Tuesday, February 12, 2019
Wow. We are so very exhausted right now, but happily so after a very full OR schedule for 3 days—We are happy to report that we got out of the OR just before nine last night, and then we didn’t go to the hospital until 8 this morning. We rounded on our eight patients, and discharged five of them who looked great. We have prevailed upon the good graces of one of the local doctors to round for us tomorrow morning on the last three and hopefully send them home. Please be praying for continued healing in their homes.
One of the coolest parts of this trip/mission is that we have so much more follow up and long-term relationship than most other “short-term” trips. Our patients will come back in a couple of weeks to be seen by one of the nurses here who Dr. Hoak (the general surgeon from the US who has been working here since 2006) has pretty much trained up as a mid-level practitioner at this point—She will review their pathology reports, send me copies of them via email, and call me if there are any concerns or issues. Very cool and reassuring.
Today we will take a small van up the road about 30 minutes to the town where I used to live, then catch a private plane out to Canilla, a smaller town a little up north where my friends (basically family by now, though!) the Fickers live. You can read more about what they do at www.adonaiinternationalministries.org, but they do amazing, amazing work—especially in the medical realm. They have literally built a whole hospital! Although we are still praying for staff for the hospital to come—especially OB, anesthesia, and peds.
Apparently as of 8 am there were already 15 patients waiting there to see us, so it looks like we will be busy this afternoon too! It’s definitely nice to be able to provide occasional OB/GYN consults there, though, so they schedule them in the intervening 3-4 months. Unfortunately quite a few infertility patients, and then a mix of other things. We are grabbing a good breakfast before we go, just in case 😉
We will leave you with some pictures from around the hospital... enjoy!
The women's ward... and the overflow ward...
The beautiful courtyard! By far the hospital's best feature...
And three of the hard-working nurses who take good care of the patients... bless them!
Saturday, February 09, 2019
Whew! We are now at the end of two long days in the OR so far… yesterday we saw 11 more patients before the anesthetist arrived, and we scheduled one more for surgery on Sunday. Unfortunately, we had to turn 2 more away that wanted surgery but we simply don’t have time to do this week. It’s good to be “popular”, I guess?!
Yesterday we operated until somewhere after 10:30pm, which as you can imagine was exhausting. That was three major cases after our anesthesia arrived, plus one minor procedure under local before we saw the other 11 patients. The cases all went well-ish, although one was significantly more challenging than the others. Thankfully, all the patients have looked good today and should go home tomorrow.
Today started off with a great blessing—Some of you may remember that when Kathryn was last here with me in June, we saw a lady who was 32 weeks pregnant with preeclampsia. This pregnancy was actually the result of infertility treatments (Clomid) that I had given her previously, so it was such fun to see her pregnant! And then sooooooooo scary to have to send her to the national hospital when we left! And then sooooooOOOOOooooo much scarier to follow along as we prayed for her quite premature infant who only weighed three pounds to gain weight and be discharged. And then scary still as we prayed for him to stay healthy at home and really put on some weight. I’ve been able to keep track of her with phone calls here and there, and we unfortunately missed each other on my last trip in October.
TODAY I GOT TO MEET HER SWEET BABY BOY, Tomas, for the first time!!! And thus started our day. It was an amazing blessing and many pictures were taken by both her AND us. There were gifts that I had for the baby (tiny things) and a gift from her to me—a really nice tablecloth that is very typical of this area. I can’t even describe how wonderful it was to see his sweet, chubby little cheeks.
After that, there were two “vag-a-thons” and then a (thankfully relatively straightforward) abdominal hysterectomy. To say we are tired now is an understatement, but we did manage to get home just after nine tonight so it feels early! It’s been ramen for dinner the last two nights since everything around here closes by 8 or sometimes 9, but impressively this team’s attitudes and willingness to serve just keep being positive and amazing!
Here are a few more OR pictures from today and yesterday, plus a cute one of Mili serving a pre-op patient with a new pair of cozy socks to protect her feet in the OR...
Here are a few more OR pictures from today and yesterday, plus a cute one of Mili serving a pre-op patient with a new pair of cozy socks to protect her feet in the OR...
Tomorrow you can please pray for straight-up supernatural energy in the OR—we have 3 vag-a-thons plus another difficult vaginal surgery scheduled! Why I did this to us, I am unsure. I usually try to keep a rule of no more than two vag-a-thons daily. But this is the most commonly needed surgery, so we are praying that as we are faithful to do what God has sent us to do, He in turn will provide some favor tomorrow in the OR.
Thanks, God bless, and GOOD NIGHT!
Thursday, February 07, 2019
Getting ready to set up clinic! The cool thing about this mission is that it has been ongoing for so long and has been so sustainable. This is the storeroom where we keep the clinic supplies on designated shelves when we are not here. (Heidi pictured)
Three sweet sisters! I love this picture and these ladies-- we are operating on the one on the right tomorrow...
Mother and daughter, operating on mom this week
Unflattering picture of me, but at least I look passionate? I'm praying fervently for this lady, who we are doing surgery on this week-- We are really worried about the state of her tissue that we are operating on. Please do pray with us for Matea's surgery!
Part of our clinic set-up this morning-- pretty state of the art exam lamp, right? (#itworksfinethough)
Heidi and Kathryn giving a quick talk to the patients before starting clinic, asking for their patience to wait their turn on this long day, and letting them all know they will be seen eventually but can EAT in the meantime (they all tend to show up fasting!)
From the second floor of the hospital-- I have always LOVED the open air here! I swear it helps them heal to be out in the sun on their post-op days and not cooped up in a sterile hospital room!
Three of our nurses that will be worked HARD this week once we start admitting patients tomorrow... feel free to keep them in your prayers also. They manage to keep great attitudes all day and all night long despite the tripled or quadrupled workloads while we are here.
Photo cred for ALL of these to Mili! THANKS! I'll try to upload one with her in it in a minute...
So these are out of order because, long story short, I posted this to the wrong blog this morning-- sorry!
Long-time readers know that the first post of the week is always “meet the team”…
FIRST-TIME or new readers, WELCOME to “meet the team” that invites you to join our journey this week—there are three of us traveling together this time, and I’m super-excited to once again be blessed with two other awesome attending physicians.
First I have to tell you who “I” am, though—briefly, my name is Heidi Bell, and after finishing residency in 2006 my husband Matt and I moved down here to Guatemala to serve as full-time medical missionaries for two years. It was an amazing privilege then, and it’s been possibly even more of a privilege to be able to keep up a practice of sorts here in Guatemala by coming down for a week every three months on a regular schedule. God has been super-faithful to provide for this mission through six years on faculty of a very busy medical school, contracted pharmaceutical work, unemployment for nearly a year, and now full-time work with a pharma company. I mostly left clinical medicine in the US in 2014 for a better work-life balance, so now I live in Cary, NC, with my husband and two crazy-but-fun children- Isaac is 11 and Micah is 7. Gotta give mad props, always, to my husband and especially my in-laws, who faithfully support this mission by driving down from Michigan nearly every time I come down here to help with the kids!
I’m traveling this time with Kathryn Pool, who some of you will remember from last June! She and I met in a facebook group that we are both in—and she came down and met me in Guatemala sight unseen from Columbus, Ohio! I was so impressed that she would do that once in a lifetime, so imagine how excited I was when she said she was coming back! Mad props to her family, also, for supporting her in it. Especially with 3 teenage girls! Let’s be praying for Dad this week, right?! Dr. Pool is in practice that is fairly heavy in obstetrics and light in gyn surgery, but you would never know it by her skill in the OR. I can’t say enough about how excited I am to have her back down here!
The third member of our party should “complete us” quite nicely, I think— Dr. Milicent Triche and I graduated from residency together! We’ve been facebook friends for a while, and I have LOVED watching her three kids grow up—Ty is 14, Micah is 12, and Maya is 11. They are awesome and active, so that’s another Dad to pray for and be thankful for this week! Oh, if 2006 could see us now… SO cool to get to work again with a friend from residency. And if anyone that knew us at LBJ’s ears are burning this week, we are definitely why. Mili opened her own practice (!) in Houston, Full Circle OB/Gyn, in 2008 just two years out of residency, which never ceases to amaze me. Can’t wait to hang out with her in the OR especially this week.
Our trip got off to a rough start when my flight to Atlanta this morning was delayed and I missed my connection to Guatemala. These poor ladies have been major troopers all day hanging out in Guatemala City with mostly just medical Spanish skills. In the market, it’s not really helpful to know how to ask someone about their vaginal bleeding or how well her baby is moving, so you can imagine the stress of waiting nearly eight hours for me! We are now finally headed up to the mountains and Chichicastenango, but we will likely arrive to our beds after midnight tonight. Please pray for supernatural rest and strength since we are scheduled for a long day of clinic tomorrow.
So today, as always, was a busy clinic day. We ended up seeing 22 patients, but unfortunately have at least 10 more to see tomorrow between surgeries that showed up today but were turned away. Clinic tends to run long because each patient gets a full history and physical (in Spanish), and surgical patients also get consent counseling, financial counseling, labwork (fingersticks plus urines), paperwork for admission, and instructions for the day of surgery. It can take a while!
And today, we scheduled 11 of our 22 for surgery! There were at least two more that have surgical issues but don’t quite want surgery yet. Others were an assortment of “macarena” body aches and pains (when they start telling you their symptoms and pointing to where it hurts and it pretty much literally looks like they are starting the Macarena dance!), a lady who is unmarried and had an elective abortion 26 years ago with pain ever since (likely with a psychological component), a couple of abnormal cervical biopsies, one post-op from October that looked GREAT (thank goodness!), and one lady whose problems were really all due to her diabetes that is out of control. (For you medical types, she had a Hemoglobin A1C of 12.4!)
Surgeries scheduled for the next few days include:
1 Partial Colpocleiesis
6 vaginal hysterectomies with prolapse repairs (what I lovingly refer to as a “Vag-a-Thon”!)
2 abdominal hysterectomies
1 removal of a prolapsed fibroid—who has a hemoglobin of 7!! She has been bleeding for 2 years straight, y’all… and we were sooooo happy to be able to diagnose the fibroid and not cervical cancer which had been suspected on a recent ultrasound!
Please pray especially for one of our vaginal repairs patients. Her name is Aura, and she was in tears in clinic today asking for prayer for her and her husband, who she thinks is having an affair with another lady in their church! He ended up showing up at the end of the appointment after we had explained and arranged everything with her—so of course we got to kind of start over with him! And this is why many more than 20 just doesn’t work in the day.
We did manage to get some photos today of some of these special women, and a few from around the hospital. I will share those in a separate blog post hopefully still tonight, but want to go ahead and upload this since the pictures take a bit longer!
Thanks for your prayers and well-wishes this week. Let us know if there is anything you want to hear more about!
Monday, October 15, 2018
So every now and then, I make the grave mistake of starting to think that I kind of have some stuff together. I start becoming confident in my surgical skills, or my parenting tactics (ha!), or sometimes even in just my ability to be a “good person”. Those are the times that God, in his grace, steps in to humble me before I really manage to get out of control!
This week—and especially today—was clearly one of those times. I’ve been going along nicely for a while now, without really getting in to anything scary or nerve-wracking or starting to feel like something I couldn’t handle in the OR. I’ve also been going along nicely for a while without encountering any really major surgical complications in my patients. Do you know where this is going yet?
So this week, I got to take not just one but TWO former patients back to the operating room for repair of a surgical complication—one from earlier this year and one from three years ago! I’ll spare you the details since you aren’t all gynecologists, but suffice it to say that neither of their conditions was at all pleasant to think about living with.
Dr. Hoak was ready, willing, and ABLE—as always!—to help us repair a fistula, and I thank God that he and I were finally down here at the same time (I haven’t seen him in about a year!) when this lady came in so I didn’t have to put her off until further help could be found. Her surgery took us several hours yesterday, but she looked great this morning. She is in for quite a long recovery, but we are hopeful that she will be feeling much better soon.
Today we took another lady back, who had a repeat of “things falling out” after we did a hysterectomy and fixed those things three years ago! This is a known risk of the surgery, but heartbreaking when it happens. I’m very hopeful that she will feel much better now after her re-operation today (colpocleiesis for you gyn-curious folks—if you don’t know what that is, suffice it to say you do NOT want to Google it!)
Our second case today was a very sweet and very bright young lady who wanted to wait until today to operate because she has University classes on Saturday. We knew her case was going to be challenging, but neither Lee Ann nor I has ever encountered the amount of bleeding that we did on starting the case as a vaginal surgery. Every single clamp we placed after the first few seemed to only make the bleeding worse, when anatomically they “should” have stopped it easily!
It wasn’t long until I asked the nurses to start asking the family to gather up some blood donors for the patient as it looked like we were headed towards the need for transfusion. I’ve always felt I had a bit of a safety net since I’m a universal donor in case of emergency, and after a few minutes I asked them to actually send someone in to use my foot to collect a unit of blood from me while I operated with my hands!
THIS was when I finally learned that today, apparently, there is no one available in the hospital lab who can perform the studies needed for a transfusion. Umm, this would have been good information to have before we were in the process of losing what turned out to be about two-thirds of her blood volume! Thank GOD Dr. Iris Gamez, a REALLY good anesthesiologist, was here today and on top of it!
It was clear by now we needed to open up the abdomen emergently to get the bleeding stopped, which we did quickly—but the damage was definitely done. Dr. Gamez struggled with meds and fluid for several hours before someone arrived at the lab that could make a transfusion happen. Her family members stepped up like I have never seen a family here step up before, and long-story-short, she has now received two of three total bags that she will end up receiving.
There is nothing quite as humbling, confidence-shaking, and exhausting as realizing how close you came to actually killing a patient by operating on them. May we never forget to properly respect the privilege granted to us of operating on another human being. It is indescribable how cool it is to know you can cut things open, fix them, sew them back up, and cure a patient’s problem. But let us not forget that with great privilege comes great responsibility, and let us continue to pray for Ester’s recovery.
The hospital we work at here, the “Good Samaritan” hospital, is truly a place that I believe is blessed by God’s hand. For all the faults and missing equipment, and for all the grievous errors or breaches of “sterile” technique, we have almost inexplicably good outcomes. I believe with all my heart, and have for many years, that it is only a result of God’s grace being poured out due to the people working here with true hearts for the patients and in obedience to The Lord.
So tonight we will go to bed exhausted—physically, mentally, and emotionally—but resting assured in God’s love and provision for us as we bumble along in this world trying to make the most of it.
Friday, October 12, 2018
Tonight we want everyone at home to know one thing for certain: no matter how hard we might try to come down here to be a blessing to the people here, we always end up being the ones that are more blessed! I’ve always loved the (true) saying, “you can’t out-give God”. And even when we have given 13 and ½ hours at the hospital today between four major surgical cases and 15 more clinic patients, the saying holds true.
Today we were blessed by the smiles and tears of relief and gratitude of several family members when we were able to tell them that their loved one’s surgery went smoothly and they would be out of the OR in a few minutes.
Today we were blessed by a hospital staff that worked right alongside us without (much) grumbling or complaining, despite the fact that they work three or four times as hard during the weeks we are here than when we are not, and they don’t get paid extra.
Today we were blessed by a patient that brought us apples as a gift—out of gratitude for us “taking care of her so well”—Friends, I am not exaggerating when I say we did almost nothing for this patient, and she waited from probably around 7:30 am until 4:15 pm before we could even see her!!!!! We explained that a problem she thought she was having was actually normal and gave her a small tube of cream for some itching. I truly hope and pray that what she felt, though, was God’s love working through us to bless her. (God knows we were tired enough to have very little left of ourselves to give her at that point!)
Today we were blessed—as we always are!—by the hot lunch that the hospital cook provides us. She is simply amazing, and it’s embarrassing how well we eat here while on a “mission” trip!
And today we were blessed, most of all, by each other’s company and laughs and silliness and energy keeping each other going. Do you know I have NEVER had any personality issues with any small team I have brought down here, despite 10 years of travel with folks that often didn’t know each other, sometimes didn’t even know ME, and have always stayed in quite tight quarters? Never. That’s nothing short of divine intervention, friends, and I am so grateful for it!
We do need to ask for some extra special prayers, though, for our new friend Ofelia. We diagnosed her with a bad cervical cancer tumor today (biopsy results pending but it was pretty obvious). It is not operable, and her only treatment option is to get very expensive radiation therapy down in Guatemala City several hours from here. She is basically the single mother of a nine year-old little girl, as her husband left for The States about six years ago and rarely sends money anymore (he has a new family there now). Her little girl’s name is Yesica.
I lost my mother when I was nine. That’s no way to grow up. Please pray for divine intervention as well as for the father to step up and pitch in! I’m really worried about how advanced her tumor is.
I’ll really try to post some pictures so as not to end on a low note here, but no promises—internet is spotty 😉
God bless you all, and good night!
Thursday, October 11, 2018
Enough with the clinic already!
Wow. Like seriously—enough! We had 36 patients show up (25 is really, really hard to get through in a day…) and ended up sending a few in the afternoon home to come back tomorrow. We saw 28, and of those we scheduled an unprecedented 12 surgeries for the next 3 days! I have never, ever filled up all of the possible surgeries we could do on the first day—AND we sent two others home to come back for surgery in February because we simply don’t have time to operate on them! It’s good to be needed and wanted, but we were begging for mercy by the end…
The team rocked it out, of course—there’s a LOT that goes in to bringing a patient in, getting a history from scratch, writing it up in Spanish, doing a full physical exam (insert gynecologist-with-a-stethoscope joke here…), determining the plan, counseling the patient, often doing an ultrasound, getting the urine dipped or urine pregnancy test, vital signs, and finger stick—not to mention surgical consent and financial counseling about the costs—on each patient all in the same small room!
Here are some of the “stats” for the day—
· We’ve already said 28 patients, 14 surgeries
· One lady whose chief complaint (at age 52) was that her back hurts when she chops firewood! God bless her. Wasn’t really sure how to fix that one…
· One patient that had 11 babies—today’s record
· Four pathology specimens sent from clinic today (biopsies and such)
· Only two or three calls to Dr. Hoak for help 😉 He’s the general surgeon here that I thank God for daily
· One fistula—if you don’t know what that is, you don’t want to. Or according to Dr. Nikki, “just know that urine in the vagina is no good; poop in the vagina is even worse”… Sorry for that. I told you it was Nikki…
· One case of depression, unfortunately—pretty severe, unfortunately. Please pray she can find a good Church and friends for support
The rest of the stories will have to wait for when we get home… sorry; we are tired.
Will try to post some pics if Nikki can send me some from her phone; wish us luck!
Good morning from Guatemala! Hoping that I will have some time to get some internet coverage (it’s pay-as-you-go physical, plug-in modem here mostly—remember those?!) so I can get this posted today. Wanted to get everyone up to speed and on the same page… so it’s time to
“MEET THE TEAM”!
Long-time readers will know that is literally the title of the first post of every week here, so let’s go…
I’ll start with introducing myself better to the new folks: I’m Heidi Bell, an OB/Gyn from North Carolina (currently in the Cary area) with a bit of a winding road of a career history-- It goes like this:
- · Studied medicine at ECU (where you’ll see I met most of the others on the trip later)
- · OB/Gyn residency in Houston, Texas—where God was clearly preparing me for His work in Guatemala by teaching me Spanish through my patients
- · Met my amazing husband Matt while in Houston, and he and I felt called together to move to Guatemala after my residency training
- · Spent an unforgettable and life-changing two years living here in Guatemala with the support of a group called Agape in Action from the Houston area—you can read more about them here: agapeinaction.org
- · Returned to the US to take a faculty position at ECU in 2008 where I stayed until 2014
- · Have been amazingly blessed and privileged that God has been faithful to provide for and continue to keep going this current mission set-up, which consists of 3-4 times yearly, one week trips down to do a few different things:
o Perform affordable gynecologic care and surgery for the indigent population
o Be the hands and feet (and yes, scalpel!) of Christ for these people in any way that I can
o Strive to encourage the long-term missionaries here in the area with whom I have become very close over the years and been blessed to know—especially the Ficker Family who you can read more about here: adonaiinternationalministries.org and docsforhope.org
o Bring different small (2-5 people usually) teams with me each time who hopefully go away with a renewed sense of how “the rest of the world” lives and hearts renewed by The Gospel as well.
And that was way too much about me! But I should also mention this can only be accomplished with the support and patience of my family (including in-laws, a husband, two kids, and a goofball Boxer dog) at home as well as my church family in Cary. Life is truly better than I deserve, friends.
I’m joined this time by three ladies who I look forward to getting to know better—I’m continually blown away at how many people “sign up” for this trip sight unseen and with very little detail about what they are getting in to! Serious cool-cat-easygoing-hero status here, y’all~
So Lee Ann Garner is an OB/Gyn working in the Wilmington, NC, area currently. I met her at ECU when she was a medical student there, and one of her current partners, Julia Posey, came down with me a few years ago as a resident. You might recognize the city of Wilmington from recent news, where Hurricane Florence hit. Her kids (10, 8, and 4 if I remember the ages correctly) are STILL not back in school there! What an amazing sacrifice to show up for the trip anyway, right? Let’s pray that she and her family will be truly blessed this week!
Dr. Nikki Parson was an OB/Gyn resident while I was on faculty at ECU, and we’ve been talking about getting her down here for years now. She works in Charlotte now, and I absolutely LOVE that she brought along her “right-hand (female) man” from her office for the experience. Crystal Yarborough has worked with Nikki in her office since she started there out of residency, a little over 3 years ago now as a Certified Medical Assistant. Theirs is clearly a special and close relationship, and it has been awesome meeting her! Nikki has two beautiful boys in 6th and 7th grades at home with another clearly amazing husband of the group.
It is Crystal’s first time leaving the country, so maybe some extra-special prayers for her this week? She has been an awesome trooper so far, especially since she has two kids (16 and 9!) at home and clearly is very involved and beloved in her community. Poor thing was up at 5:30 this morning with well-wishers calling to check on her (not quite realizing that we are two hours behind NC here… 😉)
So today will be a bit of time in market and then a LOT of time in clinic seeing patients and hopefully setting up lots of surgeries for the coming days. Pray for patience, wisdom, and perhaps a bit of efficiency as we dive in to usually 20-30 patients. But above all, pray that we can truly be a light and just a tiny reflection of God’s love for them—it’s pretty hard to feel in a world that can feel rather bleak at times.
Everyone hug your families hard and appreciate them today! We are running off of your prayers and love from afar… so thank you for that.
Saturday, June 23, 2018
Sorry for the lapse last night—we were pretty tired! Three full major OR cases yesterday, and we finished up around 7pm or so… then grabbed supper and definitely headed for bed. The three cases went really well and smoothly, but were quite time-consuming.
Today, we went to round on our patients—they are all doing fairly well, although we are a little worried about sweet Rafaela—she seems to have lost more blood than we feel like we saw at the time of surgery, and we are watching her closely in case of a hidden (retroperitoneal) bleed. Tonight she still looked quite stable, but please send up a little prayer for her expedited healing. I’ll probably end up giving her a bag of my blood in the morning—thankfully, God has blessed me with O negative blood that the Red Cross won’t accept because of my frequent Guatemalan travels!
Then down in clinic we only had two patients—our sweet little 31 week preeclamptic lady (who is, unfortunately, looking more and more preeclamptic…) and a little teenager worried about her cycles. Yesterday was a little more interesting at least—our last patient of the day (who waited from 8am to after 4pm to see us!) had a complaint of headaches and feeling “sweet” around her mouth! Being gynecologists and all, we did our best to treat her ailments on the opposite end of her body from where we specialize! Not sure we took care fully of the “feeling sweet around her mouth”, though?!?!
Today’s surgeries also went smoothly, and were really quite a lot of fun. We had an older lady with a prolapse, then a younger lady with a more challenging uterus to remove vaginally. I may or may not have stolen the second one from Kathryn a little 😉 They looked good this evening, so hopefully they will look great tomorrow and be ready for discharge before we leave on Monday.
Today was also Naomi’s birthday, so of course we had to go overboard for that! We had the hospital staff help us surprise her with a cake and a piñata for a nice traditional Guatemalan celebration! I thought it was pretty nice of us not to wake her up at 3am with firecrackers outside of her window, which is another quite traditional Guatemalan way of celebrating…
Here’s some pictures to try to keep things interesting…
Naomi being tortured by us trying to bust the piñata... (don't worry; we all go our turns!!)
A couple of views of the central marketplace in Chichi from a balcony where we enjoyed a hot chocolate this afternoon...
And an amazing photo Kathryn took in the restaurant where we went for a little night on the town tonight! It was truly lovely...