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.

Top Ten Questions (Children of the Americas style)

David Letterman is known for his comedic Top Ten Questions that he answers during his evening program. While his questions and answers are funny, they also ring of truth, which is the hallmark of good comedy.

Those of us on the Children of the Americas board have our own list of "Top Ten" that we have been asked frequently over the years. We thought this would be a good venue for telling you our answers.

Common question # 1:
Who started Children of the Americas?
Answer: COTA was started in the early 1980's by Judy Schwank in Bowling Green, KY. Judy saw the incredible humanitarian need in Guatemala during a natural disaster that occurred there, and founded COTA as a result. She has since resigned from our program.

Question # 2:
How do you find your volunteers? 

COTA Pharmacy Volunteers

Answer: We are SO blessed. COTA volunteers truly are the best of the best. They are intelligent, committed, talented and hard working. Our volunteers tend to find us. They either have friends who volunteer for us and share the news of what we do, or they seek us out on the web.

Question # 3;
Where do most of your volunteers live?
Answer: Everywhere. From upstate New York to Seattle, Washington and everywhere in between. We also have many great friends in Guatemala who have been associated with our program for years, and they help us with logistical support and translating during our team week. With over 100 volunteers, we are the largest medical team that travels to Guatemala.

Question #4:
Where in Guatemala do you work?
Answer: Wherever the need is greatest, the Guatemalan hospital director can host us and the town can accommodate us. We alternate between working in coastal communities as well as in the mountains, with our goal being to reach the women and children who have no other access to surgical/medical care. Think of COTA as a mobile mash unit, and you will understand all that is involved in making a team happen. The logistics of getting a surgical/medical/dental/pharmaceutical and prosthetic team up and running for the week we are there in January takes many months of work before our volunteers even depart their hometowns in the states to join us. 

Cleft patient, Team 2011

Question # 5:
How does Children of the Americas fund the work that you do?
Answer: Tenacity.
A few of our board members write grants. Some of them speak at churches, Rotary groups and private events, or even write personal checks. In this economic climate, it is difficult.

Question # 6:
How many paid staff members do you have?
Answer: None. We are an all-volunteer board and organization. 

Question # 7:
Who pays for your volunteers expenses to travel with your teams? 
Answer: The volunteers pay their own expenses, take personal vacation time, and bring items to donate to our patients. As we said, we have great volunteers!

Question # 8:
Where is the Children of the Americas office?
Answer: There isn't one!
Our Executive Director and President run COTA from their homes. This allows our organization to have very little overhead. Our operating budget runs around $50,000 per year, which allows us to donate around 130-140 surgeries, see several thousand clinic patients, take care of over 300 dental patients and provide free pharmaceuticals to our patients, as well as providing free prosthetics. If we had a physical office, our donated dollars would not go as far as they do.

Question # 9:
I understand that your organization only works in Guatemala. Why is that? 
Answer: When COTA was first founded, Guatemala was the adopted country of the person who started our organization. After a few years of traveling to this Central American country, our infrastructure was in place to allow us to do our work there. But the real reason is that we love the people and country.

Question # 10:
Children of the Americas sounds amazing, but I still don't "get" why your volunteers and donors like it so much?
Answer: COTA volunteers share a passion for making a significant humanitarian difference in the world. COTA offers us a wonderful venue to do this.
Want to know more? Here is our website:
http://www.childrenoftheamericas.org/ 

COTA + Caring = Diplomacy

The history of political strife in Guatemala is complex, and the ramifications remain embedded in the daily lives of most of the citizens of this beautiful country. As a medical relief organization, it is not our place to get involved in the  government or justice system of this tiny Central American country we love. COTA volunteers have a passion for justice of a different kind: the right to be treated respectfully as a human being, and to have basic daily needs met.

We would like to think that when a father meets us at the Guatemalan airport to receive his baby back following donated surgery in the United States,

Greeting his baby after a visit to the U.S. for donated cleft surgery

or a child gets a free consult from an American pediatric specialist who is traveling with our medical team, COTA volunteers are creating our own form of international diplomacy. Person-to-person, hand-to-heart, one patient at a time. 
When the patients we see in Guatemala observe our caring and competent volunteers offering free medical, dental, orthotics and surgical care, they feel the concern we have for those we help. 

Dr. David Hennessy, assisting Guatemalan pediatric patient

Our Executive Director, Rosemary 
Vance, meets with the embassy staff every year to continue fostering the excellent reputation we have in Guatemala. The hospital directors who host our teams are the beneficiaries of our donated medical equipment and supplies, so they have resources available to continue good medical care after we leave. Local vendors benefit from our 100+ volunteers who visit the towns in Guatemala where we work on our annual teams. Nurses teach us how bedside care is done in Guatemala, which offers our COTA nurses valuable insight into culturally appropriate medical care delivery. 
Diplomacy is not in our mission statement, but as with all good nonprofit organizations, it is sometimes the unintended benefits that are the most long-lasting and meaningful. 

Dr. Carol Cottrill, COTA Board President, with Guatemalan nurses

Definition of a Father

fa·ther  (fär)n.

a. A male person who contributes to the conception of a child.

b. A man who adopts a child.

c. A man who raises a child.

Warren, COTA Foster Dad

Children of the Americas routinely touts the benefits, joys, trials and tribulations of fostering the children in our program who come to the states for medical care. It is not an easy job to enter into a long-term relationship with a sick child from Guatemala who speaks no English, is homesick, may be malnourished and will have medical care issues. Our accolades for this challenging job tend to go to the foster mothers. In honor of Father's Day, we are reversing the familiar ditty, by claiming that behind every good woman, is a great man.

Henry, COTA Foster Dad

There is something that happens in the heart of a woman when she feels the need to foster a child. That "something" is different for each person who takes this job on.

It may be an empty nest. Or no nest. It might simply be the need to assist a Guatemalan mother who needs help for her child.  The glimmer of an idea becomes a nudge that leads to a call to COTA volunteers and if the there is a need, a child finds a sanctuary in a foster home that leads to restored health.

Mike with foster daughter

None of this would be possible without the consent of an understanding husband who is willing to be second-best while the household revolves around the needs of a sick child.  
 Amazingly, 114 men have said "yes" when their wife uttered the words "Honey, we need to talk."

These men have agreed to long drives to airports, clinics, and hospitals. Our COTA foster fathers gave up timely meals, or sometimes any meal at all. They have shared disposable income, time with their wives, and days off of work. These foster fathers add sick children to family vacations, to carpools and to homework schedules. They worry, keep bedside vigil and change surgical dressings like a pro. Many of them agree to foster more than one sick child over a period of years. These men are fathers in every sense of the word. The best of the best. 

Vince, with COTA Foster Child

One of the most common misconceptions about our program is that our foster parents and board members get paid for our work. Our foster fathers do get paid, but not with money. Instead, their fortune is earned through experiencing the repair of a cleft lip, or the ability of a child's ability to walk again. These men understand that the intrinsic rewards of stepping up to meet a significant and worthwhile need are the best fortunes. In our organization, we  think there should be a new dictionary definition to the word father. For COTA purposes, the definition should read as follows: 

   fa·ther  (fär): one who agrees to take a sick child into his heart and home, only to have to return that child to the biological mother upon recovery. A man who is willing 

 to sacrifice for a child who is not his own. 

Happy Father's Day to our COTA Foster Fathers.

You have made the world a better place in every sense of the word.

A Good Kind of Tired

Children of the Americas surgical team members recognize the "look" (left). This volunteer's face radiates a mixture of heat exhaustion and physical fatigue during our recent medical/surgical and dental team to Retalhuleu,
Guatemala. When one gets this tired, the only thing keeping the body going is grit and determination and the kind of fortitude that makes someone sign up to volunteer for a team to Guatemala.

At the end of our week in Guatemala, even our patients are tired. They have often waited several days for our services.The women and children we donate medical care and surgery for know that if they don't wait their turn, the chance for restored health may not come their way again. So they wait, so patiently that it inspires us to push ourselves even harder. We perform surgery, pull diseased teeth, dispense a truck load of crutches and wheelchairs, see masses of clinic patients and dispense more medicines than we thought we could possibly do, so that the last patient in line gets cared for.

At the end of the week we go home to loved ones, and hug them a little tighter. We appreciate the ease of life in the United States just a bit more than we usually do. We complain less, stand in lines at the grocery more patiently, and are profoundly grateful for good medical care the next time we are sick. Gratitude for the abundance of necessities in our country is foremost in our minds when we return to the states.
During quiet moments, we think of the patients that touched our hearts while we were in Guatemala. There are always those special ones that we know we were meant to be in Guatemala for; the clefts that would not have survived, the children who might not have ever walked, the women who would have struggled with unresolved surgical needs. Gratitude: for the chance to both travel with COTA and return home...very tired.

(photo credits:David Horner)

Having a Bad Day?

Here are a few of those someones

Traveled all night for surgery, but still cheerfully waiting

Single Mother with no job, awaiting free medical exam

Children awaiting entry into COTA Team Clinic

 Thrilled that their daughter traveled to U.S. for donated surgery

Happy Birthday to Our Executive Director

Our Children of the Americas blog is usually reserved for updating our supporters and donors with current events related to our goals as an organization. But today we are making the choice to use this platform to thank our Executive Director, Rosemary Vance.

This is Rosemary's birthday, but our guess is that she spent it just like she has every day since joining COTA as a volunteer....thinking about the needs of COTA. Rosemary is one of our longest-term volunteers, which means that she has had COTA concerns on her mind for well over twenty years.
There isn't a job within our little nonprofit that Rosemary hasn't participated in. She has always done the "ABC's" of whatever Children of the Americas needed:

• Accounting.
• Begging for supplies.
• Caring for countless foster children.
• Doing all of the odd jobs nobody else wanted!
• Excel lists.
• Financing trips to Guatemala on her own dime.
• Going wherever, and whenever COTA needs her to.
• Hosting board members from out of town.
• Insisting that our board follow proper protocol.
• Juggling a full-time job with the demands of COTA.
• Keeping medical supplies in her house.
• Lifting boxes of medical donations when her doctor told her not to!
• Mediating (the many) issues on COTA team trips.
• Nudging donors to support our program.
• Orthotic and prosthetic patient care coordination.
• Pediatric surgical donation networking.
• Quotes the lowest price COTA can pay to save our donated dollars.
• Reprints forms that got soaked in Hurricane Sandy.
• Sending countless emails weekly for COTA.
• Travels to Guatemala at least twice a year.
• Understanding logistics of running an international nonprofit.
• Volunteers endless hours.
• Warehouse gleaning of supplies from other nonprofit organizations.
• X-tra understanding of those board members who occasionally falter with their energy.
• Yearlong devotee of anything concerning COTA.
• Zest for all things related to the concerns of the women and children of Guatemala.

It is not an understatement to say that Children of the Americas has continued to be a vital, life-changing organization thanks to Rosemary's dedication, intelligence and enthusiasm.
Happy Birthday Rosemary!

Perspectives on a COTA Team from Dr. George Quill

Suicide showers are...

• Somewhat slippery.
• Either freezing or scalding.
• Big enough to wash a Volkswagen as well as yourself, but only a trickle of water will flow down upon the both of you.
• Those that have windows that open onto the street below.
• Those that have exposed wiring around the spigot leading to the contraption that heats the water to either scalding temperature or reminds you of a dip in lake Michigan with the January Polar Bear Club.
• Those whose exposed wiring has been known to catch on fire the hair of a young lady who stands more than six feet tall (true story!).
• Those which I am slowly figuring out how to modulate the variable flow rates to get a somewhat tolerable temperature.
• Preferable to walking around all day and night so sweaty and greasy that, when you move, your clothes don't always travel in the same direction! 

__________________________________________________________________________

                        "If you can walk into my OR you can keep your boots on."

______________________________________________________________________

 I've only seen this once since 1987!
X-rays of a 19-month old Guatemalan girl with wide-set eyes, slightly blue sclerae, open cranial sutures and severe bowing of all her long bones.
In addition to a diaper full of caca, these films are consistent with Ricketts due to vitamin D deficiency.  We prescribed Tums and recommended that mom take her baby out in the sunlight every day.  Hopefully, we can check this child again on our mission trip next year.
  The pictures are a little difficult to make out because there are no functioning X-ray view
        Boxes down here and I had to hold up the film to the window to take the picture. 

_______________________________________________

 So, today, Wednesday, was a usual day except the power to the whole city was turned off for a while.  The. Hospital generator would work the anesthesia machine and tourniquet box, but not the A/C.  At one point the a/c came back on, but not the lights.  Finished the case by flashlight and soaking in my own sweat.  I'm always hot and always thirsty down here!

____________________________________________________

Puzzled

When our friends and family hear that COTA team members are planning our annual medical/surgical/dental/orthotics trip to Guatemala, we typically get one of two reactions. 

" Oh, I would love to do that someday."

Or

" How do you stand to go there and see all of the poverty and despair? "

Most of us have family responsibilities or limited financial resources, and we realize that willingness alone is not enough to make it the best time to board a plane and head to Central America to do good work. The second response however, leaves us puzzled. 
Children of the Americas volunteers typically have a long-term relationship with our organization. We travel to Guatemala regularly and for some of us, it is our international destination of choice. The lack of infrastructure in this tiny country makes travel difficult;

The hotels don't come with a four-star rating. Food is interesting, water needs to be regarded with caution, and the weather, especially in the rainy season, can be interesting.
It is expensive to go back repeatedly on our own financial resources, and we come back tired, sometimes even sick. Stateside matters of work and family take a back seat to all matters Guatemalan before and during the team. 

Why then do we return, time after time?
Here are the reasons:

For the Amazing Natural Beauty

Beautiful Old World Architecture

For the Children that Need Our Medical Specialists

And for the Mothers who need to stay healthy to raise them

Recipe for a COTA Team

Children of the Americas has been taking medical/surgical teams to Guatemala since the late 1980's. This may make us the longest-term organization that has consistently traveled to Central America for the purpose of delivering medical care to the citizens of Guatemala who have little or no access to these services. We have donated surgery for many hundreds of patients, seen thousands more in our clinics, and five years ago, we added dentists to our teams. Our pharmacy dispenses over 5,000 prescriptons on each team and the orthotics volunteers quietly and competently support our services with their work to benefit our patients. 
What does it take to create the miracle of donated medical care for the poor of Guatemala? 
There aren't enough words to tell the story. It would need to be a book instead of a blog. There are too many hours to write about, too many details to post, too many daily challenges to explain. Perhaps our story is best told with pictures. As they say, a photo is worth 1,000 words.

Some would think that forming a new COTA team starts mid-summer, six months before departure, when we start gathering supplies in our respective garages and basements.

Child with tumor who was brought to U.S for donated surgery in collaboration with Word Pediatric Project

Same lucky toddler, post-op, playing before departure home to Guatemala

Mary Knoll Nun, Jude

Few know that the next team starts within a few weeks of landing the team members back on American soil in late January. Children who couldn't make our surgery schedule in Guatemala, due to complexity of care, are networked into partner organizations or hospitals that will donate surgical intervention. All OR charts are flown home with us, organized and the information is compiled to share with the COTA board. Many emails go back and forth about the welfare of our surgical cases. Pediatric cases start arriving in KY for donated care that was too complex to fix on a team. Many, many hours and piles of paperwork later, the half-dozen cases from the previous team are safely operated on and back home to their parents in Guatemala. Which means we are then ready for new team referrals from our wonderful friends in Guatemala, like Jude (above,left). 
And then things get busy. We pack supplies: 

 

We fund raise:

Roger and Rosemary, presenting COTA to Lexington Church

 We travel to Ohio and Louisville, to glean supplies for the team.

Thank you to Matthew:25 !