Wrapping things up

            I’m sitting at terminal D5 at the Miami International Airport – we will soon return to an English speaking country.  We have already cleared customs – I will admit that this always comes as a relief nowadays.  I never know how to fill out the declaration forms any more.  Have I been in contact with any livestock?  I did ride a bus with a chicken just this morning, but I didn’t touch it, so I guess that depends on how strictly one interprets “contact.” Am I bringing any insects into the country?  Well, I haven’t showered since yesterday and I stayed at the Hotel Ochotu, so I’m pretty sure that’s a yes.  In the end, the customs official was in a very chipper mood and had no intention of checking me for head lice, nor did he care to confiscate any of the tampons that the team had hidden throughout my carry-on bags as a goodbye prank. 

The North American half of our team enjoyed one last meal together at the airport Cuban restaurant before heading to our separate gates.  We all expressed our hopes to do this again together soon – maybe even next year.  Now it’s time to find some good coffee if I am to have any chance of staying awake for the drive home from O’Hare.  We land around 11:15pm.

The last day in Santa Rosa is always somewhat of a blur and this one was no exception.  We have a half-day in the clinic and OR before breaking everything down and loading it onto Ruben’s truck and our bus.  We then been invited to a barbecue with the mayor at the local Karaoke bar/ Discotheque.  Some of the team (those here for the first time) are even heading for Santa Cruz for the day (~2.5h drive) to do some touring and shopping before heading back for the dinner.

Rounds went well.  Modesta looked like a million bucks (or roughly 6.91 million Bolivianos) and posed for a picture or two before heading home.  We actually discharged all but one patient – he will stay through the weekend before having his drains removed and heading home, but even he looked quite well.  After rounds, we had a smattering of minor cases that we had been putting off until the last day in order to make room for the more major procedures earlier in the week.  There are always a few of the hospital staff who file in with lipomas or cysts to remove, and they all enjoy helping out on each other’s procedures.  We even took some skin tags off the mayor (with a few of his staffers snapping selfies in the OR with him (awake) draped in the background (clearly no Bolivian equivalent to HIPPA yet), but not before he and I were interviewed for a Bolivian television spot out under the mango trees. 

We managed a decent siesta during the hot afternoon – it was dry, but was probably somewhere around 90 degrees and it was nice to laze around in an air-conditioned hotel room and pack our bags – we would depart at 5:00am Saturday morning.  Cleaned up with another 220 volt shower before heading over to the disco/ karaoke/ barbecue/ farewell ceremony.  The mayor and other officials presented certificates of gratitude to both the MMI team and to the local hospital staff for their efforts this week, then we did some salsa dancing (I do not suggest the gringo variety) while a variety of mammals roasted on the grill. 

As the evening wound down to a close, I tried to clear some space for a group photo – some of the Bolivian team was to head back to Santa Cruz that very night as they had classes the following morning.  I dragged some stacks of white plastic chairs across the dance floor as people started to line up and hand all their cameras to Gladys.  In the process, a chair dragged across my left big toe, slicing it open a bit.  I looked in vain for something to stanch the bleeding.  Every napkin I could find already had barbecue sauce on it.  All the wound care supplies were already tied down under tarps in the bed of Ruben’s pickup.  The bleeding continued – this was going to make for a very awkward group photo and everyone was now lined up, waiting on me.  If only I could find something clean, something absorbent.   I needed something, anything designed to absorb blood quickly so as to avoid awkward social situations.  Someone in the crowd sensed my need and discretely handed me a small, flat pink and white wrapper.  Faced with an apparent nation-wide shortage of tampons, I was given an alternative product, absorbent on one side, adhesive on the other.  I wrapped it snugly around my big toe and hemostasis was instantly achieved.  Clearly everything has its purpose.

We headed back to the hotel, finished packing, and said our goodbyes to the car heading back to Santa Cruz.  We ourselves left on the team bus at 0500 the following morning and pulled into our driveway about 24 hours later (and 60 degrees cooler).  Four hours later, two girls in their jammies pile into our bed with us and jockey for the warm spot between mom and dad.  Oblique winter sun breaks the crust off our eyes.  It is good to be home.  Much thanks for all your thoughts and prayers this past week. 

Losing Count

Losing Count

     I would like to extend a half-hearted apology to those who expected more frequent updates on all that is happening in Santa Rosa del Sara.  Alas, there has been so much happening in this metropolis of the Bolvian heartland and I have had precious little time or bandwith to record and share it all.  Even now, I only have time to put down these thoughts by waking earlier than the rest of our team (though the roosters of Santa Rosa have been up for a couple hours already).  It is already our last day – I can’t believe how fast a week can go.

    Now, I am the first to admit that I am no accountant.  I did carry a math minor for a few semesters, but dropped it like a bad habit after it took me an entire semester to “prove” that 1=1 (apparently, writing “duh” on an exam does not cut it at the college level).  Nonetheless, I do come from a numerically obsessed profession, which can be both a good thing and a bad thing.  Though we measure success in less concrete ways, at the end of the project I will still be able to tell you how many procedures we performed, how many consultations were seen, and how many prescriptions were written.   Though we can say that it’s “not about the numbers”, the numbers are, in the end, individual people, and it is indeed all about the people.  Each of them are a singularity of infinite importance, neither greater nor lesser in value or in substance than another.  On this particular project, God has chosen to shower His blessings upon us with both people and numbers, with both quantity and quality of interactions with both our patients and our partners in service.  It has been wonderful. 

     One specific application of numbers in the field of surgery is that of making sure that our “counts” are correct.  That is, we want to make sure that we finish an operation with same number of needles, scalpel blades, instruments, and gauze pads that we started it with.  This is a good idea due to the dangerous consequences of leaving something behind in a patient.  Though a healthy idea in the operating room, I would contend that there are other areas of life where neurotically keeping such counts is neither possible nor advisable.  Now I am very happy to say that we kept very good count of our instruments and supplies in the operating room, but I am equally happy to tell you that I have completely lost count of much more important things through our week here in Santa Rosa. 

    I have already lost count of how many operations we have done – I believe it is around 30 over the first four days – For a two surgeon, one week project, this will be a record pace so far as my own projects go.  Today will be a bit lighter as we will be packing up the anesthesia machine and most our supplies while repairing a hernia and removing some lipomas (small fatty tumors) under local anesthesia.  We were originally going to head back to Santa Cruz tonight for some sightseeing/ souvenir shopping, but the mayor of Santa Rosa has planned a barbecue for us and the hospital workers as well as an official ceremony at the downtown square.  I hope they don’t make me give a speech; all I can really do in Spanish is ask for a scalpel and tell you how many ibuprofen tablets one should take after I use said scalpel. 

     I have lost count of how many belly-laughs we have shared as a team.  Everyone has a great sense of humor and irony.  The language barrier, along with the often-embarassing moments that make up healthcare have provided plenty of fodder (as have my tampons).  Everyone has had a turn at being harassed by their teammates.  One would think the medical director (“Del Medico”) would be spared such harassment, but alas he has not. 

     I have also lost count of the number of times I have been encouraged by my teammates down here – not flattered or patronized, but truly encouraged.  Surgery in this environment can be quite easy one moment, and then can become an immense stress when a case gets difficult.  The lighting is poor, the equipment old and limited, and the ancillary resources are few with which to manage a complication should one occur.  It can get difficult to maintain one’s cool in a hot operating room with two cases going on at once. When I wear that frustration on my sleeve (I may have stamped my feet once or twice), the others have been quite forgiving and gracious with me.   Our helpers, whether they be our North American volunteers, our Bolivian volunteers, or the local hospital staff working unpaid overtime (and hence volunteers in their own right), have bent over backwards each time to enable me to complete the task at hand.  After a difficult case, I am offered words of encouragement, a drink of cold water, a five minute break, prayers of encouragement, and sometimes a mood-lifting laugh.    

     I’m sure the clinic team has also lost count of the number of patients they have treated, as well as the number of pot-holes they have had to drive Ruben’s 1984 Land-Cruiser through to get to their locations.  Long lines always await them followed by long hours in hot, humid exam rooms.  In spite of their daunting task, it is quite uplifting to hear about the amount of time they manage to spend listening to their patients. The chief complaint may only be a headache or arthritis, but instead of quickly moving on to the “more interesting” patient, they have taken the time to sit with, listen to, encourage, pray, and share the love of Christ with their patients.    Our translators have been instrumental parts not only the medical care, but also in our ability to personally connect with people whose lives are so different than our own. 

     I have lost track of how many times our wonderful recovery room nurses Dorothy and Freddie have gone back to check on our postop patients, even long after they have left the recovery room.  We did a component separation (huge hernia repair that involves separating out the muscle layers of the abdominal wall) the first day on a sweet little lady named Modesta (and by sweet I mean incredibly stubborn).  At first, we would ask her to take a deep breath (to prevent postoperative fevers and pneumonia) – she would just shake her braided head and say “no” – no discussion, no excuses, just “no.”  It has been a real joy to see Dorothy visit her a few times each day to attend to her needs and to see her soften up in response.  By Thursday, we were laughing about her “bad hair day” and were recruiting her to help on next year’s project. 

     We are told (and are tempted to try) to count our blessings.  I think this is so that we will appreciate them appropriately, though the temptation is often to formulate ways to pay them back or to “pay them forward.”  It is human nature to try and make sure that our “counts are correct.”  The reality is however, that I can never adequately pay anyone back for the blessings I have received.  Even the attempt serves to insult the giver, to spoil the gift, and to oblige the recipient towards reciprocation based in guilt rather than joy.  In the end, sometimes all we can and should say is a heart felt “Thank You” and to happily lose count of both what we have given and have been given.  So to the people and government of Santa Rosa, to the staff of Hospital Dr. Melchior Pinto Parada, to the bevy of Bolivian MMI staff and volunteers, and to everyone who came (or enabled us to come) from the States – Thank You.  I cannot ever hope to pay you back. 

A Day Under the Belt

11/3/2013
      I am finally lounging on my bed in the Hotel Ochotu after a whirlwind 36 hours of international travel.  I have reason to believe that I may be able to post this without having to brave the sweaty Santa Rosa internet café scene, so I am blogging off-line, on faith that I will find a wifi network somewhere before the end of the project.  Where to start?
      The day got off to a smooth start – we were actually finished packing the night before we left, so we enjoyed a relaxed morning reading, eating waffles with the girls, and watching the roofing contractors/ FEMA crew as they continue to make our house looks as close to a Bolivian construction zone as possible.  Lindsay and Dorothy arrived on-time and we kissed our girls goodbye, condemning them to a week of certain spoilage at the hands of their grandparents (Thanks, Mom & Dad).  We made good time to O’Hare and made it to Miami with only a few minor hiccups on the way.  We met up with Dr. Kong at MIA before boarding for Santa Cruz – only at 40 minute flight delay, but thankfully no international connections to make.
     Wendy and I both managed to get decent sleep on the plane and no one suffered from altitude sickness in La Paz, so we managed to land in Santa Cruz feeling (though not smelling) refreshed and ready to clear customs.  And this is where the fun begins.  Franz (Bolivian MMI doctor) and Jula (health department official) were there to meet us and, as usual, managed to arrange our own line through immigration – Visas were no problem at all.  The problem came when it was time to take our bags through customs.  They have you load your stuff onto carts, then randomly select about one in three carts for a hand search (everything else gets a free pass, I guess).  You press a little button, and if the light is green, you’re good to go.  Wendy’s light turned green.  Mine was red this time. 
      Now mind you, nothing in my bags is technically illegal, but Bolvian customs is always on the lookout for things that look like imports on which they can collect a duty.  If they get the idea that any of our things are meant for resale, they want their cut.  Worse yet, they want to impound such items while they take two or three days to figure out how much they can squeeze out of you – days we can’t afford to lose if they set their sights on something essential to our work.  Within my suitcases were bags and bags of sterile gloves, needles, syringes, surgical dressings, medicines and vitamins, as well as some non-medical items that have been requested (random stuff like soccer balls, peanut butter, chocolate chips, and tampons).  Which of these things, you ask, did junior customs official Lopez find most suspicious?  That’s right:

Tampons

     I’m not sure what is so suspicious about tampons (other than the fact that a 36yo male had about 150 of them in his suitcase), but the LADY didn’t even know what they were.  So there I am, with the rest of the customs line behind me, trying to explain tampons via pantomime to an armed, non-english speaking woman with no sense of humor.  I failed. 
“Are they candy?”
Um… no.
“Can you demonstrate?”
Um… no.
“How much are they worth?”
That depends…
      Eventually (after an HOUR) she decides that she will impound the 150 tampons, three soccer balls, 200 syringes, 100 needles, and 50 scalpel blades.  They keep my passport for a disturbing amount of time while filling out more paperwork (I read the little form on the plane twice, and NOWHERE did it say I had to declare my feminine hygiene products!)  before finally giving it back to Franz. (I am now probably registered with Interpol as an international tampon smuggler and am quite fearful of my next TSA inspection.)  I finally make it through to the coffee shop and join the rest of the team.   It was good to finally see a happy mix of new and familiar faces ready to board the bus for Santa Rosa. 
      We finally made the drive to Santa Rosa after a quick breakfast at the airport coffee shop.  Traffic was dense all the way through Montero, so it took us about 4h – we arrived around 1:30pm.  We went straight to lunch – a different restaurant than in years past, thankfully with more elbow room and fewer canines patrolling for scraps.  We then stopped briefly at the hotel to check in before heading to the hospital to see some pre-screened surgical patients – we saw 18 consults and scheduled 13 of them for surgery before heading back to the restaurant for dinner – made it back to the Hotel around 8:30pm It was a long day and the team maintained a good attitude through all the sleep deprivation and airport hassles.  It will be nice to have already seen so many pre-surgical patients before the first OR days starts. 
       Monday will start early with breakfast at 6:30 – the clinic team has a 2h drive on bad roads to reach their destination.  The OR team has 4 cases scheduled, including a massive hernia on a little old lady that will probably require a complex procedure called a component separation.  Dr. Stan does these often as part of his practice and I am looking forward to doing one with him.  We also expect to see a large number of consults through the day.  We seem to be running a special on hernias this year because they really got word out through the rural areas where the hard working folks have been working on enlarging their hernias through decades of dairy farming labor. 
     Tomorrow comes quickly.  We are trying to cram a lot into one week, so not sure how often I'll get to post.  Thanks for following along. 
-Matt

Gearing up to go!

     Just a short note here to let folks know that we are heading back to Santa Rosa del Sara, Bolivia in T-minus 18 hours. Just a short, one week MMI project this time. It will be my third time to Santa Rosa which has a special place in my heart as it was my first Bolivia project location (in 2010). I get to take Wendy with me again this time, but the girls are staying behind with my parents – So nice to have them in our neighborhood now. We are truly thankful for their help this week.
      I am excited about our team this time around. We are joined by Lindsay Lorenz, PA-C who lives here in the Manitowoc area and works in multiple emergency departments in Green Bay. She has surgical experience as well, having worked with us in my office in the past. She honestly has so many skills, I’m not sure where she will do the most good. We also have Dorothy Grossheim, RN from our Same-Day Surgery department here at Holy Family. She will fill a much-needed role in preparing patients for surgery and monitoring them afterwards. That rounds out the Wisconsin Contingent.
      We also have a West Coast part of our team. I’m excited to work again with Dr. Stanton Smith, another general surgeon practicing in Klamath Falls, OR. We worked together last year in Santa Rosa and had a great experience. Stan gets to bring his wife Valerie this time as a general helper. We will also be joined by “Freddie” Buhr, a recently retired nurse who has known Dr. Smith for quite some time and who has always wanted to go on a mission project.
      From Ohio, we will have Dr. Roberto Kong joining us again. Roberto is an anesthesiologist practicing in Dayton, Ohio (GO BUCKS!) and this will be our third Bolivia project together. He was with us in Santa Rosa in 2010 and in San Juan in 2012. He is an extremely compassionate, conscientious, and skilled anesthesiologist. I’ve seen his MacGyver skills in action, but he is probably looking forward to working with the new anesthesia machine HFM donated last year (I’m pretty sure he’s still bringing his duct-tape and chewing gum, though. Just in case…)
     A late registrant is Dr. Henry Bush, a family practice doc working in Puerto Rico. He will be working with our clinic outreach team out in some of the smaller outlying communities in Santa Rosa county.
     We are in the final packing stages right now – a mad dash of Suitcase Tetris as we try to push each bag right to the weight limit. I have managed NOT to lose my passport this time around and I think I have all the paperwork ready to go. Not bringing any heavy equipment this time, so that should make clearing customs a little less “Bourne-like” this time around.
We get to stay again in the “Hotel Ochotu” again this year – a cozy little enclave three blocks from the hospital and perpetually under construction. I recall them also having intermittent AC and electrifying showers. To prepare, we have decided to have our home’s roof re-done as we leave – we are now pre-accustomed to construction noise and shouting en-espanol late into the evening. Our electricity also goes out on occasion.
      Not sure how much I will get to blog while we are down there. We tend to work late into the evenings on short projects, and as of 2012 the hotel did not have internet. In fact, the only internet access in town was at a quaint little internet café downtown. It was basically a 100 degree phone booth with 8 workstations (486 PCs on dial-up), seven of which are occupied by sweaty gamers at all times. The place is named “Need for Speed,” which is more of a plea for help than anything. I am not sure if it will be available this year as I hear it is serving as the outsourced headquarters for Healthcare.gov. If I am unable to post from the project, I’ll try and journal anyways and then post them when I get back to the airport next Saturday.
      Well, I’ve gotta go. More packing to do and I’ve got a seven year old girl trying to use me as a jungle-gym which will make fir intolerskjnble typos and unredablk blgs.

     Hasta