Thursday, October 31, 2013

The COTA Stork

Baby boomers remember the classic story about a stork, and its amazing ability to deliver infants to households wishing to expand their numbers. This large mythical bird had the strength to carry a full-term infant in its beak no less, flying endless miles to safely deposit a healthy and smiling infant into caring maternal and arms.
We are all wiser now about how babies make their way into the world, but you may not realize how complicated it is when the "COTA stork" network gets involved in bringing a sick baby to the United States for donated surgery. Here is baby B's story.

Surgery site being examined by COTA nurse Barb, 9/12
Born with a closed rectum, B. had a rare and complicated birth defect that required an emergency colostomy. While this surgery saved her life, the surgical intervention needed to allow her to pass stool correctly was not available in Guatemala. Her parents did the best they could to manage her bowel issues. Without running water, access to further medical care or colostomy bags, maintaining B's health care needs was a challenge that they were unable to meet. The parents were concerned about the future of their daughter, since the current surgical site was becoming too narrow for stool to pass through, the skin was breaking down around the surgery site and they were finding it more difficult to manage hygiene problems without colostomy bags.
Fate put three COTA volunteer nurses in B's village in September of 2012. Word that the American nurses were visiting the mountain traveled up a long path to Baby B's parents, and they quickly brought her down. Her abdomen was wrapped in rags to contain her stool, but the baby was well loved and cared for. On that rainy, cool day in the Guatemalan  mountains, B's parents made the decision to trust Children of the Americas to network donated care in the U.S. for their baby.

If only it were that easy. Here is what had to fall into place for the "COTA stork" to start travel.

1. Foster parents willing to host this baby for 6-12 months had to be found. Bev and Warren Brandwine, long term COTA volunteers from New Jersey, quickly stepped forward. Before feeling 100% comfortable sending her baby to the U.S., baby B's mom wanted to meet Bev and Warren, which she did in January of this year. The baby cried, mom smiled. All was good.


Mama and baby meet foster parents, 1/13

2. A pediatric surgeon who specialized in this complex surgical repair had to be found, he had to agree to do the surgery free of charge and he had to secure paperwork from his office stating he would do so.
3. Repeat # 2 for a hospital qualified to care for the baby post-op per gratis. This took many months, since the hospital had valid concerns about the severity of the case and what was involved.
4. Medical exams and studies had to be obtained in Guatemala, showing barium studies of the baby's lower anatomy, to ensure that her repair was possible. Rosemary had to wire money to the person in Guatemala who was responsible (thank you Roland!) for getting the family to the testing site so that they could afford to travel, and have an interpreter.  The tests then had to make their way to New Jersey for review.
5. The volunteer surgeon wanted to meet baby B in person, to examine her himself to assure he could repair her properly. In order to facilitate the meeting of the baby and surgeon, Bev and Warren and the surgeon flew to Guatemala City, where the surgeon examined the baby. Traveling back and forth to her village took the family several days and once again required a translator and escort.
6. Baby B had to travel with her family to the capital twice again to obtain the passport and visa, after lengthy paperwork done by our executive director, Rosemary Vance. The embassy in Guatemala City required an interview process, which overwhelmed Baby B.'s mother, but she knew this was a unique opportunity for her baby.
7.  After all of the paperwork was complete, Bev and Warren prepared the house for a new foster toddler, and Bev flew off to Guatemala to escort baby B. to New Jersey. Son Cory provided a free airline ticket!
Post-op with mama Bev
8. Sending your toddler to a foreign country to live with strangers is something most mothers can't fathom. Baby B's mother needed lots of support. As in a dozen relatives showing up at the hotel to say goodbye. Chaos reigned. Needless to say, neither Bev nor Baby B got much sleep in the hotel room that night before flying out of Guatemala.
Baby B, 10/13 in N.J.
9. Once in New Jersey, fate  (a plugged colostomy site) necessitated that surgery be done sooner than had been planned. Stage one surgical repair was scheduled and went very well.
10. Soon after surgery, Bev and Baby B ended up in the ER again, this time for a skin and stoma infection caused by antibiotics. Long days in New Jersey, but overall good as both Baby B. and Mama B. grew into this new relationship. 
Here is the end result....a toddler, still facing another surgery, but on her way to a new life free of a colostomy, social stigmas and poor hygiene.
 It took a year of paperwork, worry, planning and a flock of "COTA storks" but it was worth every flap of the wings.

Twenty Years of COTA: Perspective and Memories from Warren Brandwine

         My first COTA mission to Peten was in January, 2000. We flew up to San Benito in a surplus C-130 with the door held on with ...