Thursday, February 14, 2013

Wrapping Up...

Well, with all of our patients doing well and no one in our group very sick or completely broke, I think we are wrapping up a really great week!  Still plenty of surgeries to scrub in to with Tom, and Nichelle and Kimberly are headed to Lake Atitlan for the weekend to catch up with some buddies from Chapel Hill (Turns out it really IS a small world, after all!)  (Oh-- and don't worry, mothers who are reading this.  We have hired safe, private transportation that will take them to trustworthy hotels, and left them with a working cell phone!)

I continue to be amazed with how well our patients do post-operatively here.  The only one still with us-- and she might go home this afternoon if her intestines "wake up" a little bit--  had an 8 pound, 4 oz uterus removed on Tuesday.  All the others have already gone home looking great.  The people here are amazingly tough and resilient.  You really get some perspective on nuisance problems in the first world when you see people truly struggling to feed their families and put shoes on their feet.

Today, we are back and forth to the OR with Tom (essentially taking turns taking advantage of his amazing teaching in the OR) and hanging out in the market.  Hale, Elizabeth, and I fly out to the City and then to the States with Duane and then American Airlines tonight.  Hale has been shooting pictures like crazy in the market, so we will probably have more to share soon!  We also have some beautiful shots of our precious patients to share as soon as I can hook his camera up to my computer again.

Happy Valentine's Day to all of those that we love and miss-- we will see you soon!  Thank you for all the love and prayers this week and always.

Mostly pictures (written last night, but apparently forgot to his "publish" til this morning...)

Sorry, today was actually a much calmer day, but we really let time get away from us-- and after dinner, we talked Tom in to getting out his photos from so many of the patients he has taken care of over the years down here and couldn't pull ourselves away!  We are now up way too late, but with our heads spinning with amazing stories of what The Lord has done down here through his hands.  

We did get a chance to snap a few more pictures today to share, though.  The first one speaks to the universality of little kids putting things up their noses... just because they can!  This girl was irresistibly cute, and entertaining herself quite effortlessly while her parents were praying at the front steps of the church.  Hopefully they were praying that nothing got stuck up there!

Here is one shot of the hospital from the outside for those of you who haven't seen it before.  It translates to "The Good Samaritan Hospital".  One of my favorite quotes of the week is that every time Hale looks up at more power lines, he shakes his head and just says, "good thing concrete doesn't burn!"  It is amazing that very few injuries or fires are caused by these, but we did have one guy come in to the ER today with electrical burns from touching a steel pole from a live wire to his stomach!  Tom will be taking care of him for a while... so if you need someone else to put on your prayer list, he could probably use it!

Apparently, these pictures upload in no particular order ;-)  Here is one of the catholic church here in town... just another nice shot of Hale's from the week.

As a teacher, this is one of my favorite pictures, although you can't see that it is Hale that Nichelle is looking up to for further guidance during her first ever hysterectomy.  I just love that expectant and "drinking it all in" look of a truly interested and bright student.  I know it's kind of dorky to be in to that kind of thing, but I think it will always be what really makes me tick in the OR!

Another favorite shot from the week... Hale operating with his daughter Elizabeth!  You might recall she is a college senior at Carolina, considering (hopefully now more than ever!) a career in medicine like Dad.  It was really cool to see their father-daughter relationship this week and how much they respect and love each other.  I will pray that Matt and Micah someday have that, and I have really been inspired by it this week.

And one last one before I am off to bed... another uterus we took out, this time with the whole team (except we couldn't get Al convinced to pose with us...)  That's Angelica (left) and Alma (right), the Guatemalan scrub nurses who run the OR here.  They are such gracious hosts-- always happy to see us come even though it means a really, really, really long week of work for them!  They even remember my glove size from one trip to the next, and I am continuously flattered that they send family members to see us for consults almost every trip.  God bless the hard-working staff at this hospital!  It is truly unique and blessed place in His world.

Oops, I lied-- HERE is the "one last shot" for the day... I don't think I can even do justice to a caption for this one, so I'll just let it sink in...

Tuesday, February 12, 2013

Finally figured out how to post pictures more efficiently...

One of my favorite "little old Guatemalan lady" pictures of all time... thanks to Hale Stephenson!

The sound of women's hand shaping tortillas is ubiquitous on any Guatemalan street...

Beautiful flowers for sale in the market... Couldn't resist buying them for about $1.30!

 Our clinic room.  There's a nicer ultrasound we can use across the courtyard in another room, but this one works in a pinch!

 Our "own" shelf in the storage room.  How amazing to have such a well-stocked clinic here! Thanks to all who have donated-- from clinic nurses who squirrel away expired meds to Keith Nelson buying us a scale to bring down to my in-laws stocking us up with donated glucose testing supplies from friends and family, to Hale bugging the hospital and drug reps for supplies, to students gathering them up over the years, to the ladies at the SurgiCenter in Greenville and their ongoing efforts to "waste not, want not", it is amazing how it all adds up!

One of our favorite shots of the week... Nichelle trying to overcome the language barrier to teach a patient how to arch her back out for the anesthesiologist to put a spinal anesthetic in...

More pictures!

Kimberly doing consults in clinic

Sweet little girl that we couldn't resist flirting and sharing bubbles with...

"Slightly" staged OR picture after we had just gotten the uterus out...  Heidi and Nichelle

 Kimberly's first skin incision!

And the team's first uterus of the week!  Ain't she a beauty?! ;-)

Highlights Only Tonight...

OK, so the last two days have been a little crazy-busy, but overall really great!  We have had six successful surgeries and have seen another 26 patients in clinic.  Nothing very serious in clinic, but a lot of chances to provide reassurance and guidance for young women, which is a great privilege.

Last night we did not have internet access (I know, "first world problems"...), but we did sit around as a very tired group and just typed up the few highlights below.  Now I am finally getting around to posting them for your reading pleasure...

  • ·      5 am, “quiquiriqui!!!”  (That’s cock-a-doodle-do in Spanish… our wake-up call)
  • ·      Nichelle and Kimberly each got to do their first skin incisions and abdominal closures
  • ·      Kimberly also got to do half of a hysterectomy!
  • ·      Elizabeth scrubbed in to her first surgery!  (And did great!)
  • ·      All three of our surgeries went well and are expected to recover well!
  • ·      We saw 9 patients in clinic
  • ·      We got to show a young couple their baby’s heartbeat for the first time (7 and 2/7 weeks!)
  • ·      The Guatemalan OR team did a fantastic job working as a team to help us emergently convert a vaginal case to an abdominal case quickly and safely. 
  • ·      Jana made an amazing pizza dinner, which just hit the spot when we got out of the OR around 7 pm
  • ·      Limes were successfully purchased in the market by Kim and Elizabeth, who also managed not to get lost many times going to the market by themselves
  • ·      At least three patients had their cell phones ring during their consults today—a growing issue! 
  • ·      We got to see a patient for a follow-up visit whose hysterectomy we did in 2010!  She looks great, and is still grateful and appreciative
  • ·      No one is very sick on this trip currently
  • ·      We are looking forward to operating on three more special ladies tomorrow.
  • ·      We’ve seen lots of women who came in with very supportive husbands for their consults, which is always positive to see
  •       We took lots more great pictures in the OR, which we will try to share as soon as the internet is fast enough to upload them!
Today, one of the best highlights was our first patient, who came in because she was told she needed a D and C for a miscarriage.  When we went to ultrasound her, however, we were able to show her what appeared to be a normally growing baby inside with a very early heartbeat!  As I always teach the students and residents that I work with, we "always give the pregnancy the benefit of the doubt" when it comes to very early diagnosis of miscarriages and other pregnancy mishaps.   It was another in a very long list of great teaching points for all of us learners on this trip.

Tom and I actually got called to the OR around 9:30 last night to an incarcerated hernia case, and got out just after midnight-- so I was even more thankful for an upbeat, energetic, and helpful team today.  I continue to be amazed by the talent levels of all of the people I am working with, and will of course never cease to be amazed by the patience, gentleness, and generosity of the Guatemalan people that I am so privileged to serve.

II am now going to attempt to post some more pictures, but I have learned the hard way this week to go ahead and post the text first then try to deal with the pictures; internet has been sketchy for posting large files lately! 

Good night to all-- and thanks for reading and praying for us!

Monday, February 11, 2013

Pictures... Finally!

Great First Day in Clinic!

Wow.  Just wow.  I can't believe how great today was.  All of the talented people that I had to work with, and all of the really interesting patient stories, and fun time in the market, and, and, and... wow.  I truly am in awe of this team and the amazingly strong people here in Guatemala.  It's pretty late after going through all of Hale's pictures from today, eating pizza, getting things cleaned and ready for tomorrow, and not to mention seeing the 20 clinic patients that we saw today, so just a few quick stories and prayer requests will have to suffice for the blog tonight.

Our first patient today was Tomasa, the lady I mentioned before who has been waiting for someone that can do her abdominal sacrocolpopexy for about a year now.  She is first on the schedule for tomorrow! The really cool part of her story, though, is that when we first operated on her about 18 months ago, she was in the "Catholic" church here (although basically unchurched) and did not know Christ.  Her daughter that was with her, however, was and still is in a strong Evangelical/Protestant church, and was really excited when we brought up the subject with her mother as she has been praying for her to come to know Christ for quite some time.  Sometime since her last surgery, she has actually started going to church with her daughter, who believes that she is really coming close to accepting The Lord lately!  I am truly awed, once again, with the amazing privilege of being able to serve these women regularly and provide continuity of care-- over years in several cases!-- that allows me to see them grow in so many ways.  God is so good.

We saw a total of 20 patients, scheduled six surgeries, and did three in-office biopsy procedures today already.  Almost all of the surgeries will be great teaching/student cases, which is really exciting for Kim, Nichelle, and Elizabeth.  Hale did a fantastic job of teaching them during clinic today while I was writing notes, and I pray that they will truly have a great learning experience this week!

Apparently, we did take a little long in the clinic, though-- one lady told the front desk that she was 31 when she walked in and asked for her consult, but then told us she was 32 when we started her consult in the afternoon!  We didn't realize we were going THAT slowly, but then another patient's husband also told us "buenas NOCHES" on the way out!  Oh well, at least we finished by eight...

Unfortunately, we also told two patients that they likely have cancer-- one that we are operating on Tuesday and one that is sadly inoperable.  Please pray for Juana and Maria, who are both in tough situations, with vulvar and cervical or maybe vaginal cancers.  It is so difficult to feel so helpless for really sick patients sometimes, but I am thankful that we at least had some pretty good pain medication to offer to Maria thanks to donors in the U.S. who have generously given of loved one's medications after their passing and/or no longer needing them.  Prayer and pain medication were all we had for Maria, but we pray it will go a long way towards making her feel a little more cared for than she otherwise would have.

Tomorrow we are doing Tomasa's abdominal case, another abdominal hysterectomy, then a vaginal hysterectomy and incontinence procedure.  We have three cases scheduled for Tuesday as well.  We will see what clinic brings us tomorrow-- I sometimes have to remind myself that God will not send us more than we can handle.

 Pictures are from market this morning (I am so impressed with Hale's photography; he has a great eye for it!) and clinic this afternoon, mostly self-explanatory.  Enjoy!  (They may not post until the next post; I am going to go ahead and upload this text now and then try again since they failed last night :-/  (First world problems!)

Saturday, February 09, 2013

Meet the team!

Today was, as usual, a long travel day for the team—which is kind of nice since it gives us a chance to start getting to know each other a little bit!  This trip there are two people that I met for the first time at the airport in Raleigh this morning, so it has been an exciting day already.   We are all ready to crash tonight after a long trip to Guatemala via Miami, then up the mountain to Chichicastenango.

Many who have talked to me over the past few weeks know how excited I am about the cool group of people I have on this trip, so let me tell you more about them:

Hale Stephenson is a private OB/GYN in Greenville who I have known since I started with ECU in 2008.  He is a fantastic vaginal surgeon, and I am really excited that he is willing to help with a particular repair for a patient by the name of Tomasa.  I have been trying to find help for for almost a year now!  She needs an abdominal sacrocolpopexy for you GYN types that are reading, but the rest of you will just have to take my word that she needs his help ;-)

I walked up to Hale a few months ago after he gave a lecture to our department about urogynecology, and told him I had a couple of patients I would love for him to see.  He was a little surprised when I admitted that they happened to be in Guatemala, but it didn’t throw him off for long!  Before I knew it, he was signed up for the trip, and brought his daughter along too.

Elizabeth Stephenson, his daughter, is in her last year at Carolina, set to graduate in May.  She is planning to do a fellowship next year that combines some real world work experience with some seminary classes and church leadership in Charlottesville, VA (The Trinity Fellowship for those of you who are familiar).  She is considering applying to medical school after that, so prayers that this week will help her to sort that out would be appreciated!  We weren’t sure we were going to get her down here since she is missing a week of classes, but it turns out her professor adopted her little girl from Guatemala so she had no problem excusing her!  I love when God works things out like that.

Kimberly Newton is a fourth year medical student at Carolina, and the daughter of Ed Newton who I work with at ECU.  I am thrilled to be working with her also, and flattered that Ed has always been excited enough about the work I do down here in Guatemala to get his daughter set up to go with me!  She is actually planning to go in to Family Practice with some further training in obstetrics.  From what I hear, her Spanish is pretty good, too.  I don’t even know what I’m going to do with myself on this team with all of this help—both with Spanish and medical training.  I think Hale is the only one who doesn’t speak a lot of Spanish, but he will more than make up for it in the OR.  I can’t remember the last time I was on a trip with both medical and Spanish-speaking help at the same time!

Nichelle Barbari is a third year medical student with us at ECU, who also goes to Integrity Church with Matt and I.  She is going in to OB, and managed to talk the school in to letting her spend her third year elective rotation time with me.  It makes perfect sense, since she definitely has a heart for missions as well as OB/GYN, but I was still pleasantly surprised that it worked out.  She has actually served as a medical translator in Peru before—talk about a serious talent set! 

We met Al Jones, an anesthesiologist from Wyoming, at the airport and traveled up to Chichi with him today.  He has been down several times helping Tom and is back for a long week this time!  We are always excited to have anesthesia help, as many of you know.  We will look forward to getting to know him better this week also.  The picture below is of Al, Hale, Elizabeth, Kim, Nichelle, and I in that order...

As I said, I am really looking forward to the chance to get to know everyone better as we serve together in Chichi this week.  We will keep you posted.  Please pray that Hale both recovers quickly from his cold and doesn’t pass it along to all of us, and for safe travels, patient spirits, and patients that we can truly bless this week.