (team doctor), Alison (mission coordinator) and Reza are working on malnourished patient cases. They subjectively target patients who come in for screening that are too small and record their information for follow-up. Meanwhile, they’re given nourishment packages. The problem with cleft lip/palate babies is they can’t create a suction to the breast so aren’t breastfeeding the first 6 months of life which is vital for substantial nourishment especially in some of the impoverished situations these families come from.

During post-op, Minh and I will collect the data from the first few pages of every single patient’s charge whom we interviewed with our survey, which ended up being about 208. This is a great sample for a study! We may have to throw a few out and will use some for validity testing. I also re-interviewed some patients for reliability testing with the test/retest method. This will help our study’s credibility. I hope we can produce strong results, even if they’re only qualitative.

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