The best laid plans

So, my plan for the weekend was to catch up on blogging, reliving last week one day at a time. But then there was this pool, my children, my wife, a bed, and a wandering Emu, and a coffee plantation... and here I am in the hotel lobby about to board Francis' 1992 Land Cruiser (aptly named Methuseleh) to head back to Santa Rosa where they have yet to discover WiFi. If we can manage to finish operating by 10pm this week, maybe I'll have a chance to catch up the blog then.

Said ciao to Wendy and the girls, the Wolheters and their boys this afternoon. It was wonderful to have them here this week, though I regret not seeing them more (I saw less of them here than I typically do in Manitowoc), yet proximity still means something. Emma was quite tearful as we departed and it wound up being contagious. Reuben (the big logistics guy) kind enough to steal the hotel's horse cart and give us (me and the kids) a ride to the gate to make saying goodbye a bit more fun - Emma was not fooled, but it was nice to have her cuddle in my lap for a few more minutes.

If I don't have the chance to expound, I will attempt to summarize our work so far (for week one). We did 33 operations, most of which were gallbladders (around 12), hysterectomies (7 or 8), a smattering of hernias, a c-section, an appendectomy, and a number of lipoma or cyst excisions (we did those under local). Turnover time between cases tends to be long as we have to be sure that the patients in recovery are being watched closely, their pain medicines drawn up and orders written, the instruments for the next case are sterilized, the sutures gathered, the patient located, the room cleaned, and we have to drink about 2 gallons of water to replace our own sweat losses.

We also squeeze in our consults between operations so we can make sure tomorrow will be just as busy. Bill was seeing consults almost constantly, stamping out PID with a smile. Jenny Wolheter, our friend from Cochabamba, did much of his translating while her husband James helped us commincate with the OR staff. We take lunch in shifts - lasts about 15 minutes, but at least the room is air- conditioned. We are one or two translators short, so we often scramble to find one or just use my Spanglish/ Gringlish and a lot of pointing. At the end of the day, we make rounds with the local physician who will be staying the night at the hospital and watching the inpatients. They don't usually take care of surgical patients here, so we have to do a lot of explaining when we write orders. We missed dinner pretty much every day but Monday, but the ladies at the La Tapera restaurant were kind enough to stay open and save some food for us.

The Clinic team had equally long days, often travelling off road for ~3 hours each way and setting up in insufferably hot villages to see ~100 patients, dispense meds, and screen patients for more serious illnesses and surgical diseases. Wendy and the girls went with them on Friday since the drive was shorter, but the heat was still a challenge for them - Emma just wilts. They still had fun making crafts and playing parachute with the Bolivian kids - there were many more of them in the village since school is let out for the event.

Alright. Methuseleh is idling and I have scored a cold Coca Cola from the hotel bar for the 1.5h drive back to Santa Rosa. My hotel room will be lonely, I fear. May blog more often after all.

-Ciao


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Location:Lobby at the Eco

Looney Lunes - 10/22/12

Woke up this morning to find out that cracking the window was a bad idea. Mosquitos have found their way into the room and we all have a few bites. I manage to sneak out of the room and set up the MacGuyver coffee maker - nothing like a cup of French Pressed, American-Roasted Nicaraguan to jump-start the Bolivian dawn (much thanks to Rich @ Culture Cafe for hooking me up).

Read in Matthew 4 about the temptations of Christ. Struck by how He resisted the temptation to take the path of least resistance, refusing to turn stones into bread. He fully embraced his humanity, part of which was a reliance upon God as his father to provide for him as he started his time of ministry. We certainly have not chosen the path of least resistance in coming here - I know today will be a challenge as first days always are.

We have breakfast at la Tapera, then head to the hospital. We are unable to get cases started right away - a myriad of small delays and trying to find supplies we had failed to locate last night. Then, the mayor has an opening ceremony of sorts in the hospital courtyard, a smattering of around 50 locals show up to welcome us and enjoy the free cheese empanadas - I had a few myself. Chances are I will need my own gallbladder removed before this project is over. We finally get rolling clinically around 10:00am.

First case is a reoperation on a lady who has already had a cholecystectomy, but apparently still has a remnant gallbladder remaining that has managed to re-accumulate stones - I have no idea how this happens - but we struggle through a tough dissection (much scar tissue) in dangerous territory. Case went well and the anesthesia machine worked well (as did Jean, our capable anesthetist). Next, Bill does the vaginal hysterectomy, complete with the. patient's son watching and asking a lot of questions (not sure I can do that to you, mom). The case takes a long time to get started for myriad reasons, then it takes a long time as the language barrier and lack of familiar instrumentation start to take their toll. Everyone is meeting everyone for the first time and roles are still being defined.

As the day drags on, my frustration starts to build. We have promised to fix a hernia and take off a large lipoma as well, but the consults keep coming and it becomes exhausting just confirming that we have adequate sterile instrumentation for the next procedure. I feel like I'm doing everything (but so is everyone else), yet nothing seems to get done, and the patients wait patiently, dutifully fasting as told. Stan winds up excising the lipoma on a table in the recovery room while I see consults and bird-dog the supply prep. We then manage to fix a hernia under local anesthetic on the secondary table in the OR while Bill finishes up the Hysterectomy. We see a few more consults (actually, Bill sees TONS of them - they are really hurting for good gynecologic care here and he is in much demand). Then, make rounds on our postops. The gallbladder patient is having a lot of pain and a low grade fever (we later find that lowland Bolivia IS a low-grade fever for most of the year). This has me nervous - we don't really have the capability of doing bile-duct reconstruction down here and I'm not in the mood to improvise. We check back one more time after dinner and she is doing better. We get to dinner around 8pm and debrief on what we feel is a successful day - pulling off four cases in the first day at a place where they haven't done any surgery since this time last year. We talk about ways to improve the process tomorrow - everyone has productive insight. Our clinic team (entirely Bolivian) saw about 100 patients as well.
Wendy says the girls were still travel-weary much of the day, and with the heat they spent a good part of the day back at the hotel. Thank God the AC was repaired. They have looked out for our safety too as our shower knob is now wrapped with an insulating layer of electrical tape. I enjoy a cold shower before hitting the sack.


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Location:Somewhere northeast of Yapacani

Mucho Overdue

Where to begin. The project has been a whirlwind (a very hot whirlwind) ever since we arrived in Bolivia. I'll try to hit some highlights. Apologies for not updating until now, but we have been so busy I have not yet had the chance to hit the Internet cafe. Now that we are resting for the weekend, it will be. good to get my thoughts down on "paper." Apologies in advance for any irrelevant or gruesome details. I will post in day by day entries - hope I can "catch up" before the weekend ends.

Sunday - managed to "clear" customs with some difficulty. Apparently, Bolivia replaced their entire customs staff five days prior to arrival. Any advance preparations on the part of our Bolivian staff were null and void. Bags and declaration lists were inspected and they threatened to hold Dr. DRE hostage unless I promise to bring him home. Conditional "promises" were made and we were at least able to take him to the project site, but further haggling over customs, tariffs, duties, and import "laws" must still take place. Prayers would be appreciated. Feels like we are being extorted for a bribe - not giving in yet.
Sunday afternoon we took the hot 3h drive to Santa Rosa, checked into the Hotel Ochotu (AC in every room, hot showers - more on that later, and a new balcony from which we can enjoy the sunrise and the perpetual rooster crows). We had a late lunch at the restaurant La Tapera - no frills, but we have Yoko, our own personal "health inspector" who makes sure our food and water are safe. Hoping to avoid giving Montezuma any opportunities to seek revenge this week. We then went up to the hospital to set up for Monday and even see some consults - a chance we didn't have in San Juan - it will be nice to "hit the ground running" on Monday since we only have Bill (Gyn) and Stan (Gen Surg) for one week. Looks like we've already got some gallbladders lined up for tomorrow. Bill gets to start out with a vaginal hysterectomy and colpoplasty on the local doctor's mom - noooooo pressure.
We set up the new anesthesia machine and everything seems to be working - at least for now. The AC in the OR works and we didn't have to risk electrocution to fix the lights this time. Francis manages to "fix" the patient monitors (for now) and we utilize way too much duct tape in an attempt to safely ventilate the overflow of the anesthetic gasses out the back window.
Made it back to the hotel and put the girls to sleep - they've had a long day and a half of travel, but did quite well. At this point, the cool of the evening is setting in, aided by the AC. I figure I'll take a warm shower to wash off my travel stink. In Bolivia, this involves flipping the breaker switch on a 230 volt circuit which is conveniently located, yes, in the shower. This goes well, but is followed by a warm, tingly feeling as I touch the steel shower knob - should have worn those rubber flip-flops after all. I let go and continue with my shower, but soon the lights go out, the water gets cold, the AC turns off, and the tingly feeling goes away. My apologies to the team - no AC tonight after all. It will now be a long, sweaty night at the Ochotu. Breakfast is at 6:30 (0530 Wisconsin time), it is 11pm. The roosters have already started and apparently everyone in Santa Rosa has a motorcycle.


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Location:Santa Rosa Del Sara, Bolivia

Up in the air

It's 5:00am. I usually don't sleep well on planes, but somehow have managed to do so. I was pleasantly awakened to the flight attendant offering me coffee and the pre-dawn orange over the Andes out my window. Emma's head is in my lap - she slept well too. Wendy and Tessa are still comatose in the row behind us. So far, the trip has been kind to us.



We checked in at O'Hare without much difficulty. We were able to take advantage of the extra baggage allowance on the American Airlines platinum card and check four extra bags. Thouugh they could have turned that down on some technicalities, the lady at the desk (Patricia, I believe) found a way to make it work (saved us hundreds), though we still had to pay extra for the heavy anesthesia machine. Later, we watched out the window as they loaded our luggage onto the conveyor belt leading to the plane. Apparently, bright orange duct-tape reading "This end up" means nothing to Chicago baggage handlers, and "Fragile!" (Fra-gee-lay... must be Italian) must mean "tip me over forcefully." Oh well, at least it's on the plane.

The girls slept pretty well on the flight from Miami to La Paz. Unfortunately, the altitude got to Tessa who made full use of her "motion discomfort" bag, and now that we are descending to Santa Cruz, the pressure is really hurting Emma's ears. Only about 30 minutes left in the air, then comes the adventure of clearing customs. I've never had problems in Bolivia, but then again I've never brought quite this much equipment - hoping we don't get hit with much duty on "Dr. DRE."

Not sure when this will post. Hoping to find WiFi at the airport (and hoping they don't charge quite as many pesos as they do in Chicago and Miami).




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Location:Somewhere East of La Paz

Packed and Ready

It's here. We leave this morning for about 26 hours of travel and tomorrow will be soaking up the sun in Santa Rosa del Sara - (a place so small it gets no props on the new iOS6 maps app). Tessa is so excited she couldn't fall asleep last night. I asked her why and she said she is looking forward to watching a movie on the miniature TV screens on the plane. Sadly, I had to inform her that we are flying American Airlines and we should be thankful enough if the seats are merely bolted down. She also says she wants to make new friends in Bolivia, but wishes she could take hers with her.

I can't think of anything else to pack, mostly because it would require throwing something else out. Last night, a bag of almonds were sacrificed in lieu of a bag of bladder catheters for example. We were really packed by about 8pm, but I remained restless as I often do the night before a trip. I don't think I've forgotten anything, yet I KNOW I've forgotten something. This anxiety is only kept at bay by endlessly searching for that something, and when that doesn't work, I make the requisite last-minute trip to WalMart for fluorescent orange duct tape, a pink umbrella, and a fresh bottle of Gaviscon.

Now it is morning and I've had a few good winks. The coffee is brewed and I am now clinging to the familiarity of my morning routine (except for the blogging, that is) - Bible, books, fireplace, couch, and trying to let the girls sleep as long as possible. Tomorrow we will wake up at 11,600 feet (LaPaz) and on Monday morning I'll be reconstructing the MacGyver coffee setup to caffeinate our team before setting up the OR. On one hand I feel unsettled, on another hand I'm looking forward to resuming what has become my routine away from my routine, and I am quite happy that I will be joined by my family.


Reflecting this morning on all that I have to be thankful for. The number of people who have contributed to this trip is astounding. 4H kids collecting vitamins, sales reps donating their stock, numerous people contributing towards the anesthesia machine (fully funded in one week!)... I have no hope of offering a comprehensive list. It is truly humbling to see the interest so many of you have taken in setting this project up for success. In a way, you will be with us as we care for patients and their families in Santa Rosa. Thank you.

If you have opportunity to pray today, we've got some specifics for you.
- Wendy has been feeling a bit under the weather, mostly fatigue.
- We have a LOT of luggage and we are hoping American Airlines does not try to bail themselves out of bankruptcy with overage charges.
- We have a heavy but delicate Anesthesia machine (now clearly labelled as fragile with lots of fluorescent orange duct tape) in search of a gentle baggage handler in Chicago (and for a TSA agent who can distinguish it from an explosive device)


- We have a small team with some noteworthy gaps (no nurses, no techs) that we are hoping can be filled with Bolivian volunteers.
- The lavish hotel Ochotu (with AC in every room) is filled with Oil Company employees, so we will be staying someplace else -AC tbd. Sounds petty, but temp is 90's during the day, overnight lows around 78 - it can really suck the energy out of the team.

Thanks again, everyone. We'll keep you posted as often as we can.


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Location:Manitowoc, WI

Dr. DRE is a bit... heavy 

     Much thanks to all who have given so far towards the purchase of the DRE-Medical portable anesthesia machine for our projects in Bolivia with Medical Ministry International (www.mmint.org).  Your generosity is truly astounding.  With the help of matching funds from the HFM medical staff and the fundraising assistance of HFM Fund Development, we are nearly at our goal!  Remember that any excess funds donated will still go towards supplies and medications on these projects as well as towards sholarship funds to assist RNs and Surg. Technologists wishing to go on future projects.  

 

    We are getting excited as the custom-made protective hard case for the machine has arrived (and not a moment too soon).  Unfortunately, the combination machine/ case weigh 85.5lbs - you could say that Dr. DRE has a bit of a weight problem.  It will cost a bit extra to take him down there, so some of the donated money may still go for that and other luggage overage as supply donations have been astounding.  We (DRE included) about 435 pounds of luggage (8 bags pushed to their limit), plus whatever our companions bring along.  Just back in January, I struggled to fill 2 suitcases with supplies.  This time we have 8 and they are packed to the gills.  So much thanks to all who have donated supplies, extra suitcases, vitamins, medications, Bibles, money, and instruments, and your thoughts and prayers for the project.  So many have stepped forward to help.  We are so blessed and we can't thank you enough.  

    Further donations can be sent, tax-deductible to HFM Fund Development, 2300 Western Ave, Manitowoc, WI 54220 - labelled "restricted funds - anesthesia machine." or call (920) 320-2011 and as for Erik Barber/ Fund Development. 

Dr. DRE and associates

    So. I’m about to head back to Bolvia (Santa Rosa del Sara, to be exact) in 10 days. I’ve been participating on surgical/ medical/ dental missions projects with Medical Ministry International (www.mmint.org) since 1997 as a premedical student. On most of these projects, volunteer Anesthesiologists/ Anesthetists manage to make-do with meager anesthesia equipment. In Bolivia, this has involved a very old anesthesia “machine” which actually consists of parts from different anesthesia machines transported in an Igloo cooler and held together by electrical tape/ duct tape and a certain amount of rust. It leaks – so bad that the patients aren’t fully asleep (and the surgeons aren’t fully awake).

Old Machine – trust me, it leaks.

      One of our participants (Jon Klatt, MD – Anesthesiologist at Holy Family Memorial in Manitowoc, WI) from our previous project (Colonia Japonesa de San Juan – January 2012) worked with this machine and felt moved to spearhead an effort to get a new anesthesia machine for our work in Bolivia. Jon hopes to return for future projects as do some of his colleagues at HFM. In fact, Jean Reindl, CRNA is coming along with me this time for her first surgical missions experience. I am so excited for her and thankful for her generous donation of her time and willingess to take on such an adventure.

     The machine costs about $10,600. Manufactured by a company called DRE, it is a bare-bones, durable, portable machine perfectly fit for the conditions in Bolivia – MMI does about one project a month in different towns/ cities accross the country – the machine goes with them. With the project coming so soon, Jon and his colleagues went ahead and obtained the machine so Jean could use it on this project. They purchased it on faith that we will be able to raise the funds to cover its cost – I am truly humbled by their generosity and enthusiasm for surgical missions in general and the people of Bolivia in particular. Judging by the age of the current setup, this machine is likely to see 30-40 years of use down there.

“Dr. DRE” – tough, efficient, no leaks

      In an exciting development, the Medical Staff at Holy Family Memorial, in a unanimous decision, voted to provide matching funds up to $5000 for the machine! That means any donations routed through HFM Fund Development for this machine are doubled, and they remain tax deductable! How do I give, you ask? You can send a check to:

HFM Fund Development
2300 Western Ave
Manitowoc, WI 54220

Put a note with the check that states “restricted funds for anesthesia machine”

     Any excess funds raised will stay in the fund and will go towards things like supply purchases or to create scholarships for Nurses and Surgical Techs wishing to go on a mission project. We’d greatly appreciate your assistance (any small amount helps) in helping to send the DRE machine (I think I’ll call it Dr. DRE) to Bolivia with us. I’ll send updates during the trip as often as the Santa Rosa internet access allows.