Just Pictures Today...

Kelly with Alma and Angelica, the two scrub nurses at Buen Samaritano. (Kelly looks wet because of the cool towel she wrapped around her shoulders before scrubbing-- it gets hot in that OR when the afternoon sun comes through those windows!)

Sweet little girl that is at least as tired as we all are tonight...

Heidi and Chris operating on one of four patients today...

Kelly and Chris anxiously awaiting lunch between cases!

Kelly took a nice shot of the OR here that I stole off of her camera to post (OK, technically I stole all of these shots off of her camera to post, but I was particularly partial to this one!)

Some Pics "Scene around Chichi" and words from Dr. Chris...

Day 4-5: "Never saying "quiet" applies to Guatemala too!"

by Christina Schwering on Wednesday, November 9, 2011 at 7:30am

Good morning! So the old superstition we develop in residency where you NEVER should say the word "quiet" without cursing yourself to a crazy patient load apparently applies to Guatemala TOO! I had no longer finished telling Tony how clinic usually slowed down on Tuesday when the nurse walked in with our "6 or 7 patients" which were really 13-14 charts... yikes! Then our anesthesia guy, Dr Palma, walks in and informs us that he has to leave at 2:30... uh oh! Thankfully God is good and as it always does, it all worked out!

Me and Kelley and Heidi started our tough case of the day while Leisa screened patients downstairs in the clinic. I have decided that we must have had an invisible extra scrub tech (yep, thats right, Jesus is our scrub tech ;-)) because despite a non-functioning Bovie (cautery), a patient with pretty impressive leg contractures(makes for tough visualization), and miserable tissue, the surgery actually went really well! We removed the really damaged, ulcerated mucosa, took out the tiny little offending organ (:-)), and re-inverted her poor vagina without a lot of problems! It was tedious, but God was certainly with us, because I was completely prepared for a 4-5 hr case like my last trip and we were out in a little less than 3 hrs! We then got some lunch and me and Kelley started our next case while Heidi saw patients with Leisa. At his point I was pretty certain there were some extra hands fishing me stuff from that scrub table, because when Heidi showed up about an hour later, me and Kelley were almost done with the case! Went beautifully... God is SO good!

So today is a busy OR day... not sure about clinic, but worried we may need to turn away people if it is like yesterday. We will probably start a little later as Dr Hoak has an eye mass removal at 8, but after that we have a vaginal hysterectomy for bleeding, 2 abdominal hysterectomies for big goomba uteri (aka lots of fibroids ;-)), and an open ovarian cystectomy for a 10cm complex cyst (hoping for a dermoid so I can gross out my hubby with some teeth and hair *lol*).

For all my prayer warriors... my 2nd case from yesterday DOESN'T know Christ... she has family that does, but has not accepted Him. Please pray that the kindness of strangers here may show her His love in a way that softens her heart and brings her to Him! Her name is Esteban. Pray for all of our patients today that we will see, but I especially feel led to ask for prayer for our little old lady with the VERY large uterus that we are taking out (the size of a 36 wk pregnancy!)... don't know why, just feel wary of it. It is big and will be tough, but something more than that that I can't put my finger on! Sending lots of love to everyone at home!! Tomorrow afternoon we will likely head to Canilla so last full day in Chichi! Its been a great trip! See you soon!

From Chris Schwering this morning...

Guatemala Day3-4..."Your stomach hurts in your breast??"

(Thank you, Dr. Chris, for being generous enough to let me "steal" this off of your Facebook blog to repost here!)

by Christina Schwering on Tuesday, November 8, 2011 at 7:45am

Good morning! Well I will eventually have to wake my very soundly sleeping hubby who doesn't seem to be bothered at all by the noise here (oh that I was so blessed, but alas, earplugs are a beautiful thing!) but for now, I have a little time to sit in bed with my computer, serenaded by the rooster somewhere outside our room, and share a bit so here goes!

First of THANK YOU for your prayer support! This has been a great trip so far! Our patient load has been a little lighter than average but the percentage of people we can help has been higher than I can ever remember. I think of the 18 patients we have seen so far, all but 2 have actuallly had OB/GYN related issues! You always will get the "Macerena patients" as Heidi calls them ("Donde esta tu dolor?"... and they do the Macarena to show you...) and the sweet ladies whose stomach pain is located in their breasts and whose lung pain is in their shoulders (the Guatemalan counterpart to the "every back pain is my kidneys and every lower belly pain is my ovaries" patients), but most were referrals and therefore pre-screened and legitly needed our help!

So people who don't care for the medical details can skip on to the next paragraph, but for those interested... Yesterday we did 2 "vagathons" (vaginal hysterectomy with prolapse repairs) and a D&C for a uterine polyp... All 3 went beautifully. Kelley is transitioning to Guatemalan "instrumentista" beautifully and the two of us (with her functioning as both scrub tech and first assist the first half of the both vagathons) had a nice little rhythm worked out... don't know many scrub techs who could organize and hand instruments from a limited table while functioning as the ONLY assist on in a vaginal case like that... at home I usually have 3 people to do what Kelley was doing here... did I mention she is awesome??? Has an invite back ANY time! Heidi came in for the repair portion of the cases and has kind of let me just be primary surgeon so far which I have to admit, I kind of love! During other times her and Leisa handled clinic effortlessly despite some of the confusing stories given by our patients! Today we have 2 particularly tough vagathons for prolapse patients that even Dr Hoak, the general surgeon here who is USED to seeing ladies with their girls parts hanging between their legs, deemed impressive! Our one lady has a small grapefruit hanging out which is pretty ulcerated, but we are hoping has enough healthy mucosa to leave her with a functioning vagina. We also scheduled 3 for tomorrow including 2 abdominal hysterectomies for fibroids (1 at 22wk size and one at 36 wk size!) and a vaginal hysterectomy for menorrhagia (heavy bleeding).

Tony is doing well here in Guatemala too... he has been busy playing with kids and catching up on some video editing so far, but plans to do some video of what we are doing and maybe help out Dr Hoak with some things around the apt. I am hoping he is enjoying and finding his niche here a little... I know not speaking the language is tough and I want him to KNOW he is valued here even if he isn't Spanish speaking or medical!

Today we continue in the OR... please pray for our OR patients today and for those recovering... pray especially for these patients to understand where our desire to help them comes from! He is SO good and loves them so much... we want them to understand that! Pray for His continued favor today!!! Thanks guys and God bless!

Praise God for a great day in the OR!

Short note tonight, just to let everyone know that we had a great day-- We operated on Maria, Maria Antoineta, and Tomasa today and they are all doing very well! (Maria Antoineta had a day surgery so is already home, and we just checked on the other two and they look great so far!) Also saw another eight clinic patients and scheduled three more surgeries, so life is good in Gyno-land.

Please continue to pray especially for the patients that we are operating on this week who do not know Christ, and pray that we will be focused on our primary mission of being a blessing to these people that we encounter here and showing them Christ's love for them. It gets harder as we all get a little more tired, so we will try to keep our hearts and minds focused over the next few days.

We were completely delinquent in the photography department today (See? It just proves how hard we were working, right?!), but we'll try to do better tomorrow!

Nearly Perfect Clinic Day

Well, anyone who knows any surgeons know that a "perfect" clinic day (if there is such a thing) is one where you schedule 100% of the patients you see for surgery! We came closer today than ever. I am grateful that God's mercy seemed to be upon us today in the scheduling. We had eight patients show up (then saw two of the local nurses also, for a total of ten)-- Of the eight first ones, seven actually need surgery, and five are scheduled! The other two are not sure they are ready so might come back tomorrow or might come back in February.

I think one of the best parts was that the two hospital employees asked me for a "consulta" today-- This has been happening a little more commonly lately, and to me it is a sign that we are really gaining their trust and respect. At least I hope it is! I have been working here at the hospital for nearly five years now, and I think the first time this happened was my last trip, so it's been pretty slow in coming. Praise God for the positive feedback!

Biggest prayer request of the day: the couple in the picture below. We will be operating on her tomorrow, and they are actually the only patients we saw today that don't at least claim to be Christians. She is in the Catholic church here, in which it is not acceptable to accept Christ. Very sad state of affairs for the Catholic church here, but unfortunately true and we will pray for her hard this week! Her name is Tomasa Mejia and she is pictured with her husband.

The other pictures are Chris and Kelly with our first "paycheck" of the week... a bag of apples from our first patient! I've actually only very rarely had anyone bring a gift like that to their first consult, so it was really quite nice. The second two are of the group (I took the pictures, using the excuse that most of the readers already know what I look like ;-) One is with the "Welcome to Chichicastenango" sign, and the other is just closer. I am so thankful to be here with such a fun and hard-working group!

Travel Day and Safe Arrival!

Well, so far today has been our typical long Saturday of travel—I got up just after Matt got home last night to drive to the airport (around 2:30 am) and have been going ever since. Leisa, a Nurse Practitioner from California who knows Tom Hoak from his previous days there, met us in Guatemala City and had us beat—she started at 6:30 am yesterday!! We’re all very tired but thankful to be here safely and planning to sleep well tonight.

Let me tell you a little bit more about who “we” are this trip—Most of you reading this know Dr. Chris (DeLuca) Schwering who is back on this trip with a new last name and her new husband in tow! We are very excited to have him share in the experience that we have come to love dearly here in Guate.

Kelly Cromer also came down with Chris and Tony—She is a scrub tech at the hospital where Chris practices and I’ve been hearing about her and how Chris wanted to bring her down here pretty much since she started working there! We are hoping that Alma (the Guatemalan scrub tech who has been in that position longer than anyone can remember) will let her give her a break during some of the cases this week. It would also give our brains a little bit of a break since we could ask for instruments in English again! I’m pretty sure that in English we won’t try to ask for “scissors with teeth” or anything like we tend to in Spanish.

Leisa, mentioned above, rounds out our team of five for the week. I am here with no children in tow this time, which will be a great disappointment to the nurses at the hospital but a whole lot easier for me! We are so blessed to have Matt’s parents, Mary Jean and Denzil, staying with him and the kids this week to help while I’m gone. Having the grandparents around definitely takes the sting out of missing Mommy, it seems! (At least that’s what I tell myself, since the alternative is to wonder whether they do miss me!…)

Tomorrow will be our typical very busy day—market, then church, then start the clinic and work until we’re done! That and Monday when we start operating AND trying to see patients in clinic are definitely the most stressful parts of the week, so feel free to pray extra hard for us then! We will do our best to keep you posted, and we'll try to get some pictures up soon, too!

OR Day Three

The last two days have been long but productive ones! Yesterday we took out a 13 and 1/2 pound uterus (the second biggest that Tom and I can remember taking out together) and went to the hospital thinking that was the only case we had scheduled... those of you who know how things go down here are probably snickering at that since you know it didn't stay that way!

So Tom had two patients waiting for him in the ER when he got to work in the morning, and promptly diagnosed one as very sick from her gallstones and the other with a likely colon cancer. We operated on the lady's gallbladder, then did a sigmoidoscopy to confirm the tumor diagnosis before operating on him today.

This morning Tom started with the colon tumor with Maryann while I did what I had hoped would be a "quick little LEEP" procedure in the clinic downstairs. I was so glad that Keith Nelson had just done his Grand Rounds on the use of electrosurgery, since I actually had some idea how to use the machine that we had available. Having NO idea what to set the power at, I hopped down to the butcher shop to buy some meat to experiment with before getting started. Then we spent an hour or so troubleshooting why only one setting would work, and the last experiment I did was with both the meat and the grounding pad on my calf while I cut the meat with the Bovie. (I called Keith at his clinic before trying this just to make sure I wasn't missing anything in my understanding of electrosurgery!)

By then there was a patient in the Emergency Room that they asked me to see-- a 36 year old with 5 living children (although she has given birth to 8...) with vaginal bleeding and saying she is 3 months pregnant. I spent the next 5 minutes or so diagnosing her with about an 18-week sized Molar pregnancy, and the next hour or so trying to explain this to her and her family and talk her in to a hysterectomy. (For the GYN types out there, I'm not really excited about trying a D and C on that with nothing but wall suction, pitocin, and methergine-- Remember I have no blood bank here...)

Unfortunately, so far Marta has refused surgery-- she insists that she feels her baby moving inside of her, and wants to wait out her nine months and see what happens. I am heartbroken over this, but she is supposed to come back in the morning to get the results of some labs so I am hoping for maybe a change of heart overnight. I am afraid she will bleed to death from this if we don't take care of it soon.

The rest of our cases went well today, except for the colon cancer tumor turned out to be inoperable (It was too stuck down to some very important veins for even Tom to be able to safely remove). Tomorrow we have several more lined up, and I will be praying tonight over Marta's case as we might do her hysterectomy. Please join me in that!

(I tried to post a picture of the electrosurgery machine but I can't get my phone to send it to me... sorry!)

OR Day One

Whew! Long but good day today... started out with trying to go down to the hospital at about 7:30 to get organized for the day, only to turn back around and come back to the hotel when there was no one to open the locked hospital doors for me! So I tried again-- more successfully-- around eight.

Mom and Micah hung out at the hotel most of the day, but did get to come say hi to us in the OR a little later. We were hoping to grab lunch or something together but our timing was off-- Micah had just fallen asleep every time I called when I got out of the OR!

I was happy to see a lady in line this morning with a card from Leslie Ficker's clinic in San Andres-- she had a large abdominal mass that they found yesterday, so I saw her early, admitted her, and operated this afternoon! Turned out it was just a large fibroid uterus, thankfully. We'll send it to the pathologist but I'm fairly certain it is benign.

The first two cases were the ones scheduled from yesterday-- a tubal ligation ("tubes tied", for elective sterilization) who went home this afternoon, and another abdominal hysterectomy for a quite large uterus-- think about 4-5 months pregnant size. Please pray that Valbina's pathology report comes back benign; I am a little more worried about hers...

Sorry I didn't take any pictures today to share-- I'll try to get Mom on that task for tomorrow! But seeing 2 to 4 patients AND pumping after talking with the family, writing the op note, and doing orders in between each case I somehow didn't find the time. The other 13 patients I saw today are mostly non-surgical, except for one lady who will come back in November for surgery since we are afraid we'll be busy all day tomorrow with one very large abdominal mass. Wednesday is pretty fully scheduled with Tom's cases that had piled up already last week! He has another full day Thursday.

Don and Maryann McLeod, who are graciously providing anesthesia as well as some OR nursing expertise for us last week and this week out of Atlanta, leave Friday. It is always so nice to meet other people who have developed a heart for Guatemala over the years in so many different ways.

I actually had a pretty warm shower back at the hotel tonight, and now I'm praying that Micah, Mom/Mary Jean, and my two inpatients get a good night's sleep tonight!

Back in Guatemala Again This Week!

So yesterday we left the house at 3:30 a.m. and arrived at our hotel in Chichicastenango around 7 p.m. or so-- talk about a long travel day! But we do it every three months so I'm not sure why I'm always so surprised...

Anyway, "we" is me, Micah (now four months old), and my mother-in-law Mary Jean Bell, who is just sweet and crazy enough to come down here with me mostly to help out with Micah. I am so grateful for the company-- not to mention the help! What a blessing.

This morning we got up after variable amounts of sleep (Micah and I actually did much better than Mom... she's not nearly as used to the noise around here as I am!), hit the market for a little while, then went to Church where Pastor Don preached another one of his really good messages. Seeing so many old and new friends up at the Church here is one of my favorite parts of the whole week. I can't believe how blessed I have been to know so many amazing people who have dedicated so much of their lives to serving our Lord.

After Church, we grabbed a quick PB and J here at the hotel and then I was off to the races in clinic! I never have any idea what to expect there-- sometimes we've worked until after 9:00 p.m. seeing patients. Today there were only 14 or 15 that signed up, and I totally "struck out" with scheduling surgeries (only scheduled 2). I really got to see quite a few patients that simply needed reassurance that they did NOT need surgeries that had been recommended. These women were by far the happiest of the day as they left with a weight seemingly lifted from their shoulders.

A few other patients I was actually able to diagnose and help with creams or other medicines or just advice or education. So it was really a great clinic day although the patient-to-scheduled-surgery ratio was a little higher than most surgeons like it!

Please pray for our patients scheduled for tomorrow-- Elvia and Valbina. Also feel free to thank God for making it through customs once again without any hassles! I was able to bring in quite a few (like, at least 20) laparoscopic instruments for Tom to use-- they X-rayed all of our bags but didn't seem to have a problem with anything.

Here's some random shots from travel and our day today... just to add a little color to this post! Will try to keep you updated tomorrow. Thank you all again for reading and praying with us.

May 2011 - Day 5/6 - By Dr. Chris DeLuca - "Yay, An Airplane Trip!"

Well yesterday was a lovely quiet day! We got up and rounded on our patients and then really didn't have much to do. Went through all the supply boxes and donated things and made some sense of them and tried to clean up the clinic room a bit. Pat went "shopping" in my bag full of anesthetic supplies and was very grateful to OMH for all the recently expired goodies (ET tubes, LMAs, epidural supplies, etc)! I think perhaps I am going to start a similar "give away" box in L&D and OOB for missions because that system obviously is working great in the OR.



Got to then get some lunch and spend a little time in the market here in Chichi and then actually went back to the apt, packed up, and got a little nap in! NIce treat! Skyped with my handsome fiance for a bit then headed back to Buen Samaritano and watched Dr Hoak taken care of a walled off appy. Finished my day with a meal with 3 friends of Heidi's, Roy, Kathleen, and Jim, who I thoroughly enjoyed, and one more short talk with my honey before bed! We will discharge the last of our surgical patients today and catch a microbus to Quiche where Dwayne will pick us up in the Cessna and head to Canilla... yay!! We will get to spend some time with the Fickers and help them our tomorrow with one of their clinics, then it will be back home of Saturday!



Another great trip here, but there is always more to do, and more needed. Buen Samaritanos US machine, for example, was stolen recently... big old machine taken from behind locked doors... They are using and old borrowed Sonocyte now that really just doesn't cut it... anyone have an old machine they'd like to get rid of? If it is in working, or near working condition, it could certainly be used here... I'll be glad to help you get it here... just for starters, lets pray for a replacement for them, shall we? :-)



OK, off to start my day, hope everyone at home is doing great... see you all soon!



Chris

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May 2011 - Day 4/5 - Post by Dr. Chris DeLuca - "It's Not a Tumor"

Or at least not a cancerous one probably... YAY! So good morning! Yay for God because the surgery we were worried might be cancer WASN'T! (At least I am about 99% syre pre-pathology results... and speaking of pathology results, anyone else ever seen an olive jar double as a specimen container? Love missionary medicine!) So did 5 cases yesterday, 2 of our own and 3 where I got to play general surgeon with Dr. Hoak (kinda fun!) One non-surgical consult only i the AM... apparently Mother's Day was yesterday in Guatemala and nobody fancied a pap for Mother's Day... crazy I know! ;-) All 3 of our post-op patients are doing very well... it remains to be seen how successful Tomasa's prolapse repair will be seen (may not know until well after we are gone) but we are still praying hard. We did decide NOT to reoperate... just trusting Him. Our first case was a nice mini-lap ovarian cystectomy that ended up being a little dermoid (cool but gross cyst with hair in it) so the correct call there. The one we were worried about, Manuela, appears to just have a HUGE cervical firboid that parasitized some nutrition from the uterine arteries. It was kind of a cool case, we got in to a MILDLY enlarged uterus sitting on top of a softball! Thankfully, the softball acted nothing like cancer... rest of the belly seemed benign, shelled out pretty easily once we took care of the blood supply... praise God for the gift of Dr. Tom Hoak who came down and dissected out our ureters and protected them from harms way after me a Heidi spent about 30 minutes trying to channel Dr Semer and dig them out... *lol* He was AWESOME! Enjoyed working with Him a lot! He is a great teacher and if God ever tells him he is done over here, he should ceratinly teach somewhere! Anyway, did lose a lot of blood, but by the grace of God, she is tolerating her anemia WONDERFULLY and should do great! I also did 3 cases with Dr Hoak.... a femoral and inguinal hernia repair (short and sweet) and an open cholecystectomy that ended up being a common bile duct resection and sphincteroplasty... something I'd never get to see at home... pretty cool!



So a good day yesterday, but another long one... been so happy for God's provision and grace, even if my feet and back are a bit sore! :-) Today whatever comes in we will see, will be our last consulta day and we'll have to see if anything surgical shows up. I know that Tom has 3 or 4 cases on the schedule so if there aren't Gyn patients, we may just help him out some. Tomorrow we will leave for Canilla to spend time with the Fickers, missionary friends of Heidi who I thoroughly enjoyed meeting my first trip here. We will probably do a clinic with them Friday then back to the States Saturday! This trip seems to be going by quickly... good and bad. Good because I certainly miss being around the people I love in the States, but bad because I truly enjoy it here when I come. Praying today for his favor and continued good recovery for our patients. Pray that we wouldn't miss opportunities to help these people, physically or spiritually! Thanks for the prayer! We can CERTAINLY feel it here! This doesn't work without it! Have a great day guys and God bless!!



Chris

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May 2011 - Day 3/4 - Post by Dr. Chris DeLuca - "Leaning on Him"

Good morning all! Well for those who prayed for Heidi and Micah yesterday, Micah did SO much better... she was very good for our friend Aurelli and allowed Heidi to scrub 2 cases with me in the OR yesterday... in general seemed much more content so your prayers worked... THANKS! Yesterday was a very good, very productive day for the most part. Thanks to our other good friend Dr. Sherwood Pope (a family doc who works over at Aselsi, one of the other Christian clinics here in Chichi), we were able to turn NOBODY away for consultas despite a full OR day. He scrubbed the entire first case with me and portions of the second while Heidi did consultas downstairs.



First 2 cases went beautifully! Uncomplicated vaginal hysterectomy with repairs who should do wonderful, and a nice abdominal hysterectomy for fibroids that made this poor lady look NOT pregnant for the first time in years! :-) We started around 8:30 and had those 2 cases done by lunch. Broke for lunch and came back for another vaginal hysterectomy with repairs on a complete prolapse... (btw if you aren't interested in surgery details, now is the right time to skip to the next paragraph)... after 2 hours of patiently trying to work my way down into this inside out anatomy, we had gotten almost nowhere and the uterus (which we'd previously thought farily normal sized), wasn't descending at all. We decided to open the belly, do the hysterectomy abdominally, and then, since neither of us have any real experience the abdominal suspensions, to go below and finish the repairs from there. Get in the belly and its a 14 wk sized fibroid uterus... no wonder its not descending, it doesn't fit. What I had palpated before on exam was her 8cm elongated cervix... *sigh* So we get it out from above, but as we are getting to the bottom, we start looking for uterosacral ligaments to attach the cuff to and her tissue is so bad, we can't definitively ID them... meaning there isn't much to keep this little vagina from fallling right back out when we are done. We close the belly, go below, repair the rest of the vagina and close the cuff, trying to attach to what MIGHT be uterosacrals but knowing that is probably not the case, but finished the closure anyway, and 7 hours later walked out of the OR VERY frustrated. Praying that God finds something to supernaturally scar the top of the vagina in to keep it in place... we are considering going back in to the belly to try again to find some semblance of uterosacrals vs attaching it to the sacrospinous ligament below (something neither of us have technically done). Considered sacrocolpopexy, but again, not much experience between the two of us and its a risky surgery... just praying for wisdom whether re-operating is even the right call... Would LOVE intervention for this lady by my prayer warriors out there... her name is Tomasa.



Today we have 2, maybe 3 cases and some consultas possibly (there are always a few stragglers on Tues/Wed). Again pray for safety and wisdom in selection for our surgeries. And again pray for the Spirit to conitnue to move here. We have one lady who we are a little worried about cancer today, she could use lots of prayer today. Off to shower and round on patients now. THANKS for your prayers!!!! Love you all and will be in touch!



Chris



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May 2011 - Day 2/3 - Post by Dr. Chris DeLuca

Well everyone home is up and about (and poking me on Facebook... Tony Schwering... *lol*) but I am just getting moving... 2 hrs behind here (I PROMISE I am not THAT lazy!). As usual today should be our busy day. Yesterday afternoon we saw 14 consultas, 7 of which were surgical (albeit one was an inguinal hernia that Dr. Hoak did :)). Productive day... We have 3 cases scheduled today, 2 vaginal hysterectomies with repairs (or vagathons as Heidi likes to call them), and a abdominal hysterectomy for a big firboid utures. Also scheduled 3 for tomorrow, one ovarian cystectomy, another abdominal hysterectomy for fibroids, and the slightly scary one, a abdominal hysterectomy to take out the girl parts and a soft a baseball sized mass next to her cvx that we are hoping is only a degenerated fibroid, but a little more worried is cancer... I've seen my share of Gyn Onc as a first assist in residency, but still not terribly comfortable with having to be one... praying for Gods favor in doing an adequate job if that is what it turns out to be. We did have one we couldn't fix... incontinence picture which was ? suspicious for a fistula between the bladder and vagina. Sure enough, when we put in the speculum, urine poured out and continued to pour confirm our suspicions. Dr. Tom Hoak (the general surgeon who is full time here and does a little of everything) is seeing her tomorrow to see if he can take a crack at it... hope he can, because there isn't much in the way of urology or urogyn here obviously... not a lot of options. I definitely don't know how to do it. Her story is sad... delivered a dead term baby at home after a prolonged labor, has leaked ever since... her husband left her as a result and now her brother cares for her. Pray that we are able to fix her issue, or find someone who can. More importantly pray that He start to heal the wounds this must have inflicted on her. We will probably try to work in a few more consultas between cases today as well. One interesting thing that I was asking Heidi about this morning... on the ladies we take care of, we ask them if they are in a church, if they know Jesus, and if they have accepted Him. Increasingly, the answer this time was "Claro" (meaning "Clearly" or "Of Course"). For the 42 y/o who was leaving in 3 months for a 4 yr missionary commitment to Spain (very cool by the way, I found her to be someone I may have been friends with in a different life (one that I spoke Spanish better in... *lol*)) I believe that very much... but sometimes it seemed to come to quickly. I pray that the Spirit is indeed moving here in such a way that people truly know and trust God, but I am nervous. Part of me wonders too if they feel like they need to say that to be cared for because we asked. That is OF COURSE not the case... God rejoices over the one returning son, the one coin found, etc... we would LOVE to opportunity to serve His lost sheep... just hope they understand that. Either way, will love on them and hope somehow through our inadequacies they will still see HIM. Part of me wonders if the Sunday Christianity that is so much a part of our home country (that requires little belief, little life change, and mostly attendance) has spilled over here... who knows I guess. Impossible to see in a 1 wk trip really, but praying for real, saving knowledge. ANYWAY, thanks for the prayers and love... Heidi said Micah did sleep a little better last night. Hopefully she will settle down some today too... she wanted to feed/be held almost continuously yesterday (and I just wouldn't do) which I know was frustrating for Heidi, but she handled it with SO much grace... hoping when my time comes I can find that patience... she definitely was the ultimate mom on MOther's Day, nursing, soothing, and doing consultas all at once. :-) So the OR starts up in an hour so I best be off to get ready! Pray for everything mentioned above and for a good day of patient care, that he would guide or hands and words as we take care of these ladies.... love to you all!



Chris

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May 2011 Trip Day 1 - Posts by Dr. Chris DeLuca

Heidi is on this trip with her 6-week-old daughter, Micah. Those of you who have breastfed babies know that 6-week-olds are completely dependent on Mom 24/7. So it's very challenging for Heidi.

Because of this, we'll be stealing Chris' posts for this trip.
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Good morning again from Chichicastenango! Trip here yesterday was LONG but went easily. I drove from Seneca to Greenville yesterday after work... I think I know better to work the day before I go, but I was taking off a lot of time for the trip, and the wedding, and the Colombia mission trip with TCWC in July, so I was feeling kinda bad about leaving my partners that long, so I stayed. Got on the road at about 1:30... at about 3 I realized that my passport was still in Seneca... *sigh* So drove back and didn't get to Greenville until 10pm. Sat down to a LOVELY meal of mac and cheese (cooked by my favorite daughter to be), watched a little Modern Family, got a REALLY sweet (and completely unexpected) Mother's Day card from Ashley (its true, she is kinda a sweet kid)... and collapsed by 11pm. Woke up at 2AM with my neck in spasm and that was it for sleeping... *sigh* So about 3:30 we hopped in the car and drove to Raleigh and 2 flights and a long car ride later, made it to Chichi. All this to say that I was a bit tired yesterday and feel like it was a bit of an attack but prayerfully went to sleep and had A GREAT nghts sleep last night... SOOOO bring on the week. Heidi (the physician I join here who is an awesome OB/GYN) brought her beautiful little mini-me 6 wk old daughter Micah. Pray for Heidi... its so early right now and Micah isn't quite adjusted to the schedule here... I know she kept her up most of last night and wants to feed every 30 minutes or so which is very frustrating for Heidi who really wants to be able to get things done here. Pray for a cooperative little nina, but mostly for peace for Heidi that whatever Micah may choose, things will get done as God intends and he will provide workers if Heidi has to step away. Today we will head to the gringo church in a little over an hour and then after lunch start our consultas... pray for the women and families that we meet today, that we may be able to bless them physically, emotionally, and spiritually. Pray for the Spirit to move here in Chichi and to soften the hearts of those whose sight is blinded by the enemy. THANKS for your prayer support... I am faithful He will use this week to His glory and can't wait to see how! HAPPY MOTHERS DAY too to all the mom's out there... especially mine, Margaret DeLuca! Love to all of you!



Chris



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Days 5-6 from Dr. Chris

Well, I have gotten a slow start this morning... kinda feelin' cruddy. Looks like I've caught a nasty little Guatemalan cold and spent most of the night up coughing and sneezing and trying to breathe... ugh. :-( So this mornings note may be a little short, but here goes...

We lose Matt today as he has to head back to the States for work... will be sad to see him go as he has been a GREAT help. Yesterday was slow... 1 surgery and 1 patient in clinic... and really wasn't a Gyn patient- she came in with abdominal distention... normal girl parts on exam but LOTS of ascites... US done with some input from Dr. Hoak looked like a GI tumor... ugly and she probably doesn't have a lot of time left. Cancer is such an ugly disease, but especially out here when they are SOOO advanced by the time you get them. Dr. Hoak (the full time American General Surgeon who also does a little of every surgical subspecialty from Plastics to Neurosurg) said that when he asks why they wait so long, they usually say, "well, I thought it would go away.." Anyway, she could use prayer... they did a paracentesis for some symptom relief but there really isn't much more here. Surgery went great at very least.

So today we go and round on our patient and then head to Aselsi, another local mission to help out with their free clinic... hoping I can remember my Gen Med stuff... :-) Tomorrow we will d/c our last lady and get a day to play tourist and head to Pananjel (sp?) which supposedly is a gorgeous little town on a lake. And then FINALLY home on Saturday... I will be ready... pretty tired and this cold is taking it out of me...

Continue to pray for the successful recovery of our patients and the patients we will interact with today. Pray for the health of our team... Brandi is feeling a little better but Victoria and Kent have had some GI stuff and I have this cold... we are all pretty exhausted. Thanks so much for the support... it means the world... God bless!

Chris

(And thanks again to Dr. Chris Deluca for letting me "steal" her blog posts from facebook and repost them here! --heidi)

Days 3-4 From Dr. Chris Deluca

"Days 3-4"

Good morning to all! Well we are going into our 4th day here and a little tired, but for the most part doing well... starting to get used to the loud noises at night that our Guatemalan friends seem to love so much... *lol*

Yesterday went well, but a little slower than I would have liked. Our Guatemalan anesthesiologist (who is fantastic and wrote my post-op orders by the way... awesome!) showed up on Guatemalan time at 9:30 rather than 8 (actually not bad because I believe last time I was here there was one day it was around noon) so we didn't get started as quickly as I would like in the OR, BUT the cases we did went WONDERFULLY! Kent did my first case with me that was a decently extensive vaginal hysterectomy with repairs like he had been in the OR for years... someone needs to get that boy out of Emergency Medicine and into a surgical subspecialty quick! Got out of that just before lunch. During my cases my other 2 remaining med students had been in clinic getting histories and doing basic exams on patient so between cases, we squeezed in 2-3 patients for exams/plans. Not a lot of surgical candidates, mostly benign stuff... the only one we tried really hard to convince was a sweet old lady with pretty decent prolapse and CIN II on biopsy a year or so ago, that Heidi had attempted a pessary fitting on previously... we got a better pessary for her that she promptly declined, and then when we counselled her on surgery, she stated she wanted a few months to think about it... we did (I think, I hope) convince her to repeat her cervical screening and come back in May. Our second case was by far the most impressive case of prolapse I have ever seen... this poor sweet lady had apparently been dealing with it for about 15 years too... took about 3 hours, but I am happy to say, I think we got a GREAT result... Victoria also did a great job with the assist and a very tough case was made very reasonable as a result. I learned that gasas are lap sponges and that piencas campos are towel clips, however I still haven't figured out what sponge stick is after about a half dozen tries... *lol* Alma, our Guatemalan scrub tech does pretty well with "este, por favor" thankfully! We got out around 5 though from clinic which is pretty early and had an AMAZING dinner and a little ice cream for dessert... the little things in life. :-)

So for today, as always, pray for opportunities to share with and love on the ladies we will see today. Pray for more opportunities (and the RIGHT opportunites) to serve today as clinic was pretty slow yesterday. Pray for the lovely lady we are operating on this morning and the ones we did yesterday as well. Pray that each of us here would be CHALLENGED by this trip and come away knowing something new about the God we serve. THANKS for the prayer! It means SOOOOO much! God bless all!

Chris

From Dr. Chris...

Thank you, Dr. Christina Deluca, for giving me permission to "steal" your blog from facebook for reposting here! You are such a blessing.

"Guatemala Day 2-3":

Good morning everyone! So up this morning preparing for what I expect to be a busy day... the operating room gets going this morning in about an hour and we'll be doing consultas most of the day today so I am mentally preparing for the crazyness with prayer and Scripture and physically preparing with large amounts of Pepsi Lite. :-)

Yesterday was actually pretty reasonable... we did 13 consultas, scheduled 3 very sweet ladies for surgery today, and were back in the apt by 7pm. We started off our day on a pretty sobering note with a patient with advanced cervical cancer... if you feel led please pray for her and her family as they knew their diagnosis and were very much hoping for a cure that our science cannot offer. She does know Christ so praise God for that, but it will be long road for them all and they will need people agreeing on their behalf. We also got a chance to see the second half of the SuperBowl with some other American missionaries here which was a nice break, although the "responsible" physician of the group (oops) may have left the keys to our apt IN our apt... allowing us to see the hoodlum skills of our group when we had to break in to my bedroom window and squeeze Brandi through when we got home... *lol*

Also got to enjoy a wonderful church service over at the "gringo church" as Matt calls it... God always has a good message in time for me and led me yesterday to Philippians 2:1-8 which reads, " If you have any encouragement from being united with Christ, if any comfort from his love, if any fellowship with the Spirit, if any tenderness and compassion, then make my joy complete by being like‑minded, having the same love, being one in spirit and purpose. Do nothing out of selfish ambition or vain conceit, but in humility consider others better than yourselves. Each of you should look not only to your own interests, but also to the interests of others. Your attitude should be the same as that of Christ Jesus: Who, being in very nature God, did not consider equality with God something to be grasped, but made himself nothing, taking the very nature of a servant, being made in human likeness. And being found in appearance as a man, he humbled himself and became obedient to death– even death on a cross!" I find myself way too often writing myself as the central character in whatever story I am in... as if His plan revolves around myself, my growth, MY glory... the pastor spoke about all of our need for a life of significance, the desire for a glory that nothing in this world can provide... sometimes my desire to serve on missions becomes just that... its only about me! It is one of the ways I try to prove that my life is somehow worthwhile and of value! But the truth is, the only reason I have value is because I am a beloved of God! It is only through Christ's death and resurrection and my subsequent ability to come back to that intended relationship with my Creator that I truly can find any real fulfillment and self worth! So this morning, I am personally praying for God to help me see past ME today...to help me to "in humility consider others better than myself". Thought I would share...

Looking for a busy and challenging day... if you are walking with us in prayer, continue to pray for our patients and their physical and spiritual well-being. Continue to pray for Brandi's health as she is still feeling pretty rough. Pray for our surgical team today and the women we will be operating on. And anything else that the good Lord leads you to pray about... we LOVE and NEED the prayer support for this trip to be successful! Want to give a quick shot out to Ashley Schwering who is SIXTEEN today!!! Everyone in Greenville give her lots of love for me today! Happy birthday Ash! God bless all!

Chris

February 2011 Trip

It's really weird to be here in Guatemala without Heidi (Dr. Bell) but here we are. She's back in North Carolina working very hard to grow a "baby in her tummy" (Isaac's description).

Here in Guatemala, we are Dr. Kris DeLuca, med students Victoria, Kent, and Brandi, and your humble correspondent.

We flew in on Saturday, uneventfully (yay) and drove up the mountain to Chichicastenango, where we found our accomodations with no trouble at all. We were exhausted, so sleep came pretty easy.

Sunday morning was Gringo Church, Market, and then 15 patients. The first was a real downer - one that Heidi had seen before. She is a 30 year old woman with Stage IV cervical cancer that has spread to her uterus and abdomen. She can no longer pee, so we tried to insert a catheter, but it turns out that her bladder is empty - her kidneys have either shut down or been obstructed from all the swelling - she looks like a balloon... She's a mother of four (the youngest is 2) and will very likely not see Christmas. As you might expect, she was not terribly encouraged by our report that there's nothing we can really do for her except give her some pain meds. She is in a good church and we prayed with her and her family.

The rest of the day was a little more encouraging for us, though. We scheduled three "vag-a-thons" (vaginal hysterectomy with anterior and posterior repair) and an endometrial biopsy. We were also able to reassure a few very scared women that there is nothing wrong with them, despite the diagnoses of some local doctors.

We were even able to get out of clinic in time to catch the second half of the Super Bowl with a bunch of local missionaries.

Today, Dr. Kris and company did two vag-a-thons and saw another eight or so patients. Matt took the opportunity to run up to Quiche and check on the facial plastics team that is there now. While in Quiche, he got to see our good friend Malachi Courtney, who will probably come down to help out tomorrow.

We're all done for the day now and headed out to grab a bite to eat. I'll have to post pictures when I get back to the US since I'm on a borrowed computer, or you can check our Dr. DeLuca's facebook page for some pictures now...

Hasta manana!

Please Pray for Upcoming Trip!

So there have been some developments in our lives that God is helping and teaching us to work through, and I felt compelled today (well, okay, actually several weeks ago... but finally got around to it today!) to sit down and write to our regular readers with an update on the February trip. We will be needing LOTS of extra prayers the week of February 5-12th this year as we face new challenges.

A little over two weeks ago now, life threw a little bit of a curve-ball at Matt and I at what we had hoped was a routine prenatal care visit and follow-up ultrasound. It seems our little girl is not growing quite as quickly as everyone would like (For you "numbers" types, she was just barely at the 3rd percentile for growth at that 28 week visit). We are not yet sure what this means, overall, and there is great likelihood that she is just bound to be a small baby at term. (Some of you remember how tiny her big brother looked next to the cat when we brought him home from the hospital at less than 6 pounds, although he was technically born at 6#8oz) I was advised by my prenatal care provider to slow down my schedule some at that time, and we are doing some weekly tests on the baby that she-- so far!-- had easily "passed". We will re-measure her growth this upcoming Friday, which is the first prayer request as we pray that she shows signs of continuing to grow even if she stays small for her age.

This "slowing down" has meant a couple of things overall-- First of all, I was taken off of the call schedule at work and am only working days now. Second prayer request thus is a prayer of gratitude to my colleagues who very graciously stepped in to cover these shifts with no grumbling, and that I will heal up nicely after delivery and be able to return some of those favors! It also means that Matt has taken on even more of the household responsibilities on his own so that the baby and I can rest as much as possible when I get home, and for that I also offer prayers of gratitude.

The biggest thing, though, is that we made the very difficult decision (for me at least!) that I should not plan to fly down to Guatemala for the upcoming trip in February, which lands around the 32-33 week mark of the pregnancy. This is a HUGE deal for me, of course, and at first was probably even more stressful than the thought of coming off the call schedule and figuring out what "slowing down" means! God, as always, has been incredibly faithful in providing people and resources to keep the trip going, though, and so the final prayer request is for them...

I had three medical students set up to come down with us, named Brandi, Kent, and Victoria. I have been praying for some time for them to have a meaningful experience both academically and spiritually, as well as for their safety in travels. Please join me in that prayer, and we will get pictures posted of them as soon as possible, as they are all still very excited about the trip!

Matt has really stepped up in a major way, with no hesitation whatsoever, saying to me as soon as we got the news that I wouldn't be going, "I can't operate, but I can go and handle everything else as long as we have a surgeon!". His willingness to go on the trip, translate, help with all of the logistics and safety, and (hopefully) blog while he is there and keep you all in the loop means the world to me. I am truly blessed with an amazing husband.

The biggest piece of the puzzle, though, was whether or not I could find a gynecologic surgeon to fill in for me for the week! Some of you may remember Chris Deluca, who traveled with me and operated during an amazing week when she was a resident in our program. She has a huge heart for missions, as do the other physicians in the private practice near Clemson, SC, that she joined after graduation. She had contacted me about going back down on this February trip and I was really looking forward to working with her again! I can't even imagine the increase in weight that I asked her to take on her shoulders when I asked if she would be willing to do the trip on her own. Imagine my relief when she responded with, "I know and have known for a long time that is where God wants me that week, and there must be a reason now that He wants me there on my own!" What an amazing faith she has. I am sure she will do an awesome job of taking care of the patients, teaching the students, and operating. I do ask for your prayers of support for her as she takes this on, though, as well as continuing prayers of gratitude for her service.

I pulled out some old photos from my trip with Chris to put a face with a name, so please let's let her feel our prayers for her as the trip approaches!