Back to Work

This morning we had to say a very sad good-bye to Annie, who we hope is now safely back in the U.S. Duane flew in to pick her up, and came a little early to check out the progress on the construction. Pics below are of the progress that has been made on the fence, which looks pretty good. Matt bought paint and other supplies today to ensure that the work can continue over the weekend and while we are travelling to the Zona Reyna next week.

Yesterday's clinic at ASELSI was pretty routine, and today's at the Hospital Buen Samaritano was as well. We saw a few post-operative patients who are doing quite well, and even one lady who had her hysterectomy last May and was back in with her daughter for some minor problems today.

The more interesting news is about the patients who have shown up at the door this week, actually--

Little Tomas, the new cleft palate baby that Regina brought us a few weeks ago, was here yesterday with his very proud and happy parents. He has gained over a pound since we started him on supplemental bottle feedings just two weeks ago!! He looks so much better so quickly, and it was truly heartwarming to hear his parents talk about how "bonito" (cute) he looks. Unfortunately, this isn't a word used often to describe these babies. Please keep Tomas and his family, as well as all of the other cleft palate babies, in your prayers.

Today there was a man who showed up wanting to talk to the doctor about his wife. He was obviously very distraught, and it turns out he had good reason to be. The hospital here had diagnosed his wife with a brain tumor, which was almost 8 cm large by CT scan! He desperately wanted to hear that there were other options for her treatment.

Unfortunately, Heidi had to pretty much agree with the local docs that there is very little hope for her survival-- outside of a miracle, that is. So we prayed together for a miracle and for peace for the lady and her family. They are a very nice Christian family in crisis-- Please pray for Tomasa Tebelan and her husband and kids. We were able to offer some medications to help with pain and nausea, and assured them that our door is open if there is anything else we can do to help make her more comfortable.

We feel this is a good time to point out how we came to have medications to help this lady with-- From time to time, we will receive medications that are donated by family members of a deceased patient in the U.S. Often these are people that died of cancer or other chronic illness and acquired a large supply of meds. They are often very useful pain and anti-nausea medications which can make a big difference and otherwise be very hard to find down here. All this is really just to publicly answer the question that we receive from time to time about whether these types of meds/situations can be useful to us-- with a resounding YES! Just something to keep in mind...

This weekend will be our regular clinics in Canilla and San Andres, then on Sunday there is a new fourth year medical student joining us. Charlie will hopefully be flying in to Canilla to spend the night, since we are leaving early Monday morning for a village in Zona Reyna.

This trip will be to a village that is not reachable by any road, so we will be flying everything and everybody in and out. Lots of prayer coverage would be appreciated! Please pray specifically for the plane and safe flight, health (we are unable to take in enough clean water or food, so will be relying on local supplies), and our medication supplies-- We have no idea how much of everything to take, so we may be dependent on some "loaves and fishes" type action... Which is obviously not a problem for God; we've seen it lots of times before with our own eyes.

Our God is an awesome God.

Vacation!

With Heidi and Isaac in the US for a few days, Matt, Annie, and Beth took the opportunity to get some R&R. Monday morning, we got up and had a chance to meet with the builder for a few minutes, then headed down to Panajachel. We hired a boat to take us across Lake Atitlan to the village of Santiago. The girls did some shopping there. Then we took the boat to another village, had lunch overlooking the lake, then boated back to Panajachel where we got in the truck and headed to Antigua.

We had dinner and spent the night in Antigua, then spent most of the day Tuesday shopping and just enjoying the atmosphere.

Wednesday morning, Heidi called to say that her flight into Houston was going to be delayed and that she probably would miss her connection to Guatemala. Luckily, though, the pilot made up some time in the air and with some OJ Simpson moves (the running through the aiport moves, not the... ahem... other "alleged" moves), she made it to her connection and down to Guatemala on time.

The gang here in Guatemala had done some grocery shopping, including the purchase of a new microwave (one that actually works - the old one heated things up only slightly faster than putting them in the sun - and most of the buttons had quit working, so hopefully your desired time only had the numbers 3, 6, or 0 in it...), so after picking up Heidi and Isaac, we left immediately for home. We only had to wait about an hour for construction, so it wasn't too bad.

This morning, the girls went to ASELSI and Matt and Isaac stayed home to supervise construction. It seems that our builder got sick this week and is currently a patient in the next-door hospital, so we'll go check on him during visiting hour this afternoon.

Tomorrow is Heidi's OB/GYN clinic at the Hospital Buen Samaritano and we'll have to say good-bye to Annie. She has been a real pleasure to have around and we know that she will make a great missionary doctor (that's her plan). No worries, though, we have another student coming on Sunday afternoon who will be here for the month of March.

Weekend Stuff

The weekend started out rather typically, but took a turn for the... well... unexpected right away. We were about an hour down the road towards Canilla (13.8 miles) when traffic came to an abrupt stop. Matt walked down the road and around the bend to investigate and came upon a gasoline tanker that had failed to completely round a curve. (This is all off-road driving, mind you.) Its right rear wheels had falled off the edge of the cliff (down) on the right and its front left tire was nearly touching the cliff (up) on the left, completely blocking the road.

Pastor Rodi was the first vehicle in the line coming the other way, so Matt and Rodi talked for a few minutes in which we determined that there was no way that truck was moving any time soon. Heidi and Isaac had a flight to catch, so we turned around and went back an hour to Quiche, then drove nearly two hours to Canilla on the other road (which is significantly worse - thank God for the new Toyota!)

So a two hour drive turned into nearly four. Heidi and Isaac's plane to Guatemala City left about 20 minutes after we arrived in Canilla. So clinic was with Leslie, Katie, Annie, and Beth. They saw about 70 patients. There were a couple of kids with pneumonia, one complicated with a hint of asthma, some prenatal patients, and lots of families.

Matt worked with the guys, including a trip into the mountains to fetch a flatbed load of firewood, and a visit to Roscoe's old place in Chijoj.

This morning, Annie and Beth got to attend to a man who showed up at the gate with a sore foot (that's what happens when you're the "new guy").

Clinic in San Andres was relatively routine, with around 100 patients. There was a little boy who the family said had been to a doctor for something in his ear and can no longer hear. He no longer speaks, either, so he's been pulled out of school. One side was pretty impacted with wax and the other side looked like it had incurred some damage and scarred over. With the lack of speech, a hearing test was somewhat difficult but he reacted like he could hear some. Sadly, there's not really a whole lot that can be done other than to help with the wax impaction.

Another sad story involves a young woman whose parents brought her in with a pretty classic description of schizophrenia. There's not much that can be done for her, either, except a lot of prayer.

Heidi and Isaac were safely on the ground in North Carolina, so Heidi was consulted by phone on a couple of obstetrics patients (it's a small world, afterall).

Actually, we were rather lucky that we had some extra room in the truck (with Heidi and Isaac being gone) because we ended up giving a ride back to the hospital to an 11-year-old boy and his dad. The boy came in in some respiratory distress and some rather disconcerting torso pains. By the time he got to the hospital, he looked a little better (maybe it was Matt's driving) but the doctors here were very nice and said they'd take a look at him. Neither the boy nor his dad speak Spanish but it was very nice to see a dad who was so openly affectionate and concerned for his son. (Mayans aren't typically very demonstrative towards their children.)

Construction on the fence continued on Saturday and should be completed by the end of this week. It's going to be very nice to have a place to secure the vehicles and all of the construction materials that will start to arrive for the building of the new addition.

Tomorrow morning, we'll meet with the builder for a status update, then head to Panajachel for the day. In the afternoon, we'll leave for Antigua where we'll spend the night. Tuesday will be a tourist day in Antigua. Wednesday morning we'll head to Guatemala City, pick up some supplies, then meet Heidi and Isaac at the airport.

350th Post

Three hundred and fifty posts. Well, those of you who know us well know that we are not at all surprised that we've had that much to say. But keep those comments to yourselves.

Today was Heidi's clinic at the Hospital Buen Samaritano. She actually had some patients this time but nothing surgical, which is kind of good since she won't be around this Wednesday. She and Isaac will be leaving tomorrow around noon for the United States to run a few errands. They'll be back on Wednesday, which will give Matt, Annie, and Beth a few days to relax and enjoy Panajachel and Antigua.

The first pic is one where we're applying for Parents of the Year. Isaac would have voted for us, anyway.

The rest are construction pics, more for Roy than anyone else, but ya'll don't mind, do you?

They should be building forms for the concrete columns tomorrow and should start pouring either tomorrow or Monday. Then they'll start stretching chain link fence. That process should move relatively quickly. Then they'll need to finish the concrete to match the house and paint. The job should be done by the end of next week.

Tomorrow morning we head to Canilla, as usual. At noon, Heidi and Isaac will fly from Canilla Intergalactic Airport to Guatemala City, then to Houston. They'll spend the night in Houston, then head to North Carolina.

Thursday at ASELSI

Today was clinic at ASELSI in Chichicastenango. Matt and Isaac came along, too. Heidi took one room and Annie and Beth took the other, to start. (Sometimes, the best way to learn is by doing.) Annie and Beth are both doing a great job here and really bring a lot to the team.

We saw our pretty normal load of patients. Visits ranged from prenatal visits to a wicked case of psoriasis to a woman who thought she was diabetic because her mouth gets dry when she eats sweet or salty foods. Osny's mom (Osny was one of our cleft palate kids) is pregnant again, so we're adding her as a prenatal patient.

Cecy, our translator, signed up for nursing school last week and starts in March. She will have a year's worth of Saturdays in class, then six months in clinicals, then she'll be an auxiliary nurse. She'll be one of the best ones around!

The first two pics are of our psoriasis patient. The first is of his biggest affected area (that we can show on our website). The second is of Beth helping him to put some cream on for that. The third pic is of a short discussion between Annie and Beth on what the best course of treatment is for a patient (or what they're planning to do for lunch - one or the other).

The fourth pic is - well, we don't know. We'll be sending this and some others on to a dermatologist we consult with in the US. It's a little baby who appears to be completely flea-bitten. But we could be wrong on that. Hopefully, Dr. Hess can help us out with that!

And fifth is another shot of the fence foundation going in. Someone mentioned that it didn't look like there was any rebar in the driveway. There's not, but it's 6" of concrete. The fence, however, will have rebar in the foundation and in the columns that are spaced every two meters. Plus, we'll put in a conduit to run power up each column, in case we want to light them or place security cameras. Conduits are much easier to run when you're pouring...

Tomorrow is Heidi's OB/GYN clinic at the Hospital Buen Samaritano.

Wednesday

Wednesday was a bit of an unusual day. The woman we had been praying would show up for surgery in Chichi was a no-show. We did have other plans, though. Our friend Regina has brought us several patients in the past - some cleft lips, some microtias, even a spina bifida. Well, she called last week to tell us, rather proudly, that she found two more.

That was the nail in the coffin. We told her to bring those kids by and that, also, we'd like to meet with the local comite (think: town council) to see if we could maybe do a screening right there on site. It's not really Regina's responsibility to bring all of these kids to a place where they can be helped.

So she brought the kids to us on Wednesday morning (pics one and two), as well as the previous cleft lip/palate (from last week) so we could check on his weight. He had gained nearly a pound in that week and looks immensely better!!! (pic three).

Then we all loaded up in the truck (pic four) and headed out to Chujuyup. Three members of the local comite were there to meet us and were SO friendly. We explained that we are here as missionaries, to help the people and to demonstrate God's love for them. We told them that Regina has been so faithful in bringing us patients, but we don't believe that's her responsibility. It's our responsibility, along with the local officials, to help out. They agreed.

So we set up a date about a month from now to go out and see some patients. We told the comite that they have the perogative to give out 40 numbers. They know who has the most need and we'll see how that process works. If we need to revise it, we can. But if we don't work with them to get a certain number of numbers handed out, we'll have 1,000 patients and we're not really set up for that. Additionally, we're hoping to bring an evangelist with us - one who speaks Spanish and K'iche - to explain a little better to the people who come WHY we're there and maybe locate a local pastor we can also coordinate with.

So we'll see how that goes. Unfortunately, Annie and Beth will be gone, but we're expecting another student to be here during that month, which should help, too.

Lastly, there's a pic here of some of the construction work that's going on at the house. The guys dug some trenches to prepare for the fence that will surround the new addition. They're now starting to lay rebar and pour concrete.

Monday and Tuesday Clinics

Monday morning, Annie, Beth, and Heidi headed out to Chicabracan for our bi-weekly clinic there. Matt and Isaac stayed home to supervise the finishing of the driveway and to receive a few truckloads of construction materials. During Isaac's morning nap, Matt put another gallon of paint on the east side of the house, nearly finishing that side before Isaac woke up.

Clinic in Chicabracan was relatively routine but with many new patients. Most of our chronic patients there are on an every 4 or every 6 week schedule. This particular week we didn't have many chronic patients scheduled and we saw lots of first-timers.

One notable patient there was one we had suspected with a miscarriage two weeks ago and, sadly, we were able to confirm that on Monday. In better news (sort of), we have a patient there who we had feared had unstable angina and this time it sounds like she has stable angina and gastritis. Sometimes it's hard to separate the descriptions of actual chest pain with heartburn.

The last patient of the day told us that the number she had was for herself. She thought the baby strapped on her back had a broken arm, but the number was for the mom. Mom had a headache but the baby actually appeared to have a broken elbow. It was completely black and misshapen. Naturally, we spent a little more energy with the broken arm. We can't actually diagnose broken bones in clinic, but very strongly suggested a trip to the hospital.

This morning we met the builders here at the house and got them started, then went to clinic with Leslie and Katie in Chiminicijuan. On our arrival, we found that David was on his way to Chinique to get some more things from Roy Espinosa, who is moving back to the US later this week. So Matt and Isaac rode with him to help out and say Good-Bye to Roy.

This clinic was also pretty routine. We did, however, see a ruptured eardrum in a little baby. Also, Duane came out and did some eye exams and fit some glasses.

Arriving home, we found that the builders had made some pretty good progress on digging a foundation for the new fence. They got into a bunch of really big rocks, which they're enjoying thoroughly.

Tomorrow, we hope to make it out to Chujuyup, where Regina lives, and see if we can maybe do a clinic there at some point. We got some rain today, which is quite unusual for this time of year, so we'll see how passable the roads are in the Mazda, which we'll have to use because we'll likely have about 10 passengers. (No one ever goes anywhere by themselves, so we're expecting a full house in the morning.)

In pictures, the first is of Beth examining a baby in Chicabracan yesterday. The second is of Duane fitting some glasses in Chiminicijuan. The next three are of the construction project. One is of the recently completed driveway, one is of the chalked off border for the fence (yesterday) and the other is after nearly a full day of digging.

Weekend Plans

Saturday morning was our regular trip to Canilla for the weekend. It was Beth's first time to arrive in Canilla by ground (she had flown in with Duane to pick up Heidi and Annie a week prior).

Saturday's regular clinic time was relatively uneventful, though there were plenty of patients to go around. Shortly after clinic ended, though, a man from Chiminicijuan showed up with a large gash in his head. He had been working with concrete and managed to get hit with a piece of rebar that cut him all the way to the skull. Annie had been the first-assist on Heidi's surgery on Wednesday, so it was Beth's turn to sew. She did a great job cleaning up the wound and closing it with as much tissue as had been left by the accident. We're pretty sure this guy's modeling career is over, but probably not because of the cut.

The afternoon was fun, too. We had a chance to relax a little, then head out to Chijoj to visit another mission that is in some transition right now. The previous proprietor died a few months ago and another American family is helping to sort out what's what. The Fickers are helping a whole bunch, too.

This morning, shortly after the girls left for clinic, the boys received a phone call that the road to San Andres was blocked by a large truck that was having some trouble getting a tire changed. Duane knew of an alternate route and after some sightseeing, the girls were able to get to clinic. There were 93 patients waiting when they got there. Luckily, with five clinicians, the clinic went a little quicker than usual and we were back at home before 5pm.

Please pray for a woman who came in with a molar pregnancy (Heidi's second this week and we think #7 since we've been here). We're praying that she will come to Chichicastenango for a life-saving surgery this week. If not, we pray she gets to an emergency room somewhere before she bleeds to death (not a guarantee, but a definite possibility in her condition).

While we were in Canilla on Saturday, our contractor put in the customary Saturday half-day. The work they did looks great and we're hoping they'll finish the driveway tomorrow morning and start on the fence that will surround the new addition. With the relatively high value of materials (versus labor), it's a good idea to secure the area before starting to accumulate stuff and start construction.

Tomorrow is clinic in Chicabracan. The girls will go with our evangelist, Juan Diego, while Isaac and Matt stay at home to supervise the finishing of the driveway and to receive some more construction materials. Tuesday we'll go to Leslie's clinic in Chiminicijuan (she's been having as many as 100 patients a week out there, too, with only she and Katie to see them all).

Wednesday we'll see our friend Regina here with yet another cleft lip and another microtia. After we see them here, we'll take them home, try to meet some of the officials in her village, and see what possibilities exist for at least one clinic there. (Yes, we could try to meet them in the road, but changing plans with her is a little tricky. The original plan was to meet here and we'll have a much higher probablility of success if we keep it like that.) Also on Wednesday, we'll pray that there is a quick surgery in Chichicastenango.

Thursday will be at ASELSI, Friday will be back at the Hospital Buen Samaritano, then we'll be back out to Canilla for the weekend. That'll give us 12 straight days of either clinic or surgery. Then Matt and the girls will take two days off (probably in Panajachel and Antigua) while Heidi and Isaac make a quick run to the United States to run an important errand.

Now, in pictures, the first and second are of Annie and Beth, respectively, in clinic in Canilla. The third is of Lydia teaching them how to make tortillas, Guatemalan-style. The fourth is of Heidi and Isaac holding Isaac's first tortilla (about the size of a quarter). And the last one is a shot from Friday of the workers pouring a concrete pad for the driveway (one of twelve pads making the driveway). Each pad takes 11 loads in the mixer to fill it.

Friday and More Gratuitous Isaac Pics

Well, today the girls got up to go to the Hospital, with the hopes of doing Heidi's weekly OB/Gyn clinic and maybe even scheduling some more surgeries. Isaac went with them, since all the ladies at the Hospital keep asking when they get to see him again. There were no patients today, though! The second Friday of Lent is apparently a pretty major religious holiday here, and there were hardly any patients anywhere in the hospital.

This clinic over the past few weeks (since Dr. Hoak left the hospital to go pursue his permanent Guatemalan medical license by working for a year in The City) has been very slow-- only 3 or 4 patients! We are a little confused about why, but it is probably just a misunderstanding about Heidi still being there with Tom gone. Please pray for clarity in the direction this clinic should go. We will talk with hospital administration about maybe doing some more advertising if this keeps up.

Matt and David Ficker worked hard today overseeing more of the construction project here at the house. The first side of the driveway is done now, and they are getting things ready for the fence to go up. More pictures of that later.

Tomorrow we will head out to Canilla to see the Fickers as usual, and do clinics there and in San Andres on Sunday. Please continue to pray for direction as we look for a new Monday clinic and good guidance at Buen Samaritano.

Here are the aforementioned "gratuitous Isaac pics"-- They are his seven month pictures that we took this week...

Thursday at ASELSI

Construction at the house continues, so Matt and Isaac stayed home while Heidi, Annie, and Beth went to ASELSI in Chichicastenango today.

We've been asked what ASELSI stands for. It's an acronym for the Spanish version of "Association for Equipping the Saints, International". It's a combination Bible institute and medical clinic. It's probably one of the most American-style clinics we do. There is a front desk where patients come in and present their chief complaints. Charts are either pulled or started, labs are run, then the patients wait for their consults. Prescriptions are given by the doctor(s) and then filled at the internal pharmacy.

It's a very popular clinic with the Mayan people in the villages surrounding Chichicastenango. The reason it's held on Thursday is because that's the big market day in Chichi and buses come in from more rural areas on that day (in other words, our patients can get there on that day). They have, besides the medical clinic we work with, physical therapy, a chronic clinic (hypertension and diabetes, mostly), and a milk program. The milk program provides nutrition for well over 100 malnourished kids.

Anyway, Annie and Beth both did tremendous work today. They have both adapted very quickly to how medicine is practiced here. We practice with as much of an American philosophy as is possible but with an understanding of what resources are available and what cultural barriers there are to practicing with a fully American direction. (For example, we have to understand that illiterate patients cannot be expected to be able to take six different medications at a time - all at different times of the day.) Also, many medications require regular lab work to be done to ensure the absence (or managed control) of possible side effects. This is not necessarily possible where we are.

After market, they went to check on their surgical patient from yesterday, who is recovering nicely. Then they went to the tourist market in Chichi to check out their wares.

Matt and Isaac supervised the pouring of three of the 12 slabs that will comprise the new driveway. The workers seem to be experienced and conscientious and should produce a very nice new driveway. Their estimate is that they will be completed by Monday. We will likely use another contractor to put up a temporary fence around the construction site to prevent theft of the materials. Letting the two contractors know that competition exists should be beneficial to quality, cost, and time.

Tomorrow, the docs go to the OB/GYN clinic at the Hospital Buen Samaritano and Matt will meet Duane and David to oversee some more work here at the house, as well as starting to line up the fence contractor.

In pics, the first is of Beth, Annie, and a patient at ASELSI. The second is of Cecy and Heidi. Cecy is our translator who will shortly be starting nursing school in Solola. We are helping her with that expense. It's a lot for a Mayan single mom who only works part-time, but laughably inexpensive from an American perspective.

The third pic is in the milk program room at ASELSI. Fourth is Beth and Annie looking over some typical wares in the market. And last is what our driveway looks like today. They should finish pouring the left side of the driveway tomorrow and build the forms for the right side. Saturday will be a 50% pour on the right side and Monday will be a finish-up day - assuming all goes well...

Second Post of the Day

This is what happens when you post in the morning, so be sure to read the post below, too...

As we were posting the last entry, another patient knocked on the door. Felipa is one of our chronic patients in Chicabracan. She's one we employed, briefly, as a translator. We still use her to translate once in a while when a patient cannot speak Spanish, but many of our patients there bring their own translators with them.

Felipa's 8-year-old daughter was injured a week ago when the van she was trying to board failed to stop long enough for her to get on. She managed, somehow, to cut her inner thigh quite badly. They came to the hospital to get stitches and when they returned today to have them removed, the wound was still open. The docs in the hospital, very appropriately, told her to wait another week for things to heal a little better. Then, quite inexplicably, they told her not to walk in the meantime. Well, you get some right, you get some wrong. (Though this is not exactly what you're looking for in a health care provider!)

Heidi looked at the wound, more or less agreed with the assessment to wait another week, and explained the "use it or lose it" principle. The cut isn't deep enough to affect anything other than skin. Walking around will produce a better outcome than laying on a bed, guaranteed.

Later, Isaias returned to the house after his speech therapy appointment with a note from the therapist explaining that her opinion is that he needs a plastic insert in his mouth to help reduce the nasal quality of his voice (from the wide open palate). Luckily, we know a missionary who can help us with this.

In the afternoon, Heidi, Annie, and Beth went to the Hospital Buen Samaritano in Chichicastenango to do their abdominal hysterectomy. All went well and the patient is now recovering. They'll go by to check on her tomorrow.

Construction work continues on the new driveway. We did catch a guy trying to rip us off on a rock delivery. He claimed his truck held 10 cubic meters of rock. The contractor told Matt privately that they don't make a 10 cubic meter truck, only about 7 or 8. We asked to measure the truck and the math came out to 7.5 cubic meters, which is what we paid for. No special gringo pricing, please...

Tonight, Heidi and Matt went over to Martin's house to check on Gloria again. Please keep her in your prayers.

Tomorrow, Heidi, Annie, and Beth will go to ASELSI. Matt and Isaac will stay home and supervise the first concrete pour.

Oh, and please read Beth's blog at the following address:

http://www.inmedblogs.us/bethgullone

Tuesday "Day Off" and Wednesday Morning

Tuesday is our weekend. Usually, it means that we work around the house or take care of errands we can't do when we're in clinic. Yesterday, we helped supervise the construction work at the house.

David Ficker came over in the morning - or at least tried to. He lost a head gasket on the way over, so his truck will be spending a little time at Martin's house.

The workers have been finishing the work that the backhoe started. They're smoothing out the ground now by hand. They're being paid by the job, not by the hour, so the fact that they seem to be taking their time doesn't bother us so much!

David and Matt went to a few places in town and ordered two truckloads of rock (10 cubic meters each), 150 bags of concrete, 100 lbs of wire, 100 lbs of rebar, and some steel trussing. The workers ordered two truckloads of "selecto" - basically clean dirt and two truckloads of sand. Naturally, three delivery trucks showed up all at the same time. A truckload of rock first, which parked directly in the way of the concrete guys. Then, while they were working, the "selecto" truck dumped a dump truck load of dirt in the driveway that the other guys needed to use to leave. Fun, fun. No worries, we got everyone out, eventually. They seemed not to be at all surprised or rattled by any of this.

The truckload of rock - for those of you who don't know, 10 cubic meters of crushed rock is A LOT! - had to been unloaded by three guys with shovels. They don't have a dump truck. So they load the thing FROM THE GROUND by hand, throwing the rock up over their heads, then unload the thing from the truck, tossing the rock down on the ground. Amazing.

At 7:30 this morning, we got a knock on the door. Our friend, Regina (mother of Carolina - our first cleft lip patient), came by with her son Isaias so we could show them where their speech therapy place is. Isaias has an unrepaired cleft palate and is 16 years old. The team that came down in January said that the best thing we can do for him now is speech therapy. We have a lot of faith in them, so off to speech therapy he goes!

Regina brought along another family from her village who has a son with a microtia (malformed ear) and a new baby with a cleft lip. This makes us think that we probably need to set up a visit to her village. We'll be trying to contact the mayor and a pastor there maybe next week.

Anyway, this baby was born on December 19, making him nearly three months old, and he weighed in this morning at 6lbs 3oz. His palate is open, as well as his lip, so he can't really suck. We spent a lot of time with Mom and Dad (with Regina translating) explaining how to mix formula, demonstrating for them how to feed the baby (Tomas Mateo) with a syringe, and then how to clean the mixing bottle, the syringes, and everything.

It's helpful to have Regina translate, because she has been shown how to do all of this and can explain it to them from the perspective of someone who's done it and has a healthy baby with a repaired lip and palate to show for it.

We gave the dad three bottles of water to help them get started with the process of mixing formula. He had clearly never dealt with bottled water before. He wanted to know if he had to boil this water, too. No, we explained, this is pre-boiled (more or less) and it makes it easier for them to be able to feed the baby when they're away from home. Their water at home (pulled from a river) has to be boiled for 20 minutes, then mixed with formula and fed to the baby. Afterwards, the bottles have to be washed and soaked in bleach-water. We also gave them some bleach and explained how to make the bleach-water. Again, Regina was very helpful!

The rest of the morning, Annie, Beth, and Heidi will be working in the pharmacy. In the afternoon, they have an abdominal hysterectomy to do in Chichicastenango at the Hospital Buen Samaritano.

The pics below are pretty self-explanatory. The first one is of the dirt truck dumping its load below the rock truck that's being unloaded by hand. The next ones are of our visitors from this morning. The black dot is because there are plenty of weird people on the internet and we're not going to help them be weird.

Clinic in Nueva Santa Catarina

Today was our monthly clinic in Nueva Santa Catarina. It's usually about a two hour drive, and we were able to make it in just slightly more than that, even though we were stuck in construction for a little while. The Toyota is "a little" (nearly triple the horsepower) faster than the Mazda, which mostly manifests itself in the ability to pass very slow trucks that are climbing in front of you.

We never really know how many patients we have at this clinic - when we start, or when we finish. People just seem to keep coming up and sometimes, after you've worked for four hours, there are more people outside than there were when you started. Kinda hard on the chi, but just something to know about and deal with!

Including drive time, we had close to an 11 hour day. We had our typical tums/tylenol patients, but several more complicated patients, too. One was a man who we saw before with some... um... male problems. Heidi being a gynecologist, it was nice to have two family practice people here with us. Beth is a family practice resident and Annie is about four months from becoming one.

Without going into too many details, the man had been exposed to some things that could cause male problems. We've treated just about everything we could think of that might be causing the problem, and we treated one more today, but we also explained that guilt and internalization can cause physical problems. He got down on his knees with us and prayed for forgiveness and renewal.

About an hour later, he came back and wanted to know what kind of medicine we'd given him (an antibiotic) because his pain completely went away. Matt explained that this type of medicine can't really do that, but God can.

We saw a patient we treated for infertility (as much as you can really treat infertility here - vitamins and some prayer) who is now four months pregnant. She was so thankful for the medicines we gave her - and we explained that vitamins can't really do THAT, either, but God can.

Some of you may remember the 100-year-old woman we saw shortly after we moved here who has had a hernia for 50 years. She came back in today with a really nasty looking lesion on her face that's probably skin cancer. They say that it's growing. We explained that there's not a whole lot that can be done for this. She's not in the church and Matilde promised to go see her this week and talk to her some more (he's talked to her in the past, but time is probably running out).

We diagnosed a woman with severe hypertension only 29 weeks into her pregnancy. We spent a lot of time with her discussing what she should do (go to the hospital) and what danger signs to look for that constitue an emergency in case they just send her home.

We saw some VERY cute kids who were really not sick, but whose moms could use a little reassurance.

When we got home, we found that Duane and David had been here supervising the start of the construction project. The driveway as you know it is gone. It's now twice as wide and twice as long. Concrete should be poured soon. Matt will go get a cement mixer tomorrow to start with that.

Please pray for our friend Martin's wife, Gloria. Apparently, she fainted in the bathroom today. Martin thought she was dead. She's at home now, resting, but no one has any idea what caused the problem. We'll go over later tonight to take a look at her.

Anyway, the first three pictures are of the girls and the clinic. The next one is of the backhoe in the driveway. And the last one is what used to be our concrete driveway.

Tomorrow is a day off. We have some work to do in the pharmacy here and some preparation for surgeries on Wednesday.

Beth is Here!

Friday afternoon, Roy Simmons came up to the house for the last time for the next few weeks. He has one more week of class in Antigua, then has some business to attend to in the US before he comes back, hopefully in March or April. Construction on his addition to the dorm could begin as soon as Monday morning.

There is a new pizza place in town and they have 2 for 1 days on Wednesday and Friday, so Roy treated us to pizza on Friday night. It's even better than the previous pizza place we had used, and with the 2 x 1 deal, you get a whole lot more pizza for only a little more money. Woo hoo!

Saturday was Annie's first time off-road with us. She got bounced a little but didn't complain on the trip to Canilla. Clinic was relatively routine. Annie got to do some prenatal ultrasound screening and also some general patient consults. Her Spanish is much better than advertised and she has basically hit the ground running. We are very excited about how much help she will be this month and we're sure it'll be a great learning experience for her.

Sunday started out rather routine, but an unexpected turn of events had Matt and Isaac leave Canilla right after the girls left for clinic. A few hours later, they turned up at home in Quiche, but the girls were still in San Andres. Duane was flying down to Guatemala City to pick up Beth (our family practice resident for this month) and just made a side trip to Canilla to pick up Heidi and Annie, too, and save Matt four hours on the road.

God's hand was in the whole thing, though, as Martin stopped by the house around noon (when Matt would have still been in Canilla) to bring by a potential contractor. It looks like the driveway project could start tomorrow. The goal will be to double the width and length of the driveway, making it possible for buses to pull up. At the moment, unless you've got plenty of power and traction, climbing the driveway isn't too easy. (We've had to do it in 4-low before.)

Anyway, tomorrow morning is our monthly clinic in Nueva Santa Catarina. Our regular readers will remember that this is a clapboard shack of a church at 10,000ft altitude. It has a dirt floor and cardboard boxes lining the walls to keep some of the wind out. One of Roy's first projects (after making a place to rest his head) will be to help build a new church at this location - concrete block construction, electricity, and everything!! In the meantime, we do our best.

The first picture is of Annie and a patient in San Andres. We'll try to actually get her face in a picture tomorrow. ;)

The second picture is an aerial photograph of our house and the hospital, shot by Heidi on the way in this afternoon. The large building at the top of the picture is the hospital, the smaller one at the bottom is our house.

And the third pic is what Santa Cruz del Quiche looks like from the air on the way in. The airplane has been such a blessing to all of us here. It turns a two hour drive (from Canilla to Quiche) into about a 12 minute flight. And it's a drastic reduction on wear and tear on both vehicles and passengers. Thank you God for a safe airplane and a talented pilot!