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Turistas

A brief update.  Still no pictures,this time just because the mere attempt to upload anything may bring down the entire internet for this city of 1,000,000 plus who probably need it for more important reasons.

Wendy and the girls arrived on Sunday morning and I got some great bear-hugs in the airport before being prompty dragged to Cinnabon.  We made it safely to Cochabamba on the 11:00am flight and met up with our friends, the Wolheters.  We relaxed at their place for the rest of the afternoon as the girls recovered from aout 36 hours of continuous travel.  We took a walk that eveningto a playground that was akin to a small Crossfit gym for kids in the middle of this hilly city.  My kids would run around for about 2 minutes, then lay down to recover from the altitude (somewhere around 7,000 feet), before picking themselves up to play some more.  They slept well that night.

Monday we travelled to Parqueo Pairumani, a mountain gorge with waterfalls and a fast moving (and very cold) stream that the kids played in for hours - we almost didn´t make the climb because Emma had wilted like a leaf of steamed spinach, but we took turns carrying her up the mountain on our shoulders, and the cool water quickly restored her to her normal, playful self.  Pictures are posted in my Facebook album "Pairumani."  

Tuesday we went to visit the giant Jesus statue overlooking the city.  It was apparently the tallest in the world (even taller than the well-known one in Rio), but rumor has it that Poland has built a bigger Jesus, much to the chagrin of the locals.  We took the yellow gondolas up the hill (Emma prefered this to the 1440 steps).  Jesus has a great view of the city.  You can even go up inside Jesus, but apparently only on weekends.  Later, the girls went out for a mani-pedi with the moms and I stayed home and babysat the boys (meaning I read, slept, blogged, sorted through my photos, browsed facebook, and ate some cookies).  The adults went out for traditional Bolivian fare on Tuesday night while the kids stayed back and watched Frozen... again.

Wednesday we packed the Land-Cruiser for our trip up the Andes and accross the Altiplano to LaPaz.  I played luggage-tetris on the roof before wrapping everything into a blue tarp burrito.  We then made a long, curvy, crowded drive topping out at 14,700 feet (Pike´s Peak in CO is 14,115 feet).  We took some of the most scenic potty breaks ever.  Emma and Tessa both resumed wilted-spinach posture, this time draped all over their longsuffering mother, who took it all like a champ.  No one vomited - thanks to God (who worked via a cocktail of dramamine, acetazolamide, benadryl, ibuprofen, caffeine, and Jame´s expert driving).  The second half of the drive was accross the arid Altiplano -  broad expanses of flat pastureland with flocks of sheep, cows, and llamas attended to by traditionally dressed Aymara women.  Towards the end, the snow-peaked tips of the mountains around LaPaz, including Illimani (21,122 feet).  We got a view of the city from the plane above (El Alto) before descending to LaPaz (12,000 feet) where we carried the luggage up four stories to our apartment for the week (that was a workout!).

OK, it´s Thursday now - time to take the fam up to Lake Titicaca (and no, I will never get the kids to stop laughing every time we say it).  Hasta luego!

The ones I didn't take

Why doesn't this blog have any pictures?

                Photography has long been my hobby – I used to take hundreds of photos at a time, even in the film era (what’s film?  The kids sometimes ask.).  Once things went digital, I would take thousands.  At first, I would mostly shoot landscapes – probably because I was shooting with a manual-focus, manual-metered camera and landscapes don’t tend to move all that much.  For the most part, I stayed away from people pictures much for this reason.  The best ones are candid, un-posed, and I simply couldn’t focus and meter fast enough to catch an unscripted expression worthy of an exposure.  Once I entered the autofocus, auto-metering, digital era, taking good photographs of people became much more feasible.

                And so I did – lots of them – especially on mission projects.  There were so many memories I wished to crystallize – unique faces bearing the full range of human emotion and experience, and largely without the option or even the propensity to conceal themselves with makeup or even contrived expressions.  Every eye, every wrinkle seemed to tell a story, the ethos of which I might capture if I took a picture or ten.  I would look back at these often, even hanging some on my walls at home.  Often, they would release a flood of memories, indistinct and mostly visceral, of the emotions, even the smells I had encountered.  The pictures I took appeared to be serving their purpose.

                After a few more projects, I noticed that I was taking fewer and fewer pictures.  I would get home and have a chance to page through them and would find myself disappointed – where were those faces so worthy of a LIFE magazine cover?  How was I to remember?  I even found myself swallowing my photographic pride and emailing other trip participants to get copies of the pictures they had taken. 

                Why was this happening?  The reason is likely multifactorial.  At a very simple level, my hands were always busy doing something else.  My mind was also distracted by all the other small tasks that needed to be done to keep a project moving.  I had little down-time to seek out the perfect shot.  I was also going places for the second and third time – the newness was waning and with it my shutterbug tendencies. 

                There were other reasons as well – I would discover, trip after less-photographed trip, that the quality of my memories was not fading as I had feared.  In fact, they were improving in ways.  Faces were replaced by people.  Story-laden wrinkles gave way to actual stories.  No longer a camera between us, the nature of my interactions with people deepened. 

                Psychologists refer to the Hawthorne effect – “a form of reactivity in which subjects modify an aspect of their behavior in response to the fact that they know that they are being studied.”  I’m sure you’ve seen it – smiles become forced, tears are not allowed to linger, and unacceptable emotions find a place to hide until the shutter snaps.  In short, the process of taking the photograph changes what is being photographed, sometimes completely eliminating it.  Sure, the person is still there, but the moment one had hoped to capture is gone without a trace.  The memory preserved is a shiny, plastic replica while the genuine article has begun to fade. 

There were many snapshots I had hoped to take on this project, but didn’t. 

-          The forlorn, lonely face of our young, pregnant patient before her appendectomy. 

-          The abject fear of a toddler being taken to the OR, to be sequentially replaced by exhaustion, resignation, trust, and calm as he is sung to sleep by the anthesia crew. 

-          The hilarious and uninhibited grin of a man under mild sedation as he tried to teach us Spanish during his hernia repair. 

-          The collective smiles and laughter of a sweaty ward of inpatients as they suffer through our Spanglish.

-          The tired yet willing faces of the OR instrument crew as they agreed to stay late “uno mas” time on behalf of a suffering patient.

-          The exhausted, yet satisfied repose of our Bolivian and North American volunteers as they sacrificed sleep and comfort to do what God called them to do, some for the first time in this capacity.

I didn’t take these snapshots, or maybe I did.  Much thanks to all of you who have helped in any way to make these memories.  Hopefully you’ve shared in them to some extent through the blog.  Better yet, consider coming along sometime.  Bring your camera, but don’t use it too much. 

Now the project is over, and I’m a tourist this week.  Let the cameras roll and the shutters fly.

-Matt

Uno mas

                It has been a very busy few days.  We ran out of internet credit on Tuesday and didn’t really get sustained access until returning to Santa Cruz last night (Friday).  Hence the infrequency of updates.  Now, there is so much to reflect and report upon that I don’t know where to start.   I guess I’ll give the story of a day that typifies these projects. 

                 Monday and Tuesday had gone quite well.  We had managed to pull off 10 major procedures in two days and had functioned quite well as a team right from the start.  Everyone knew their respective roles and embraced them, yet remained flexible enough to encourage and assist their teammates.  It was good, hard work, but the days were both long – we got back to the hotel around 8:00pm both times.  I knew that Wednesday would present a challenge as fatigue starts to set in, mosquito bites accumulate, intestinal issues become manifest, and the initial adrenaline rush starts to wane.  Additionally, we would have Yessica Pardo, a gynecologist from Santa Cruz joining us, hoping to do a few procedures of her own.  We would be hiring the services of Ulices, the local anesthesiologist (he has worked with us many times here and in Santa Rosa).  At the outset, the scheduled plan was to do at least 7 procedures and we had promised the local staff that we would try to finish by 5:00. 

                The team was somewhat Zombie-like at breakfast – but they were happy looking zombies and I decided to take the risk and caffeinate them.  Paola gave the team devotion with her ever improving English.  Franz, Yessica, and I pieced together a proposed OR schedule on the bus before running it past Klatt for his perusal – he made some valuable suggestions which might make things more efficient and keep us eager-beaver surgeons grounded in reality.  We pulled into the hospital grounds around 8:00 –a crowd was already starting to accumulate under the shade trees, under the entrance portico, at the door of our supply room, and in blue plastic chairs that made up the (very busy) optometry clinic. 

                Everyone went about their tasks without any need for instruction.  Dorothy and I rounded on the 4 or 5 inpatients that we had accumulated (mostly gallbladder resections and spinal anesthesia patients who stayed the night waiting to urinate).  The Anesthesia trio gathered their supplies for the day and made their first preop assessment.  Elaine (functioning as our circulator) packed the blue duffel with supplies for every OR contingency.  I would run back and forth from the OR to the supply room pulling suture and mesh for the day’s cases.  Things were running smoothly.

                In this flurry of activity preceding the day’s first case, I was frequently stopped by the waiting patients who would speak to me, unfortunately in Spanish.  Some were expressing thanks or asking questions about relatives who had undergone surgery and were back in the wards.  Others were asking to be seen in consult or to have surgery (our schedule was already more than filled for the week).  I would try patiently to sort out the difference, usually going to find one of our Bolivian team members to translate.  On more than one occasion, we would agree to see the patient in consult and make an attempt to wedge in “uno mas” operation into the already overflowing schedule.   My heart would get a bit heavy.  Faced with the reality of how quickly we can do safe work, I knew these concessions were likely to result either in a disappointed OR staff (working late hours in spite of our promised attempt at an early finish) or in a disappointed patient who’s operation may be postponed until next year. 

                The day got rolling and was moving along at the pace I had hoped for.  Hannah and Erica (CRNA) students have essentially turned Dr. Klatt into a 6-armed anesthesiologist, making for fast turnover between cases.  Dorothy functioned like a well-oiled machine in the recovery room/ ward allowing me to stay in the OR and move things along there.  (She become the talk of the whole hospital as she was able to demonstrate incredible patience,  compassion, and attention to detail throughout long days, in a 90 degree, 98% humidity room full of sweaty, needy patients.  She was a (very sweaty) sight to behold. 

                The procedures themselves were blessed with very little bleeding – Paola and Wesley (an intern from Brazil) both made for capable and enthusiastic first assistants who were able to anticipate my subsequent steps – open gallbladders were taking less than an hour and I was able to leave incision closure to them as both have demonstrated proficiency and increasing speed.  In the end, we would complete eight operations on two tables and have the last patient in the recovery room by 5:10pm.  It was the perfect day – we might even get to walk into San Carlos for ice-cream and enjoy some of the local culture.  Then…

                Uno mas

                “Doctor, can you come see a patient?” – It was the local obstetrician asking. 

                She is 17 years old.  14 weeks pregnant.  Feverish, nauseated, and in pain for the last 24 hours.  She had a long, forlorn face bereft of any “pregnancy weight.”  She could barely speak, but her dark, hollow eyes were themselves a plea for help.  Her husband and family had all left for their homes – at least 3 hours away by motorcycle.  They have cellphones, but live far beyond the edge of the grid.  They could not be reached.  I pressed gently on the right lower quadrant of her abdomen and the lethargic girl somehow managed the strength to recoil and push my hand away.  She had appendicitis.  The rest of her abdomen was soft, indicating that it had likely not ruptured yet.  She would need surgery, and soon.

                In Bolivia, it is almost unthinkable to take a minor to the operating room without consent from her parents, or to take a married woman without the participation of her husband in the decision making process.  Family is valued over autonomy, maybe even over safety.  I sought advice from the local hospital staff and from Franz and Yessica as the OR team (without even a hint of complaint) set up for the case (we had already packed up for the night).  We got approval from the hospital director, the local gynecologist, as well as myself – hopefully the family would be in agreement whenever they would arrive.  The patient herself consented, at least feeling the urgency if not quite understanding it.

                We made incision around 6:00pm.  The appendix was massive, gangrenous down to its base, but hadn’t ruptured.  Had it done so, she would have developed severe peritonitis for sure.  We had operated in time – tomorrow would have been a different story.  In the recovery room, she looked more comfortable immediately after anesthesia had worn off, although she was still weak and dehydrated.  She would continue to recover well.  Her family could still not be reached when we left on Friday afternoon.  Though she was feeling and looking better, I still couldn'tt provoke a smile as I am usually able to do with most our patients.  We gave her some food (families usually provide the food for the pateints) and turned her care over to the local staff before we boarded the bus.  We pray her family will return soon and that she will thrive through the remainder of her pregnancy. 

               The days on these projects can be long.  What should have been the shortest one turned out to be the longest.  I will confess to a moment of self-centered exasperation when confronted with that softly spoken "uno mas."  To be honest, they were the last words that I wanted to hear.  We were ten minutes from leaving for the day.  But that was when she was given to us.  Had we left for the hotel, the standard practice would have been to transfer the patient to Santa Cruz (they usually do not call us with many night-time emergencies).  This transfer however would likely not have been carried out without her family’s approval.  I think she would have gone septic by morning and lost the pregnancy at a minimum, maybe worse.   

Often times, the words we least want to hear are the ones we most need to.  Thank God for "uno mas." 

Expectations

I’ll start by quoting a song: 

              Novices have expectations
              because they think they should.
              Experts have their revelations
              Like they knew they would.

The name of the song is “Trouble”  (Artist: Over the Rhine, Album: Trumpet Child – Buy it, you’ll love it).  Now I don’t yet fancy myself an expert at this stuff, but I’m not a novice either.  Given the choice however, I felt duty bound to have at least some expectation of what we could do on Monday.  So call me a novice still. 

                If you read yesterday’s post, you know I went into Monday with the hope of pulling off five cases.  I don’t know why I thought this would be possible – on most my past projects we have not even made incision on the first case before lunch -  there are still machines to set up, supplies to organize and sterilize, processes to iron out, and all this with a new team, a language barrier.  Some of our team only arrived last night after 40 net hours of travel, including missed connections in Mexico and Peru.  We have 6 North Americans and 9 Bolivians [this includes our cook and our bus driver] – all this for a combined Surgical, Medical, and Optometry project.  I should be happy just to fix one or two navels. 

                We arrived at the hospital to see quite a crowd gathering.  The lobby already smells of sweat and sounds like a collective toddler melt-down.  The line goes far out the door.  Today will be all about multi-tasking for me as I try to see a bulk of the week’s surgical consults, fill out the schedule, and also make sure the first cases get going safely and that everyone else is settling into their roles (some of which have yet to be defined).  It helps that this is project #3 for Dr. Klatt (anesthesia) and #2 for Dorothy (preop/ postop nurse) – they are proactive, organized, and flexible.  Dorothy’s sister Elaine is here on her first project and really helped glue processes together as combined ciruclator and patient communicator of our needs to the local staff (I think she secretly speaks Spanish). 

                It’s late, so I’ll cut to the chase (no surgical pun intended).  I’m not sure how it happened but I’m pretty sure who was behind it.  We managed to pull off five cases (two open gallbladders, two hernias, and a large scalp mass/ cyst) with the first case starting at 10:00am.  Between them, I managed to see 20 consults.  None of them spoke English and I still don’t speak Spanish.  The Clinic team (with two Bolivian doctors – Franz and Alex) saw ~60 patients.  Most of them also received integrated health counselling and spiritual support and encouragement as well.  The eye team did 55 exams, including giving them  their glasses.  And everyone even ate lunch.  The patients are doing well so far and the team is in very good spirits, especially given how hard they worked.  Everyone is primed for tomorrow (and I’m pretty sure they’re all in bed too). 

                Feel free to read my previous posts about project Mondays.  They usually make inefficiency an art form and always manage to bring me to my knees.  I proactively went there today.  I’ll admit to feeling a bit of pressure and isolation on this project – this is my first one as sole surgeon, and it’s my smallest team yet.  Should I really try to do so much on the first day?  How many operations should we schedule for the week?  How hard can/ should the team work?  How hard and late will the local staff work before they go on strike?  What if we take on too much and have to break promises to patients who have waited months for their operation?  I’ll admit to both fear and guilt in even having expecations.  I gave this over to God this morning – His message back came out of Psalm 28:13-14

     “I believe that I shall look upon the goodness of the Lord in the land of the living!
      Wait for the Lord; be strong, and let your heart take courage; wait for the Lord.”

When something is repeated in Scripture, it is usually to highlight both its importance as well as our tendency to overlook it.  What was repeated this time?  “Wait for the Lord.”  But I’m a surgeon.  I hate waiting.  Waiting is time wasted.  Waiting is inefficiency.  The one place I almost never go at work or on project is called the “waiting room” – I do not belong there.  But there it is – “Wait for the Lord.”  It was as if He was telling me to make Him my expectation. 

                He made good on this message – both to me and to everyone else.  Any slow-downs were reflexively taken as opportunities to do something else productive or to enjoy a relaxed word or smile with our patients, their families, or our co-laborers.  And everything got done.  We set our expectations on God showing up and He did just that, cloaked of course in the garb of our patients, co-laborers, and the agape-space between them. 

Now bring on Tuesday.  Hasta Manana.

Pardon the brevity

                My transcriptionists from the office will tell you to appreciate it for what it is – a rarity.  It’s late, the internet service is quiet sketchy, and we start early tomorrow.  Highlights of the first 40 hours or so are mentioned below in no particular order and will eventually require explanation.

-          Smooth travels through Miami, La Paz, and Santa Cruz

-          Cleared customs in record time (left the tampons at home)

-          Last minute hotel change (no wi-fi, pool, or 5-foot tall flightless bird)

-          The restaurant next door has a sign featuring Jesus and Snow White (guess who’s bigger?)

-          It’s never too hot for hot chocolate (especially when preparing to do diabetes education in the chocolate capital of Bolivia)

-          First patient gave me three thumbs up

-          Worried that instrument shortage may slow us down a bit

-          Orientation pamphlet substituted the word “hostages” for “hosts” – priceless

OK.  Off to bed before we begin our first operative day – hoping to pull off five cases tomorrow, but I should know better than to have expectations on a Monday.

Heading Out Again

                I have two suitcases, each at roughly 50.0 pounds.  I have my carry-on, as well as a generously stuffed “personal item.”  (For those who are wondering, I have decided to leave my tampon-ammo belt in Wendy’s suitcase.)   I am brewing my coffee (Yirgacheffe via Chemex) for the road,  finishing up breakfast (complete with a side of Atovaquone/Proguanil), and waiting for Jon (Klatt) and Dorothy (Grossheim) to  pick me up for the ride to O’Hare.  Wendy and the girls just left for the Easter Egg hunt at church (that should be fun in the fresh snow), but not until after we took care of the final round of extra-tight hugs. 

                 I love finally heading out the door for the airport.  It brings closure to the time of harried preparation and opens the door to all that is to come – the team, the patients, the adventure, the stress, the joy, the warm weather, the sights, the smells (good and bad), and the opportunity to see how God works out the details in spite of my best efforts to overlook them.  I feel privileged to go.  Humbled as well.  Mostly at this point, I am thankful for all the people who have already played a role in supporting this project.  You may have donated essential supplies.  You may have rearranged your schedule to accommodate those of us who get to go.  You may have prayed or sent words of encouragement.  You may have given us your old suitcase.  You may have told us “be careful” or “come back safe.”  You may have donated money to help someone do this for the first time.  Regardless, your gift has not gone unnoticed.  Thank you so much for helping to make this project a reality. 

                OK – gotta pour the Joe!

It’s about that time again

Medical Ministry International Surgical project BOL1404 to San Carlos, Bolivia.

     Time to resurrect the trip blog before packing and preparation truly enter a panic state. We leave in four days. This time around the team is small (6 US participants), the project is short (one week only, owing to difficulty recruiting for a project that would otherwise have included Easter weekend), and I will be without Wendy (she’s coming along with the girls a week later for some R&R up in the hills). Normally, this would leave me quite apprehensive about our ability to “pull off” a successful project. This will be trip #6 to Bolivia for me (all with MMI) and it will be my smallest team yet – but God has this tendency and track record of filling gaps in creative ways and of sizing our team to the demand we encounter. Though not unconcerned, I am at peace about things and more or less ready to go. (This does NOT mean I am packed in any way, shape or form).

      I am not worried. This worries me. Am I fully trusting God for once? Am I blissfully naïve to the challenges and frustrations we are bound to encounter? Am I overconfident in my experience at having done this before? We shall see. Maybe it’s a mix of all three – just like it was the first time. I do know that even the most frightful, overwhelming, and frustrating moments on these projects have also been those where I am most in touch with just how awesome and caring God indeed is. Though I look forward to experiencing such moments, I also fear them, feel obligated to prevent them, and dare not ask directly for them. They will come nonetheless, and there God will be ready for me to jump and trust Him.

     I will try to keep folks at home updated on what goes on, so please check the blog on occasion and keep us in your thoughts and prayers. I am always torn between blogging/ journaling and living fully in the moments of the trip as they happen. Apologies in advance if updates are infrequent. As always, the best way to experience all of this is to sign up and come with me on a future project

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

Caution: Verbose rambling ahead

51 operations, countless consultations, and I haven't dictated a single chart in a fortnight. My transcription staff at home is likely fearing the dammed-up verbiage that awaits them upon my return. So if only for their benefit, I unleash the lingual catharsis below in hopes that come Monday my words will be few. Barb, the office bookie, is currently calculating the odds - they're not good.

Crowded airplanes are not necessarily the best environment to start processing through and eventful two weeks. I'd much rather have an unscheduled day, an easy chair, a pot of coffee (or three), and two growing girls vying for space in my lap (coffee spills notwithstanding). As it is, that is the plan for tomorrow. At present, I am content with the little bubble of personal space called seat 31D. Occasionally someone stops by to offer me coffee, tonic water, or a shrink-wrapped pastry. The iPod is on shuffle. Life could be worse.

I haven't had time to compile final numbers - I think we did about 51 operations and probably saw twice as many surgical consultations. Marie, Franz, Paola, and Sarona also saw countless medical patients in her tireless clinic work. Reuben was always checking vision and giving someone glasses, even while loading the truck on our last day (he kept one box of glasses out for as long as he could). Yoko managed to keep us fed, free from illness, and somehow to spend the quality time with our patients that we could not - listening, talking, counseling, and praying with them - I have no idea where she finds the time as she never seems rushed. She multiplies minutes like loaves and fishes. Francis was here and there doing a little of everything. Occasionally he would disappear to Santa Cruz attending to urgent matters and maybe seeing his family (a most urgent matter - he is away from them so much). When he is gone, one of his disciples fills in with ever increasing confidence, grace, English proficiency, compassion, and patience. Their growth in just over a year is astounding.

Jon was again a Godsend - I love that he made the decision to come a second time. As of yet, he and Wendy are the only gringos crazy enough to come with me a second time. I can't say enough about what a blessing it is to work with him both personally and professionally - safe, efficient, compassionate care... and he is downright hilarious (or maybe the anesthesia machine was leaking). He made teasing Brenda and Paola as much of an art form as providing state of the art general anesthesia in the Bolivian hinterlands.

Brenda - I wasn't quite sure what she was going to do when she signed up for the trip - I knew very little of her background at the time. Getting to know her was a a joy in itself - I am glad she came for both weeks (I think she will be too once she has a couple days to rest up). What would she do? Everything, really (except serve Jon breakfast). She was a sterile instrument processor, a central supply runner, a circulator, a scrub tech, a Spanglish pantomime translator, and managed to take the brunt of Klatt's teasing so the surgeon could do his work in peace. Her work ethic was amazing and durable - sure she got tired - but she continued to keep things going. She was the grease on every gear (flattering, I know) of our well-oiled machine. For all our complaints about inefficiency, we did more surgery in two weeks than I do in two months at home. I still can't believe there was only one of her. She was everywhere.

I guess gratitude is what is most on my mind right now. I have so much to be thankful for. These projects are intense. Stress, anxiety, fear, unertainty, fatigue, and frustration on one hand, but also joy, laughter, love, peace, gratitude, friendship, and trust on the other. The oscillation and contrast between them seems to heighten the experience and appreciation of each. Maybe this is true of life in general, but for some reason I seem to notice it more down there. I seldom work harder or have more fun than on these projects. I dare you to come with me.

I also thank you for reading along (if you are still with me). Writing these posts has become the way I process my experiences - they can get a little wacky or personal from time to time (maybe even most of the time). If you haven't had enough yet, feel free to ask me about the project. I've got 8.8 kilos of coffee beans in my carry-on - I'd be glad to share a pot of it with any of you if you've got the time.






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At Hand

I should be packing my suitcase, but there is only one hour of daylight remaining and I would rather spend it in a hammock surrounded by bromeliads, date palms, and the birds that inhabit them. A quick look at my weather app tells me this opportunity will not be available upon my return to Wisconsin. After this, we have a mayoral dinner and he apparently has a tast for tapir, armadillo, and javalinas. So if Montezuma doesn't get me, the PETA operatives might (please don't tell them). By the time the sun rises tomorrow, we will be checking into the Aeropuerto. Hoping for a less harrowing experience this time, I have made sure all the laryngoscopes are in Jon's suitcase.
( http://campbellexploratorysurgery.blogspot.com/2012/11/bourne-in-bolivia.html )

The last 24 hours have been truly remarkable. I can hardly find words, but those who know me know that this will not keep me from trying.

Yesterday morning, in this same hammock, I was reading Matthew and pondering what it means for the kingdom of heaven to be near, to be "at hand." I'll admit, I'm still feeling around the edges of that concept even as I try to be obedient to its implications. How does this mean I should pray? How does it mean my prayers might be answered? Alas, no epiphany; at least not before breakfast.
We soon piled into the back of Rueben's truck (1985 Toyota Land Cruiser, sans seatbelts, speedometer, odometer, cup holder, muffler... you get the idea) and were headed to the Hospital - about a. 20 minute drive away. We had an ambitious day ahead of us. Did 4 cases Monday, 5 on Tuesday, why not 6 on Wednesday? And why not make them big ones (comparatively)? The day started as they have all started - slowly. Difficult to say why - it is always the sum of a million little things, none of which are worth the haste or rudeness it would take to overcome them. I have begun to accept that we will always do two operations before lunch, no matter how large or small they are, there will be two; no more, no less. They went well. Lunch was delicious as usual. This left four cases for the afternoon. So much for making it back to the hotel before dark.
First case of the afternoon was the largest of the day. A huge hernia, I had cringed upon seeing it in the consultation room the day before. She had her gallbladder out two years ago in Santa Cruz. Whatever they closed her facia with didn't work, half her GI tract now living in a basketball-sized bulge drooping down over her right hip. No binder or girdle can contain it, she must constantly lean to her left when upright. I usually prefer to take on such cases earlier on in a project (more time for follow up) and when we have multiple surgeons (even if only so there is someone else to talk me out of it). But she has no other recourse and she is why we are here. The case takes a long time - much of her colon and small bowel are adherent to the walls of the hernia, making things tedious and a bit bloody. The mesh (polytetrofluoroethylene + polypropylene patch to repair the hole in her abdominal wall) went in well, though (much thanks to mesh donations from Dustin Willette with Atrium!) and we were able to move on to the last few cases (more gallbladders and some smaller hernias).
About an hour later, we receive word that her blood pressure is low. Really low. Certainly, it must be the cuff, or maybe the size of her arm (big). If she were bleeding, her heart would be racing (it wasn't). We gave her more IV fluids and Franz kept checking and re-checking the BP. Different cuffs, other arm... still low. Really low. One liter of saline, then two - still low. Heart still not racing. We finish our cases - it's now around 7:00pm. We have the lab personnel come in so we can check a blood count. It's low. She has bled. She might still be bleeding internally, but her pressure is too low to put her back under anesthesia - just taking a look could prove deadly. She needs an ICU. We're in San Carlos.
An hour or so later, she's had more fluid and her pressure is stabilizing, not normal yet, but improving. It will be a few hours before even re-checking labs will be useful. We must wait. I feel powerless, but at least they have a blood bank if things get worse. We leave her in the hands of the on-call doctor and a straightforward plan: she will spend much of the night at her bedside with us on the other end of the phone. The weary team returns to the dark hotel. After a shorter, quieter dinner, I headed back to the room. I couldn't sleep, so I started packing my suitcase (mostly souvenirs... also known as coffee) in case I wouldn't have time later. Sure enough, a call came around 11:30. Pressure was lower. Could we come back in?

Pretty quickly, Franz, Paola, Jon, and I were piling into the back of Rueben's truck. Mariela, a volunteer from previous projects, had come up from Santa Cruz that afternoon to bring us cookies and help out. Our day went too late for her to head back, so instead she came to the hospital with us as well. It was a cloudless night, cold, or maybe Reuben was just driving that fast. The red, half-moon was setting in the West over the mountains, the stars were brilliiant and inumerable. I prayed for our patient while I stared at them, knowing their distance, feeling small. Surrounded by the heavens, yet they seemed anything but near.
In spite of road blockades developing both to the East and West of us, we managed to make it to San Carlos in under 10 minutes. We weren't the only ones making the unscheduled trip. The laboratory personnel and sterile processing staff had also come, just in case they were needed. They would sleep all night on hallway benches.
The lady was sick, really sick. Visibly swollen with the fluids she had received, her pressure was low, and now her heart truly was racing. A hemisphere away from my own ICU, there was not much I could do. Surgeons operate and give orders... that's about it. She was too sick for an operation, and I don't speak much Spansh, especially when tired or anxious. I felt quite small.
Around me however, an ICU started to form. Jon grabbed meds from the OR to temporarily support her blood pressure while starting a larger IV in her swollen arm (because this is what Anesthesiologists do). Mariela was able to translate the detail instructions we gave out (because that's what she does). Paola placed a foley (urine) catheter. Franz knew where all the supplies were as he had been manning the ward all through the day. The Bolivian phlebotomist managed to find a vein in a swollen yet dehydrated arm (because that's what they do). The blood count was low, but not beyond reach. The blood bank lady showed up with 2 units of cross matched blood - O positive - and the tubing to transfuse it. Jon hooked it up, and when it couldn't drip in fast enough, manually pumped it in using a large syringe as a piston.
Sure enough, her pulse started to slow and strengthen. She became more arousable. Some urine even started dripping through her catheter - the kidneys were still working. The second unit now running in, it was now time to wait. Or to pray for her together, as Mariela would suggest. We found some unoccupied benches in a lonely hallway, together making our requests known in whichever tongue came most naturally. We could hear the beeps from the monitor echoing down the hall. Subtle differences in their pitch tell of the trend in her blood pressure and oxygen level - they were rising.
We returned to the ward and watched the second unit finish going in. Another half hour and she continued to stabilize. She was more awake and said she was feeling better. We put together a plan and Mariela communicated it to the hospital doctor and nurses. It was almost 2:00am. In spite of the blockade now backing up to San Carlos, we were still able to make it back to the hotel. Later that morning, she looked great. Her labs would show that the bleeding had indeed stopped (I will never know what bled, but I'm blaming the omentum) and that her kidneys had survived the adventure. She was hungry.

My day had started swinging in a hammock, my mind in an esoteric cloud of theories about how God might answer prayers from His heavens which are apparently near. By night, I was offering up real prayers from the bed of an ancient pickup truck while staring at stars which were billions of miles away in these nearby heavens. How would God answer?

It is not without reason that he calls us His body. When I needed knowledge to do what I could not technically do, he gave me Jon. When I needed tongues to speak, He gave me Mariela. When I needed safe transit amidst blockades, he gave me Reuben and at truck without a speedometer. When I needed to know I was not alone, he gave me dear friends to pray with, and it struck me that while I was sending prayers to Him, I was doing so WITH his very body, which was also the same body with which He chose to answer the prayer. How does He answer prayer? In person, then it would seem. And that is indeed heavenly... and near. Amen.


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We've got problems

I'm tired. We did five more cases today and have promised another 10 or 12 (# is always changing) in our last two remaining days. The operating tables are too low, so my back hurts after about 10 hours of standing. The lights are never quite bright enough, so my eyes are tired as well. The patients' families are always stopping me in the halls with questions... in Spanish no less. Each day, we spend almost all the daylight hours in the hospital, missing out on any opportunity to enjoy the beautiful weather this week. There seems to be more and more work to do with fewer and fewer people to do it. We lost Wendy on Saturday, Jim on Sunday, Elizabeth on Monday, Marie on Tuesday... It's like a bad episode of Survivor. We've even been attacked by a hungry emu. You must feel really bad for me.

Meanwhile, families across the US grieve over loved ones lost or maimed in a senseless bombing in Boston. Half a million people live in forced labor camps in North Korea while their leader sells their rice to buy Plutonium. People across the Bolivian lowlands wait years to have their gallbladders removed, suffering pain after most their meals. One need not look far to put my petty little problems in perspective.

We have had a wonderful project so far. My sides are literally aching from laughing so hard with our team. It is a joy to serve alongside people who can do serious work without taking themselves too seriously. Laughing at ourselves (and the things we usually complain about) is one of the ways we have reacted to being confronted with so many people whose problems far outweigh our own. Such irony has actually helped us to ignore our own (small) discomforts and better enabled us to empathize with our patients down here. (Klatt) shared a video on YouTube (link below) that just about sums it up. I hope it lightens your mood (as it did ours).

http://m.youtube.com/watch?v=ybDKfGEw4aU


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