God makes me laugh!

What a day!  Today God sent me Dr. Luis Aquino and Don Allison from Canilla' to help in the OR and the clinic-- huge, huge blessing to get to work with these guys and get to know them better! Great help in the OR, great help in the clinic, and great company.

Our three surgeries today went quite well, and we just saw the patients before bed and they all look good so far post-operatively.  Tomorrow we have two more vaginal surgeries.  We saw 7 more patients in the clinic today (more difficult than it sounds since we just had to hurry and see them between surgeries!) but didn't schedule any more surgeries.  We did unfortunately have to send one lady to the National Hospital up in Quiche for her gallbladder, though... bummer to be here without Dr. Tom!!

Here's how God made me laugh today, though-- At least two of our patients were "gentle" reminders of how sometimes He just has to shove me out of the way to get His work done!  (Or just hide my passport from me, maybe... ;-))

First one:  A lady who has been seeing both me and Tom for years now for non-descript pain and complaints-- always wanting surgery but never with any real indication for surgery or reason to believe that it would help.  In short, she was a patient that I had grown somewhat frustrated with and wasn't very fond of.  I know most of the other medical folks reading this can relate, but it's the simple fact of having a sinful heart-- some patients (or people) just rub you the wrong way, you know?

So-- some of you will remember that I arrived late to my last trip because I lost my passport.  Kelly Pieh-Holder, a chief resident at the time (Now GRADUATED!!!) did clinic by herself on Sunday and Monday.  When I arrived Monday night I went through the charts to see what she had scheduled and came across this lady's chart.  I seriously thought, "HOW did she manage to talk you into a hysterectomy, Kelly?!"  But it seemed that some of her prolapse had worsened and it seemed more reasonable-- plus Kelly had some concerns about some spots on her cervix and actually took biopsies before the patient talked her in to just going ahead and doing the hysterectomy.

Turns out (of course!) that it was a good thing that both the biopsies AND the hysterectomy happened-- this lady had carcinoma-in-situ in her cervix on her pathology report!!  For those of you non-medical folks, that means she had CANCER that just had not "invaded" past a certain level yet!  It could have progressed any day to a much bigger problem.  And now-- because God got me out of my own way long enough to get His work done-- she is cured.  Humbling.  And beautiful.

Oh-- and the pathologists only found the CA-in-situ because we "accidentally" sent the biopsies off separately from the uterus-- If I had realized we were sending them both, I would have thrown away the biopsies since we had the whole uterus and not paid for two pathology specimens.  They initially read the uterus as negative in the lab, but then saw the CA-in-situ on the biopsies and took another look at the uterus.  They had to call Tom and send an amended pathology report with this finding!  Again, "solo Dios".  I would have messed that one up, too, if left to my own "wisdom".

The other story is slightly less striking but still funny and exciting in its own way-- Back in 2009, Chris and I (I think it was her first trip down here?!) went to remove what we THOUGHT (by ultrasound and physical exam) was a large fibroid kind of hanging off the top of the uterus (pedunculated fibroid).  Turns out, we opened her up and found, unfortunately, that the fibroid was inside the uterus and basically taking up the whole uterus.  We were afraid to remove it because if too much bleeding happened, then she would have ended up with a hysterectomy.  She was in her late twenties and not married so had no children at the time so that was not a risk we felt like we could take.

Well, over the years a few things have happened-- (1) the fibroid has continued to grow to the point that she was ready to remove it even if it meant a hysterectomy and sterility, and (2) she got married.  In June she came to Dr. Tom to ask for the hysterectomy and he set her up for surgery.  So guess who showed up with a positive pregnancy test on her surgery day?!?!  Today we confirmed a live, 13 week pregnancy that appears to be situated below the huge fibroid and will hopefully grow normally.  Please do pray for sweet Eva, though, as this pregnancy will likely get uncomfortable for her quite quickly as the baby grows.

Tonight at dinner, I was so blessed to be able to hear more of Luis's story about how he and Naomi met and ended up in Canilla'.  What an amazing instrument God has in him!  Also loved hearing more of Don's testimony and just sharing the amazing things that are happening in our lives.

Hope you all are having half as great a week as I am~  I would still love to have some feeling back in the side of my left hand, but so far surgeries have been okay anyway so just keep praying!

Thanks and good night,

heidi.

Fun day in clinic! (Something you do NOT hear me say very often... ;-))

Definitely felt the presence of The Lord today, as it is not within MY power to see 22 patients with patience and without losing my good attitude at some point!  Actually finished up by just before 5 pm to boot... a miracle for sure.  Most of the patients were pretty straightforward, thankfully, and here are the stats for the day:

22 patients, six surgeries scheduled, 4 in-office procedures done (biopsies and polyp removals), just over nine hours.

By far the best part, though, was when one family finally told me why they looked so familiar to me-- they were there with the grandmother of one of our cleft lip babies from back in 2007 or 2008!!!  Maria Buchan was one of the group of 10 or so babies that we took down to Antigua for surgery over the course of a few months when we lived here.   Dad didn't have a photo with him, so he went home and got her to bring to me!  I was hoping he would bring her sometime this week, but there they were knocking on my door just as I finished with the last patient...  She is now 8 (must be nearly 9?)  and has two healthy little brothers.  Isn't she beautiful?!  (First picture before repair, too bad I don't have one on this computer from the front, but you can appreciate that she had a pretty gaping cleft even so...)

What a blessing to see her-- What other short-term mission workers in the world ever get an eight-year follow up on one of their patients?!!  Just another reminder of how awesome it is to be a part of what God is doing here in Guatemala.

I also couldn't help taking my first ever Guatemalan selfie with one of our operative patients for tomorrow... I actually got her to smile a little!

Tomorrow we will see whoever shows up in the clinic in between three major surgeries-- an abdominal one to remove a large abdominal cyst (Dr. Luis sent her to me, so he will get some good follow-up on that referral for sure!), then one "vag-a-thon" as we so lovingly call them (vaginal hysterectomy with repairs for prolapse) and one just plain old vaginal hysterectomy.  "Theoretically" should be pretty striaghtforward, but stay tuned.

Can't wait to have Dr. Luis and Don helping!!! Today did get a bit lonely... plus, I have to wash the speculums all by myself ;-)

Team "YO"

Well, typically my first blog entry on these trips is just letting people know that we got here safely and introducing the team for the week.  This trip is a little unique in that I am travelling by myself!  Can’t complain at all about the provisions God has made so far to help me, though.  I had 148 pounds of checked luggage to deal with, but not once did I have to lift more than one of the bags myself!  Matt got home from work this morning just as I was getting up to go to the airport, so he was able to drive me, park, and come in to make sure all of the bags made it under weight limits.  HUGE help.  Then here in Guatemala, there’s always luggage porters trying to make tip money so I gave in and let a guy help me today.  For around five bucks, he helped me load everything on a cart and get it outside (without being X-rayed; double bonus and thanks be to God!), where Don Tono, the Hospital Administrator, was waiting!

Sweet Aaron Ficker had apparently been way more concerned than I was about me handling the extra luggage weight (in fairness, nearly 60 pounds of it was airplane and car parts he had requested ;-)) – So he had arranged for a friend from Canilla’ to meet me at the airport and take two of the bags off of my hands right then and there.  “Easy-bo-peasy”, as four year-old Micah would say…

Now I’ve had a lovely time getting to know Tono and his wife a little better (we are usually too busy to get very far past polite greetings at the hospital!) on the drive.  Absolutely fascinating to hear about the times of the Civil War here (the early 80’s were the worst) and how the hospital got by with just two nurses and no supplies.  They had little to offer and brought in very little money on which to live.  This is just one of hundreds of thousands of families that have stories like this in the current generation, and was a great reminder of where some of our patients are coming from.  The burdens they carry with them are barely imaginable to a North American who has never truly wanted for anything. 

These gentle reminders from God to have a little extra compassion, spend a little extra time offering anything positive that I can, and to focus a bit more on appreciating what I have been given are all evidence of His grace.  Another HUGE gift is that I will be joined Monday by two of the best helpers I could even imagine having—Don Allison and Luis Aquino are coming to join me from Canilla’!!  Some of you will remember Don as a PA that has spent quite a bit of time down here off and on for the past five years or so, and is currently committed along with his family to at least two years (I think) serving in the currently-under-construction hospital in Canilla’.  He is a great clinician and a great man.

Dr. Luis is someone many of you have heard me talk about—He is such an answer to such a specific prayer that it is nearly mind-blowing!  In order to open the hospital, there must—by law here—be a Guatemalan native Medical Director. There was much anxiety for a while over who that could possibly be—where would we find a Guatemalan physician with a heart for the Lord and their people who wasn’t already neck-deep in their own work or ministry?  Enter Luis—A man to whom God had given the vision of serving Him in a Guatemalan valley for many, many years during his journey to become a physician.  He did his residency in Spain, so has first-world medical training also!  Apparently, when he first drove in to the valley where Canilla’ sits (photo below), he immediately recognized it as “his” valley (he had assumed the vision was more of a “generic” Guatemalan valley prior to that.  The rest is history, and he and his wife (from the UK) Naomi and their two sons Joshua (3) and Isaac (~18 months now?) are now here for at least three years!  You cannot be around this man without seeing his genuine love for the Lord and for the Guatemalan people, and I truly feel honored to know him and his family.  Can’t wait to spend more time with him this week~ just wish that Naomi and the boys were coming, too!

Tomorrow will be a long day, as I will do clinic all by myself—no small task, as most of you are aware!  (Ask Kelly Pieh-Holder about that from the last trip; poor thing!!!)  Please pray for patience for both me and the patients, and that God can use me to provide each of them what she needs.  Also, a strange but URGENT specific prayer request tonight: 

Since falling asleep on the first flight this morning, I’ve had the pinky side of my left hand go numb.  I assume I’ve ticked off my ulnar nerve somehow (from a position I slept in, etc…)—But I would have expected it to be better by now!  Operating with two numb/tingly fingers would obviously be sub-optimal, so I’m very much hoping and praying for full recovery – hopefully even before clinic tomorrow for patient exams!

So that’s all the news from Chichi for now—(I’m typing in the truck on the way up the mountain, actually—ETA around 20-30 minutes)  The country is beautiful now during rainy season—green and full landscapes and lush countrysides and gardens.  All the more evidence of God’s grace, my friends.

Wrapping up and continuing prayers needed

Wow.  What a trip this has been!   I think I last wrote on Tuesday or Wednesday, so a quick update is in order of course.  We finished up the surgical week with the vaginal hysterectomy and laparoscopic tubal removal for sterilization on Wednesday, then stuck around to help Tom with several more cases (hernias, gallbladders, and a thyroid) Wednesday afternoon and Thursday morning.  ALL of our patients looked fantastic Thursday morning and were discharged—even Aura, who had a major surgery on Wednesday morning, was asking to go home!  We felt comfortable sending her knowing that she lived near where we would be doing clinic this morning (Saturday), so off she went.

Sweet Micaela, the lady we operated on twice, may have looked the best of the bunch.  God’s grace and provision, clearly, since it could in no way be accounted for by the “perfection” of surgical performance.  It is so humbling to see families of patients bring us gifts on top of the financial offerings they are making to the hospital—from apples (ironically, imported from the USA!) and avocadoes to hand-embroidered hand towels since they know we “have to wash our hands a lot”, they are such sweet and generous thoughts. 

Truly, though, what really makes it worth it is the smiles we can occasionally even catch on camera like this one from Marta—she stayed one day longer than “usual” after her Monday surgery, likely due more to the fact that on Tuesday, she got the news that her brother had passed away.  He had been sick for a few years, but the news was still quite hampering to her recovery.  Wednesday was the funeral, and then a large group of family and friends descended upon her in the hospital that evening!  What a gift it was to be able to get this sweet smile after all that from her when I asked her to pose with “Flat Stanley” from my second grader’s class ;-)

Thursday afternoon we flew out to see firsthand ALL of the change and excitement that God is bringing about to His people in Canilla’ where our dear friend the Fickers live.  There are no words for how amazing everything is that He is doing there!  From a full-fledged university-affiliated nursing school (with 37 students enrolled!) to footings and walls being poured for a full-fledged HOSPITAL, to doctors and other health care providers coming out of the woodwork to volunteer faster than housing can be found for them all, to EIGHTEEN kids currently under age 10 running around the compound, to another airplane that has been donated and may be able to be flown down soon, and all around in everything in between, nothing is short of miraculous.  And yet all of it is just a tiny reflection of His Glory and Grace.

I’ll share a few more pictures to leave you with for the week—mostly just for fun. 

There’s the one of “Flat Stanley” taking a rest on some lovely coasters or doilies that one patient’s family gave to us, then him getting ready to go in to the OR with me…

Then Brittany enjoying the view of Guatemala from Duane’s Piper Aztec, en route to Canilla’ from Chichicatenango.  She was so carefree and easy-going this whole week!  What a great travel partner…

Then several of the hospital grounds, including one of me playing (and losing) “king of the mountain” with Jacob and Joshua Ficker (Ryan and Katie Ann’s boys), and one of the well drilling rig that is due to start drilling any day now (it was promised in January…), and the final hospital plans for any who are interested.

We then move along to the nursing school to see Katie’s first day of TEACHING CLASS in the newly-built “wing” of the school dedicated to the nursing program…

And the last are just for fun:  Chris, Tony, and Caitlyn playing on the swingset, Abi and Grace posing for us with “Flat Stanley”, “Flat Stanley” getting ready to take off in the Cessna, and the hospital grounds from the air…

We will leave you finally with a few shots of the volcanoes seen from above the clouds on our way back down to The City this morning—I will never tire of that view!

Please continue to pray with us for healing for our patients, and spiritual growth and renewal for Chichicastenango, Canilla’, Guatemala, the US, and the World.  God bless you all.

Long Day Today

So it's 10:15 and Tom just started his second-to-the-last case of the night!  Suffice it to say it has been a long day... We had two add-on surgeries in addition to the four major cases we had scheduled, so it really has been one of those days.  God is good, though, and it is a still a privilege to serve here with people who tirelessly continue on anyway!

The first bit of good news is that our patients from yesterday looked great this morning... Here they all are, hanging out in the sun and getting some fresh air on the hospital balcony.  I can't prove it scientifically, but I swear that it must be healthy for healing!  We'll hope so in their cases anyway...

Aaaaaannnd Chris got to visit a bit with Caithlyn also... even for lunch and a consult or two!  I love the "more the merrier" attitude towards everything-- even a medical consult and ultrasound-- here in Guatemala.  They really are a close and loving people, and couldn't be more pleased especially to welcome a cute baby girl in on the action!

The good news in this picture here is that we are doing a successful laparoscopy here in Guatemala!!  The bad news, though, is that the bluish hue you see in the upper right of the TV screen is the radiopaque string of a laparotomy sponge... You medical types will know a bit more about what that means, but suffice it to say we had to go back and fix a boo-boo.  Praise God-- as always!-- for sending such a clear word through the Holy Spirit that we had left the sponge in the first patient as we were operating on the second... and God bless sweet Anastacia's family for being probably less upset about it than we were... Yes, complications happen.  Even mistakes.  Doctors are human-- and I think that goes double for me sometimes.  But thank God-- again-- for the resources to deal with them safely and for recognizing them early.  Didn't help the surgical schedule any, though...

Going to check again on the patients now as Tom finishes up a laparoscopic (!!!) gallbladder, then will see if he needs help with an emergent amputation that came in today.  A young man had some type of unexplained injury while drinking on December 22nd.  His foot was badly injured and there were some fractures in the leg bones.  He spent two weeks at the National Hospital here in Quiche, but then left AMA (against medical advice) when they recommended amputating some of his toes.  He has since tried to go back for treatment, but the clinic has not been open since the doctors have been on strike.  (I'll refrain from offering commentaries on free government healthcare at this point... ;-))  Anyway, he now unfortunately has a completely more-or-less mummified foot that will need to be removed in order to clean the injury to a point that it can be managed and heal!  28 years old.  

We also saw six or seven patients in clinic today, and a little drunk man that approached me in the pharmacy across the street asking for help with some prescriptions.  His wife had a C-section Friday and was discharged with prescriptions from the hospital.  He was "responsible" for getting them, but had apparently drank the money for them at the local watering hole before bothering to pick them up.  What a mess he was!  He is in a Baptist Church here (or was at one point...) and knows The Lord.  He knows he is in sin and needing a change.  We pray that he will bring his wife to see us tomorrow since we gave him a free appointment for her, and that there will be reconciliation in his life and in their marriage.  

Again tonight, we are thankful for so many, many things.  We hope you are, too!

Eclectic Mix Today!

So today was a busy but productive clinic day!  And I even had another new "first" even in Guatemala-- a rarity these days really...  Started the day off with a phone call from Dr. Chris, letting me know that their flight had been cancelled because the Guatemalan airport was apparently CLOSED because of volcanic ash from "Fuego" in Atitlan... So they are rescheduled for tomorrow and it looks as if they will be clear then!  Never had a trip delay for a volcano before...

Anyway, we got up and even got a few minutes in the market before getting started, saw 18 patients (3 more had signed up but left before we called them even though we were done by 4:30 which is pretty early by my usual Sunday standards!)  So we even got to get in some hot chocolate with guacamole and a side of great people-watching as they packed up the market for the day, and a gorgeous dinner with Tom and Jana. 

Today’s patients, as usual, were quite an eclectic mix… maybe even more than usual today even.  We happily scheduled six surgeries though.  (For those interested, four “vag-a-thons” and two simple vaginal hysterectomies—definitely a theme!)  We also saw a couple of young ladies for cysts and what-not, a middle-aged lady with a mass in her butt cheek (not a gynecological problem, but who’s keeping track?!), and a sweet little 75 year old whose family is convinced that all of her problems started when her uterus “fell out and hit the floor” with the birth of her second son about 50 years ago… as you can imagine, I had to do a little translating for Brittany on that story!  Other than that she kept up nicely ;-)

Please pray for our surgical patients for the week:  Tomorrow we have Anastacia for a vag-a-thon (unfortunately caught her with her eyes closed!)  Her sweet daughter-in-law was tearful after our prayer with her and very anxious for her safety!  She has 9 children, but they are apparently all daughters!  So yes, definitely pray for Anastacia… ;-)

Second up will be Micaela, a sweet patient that Leslie sent that is a “frequent flyer” at their clinic asking for help with her heavy bleeding.  Apparently a few weeks ago she felt weak from bleeding and called the ambulance.  Four hours later when they showed up, they took her to the health center and gave her a shot of vitamin K which supposedly helped some.  Probably time to go ahead and get that uterus off her hands, don’t ya think?  Please especially pray for her husband, who is NOT in the Church or willing to go/hear about Christ although she is.  As a matter of fact, it was the ladies in the Church who apparently told her that she definitely needs her uterus out.  Occasionally those Church ladies get it right ;-)

We will round out the day with Marina, who Tom has been seeing for similar problems and who is ready for surgery!  Her husband was actually quite sweet trying to talk her back in to it when she considered backing out, reminding her how long she’s been miserable with this!

Also remember to pray prayers of Thanksgiving for the lives that we all have been blessed with—not like Manuela, who only has 3 of her 10 children still living and needs surgery which we will hopefully be able to do for her in April (her tissues need some preparation and her diabetes needs some better control first!)  Or like the men and women we watched carrying ridiculously heavy loads after market today—only to do it again on Thursday and next Sunday to try to make a buck or two.  Also pray that Manuela and another patient with a very similar story will find their way back in April so that we CAN help them surgically.

The last picture is of our future rising ER doc posing in the doorway of the “Emergency Room” here at the hospital—it’s actually a single room equipped mostly with some stretchers and a couple rolls of gauze!  Not exactly your level 4 trauma center, but we do what we can…

Thanks for your prayers.  God is good.

Safe arrival and meet the team

Always, always thankful for safe and uneventful travels, but this trip was even BETTER than usual because now I live 10 minutes from the airport!!  Beats the dirt out of getting up to drive at least an hour and a half to the airport.  I didn't even have to leave the house until 4 am, so I got to see Matt when he came home! Bonus.

So tonight there are just two of us here in Chichi, but it's SOOOOooooooooOOOoo nice to have Tom and Jana in the country and upstairs again!  They are doing a back-and-forth from Guate to the US schedule these days and my dates haven't lined up with theirs in a while.  Praise God for that joyous reunion!  (And double-praise him for their cooking skills; they are amazing!)

I'm travelling this week with Brittany Walsh, a fourth year medical student from ECU-- She is actually going in to Emergency Medicine instead of OB/GYN now, but we kind of bonded and planned this trip back during third year when she thought she would go in to OB.  Her continued strong interest in women's health, though, as well as great attitude and easy-going personality, will hopefully lend itself to a great week all around!  Here's a selfie we tried to take, but I really stink at taking selfies and we're also pretty much in our PJs for the night already, so we hope you'll excuse our travel-weary look...

Tomorrow afternoon or evening we will be joined by Chris, Tony, and Kaitlyn Schwering from South Carolina, who our regular readers will remember as the OB/GYN, her husband and baby girl that have been coming down with me and/or on their own since Chris was a resident at ECU!  I'll have to get her to tell you how many trips; I've lost track even of my own but I'm pretty sure it's in the 20s since moving back to the US in 2008.  Wow.  God is good.

So many updates!!

Well, here I am on the plane again home.  Except for the fact that I will have to travel through Miami (my least favorite airport on the planet so far…), it should theoretically be a smooth day—and most importantly, now less than 14 hours or so before I get to see my family again!!!  As a bonus, it sounds like Matt will be home around the time I get there tonight, so I get to see him FIRST! 

I find my head is nearly literally spinning with all that I have seen, learned, and been convicted to pray about this trip!  So if you feel inclined, please join me in prayer first for a few special patients—there is a lady who likely has severe preeclampsia very early in pregnancy who did NOT, unfortunately, come in to clinic for us to see her today.  She was told she needed to be delivered by the National Hospital in Quiché a couple of weeks ago, but refused since her infant would not live due to prematurity.  Now if the diagnosis is correct, both lives are in danger.  So, we pray. 

And another sweet lady who has lost two pregnancies, including one that was a two-pound baby born prematurely after her bag of water broke too early, and is now pregnant with her third.  We have little to offer her, either here or in the U.S., for prevention of preterm labor or PPROM, but we did are going to be able to start her on progesterone injections just like we would do in the U.S.—and lots of prayer, which is likely more effective.

There are several patients struggling with infertility, which is a huge issue in Guatemala as anyone who can’t have kids is so likely to be left by their spouse for someone who can.   And then there is sweet Cruz, the lady whose bladder fistula we fixed on our last trip…

Apparently, Cruz’s husband hasn’t really spoken to her since her surgery, for some unfathomable reason.  For the first time in many years she doesn’t reek of urine constantly, but he’s mad that she accepted surgical treatment instead of “just taking a pill or something” (which doesn’t exist)!  She is still smiling somehow, though, since he has not become physically violent or anything and the kids are still friendly towards her.  He could use some pretty serious prayer in his alcoholic tendencies for sure!  It wasn’t even a money issue; she only paid about $12.50 for her surgery if I recall correctly.  From a medical standpoint, though, we can give thanks that her recovery has been smooth and she is doing really well!

In terms of what God is doing down in Guatemala, though, there are many, many prayers of thanksgiving to pray—as well as some specific ongoing needs to lift up!  The Ficker family, my dear friends, continue to ask for wisdom and patience (as well as continued economic resources) as they are meeting so many new people who want to help with the hospital project and trying hard to discern what is best for everyone.  This hospital is happening, my friends.  The property is purchased and paid-for in full, ground has been broken and is being prepared for construction, fencing is going up, and plans are drawn!  We definitely need to pray that we all continue to stay on the same page (God’s) as much as possible and that all of this is done to His Glory. 

Pray for the doctors who will be working here at the clinics and in the hospital—for wisdom, favor on their families as they work, peace of mind, and unity of thoughts and goals.   Pray for the nurses who will be graduating from the Nursing School that is now open, that they will be faithful providers of loving care for the patients.  Pray that some people with pastoral care gifts will show up with a heart to serve the patients and staff full-time.  Pray for me to continue to stay focused in prayer for these things.  Pray.  Pray.  Pray.

(Little David "helping" Mom in clinic, and playing outside with some new friends he found!)

And remember, God is good.  God is in control.  God is faithful, and God is working in Guatemala as you read this!  Pray that they would see His faithfulness and His love through the service of the missionaries there and that they would KNOW HIM. 

(And in case anyone missed the fun of our "ice bucket challenge", here are some more clips and pics…)

"Home" sweet Canillá!

Well, those of you who have ever talked to me for more than a few seconds about Guatemala know how much I do NOT mind having to spend a little extra time out in Canillá this trip!  We got to fly out here yesterday and spend the afternoon catching up, chasing kids, and unpacking treats.  It's so awesome to see firsthand what God is doing here and all of the projects going on.

Ground has officially been broken for the hospital, of course, first of all.  The Nursing, English, and Premed school is up and going strong.  The new home has been moved into, and renovations are under way to turn the big house in to two apartment homes for the doctors who will need to stay here.  Work is being done on laboratory equipment, the pharmacy, the water system, fences, and hearts!  Days are long and nights are short, but love abounds and most of all we see so very, very clearly the joy of serving Christ lived out in a way that few are privileged to see in this world.

The Fickers (and all of the "honorary Fickers" that are part of this place) are an amazing family, truly on fire for The Lord and His work.  Read more about them, if you haven't already, at adonaiinternationalministries.org and be sure to link to some of the blogs from there.  And if you ever have any extra funds lying around and are looking for a way that they could go to further the Kingdom of God here on Earth, feel free to send them here ;-)

Today we got to do clinic in Chumisa-- Leslie, Dr. Jared Cardwell, and I saw about 100 people with just our two Quiché translators, who are likely even more exhausted than we are tonight!  About 30 prenatal care visits and bazillions of general consults later, I do have some pictures and stories to tell… the first pictures are just of beautiful Flor, one of our translators, and some of our first prenatal patients today.

Flor has really gotten good at ultrasounds, and it was fun to work with her some more today on doing prenatal care and being sure to point out what is abnormal and how to deal with it.  One example is a lady who is just 14 weeks pregnant and has very high blood pressure, which meets the criteria for a diagnosis of chronic hypertension even though she is very, very young!  We went through what we would need to do to manage her and what to watch for in this pregnancy and if you all could continue to pray for Manuela Barrera, that would be great.  

The last picture is one of our last patients-- he is 87 years old, and his complaints were that he can't see or hear and has no energy to walk in his legs!  (Never mind that he probably walked many miles to get to clinic today)  His ears are clogged with wax, although he probably has some age-related hearing loss, too.  His eyes are blocked with cataracts.  And his legs are really just fine but understandably tired!  The picture doesn't really capture what I was trying to, which was him leaning closely in to Flor as she was yelling near the top of her lungs to tell him about his treatments.  After that failed, the man standing next to him tried the same thing at even louder volume.  Everyone got a kick out of it, and I'm not at all sure if the man understood any of the instructions but he definitely felt paid attention to!

Tonight we are all relaxing around a table full of tacos and hopefully will rest a bit this evening.  Not sure what tomorrow holds, but then… do we ever really know that?

God is good.  God is sovereign.  God knows.  And that is enough.

Wrapping Up… Already?!

Well, this has been a strange and short week, but we did find out that the "feria" (Fair or celebration) for one of the Saints is in Quiché just up the road this week.  That is the reason no one is coming in to be seen!  Even the hospital waiting room, which usually looks like a kicked-over ant hill, was empty before 9:30 this morning when all of the consults (maybe ten total, five were ours…) were done!

So that means tomorrow we will go ahead and go out to one of the happiest places on Earth for me-- Canillá with the Fickers!  Can't wait to see them again and catch up; God has truly blessed us with amazing friends and Godly counsel through them for years now.  Can't wait, also, to see the broken ground for the new hospital with my own eyes!!  Melissa and Jared are looking forward to getting back to their own sleeping quarters there, too, I'm pretty sure.

Tomorrow we will, of course, round on our patients and likely send them both home.  They looked fantastic this morning!  I am convinced anew every time I come down and operate here that the fresh AIR here in the hospital courtyard where patients recover is just good and healthy for them.  No, my academic friends, I of course do not have any data to support this.  Might be an interesting study to try to figure out though!  It warms my heart each time I see a patient of ours sitting out in the sun with her friends and family as she recovers.

Thursday will be a long and busy clinic day with the Fickers-- it's a clinic they do once a month in a rural area (the one just outside of Cruz Chich that I can't remember the name of for those of you who know the area…).  It will be nice to feel useful there, I hope!  I'm hoping I'll get to do some prenatal ultrasounds with Flor in pseudo-teaching mode ("pseudo" because she is pretty much at least as good as I am with them by now…)  Then maybe I'll do some "translating" for Jared and Melissa and learn a little something more about primary care from them surreptitiously through that ;-)

Today's pictures are random but fun… and oh-so-Guatemala!  The first one is a sweet patient of ours today who was just as enamored with David as everyone else who sees him… I love how this culture loves and cherishes children even more than ours, and how no one is ever concerned about us having a small child running around or even making some noise during their consult.  They really live out the "village" concept of raising children (since typically enough people to fill a small village may live inside the walls of single home anyway here!) as well as caring for the sick, widowed, or poor (-er than themselves).

The greatest part about mission work is that I learn more from it than I teach any of them, I am sure.  Even after two years living here and six years now of quarterly trips (over 20 total!), I learn something new or at least appreciate some of God's graces anew each time I come.  I am so blessed and fortunate to be able to continue having these experiences, and I pray they never end.

Oh-- and the second picture (I lost my train of thought for a second, "shockingly"…) is even more classic Guate clinic-style--

Yep, that's little David with Play-Doh in one hand and a (CLEAN) speculum in the other!! What can we say?  An 18-month old is GOING to be curious about what's in the bucket on the floor, right?

And with that fun thought, I will sign off for the evening-- be sure to check out Docs for Hope when you get a chance at  www.docsforhope.org -- what an amazing work God has done in and through them to turn this hospital in Canillá in to a reality!

And we're off!...

… to a rather slow start to the week, to tell you the truth!  We saw only 13 patients today, which would be awesome if more than ONE of them could have been scheduled for surgery :-/  My prayers will now be strongly renewed for God's continuing work and purpose here for me, as I always get a little paranoid when the numbers dwindle.  I'm also going to be praying even harder for Tom and Jana Hoak, as they continue to try to work out a plan that shares more time with their family and friends in the U.S. while continuing some work down here.  The hospital is much quieter without them around (and NOT in a good way), and I personally miss them dearly!

So now paragraph two after two heavy prayer requests already-- time to lighten up a bit maybe?!  We did have some delightful patients in clinic today, and I for one really enjoyed working with our mixed Guatemalan-U.S. group of physicians.  Lindsey and Paul were a great help and joy to have around.  Dr. Jared was also awesome-- so patient and wise, and working really hard to master some more Spanish but starting to catch on a bit!  

So the patients we saw today-- the only one I remembered to take a picture of is Maria Ren, the lady we will operate on tomorrow.  She was there with several of her 11 living children who are also pictured, and you can see Dr. Paul in the background also.

Unfortunately we had another lady who really could benefit greatly from vaginal surgery but had a blood sugar of 466!!  Fasting blood sugar was only 237, but we figured it would be a lot better to wait and get her sugars under control first.  So, Chris Schwering, that is our gift to you in November (assuming the metformin we gave her will be effective).

The best part of clinic by far, though, was that being less busy we really had some time to just have some fun with patients-- We had one patient that initially confused us, since she had three different daughters translating and often giving different stories!  My favorite part is when we asked if she has a husband-- one daughter said yes and the other no!  Dra. Lindsey picked up right away that she actually has a "boyfriend", but the girls's father has passed away.  I was just baffled by the higher difficulty level of that question than I had anticipated.  We all had a good laugh, though, which is healthy and fun.

We also had a little fun in the market and teaching little David to "meech" or be tied on Mom's back like a Guatemalan baby.  Both Mom and David were pros by the end of the day! The first picture here you can see he's not quite sure about this new deal, but I love the family shot on the way to dinner of the Cardwells…

Our last patient today actually just came in asking for a pap smear, which I have had happen very rarely here in Guatemala.  It is always nice to see a little bit of progress being made in preventive care education!  "Poco a poco", my friends…  (little by little)

And as we go to bed tonight (at a little after 8:30, although we all feel like it MUST be 11:00 or so), we are so blessed to know that God is good, God is sovereign, and God is IN CONTROL.  We will see what tomorrow brings.