Saying Sayonara to San Juan

1/28/12

So, a few things have happened since my last post. As is often the case, these projects wind up, not down towards the end and so they did, at least for the surgical and dental teams. The clinic team found there work slow down a bit with fewer people coming to the Centre Salud in San Juan than had come to the remote village clinics from the prior week. The weather was cooler, but only because of the rains, and the locals tend to stay indoors when this happens.

For the surgical team, we did more and more cases each day, everything ranging from removing extra fingers and toes from children to a steady diet of hernias. Most the hernia repair were actually on women, who tend to do a lot of manual labor. This is opposite the proportion seen back home. Of course, when a man comes in for his repair, the hernia is massive and has obviously been put up with for years - either for lack of opportunity to have it fixed, inability to stop work for recovery, or the nearly axiomatic truth that guys just don't go to the doctor until there is obviously a problem (and even then wait for someone else to notice it too). All this has meant a bit less down time for reflection and journaling/ blogging.

Our evenings likewise have been filled with social engagements unlike last week. Wednesday was a formal dinner with the mayor, the entire city council, and other government officials. Being a Japanese colony, this meant sushi, though I am still unable to get a straight answer as to what was actually in that Maki roll. Bolivia has no coastline, draws much of its water from tributaries of the oh-so-clear Amazon, and nothing about is infrastructure says "flown in daily." In Cipro do we trust. The dinner was a wonderful honor, however, and so far, my only known souvenir from the evening is my copy of the municipal ordinance read in our honor... in its entirety... in Spanish. It is nice to know that our work here is done with the cooperation and blessing of both the local government and health authorities. Francis has gone out of his way to develop such cooperative relationships and I truly get the sense that this local government cares deeply for its neediest people (across linguistic, racial, and economic lines), though it is often helpless to help them given the limited resources available to them.

The next evening, we were invited to the home of Miyuki, our 18 year old translator who worked with the clinic team on the first week and with the dental team this past week. Her mother is the local public health doctor who has worked closely with the clinic team. Her father owns a farm about 20 minutes north of San Juan which means one thing. Bugs. I literally ran a gauntlet of massive June-bugs just getting into the house - those that didn't audibly crunch under my feet managed to jump up and swarm my torso while I ducked for cover and ran inside. We were treated to an evening of hanging out, sipping coke, and admiring Miyuki's art (truly incredible paintings) until the dinner was served. Her father came in from the backyard pond with a pan of fresh caught fish - Paku and Sirubi (I am 100% sure those are spelled wrong - don't even bother googling them) which was prepared 4 or 5 different ways, including as Sashimi. (By the way, does anyone know for sure if Cipro covers the typical South American freshwater parasites? If not, please email me immediately.).

Later in the evening, we met her grandfather, who is 94 years old. He move to the area in the early 1950's from Nagasaki, just as the community was being founded. We did the math and he would have been 26 or 27 when the atomic bomb was dropped on his city. Seven or eight years later he would travel by boat to an as-yet uncleared portion of the Amazon basin where life would somehow be better and provide more opportunities. He has done well with what was given him and has a beautiful family to show for it. I can only imagine the stories that he could tell.

Amidst hernia-fest and one gallbladder (I must have removed the rest of them the last time I was here), the last couple of days were spent trying to tie up loose ends. This means making sure that appropriate follow up is arranged for some of our more concerning patients and that proper goodbyes are said and appreciation shown for those who have helped us.

Oliver's wound will still require meticulous care and occasional washing out under anesthesia. He tells me that the dressing changes hurt a little less each day, though he still cries when we do them. We share a hug and some laughs each day after we are finished. His room by now is filled with the crafts he has made with the pipe cleaners and construction paper that team members have given him - the paper chain must be at least 15 feet long. Fran still lets him borrow her iPad every now and then - he is getting good at Fruit Ninja and Angry Birds and apparently likes U2 music (but did he have to play Joshua tree the morning we said goodbye? That is just not fair to anyone hoping to maintain their composure).

The boy with appendicitis also has an open wound (quite common when the infection is so severe) as well which could take weeks to months to heal. Still, he is alive, and I am etremely grateful each day when i hear him say "hasta manana." At one point we were not sure he would even have one. He left the hospital on our last day.

The local doctors and nurses at the Centre Salud are being very gracious to see all our patients in follow up, even housing some who still need wound care or antibiotics. Others came back to see me on Thursday or Friday for wound checks and to confirm that their groins are still supposed to hurt a bit. They are all so gracious.

On Friday, we did one last case and made our final rounds. We packed up all the surgical supplies into their suitcases and bins and loaded them onto the trucks. We ate lunch, then returned to the hotel where I took down my mosquito net, dismantled the MacGyver coffee apparatus, and weighed my bags - I am apparently bringing home as much weight in coffee beans as I took in medical supplies. We loaded the bus and made a relatively easy drive to Santa Cruz where we did our requisite souvenir shopping before having one last meal with our Bolivian team mates. We will miss them dearly. I hope to see and work with them again, however, possibly as soon as November. By the way, there are apparently Spanish words that sound similar but should not be confused at dinner: these include Salmonada (salmon) and Salmonella, Jamon (ham) and Jabon (soap), servilleta (napkin) and cerveza (beer). Please make note of this for your future travels.

Now as we are on a plane somewhere between Santa Cruz and Miami, I have time to reflect. I'll spare you most of those thoughts for now. I have divided my time in the air between reading, sleeping, prayer, and the obligatory perusal of SkyMall magazine. To bring things full-circle from my opening post, I will now list the ten things that would have been useful had we been able to order them on the way down:

10. 140x military zoom binoculars for bird-watching (there are some beautiful birds in Bolivia)

9. Litter Robot self-cleaning kitty litter box - we'll take 250 of them for the streets of San Juan

8. Sleep sound generator - the one without the barking dog setting

7. The always cool pillow

6. Digital Bark-Free Pro ultrasonic dog repellent machine.

5. Peeing Boy of Brussels statue and fountain (It belongs here, not Brussels)

4. Cheesy Friends forever jewelry - at least 25 of them

3. Green Bay Packer auto decal - NONE of the cars down here have them. so sad.

2. Heated lumbar support cushion - because everyone in Bolivia has a bad back it seems

1. Rosetta Stone software, Spanglish edition

Enough silliness. I am onto yet another page and should spare you the rest of my thoughts (but you didn't think I'd actually err of the side of brevity, did you?) They center predominantly around gratitude as they often do at such times, but not necessarily in the way one might think. Whereas I used to fly home grateful for and eagerly anticipating reunion with my creature comforts, I am now both grateful for and in spite of them. It is pretty much a cliche by now that in serving on a project such as this, one always receives more than he could ever give. Try as one might to avoid this, it is the inevitable result of service to a God who is Himself the giver of all givers, the multiplier of loaves and fishes (raw though they may be at times), and the producer of a harvest a hundred fold what was sown. I have come to embrace it, and almost to laugh when it happens. When have I ever ended a vacation with tears of joy and an overwhelming sense of gratitude for the people I have met along the way? When have I returned so much richer than when I left?

The stuff which we left and to which we now return is mere stuff, material, yet immaterial. It is that stuff which so often separates those of us who cling to it from those who might never have any of it, or at least very little. In seeking it, we so often find ourselves alone, or in very small and loathsome company. When we seek to give of it, or to relinquish it in order to give of ourselves, we learn that we are all needy. Then we find that our needs are met in ways we could not have imagined. Scripture tells us in different passages that Christ is the giver, that He is the gift, and even the unintended recipient of the gifts we might give. We have seen Him everywhere.

I have before me a customs form instructing me to list the estimated value of what I am returning home with. Were I to fill it out truthfully, it would result in much bewilderment from the customs officials and I would likely miss my connection to Chicago (not sure what denomination I would use anyways). Please do not tell them of my omission, at least not until around 8pm Central Time.

Thank you so much to all who have followed my verbose blog posts, who have prayed or supported the project, who have come with me or have sent loved ones. I am flattered by anyone who is still reading or who would entrust so much of their time, talent, and treasure to a rookie director with much still to learn. Pictures will come soon.

Ciao.

Sometimes, the power must go out

1/24/12

We returned to work yesterday after our weekend of rest and relaxation. We returned to San Juan and found it surprisingly cool. We ate dinner and went back to the hotel to settle in. The next day would be a light one, at least on paper. Just a hernia and a scheduled washout of the femoral osteomyelitis (bone infection) on the 12 year old boy that Dr. Henry had initially debrided last week, but which the boy (Oliver) has been struggling with for months. If the planets align correctly, we could even be finished by noon and help the clinic team. (Of course, the planets never quite line up as we wish them to, and to plan your day around it happening is ill advised. I'm not a follower of astrology anyways).

I stayed up later than I should have due to an ill-advised game of team Scrabble (but at least Abby and I won with some come-from-behind double word score brilliance). No worries, I have perfected the MacGyver method of morning coffee and had everything set up and ready to go at 5:18 sharp. Alarm chirped at 5:00, I hit snooze twice per routine, then plugged in my immersion water heater ($5.99 on amazon) and sunk it into my 20oz thermos filled with filtered water. In 4 minutes it would boil and be ready to pour over some coarse ground beans in my French-press equipped Nalgene bottle. It WOULD be ready to pour had everything not gone suddenly dark and silent. The fans all stopped too, and though my coffee water stopped heating up, the room itself became still and hot. Fearing that I had blown the hotel's fuse, I walked out into the courtyard and feigned ignorance. I would later find that the outage was city-wide, so I think I am off the hook.

There was enough natural light for us to get ready for work. The water heater in the men's shower had never taken advantage of available electricity anyways. We still managed a hot breakfast since the clinic kitchen runs on propane. The hospital has a generator, so the outage should not affect our work there either.

Francis had left the evening before on a run to Santa Cruz to get more supplies and medications. The clinic team had added another Bolivian physician as well as Scott and Julie in the dental room. All together, this put us in real crunch for interpreters and I still do not habla mucho Espanol. The hospital team would have only one; Sandra. She is an excellent interpreter and a hard worker (her English is excellent as she spent two years in Ohio), but has yet to learn how to be in five places at once.

The day started with the usual "Where the heck is our patient?" causing us to send for Oliver instead, thinking we would get his short leg debridement out of the way so he could head back to his room at the health center (he is staying there for daily IV antibiotics and painful, deep dressing changes) and eat. By the time he got there however, so had our other patient who had been promised a morning time. Moreover, the head Japanese nurse would not allow us to do any other operations after Oliver since his leg was infected and would somehow permanently contaminate the operating room (though this didn't seem to be an issue last week). We complied so as not to offend our hosts, but this would put poor Oliver into an indefinite holding pattern wherein he would sit alone on a wooden bench with no food or entertainment. Any further cases we would find would bump his back even further. We felt bad for him. He has been through so much and always with a smile (always except when we are changing his bandages, that is). We did end up finding another case too - a bilateral recurrent inguinal hernia that would take a few hours to do (recurrences always take longer) on a man who had travelled many hours to get to us.

The morning was definitely off to a slow start. In addition to tardy patients and haphazard diplomacy with head nurses, the local orthopedic surgeon asked me to see some of the Japanese patients that had come in through the night (the Japanese general surgeon is out of town for the week). They were both elderly patients with potentially acute abdomens and both appeared quite ill. One was a 74yo male with typhoid and an ileus, but thankfully no evidence of perforation. The other, a 93yo woman, emaciated and moaning, who had been vomiting blood and with an apparent bowel obstruction. She was quite anemic and was getting short of breath, a bad sign when it is due to a problem in the abdomen. Her son seemed bewildered and concerned. These would not be quick consultations and would sideline not only myself, but also Sandra. We would not be able to start our first case until 10:00.

We had numerous obstacles in getting things started. The OR is out of anesthesia papers and the office was locked, thus requiring our one interpreter to ask for the key. The oxygen tank was empty, requiring our one interpreter to find the one man with a wrench large enough to change it out for a new one. The other patients' families had questions, many questions, all of which would require our one interpreter to answer. And Oliver, poor hungry uncomfortable Oliver could only wait. Siesta (11:00 - 2:00) was now fast upon us too, meaning the rest of the hospital staff would disappear and it would get even more difficult to move things along. And still, Oliver would wait.

I was frustrated and I felt like others were frustrated with me. Better planning from the medical director could have prevented this. This shouldn't be happening now into our second week. I felt pulled in multiple directions, which required me to pull our interpreter in even more directions, which I could tell was frustrating to her as well. Scott, our dentist, had shown up to look for some equipment and asked if I was alright. Moved by his concern, but was my frustration so apparent? I must have been wearing it on my sleeve, which only frustrated me further. And as soon as I start to indulge in self-pity, there is the 93 year old woman suffering through what may be her last day, and there is Oliver.

Of course, Oliver is now grinning from ear to ear. He is sitting on the same bench, but now he is with Fran, one of our wonderful OR nurses from Winnipeg. They are laughing together as she teaches him to play video games on her iPad. He would learn quickly, and she would entrust her iPad to him and his dirty little fingers, unsupervised, for much of the afternoon. She would come by frequently to check on him, to re-charge the battery, to make sure he wasn't lonely, and to imbibe in his infectious smile (Oh, were that the only infectious part of him).

The best advice is usually the hardest to follow (otherwise, there would be no need to offer it). I recall my dad once telling me (during the years where I directed a summer camp, having every detail planned out down to the minute) that the whole purpose of my well-laid plans might be to serve people, but that those in greatest need would likely show up as an interruption. At that point a decision would need to be made; put your head down and serve the plan, or set it aside and serve the interruption for whom the plan was all along intended. Today, I would again learn this lesson. It was a frustrating day, but then again, how would we learn anything without such frustrations, such interruptions.

In Mark 5, Jesus is on his way to heal one person and is stopped in his tracks by an unscheduled consultation. The scripture says he felt the power drain out of him (He who even has an infinite supply of it). He was also likely being prodded along to get on with things and attend to the task at hand (that task itself another person in need). Jesus is God, but he was also human. He had the same decision to make, and he chose to stop and not only heal the woman, but also to take even more time and affirm her faith and speak into the life of one who had likely been long ostracized by her illness.

I have a feeling I will need to learn this lesson again at some point, but for now, Fran's small demonstration of Christ's love for Oliver serves as a crystal clear reminder that we are here for the blessed interruptions. It would empower me to return to the elderly woman and take time, as much as required, to explain her plight and console her already grieving son - she would die that night. I am sure I will need to learn this lesson again at some point, and at some point that may just require the power to go out once again.

Recharged, Relaxed, Ready

1/23/11

We have had a wonderful 48 hours of rest and relaxation here at the Amboro Eco-Resort. As I said yesterday, we deserve none of this, but are deeply thankful for our time here. It has been a wonderful way to welcome Scott (Zak, dentist) and Julie (Risse, dental hygienist) onto the team, giving them plenty of time to get to know the others. They are now chomping at the bit (bad for the teeth, ironically) to do some dental work. We were going to try and set up a village dental clinic today, but torrential rains early yesterday have most the roads unpassable.

Yesterday, we had the privilege (I promise, I had NOTHING to do with this) of visiting

a local organic coffee plantation. We took a tour where they walked us through the whole process from seedling selection, coffee tree cultivation, berry picking and peeling, bean drying and selection, and on up to roasting and drinking the stuff (still my favorite part). It was neat to see the different stages of growth. They manage not to use any pesticides (we have the itchy bites to prove it) and to preserve the rainforest canopy and still get quite a good crop. They are finding this even more profitable too. Even though. the plants' leaves are somewhat insect-eaten, the insects overall have a net positive contribution to the soil and ecosystem such that it results in a good harvest without spending money on chemicals and wasting time trying to "sterilize" the process of all things natural.

I had 2 or 3 espresso back at the shop - incredibly smooth pull by an expert barista. Did some wheeling and dealing and will be bringing home about 8+kg of unroasted beans (Mike and Michelle, you can start the bidding now).

The mountain scenery was beautiful, though I wish we could have stayed until sunset. The plantation is on one edge of the valley with cattle farms and jungle in the lowlands and cloud-blanketed mountains in the distance. I have posted pics on my Facebook page for those who care to see. What you will not find posted anywhere is any footage of Bolivian Karaoke. It never happened, I promise.

Swam lazily in the pool with the team this morning, then lounged around poolside until it was time for the all you can eat barbecue (though I passed on the tripe and grilled cow intestine). We head back to San Juan in about 2 hours, luckily the drive is short. The break has been long enough to fully relax, but I'm glad to get back to work in the morning. We will likely put in full days Tues thru Fri and head back to Santa Cruz on Saturday morning. This will likely leave little if any time to buy souvenirs and postcards, but I can't say I'm too broken up about that (of course I've been here before). If the rest of the team needs to shop or are nervous about missing the plane, we may end up heading back to Santa Cruz on Friday evening.

Guest Post from Jungle Gary

1/23/12

I do not have the heart to blog about all we have suffered over the last two days. We have been whisked away from our comfortable digs in San Juan and were forced to stay in a nearby "Eco Resort" what with animals walking around, tropical birds chirping all morning, and a swimming pool way too large to enjoy all of. And the all you can eat buffets... so much work! So, in an attempt not to arouse pity from those at home, I have asked Dr. Gary Schmidt to write a guest post regarding his experiences with the adventuresome clinic team. I have read it, and though he disses the surgery team (out of sheer envy, I am sure), I will post it nonetheless.

On a serious note, I have been so blessed to hear their stories at the end of the day. As Gary details, one is limited in what he can do to treat illnesses, especially chronic ones, in such deplorable conditions, in such poverty, and with such limited infrastructure. At times, the only medicine to be offered is a listening ear and a caring touch. Such caring, touching can get exhausting. Jesus Himself even felt the power drain out of Him (John 5:30) when touched by a hopeless sufferer, He with unlimited power to heal. Yet God has sustained the clinic team through long days of both physical, mental, and emotional exhaustion, such that they seem to get stronger with each passing day rather than tiring. That said, they are enjoying R&R at the Eco-resort quite a bit. None of us deserve such a break (especially when so many have no reprieve from their poverty and illness), but we can be thankful for it and use it to prepare us for the work ahead.

So, to see how the other half lives...

"Have clinic will travel.

Unlike the hospital based team, the clinic team were not able to walk to their locations, did not have air conditioning, sleep in to 6:00, and did not just see 2-5 patients a day. Our team is composed of Katie Henry, Janet Schmidt RN, Abby Getz, an RN from Indiana, Lynne Pendse, a recreational therapist from North Carolina, Francis, and Deborah, two physicians from Bolivia, 3-4 MMI volunteers from Bolivia, and myself, Gary.

Our days have consisted of traveling between 30 minutes to two hours in a cab of a pick up truck or the back of an ambulance over roads that are in worst shape than any in the US. Going sometimes only 5-10 miles an hour for an hour, and driving from one side of the road to the other in an attempt to do the impossible, to dodge the pot holes, dogs, cows, chickens and pigs. On two days we actually had clinic settings to workout of, but most of the time it was a school house or another available building. Much of time my office was a table set up outside a building either on a porch or in the yard which was only dirt (which becomes mud when it rains), sometimes under a tree or mosquito netting (so much for confidentiality and HIPAA). There were dogs, cats, chickens, and lizards invading our space or were we invading theirs. Luckily the alligators and anacondas stayed in their on water holes.

We traveled to communities that consisted of between 4 to 25 families. Seeing anywhere from 70 to 105 patients at the 1-4 communities we went to that day. We got there and blew the siren on the ambulance or rang the gong on the porch to let people know that we were there. Our pharmacy consisted of 7 boxes on the back of the pickup truck or set up on the porch of the building which contained medications that had been donated to MMI by organizations such as Holy Family Memorial.

The medications were used to treat diseases as simple as colds, sores, and fungal infections to as complex as leprosy and Dengue. Treating hypertension and diabetes is complicated because we can give them the medications for a month or two, but after that they won't have access to or be able to afford any follow up. And to only test we are able to do other than their vital signs is a blood sugar. Diabetes is not common and most of the blood pressures are low normal.

Their life is very simple and they survive in a climate where now temperatures are 95 F and the humidity is in the 90's. Their poverty is very obvious with living conditions that we may consider dismal. But they are happy and very appreciative of the any help we are able to give them.

We come back to the hotel (not air conditioned), tired, dirty, sometimes muddy, smelling of sweat and DEET, but very thankful that God has allowed us to help His people as He has instructed us to "go to all the world".

Romans 8:28

Roughing it

Roughing it

1/21/12

Sorry to take such a break from posting. Settling in often means becoming busier and more immersed in the work and people at hand. Though unique experiences abound, they become more numerous, and for some reason I felt less compelled to immediately blog about them. I am also enjoying hearing the experiences from our clinic team who have been out and about at increasingly remote and destitute locations. Stories of train-cart rides through the jungle to grass-hut villages replete with Dengue, anacondas, naked children, even a leper. Considering having one of that team write a guest-post as they are seeing and experiencing parts of Bolivia I have not seen (and might not get to anytime soon).

From a surgical standpoint, we have become busier and thus more efficient with each day. Dr. Henry got to do a number of orthopedic cases, especially on Weds thru Fri. Katie (his daughter) got to observe a femur nailing on a day off from her work in the clinic. I have been a hernia fixing machine, but have had a few different cases mixed in. Got to take out a suspiciously ovary that wound up being a teratoma (complete with hair and teeth... pretty cool). Had to do a hemorrhoid (I told him not to tell anyone, lest a reputation be built).

The most memorable case to date has been an appendectomy on a very sick 5 year old. While I was in working on a hernia, Dr. Pendse was called to the ER to evaluate him. He was listless. Had been sick for at least 2 weeks according to what we could make of the chart. He was barely conscious, heart racing, blood pressure too low, feverish, and his labs demonstrated an anemia shocking for a 5 year old. Dr. Pendse made the diagnosis of ruptured appendicitis based on the history he got from the kid's mom. He admitted him and hit him hard with fluids and antibiotics, trying to get him to make urine and to stabilize his blood pressure before we took him to surgery.

In the States, he would be at a specialized pediatric hospital, admitted to the ICU, and descended upon by a team of specialists (surgery, critical care, ID, hematology), would get a CT scan and likely an attempt to drain the abscess with a CT guided needle. He would get blood transfusions. He would get everything. None of these are options here. It is surgery or nothing, and surgery on a child in this condition is risky. We seldom see kids so sick.

We got him somewhat stabilized and brought him to the OR, offering the family what assurances we could. They would pray and so would we. We started. He bled tremendously from places that should not bleed. With limited lighting, limited retraction, and weak suction equipment, it was nearly impossible to tell where it was coming from. The infection was severe, but contained and we were able to clear it out and remove the appendix without too much difficulty. But the bleeding continued and seemingly from everywhere. We estimated it at about 20% of his already anemic blood volume. Jon (anesthesia) tried to keep up by pushing more and more fluid through his little IV. We extended our incision, but still could not find the source. We packed him tightly with gauze sponges, a maneuver from damage-control trauma surgery intended to slow the bleeding enough to give the blood time to clot on its own. But would it? We packed and we prayed. Each of us, silently, even as our hands worked.

It stopped. All of it.

We will never know where it came from or why. We washed him out and removed the gauze. We looked everywhere for bleeding and could find none. His heart slowed a bit and his pressure remained steady, no longer dropping. We closed and moved him to the ward, alive. At home, we would keep him asleep on a respirator in the PICU and do the breathing for him. At home, we would give him blood. My translator, Sandra, is a match and tried to donate, but it was late and the lab was not even open to run the necessary tests on the blood. He would have to make it through the night on his own, though his blood count was only a third of what it should be.

He was still listless in the morning, but he was alive. He will likely receive blood from a family member today if the tests are able to be run. He is most certainly not out of the woods yet. There is much infection and inflammation to fight and limited resources with which he can do that. God must sustain him.

Returned to see him later and he was actually standing up with the help of his mother. Though small, it is a sign of strength and we pray he will find more of it. Will try to keep everyone updated as to his progress.

Hurry up and wait

1/19/12

Things continue to progress well down here. We are definitely feeling a bit more at ease in our environment and are at least developing a rapport with the local staff. I was able to fix a hernia today with the local Bolivian surgeon so we could share techniques. Turns out, he lived in Bellefontaine, Ohio for about two years via some connection with the Mennonite Central Committee back in his college days. Small world indeed. Dr. Henry is doing a slew of orthopedic cases today with Dr. Nitabara, the local Othopedic surgeon and they are developing a good working relationship as well. Things like this bode well for future projects in this area and hopefully they will become more effective and efficient as a result.

During the frequent lulls in activity, the team has banded together and created a detailed inventory of all of MMI Bolivia's surgical supplies. A daunting task to organize and inventory 40 some suitcases of randomly sorted supplies, but now we can send it out to upcoming participants so they can gather supplies to fill the shortages. I give Jon Henry and Jon Klatt full credit for starting up the idea, but everyone pitched in and made short work of it.

I got to visit the local internet cafe last night and was also able to make a phone call to Wendy and the girls. It was fun, but the girls still are not very talkative with me on the phone. It was still fun to tell them I love them right as they were going to bed.

The day is winding down for most of the team. Dr. Henry is still in fixing a pelvic fracture, but the rest of the team has left the hospital. The clinic team is staying out in the bush tonight, or at least in a small school in some remote village I can't pronounce. They have to stretch their mosquito nets over school desks and lather up with DEET to avoid Dengue. Mosquitos haven't been to bad in San Juan.

-Matt

Getting into a groove:

It’s Wednesday and we are finally settling into somewhat of
a routine. Monday (read earlier posts)
was a flurry of activity and awkwardness as we tried to set up our supplies and
learn our boundaries here at the hospital.
It is a different arrangement working in a private Japanese hospital
than it was working in a Bolivian government hospital last year in Santa
Rosa. Here, we
are one set of guests treating yet another set of guests. The Japanese have more stringent customs and
we are trying hard to honor those, avoid offending our gracious hosts, but
still to get our work done in such a limited time.

To summarize, Monday we only did two operations – recurrent umbilical
hernia (myself) and repair of a tibial plateau fracture (Dr. Henry). Yesterday, we managed to do an orchiopexy and
rectal biopsy on an 11 month old (Dr. Pendse), release of congenital syndactyly
on a one year old (Dr. Henry), an inguinal hernia repair on a 74yo female
(myself), debridement of femoral osteomyelitis on a 12yo (Dr. Henry) while the
local staff did some procedures on their own. I have come to accept my low volume of general
surgical cases at this point as I am busy enough with directing things and
making sure Dr. Henry has a chance to squeeze in as much ortho as possible
during his only week here.

Today, we have a few hernias to fix (if the patients show
up), and Dr. Pendse has already done a circumcision for phimosis. I am seeing more consultations and trying to
defer elective gynecologic procedures to future projects which might have a
surgeon better equipped to do them.

We found out that Monday has been declared a national
holiday (it’s the Aymara new year). Though
neither the Japanese, the Americans, nor the bulk of Bolivians celebrate this,
the local Japanese hospital staff are planning on taking the day off
nonetheless. We have arranged to work
Saturday and they will grant us enough staff to do that. This means our weekend will be Sun-Mon
instead. We may get to make a road trip
to do some sightseeing – will see. There’s
not much to do in San Juan (other
than surgery and sit around and sweat a lot).

Will try to keep posted as often as possible. Thank you all much for your prayers and
support.

Project Update 1-17-12

Brief update on project start:

To make a long story short, our internet access is limited
(hopefully to be remedied soon). I’ve
typed up a long blog post on my ipad which I hope to post eventually, but it is
trapped there for lack of WiFi. I typed
up a longer post on a laptop to find out that it has sketchy power supply. Because I didn’t save it sooner, I lost a
page and a half and can’t get it back. I
took a break and did some reading as it’s been a very long day. Hold on a sec while I hit “save”…

Okay, back now on a recharged laptop battery. Hoping to post this sometime tomorrow
(Tuesday) if I can make it to the internet café with my thumb drive. Enough about technology (or lack thereof).

We made it to Bolivia safely and smoothly, cruised through
customs with the help of our well-connected hosts, and managed to score some
espresso AND bacon at the airport before the bus ride to Colonia Japonesa de
San Juan de Yapacani (from here on simply known as San Juan). San Juan and its hospital are essentially a
ghost town on Sunday, so we were not able to get in to do any setting up - just
a tour of the builings without really going inside any of the rooms. We spent most the day coping with the heat
(98.6F + stifling humidity), settling into our lavish rooms at the Residencial
Jordan hotel (not too shabby by Bolivian standards), and getting to know one
another. So far, being medical director
is going well because I have had nothing medical to direct.

For our first workday (Monday), we ate breakfast and I gave
a devotion out of John 1:16-18 (the God who came) and Mark 1:40-41 (the God who
was willing to touch). Clinic team then
boarded the buses for an off-site location about 45 minutes away while the
hospital team started to unpack and organize the equipment and OR and to see
some initial consultations. Just like
last year, I am struck by the need to think of EVERYTHING involved in the
process of getting a surgical patient all the way through consultation to
postoperative care. Quite a bit is
involved, 98% of which is NOT usually my responsibility at home and which now
IS suddenly my responsibility is here.
Somehow, we managed to get about 40 suitcases and crates of supplies
organized, see consultations on everything from Hirshprung’s disease to hernias
to congenital syndactyly, to assemble the anesthesia equipment, put together
instrument trays, sterilize them, and then get two operations done, all with
the use of a single interpreter (she’s now curled up in the fetal position, but
should be fine by tomorrow). Francis had
to head back to Santa Cruz for the afternoon to pick up supplies to fill some
glaring gaps in our supply list (things like retractors and scalpel blades)
which are in shorter supply than we had expected. The fact that we got any procedures done
(specifically a ventral hernia repair and a delayed repair of a bad tibial
plateau fracture) was somewhat miraculous.
Rather than being frustrated by the pace, I tried to stay positive and
productive as did the rest of the team.
Francis encouraged us to be flexible, patient, and cooperative with one
another - such encouragement paid immediate dividends for the surgical team.

The medical team had an equally busy day, but managed to see
87 patients between the three doctors.
Not bad considering they had the assemble the clinic from scratch on
site. I don’t know many other details as
we haven’t had much time to debrief. Our
work may remain somewhat separate for the next few days as each team has to gel
and work on process improvement to become more efficient. That means sleep, which is what is on tap
starting in about five minutes.

Miss everyone stateside. I am definitely a bit more “on-edge”
here than my usual happy-go lucky self, but that doesn’t mean it isn’t exactly
where I’m supposed to be. My meditation
this morning was out of John 3:30 - that He must become greater and I must
become less. Today felt like it was much
about becoming less. Now eagerly
awaiting the part where God becomes greater.

Battery is about to die again, as is my wakefulness. More to come soon, time and net access
permitting.

-Matt

From Manty to Santy

1/14/12 - Getting started:

There is a sense of relief I experience once I have actually left for a trip. Once on the road, I am officially done with preparation, regardless of whether or not I am actually prepared. I am able to finally move forward with eager anticipation, rather than the anxiety of "what am I forgetting?" What is done is done, what is not done is not done and cannot be done, so there is no use fretting about it. A simultaneous letting go and taking hold.

We had a nice little send-off at church (complete with bear hugs from the girls) and loaded up the bags. A smooth drive to O'Hare with a brief stop for burritos in Milwaukee, followed by a relatively easy check-in. Sailed through security without so much as a bag search or prostate check. Met up with Abby (ER nurse from Indiana), and then we were seven. Will be meeting the rest of the US/Canada team in Miami before the red-eye to LaPaz... that is if our flight is to take off (hour delay to rearrange the bags by hand, which apparently still requires my seatbelt to be fastened and is incompatible with use of unapproved electronic devices). Pretty bad when you've finished reading SkyMall and the plane hasn't taken off.

Top Ten things In SkyMall magazine that I will not be needing in Bolivia:

10. A seat from Yankee Stadium ($999.00)
9. Life-saving hurricane/ tsunami light ($34.99)
8. 15 foot tall cold-air inflatable blue gorilla ($1895.00)
7. Pink sapphire crystal clip-in hair extensions ($19.95)
6. Cast-iron giraffe shaped toilet paper dispenser ($29.95)
5. "Peeing Boy of Brussels" statue (and fountain of course) - ($199.00)
4. Fleece poncho with built-in pillow ($29.99)
3. iGrow laser hair-growing helmet ($695.00)
2. King Tut's Egyptian Throne Chair ($999.00 - hey, I am the "medical director" after all)
6 foot tall 16th century Italian armor suit with halberd ($995.00 - probably impervious to Amazonian blow-darts)

Well, if you are still reading, I applaud you. I will try and update as often as I can, but this is highly dependent on the availability of wifi in rural lowland Bolivia (or my skill at securing the lone seat at the local Internet cafe - a skill I did NOT possess the last time I was in Bolivia). Please pray for our team of Badgers, Buckeyes, Boilermakers, Tar-Heels and Canucks as we join with our Bolivian brothers and sisters in Santa Cruz and head to San Juan. We should be at our final destination by Sunday afternoon and start work Monday.

One last thing: Go Packers!

From Manty to Santy

1/14/12 - Getting started:

There is a sense of relief I experience once I have actually left for a trip. Once on the road, I am officially done with preparation, regardless of whether or not I am actually prepared. I am able to finally move forward with eager anticipation, rather than the anxiety of "what am I forgetting?" What is done is done, what is not done is not done and cannot be done, so there is no use fretting about it. A simultaneous letting go and taking hold.

We had a nice little send-off at church (complete with bear hugs from the girls) and loaded up the bags. A smooth drive to O'Hare with a brief stop for burritos in Milwaukee, followed by a relatively easy check-in. Sailed through security without so much as a bag search or prostate check. Met up with Abby (ER nurse from Indiana), and then we were seven. Will be meeting the rest of the US/Canada team in Miami before the red-eye to LaPaz... that is if our flight is to take off (hour delay to rearrange the bags by hand, which apparently still requires my seatbelt to be fastened and is incompatible with use of unapproved electronic devices). Pretty bad when you've finished reading SkyMall and the plane hasn't taken off.

Top Ten things In SkyMall magazine that I will not be needing in Bolivia:

10. A seat from Yankee Stadium ($999.00)
9. Life-saving hurricane/ tsunami light ($34.99)
8. 15 foot tall cold-air inflatable blue gorilla ($1895.00)
7. Pink sapphire crystal clip-in hair extensions ($19.95)
6. Cast-iron giraffe shaped toilet paper dispenser ($29.95)
5. "Peeing Boy of Brussels" statue (and fountain of course) - ($199.00)
4. Fleece poncho with built-in pillow ($29.99)
3. iGrow laser hair-growing helmet ($695.00)
2. King Tut's Egyptian Throne Chair ($999.00 - hey, I am the "medical director" after all)
6 foot tall 16th century Italian armor suit with halberd ($995.00 - probably impervious to Amazonian blow-darts)

Well, if you are still reading, I applaud you. I will try and update as often as I can, but this is highly dependent on the availability of wifi in rural lowland Bolivia (or my skill at securing the lone seat at the local Internet cafe - a skill I did NOT possess the last time I was in Bolivia). Please pray for our team of Badgers, Buckeyes, Boilermakers, Tar-Heels and Canucks as we join with our Bolivian brothers and sisters in Santa Cruz and head to San Juan. We should be at our final destination by Sunday afternoon and start work Monday.

One last thing: Go Packers!

Sent from my iPad