Wrapping Up and Winding Down

 Well, here we are at the airport to head home after a fantastic week!  Yesterday morning we were able to discharge our last two patients from the hospital before flying out to meet up again with my dear friends the Fickers (http://adonaiinternationalministries.blogspot.com) in Canillá, El Quiché, Guatemala by small plane.  If only every morning we went in to round at the hospital our patients were taking in a bit of sunshine on the balcony like sweet Maria was that morning!  Love this picture…

Please continue to pray for healing as these last two patients especially recover from tough abdominal incisions at home.  Their names are Maria and Sebastiana.  Sylvia somehow managed to talk Sebastiana in to giving us a picture of her beautiful (somewhat toothless) smile on the last day—those of you who have any experience photographing Mayan women know that is quite the feat!  Dr. Sylvia used her own beautiful smile, though, to convince her to flash hers long enough to capture it…

Then out at the Fickers it was time for spiritual sanctuary, catching up with my “family”, making new friends, learning new prayer requests, and seeing the amazing things that God is doing is down here right now!  Here are some new shots from the nursing/English/pre-med school and the Fickers’s farm and clinic area also.  What a nice time of spiritual and physical renewal and rest before traveling home today. 

We look forward to the next trip!  Thank you all for following along and continuing to pray with us…

Girls' selfie in the plane:

Walking out to the new house, which will be ready to move in to soon!

The inside of the new house!  Beautiful work, guys!

At the school, the Mission and Vision Statements (obviously, this was in the English classroom!)

The computer lab… Might not look too impressive by North American standards, but trust us when we say that it rocks the worlds of the Guatemalan education system!

The entrance to the school… Love this!

The front of the Ficker property, taken from the back...

Walking out to clinic… 

Adrienne checking in patiently waiting patients this morning...

Anna checking and recording blood pressures and glucose measurements on prenatal patients this morning before we flew out.  We managed to see maybe 2/3 of the pregnant patients before we left, I hope...

A view of the clinic entry way wall:

Cultural Appreciation Day?

 So this morning we were able to "sleep in" a little and didn't go down to the hospital until 8:00.  There is a worship service there every morning, and it is always a special privilege to attend.  We worshipped, listened to a brief message from sweet Pastor Julian who preaches and visits with patients there each day.  We then prayed corporately for the patients we had operated on as well as for several other requests that the group had.  I was asked to pray, which is always intimidating in front of a group in Spanish—good thing God even speaks a little “gringa español”!!

We then got rounds done and discharged several more patients who looked great.  Thanks especially for your prayers for Marta, the hematoma from yesterday who looked much better this morning.  We were much more comfortable sending her home after watching her overnight and seeing her hematoma shrink significantly.  One more patient was begging to be seen this morning so despite our prior plans we caved and saw her, and will hopefully save her jumping through a bunch of hoops and spending a lot of money to get a surgery at the National Hospital in Quiché that she doesn’t probably need!

After that it was off to the market!  Much damage was done to many wallets and the soles of our feet, and there was full-blown sensory overload with all of the colors and products.  I think everyone made some great purchases and definitely enjoyed the experience and a little down time.

This afternoon we sat around at a café where there was WiFi, and I have to say it’s the first time this group has sat around and been in front of computers and iPads this week instead of talking and really having meaningful conversation.  What a great group.  I continue to be really impressed. What a blessing!

Here are some scenes from around Chichi… captured mostly by Hale, who has a great eye for photography.

And then there are some scenes from the hospital: Hale snuck a picture of prayer with a patient on her way to discharge home this morning…

And then breakfast trays were brought, and he surreptitiously caught this shot of sweet Cruz blessing her meal before eating it.

This one was from earlier in the week, but apparently I was getting a little tired of the camera in the OR-- sticking your tongue out at it has a little different effect with the mask on, though!

One of my favorite things to teach people that come on the trip is how the family of the patient wants to see the removed organs after surgery when we are telling them how everything went!  Here is Angelica, the sweet nurse that is a huge help in the OR helping Sylvia, Hale, and Anna tell the family of yesterday's last patient that surgery went well-- "thumbs up"!

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Then there's some really cute shots of the team from the roof of the hospital, one of my favorite places!

 And this last one is probably my favorite… this little girl, Gladis, is the now SEVEN year old daughter of (the late) Maria Suy Chan, who some of our very long-time readers may remember as the lady that we diagnosed with breast cancer when she was pregnant with Gladis.  I always see her husband and other kids in the market, and today when Gladis was there he took special care to point her out to me.  She followed us up the street and chatted for a while, then let us take her picture (for which she was somewhat handsomely compensated with enough cash for ice cream for her and her siblings, of course!)  She is beautiful, and reminds me of her sweet mother, God rest her soul.

 Tomorrow we will round, hopefully discharge our last two patients, and fly out to Canillá to see the Fickers, which is like my spiritual retreat and a place where God is really moving!  Check them out at their own blog for further reading at http://adonaiinternationalministries.blogspot.com !

Pictures and Prayer Requests

Just prayer requests and pictures today!

Sorry no blog yesterday… We were T.I.R.E.D… and then in fairness, I tried to do the “lazy blog” thing and just post pictures, but then realized my computer charger was down in clinic and I was already in my PJs for the night so I just gave up and went to bed on reserve battery power.  Sorry!

So yesterday was the busiest day yet, and we definitely came home tired—but the attitude of the group was again completely unbeatable, and for that I am thankful.  I was so impressed with the way the team could still smile and love on the last patient in the clinic after the long OR day just as well as the first, and ask your prayers that we would continue to (hopefully) bring glory to God’s name here in Chichi. 

Specifically, we need prayers for me to feel better as I have a pretty harsh cold today that reared its ugly head.  I’m thankful to the team for sending me home this afternoon during the very last surgery to nap, which helped quite a bit.  Also for a young girl named Marta who has our only known surgical complication so far in the form of a hematoma (big blood blister or bruise) at her surgical site that we would really like to see not grow and ideally go away very quickly.  We would also like to get all of our patients doing well enough to get home by Friday when we leave since we don’t really have anyone here to follow them up after that with Tom and Jana currently in the States.

Also, we discharged Izabela, our abdominal pain and fluid collection patient today, having unfortunately told her there was nothing else we could do for her medically or surgically at this point.  We asked her to please go get checked out in The City and gave her copies of all the labs and studies that we had paid for/obtained for her, which we can only hope can help.

Esmirna, the cervical cancer patient in the green shirt below, never did show back up—so please continue to pray for her healing and peace.  She and Izabela both say they know The Lord and have accepted Christ in their hearts and seem to be ultimately at peace with their diagnoses, but it is still not ever easy to face these things and I would love to know that many people remain in prayer for them!  (I am counting on you, since I’ve already told them that “WE” will be!) 

Also pray for Cruz, the sweet lady whose fistula Sylvia was able to repair this week, pictured here with her.  I love this picture—one of my favorite from the trip.  Pray for continued healing, for healing of her relationship with her husband (he basically ignores her in the home currently, probably because she smells bad because of her urine leakage for many years), and ultimately for her heart and salvation.

You can also pray that our team continues to enjoy a positive and favorable reputation here at the hospital, such that the nursing staff (here pictured, Alicia with her sister and mother) feel comfortable bringing their families in for consults to us!

And that we would have the patience to serve as many as possible… Here is a shot of a little bit of the line of patients waiting to be seen one morning.

And that we would continue to be uplifted during the day when we most need it by precious smiles like this one!!!  What a doll.

And for Anna's career plans, wherever they may take her.  What a cool privilege to get to operate with your Dad while contemplating a career in medicine!

Off to a Great Start in the OR!

 So today we got off to a great start in the OR and saw about 9 more patients in clinic.  We didn’t schedule any new cases for the rest of the week, unfortunately, but got some time to focus more on Izabela’s case for planning the rest of the week.   We also had an awesome surprise visitor from Canillá—Victoria has been down for a while now from Charleston and is such a delight to be around!  It is a joy to watch her serve the Guatemalan people, and she was a huge help translating today and just a great part of the team.  We put her to work in the OR today (she is currently hoping to start medical school this fall) as you can see…

We managed to get a team picture (all of us except our photographer, Hale, that is) also somewhere in the craziness…

Sylvia got us off to a great start with her teaching and operative skill on two ladies that have stress incontinence, and both are doing very well tonight.  One went home, actually—she is the hospital director’s wife who definitely has the resources to give us a call if she has any issues overnight.  The other lady, Tomasa, should go home tomorrow. 

We also spent quite a bit of time this morning AGAIN trying to track down our fistula patient who didn’t show up for her surgery this morning!  We were so disappointed, but managed to find out that she was concerned about how much she would have to pay for the surgery (despite us asking for “only what she could afford to offer”; something obviously got lost in translation!).  We got in touch with a couple of people that knew her and they managed to get her in by about 1:00, so she got her surgery after all!

Talk about a win-win situation—Cruz (the patient) got a life-changing surgery (she basically just leaks urine all of the time, which should improve drastically at this point!), and I got to see Sylvia do the repair surgery, which was quite a highlight of the week for me already.  Tomorrow we are doing a prolapse repair which will be another great learning experience for me from Hale and Sylvia, as well as providing a great outcome for the patient! 

Update on Izabela:  at this point, we are not at all sure that she has a gynecologic cancer, but we did take some fluid (like, more than half a liter)  off of her abdomen this morning and sent some to the lab for a little bit more information (an SAAG if there are any Internists who happen to be reading!)—Unfortunately the fluid had recollected by early this afternoon, which was a strong signal to us that it would be dangerous to operate without ICU and better lab support.  Also, we asked the opinion of Dr. Iris Gamez, the anesthesiologist who I really respect here, and she had great insight and reasoning as to why we should not open her abdomen to operate this week.  At this point, we feel pretty clear that we are not going to operate on her to try to remove a tumor—especially without knowing if or where she has one!  Tomorrow I think we will take her and do a biopsy inside of her uterus to at least try to start figuring out if she has cancer in the uterus.

The other lady we were praying for guidance on with the cervical tumor, Esmirna, actually did not show up for the X-ray that we wanted to do to help plan for surgery.  This was surprising to us, but a pretty clear message as to whether or not we should operate! 

The other pictures are from inside the hospital courtyard, looking up at the patient wards and some of the patient families,  and a view from inside our clinic room—thanks to Dr. Hoak for the loan of his clinic for the week!  Sorry it looks like an explosion just happened in a mattress factory in there; we promise we’ll clean it all up and put it back in the bodega before we leave! ;-)

What. A. Day!

Wow.  That one was a long one.  Here are the stats:  21 patients (plus Izabel from yesterday, who we sent for a CT and got a chest X-ray on during clinic today), 7 definite surgeries scheduled—6 of which are Urogyn cases!—plus two possible big cancer cases that the team is still feeling out and praying over, 1 decent meal (supper after clinic, which we finished around 8:15), almost 11 hours in clinic, and started with 2 but ended with a FOUR person team—YAY for Hale and Anna making it safely here around midway through clinic today! (Just to prove it, here's Anna doing a fingerstick blood glucose-- yep, we threw her right in to working as soon as she got here!  Poor thing might sleep for the rest of the week after the day we threw at her…)

So, prayer requests:  Please continue to pray for Izabela, pictured below.  We admitted her tonight and planned to take some fluid off of her abdomen to see how fast it recollected, how much protein is in it, and keep thinking about whether we think it is safe to operate on her.  She actually looks and feels a little better tonight, so we are going to hold off for now and see if she continues to improve in the morning with your prayers and ours!  I’ve seen God do even bigger things, and I never discount it, so keep those prayers going up… but especially pray for wisdom for the team to do the right thing for her.

 

Esmirna is another really tough case.  She has a large cervical cancer tumor, and is begging us to operate to try to give her a chance of living longer or even surviving—or maybe just giving God some more room to work His magic.  It’s really an inoperable tumor that should go for radiation, but she flat out refuses to go for that since the last time they went to the cancer hospital her father died there—after spending their entire savings trying to save him.  “Not going to happen” was a very clear message, leaving a tough decision for our team. 

I really wish I knew in these cases, “What would Jesus do?” like everyone was wearing on those hokey bracelets a few years ago.  It would be nice if I could let her touch my robes in faith and be healed, but that just doesn’t seem like an option!  So it’s back to our knees and our time with The Lord, and hoping for clear direction from The Holy Spirit and some radiology tests tomorrow.  She is the lady in the green shirt in the other picture.

Tomorrow we have two sling procedures and a fistula repair.  Of note, we are operating on the hospital administrator’s wife in the morning!  So definitely wish us luck with that one… It would really be nice if that went well, obviously.  “Don Tono” has been a huge blessing to the hospital, the people of Quiché, and to us personally over many years now, and his wife Ofelia is a delight that we look forward to helping.

We are all exhausted and going to bed now, so I’m sorry about the lack of other details and fun stories~  We’ll try for more entertainment later in the week, but now it’s all about prayer… and sleep ;-)

Meet the Team and already an urgent patient/prayer request!

This trip is one of the most exciting I have had in a long time in terms of shear talent that I have brought with me!  The only disappointment (and those who know me well know it’s kind of a big one in a lot of ways) is that there are no students or residents here with us this time, but I’ve fully embraced the fun of putting myself in to the role of “learner” or student this week, and I look forward to gleaning what I can from Drs. Sylvia Botros and Hale Stephenson in the operating room.  Pretty sure that is going to be amazing.

So Sylvia Botros is an actual Urogynecologist—for those of you who don’t speak medicalese, that basically means she is actually trained and qualified and specializes in doing what we mostly do down here, which is prolapse and incontinence surgeries.  These surgeries are definitely a stretch of my own skills, and God and hopefully the patients know that I do the best that I can—but I can’t even begin to express how excited I am to see how someone with her skill set would handle these in this environment.  Not only will the patients on this trip benefit, but all of the future patients that I operate on.  Literally.  All of them. 

Sylvia is also another great example of how God is always working behind the scenes on these trips in ways that I just never even know about.  She was a fourth year resident when I was a first year at LBJ in Houston “back in the day”, and we really didn’t know each other well.  If any of you readers have ever benefitted from my “30,000 foot view” of urogynecology talk, it’s actually pretty much stolen from an informal teaching session from her in the parking lot of the hospital the day before our in-service exam that year we worked together.  We ran back in to each other at an APGO meeting a couple of meetings ago, and she is one of the probably 35 to 50 people a year that expresses interest in going with me on these trips.  I email the dates out and generally maybe three or four actually end up going.  Obviously, it was a sweet and pleasant surprise to me when she let me know a few months ago that she was on board for this trip!  I really look forward to getting to know her better and hearing more about her two kids and family life in Chicago.

Hale Stephenson has been down once before, some of you will recall, with his oldest daughter Elizabeth.  He is a very highly respected vaginal surgeon in Greenville and works with one of the private groups in town.  We had a great trip, and apparently the middle daughter, Anna, has been asking when it’s her turn ever since they got home!  She is in undergrad at Carolina, and apparently now it’s her turn.  They are delayed for a day—at least we hope it’s only a day!—to get a medical test done and be sure she is fit to travel, so please pray for clear tests and safe travels for them to join us tomorrow. 

For the new readers, I am Heidi Bell, and I’ve been doing these trips quarterly since 2008 when I joined faculty at East Carolina University medical school as a general OB/GYN after living in Guatemala for two years as a medical missionary after residency in Texas.  My husband Matt and I were newlyweds when we moved there together and a large part of our hearts belongs to the people and the country of Guatemala.  Our son Isaac was born here in 2007.  His little sister Micah followed here in North Carolina in 2011.  We attend Integrity Church in Greenville, NC, and have also been strongly blessed and supported by St. Luke’s Lutheran Church in Temperance, Michigan where Matt’s parents are members.  Agape in Action and New Beginnings Resources in Porter, Texas, continue to help with 501(c)3 tax paperwork as well as significant financial support for the patients that we operate on that can’t afford their surgeries—check them out at nbri.net and agapeinaction.org  --We have been amazed for years now by the continued outpouring of support for these trips both in prayer and donations of unused medications or expired/unused medical supplies.  Keep those prayers coming up and supplies coming in please!  

UPDATE NOW BEFORE BED AND URGENT PRAYER REQUEST:

1.  Hale and Anna are on track to be here tomorrow afternoon!  YAY!  All smooth sailing with that so far.

2.  At the hospital this afternoon when we stopped by “just to pick up the apartment key”, there was a patient waiting for us.  She looked pretty sick so we agreed to go ahead and set up the clinic early—there was a note from Leslie Ficker saying that she is 37, has been told she has a mass in her abdomen that needs surgery, and her abdomen is now full of fluid (which is often a bad sign of late stage ovarian cancer!)  After examining her, ovarian cancer—despite her age—is still at the top of our list for differential diagnosis, and the plan is to pray about her individually tonight, together in the morning, have Dr. Stephenson look at her with us tomorrow afternoon, and get together as a team to prayerfully decide how we can help.  The problem with operating is that we don’t have a way here to follow salt/electrolyte balances in the blood, which tend to occur with large fluid shifts with removal of the fluid in her belly.  Scary at best, very unlikely to do much more than buy her some time and let her know that we really did want to help and give her a definite diagnosis to take to the cancer hospital that she can’t really afford much treatment at.  Her husband is working down at the coast cutting sugarcane for the season right now, so her father and son brought her in.  She is quite debilitated.  Please pray for Isabella, the mother of eight (the youngest of whom is ten months old!) and for wisdom for our team this week especially!  We will try to get a picture of her up tomorrow...