Thursday, November 29, 2007

ASELSI Thursday

Tuesday, we took some time to run down to Antigua, relax, and do some Christmas shopping. We had a nice dinner there and spent the night in a hotel we found during our stay with the cleft palate kids last year. On Wednesday morning, Matt ran over to the Guatemala City airport to leave our heavy luggage for the trip back to the US on Monday. Since we have to leave our truck for Paul and Lindsey, Duane is going to fly us to the airport on Monday morning and there's not room in the plane for all our stuff.

Wednesday afternoon, Heidi had a quick surgery in Chichi. You may or may not remember the patient she had a while ago in whom they accidently cut her ureter. (When you're dealing with a 10 lb uterus, things are not always where they're supposed to be.) Well, to repair the ureter, they had to put in a stint - basically a plastic tube that serves as the ureter while the ureter is healing. Eventually, that stint has to come out. And thanks to Dr. Flavia Horth and the Wichita Falls team, we now have a tool to remove that stint without opening the patient back up again. The surgery went quickly and without complication.

Thursday morning, we headed to ASELSI for our last clinic of the year there. We saw several prenatal patients, a few new babies (whose moms were patients of ours during their pregnancies), a couple of cleft kids, and a microtia (it's an ear problem) kid. Heidi and Virginia have been working very hard to plan the cleft/microtia trip for this January. All of the preliminary work has to be done before we leave next week. So pretty much all of the kids and their families had to be reached (not always easy here - not everyone has a phone and some that do don't speak Spanish) and told where to be and when to get their pre-op labs done. Then all of the logistics to transport a dozen or so kids and their parents to Antigua for the surgery had to be done. Virginia and Sharon will be helping to arrange all of the labs and transport while we're on our way back in January. Like last year, we'll meet the kids in Antigua. (Also, thanks to Matt Capehart for loaning us his school bus to get everyone there!)

We did have a few interesting patients today. One was a 28 year old woman with high blood pressure. She appears to be in great shape but clearly something is wrong. We sent her for some studies, some of which we'll have to help her pay for. She's single and her dad has already died, so she really has no financial support at all.

Another patient came in as a prenatal patient but it appears that her baby has died at about 3 months gestation. She is 39 years old and this is her 14th pregnancy. She has 10 living children. Her husband has given her permission to go on birth control after this baby. Unfortunately, there won't be a living baby here. We prayed for her in clinic and she seems to be taking this rather stoically, but we know that it's very bad news.

Another patient is desperately seeking to get pregnant. She came in a month or so ago with her husband and we sent them both to get some lab tests. It was a little uncomfortable to discuss the sample procedure her husband had to go through, but he was very supportive and didn't complain, though we did get about a tenth of a second of a weird look! She came in today with the test results and it looks like there are no hormonal problems with either one of them. So we're suggesting a basal body temperature test for the month while we're gone. We'll look at the results when we get back and try to figure out the next step. We reminded her that throughout the Bible, there are many, many stories of couples who wanted kids and prayed and prayed and prayed and finally had them. Sometimes, persistence is the key.

Yet another patient came in with a story of post-menopausal bleeding. This is almost never good news. Heidi couldn't find anything obvious on exam, but she is so twisted and bent with arthritis and just old age that it's not unlikely that she's got some other badness going on. She's not exactly the best candidate for surgery, though, so we talked about prayer with them, too.

Our last patient of the day was a nine year old boy who is deaf and mute. He's also mentally retarded. He had had some type of plastic surgery to remove some scarring on his foot so he can wear shoes. Our job was to remove the sutures. It was pretty hard because it's hard to communicte with him and tell him what we're going to do, to encourage him, and to commend him for being so brave. We basically had to just hold him down and let Heidi work. He did really well and got a sucker for his trouble. He really liked Isaac, though. Isaac was having one of his good day/bad day days in which he's okay for a few minutes, then not. He and this little boy did take time to smile at each other, though.

Well, tomorrow is Heidi's clinic at Buen Samaritano, then this weekend is our last weekend in Canilla before we leave for Christmas. My, how time flies. We haven't been to the United States since April and that was only for a few days for a wedding.

Our plans will take us to Houston, Dallas, St. Louis, southern Michigan, Cleveland, Salisbury, NC, Raleigh, maybe to Atlanta, then back to Houston. All on the road. Wish us luck!

Monday, November 26, 2007

New Word

We learned a new word today: atrancado. We'll get to what that means in a minute. (Those of you who speak Spanish are already laughing, aren't you?)

Today was clinic in Chicabracan. There was a fiesta in town, so not too many patients were waiting for us. Besides, we'd given all of our chronic patients enough meds for a month the last time we were there (two weeks ago), so we had kinda hoped for a quiet day.

Paul and Lindsey were with us, which is also a huge help, especially since Isaac has not been a very good boy the last few days. It might be because some bugs tried to eat him alive in Zona Reyna. He's probably itching like crazy. We're doing what we can with hydrocortisone cream, but he doesn't really understand that. Oh well. Being a missionary (even a 4-month-old one) sometimes has its price.

We only had about 25 patients today and they were mostly quite easy. There were some good teachable moments - like the woman who gets a pain in her lower abdomen about once a month - between periods. Some months it's on one side, some months it's on the other side. Lindsey did a good job of diagnosing the problem and the patient felt a lot better when we told her that this was nothing serious or dangerous.

We had one 14-year-old girl who has had some very heavy first periods - so heavy that she got pretty pale and couldn't leave the house for a week each time. It's probably normal, but we'll send her for a blood test to make sure she doesn't have Von Willebrand's disease (the docs will know what that is - for the rest of you, it's rare enough not to clutter your brain with it).

We also had a patient who was complaining of chest pain. We're treating for that, but more importantly, we wanted to know the status of her soul. She told us that her husband left her 20 years ago, which was kind of a blessing, she says, because he used to beat her and he has kids with 8 other women. So she's had a hard life. It's a long road for single moms here. In any case, she attends church but hasn't really picked up on the key learnings. She knows that Jesus died for our sins but isn't sure what that means in relation to where she'll go when she dies. We got to spend some time explaining to her that His sacrifice was both necessary and sufficient for salvation. Accepting His gift is all we have to do. It's pretty ridiculous to believe that we can do anything to earn favor in His sight, especially considering that the Bible says that our good works are like dirty rags to Him. Clearly, works are a fruit of a saved soul, but don't ever believe that anything you do is earning you brownie points in heaven.

Anyway, we were lucky enough to leave clinic an hour or so before lunch. The fiesta at the school on top of the hill left a bunch of trash in the driveway we usually use to get out, so we had to turn the wrong way down the road to leave. We drove about 100 yards and saw a big grassy yard to turn around in. Instead of simply driving in and backing out, we just pulled a U-turn using the yard. I mean, it looked completely dry to us. It hasn't rained here in a few weeks. However, we soon got to learn that "atrancado" means "stuck". Not all 4 wheel drive systems are equal. Since we don't have full lockers, we were spinning one tire on each axle, effectively digging ourselves a pretty nice hole.

First, Paul, Lindsey, and Heidi tried to push. No luck. Then we flagged down a 2-wheel drive truck. We ran to the local tienda and bought some ropes (the truck was so full of meds we didn't bring our emergency box that has a really nice tow strap in it). All the 2-wheel drive truck could do was spin his tires and almost get stuck himself.

Then we flagged down a dump truck. He broke two ropes and nearly pulled our bumper guard off. We'll be without that bumper guard from now on. You know you can actually twist those???

So what's left to do when a DUMP TRUCK can't pull you out? You call Martin, of course. He's Paul's uncle, too - don't know if ya'll knew that. So 30 minutes later, he and Geronimo showed up and winched us out quite easily. For future reference, just because grass looks dry and it hasn't rained in nearly a month, don't assume you can just drive somewhere.

Yes, we're still praying for a Toyota!

Sunday, November 25, 2007

New look and some pics

Do not adjust your computer screen. Yes, we changed templates for our blog. It's supposed to be better. Time will tell.

In theory, there will be a slideshow of some pics we've shot on the right hand side. Apparently, our technical skills are not up to the level of the average 8-year-old because it's still not working. Be patient. We're missionaries, not computer whizzes.

We're also going to try to embed a video or two here in a minute. God have mercy on us!

Today was church with the gringos in Chichicastenango. We had a bunch of guests, too. There were some Americans in to visit as well as about 20 kids from the Guatemala City Dump - no kidding.

Some of you know that tens of thousands of people actually live in the Guatemala City Dump. They scratch out a living by digging through garbage to find food and things they can sell. There are some ministries that reach out to these kids. One ministry provides a two week camp in Chichi for some of the higher achieving kids. The ones we saw today have learned some English and presented two songs to us and recited a Bible verse in English. It's so sad to think that in a few days, they'll be back in the dump, digging through trash trying to find something to eat or sell. Please pray for these kids and everyone they live with there. Poverty outside the United States is very different from what we think of as "poverty". Poor people here are not overweight and do not own cars or live in apartments. Poor people here do not have designer shoes or televisions. This is what the other 90% of the world is like.

Speaking of poor, here are some more pics from our trip to Zona Reyna...

Saturday, November 24, 2007

Zona Reyna for Thanksgiving

For Thanksgiving this year, we decided to celebrate by going up into the rainforest/jungle of Zona Reyna to do clinic. This was our third time in this area. There is no electricity, no running water, and no churches in the area. The people do okay, more or less, by growing and selling Cardamom (a spice produced here in Guatemala) but the standard of living is still pretty low and these people are absolutely starved for the gospel.

As many of you know, this is the area we've been trying to reach for a while now. The enemy is clearly opposed to this. This is where Duane and the boys broke the nose gear on the Aztec airplane a year ago - and that plane is still out of commission. Every time we go to this area, we lose a vehicle (this time being no exception - read on). And we have had many, many small battles with the enemy here, logistical and otherwise. Things just always seem to be more difficult than they need to be.

In the past, we've brought a few friends along to help evangelize to the people. This time we kicked it up a notch by inviting the Stuckenburg family to come along. They are a missionary family who lives near Lake Atitlan (who took in Baby Sarah earlier this year, if you'll remember). They specialize in evangelism and outreach and have worked in probably around 50 different countries. Tom (the dad) brought 8 kids with him between 13-23 years old to help evangelize and work with the local children. They put on plays, taught songs and games, handed out coloring pages and crayons (which the adults seemed to enjoy as much as the kids), taught Bible stories, and showed the Jesus film overdubbed in the local language of K'ekchi.

Once again, the enemy was at work. We had been told to expect 1,000 patients, so we planned accordingly. We had 150, some of whom were "manufactured" patients. Clearly, someone is trying to discourage us. But no such luck. We had a great time and left even more convinced that this area needs to be reached.

Of course, since we were in Guatemala, every day was an adventure. We mentioned the Stuckenburgs, but additional members of this cast of characters included our friends Arlen and Deb from St. Louis, Dr. Jeff Lambert from the Woodlands, Craig Phoenix (also from St. Louis), Tomas and Juanito (two of the Fickers' workers), the Bell family, and the Ficker Family. All in all, 26 of us went, counting 4-month-old Isaac and 2-year-old Grace.

We all met at the Fickers' house in Canilla for Thanksgiving Dinner, complete with Turkey, stuffing, cranberry sauce, and pumpkin pie. Even outside the US, we can still eat like Americans! The logistical plan for the trip involved sending the big F-350 (loaded with equipment - and 8 passengers) and the Tacoma (with 9 passengers) up into the jungle at 4am on Thursday. (It's about a 5 1/2 hour drive.) We were going to receive a weather report from a local in Saquixpec at 7am and decide whether the rest of the crew could fly in or would have to drive. We prayed for good weather and got it. The doctors and the babies got to fly, as well as a few others - Duane made two trips (great because the docs were preparing to see a ton of patients and the babies really don't appreciate being locked in a car for 5-6 hours and it's only a 15 minute flight.)

However, nothing really happens quite that easily. When we tried to add just a touch more air to the front strut on the plane, something went wrong and we lost ALL the air in that strut, making the plane unflyable. Over an hour, a phone call to the US, a trip to the local gas station, and lots of prayers later, we got some air in the strut and we able to fly 8 people into the jungle. Then one more truck had to go with the remainder of the equipment.

Friday, it rained all morning, making a set of flights out look a little unlikely. But with some additional prayer, the skies opened up in the afternoon. Duane was able to ferry 8 more people out by air. Then the fun started.

Less than an hour into the return trip, the front bearing in the Tacoma failed. We had been nursing it for a little while and thought it would make the trip, but we were wrong. The front hub locked up and that was that. So we found a small church in the village we had just come through and asked the pastor if we could leave the truck in front of his church for a few days. We gave him a few Quetzales and a bunch of bananas. David, Aaron, Juanito, Joe, and Matt worked on tearing the front assembly out of the truck while Tom, Katie, and Deb supervised the consolidation of three trucks worth of people and stuff into two trucks. About six people ended up riding in the back of Aaron's old truck (the vehicle that came up after the plane left on Thursday) and a bunch of gear got left locked up in the Tacoma.

Later in the trip, the Ford punctured a tire. It had already lost one on the way up and the spare had been patched, sort of. Luckily, Craig had brought down a tire plugging kit and we plugged the tire in the middle of the street in another small town - while a police officer was trying to make us get out of the way of some chicken buses that were supposedly going to come through. David works fast, though, and we were ready to roll by the time they got there.

The crew that had left Saquixpec before 3pm finally arrived back in Canilla about 10:30pm. The group that had flown in earlier in the afternoon had been able to get dinner and some warm, dry beds ready for them with the help of the recently donated generator (of course, there was no power in Canilla Friday afternoon).

This morning was clinic in Canilla. Again, the power went out and we had to use the generator to finish clinic. Duane had a charter flight to Guatemala City, so he took that opportunity to pick up the bearings for the Tacoma. The boys will have to go back up into the jungle this week to fix the truck and drive it home. Fun, fun.

Since Leslie will have plenty of help at clinic in San Andres tomorrow (she'll have Katie, Arlen, and Deb), we're taking the opportunity to go to church in Chichi. Monday is our clinic in Chicabracan.

And here are some pics from the weekend. I'll post a few more tomorrow, maybe.

Monday, November 19, 2007

Nueva Santa Catarina

This morning, the alarm went off at 5:30 so we could get up and head to Nueva Santa Catarina. Isaac and Heidi had already been up for a while. Ewww! Isaac is falling asleep pretty early now which translates to pretty early mornings. We could try to keep him up later, but he turns from cute to monster at about 5pm, so...

Anyway, Nueva Santa Catarina is a little village about two hours away on some of the best roads in Guatemala (which ain't saying much, but at least they're paved). The good news is that our repaired truck isn't leaking antifreeze all over the floor anymore, but the bad news is that we think we're smelling another small leak. Time will tell. We'll keep an eye on it.

When we arrived at clinic this morning, one of our chronic seizure patients was sitting inside the church. He had just seized while waiting for us to arrive. If it hadn't been for two construction zones, we probably would have been there. Unfortunately, in his post-seizure state, he couldn't answer many questions, but we did our best to help him and will definitely pray for him a lot.

This clinic is at 10,000 ft altitude and the dry season just started, so everyone has dry, itchy skin, sore throats, headaches, and just general dehydration symptoms. We also saw a young girl with a rash we couldn't identify, so we're sending pictures to a dermatologist friend in the United States. Nothing really serious today, but we'll probably make some big quality of life changes in a bunch of people with simple OTC meds.

One group of three women came in who needed some evangelizing and Matilde (our translator and the pastor at the church) took over from there. It's nice to have him there. Evangelism isn't a big strength for either of us, especially in K'iche. We do our best, but it's better to have someone who really has a gift for it, right?

Many of you have followed our exciting adventures with vehicles. Well, thanks to some generous donations, we are in the process of looking for a vehicle in the United States to drive back down through Mexico after Christmas. We pretty much have the "looking for" part covered, but we could always use a few extra bucks to help buy the vehicle and pay the transport costs back to Guatemala (the best way through Mexico is on toll roads - fewer police looking for bribes, etc.) We're buying used, so we're not asking to help buy leather seats and satellite navigation systems, but just a reliable 4x4 to help us get to our clinics and make emergency runs when necessary. We're a 501(c)(3) organization, so donations are tax deductible. We try not to ask for money very often, and when we do we try to ask for direct donations for patient care, but if we can't get to our clinics, we can't help the people. Anyway, if you feel led to help in this way, we'll get you in touch with the necessary folks in Houston. End of commercial (sorry about that!)

Tonight we're entertaining some American friends who live here in Quiche. He's a volunteer fireman and they're both English teachers. They're a fun young couple we really enjoy hanging out with.

Tomorrow we're working on the truck and getting ready to go up into the jungle. Wednesday, we'll go over to Canilla, celebrate Thanksgiving a day early, then go to bed. Thursday morning, we will send at least one truck really early in the morning up to Saquixpec with all our equipment and meds. If the runway looks good, Duane can start flying doctors and nurses in. It'll save them 8 hours on the road if we can. The flight is only 15 minutes (crazy, right?). Yes, these roads are quite bad! We usually take at least one truck out of commission on each trip...

So here's a pic of Isaac hanging out with some of his Guatemalan friends outside clinic.

Sunday, November 18, 2007

Fickers to the Rescue (again!)

As most of you will remember, we've recently had more than our fair share of vehicle problems. One of the omst frustrating things here is that it seems like we spend about half our energy just keeping vehicles running. The Mazda recently had two separate stays at the dealership in Guatemala City (the only Mazda dealership we know of in Guatemala). The reason we had to take it in originally was that we were blowing smoke all into the vehicle and overheating. It turned out that it was because there was a leak in our heater coil. So they replaced it. A week or so later we found out that because the heater coil had leaked, we had lost cooling to the head and cracked it. So it spent a few weeks getting that replaced.

This past week, Heidi thought she smelled antifreeze again in the truck. Matt wasn't sure, but on Saturday morning, there was no doubt. It was about 40 degrees and we made the trip all the way to Canilla with no heater. When we would try to use it, we were full of smoke again and the windows got so coated with antifreeze film we could barely see. Not good on windy mountain roads.

By the time we got to Canilla, our floorboards were completely soaked with antifreeze. So David and Matt spent the morning at the airport taking the dashboard out of the truck to get the heater coil out. We brought it back to the house and found a leak in it in a place we couldn't really get to to repair it. So the options were to simply bypass the heater (not really the greatest in November at nearly 7,000 ft altitude with an infant in the vehicle) or to try to repair it.

So we called our friend Martin in Quiche, he found a shop that was open that could fix it, we flew it to Quiche, got it repaired (sort of), and flew home. This morning, we re-installed it in the truck, replaced the dashboard, and were on our way.

When we say "sort of" repaired, what the guy had to do was pull all the fins out, coat the tubes with a special high temperature epoxy, and hope for the best. It pressure checked okay, but time will tell how well it holds. The dealership claims that it's a two day job to pull the dashboard and replace the heater coil. David and Matt did the entire job in about 8 hours - and it was their first time messing with it. There won't be a next time (we'll just bypass it and shiver) but if there was, it'd be a whole lot faster. We can only hope that it holds while Paul and Lindsey have the truck in December because they don't really have the resources to address the problem if it goes bad.

Anyway, that whole operation probably saved us another $3,000 repair job from another cracked head - which is what would have happened if we had tried to drive the truck without a repair. So nice to have friends, right?

With David and Matt tied up with the truck, that left Heidi caring for Isaac - even during clinic on Saturday. Luckily, Saturday was a very low key day and Isaac was very well behaved. The only notable patient from Saturday was a woman who complained that she throws up all the time - but only when she sticks her finger in her throat...

Today, Heidi and Leslie went to clinic in San Andres and were pleasantly surprised to only have around 60 patients. That used to be a pretty busy day there, but the word has spread and there are usually in the neighborhood of 100 patients every Sunday now. Heidi had a patient today who came in with some pretty vague complaints and they quickly arrived at the fact that what he really needs is some spiritual peace. So she talked to him quite a bit then got our translators' uncle to evangelize a little more. The patient was pretty interested in knowing more about Jesus and was asking some good questions. Please pray for his spiritual journey to continue from here, not to find an abrupt end.

A 45-year-old woman came in pregnant. She herself has a cleft lip and palate so severe it was hard to understand her when she talked. She had had one baby with a cleft lip that starved to death after only a few months (most can't really get any good suction on the breast). She was very early in her pregnancy, but Heidi told her that if we see a cleft on ultrasound or if the baby is born with a cleft, to PLEASE come to us for help. We can get special bottles to help the baby eat until he or she is big enough for the surgery (most anesthesiologists want to see babies at at least 10 pounds).

And we had to give the bad news to one of our chronic asthma patients that it's really not a good idea for her to try to have another baby. She wants one, but her last pregnancy nearly killed her about 5 different times and she's gotten worse since then. It's sad to have to tell her that any attempt to have another baby will likely kill her and leave her daughter without a mom, but that's the unfortunate situation she's in.

Pics. The first is David inside the truck with the dash torn out. The gas can is holding up the steering wheel, which we had to drop down to get the dash out.

The second is the offending radiator with its slightly... uh... unsightly repair.

The third and fourth are of Isaac helping out. First by supervising, then by taking a nap. Wow - those car seats sure are great babysitters!

And the last one is of Heidi's translator, Manuela, practicing her ultrasound skills (with some help from Heidi!)

Thursday, November 15, 2007

ASELSI in Chichicastenango

Today was our nearly weekly clinic at ASELSI in Chichicastenango. We say "nearly" because that doesn't include the first Thursday in each month. Anyway, today was a pretty interesting clinic day. Luckily, most of the routine patients were very routine, because we had some that required quite a bit more time.

Our friend Regina (mother to three of our cleft palate kids - and who you'll see in the first picture below) has been pretty good about bringing us some patients that we really need to see. About once a month or so, we get a call from her at home asking if we can give some numbers at ASELSI. Because of where Regina lives, she can't get to ASELSI early enough to get a number (they start turning people away by about 5am every week!) Nearly every time Regina has brought us a patient, it's been someone who truly needs medical attention - not just a headache or a stomach that burns when they eat chili.

This time was no exception. She asked for three numbers and two of the three were in pretty bad shape (a father and son). Naturally, the mother had to come along and we treated her with Tums and Tylenol. The son had been working at the bus terminal in Guatemala City about 8 months ago when he got shot in the leg with a 9mm. Since then, he hasn't been able to walk (or work) and has been quite worried about feeding his family. He's on crutches and can't even put any weight on his leg. So we sent him to Buen Samaritano to get an X-ray. He came back with evidence of two bullet fragments still in his leg and an apparent spiral facture that hasn't completely healed. We referred him to Dr. Edgar, our orthopedic surgeon friend.

The dad presented with diarrhea and really swollen feet. We asked to make sure he wasn't pregnant (with the swollen feet and all) and got a pretty good laugh out of that. The part that's not funny is that his liver is huge. He used to drink - about 20 years ago, before he joined the church - but it looks like the damage is done. So we sent him to Dr. Hoak at Buen Samaritano, who at press time hadn't called us to let us know what's going on with his liver.

Later, we had one of the workers at ASELSI who has been married for 8 years and still doesn't have any kids. That's pretty unusual here. She's been to several doctors and if they actually told her what she says they told her, we shudder to think what the thought process is! Her husband came in, too, and will be a participant in the process to try to figure out what's not working right. Both will need to go get some labs and we'll pray a lot for them.

We got to see three or four babies whose mothers we've provided prenatal care for. Those are always fun! And we saw a dozen or so prenatal patients, too, including our friend who is on her 11th or 12th pregnancy, is diabetic, and had a c-section on her first baby but has delivered each subsequent child at home. As always, we're encouraging her to go to the hospital to have this baby and to at least consider some type of family planning, but history tells us that she'll probably ignore our advice.

One mother came in with her baby to check her weight. She's been in twice - asking for free milk each time. Apparently she's breast feeding about eight times a day and giving a bottle a few times a day, too. The problem is that she only breast feeds for about two minutes on each side. So we had a teaching moment. The problem is that moms around here think that because it comes in a can it must be better than what you get for free if you'll only breast feed. So we get a ton of moms who come in and want free milk. The milk programs we work with only give milk to malnourished kids, and only about half of what the baby needs. If Mom is not going to breast feed, she at least needs to participate and buy SOME of what the baby needs. ASELSI and the Fickers both spend insane amounts of money on milk and we can't afford to give it to everyone who asks - nor should we. Getting babies started on bottles can be downright dangerous. Hygiene isn't always the greatest and we're reasonably sure that not all moms clean the bottles well with soap, water, and bleach. If a baby is already a little malnourished, diarrhea could easily do them in.

Using that as a segue, our last patient of the day was a mom asking for milk for her baby since she didn't have any breast milk. 99% of moms who say that have plenty. Heidi always makes them show her and usually gets squirted with milk for her trouble. This woman had nothing. Plus, she's about 45 years old (or more). In Heidi's opinion, she didn't look anything like a woman who had just given birth. Yet, she insisted that this was her baby. Through our translators, we explained that we're not going to call the police or anything, but we need to know, for medical reasons, whether this is her baby or not.

Finally, she and her husband admitted that this is not their baby. They don't have any kids and are worried about who is going to take care of them when they get old, so they're "adopting", which basically consists of them going to the local health office and claming that this is their baby. Then they'll get papers for her. Mom has quite a large belly, though, and we wanted to take a look on ultrasound just to be sure. It looked like her bladder was completely full, so we asked her to go pee and come back. When she came back, she was still completely full, so Heidi catherized her and got nothing out. Clearly, the ton of fluid we're seeing inside her abdomen is not urine. So Heidi tried to get her to come to Buen Samaritano tomorrow where she has a lot more resources. But the patient is scared of hospitals and is not going to go. We've put them in the milk program at ASELSI, as the only thing they've been feeding the baby is warm water - milk is too expensive. We're not sure how they're going to care for this baby so it lives long enough to take care of them, but...

Anyway, here are some pics from the day. The first is Regina with her daughter Carolina (one of our cleft kids) on her back and Isaac on her front. The second, third, and fifth pictures are of the new babies we mentioned earlier. And the fourth pic is a woman who is completely riddled with rheumatoid arthritis and had an appointment with the orthopedic surgeon last week, but can't read and came in on the wrong week. We pulled her chart and continued her on the same meds he gave her last time and gave her another appointment to come see him when he comes back.

Tomorrow is Heidi's clinic at Buen Samaritano. Next week is Thanksgiving, when we'll be headed up into the jungles of Zona Reina for two or three days. Please keep praying for all of that to go smoothly. We're expecting about 1,000 patients. No kidding.

Monday, November 12, 2007


Today was our bi-weekly clinic in Chicabracan. We had a full truck this morning. It was Heidi, Matt, Isaac, Paul, Lindsey, Juan Diego (our evangelist), and two patients we picked up on the side of the road on the way to clinic. Plus four boxes of meds, an ultrasound, a computer, our lunch, and Isaac's diaper bag. All this in a truck about the size of a Ford Ranger. Luckily we only live about 30 minutes from clinic!

We were on our vacation two weeks ago and had postponed this particular clinic, so it was no real surprise to have 50 patients when we're used to about 35. Many were first-timers, so it was great to have some fresh ears to hear Juan Diego's lesson. His lesson today was about the woman who had ten coins, lost one, and searched the whole house until she found it. The folks here really understand that concept. We have such a throw-away culture in the United States that we probably don't really feel the panic that these folks do when they lose a coin. The point of the message is that no matter how many followers Jesus has, He's always so excited when one more comes to the fold.

Our first patient, the one we brought with us, was our friend Gregorio Zapeta. He is probably our most confusing diabetic. He always looks like he's knocking on death's door - and he's not very old - maybe in his 30s or 40s. Sometimes he's almost completely blind from his diabetes. For a while, his blood sugars were in the 300-400 range, no matter what meds he was on. We were about to start him on insulin one week when he came in completely normal. For the next six months, he was absolutely normal. Then one day he came back in at around 300. He swears up and down that nothing in his diet has changed. Last time, he couldn't come to clinic because he was sick (more on that in a second). So he's now been without meds for two weeks. We expected his blood sugar to be sky high. But no, completely normal. We have no idea what's going on with his body, so we prayed with him. He is a Christian, which is great because with his blood sugar, he could fall into a diabetic coma and die just about any time.

We've often laughed to ourselves when patients tell us that they couldn't come to clinic because they were sick. Seriously, where else would you go when you're sick??? But think about it, sometimes our patients have to walk a couple miles up a mountain to the nearest road, then hitchhike to clinic. If you're truly sick, can you walk up a mountain? I sure can't. So with our American mindset, it's completely ridiculous to not go to the doctor when you're sick. But things are different here...

As we mentioned, Paul and Lindsey helped with clinic again today. It's so nice to have four extra hands. It makes handling Isaac easier, it makes gathering meds go faster, it helps to have native Spanish speakers, etc. Plus it's nice for the patients to see us working together. It gives us both credibility in different ways.

Another thing that's different between the American "immediate gratification" culture and here - we had a woman come in today who we could barely examine because she was hurting so badly. Her gallbladder has been bothering her for five months. And she has a seven month old baby! How miserable to be suffering with an infected gall bladder for five months - and caring for a newborn the whole time! She lives a long way away, but her sisters are regular patients of ours and they told her to come to us, so she's now staying with them for a few days so she could come to our clinic. We referred her to Dr. Hoak who can take her gall bladder out without giving her any kind of run-around.

Anyway, there were lots of stories and only a limited space here... so onto the pictures. The first is of Paul and Lindsey with a patient. The second is a little boy who had worms. He looked so sad while he was chewing his albendazol tablet! In fact, this picture was taken about 5 seconds before he threw it up all over himself...

The third pic is of Isaac and his daddy. (We had to prove that they actually came to clinic!) The fourth is of Heidi ultrasounding a pregnant patient. Note that the patient is laying on top of one of our medicine boxes - we don't have an exam table in this clinic. Lindsey is holding the patient's 19 month old baby, who screamed from the time she realized her mommy didn't have her until Mommy got her back.

And the last pic is Heidi and Isaac, Paul, one of our patients, and Lindsey.

Tomorrow and Wednesday are our days off. Hopefully, Matt will get some much needed recording time. And Paul will probably come over with some local musicians to talk about another recording session. We only have a few weeks when Paul is on vacation and Matt is in town, so we'll try to get some more work done...

Sunday, November 11, 2007

Weekend Clinics

Saturday and Sunday were our weekly clinics in Canilla and San Andres. For whatever reason, Isaac has decided that he doesn't really like clinic days any more. He had done better for a few weeks, now he's on a down cycle. Patients continue to think that he's the cutest thing ever, but we have to admit that he's cuter when he's smiling than he is when he's fussing or screaming...

We continue to be a little frustrated by some of the differences in values between richer cultures and poorer cultures. (We find that the Latins and those in Guatemala City have values much more "American" than the Mayans do.) One patient came in pregnant. She's 21, is on her 4th pregnancy and has one living child. Naturally, the question is, "What happened to the other two?" They were breech and died during delivery. Her baby is breech now, too. We asked her if she was going to go to the hospital for delivery in light of the previous two bad experiences. Her answer was that she's afraid of the hospital and pretty unlikely to go.

It's not just her. We hear this from lots of patients in life or death situations. Not all, as one severely pre-eclamptic patient told us that she WOULD go to the hospital. We're not sure the family really understands the gravity of the situation, but they at least acted like they were going to go. But many patients and families are so afraid of the government hospitals that they refuse to go. Some of this stems from stories about how patients can get treated at the government hospitals. We've seen both good and bad treatment of patients there - it kind of comes down to the luck of the draw sometimes. The rest of the fear probably comes from fear of the unknown. Our patients probably average about a kindergarten level of education and don't really understand anything that happens in the hospital. Communication is difficult, especially when patients don't speak much Spanish. And even when they do, the education levels are so different and the hospitals so busy that very few doctors really take the time to explain the situation to patients on a level that they can understand.

Also, we occasionally get stories from patients that make us wonder if the doctors DID try to explain things on a level they can understand. The trick here is to try to guess what the doctor's thought process was so we can take a stab at what the docs think the problem is. For example, if someone tells us that the doctor told them their stomach was too small, what possible medical conditions could possibly be described that way? Fun, huh? Well, it can be!

Today, Heidi had a 13 year old boy come in who had sustained a blow a few years ago to... well... an unfortunate place for a boy. At some point he ended up catherized. Now, the catheter has been removed and he is incontinent. This would be inconvenient for anyone, but a teenage boy? He's completely aghast. We're referring him to Dr. Hoak to see if anything can be done. Heidi deals with female incontinence, but boys are plumbed slightly differently. Maybe she'll get a chance to learn some.

Over the last few weeks, Heidi has been working to teach her translator, Manuela, some medicine. Education is so critical, especially out in the rural areas. If we can take some of the mystery out of health and health issues, people may be more accepting of medical treatment - and more importantly, of the other things we have to say to them (specifically about Jesus). Last week, Heidi taught Manuela some of the basics on ultrasounds - mostly to check and see if there is, in fact, a baby in there. This week was Lesson #1 on how to take blood pressures. Matt had told Manuela last week that if HE can do it, SHE can do it. He was right. She mastered the concept on the first try (see picture). Maybe next week we work on taking blood sugars!

Tomorrow is our clinic in Chicabracan. We're hoping to bring Paul and Lindsey with us. They were very helpful last week and since they'll be covering clinic while we're in the US for Christmas, it's nice for patients to see us working together so they understand that we're all part of the same organization and all have the same goals - demonstrating Christ's love for us by providing medical care to those who often have nowhere else to turn.

Please continue to pray for people seeking God's guidance in their lives. We know of many people (including ourselves) who are contemplating major life changes and simply want God to reveal His will to them. Also, please pray for Baby Sarah. Duane is bringing her to Quiche tomorrow for a check-up as part of her adoption process. As you'll remember, some major prayers have already been answered for her and we continue to ask God to keep His hand on her. Oh, and if you still have prayer time, pray for the work that the community is promising us (to be done on the runway in Saquixpec) to be done well so we can safely fly in there over Thanksgiving.

Friday, November 09, 2007

Isaac's Four Month Pics (1 of 2)

We already posted one blog today, but it was all business. So if this is your first time here today, don't forget to scroll down and read about what we're actually here for.

In the meantime, is it four months already? Well, not officially until Sunday, but we feel pretty good about having made it this far anyway. (Considering that we really still know very little about babies... thank God for Leslie!!)

The first pic is one of Isaac's "old man outfit" pics. There's another one in the next post, too. We figured that since he has no hair, no job, and no teeth, he's practically retired anyway - might as well dress like it.

The next one is Isaac's attempt at the crooked Harrison Ford smile. Think the ladies will go for it?

Third is his most common face - you could put SO many captions on this!

The last two are his official Thanksgiving outfit. Since we'll be up in the jungle on Thanksgiving day, this'll be his only chance. Besides, he doesn't really like turkey or cranberries anyway.

Isaac Pics (2 of 2)

The first is Isaac in his little stick-horse outfit. We didn't have any other props, so we just used a cowboy hat that's a wee bit too big for him.

The next two are him being absolutely fascinated with a new (to him) Pooh Bear. We could hardly get him to tear his attention away from the bear!

The next is just a cute smile, but the last one is his "old man" outfit. If we had only had some tall black socks and sandals...

Medical Team at Casa Del Rey

This week there is a medical team staying at Casa del Rey. Many of them we know from previous visits - some come down several times a year. Their main mission is to do rural clinics much like the ones we do, but on a larger scale. When you have a 10-20 person team, you can see a lot more patients!

We mentioned that this team has an anesthesiologist and that allows Heidi and Dr. Hoak to operate more and cheaper. Our local anesthesiologist is a wonderful woman but she works in the state hospital in the morning and then at Buen Samaritano in the afternoons - and not for free. So surgeries have to be scheduled when she's available and then the indigent fund has to absorb her cost. With a visiting volunteer, we can operate all day and without the extra fee.

Plus, this team has some handymen who are installing a central vacuum and central oxygen system. At the moment, we have to use a little electric vacuum pump that only holds about a liter and we have to use oxygen bottles. This will be a wonderful improvement and will increase both convenience and patient safety factors!

Heidi did two surgeries this week. Four were scheduled but two patients were no-shows. It happens. Both surgeries were vaginal hysterectomies with some additional repair work (clearly, Matt is writing and he's not a doctor!). One patient is getting on up there in years (they're not always exactly sure how old they are) but told Heidi she'd rather die on the table than continue living with her uterus hanging between her knees. Guess that's a pretty good indication for surgery!

Yesterday was Isaac's four month check-up at the pediatrician in Guatemala City. Everything looks good. He's more or less at the 50th percentile for "height" (really length) and weight - by American standards. He's about the biggest 4 month old most Mayans have ever seen! He got two more vaccines and tolerated them pretty well - only about a five minute meltdown.

We were on our way down to Guatemala City on Wednesday evening (the trip down and back in one day is too much for him) and got stuck in three different construction zones in the course of about a kilometer. Apparently they don't talk to each other. It started getting dark and our normal hotel was full. As was the hotel we stayed in when he was delivered. So we called our buddy Matt Capehart (owner of the Casa del Rey hotel - see the link on the right hand side of this page to "The Capeharts") and he said he could get us a hotel-owner's discount at most hotels. He called back and said he'd made reservations for us at the Tikal Futura hotel. It was FABULOUS! What an amazing hotel! We were ready to sell the house and move in - except that we don't own the house and it's a really long commute.... And all of that for about $70. Thanks so much, Matt!!!!

It must be construction season (still) in Guatemala because we got stopped for two more construction zones on the way home. What should be a 3 1/2 to 4 hour trip is now taking 6-7 hours. Fun, fun.

Today, Heidi is in her clinic at Buen Samaritano. She has a few post-op patients and whoever the team referred in to her. She often gets lots of referrals from teams - and we've gotten some good surgeries out of these. Many times, though, it's a chance to educate and evangelize a bit, too, so today should be good. Pray for her to have lots of patience (with a "c") because she's bound to have lots of patients (with a "t").

Monday, November 05, 2007

Chinique Clinic

Today was our monthly clinic in Chinique. Paul and Lindsey (the Guatemalan medical students Agape is helping to support) are on their two-month vacation and came along to help. It's a good thing, too! Isaac must not be feeling well today because he was a little monster all morning. Matt actually had to step out and stay out through basically the entire clinic because all Isaac would do was cry. This would ordinarily have left Heidi all by herself with the patients, the meds, and the computer, but Paul and Lindsey were a huge help.

We saw around 40 patients today and are continuing our discussions with them about the status of their souls. Since this clinic is mostly chronic patients, we see the same people every month. Instead of just reviewing their blood sugars, blood pressures, and muscle ache complaints, we're also making sure they have a solid understanding of why we're here and how much we'd like to spend more time with them after we've worn out these tired bodies! (At least then we'll be able to understand each other a little better - our Spanish is really coming along nicely, but we're a long way from fluent - and so are many of them!)

Abraham, our friend with the REALLY bad psoriasis, came back today. Thanks to some help we got from Dr. Sugarman in North Carolina and some prayers, he is looking a whole lot better. He's a relatively young man and has really been suffering with this skin condition, so it's great to see some improvement in his case. (First pic was from June - the second from today.)

Tomorrow and Wednesday, Heidi will be operating pretty much all day in Chichi. Like we mentioned, there is an anesthesiologist here for the week and our "surgical fund" can save a lot of money. Anesthesia runs around $100 per surgery. And when the average surgery costs less than $1,000, it's a pretty big percentage of the total cost. (Any of you anesthesiologists out there, if you'd like to come down and volunteer for a week, we can hook you up with some very nice accomodations and we'll be eternally grateful!!!)

In your prayers this week, please pray for God to reveal His plans to those who are seeking them. We are starting our search for a job for Heidi in the United States and we are starting to look for replacements for ourselves here. Also, we have some good friends in other missions who are searching for some direction themselves. Whatever God's plan is, we're happy to follow it - we just need some guidance from Him on exactly what it is we're supposed to do!!!

By the way, please check out the link on the right hand side of the page for "Agape in Action". This, if you didn't know, is the name of our group. Bethany Leatherman has done a fabulous job of re-working this site, so it's all new and fabulous!

Sunday, November 04, 2007

Back to Work

After our nice vacation last week, it was good to get "back in the saddle" and head out to Canilla for our weekend clinics. Roy Simmons and his grandson, Cole, were with us for a few days to do some more planning for the addition onto the dorm. (Roy is going to be spending a lot more time down here and he's building two 2-bedroom apartments onto the current building.)

Saturday morning clinic was a little quieter than usual, with about 45-50 patients. One of the sick little babies we told you about a week or so ago came back. He had had pneumonia pretty bad and we were awfully afraid we were going to lose him. He got one dose of antibiotics in our clinic and went home. Mom sought no further treatment for him because she didn't feel good herself. Well, no one can claim that the medicines healed this kid - one dose of antibiotics wasn't the culprit. God definitely had His hand on this little baby - he looks 100% better!!

The rest of the morning consisted mostly of prenatal patients, our standard group of milk program (malnourished) kids, and general health problems (musculo-skeletal pain, gastritis, etc.). Roy and Cole got a chance to see some of the clinic and then we gave them a tour of the hangar, the airplanes, and some info on our upcoming projects.

A good part of the afternoon was spent counting out vitamins for our Thanksgiving Weekend trip to Zona Reyna. If you'll remember, this is an area a bit north of here that is down under 2000 ft. elevation (rain forest/jungle) that has no electricity and often no passable road between it and a hospital. It's about a 12 hour drive off-road to go about 25 miles as the Cessna flies (it's a 15 minute flight). The last time we were there for two days, we saw over 1,000 patients. This time we should have about 5 clinicians, including 2 doctors. With any luck, the local comittee will have done enough work on the grass runway that we can safely fly some folks in. Others will still have to drive. Remember that this is the runway where we lost the Aztec airplane - we're a little nervous about it!

Sunday was clinic in San Andres, as well as the second round in the national elections. Guatemala has around 30 political parties with many of them running candidates for President. Since no one candidate got more than 50% of the vote in the first round in October, we had the second round today. We don't involve ourselves in the political process here (we have bigger fish to fry) but it's been interesting to watch. We'll know in a few days who the new president is - unless there's some weirdness in Florida, of course.

Heidi has been having some fun teaching her translator (13-year-old Manuela) some basic medicine. Today they started teaching her how to do ultrasounds. Next week might be blood pressures. We've already mastered the pregnancy wheel and some basic diagnoses, such as body aches and heartburn. It's always good for people in the local communities to get some health education. Things that we consider common knowledge in the United States (if you have a headache or have some muscle aches, you can take ibuprofen - if you have heartburn, try a Tums) are completely beyond the common understanding here. People are often baffled that the same pill can help with a headache and a sore knee.

Today, Leslie saw a family that said that all of the kids in their village were feverish and had a rash. While we were a little unsure of exactly which one of the childhood viruses it was, it's clearly one of them. Reassurance is the biggest thing we can offer - it's pretty unlikely that this is going to be a fatal thing for anyone. Again, when health education is lacking, these things can be kinda scary. Especially when someone points out that their kid had a fever a few months ago and died.

Tomorrow is clinic at Roy Espinosa's church in Chinique. Paul and Lindsey may be able to join us (her mother has had some back surgeries and they were bringing her home today). Tuesday and Wednesday, Heidi will be operating at the Hospital Buen Samaritano because an American anesthesiologist is here (anesthesia is our biggest single expense on surgeries because we have to hire a local doc to do the work). Thursday is Isaac's 4-month check-up at our pediatrician's office in Guatemala City. Hard to believe it's four months already, huh? Some days it seems like it's been a whole lot more!

Thursday, November 01, 2007

Vacation at the Beach - 300th post!

As we mentioned, Monday morning, we flew down to Puerto San Jose for a few days on the beach to celebrate our 2nd wedding anniversary. Naturally, we took Isaac with us. He really enjoyed being able to just lay around and take naps - no clinics, no car rides, nothing! Heidi and Matt took turns hanging out in the room while he was sleeping so the other could get some quiet time by the pool. The resort was beautiful - two pools and some exclusive beach front on the Pacific Ocean. There are over 30 volcanos in Guatemala, so the beach sand is pitch black volcanic sand. Weird but beautiful.

It was basically the perfect vacation. There was little to nothing to do, so that's what we did. Naturally, we fielded some phone calls from patients and some of the other missionaries regarding work, but that doesn't really count as work now, does it?

This afternoon, Duane and Joseph flew down to pick us up. Flying is SO much better than driving. Los Encuentros is a town that's about an hour or so drive from Quiche - and we have to go through it to get to Guatemala City. As you're passing over Los Encuentros in the air, Quiche is directly in front of you - about 5 minutes out. Amazing!!!

This afternoon, Roy Simmons and his grandson Cole will be coming in for a few days to do some more prep work for the new addition on to the dorm. They might be riding out to Canilla with us this weekend, too. We'll spend the day around the house getting ready for a long week coming up - 6 clinics and 2 surgery days in the next 9 days. We're also going to try to get back out to our new clinic in Totonicapan the following week and maybe prep for a surprise trip up into Zona Reyna over Thanksgiving weekend (the mayor called this week and wants us to come up this month yet).

Pics - the first is Heidi and Isaac in the back of the plane on the way to the beach. The second is Lake Atitlan and the volcanos. The third is Matt and Duane in the front seat. And the fourth is another shot of the lake and the volcano.

Vacation Pics (2 of 3)

The first is Heidi in our room - notice Isaac on the far bed!

The second is Matt and Isaac on the bridge to the beach.

The third is Heidi and Isaac playing in the Pacific Ocean (note the black volcanic sand)

The fourth is Matt and Isaac in one of the two pools. Isaac's not the biggest fan of swimming just yet. Sitting in two inches of water, yes. Being held while in deeper water, not so much.