Pictures as Promised

Here are the pictures that I promised everyone that were supposed to go with that last post...

First is David and Juanito re-wiring the Dodge so that we could drive it in to Canilla with at least one functioning headlight!

Next is one of our ASELSI patients, with her sweet baby that she brought in...

Here is the front of ASELSI's beautiful facility there in Chichicastenango, for those of you who are less familiar with the area...

Again, you can read more about ASELSI at aselsi.org if you are interested... We have truly been blessed by the opportunity to work with them over the years!

Signing off now until next trip, which will be in November of this year.

Wrapping up the Week

(OK, I will go back and try to re-post the pictures later; for some reason they don't want to upload tonight and I'm getting impatient to go ahead and post this! Sorry...)

Thursday was a very nice “blast from the past” for me this week—I did clinic at ASELSI (read more about their amazing work in Guatemala, if you want, at www.aselsi.org) with Dr. Sherwood Pope, his wife Areli, and my old friend and most excellent of translators, Cecilia or “Ceci” as we have always known her. She is the Quiche to Spanish translator that Matt and I worked with for two years there at ASELSI, and offered a scholarship to when she eventually became interested in going back to nursing school. She now has what is essentially the equivalent of an LPN (Licensed Professional Nurse) degree and has been able to increase her hours and earning potential with it. She is still a great translator, tirelessly educating patients without even being prompted anymore about hygiene, clean water, hydration, proper care of children, and much more.

Ceci and Areli both are showing great interest as well as skill with the ultrasound machine in pregnancy, so I got to be really in my element for a while and do some teaching! Areli has really been helping Dr. Sherwood quite a bit with the prenatals, and is becoming quite handy with the ultrasound machine. That’s something she probably never planned on using her degree in International Studies for, but I am continuously awed by her flexibility and patience. The first two pictures are of ASELSI's main building and one of our first patients and her baby.

In all, we saw about 50 patients between the three of us—I remained worried the whole time that David Ficker would call at any second and say that they were ready to pick me up in Quiche immediately (I was scheduled to ride out with him to Canilla and hated to think about making him wait for me…) Those of you who have ever either been to Guatemala or had many things scheduled on “FST—Ficker Standard Time” are of course now laughing at my seeming naivete in my concern! ;-) It was only after the obligatory seven or eight plan changes that we met up relatively smoothly in Quiche for the long ride over the mountains to Canilla.

I’ll spare you all the details of that trip (we managed to get there having lost only one lug-nut, having stopped only twice to check on the drive shaft, and to re-wire a headlight directly in to the battery so that it would stay on for more than a few seconds at a time after it got dark…), but it was even more adventurous than usual for that trip! Any of you who have known the “adventure” (read: sheer peril and terror) of driving that road during the rainy season in broad daylight will just have to imagine how fun it was after nightfall with no working headlights! David Ficker is truly an amazing mechanic and driver… and even provided for a photo op or two! The next pic is of him and Juanito, a friend of the family, rewiring the headlight—successfully, of course.

Late in to the night Thursday, we greeted a team from Real Life Missions out of Washington state who are there for the week. They are poised to do some great work, teaching and evangelizing in local schools and building a widow a new home out near one of the clinics. Friday was spent helping them settle in and just reconnecting with the Ficker family (check out their new website at adonaiinternationalministries.org). What an amazing opportunity to work with them again! There was even an afternoon beach volleyball game after the usual trek through the river to get to the court… THAT truly felt like home, sweet home again!

This morning we were able to see most of the prenatal patients who were waiting with the help of a local Peace Corps volunteer, Cali, who has also become a great friend over the last two years. My flight out was around ten this morning from Canilla, so we were actually hoping to get through them all before that… but we got of to a late start due to another unexpected change in plans, of course. When we opened the doors to call for the first patient, we were greeted instead by one of the nurses from the Health Center with a patient in her hospital gown that they were asking for help with. They had brought her over in the ambulance because she had reported laboring all night with no baby yet delivered. A quick review of her “prenatal records” (handwritten in the card that she carries with her from the Ficker’s clinic there) revealed that she was full-term and the baby had been in the right position at her last visit, so we hoped for the best as we put the ultrasound on! We were able to confirm a strong heartbeat, head-down or normal position, and about 5 centimeters of cervical dilation before they popped her back in to the ambulance and took her back to the Health Center where there is actually a doctor to attend her delivery. We heard she delivered about an hour later with no problems, so thank God for that.

I am now on the plane headed back to my true home, sweet home—my “boys”!! It has been a long week away from them like it always is, but I am forever thankful for the opportunity to remain connected to Guatemala and her people. Leslie is preparing at least one more patient for us for surgery in November—a lady we have known for a long time with a complete prolapsed of her vagina after a hysterectomy, which re-prolapsed after an attempted surgery many years ago. She has been miserable with this for many years now but has refused further surgery. Leslie mentioned to her that we might be able to help with a different procedure (essentially to close up the vagina completely—reserved for pretty unique cases, of course) and she is now actually considering this, so we pray that she will do well with this surgery in November.

Stay tuned for more updates, we hope, as our November trip draws closer as soon as this one draws to an end… We will continue to pray for Maria and so many others in whom we hope some seeds have been planted this week and over the years, and that God will continue to bless our feeble efforts in His Name in Guatemala and the U.S. Thank you all for your support and prayers over the years and during this week!

Clinic Day with Agape!

Today was definitely a special treat-- I got to go out on the road to one of the remote clinics that Dr. Sherwood Pope and his wife Areli are now running with Agape in Action! They have been working down here essentially in the role that Matt and I played full time back in 2006-2008, and you can always read more about them at missionarydoc.com, nbri.net, or agapeinaction.org. They are a young couple, full of faith and patience and medical skills (Dr. Pope is a US-licensed Family Practitioner, and Areli-- although with no formal medical training-- is VERY good at picking up on small details from the patients during consults and picking up some ultrasound skills very quickly!) The first picture today is of us turning off of the main road from Quiche, which thoroughly disoriented me at first because I had no clue where we were! I didn't remember there being another tunr-off from that road, which is because it was never PAVED when we drove it for two years... A pretty good stretch of it now is although there is still a long way to go before it is completely paved out to where the Fickers live in Canilla... but time indeed does march on.

The next picture is of the Church where we set up our mobile clinic-- that's it, the little white speck in the middle of the picture! This picture is, unfortunately, taken from our "parking spot" where the truck could pass no further in the current road conditions. Rainy season has really been rough this year for ground transportation.

Luckily two strong-backed Church members came to our aid and lugged (and lugged... and lugged... and lugged...) our stuff down and then back up the hill on their backs! These truly are amazing people here. Areli and I between the two of us could barely make it with just ONE of these trunks on the way back!

About the time we were crossing over this "bridge" was when I figured that-- because I KNOW myself quite well, I should probably put the camera away before it went in the river or the mud where the rest of my body was likely headed...

Unfortunately, though, I forgot to ever get it out again to take any pictures during clinic or of the patients! Well, except technically the two guys carrying our stuff did ask for consults-- one said that his shoulders hurt a lot and feel tight all the time! Go figure. I tried massaging his back for him for a little while, but he said that hurt so we gave him some ibuprofen instead!

The patients we saw were pretty routine today for the most part-- lots of gastritis/gastric reflux, prenatal patients or women for pregnancy tests, body aches and pains, and kids with colds mostly. Please pray for our most interesting (and hopefully most fruitful) patient of the day, Maria Vicente. She had been in several times for aches and pains, ibuprofen and vitamins and such. Today, though, her chief complaint was that ever since a horse down by the river had charged after her a few weeks ago, she is very anxious and afraid all of the time. The translator was explaining to us that this animal has scared lots of people and runs a little wild, but after ruling out the possibility of prescribing a rope or chain to tie it up (a joke somewhat lost on the patient and our translator but nonetheless amusing to us!) we delved deeper into her issues.

Here in clinics, we have very little access to psychiatric medications generally speaking. This has led us over the years to probably a more effective treatment of anxiety and depression issues than I give many of my patients in the U.S., as we are left to witness to them of the only effective anxiety relief we know of-- the assurance of eternal life with our Lord and Savior by acceptance of Jesus Christ's gift of salvation for us. She was in the "Catholic" Church here (really often just a traditional Mayan religion, especially out in smaller villages) and claimed she had never even heard of Jesus Christ. Surely what we shared with her today and the prayer we prayed with her are just a tiny little "starter seed" planted, but we will continue to pray that it grows in her heart until she can share in the peace that we possess only through Him.

The area we were in today, called Tabil, is largely unreached by the Gospel in general and I am thankful for Agape's continued efforts there. Please pray for their continued strength, patience, and perseverance as they try to chip away at the darkness there one "Maria" at a time.

Tomorrow I will be back at ASELSI, another old "stomping grounds" from when we lived here, which will be another special privilege. I haven't even made it by there on most of my recent trips down here, so I am excited to see how much it has grown. I made Dr. Pope a deal that I would see all of the prenatal patients if he would see at least most of the men tomorrow, so I hope he holds up that bargain! Every now and then it's good to play the "gynecologist" card...

Two Days in the Life of Chichicastenango...

Well, yesterday and today were fairly routine in terms of clinic patients-- today I actually saw almost exclusively prenatal patients, which has been rare up to this point! The most promising thing about seeing all of them, though, was that almost every one of them actually had received some prenatal care elsewhere also and were essentially here for an ultrasound. It was very encouraging that prenatal care as a general concept continues to catch on, and I gave them all copies of their visit/ultrasound results from today to take back to their other providers in hopes of more continuity of care.

I also saw several more of my own return patients, which I try to take as a good sign that there is growing trust in me and in our care here at the hospital. I was also able to pull several charts from patients that I had seen in May and referred back to Dr. Hoak for various reasons, and was very pleased to see that they had followed through and had their surgeries done.

I think the best and most exciting new yet, though, is what we spent about half of the morning doing today-- When I walked out from seeing my last patient in the stack, I met one of the nurses who was dressed in an OR gown, gloves and mask in the hallway with a broom. Intrigued by her attire, I of course asked what she was working on, and imagine my surprise to find out that she and three others were cleaning out one of the "bodegas" (storerooms). It wasn't actually a bodega, but more like a big hallway behind one of the bodegas that has been filled literally floor to ceiling with "overflow" junk over the years. They were all climbing in there and sorting through things, and actually throwing a large portion of it away! Those of you who know anything about Guatemala know that Guatemalans voluntarily throwing ANYthing away-- especially at this Hospital!-- is nothing short of a minor miracle. So I threw on a pair of gloves and did what I could to encourage their efforts... especially acting as a "consultant" to look at boxes full of junk disguised as donated medical supplies and equipment and determine whether it was anything that we could possibly ever conceivably need to use or not. The project didn't last long, but it did create a small mountain of trash that I think was later burned... The first picture below is thus of the only "surgery" that we did today-- a trash-ectomy!

The second picture is a new Guatemalan classic for me-- I always knew they could and would grow CORN anywhere here, but seeing it in a planter on the roof was another first for me! Just when I thought I had seen it all... But in all fairness, the rest of the world would surely think we were all even crazier for growing tomatoes upside-down on our porches, don't you think?!

The last picture is just something that amused me when I saw it on the Hospital wall today-- a poster advertising a Medical Conference coming up on "Cancer Treatment in the New Millenium". Apparently quite a few international docs are coming down to speak, including three from MD Anderson in Houston. What amused me, though, were the prices-- $250 bucks for docs from outside Guatemala, 400 Quetzales (about $50 bucks!) for Guatemalan docs! Those of you planning any international continuing education conferences any time soon, just be aware you're being gouged... but enjoy nonetheless!

Tomorrow's plans are still up in the air, depending on whether the Fickers are able to fly me out there or not... We will see what God has in store, and if I don't go out there then I may see if I can help Dr. Sherwood Pope and his wife Areli with Agape in Action or at ASELSI on Thursday or something... My father-in-law always tells me, though, "If you ever want to hear God laugh, tell Him about YOUR plans!"...

We will see what HE has in store for me the rest of the week.

Clinic Sunday!

Today got off to a great start... after going to bed at around 7:30 p.m. local time last night, I was ready to roll when 7:30 a.m. came around! Finding out about the need to buy toothpaste after I woke up, though, wasn't on my Top 5 events of the day list... but oh well! Mission soon accomplished. You can't really throw a stick here without hitting some kind of "tienda" or convenience store, so it wasn't that big of a deal.

I then rushed out to market to do some "power shopping" as I didn't have much time before Church (or so I thought... see below.) and lots of gifts to buy! It's always fun to see what is new, and also what never changes... I am seeing a lot more local pride here in Chichicastenango in T-shirts and things for sale with the name of the town on them, which I think is pretty positive. I then ran up to go to one of my favorite spots on the face of the planet-- the "Gringo Church" that meets up at the Hotel Casa del Rey every Sunday! Except sometimes during the summer, apparently, when too many people are gone back to the U.S. to raise funding... oooops...

Anyway, that at least meant that I got to start clinic a little earlier and I got done at a decent hour, so life is good! I saw about 14 patients today, but 5 of those were return appointments that I had made either in February or May for myself! It is so uplifting and encouraging to see people keeping these appointments. Most of the rest were ones that Dr. Hoak had sent, and the others were self-referred. Only two seem to need surgery, and they are now set up for November! So, Keith and Cyndi, get ready to operate!! Hopefully more will come in tomorrow, and still more by the time November comes around. The first picture is a lady we will operate on in November, who needs a vaginal hysterectomy for a prolapsed uterus (or for you non-gynecologic types, "her uterus is falling out"!)

The second picture is another patient, who is talking with me through one of the translators at the hospital (Quiche-to-Spanish translator) about her symptoms. She turned out to have a very treatable infection, so we hope she feels better soon. We had a few more run-of-the-mill gynecology patients (discharge, painful periods, etc...) then two interesting infertility patients. One was a young couple, married for 2 years and in seemingly good health, with unexplained infertility. I have no guess as to why they haven't conceived, but they are quite bright and educated so we went through lots of education about calendar-keeping for her cycles, the most fertile days of the cycle, basal body temperature charting to track ovulation, etc... I hope to see them back in November. There are some drugs available and affordable here to help her ovulate if it doesn't look like she is doing so on her own, so we'll see! It was nice to be able to do some real patient education on a pretty high level with this young couple. You have to keep in mind that with many of my other patients, when they complain about their "period" or menstruation coming in some abnormal way, the first question I have to ask is what color it is!! Often they mean they have a white discharge instead of bleeding... so yeah, there's a big difference here.

The other young lady was very different. Married for 8 years with no babies, but did have one on her back that she had just adopted at least! I could take one look at her and diagnose her with Polycystic Ovarian Syndrome, but unfortunately I could also do a fingerstick blood sugar and diagnose her with full-blown diabetes! This is going to be a tough problem for her throughout her lifetime. I did my best to start explaining to her what diabetes is and what she needs to do about it, but I pray that she seeks more ongoing treatment like I asked her to.

The other two pictures are for those of you who may not have seen the Hospital here before-- The "Good Samaritan" Hospital is really a pretty nice facility. Those of you who know anything about Chichicastenango on Sundays know that I cheated and that these pictures were NOT taken today, of course. (Market days are impossibly busy and you can barely see the Hospital for all the street vendors!) We will see what comes our way tomorrow, but for tonight I will sit and enjoy my hot tea, a hot shower, and a nice warm bed! Ah, the difficulties of missionary life, right?!

Long but Smooth Travel Day!

I am so thankful to God once again for safe travels and another opportunity to spend time with so many people in this land that Matt and I have come to love over the years through His grace and guidance! Today was a very long travel day, but I am finally here getting unpacked and settled in for a nice long night’s sleep, I hope! I left home at about 2 o’clock this morning, which is about midnight local time, and arrived here in Chichicastenango about 4:30 p.m.!

I realized too late—as in yesterday!—that I had left everyone hanging on the pathology results from the last trip and for that I apologize. I had heard from Dr. Hoak just a few weeks after returning home that all was well with all of the reports. Nohemi turned out to have a benign tumor after all, which is wonderful. It is such a blessing to have such great follow-up on pathology reports and how patients are doing after flying home again, and something that is really quite unique to the short-term trips that I do here as far as short-term missions go in general. For that I am truly grateful.

This trip is a little bit different in that I do not have any other surgeons or anesthesia help travelling with me. With Dr. Hoak also being up in the States with his family this month, we prayed very hard over what I should try to do on this trip and have felt like it is not my calling to operate any during this particular week. I am certainly open to the possibility of something more urgent than usual coming up, though, so please pray for wisdom and guidance as I evaluate the patients who come in this week.

The hope is to set up quite a few surgeries for us to do in November, when I am VERY excited that I will have one of my Faculty colleagues as WELL as one of the Chief Residents in our program joining me! That will be an amazing trip both from a medical/surgical as well as personal/spiritual standpoint, I hope! This trip is hopefully going to be a lot more about reconnecting with the people here—both the locals and the long-term missionaries—as time might permit a little more liberally if I am not in the OR until all hours of the day and night each day. My bags are packed with everything from charger cords left behind recently in the U.S. to silly toys and things for the Ficker girls to bags of excess toys to take out to remote clinics to eventually be given out at Christmas to small gifts for the Church members that I can’t wait to see tomorrow to vitamins and a few medications! If TSA looked through them, I’m sure they are still scratching their heads pretty good… There is, of course, also plenty of suture, other OR disposable supplies, gloves, masks, glucose test strips, and lots of other medical goodies that are mixed in there. And yes, they are bulky and heavy! They did, for the first time in a LONG time, wave me right through Customs today without X-raying my bags looking for things they didn’t want me to bring in for free, so that was probably the biggest blessing of the day!

Later in the week I will be going out to the Fickers to hopefully help them with a “jornada” or mobile medical clinic out in the jungle areas to the north of them—many of our regular readers will recognize the Zona Reina area as one they have been trying to reach for years now, and we are hoping to make a little bit more progress on those relationships this week, Lord willing.

Thank you all for your continued interest and support of our mission here. Please always let me know if you want to get more involved or if you have any questions! And thank you especially for your prayers for safety and wisdom this week. God bless you all!