The Last Few Days

It's been a busy few days with Matt's parents in town. It's been very nice to have some help with Isaac and a great chance for him to play with Grandma and Grandpa.

Thursday was clinic at ASELSI. Heidi went down by herself so Matt, Isaac, and the grandparents could stay at home for a bit and get Isaac his morning nap. He does a whole lot better when he gets that. After his nap, the whole gang went down to see Heidi and to go shopping in the market. Also, Matt had a rehearsal with ASELSI's praise band.

The reason for the rehearsal was that on Friday there was a huge celebration for John and Sharon Harvey's 15 year anniversary in Guatemala. Over 500 people came to celebrate with them. They fed the entire crowd (Isaac's "Aunt Cecy" was in charge of making 500 tamales) and then had a worship service. Matt played with the band. (See pic #1)

Saturday, we all went out to Canilla where the house was eerily quiet. Duane, Aaron, Katie, Joe, and Rachel are all in the US to attend Aaron and Katie's wedding reception(s). David and Leslie stayed behind with the babies. Sabina, a friend from Lake Atitlan, has been at the house to help out, too.

Clinics on Saturday and Sunday were relatively routine, but it's pretty obvious when a member of the team is missing. Katie, hurry back!

Today was our clinic in Chicabracan. Again, Matt, Isaac, and the grandparents stayed home because Toby and Britney went along to help out. We're really going to miss them - they're leaving Guatemala this week to go on a tour of Central America, and then they're moving back to the US for Toby to start law school.

Tomorrow morning, Matt will take his parents back to Guatemala City for their flight back home to Michigan. Toby may ride along as he's got some errands to run in that area and it saves him another Chicken Bus ride.

Oh, and in Isaac news, he's now officially mobile. After a few weeks of frustration (he knew he SHOULD be able to crawl but couldn't do it) he finally took off at the Fickers' in Canilla. (See pic #2 for Isaac in mid-crawl)

He had a minor setback on Sunday morning when he got up in his hands and feet posture and took a noseplant onto the tile floor, bloodying his nose. But he's still got a long way before his nose looks like his daddy's, so we'll just go with it.

Surgery, etc.

Today was a morning off and then surgery in the afternoon. So we got up and made some banana pancakes (yes, the mission field is all about the suffering) and enjoyed a nice morning here at the house. We fielded a few questions from the construction crew, but it was mostly "tranquilo".

After lunch, Heidi picked up our friend Toby and headed to Chichicastenango for one of two scheduled cases.

Yes, this is one of the frustrating parts of mission work. The woman we discussed in a previous blog who needed a biopsy of a mass in her breast had her husband call us last night to tell us that they couldn't come. The issue, at least the one they gave, was that they couldn't afford the trip.

Remember that the hospital is a non-profit. That means that they have to break even. So there is a cost associated with each surgery and that cost averages out around $700-$1000 per surgery. Clearly, our patients can only dream of having this much money. So we take what they can afford to pay us and we have a fund that covers the rest. The average patient contribution is between $13-$50. Sometimes it's a bit more but we normally encourage patients to try to come up with at least $10. It's not THAT far out of the realm of possibility for most (though we have operated for free before when the patient's family circumstances warrant).

This patient, who is married, and thus better off than many, said she could only come up with $13. You may remember that she has a suspicious breast mass and her daughter's name is Heidi. Dr. Heidi's mom died of breast cancer when she was about the same age as the patient's daughter, so this one hits a little close to home. So, we agreed to operate for $13. However, she said that she couldn't afford the trip to Chichi, so Heidi offered to reimburse her for the trip when she got to the hospital (we don't just hand out cash - that's a really bad idea).

So back to last night. The husband claims that they can't afford the trip. They can't come up with the $7 for the two of them to travel to Chichi. Heidi asked if they were still planning to pay $13 for the surgery. Yes, they have that much, but they don't have $7 more. Heidi reminded them that she will reimburse them for the bus fare, meaning that they could just use $7 of the $13 they had set aside for the surgery, since they'll be getting it back when they arrive in Chichi (not to mention that it's all going to the same place).

Obviously, there's a reason other than cost that they don't want the surgery. It's frustrating, but you can't force people to get operated on. People have a right to make their own health decisions, even when they're probably not the best ones. All we can do is make every effort to try to help.

Now, to today. The patient who DID show up was a woman who had come in originally about a year ago and was scheduled for surgery with one of the teams who came last summer. She didn't show up and we had no contact with her until about two weeks ago. She called two weeks ago basically stating that after a year, she now felt that her situation was emergent and wanted Heidi to see her right away. We weren't in town for a few days and she was a little annoyed with us for asking her to wait a week until we were back.

In any case, she was scheduled for her vaginal hysterectomy and anterior repair today.

If you've ever had surgery, your surgeon probably explained to you ahead of time that there are possibly complications that accompany each case. In the case of a vaginal hysterectomy, the hope is that you wake up from anesthesia with the uterus removed and no external scar. Recovery time is VERY short and life is wonderful. Occasionally, however, things don't go exactly as planned. Every now and then, a surgeon will have to make an abdominal incision to clean up a mess that couldn't be accessed vaginally. These things are all explained to the patient and the family ahead of time (assuming you have a good surgeon, which this patient did).

Well, there's a reason for that.

After three hours of working vaginally to remove the uterus and try to stop some bleeding that was coming from a place that couldn't really be seen, the very difficult decision was made to open the patient's abdomen. (Keep in mind that Heidi is operating with NO backup surgeon, NO blood bank, and many fewer tools that most American surgeons are used to.)

She had to re-scrub before making the abdominal incision. So she took a minute to explain to the 20+ members of the patient's family who had come in that one of the possible complications they had discussed earlier had come to pass and that they would be a bit longer. She was able to locate the bleeding, stop it, and close the patient with about a 600cc blood loss. That's quite a bit for a vaginal surgery, but nowhere near the danger zone. God was watching out for the patient and her surgeon tonight. This is why we ask for prayer coverage on all of Heidi's surgeries.

Meanwhile, back at the house, work has been continuing on the addition. We forgot pictures yesterday, but here are a few from today.

The first is of some of David and Juan's handiwork (plumbing and drain work). The next two are some shots of the site. And the last one is of a very helpful little boy.

Oh, and while Heidi was gone, one of our patients from Chicabracan showed up. She had had a molar pregnancy about 6 weeks ago and came to the hospital here for her D&C (where they scrape the tumor from the inside of the uterus). A series of blood tests are needed to make sure that the body no longer believes that it's pregnant. The test costs about $20. We offered to pay for that test, since without that offer, the patient wouldn't get the test and we wouldn't know whether the hospital had gotten all of the tumor out or not. It's simply not worth dying for lack of a $20 test or two.

Well, her test results came back a little higher than we had hoped, so we asked her to come to our clinic in her village this Monday and we'll discuss her options with her then. Please pray for her that her body will overcome this little setback and she'll be okay.

Tomorrow is clinic at ASELSI and Heidi will run back to the hospital to check on her patient from today.

Monday/Tuesday

Monday was our second time at our new clinic in Chujuyub. We needed to get to Guatemala City in the afternoon, so we were a little pressed for time, but still saw 33 patients. One was our little cleft palate baby from out there, who was in for a bit more formula. His mother originally didn't have very much breast milk, but between attempting to breastfeed and using the breast pump we gave her, she seems to be making quite a bit now.

Also, we got a chance to see a patient again who presented with a very bizarre history the first time. We took a guess and figured that they were describing some quite atypical seizures, started him on seizure meds, and found that on quite a low dose of seizure meds, the attacks have basically completely stopped. We'll give God credit on that one, we still have no clear idea of what exactly the family was describing. But they're very thankful and were quite sure they wanted more of the meds we gave them.

After clinic, we returned to the house, dropped off our meds, met with David and Juan (who had driven in from Canilla to work on the water piping in the new addition), and got on the road to Guatemala City. See, they're widening the road between Xela and Guate and it's only open for 30 minutes out of every two hours. So we raced to the construction zone hoping to catch a break in the work and not have to sit for two hours. And we made it!

We got down to Guatemala City, checked into our hotel (after Isaac had been strapped into the car for over 6 hours in one day, he was DONE), then contacted the surgical team who will be operating on Rudy this week. Dr. Hollier, the husband of Heidi's residency program director, is the chief of pediatric plastic surgery at Texas Children's Hospital, and is heading up the team, so we had a very nice dinner with him. (See Pic #1).

This morning, we got up, went to check on Rudy and his family, drove past the National Palace (Pic #2), got some grocery shopping done, and headed home. David and Juan didn't get finished with the water lines yesterday, so they spent the night at the dorm and finished them up today. The next step for the builders will be to pour the concrete floors. (Forgot to post a pic today - we'll do that tomorrow.)

Isaac's grandparents brought down lots of goodies with them, so we had "Christmas" this afternoon. (Pic #3).

We have a few items for your prayer lists now.

First, there were some Americans who flew into Canilla a week or so ago in their private plane to investigate some mission work possibilities. As they were leaving, their plane crashed - about 200 yards from the end of the runway. Duane and Leslie were trying to have a date night in Guatemala City but made the emergency flight home. Thank God no one was seriously hurt, but the plane was completely destroyed. The boys spent two days recovering the wreckage and are now awaiting news from the US on what to do with the plane. Please offer prayers of thanksgiving that no one was seriously hurt, prayers for healing on the passengers who were hurt, and prayers for wisdom on what to do next.

Second, please pray for Rudy (his surgery is Wednesday) and for his surgical team. Also, Heidi has a breast biopsy tomorrow (not on her, a surgery she has to perform on someone else). Please pray for everything to come out okay on that, too.

Third, we ask you to pray for Katie. She had an unfortunate diaper changing accident last week and bopped her lip pretty good. She and Aaron are flying to the US this week for a whirlwind tour of wedding receptions and we need Katie to look good for her pictures. Actually, ALL of the Fickers (minus David, Leslie, and the babies) are going up for the receptions. Please pray for Leslie to have an easy week with the girls. Abby and Grace are very active little girls (2 and 3 years old) and will likely be quite a handful for Leslie there more or less by herself.

Weekend News

Saturday morning found us out at the Fickers again as usual, but by now the regular readers know that clinics tend to be anything but usual! Saturday was relatively benign, with just two of the last few patients throwing us for a loop.

One little boy, less than two years old, can barely walk because his left knee is so swollen. There's no history of trauma that the parents are aware of, so our best guess is that there is an infectious cause. We gave him antibiotics, prayed for him and his family, and hope that they will come back if he is not getting better.

Another little baby was in with quite a bad case of pneumonia, needing oxygen to breathe comfortably. We provided that in clinic while we set about the task of trying to overcome the obstacles to get this baby to the hospital. The young (18-ish) mom was there by herself, with the father away at the coast working the sugarcane fields. She refused to go or make any decisions without her own father since she couldn't get in touch with the baby's father. They live four hours away on foot, and at least about 1 and 1/2 hours away if they can find a vehicle to bring them.

To make a long story short, we did finally get in touch with the grandfather and got him to come to the clinic. A few hours later when he showed up, we were able to find them a ride to the hospital and hope to be able to check in on them in the next few days.

Today was a little more crazy... but we'll start with the good news. A man that we met two weeks ago, with an obvious chronic illness of unclear origin, had told us and the pastor that we sometimes work with there that he would "think about" what we had told him about Christ. Today he came in and told us he was ready to accept Christ, and Mateo (the pastor) prayed with him as he did so. It's always great to start the day off on the right foot!

Our next few patients are all prayer requests-- One, Candelaria, is a 30-something pregnant mother of four who has just been kicked out of her home by her so-called husband, who is now with another woman. She is, by local custom, required to take the kids with her. This lady's parents are dead and she has no brothers or sisters. She is truly alone in this world as far as she knows in terms of anyone who can help her in this crisis. Her baby is due in about a month, and is currently breech. We are not sure yet how we are going to help this woman, and tossed around a lot of ideas in clinic today. We ended up leaving it with giving her bus fare to come back in a week while we pray and ponder over it. Please pray with us for wisdom to know how best to help this woman.

This is truly a difficult case for missionaries everywhere. It's the age-old problem of trying to figure out how to "teach a man to fish", instead of just giving him fish to eat for a day. This lady does not have many options for finding the means to feed her family currently-- Even if we can find her a place to live for a while, the real problem is how to get her actually on her own two feet again. With four malnourished kids already, a new baby, no family to help, and living in a culture where there are already few options for women who want to earn a living, our options aren't exactly limitless here. Our prayer then, is truly for wisdom in dealing with this lady's situation in the best and most permanent manner.

On a happier note again, the lady who we asked to come back with her husband to schedule a breast biopsy did indeed show up, and we scheduled her for Wednesday. Please pray that she shows up and that the surgery goes well. It is another procedure that is really outside of Heidi's realm of expertise or experience, but sometimes we are called to test our limits.

Also on a very happy note, Matt's parents arrived safely today and will be spending nine days here with us and Isaac. Yippee! Isaac is excited about playing with Grandma and Grandpa and having some new entertainment for a while. We will be glad to have their help with him while we do our clinic tomorrow.

Tomorrow night, we will drive to Guatemala City and hope to meet up with Dr. Hollier, the pediatric plastic surgeon from Texas Children's Hospital who hopefully will be doing Rudy's surgery this week.

Unfortunately, we forgot to take the camera with us this weekend... Sorry!

Thursday/Friday

Thursday was our normal clinic day at ASELSI. We found out late on Wednesday night that Rudy's family was planning to meet us for sure in Chichi on Thursday. We had asked them to call us on Tuesday night or Wednesday morning so we could make reservations and plans, but when we didn't hear from them, we just made the plans that we thought we could cancel if we needed to.

Anyway, clinic actually went quite smoothly. We got some good news on Sharon's health concern and were able to share our thankfulness at hearing that news with her.

We saw a boy that was referred to us by Keritas who appeared to have had a stroke a few years ago. The family's story is that he was a year and seven months old when he was brought to the hospital here in Quiche with appendicitis. They believe that after the surgery he contracted meningitis. They also believe it's possible he had a bad reaction to the anesthesia. In any case, he went into a coma for a few days and when he woke up, he basically had no control over the left side of his body.

For a while, he was unable to walk. Then he was fitted with a plastic brace to hold his ankle in the correct position. With that he can walk and even run a little. He's not about to win any Olympic track events, but he can get around and even play a little soccer (which is of the utmost importance for ALL boys here!). Also, his left arm usually just stayed behind his back, twisted up back.

They did a surgery on him somewhere here that cut and repositioned some tendons in that arm so that it stays in front of him now. He still can't control it - it moves around and his hand opens and closes without any input from him - so he usually keeps it tucked under his right armpit to keep it from swinging around.

We got him an appointment with our orthopedic surgeon friend and informed him of the existence of the physical therapy program at ASELSI. His dad was appreciative of the orthopedic consult, but was a little concerned about physical therapy because the boy is in school and they don't want to pull him out of classes one day a week for PT. The hope is - if Dr. Edgar thinks PT will help - that he can come a few times and learn some of the exercises he can do by himself at home and maybe make some progress that way.

Another patient that day was a woman we met a few weeks ago when a team was here. She is extremely sick - with what we're not sure - but she weighs about 70 lbs and her hair is falling out/breaking off. She's a bit jaundiced and her liver function tests came back abnormal, but negative for hepatitis (she told us that another doctor had diagnosed her with hepatitis before). She says that her husband thinks she's 28 years old but she's not sure that he knows for sure, so she's going to bring her ID card next month.

She has been pregnant twice. One baby miscarried at 7 months. The second one started to come premature. They went to the hospital in Quiche because she started bleeding a lot. The baby was delivered by c-section and sent by ambulance to Guatemala City because it needed a ventilator and they didn't have one here in Quiche (or didn't have one available). That was the last she ever saw of her baby. She said that her dad tried to go down to Guatemala City to find out about the baby and because he didn't have a chart number or case number, they couldn't tell him anything (they usually don't name their babies here until quite a long time after birth). They tried one more time to find out about the baby but no one could really tell them anything. So she doesn't really know if her baby lived or died. She thinks it probably died, but she never saw a body or was officially told by anyone. Can you imagine????

Anyway, after clinic, we went to go check on Heidi's patient from Wednesday. We really need to study her condition a bit before we give them any prognoses or options, but a rapid metastisis of bone cancer in a 29-year-old probably means that she has less time that you'd hope for. We will spend quite a bit more time with her on spiritual matters when she comes back for her follow-up appointment in two weeks, too - probably involving our pastor friend, Bill.

At about the same time, we met up with Rudy and his family. Apparently, they have some friends who are a married couple who live near them who have a little bit more money and have been very nice about helping them out. Rudy has been to most of the major hospitals in Guatemala already and his dad tells us that this man "always accompanies them" when they go anywhere. This couple brought them to Chichi to meet us and wanted to meet us and thank us for the work we're doing for Rudy. We thanked them for all the help they've given throughout the years, too, and for their concern for this family.

We hopped in the 4Runner and headed down to Guatemala City. We went to the hospital, got Rudy registered there with the social worker, took the family over to the Hospidaje (think: Ronald McDonald House) that they will stay in for the next week, which is very beautiful, run by some nuns, and costs $2 a night for the family. That includes all of their meals, too!

We gave Dad Q100 (about $13) for some "walking around town" money and instructed them to meet us back at the hospital in the morning. They were to arrive at 7am to register for their pediatric consult. We came in around 8am to wait with them and help out with any issues that might pop up (Guatemalans tend not to be too persistent when someone tells them that something can't be done).

When we arrived, Rudy's dad had already paid for his consult (from the money we gave them - instead of just waiting for us to arrive) and bought a phone card to be able to communicate with their friends back at home (who had already asked about when they could come down and visit).

After Rudy was seen by the pediatrician at the hospital, he was sent for a CT scan. That cost $40. Dad makes about $8 a week, so we obviously picked up the tab on that one. They needed to wait for the results and we needed to get going (the construction zone only opens for 30 minutes and then you wait for two hours), so we gave them money for a cab ride back to the Hospidaje and instructions to call us if they needed any help.

After our clinic on Monday morning, we'll drive back down to Guatemala City and meet up with them again, try to meet up with Dr. Hollier, and see what else we can do to help out on Tuesday.

In the meantime, though, we have our regular clinics in Canilla and San Andres. Isaac's Grandma and Grandpa Bell fly in on Sunday and Duane will pick them up and fly them to meet us in Canilla (turning a 4-6 hour drive into 25-30 minutes).

In pictures, the first two are of the 40-plus kids who graduated from ASELSI's milk program this month. They are now spending over $1,000 a month (that's DOLLARS, not quetzales) on milk for over 200 kids. Most of those kids would die without the help they're getting from ASELSI. So if you have a few extra bucks sitting around and want to help out, we can get you in touch with the right people. (Yes, your math is right on that - $5 a month can help keep one incredibly cute kid from starving to death.)

The third pic is of Isaac flirting with a little Mayan girl while swinging on the swingset on the playground there.

And the last pic is of Rudy's mom and new little brother, Ronnie, at the hospital in Guatemala City. That's one kid who's not starving to death!

Busy Day

Today was a construction day at the house. David was already here from last night. Duane, Joe, Juan, and Mynor flew in this morning. Plus, Justo Rufino (the builder) and his crew were here.

Also, Toby and Britney came over because they have been out of power at home for four days now and they needed showers and laundry done.

With the crew here, Heidi, Toby, and Britney spent the morning cooking lunch and keeping Isaac entertained. The boys worked on getting the roughed-in plumbing done on the addition.

After lunch, Heidi and Toby went to the Hospital Buen Samaritano to operate. They had originally had two cases scheduled but one cancelled last night. So the only one left was the biopsy on the amputee lady.

I think we've given her history, but Dr. Hoak amputated her leg above the knee last year due to bone cancer in her knee. Her husband drinks and when he drinks, he often beats her. He beat her a few months ago and she developed this big lump on the stump of her leg. We were hoping that it was just a big hematoma that needed to be drained. Unfortunately, it's cancer. She's only 29 years old, has four kids, the youngest a one and a half year old, and probably only has a few months to live.

We have discussed the status of her soul with her, but with this latest news, we have a little more chatting to do. We want to make sure that she has the best ministerial help she can get.

Tomorrow, we have clinic at ASELSI, then we have no idea what happens next. We never heard back from Rudy's family, so we'll just be prepared to go to Guatemala City from Chichi in case they show up. So we may be driving several hours, we may be coming home.

The pictures below were from the work today. The first pic is of the Fickers' Ford, loaded to the gills with construction materials. It doesn't look too weighed down, but that's because we jacked the back end up about a foot so that all that weight wouldn't be sitting on the springs all night.

The second shot is just a view from the corner of the addition, looking back at the existing house.

The third is of Joe and Duane, studying the blueprints and trying to decide exactly how to plumb that bathroom.

Next is Juan and David in a rare moment of inactivity.

Last is Isaac showing how a 9 month old helps out. See, everybody works. There are no spectators here. He's keeping that box from blowing away.

Another "Day Off"

Yeah, today was our day off, but you know how those go around here.

Since Isaac was sick all day yesterday and didn't really eat anything, he woke up pretty early this morning - hungry, but still not terribly interested in eating. So he fussed around most of the morning, pretty much unable to get happy. He seems to be feeling a bit better than yesterday, though, so hopefully tomorrow will be better yet.

We called our pastor friend in Nueva Santa Catarina this morning to find out whether Rudy's family could be found. Remember that yesterday he told us that they do not want the surgery to fix Rudy's face because they don't have any money. He hadn't been able to contact them again since the original discussion because they live pretty far from him and he doesn't have a car (he used to, but he sold it because gas was getting too expensive).

He asked if we could "come over" and go to see Rudy ourselves. We say "come over" because it's a 2-3 hour drive with at least three construction zones between here and there. Our original response was that we really can't, but after some thought, we decided that there really is no better excuse to make that drive than to try to help this little boy.

Heidi had a meeting in Chichi with the other medical missionaries and it wasn't really fair to leave her alone with a sick, fussy little boy, but she felt that it was worth it for Matt to go look for Rudy. So Matt went to Nueva Santa Catarina and Heidi and Isaac went to Chichi.

After getting to Matilde's house, Matt and Matilde drove another half hour off road to get to Rudy's village. Then it was a bit of a walk to their house. The family was very nice but most of the conversation was in K'iche. (Only Matt, Matilde, and the dad speak Spanish - and K'iche is the language everyone is most comfortable with, anyway.)

It turns out that Rudy had a surgery at a national hospital in Quetzaltenango last July to take out a pretty good chunk of his tumor. It's not nearly all gone, though, and there's quite a bit of reconstructive work to do yet. Luckily, Dr. Hollier, who is coming down with this team, is the chief of pediatric plastics at Texas Children's Hospital. There are very few surgeons in the world with his skill set and if Rudy's family will bring him, he has a chance at an outcome far better than he could probably get with local surgeons.

So we talked for quite a while. The family wants us to get in touch with Rudy's original surgeon in Quetzaltenango to make sure we know what he did. Luckily, they had a piece of paper with Rudy's chart number and doctor's name on it. So we'll do our best to get in touch with him.

Also, they understand the plan, which is to meet us in Chichicastenango on Thursday for a trip to Guatemala City that afternoon. We'll put them up for the night, then they'll have an appointment at the hospital with a Guatemalan doctor on Friday morning. Assuming that all goes well, he'll meet with the Americans on Sunday and get operated on next week.

All of this will require two trips to Guatemala City for us and probably two overnight stays, but if we can help contribute to Rudy's surgery, it'll be worth it.

Anyway, the way they left it was that they wanted to talk to some family friend in Antigua and then they would call us back with their decision. They were very appreciative of our time and effort, but Guatemalan families tend to be a little slow on the decision-making. They take surgery very seriously and do not rush into this type of thing.

Another example of that is the phone call we got this evening. Heidi had a surgery scheduled for tomorrow for a family friend of our mechanic friend, Martin. This woman is in her 60s (she thinks) and very likely has uterine cancer. The plan was to remove her uterus tomorrow. She decided against the surgery today, though, and her daughter called us to apologize and cancel the surgery. There's really no apology necessary, our job is to serve the people here. The best thing for the patient is probably a surgery, but we can't exactly kidnap people and forcibly remove their organs. Plus, they told us that the decision was made prayerfully and we have to respect that. Perhaps God knows something we don't. (Well, He surely does know a few things that we don't, but specifically on this case, we're guessing...)

So we were just getting started on Isaac's dinner when we got a knock at the door from David Ficker. He was in Guatemala City picking up some things for the addition to the dorm and had a much longer than expected trip up the mountain. He got into Quiche just before dark and decided to spend the night here to save him a drive to Canilla after dark and a turnaround to come back in the morning. (Duane, David, Juan and Matt are going to work on the plumbing for the addition tomorrow.) So we had a really nice visit with him and he'll be here tomorrow, too. We actually got to play host, for once, since they host us two days a week or so at their house!

Heidi is now down to one planned surgery for tomorrow - the woman whose leg was amputated last year and now has a mysterious mass on her thigh. Not exactly gynecology, but not terribly far from that area... Please keep the patient and her doctor in your prayers.

Below are some pics of Rudy. The first picture is when we met Rudy. This picture was taken on October 2, 2006 - Matt's first birthday in Guatemala. The second pic is of Rudy right before his surgery at San Juan de Dios in Quetzaltenango last July. And the bottom one is of Rudy today. We'll send it to Dr. Hollier in the US tomorrow morning to make sure that if he needs any specialized tools, he can bring those with him when he comes.

Monday Clinic, etc.

Today was our bi-weekly clinic in Chicabracan. Luckily, our friends Toby and Britney were free to go with us today. We've wanted to go to clinic together for some time, but they've had this JOB that kept getting in the way of our fun. Now they're near the end of their time here and things are opening up a bit in their schedule so they had a morning to spend with us.

We say "us"... What we meant was "Heidi". Knowing that Heidi was going to have some help, Matt decided to stay home with Isaac and let him have his routine here at the house. Good thing, too, because as of press time, he's thrown up about seven times today. Poor little chipper - he feels terrible. Lots of whining and crying... Hopefully we'll get that whole thing figured out today and tomorrow, because we have to make a long drive on Thursday (we hope).

On that note, our little friend, Rudy, with the large facial tumor (he's going on 7 years old now) has an opportunity at a surgery in Guatemala City next week. A team from Texas Children's Hospital is going to be down. We're offering the family a ride to Guatemala City this Thursday afternoon, a night in the city, then his pre-op consult on Friday morning. The pastor (and our translator in Nueva Santa Catarina) called this morning to tell us that the family doesn't want to go because they don't have any money. We told him that God will send money. Do not let a few dollars get in the way of Rudy getting his surgery. He said he'd tell the family. We're hoping to hear back tonight or tomorrow.

Also, one of our pre-eclamptic patients out there had her baby yesterday. Mom refused to go to the hospital (see our last entry for more on that) and had the baby at home. She didn't seize and the baby was born "bien gordito" (or "nice and fat") at an estimated 9 lbs! Praise God for that!

Anyway, back to clinic in Chicabracan. One of our regular patients out there has had surgery in Guatemala City for a blocked tear duct. She has occasional appointments in Guatemala City and comes to us to ask for help with her bus fare from time to time. Bus fare to Guatemala City is around $3, so we give her that when she comes in. Unfortunately, we recently diagnosed her with a miscarriage. She came to the hospital to get all of that taken care of and they sent her (appropriately) for some lab tests. Apparently, she has had a history of molar pregnancy (which she did not tell us about). So when she comes in to town on Wednesday, she'll come by the house with her receipt from the lab and we'll cover the $20 lab test.

Also in clinic today, we saw at least three new prenatal patients. It seems that word is getting around that we can help with prenatal care. And we got a POSTnatal patient, too. She brought in her baby for us to check out. (Picture #2. Pic #1 is of Toby checking a blood sugar level on a diabetic.)

Toby and Britney have been out of power at the house for a few days now, so they'll come over tonight to take hot showers (they have electric hot water) and for some supper. Heidi's out on the patio with Isaac in the hammock (next to an electric heater).

Tomorrow is our Saturday, so hopefully we'll be able to nurse Isaac back to health. Wednesday, Heidi has a couple of surgeries that Toby will scrub in on. We already talked about our possible trip to Guatemala City on Thursday afternoon and Friday. And on Sunday, Matt's mom and dad come in to hang out with Isaac for a week and a half. We think they might be coming to see us, too, but we're sure that we're a distant 2nd and 3rd place... as it should be!

Weekend

Well, Friday was a pretty good day in clinic for Heidi-- She was back up to almost a full patient load, for the first time in several months at the Hospital Buen Samaritano (since Dr. Hoak left...) She was able to schedule another vaginal surgery to be done on the 23rd and saw quite a few follow-up and prenatal care patients. One very happy patient is about 8 months pregnant, and was last seen by Heidi around this time last year for a miscarriage at about 14 weeks. It is always a privilege and a lot of fun to see patients in follow-up at happier times in their lives.

Saturday morning started early... We always leave here at 6 a.m. to get out to the Fickers's for clinic, but this time we had someone waiting at our door when we opened it to load the truck! A man was asking us for help finding out something about his wife, who he had left at the hospital in labor at 3 a.m. to take his mother-in-law home. The husbands and families are not allowed in the same room as the laboring moms here, and they are rarely given any information about their condition as things progress. This man had been told once that she was in the O.R. for a C-section, then several hours later that she was still waiting to deliver on the ward, then again another couple of hours later that she was in the O.R. for a C-section... That's when he had to leave! So he came back around 6 having no clue whether his baby had been born and whether his wife was okay.

This is just one example of why the people do not want to come to the hospitals to deliver. The man was not allowed in to see his wife (visiting "hours" are from 2-3 p.m. only) and no one could/was willing to give him any information at the ER, which is the only place that was staffed at 6 a.m. on a Saturday. So Heidi went down and walked him back to where his wife was, and found out that his baby and wife are both doing well. It just didn't seem like the kind of thing we should have had to "pull strings" to make happen... Very frustrating, but at least there was a happy ending.

Saturday clinic was pretty routine-- We're seeing lots of viral GI illness with vomiting and some diarrhea in the kids. One little baby showed up with mom at 6:30 this morning at the Fickers looking quite miserable with this. She had a temperature of nearly 104 degrees and couldn't keep much food down. Please pray that she got to feeling better with some symptomatic support-- We instructed mom to bring her to the hospital for IV fluids if she was not keeping something down by this evening.

Today was a little more interesting at San Andres-- One of the early patients had a breast mass that Heidi will try to biopsy at the Hospital next week... Please pray that the old adage about "see one, do one, teach one" holds true for Heidi-- and thank God that she has at least seen Dr. Hoak do one open breast biopsy down here! Also pray for the patient, Juana, and that she does not have a cancerous tumor-- this is another one that hits a little close to the heart for Heidi, having lost her own mother to breast cancer at a young age. Imagine her surprise and heartache to find out that this lady has a 7-year old little girl... named "Heidi", of all things!

There was also a ten-year old boy who came in with a machete cut from this morning on his hand which we were able to sew up. The funny(-ish) part of the story is that we couldn't figure out why there were two parallel cuts there in the same area, so at first were wondering if he had cut himself with some kind of weird tool with two blades. Upon further questioning, though, the mom told us that the other, shallower cut (literally about 1/2 and inch away from the one Heidi had to sew up today) was from where he cut himself doing the SAME work with the SAME machete YESTERDAY! Wow... fast learner. At least we were able to get him to laugh at himself during the procedure to make it go more smoothly.

Meanwhile, back at the house, Matt and Isaac were quite busy. Isaac is trying very hard to learn to crawl, and he seems just moments away from it every time he gets up on all fours. But alas, each time he finds that he can only go backwards (Matt calls it the "French Army crawl"... all he knows how to do is retreat, get it?!) He is so funny when he gets frustrated about it... especially when he gets his backside stuck under a couch or something.

Anyway, now we're home and getting ready for clinic tomorrow. We're excited that our friends Toby and Brittany are going to come with us to help out and to see what we claim to do all day down here. Toby will also be helping Heidi out in the O.R. on two surgeries Wednesday. Any volunteers for next Wednesday? She still needs a surgical assistant for then...

ASELSI and More

Today was our weekly clinic at ASELSI in Chichicastenango. First, we must ask for prayers for Sharon. She is dealing with a personal health issue and we ask for your prayer coverage on her - that all will be well and that there is nothing serious to worry about.

We had our normal full load of patients today - some prenatals, some diabetics, a few sick kids, a new cleft palate, and a patient we were very thankful to have Jason around for.

Today was Jason's last day here. Matt took him to Guatemala City today to catch his flight out first thing in the morning. Jason's specialty is in orthopedics. Today we had a 29-year-old patient who had her leg amputated above the knee about six months ago due to bone cancer. She told us that her husband drinks and that he fell down and hit her in her stump. After that, she developed this golf ball-sized lump on that leg.

Following a discussion with Jason and a call to Dr. Hoak (who had done the original amputation), we are looking at a couple of possibilities. One is that she just has a big hematoma (think: bruise) that has gotten infected. Another is that the cancer was able to spread and that she has a fast growing metastasis. Clearly, the bruise would be preferable. Heidi is going to take a closer look at Buen Samaritano next week.

After clinic, while Matt and Jason were on their way to Guatemala City, Heidi, Isaac, and Cecy (our translator) drove (and walked) out to Carolina's house. Carolina is another one of our translators at ASELSI who just had a baby. So it was nice to be able to go visit her and her new baby (who is SOOOO cute!)

After arriving home from that, one of the cleft kids we're helping with milk came by and got another big can of formula. He's not growing tremendously fast (10 oz. in a month) but he's growing and looks MUCH better. He's even got some fat around his belly now. The dad told us that he's sure the baby would have died without our help. Heidi let him know that it doesn't have too much to do with us, but rather God who provided the milk. He said that he understood that, but was still appreciative towards us.

Speaking of appreciation, Heidi went to go check on her surgical patient from yesterday at the hospital in Chichi and was given two beautiful rebosos (locally handmade cloths that are used for pretty much everything). One was for her and the other is for "the other doctor who helped you". So, Jason, you got paid for your work. We'll have to ship it to you!

In pics, the first two show Cecy learning how to do prenatal ultrasounds. She has a real aptitude for it. She started nursing school this past weekend and will be a fabulous nurse and a real blessing to her patients.

Next is a picture of our new cleft patient, Roberto.

Then are two pics of Carolina and her new baby, along with Cecy and Isaac.

Tomorrow, Heidi may go to Buen Samaritano for her regular OB/GYN clinic, or we may have to play hooky and go up to Zona Reyna. Katie and Leslie went up today and saw well over 100 patients and they're begging them to come back tomorrow. If they decide to go, Heidi will probably go with them, meaning that Isaac and Matt will hang out in Canilla for the day. (It's only a 15 minute flight.)

Monday-Wednesday

Monday morning, we got up early and drove almost three hours to Nueva Santa Catarina. It's normally around two hours, but we hit every single construction zone on the way there.

We had some fantastic patients there, including bunches of pre-natals. When we first started working there, there were hardly any, but we've clearly gained some trust in that area. We saw a few of our seizure patients we haven't seen in a while. We also saw a woman we think may be having SVTs (you medical people will know what that is). Her original complaint was that she can feel her heart. Then it climbs into her head and makes her wet all over the floor. Sometimes it's difficult when we don't speak the same language - and not just literally (she's a K'iche speaker and we're English speakers). Someone in her culture probably understands exactly what she's saying. But it's a little harder for us.

We also saw this cute little boy with a wicked rash around his ear. We've seen him before and treated him with antibiotics and Mom says that it gets a lot better but then comes back even worse. It's a little impressive that she still trusts us enough to come back and we're trying a few more things this time, including a consult with our American dermatologist, but we won't give up on him. (First pic.)

The second pic is a little cleft baby that the mom brought in. He's pretty young, just a few months, but the cleft isn't too bad and should close up quite well. We will contact her as soon as we know when the next team is coming down to operate.

After clinic, we headed to Antigua for some R&R and some photography opportunities for Jason.

This morning, we drove back to Chichicastenango to see a couple of clinic patients and to do two operations. Jason being a former surgical assistant, he helped Heidi on those cases.

Tomorrow we'll do clinic at ASELSI, make a quick stop in the Chichi tourist market, and then take Jason back to Guatemala City for his flight out on Friday morning.

The third pic is one of Jason on the roof of our hotel, in a good location for shooting some of the sights. And we know the fourth one is wrong on too many levels to discuss, but we couldn't resist.

Lots of Stuff

Sorry we haven't written much in the last few days, but we really haven't been around.

We had a few days off last week. Tuesday and Wednesday are our normal "weekend" days and the first Thursday of every month we're not at ASELSI. So we let Isaac have two days at home on "his routine", which he does much better with, and then on Thursday we went down to Guatemala City to run some errands, have dinner with Dr. Hoak, and spend the night. Then, on Friday, we had Isaac's pediatrician's appointment (more vaccines) and picked up Matt's friend Jason from the airport.

Matt and Jason played in the band together in college and were really good friends there. Jason came to Texas and played with Key West (Matt's band) once or twice, too. Then they lost track of each other for a few years before meeting up again on the internet (amazing thing, that internet).

Jason was a Physician's Assistant as well as a Paramedic and a medical officer in the Navy. So he's a handy guy to have visit. He'll be operating with Heidi this Wednesday, as well as helping us out in clinics this week.

Anyway, the first pic is of Heidi and Jason with Flor and Rosa, two of our translators in San Andres. (Jason is also a photographer, so look for some really good pics in the next week or so.)

Yesterday in clinic, we got to see a baby again that we had seen before. Every now and then we'll post pictures of some sick kids and ask you to pray for them. This was one of those kids. And he looks terrific now! Praise God! (Pic #2)

Picture #3 is of Isaac checking out the CV Joint boots on the 4Runner. We found out this week that the rear seals are leaking and we'll have Matt's dad bring us some from the US when he comes down in two weeks. (Parts from the US are always cheaper.) So Isaac helped us out by checking to make sure everything's peaceful on the front end. He gave us a positive report on that.

There were way too many stories to tell from clinic today, but one included a family that Heidi and Jason spent just about an hour on. When they came through the door, Jason's first comment was, "Ooh, heart failure". Sure enough, the mom is in heart failure. She doesn't know the Lord, but they spent quite a bit of time with her and she may be ready to accept, she just wants some more time. She doesn't have a whole lot of time, probably, so we pray that she will be touched very soon.

The daughter in the family complained that she is always cold at night. She sleeps on the floor (doesn't have a bed) and only has one blanket. Heidi suggested that perhaps another blanket might help. Well, Dad isn't around any more. He used to beat Mom, so it's probably for the best, but fatherless households around here usually struggle financially. So Heidi stepped into market and bought a blanket for the girl, who seemed VERY appreciative.

Anyway, there were too many stories to tell, but God's hand is definitely at work in San Andres. Please keep covering that clinic with your prayers - some of the neediest people we see are there in that place.

Tomorrow we're off to Nueva Santa Catarina for our monthly clinic there. After clinic we'll run down to Iximche (some ruins) and try to get some good pictures. Then it's to Antigua for two nights. Then we come back on Wednesday to operate and see a couple of Heidi's Buen Samaritano clinic patients. Thursday is ASELSI and Matt takes Jason back to Guatemala City. Then on Friday, instead of clinic at Buen Samaritano (which is why we're seeing those patients on Wednesday), we'll fly back up to Zona Reina for a clinic there. Then the weekend will have us back in Canilla again.