Two Days in the Life of Chichicastenango...

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

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

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

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

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

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

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

Clinic Sunday!

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

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

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

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

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

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

Long but Smooth Travel Day!

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

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

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

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

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

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

Back Home Again

Just a quick "wrap-up" note to let everyone know that we made it back home safely late on Saturday night-- Many thanks to Tom for driving Pat and Monica and Duane Ficker for flying me down to the airport Saturday on time and safely! I was so glad to be able to make it out to the Fickers on Friday to visit with them; please pray that they will continue to receive the support and guidance from God that they have faithfully relied on for more than 10 years now!

It is always good to be home, but it is also always sad to leave again... It is such an amazing thing to always have a return date already scheduled, though! All of our patients have done well so far post-operatively, and they will all follow up with Tom within the next few weeks. He will also be able to follow up on the pathology results from some of the surgeries we did, which is such a blessing! Please continue to pray that especially Nohemi's pathology comes back benign.

We are also praying very hard now for another surgeon that can accompany me on my next trip to Guatemala in August-- Dr. Tom Hoak will be in the U.S. during that time to get his daughter off to college. I am not sure that operating by myself with no back-up or anyone to bounce thoughts and ideas off of prayerfully will be the right thing to do-- Please pray for both guidance in this area if no one steps forward or for someone to step forward that can come help! We know He has a plan, and just pray that we are mindful of it at all times.

I pray that someday each of you reading this will have the opportunity to be blessed even nearly as each of us participating in these surgical trips has. I will write more when our August trip gets closer, or if we hear something back on pathology reports soon.

Thank you all for your continuing support and prayers!

Some Fun Before We Go...

Oh, how nice it was to get everybody out of the Operating Room and all of the scheduled patients seen before noon today! Monica was nice enough to help Tom with a hernia repair surgery he had scheduled which gave me time to finish up the consult patients and be ready for our second case. She was a young lady with a breast mass that is almost definitely not cancer-- we were able to remove it under just local anesthesia, which she appreciated since she would like to be back at work as a teacher tomorrow!

All of patients-- thanks be to God!-- looked pretty good this morning when we rounded, and slightly better even this afternoon before we left the hospital. I will check on them again this evening, and hopefully send them all home tomorrow and not have to leave Tom stuck rounding on anyone.

We then treated ourselves to a nice buffet lunch together, which really was a treat considering how little time Pat, Monica, and I have had together all three of us at all! We picked up a few last minute "needs" in the market and this afternoon are mostly cleaning up and planning for tomorrow.

We are still praying for negative pathology reports (i.e., telling us it's not cancer) on Nohemi, Maria, and another Maria especially, so please keep those especially in your prayers.

We still don't have a straight story on the lady that came in "just for an ultrasound" and we found the postmenopausal ovarian mass, but we are fairly certain she does NOT know Christ (although she considers herself Catholic, her neighbors consider her also to be a "witch"-- and unfortunately the Catholic Church down here has suffered from so much syncretism that those two are not mutually exclusive anymore!) We also found out that her son actually owns one of our favorite restaurants in town, so we did ask her to kindly pay her whole bill and not just the tiny bit she claimed to be able to pay before she left. This she did, to her credit, without grumbling-- I guess she knew she was essentially "busted".

It is always frustrating to know that would certainly not have been the first time we were taken advantage of by people who really do have the money to pay for their services, but the "Serenity Prayer" has been the only thing that has ever helped me come to grips with that in my years here...

"God, grant me the serenity to accept the things I can not change, the courage to change the things I can, and the Wisdom to know the difference..."

I hope that my Grannie is looking down and smiling on me quoting those words I first learned from her needlepoint sampler that still hangs in her old apartment, as I struggle to truly rely on God's sovereignty even in our human need for his unending Grace at every level.

Amen.

Oh-- and the pics are mostly just for fun today... One is a "paycheck" from one of the patients, that brought us these beautiful plums from their tree (one of my all-time favorite Guatemalan treats!), one is of Pat feeding the Parrots at the restaurant (tortillas, of course! What else would a Guatemalan Parrot eat?!), and then there's the beautiful view out the back window of the resaturant (Try to imagine if that were a real waterfall and not just a "waterfall of trash" as one of our students once dubbed it ;-), and the other is just some of the patients waiting around to get well! Thanks be to God that they are indeed well on their way...

Operating and More...

Well, last night we were too exhausted after a pretty grueling day in the OR to write anything, so here's a quick catch up... Yesterday was one of those days when we just couldn't get anything to go right-- From not being able to start our first OR case until nearly noon to having to stop and change the tube in the bladder out because the first one wasn't working to running in to more bleeding than we wanted to calling Tom because I panicked and thought I had cut in to the intestines to... well, you get the picture. The ladies who work in the OR thought it was a spiritual attack brought on by the fact that our patient practices some witchcraft, and I'm not at all sure I don't believe them!

Thanks to all of you who have been praying so faithfully for us, today was a million times better and one of the best days I've ever had down here! The patients from yesterday looked fantastic this morning, the one from Monday went home, there were only three consults waiting for us, and four good surgeries scheduled. For the first time this week, we actually got all the scheduled cases done today! Tomorrow should be a relatively light day in theory, so maybe we'll have time to catch up on odds and ends (and shopping, of course!) that have eluded us earlier in the week. There are several of the nurses at the hospital that want to talk to us about something or other so we can finally see them tomorrow maybe.

Today we have a few fun pictures to share also... One is of Monica receiving a random but much needed shoulder rub from a young girl who came with her mother for her consult today! Never mind that they had been waiting by that time a good five or six hours to even see us and we had relatively little to offer for their non-gynecologic problems-- The girl saw that we looked tired and took over trying to help US out, which is just another example of the spirit of the Guatemalan people we are so privileged to serve.

Warning: pictures that follow are not for those who really don't like gross stuff...

There are also some pictures of a great big uterus that Tom and I took out at the end of the day, which was actually a lot of fun considering how smoothly the surgery went. Also pics of Tom and I operating (Monica was nice enough to be operating the camera for this one) Monica got to be a little more involved on the cases today since they were going more smoothly, which was a blast for me (and hopefully for her, too!) to get to have her open up and close up her first surgery!

Thank you all for your continuing prayers-- We really felt them today in the operating room and in the Hospital in general and are feeling refreshed even after such a long day by being reminded once again how great our God is.

First OR Day-- So far, so good!

Well, more or less good anyway... Always a few set-backs, but nothing that we won't be able to work out. Today started off less stressful-ly than I was prepared for, which was good and bad in a way-- only 8 total patients came for consults with us, when we were expecting more like 15 or so from what we were told of how many were turned away yesterday! I'm worried that people didn't bother returning, even though I tried very hard to explain to people in the waiting room in one long "speech" about how we would see everyone that showed up even if it was today or Tuesday... But we just have to continue to trust that God sent those that needed us and do our best to help those that come.

We scheduled three more surgeries today out of clinic, which we were able to mostly get done before we got started in the OR. Then Monica and Tom went up and did a prostate surgery (slightly outside the scope of most general OB/Gyns...) while I finished up clinic, which made starting our vaginal case much less stressful with no one waiting on us. The case-- a vaginal hysterectomy with anterior repair, culdoplasty, and perineorrhapy for a complete prolapse for you gynecologic types-- or what we often affectionately refer to as a "vag-a-thon" for the others!-- went quite well overall but was very challenging. We will pray that she recovers well and doesn't have her problems recur in the future-- her name is Maria.

Our third case today was supposed to be the lady we blogged about yesterday with the ovarian mass and no complaints, but her labwork showed that her hemoglobin (measure of anemia) was at about half the level it should be (7.3) and we needed to get some blood donated for her before we could safely start! The husband's blood type was not compatible with hers and they only have one son in the area whose blood type they don't know, so it was looking a little iffy for a while. Then the family members of the first lady we operated on offered to "donate" theirs for her (for a fee, of course... I stayed out of those negotiations!) and we thought we were back in business.

Then we got set back again by the laid-back culture of Latin America-- It turns out that the lab tech, who is of course the only one in the hospital who knows how to crossmatch the whole blood and test for HIV and Hepatitis before transfusing it, decided to stay "a few extra hours" in her home town a few hours away this weekend and wouldn't make it back until tonight. She is usually back around 3 or so on Monday, but not so much today... So to make a long story short, we managed to send the men up to another private lab in town with some blood storage bags we found in the lab here, where they donated and brought the blood back. It is now waiting in a refrigerator overnight until it can be screened and prepared tomorrow and this lady can finally get her surgery! Of course we already have a pretty full load for tomorrow, so we'll see how we end up getting through it all. Somehow we will manage with God's help; we always do.

At least we got to take advantage of our early evening by a nice dinner out with some other local missionaries-- thanks to Roy, Erna, Sally, and Ervin for such a great time with old and new friends!

Will let you all know what tomorrow has in store...

Pictures today are of Monica and Tom operating on a prostate, then the "obligatory" first uterus picture of me and Monica after her first hysterectomy that she scrubbed in on! There's also one of the upcoming women for surgery with her husband in the courtyard of the Hospital, which is looking a little better every time I come down. What a lovely place to be called to work...

Long Clinic Day

First of all, a quick HAPPY MOTHER'S DAY to all of my favorite Moms out there... Hope you got a little more pampering than we did today! ;-)

Today was a great day, but quite long-- started out to market around 8 or so after going to bed around 8 last night, so at least we started out well-rested! Monica got to experience the market for the first time, and Pat was there to faithfully help shepherd her through and give her the personal shopping experience that only Pat can... Then we hopped up to Church at the Hotel, which was another great service as always. Then it was off to the races when we arrived to a "standing room only" waiting room at the hospital!

We saw a little over 20 patients today, which won't sound like many to some of you but it took us almost 8 hours... We write up pretty full histories and physical exams on them all and try to make sure they all leave feeling like it was worth their while to wait the 8 hours to see us, which is sometimes more challenging than others of course! Either way, it was more than I've ever seen in a day at this clinic by at least 25%, and we turned many away to come back tomorrow. So there's no telling what tomorrow will bring, but God will provide for whatever He sends our way...

So speaking of what He is sending, our most interesting patient of the day was the 9th one we saw-- she was the first patient we saw that literally had no complaints-- she just wanted an ultrasound to make sure everything was OK "before I get any complaints from anything". She literally repeated and harped on the fact that she had no complaints until Monica learned that word quite well in Spanish! So we figured this one would at least be quick and easy and we could give her what she wanted as we walked over to the ultrasound room. It got less quick and easy when we diagnosed an ovarian mass the size of a small orange (she is post-menopausal so this is particularly concerning) and set her up for surgery tomorrow! I am now quite suspicious after reviewing some blood work that she may have ovarian cancer. If she does, though, it will be picked up early and maybe even cured without further treatment. Those of you who know anything about ovarian cancer know that this is rarely the case, so praise God for sending her today! I do not think she knows Christ personally yet, so please pray that we can really use this opportunity to minister to her and lead her to Him.

Please also pray for a young lady-- in her 40's, I think-- who has inoperable cervical cancer and likely only a few months or so to live. There is nothing I can do for her but hug her, pray with her, cry with her and her husband, and give her some pain medication. As a physician, those are some of the hardest times. As a Christian, though, it was a huge relief to know that she knows The Lord and is planning to spend eternity with Him in His kingdom. We will see her there someday and it will be a joyful reunion.

If any of our old regular readers remember the young lady that we tried so hard to help with her breast cancer a few years back (Maria was diagnosed while both pregnant and breastfeeding-- no-showed her mastectomy, tried some "faith healers" and such then finally did go to The City to get treatment but way too late...), we saw her family in the market today and they seem to be doing well. The first picture is a picture that I took of her husband's cell phone-- He has her picture as his home screen, which I thought was a beautiful reminder of her this Mother's Day. I get to see one of her daughters and her husband almost every time I come down, which is a great privilege in my travels here to have such continuity with a family.

We also scheduled several vaginal hysterectomies for prolapse, and a bladder evaluation (cystoscopy) for a lady with no prolapse but lots of bladder complaints and blood in her urine that is unexplained. I'll save some of the other clinic details for tomorrow or the next day; I guess y'all get the gist of it by now... the other pictures are some of the ladies we will be operating on this week, and the last one is just for fun, showing the "glamorous" side of gynecology which Monica snapped when I had stepped out to wash some speculums!

I did have at least three patients today that I had given appointments to come back and see me myself, which is always exciting-- one post-op from February and two other follow-ups for an abnormal pap smear and fibroid uterus. It is always wonderful to start those relationships and be able to provide continuing care, even when you're only here every three months! What a privilege, and what a wonderful way for God to prove just once again how good He is...

Quick Update Before BED!

Just a quick note to those of you out there reading that we are here safely for the night.

GOD IS GOOD.

Tomorrow will be another long but exciting day, so we are pretty much tuckered out and ready to turn in, but I thought I'd post a quick photo of Monica and Pat (they asked me to remind everyone that this is around 5:00 a.m., after getting up to travel starting at 2 a.m.-- they weren't exactly thrilled with me for taking it, but I think they are beautiful! ;-)

Monica is on the left, and Pat is on the right... just to put "faces with names" for those of you praying with us this week... Good night!

Ready for Take-Off!

Just a quick update now from RDU airport, where we have arrived safe and sound, with all luggage checked through and no issues so far! To introduce you to the "team" for the week, it's me (Heidi, OB/Gyn), Pat Peabody (a CRNA or Nurse Anesthetist who will be running anesthesia for us and saving us TONS of time and money-- this is her third trip down to Guatemala with us and she has become quite the tour guide!), and Monica Horne, one of the Certified Nurse Midwives on ECU's Faculty with me-- her first trip out of the country ever so please pray for a good experience for her especially! I am excited to have her helping me out in both the clinic and the operating room this week, and you never know what God will send us in the way of babies needing to be delivered since I'm bringing an expert with me... It really does tend to work that way.

Please pray for safe travels and some rest for us today-- we all got up before 2 a.m. to get here to the airport! Also pray, as always, for the patients that need to be seen to show up and that each patient walks away with what they need or what God wanted them to have from us this trip...

Thanks and God bless you all! We are boarding now so I'll try to update again probably tomorrow night after a full day of Church and clinic...

Preparando

It's amazing how time flies. It seems like Heidi just got back to the US from her last trip to Guatemala and it's already time for another one.

The team this time is Heidi, Pat, and Monica. Pat has been several times already but this is Monica's first time. Please pray for their preparation and safe travels.

Plane tickets have been purchased and a packing party is imminent.

We'll post more details as we get them.

Back Home Again To Reflect and Give THANKS

Well, we didn't manage to get a blog post up Monday like we tried, but hopefully we can still go with "better late than never" for the follow-up?!

Anyway, we've all been back in the full swing of things in our clinics and at the hospital, so Pat and Carrie and I have seen very little of each other this week. I know they have both had some opportunities to share some of their own stories from Guatemala last week with colleagues and friends, though, and for that I am always thankful.

Our week finished up relatively without incident-- Glory to God for seemingly very safe healing of all of our gyn surgical patients, who all went home on Thursday! Thursday we had another few general surgeries-- a gallbladder and two biopsies on possible enlarged lymph nodes in a brother and sister from the same family. We also did a more involved case on an older gentleman that Tom had been observing for a day as an inpatient, who had come in with severe abdominal pain overnight on Tuesday. He was finally starting to convince us that surgery could help, and we were glad to find out upon operating that we were right! (well, okay, "we" is really just Tom; Us gynecologists don't spend a lot of time on the men's ward usually!) He had what looked like a pretty long-standing appendicitis, so Tom and Carrie cut out that section of his intestines to cure him of that. He will have a large surgery to recover from, but should be feeling better soon. This is the type of patient who could truly die if it weren't for life-saving surgery, and we are always grateful for God's faithfulness in providing for his children.

Without your prayers and financial support, people like this do get turned away from many other hospitals-- or delayed long enough in the government hospital that they get too sick to operate on or die anyway! I thank God regularly for His provision, and for people like Tom and Jana who devote their lives to caring for His children. We look forward to another great trip in May, so please stay posted for more on what we are doing.

Oh, wait-- Almost forgot to explain the pictures today... The first is a relatively rare shot of a Mayan lady smiling! (Smiling in pictures is not a cultural norm here, generally...) She was one of our vaginal hysterectomies from Tuesday, and we were thrilled to see her up and about and looking so well. She is pictured with several of her family members and friends who were there to support her. The one here at the end is of a young lady who delivered her baby overnight at the hospital. They called Carrie and I to come evaluate her because they thought she might need a C-section, but the baby delivered within the five minutes that it took us to get down to the hospital! We were able to print a copy of this out for her, which is a rare gift for the poor in a developing country and brought a lot of smiles to the family's faces. What a privilege to ever be a part of something like that!

Finally Home

Snowmaggedon, Snowpacolypse, whatever you want to call it - it managed to affect life not just in the United States, but also in Central America. No, they didn't get any snow, but the airplanes that come to Guatemala to bring people home DID have to deal with the snow.

Heidi, Carrie, and Pat arrived at the Guatemala City airport in time for their 1:50pm flight back to the United States on Saturday but their plane didn't. It was coming from Atlanta (in order to return to Atlanta) but was part of the biggest cancellation of flights since 9/11 and was about six hours late.

Of course, with that delay, the girls missed their connecting flight and ended up spending the night on the floor in the Atlanta airport. They were re-booked on a flight for Monday but all needed to be at work on Monday. So they put their names on the standby list, tried to rent a car (which wouldn't be available for 12 hours), and even explored the option of having someone drive in from North Carolina to get them.

But God smiled on them and they were able to get on the first morning flight out of Atlanta and arrived in Raleigh at 10:05am - about 10 hours after their originally scheduled arrival.

With the exception of the more-eventful-than-usual return flight, it was a hugely successful trip and we'll post some more stories and pictures tomorrow. Thanks for all the thoughts and prayers.

When you are considering your giving for this year, please keep this mission in your prayers. We are currently trying to raise funds to help pay for all the surgeries we do in Guatemala. Obviously, the surgeon does not collect a fee, but the hospital does. The patients have to be fed, given medicine, put in a bed, and given nursing care. The average cost of a surgery is $200-$300. The patient contribution probably averages around $10-15. And while the balance is pretty inexpensive by American standards, operating on 10-12 patients per trip multiplied by four trips a year leaves us with a hefty bill.

The members of the team all travel to Guatemala on their own dimes - and most of them use precious personal vacation time to go. If you feel led to contribute, know that 100% of your donation goes directly to patient care. There are no administrative expenses, no doctor travel expenses, no candlelit dinners, etc. Every dime goes directly to helping some very needy patients. And your contribution is fully tax deductible through Agape In Action, a 501(c)(3) organization.

And if this is not where God is calling you to contribute financially, we still appreciate all of your prayers. We can't do our work without those, either!

Welcome, Baby Anna!!!!

Thank GOD for the safe arrival of beautiful baby Catherine Anna Ficker this morning at around 6 a.m. (also, about ten minutes after safe arrival at the hospital in Guatemala City!!) God is sooooooooooooooooooooooo good! More details later... It is really not my story to tell, but please when you talk to God today, thank Him again for his sovereignty, love, and protection of his precious children down here...

More Operating Time...

Wow, God really kept us busy yesterday, so we're really glad we got a little bit of a break today! I don't know if the time stamp on this thing works, but it's about 5:30 p.m. and we are essentially done for the day, after a nice lunch and even a little market time...

We did have several consults to do today on clinic patients, and Carrie and Tom stayed scrubbed in to a particularly tough gallbladder case for about 5 hours!! Unfortunately, the other patient we had scheduled for today did not show up, and she is the one who probably needs her surgery the most! Please pray for Julia, who needs surgery for about a 10 cm mass in one of her ovaries-- pray that it is not cancerous, and pray that she gets the surgery that she needs soon to know for sure! Her husband is away working down near the coast right now (cutting sugarcane, most likely...) and likely did not give her permission to have her surgery without him here. A very sad state of affairs on many levels, and one of the realities that many Guatemalan women live with.

We do have good news, in that all of our post-operative patients seem to be doing well overall! Yesterday we operated on three ladies who needed various kinds of hysterectomies (for you OB/Gyn types out there who are interested, a TAH s/p 3 C-sections, a TVH with anterior repair, culdoplasty and perineoplasty, and another TVH with culdoplasty, perineoplasty, and a prayer that it holds since her tissues were too post-menopausal to do anything more substantial!) The second case took much longer than we had hoped but so far the outcome has been good and that's what really matters this week. In the long run, of course, we just hope that they will feel the love of Christ while they are here and know that it is only because of this that we are able to help them at all...

Today brought an interesting "mystery" story our way from clinic-- A lady who is around 49 years old, who came in stating that she had a hysterectomy last September done by some visiting North American doctors down in Antigua, Guatemala. She says she had her surgery because of some heavy bleeding she was having, and that they told her they also took out both ovaries. She was doing well until January 1st, when she started bleeding again like she was having another period, which has kept going through today! She brought in a pathology report with her name on it that said her uterus, tubes, ovaries, and cervix were all sent to pathology and that she had a cervical cancer found on pathology! Luckily, the cancer was small enough that the surgery should cure it permanently.

But imagine our surprise when we went to examine this lady and found that she has a cervix, a uterus, and at least one ovary still intact inside!!! Hmmmmm... where to start?! The patient strongly believes that she had her uterus removed, but was unaware that the pathology report (which is obviously NOT hers as she still has her cervix intact!) read "cancer". So now we have TWO problems-- Someone DOES have cancer, DOES need to follow-up with regular pap smears and doesn't know it! And THIS lady... well, has a uterus, what appears to be a complex cyst in one ovary that probably should come out, but unfortunately also has very uncontrolled diabetes making us more than a little hesitant to operate on her just to find out for sure what's going on!

I tried calling both the pathology lab and the Hospital where the surgery was done (both generally quite reputable places down here...) and talked to very nice people who promised to call back soon when they found some information but whom I have yet to hear from. Maybe tomorrow we'll hear something, but I won't hold my breath! I checked some lab work to make sure she's not anemic, biopsied her uterus, did a pap smear, and then sent her with some paperwork to try to get a CT scan a little ways up the road to get a better picture of what's going on with this ovary of hers! Tom is nice enough to follow all this up in a few weeks, and we gave her a lecture about controlling her diabetes better in case she needs surgery, but who knows where it all will lead?!?! I'll call the hospital again tomorrow and see if I get any further...

Speaking of tomorrow, just a few quick general surgery cases (gallbladder and two lymph node biopsies), and hopefully we will send almost all of the patients from this week home. Then the girls will surely hit the market hard again, assuming that we don't have another 20 clinic patients to see!

A few random pictures today... The first is of Carrie with the family (or maybe the whole village, it would seem!) of the first patient we operated on yesterday-- Yes, that is the lady's uterus that her husband is holding in the basin there! They like to see the "parts we took out" here after surgery... Usually a new cultural experience for most people that come down here!



The second is from inside the hospital, a nice view of the courtyard that everyone enjoys and takes good care of...




Will try to bring you more stories tomorrow!

In the Operating Room

Thought I'd start out today with a precious picture of our youngest patient today-- It took forever to get her to warm up to us and smile (bubbles are universal, though!) but sooooo worth it! Dr. Hoak repaired a hernia for her with Carrie's help this afternoon, so don't worry; we're not going around taking out EVERYONE's uterus around here! ;-)

Aura (the beautiful little girl above) was actually the third surgery of the day, preceded by two women who needed surgery to repair prolapsed uteruses (?or is it "uteri"? I've never known how to say that! Guess they don't teach everything in "Gynecology School", as my husband calls it...) Carrie did a beautiful job with these two vaginal surgeries and gained some valuable experience that she hasn't had much of in the U.S. recently while busy practicing robotic surgeries instead! These women's lives, with God's help, will be changed dramatically by the relief of their symptoms, and our prayer is that that Rafaela (our second patient today) will come to know Christ eventually through our work here.

The first patient, Paula, was a little bit of a "breath of fresh air" for our friends the Fickers, who recommended she come to see us here and were pleasantly surprised when her Pastor stepped up from her very small little village and said HE would take her! This is about a 2.5 hour trip for them, and he is planning to come get her on Wednesday when she is discharged, too. I called on his cell phone after the surgery to let him know she was doing well, and he asked if I could give her the phone so he could speak to her, too! What a wonderful example he was for so many... A true shepherd to his people and a huge blessing to her.

The third picture is of Carrie and Tom doing a gallbladder as the last case tonight-- This lady may also need a hysterectomy in a few more months, but we are going to try to control her symptoms with medicine first before doing another surgery.

The last picture is one of my favorites of the day... Pat finishing up the anesthesia for the little girl Aura...
We also saw a few more patients in the clinic in between cases... Scheduled a couple more cases for the week and were able to provide some reassurance to a few other ladies in need of it. Lord willing, we will be operating all day tomorrow on three tough cases and then we'll see what God has in store for us on Wednesday and Thursday!

Long Clinic Day!

What a great-- but LONG-- day today!

Started off with market around 8 a.m., which Carrie got to experience for the first time but Pat's an old pro at by now! We then headed up to Church with the other local missionaries at 10, where we heard an amazing sermon on suffering and God's ultimate plan based on the raising of Lazarus from the dead. Then a quick (but really yummy!) lunch at a local restaurant that Pat has been talking about since the last time she left I think...

Then we ran over to the hospital to start seeing patients... 16 total came in, and we scheduled 5 surgeries for this week as well as some that want to come back later in the year for surgery. It's always wonderful to see patients back for a final post-op visit, so picture number one is a lady that I did a vaginal hysterectomy on back in November who is doing GREAT! Please pray for her, though, as she has not accepted Christ as of yet despite her family's efforts to convert her. She is in good health overall but getting on in years and I fear we are running out of time... It was nice to see her back to be able to show her some more of God's love for her today, though, and we just keep praying that our seeds we are planting will one day grow in to a beautiful relationship for her. She is pictured with her daughter. Her name is Manuela.


The next picture is just of me getting ready to start for the day, but it shows our trusty little clinic room, which is actually decently well-equipped with an exam table, light, and lots of supplies we have brought in over the years. Thanks to Carrie for being my photographer today; hopefully tomorrow we'll get some pictures of her and Pat up!



We also saw an assortment of ladies needing hysterectomies, or who needed reassurance that they did NOT need surgery for their tiny ovarian cysts that some of the local doctors want to make money off of. That is an unfortunately common thing here. We also saw a lady with a 10 centimeter ovarian mass that DOES need to come out (pray it's not cancer!), a lady who needed follow-up on an abnormal pap smear which we were able to help with, and a couple of ladies with pains that we aren't really able to explain. At least we were able to offer reassurance that they don't have anything terribly wrong with their uterus or ovaries, though!

After we had seen about 10 of our 16 patients, the local doctor called to see if we could help in the emergency room because there was a breech baby they were trying to deliver! So Carrie and I rushed over to see what we could do... Unfortunately, the young girl had tried to deliver at home and the baby's body had been delivered for quite some time before she arrived at the hospital. We were able to get the baby delivered safely for mom, but it was obvious that the baby was not alive at all even upon arrival to the hospital. How amazingly sad to have to tell a teenage girl that her first baby is a stillborn... and all for lack of delivering where there is a doctor trained to help! I don't even know the young lady's name, but I'm sure God will know who you are talking about if you send up prayers for Him to help heal her heart from the ache it must be feeling tonight.

Tomorrow we will operate on at least two ladies who need vaginal hysterectomies, and see what else God sends us! Hopefully we will get a good night's sleep tonight and be ready to go tomorrow... There are also currently 2 surgeries scheduled on Tuesday and one on Wednesday. I'm sure others will show up, though!

Safe Arrival!

Thanks in large part to lots of prayer coverage, we have arrived safe and sound in Chichicastenango! And the best news is that we didn't have any medications or other supplies "held" (i.e., stolen) in customs, which is becoming a bigger and bigger issue with entry in to the country with any medical supplies lately... Kudos to Pat for being organized enough to get all of her meds listed and approved in advance, and many thanks to Don Tono, the administrator at the Hospital Buen Samaritano, for getting the paperwork done! That's a huge load off of our shoulders already...

Today has been a long day (We left home about 2 a.m. local Guatemala time and it is now 9 p.m.) so this will be a short post, but wanted to thank you all for your well wishes and prayers during this week. We will get up tomorrow morning and probably hit the market for a little early bird shopping before heading up to Church. Then as soon as we can, we will start seeing patients until we are done! We hope for a good turnout, of course, but always pray also that God will never send more than we can handle.

Ideally, we would like to see all of the patients first tomorrow and then just schedule the surgeries that are needed for the rest of the week and not have to try to rush to see patients between surgeries later in the week... But we know that's not always going to work perfectly, so there will be plenty of work to do all week and we will need to pray for lots of patience especially the first few days. It is so tough between surgeries when you have time to see maybe one or two patients before they are calling you back to the OR-- the next patient in line always looks so crestfallen when they realize you are leaving again for what could be another several hours before you can come back down to see them. Luckily for us, Guatemalans are generally a lot more patient than we North Americans are...

Will try to post some pictures tomorrow, of course, so please stay tuned!

February 2010 Trip

Yes, several months have passed since our last blog and a few trips. The second week of the second month of each quarter is the scheduled trip from Greenville, NC to Chichicastenango, Guatemala. (February, May, August, and November).

Heidi has been fortunate enough to have some wonderful experiences her last few trips and has been able to perform some badly needed surgeries, as well as transport some critical supplies. Thanks to the generosity of many in Matt's parents' church in Michigan, literally thousands of diabetic test strips have been sent. A couple ministries were even on the verge of discontinuing treatment of diabetics for lack of strips but God always comes through and we're thrilled when He uses us as His "boots on the ground".

The next trip is scheduled for February 6-13, 2010. Traveling with Heidi will be Dr. Carrie Ballard, another ECU faculty member, and Pat Peabody, a nurse anesthetist who made her first trip to Chichi last May.

In her last two trips, Heidi has been very encouraged by the fact that she's given some patients pre-surgical courses of treatment that they've followed and returned for surgery, she's seen several return patients, and it seems like word has gotten out that this doctor who says she's going to come every three months is actually coming every three months. She's also had an opportunity to operate with and assist Dr. Hoak which is both helpful to him and educational for her.

In the August 2009 trip, Heidi was accompanied by Dr. Chris DeLuca, a chief resident at ECU. Below is a picture of Chris with a few of their post-op patients eating breakfast.

Next is a picture of Heidi, Katie Ficker, and Duane in Zona Reyna (yes, she had time for a short trip out there) to see over 100 patients with Katie and Chris.

The next picture is inside the clinic building there. There are no roads to this village. Visitors must either come by bush plane or walk a LONG day over a mountain. It's so steep that horses can't even make it, so everything would have to be carried in on your back. Thank God for airplanes! Only a few residents in this village speak Spanish (everyone else speaks K'ekqchi) so translators are needed for every single patient. Typically, the medical people will see patients, the rest will evangelize or help with projects that need to be done and keep an eye on the sky. It takes two or three trips to get everyone in and out and if the weather starts to turn bad, Duane has to start ferrying people home or risk getting stuck in the jungle all night with no power (don't laugh, it's happened!)

The last picture is of a beautiful rainbow they saw on the way back to Canilla Intergalactic Airport. It's an awesome reminder of the promise and the faithfulnessof God.

Surgical Trip

Wow, where to start? I probably should have started blogging a little earlier this week as I am somewhat out of practice with blog-writing! We (Heidi and some friends from work) have been down here in Guatemala operating at the Hospital Buen Samaritano in Chichicastenango all week. We are hoping that this is the first of our quarterly trips down here, and are praising God today towards the end of the trip that everything has gone well!

We were not sure what to expect-- how many patients, how our transportation would be arranged, how much help we would have, whether we would spend the whole time at the hospital, etc..-- when we got here, but we did know that God already knew and that was enough! He has been faithful-- as always-- in providing for His people here in Guatemala. This week, specifically, He also provided three women who had never done missions in Guatemala with a wonderful experience. We are praising God that everyone is already talking about when they can come back!

Our first picture is of our team-- We are in front of the fire at the Hotel Casa del Rey here in Chichi, and from left to right we are:

Erin Hartwell, a fourth year resident at ECU in OB/Gyn, who Heidi has enjoyed working with since September. She had the chance to not only do some great gynecologic surgeries, but also some general cases with Dr. Hoak that she would never get the chance to see and do in the U.S. Heidi is sitting beside her, of course.

Pat Peabody is a CRNA (Certified Registered Nurse Anesthetist) who tirelessly ran anesthesia for us this week. Heidi has also had the great honor of working with her at Pitt County Memorial Hospital since September. It took a little less than a week of working with her before Heidi was hitting her up to join us on a Guatemalan trip, and she has held fast to her promise to do so!

Patty Palmer is a circulating nurse in Tulsa, Oklahoma, who actually arranged to come down here through Sharon and John Harvey at ASELSI. We quickly snagged her up and adopted her on to our team, and she was a true God-send all week! She helped with everything from prepping and transporting patients to getting hair out of Heidi's eyes during an operative case, and even found time to do some classes for the nurses there at the hospital about how to use the new autoclave for sterilizing instruments properly. She is also to thank for many of the great pictures that we have from the week.



The next picture we just had to include for our old regular readers... Some of you might just recognize the lady in the sharp-looking nurses' uniform as Cecilia ("Ceci"), our translator from ASELSI! When we found out over a year ago that she was interested in putting herself through Nursing School, we offered her an informal "scholarship" to do so. She is now just about a month away from her degree (equivalent, basically, to an LPN in the U.S.) We are so proud of her! She is truly a success story out of the ASELSI mission... a single Mayan mother with a professional degree? What an unheard-of and wonderful bit of news!


Now on to the patients, finally! What an interesting week... that has left us full of prayer requests to post! The first picture here is of Heidi and Erin posing with the uterus they took out Tuesday night. The normal uterus should be less than the size of a fist, just for a frame of reference... This lady should be feeling much better from here on out.



And here is our BIGgest prayer request from the week. The picture below is of Heidi, Erin, and Tom Hoak operating on our patient Petrona. She was diagnosed with cervical cancer by Tom recently, and we attempted to do a curative surgery on her this week. We knew that none of us is truly qualified to do this kind of radical surgery, but we also knew that this lady would NOT get any help from anyone here otherwise. Dr. Hoak has enough experience with the Guatemalan medical system now to know that there was essentially no chance of her getting a safe surgery here-- if anyone would even operate at all. The other option-- radiation-- is something she will not be able to afford, most likely. She refused to even go to The City to explore that option, so we all spent lots of time praying over her and agreed that surgery with us was the best option. God provided a peace with this decision, and we proceded with as much love and patience and diligence as we could.



Seven hours in to the surgery, however, we eventually encountered a stumbling block that we could not overcome. (For the medical folks, her left ureter was completely encased in tumor, which we did NOT expect from our clinical exam. This makes her an inoperable Stage IIIb cervical cancer) We could not safely remove the tumor, and had to terminate the surgery. Her only option now is to go to Guatemala City and try to get radiation, which she is unlikely to do. So the other option is praying for a miracle, which we invite you all to join us in. Either way, we hope that she felt the love of Christ that we tried to show her with our efforts.

The last picture is of a little 3-year old boy that a team from ASELSI actually brought in to the Emergency Room after finding him on a home visit that they made. About 10 days ago, he stuck both hands in to some boiling liquid and severely burned them as you can see. The family had sought no medical care to date, and it is really quite lucky that he has not become severely infected. Tom, Pat, and Erin took him to the operating room and cleaned his wounds under anesthesia. Tomorrow they will do a skin graft to try to save some function of the right hand. ASELSI will follow up with physical therapy, and the whole thing will hopefully be a wonderful testimony of how God can really work in people's lives when we all work together for His good!

Please pray for the rapid recovery of Hugo Emmanuel. He will be hospitalized for a while here, but hopefully will continue to do well.



Today Erin and Heidi were supposed to go out to the Zona Reina with the Fickers, but that trip was cancelled due to some forgetfulness on the part of the community leaders where we were supposed to go! Bummer, but at least it gives Erin something to look forward to when she comes back!

Tomorrow Heidi will get up to Quiche where Duane has generously offered to come pick her up to spend the day and night with the Fickers. It is hard to imagine a trip to Guatemala without seeing them, but the logistics proved to be a little challenging this time with no vehicle. We will all meet up back at the airport Saturday morning (Thanks, Tom and Jana, for offering a ride to Erin and Pat!) and fly out...

We have missed our friends and families this week, but are truly blessed to be a part of God's continuing work here in Guatemala. May He continue to bless you all and all of his people here in Guate!

Merry Christmas

Merry Christmas, everyone!

The two main holidays in the Christian world are Christmas and Easter. One because it celebrates Christ coming to be with us and the other because it celebrates the accomplishing of his mission.

This season, we celebrate the fulfillment of a promise. God had been promising his people for thousands of years that he would send a messiah. And in a tiny town in modern-day Israel, that promise was fulfilled.

It's a reminder that ALL of God's promises are fulfilled - in His time. That's why this is often called a season of hope. See, another one of God's promises was that Jesus will come back in the same way the disciples saw him leave. So, like the old testament Jews waited for Jesus to come the first time, we now wait for him to come back.

In the meantime, there is work to do.

Agape in Action is very excited about the next chapter of our story in Guatemala. Dr. Sherwood Pope and his wife Areli will be moving to Guatemala in a matter of days now. Please keep them in your prayers.

Also, since Agape in largely funded through investments in the oil and gas business, and you may have noticed that oil prices are dropping, please consider a financial gift to the ministry. Less money at the pump in our case means less money for missions. So maybe a bit of what you're saving could be put to good use???

Just a thought.

We pray you have a blessed Christmas and New Year!

Happy Thanksgiving!

It was a pretty typical American Thanksgiving week for us. Busy, busy, busy!

Heidi, being junior faculty at the hospital, was blessed with a 24-on, 24-off schedule for the week. The trade-off is over a week off at Christmas, though, so no complaining here!

Matt played Wednesday-Saturday nights, so we spent a few nights at Heidi's Aunt Mary Ann's house to celebrate Thanksgiving with her and to have a place for Isaac to stay while Daddy was out playing "rockstar".

God continues to smile on our end of the ministry here in North Carolina. We have a very different role now, but we're still working for the kingdom. Heidi has been busy collecting "trash" from the hospital. Yes, it's hard to believe, but we Americans throw away a lot of stuff that can save lives in other parts of the world.

We are using the attic in our house as a storage facility for these donations and will start working on a plan to get these things into the hands of the hospital folks in Guatemala.

And to echo our last post, during this time of worry and fret here in the United States, please remember that we are still the richest country in the world. Our bounty is so ridiculous that the obesity epidemic is the most pronounced in our poor population. Not too many other countries in the world worry about how fat their poor people are.

Please, please, please, keep giving to missions, especially when times are tough here. If they're tough here, they're even tougher everywhere else. Just a few dollars a month can make a huge difference in the third world.

And if you're looking for a place to send money, Agape In Action sends 100% of all donated money directly to the mission field. NO administrative expenses are taken out - those are already covered from their business ventures. So you can know that every penny of the money the Lord has led you to give ends up in the hands of those who are spreading the gospel.

Also please keep Dr. Sherwood Pope and his wife, Areli, in your prayers. They are preparing to move to Guatemala to take over the medical mission there and do amazing things with it. They are young, energetic, and spirit-filled, so you can only imagine what God has in store for them. Please pray for an easy, uneventful move and for God's revelation to be clear to them.

Guatemala Trip Scheduled

Ironically, sometimes things move a little slower here in the US.

It's taken us a little while to get our feet on the ground here in North Carolina and now we are ready to schedule our first round of return trips to Guatemala. It looks like it'll be the second week of the second month of each quarter in 2009. Our time will be spent in clinic and in surgery, God willing, along with bringing and delivering supplies to other missionaries in Guatemala.

And, of course, Isaac needs to visit his "big sisters", Abby and Grace, in Canilla. Now that he can walk, he might be able to defend himself a little better. But what are big sisters for, right?

With the tough economic times here in the US, sometimes it's hard to remember that we are still, far and away, the richest people in the world. If you get sick, you have almost immediate access to world-class health care. Gas costs way less than a day's wages per gallon. Meat costs less than a day's wages per pound. You are probably feeding fewer than 10 children on more than $15 a week.

Even if it means cutting back on "necessities" such as that extra package of channels on your satellite TV, eating out twice a week, or even buying brand name detergent, please remember the missionaries around the world in your weekly or monthly offerings.

We are hearing incredibly sad news that missionaries in Guatemala and around the world are suffering due to huge decreases in giving. Know that the work of God must continue. Souls are being saved in distant lands - places where the name of Jesus has never been proclaimed - through the work of missionaries. We understand that during tough economic times, sacrifices have to be made. But please sacrifice in your own life and not in the lives of those so much less fortunate than ourselves.

You can't out-give God. Give Him an opportunity to prove it to you. Please keep giving to missions, especially during these times.

Also, check out our new link on the right - to the Fickers!

Nueva Santa Catarina - And A New Doc!!!

Sorry again for the long delay in posting. Life in the US moves at a little different pace than life in Guatemala...

We got a call from Aaron and Katie last week around 8:30pm. They were on their way home from clinic in Nueva Santa Catarina. This was one of our "solo" clinics that they are covering for us now.

They had between 60-70 patients - about double the normal load there - but were able to see them all and get them taken care of.

Just a quick note to those of you who are still following.

We are so thankful to God that He has provided a replacement for Heidi and Matt. Many of you close to the mission already know, but Dr. Sherwood Pope and his wife Areli will be moving to Guatemala in January to take over the reins for Agape in Action.

Dr. Pope is from Michigan and his wife is from Mexico City. We prayed for them long before we knew who they were and we will continue to pray for them now.

Please check out their current website at http://www.missionarydoc.com and keep checking here for updates!

Safe and Well in Guatemala

We got news today that Don Allison and John Villanueva made it through to Guatemala.

Apparently, as usual, they had some adventures, but nothing too terribly scary.

They split up once they made it into Guatemala. Don went to Guatemala City to pick up his family at the airport and John went to Quiche to spend the night at the dorm. They should all arrive in Canilla later today.

Ike Invades Houston

To anyone not familiar with Houston geography, all of our support team is directly in the path of Hurricane Ike. To the best of our knowledge, everyone is evacuated.

While Ike will not "make landfall" until the middle of the night tonight, Galveston and the surrounding areas started flooding this morning - more than 12 hours ahead of the full force of the storm.

Houston and all surrounding areas will be subject to severe flooding and crazy high winds. Almost everyone will take some type of damage.

Please keep the Shaws, the Leathermans, the Villanuevas, and the Allisons in your prayers, as well as the rest of the Houston metro area.

We'll post more details as we get them.

Slight Change in Plans

Matt flew to Atlanta this past weekend to attend the wedding of a friend he used to play with. It was beautiful! Many congratulations to Jared and Heather!

After the wedding, he flew to Houston to meet up with Don Allison and prepare for the drive through Mexico. There had been a slight paperwork mix-up, though, that generated a few problems.

Without getting into all the details, there is a waiting period of 72 hours from the time the US Customs Department receives your vehicle title until you can cross the border. Because of our mix-up, we won't be allowed to enter Mexico until Thursday.

It's about 28 hours of driving from the Texas-Mexico border to the Guatemala-Mexico border. If we crossed into Mexico by noon on Thursday, drove all night Thursday, and nothing went wrong (yeah, right), we would arrive at the Guatemala-Mexico border just as it was about to close for the weekend. Matt's flight out is set for Monday morning. There's virtually no way he could make that flight. So if the guys encountered more than a one hour delay in the entire trip, they would be forced to sit in a Mexican border town for two days, miss Matt's return flight home, and generally be miserable.

So we came up with Plan B. John Villanueva to the rescue (again).

John is vacationing in Chicago right now. He flies back on Wednesday. On Thursday, he and Don will drive to the Texas-Mexico border, fill out all of their paperwork on the US side, spend the night, then cross the border Friday morning. They have all weekend to make it to the Guatemala border (which means they'll get some nice time on the beaches of Tampico and Veracruz), then they can enter Guatemala on Monday. Matt will simply return to North Carolina tomorrow.

So, it looks like God knew what he was doing when he had John ride down with Matt in January. John will get one more trip added to his "experience list" and Don will get the help he needs. Additionally, the Fickers will get the 4-wheeler they've been waiting on for a couple of years.

About that 4-wheeler. In the area of Guatemala where the Fickers live, the "roads" are often impassible by car. So a 4-wheeler or dirt bike is needed. They have a couple of small 4-wheelers and several dirt bikes, but to really haul any medical equipment or accomplish a medical evacuation, a larger 4-wheeler is needed.

They have a big Honda Foreman 4-wheeler but it has almost 20,000 miles on it (and not easy miles, either!) It's becoming a bit inconvenient to keep it running as all of the parts have to be imported from the US. This 4-wheeler we're bringing down to them is a nearly new Foreman that has 4 wheel drive. So it'll be even better than the one they already have. Now they'll be able to get supplies and people to even more places than before!

It's important to remember that even when things do not seem to be working out the way you're hoping they will that God is always in charge. He will never close a door without opening a window....

If you're not watching the news, there is a hurricane drawing a bead on Houston as we speak. All of the fundraising staff here and their familes will probably have to evacuate. This includes John's wife and two kids (while he's on a trip to Guatemala). So please include all of them in your prayers.

We'll ask for prayers for the following:
* A safe, expedient, hassle-free and uneventful trip to Guatemala for John and Don
* A safe and easy evacuation for the Leathermans, Shaws and Villanuevas
* No damage or major inconvenience from the hurricane
* A safe trip back to North Carolina for Matt

Guatemala News and Trip

Sorry it's been awhile, but we've been busy here in the United States.

Heidi officially started work this week. She has a new office, phone, pager, schedule, etc. Matt's mom and dad are in town for a few weeks to help out with Isaac because Matt leaves in the morning for Guatemala (with one side trip).

We heard back from Aaron and Katie. They went to Chicabracan on Monday to cover our clinic there. It's so nice to know that our patients have not been abandoned, but are in outstanding hands. Katie took the first two pics below (of patients of ours) so we could see how they're doing! Thanks so much, guys!!!!

We also got an email from the group in Houston with a funny story about how they managed to squeeze a 4-wheeler (and a big one at that) in the back of the 4Runner. It involved planks, trees, and a few concrete blocks. You don't want to know the rest. The other three pics below are of the legal portions of that process.

Anyway, Matt flies to Atlanta tomorrow for a friend's wedding, then to Houston on Sunday. He'll meet up with Don Allison, pick up the 4Runner (with a 4-wheeler inside it) and drive to the Texas-Mexico border. They'll spend the night there and hit the border first thing Monday morning.

If all goes well (and it never does), they'll arrive in Guatemala on Wednesday. Matt will hang out a few days, then fly out of Guatemala City on Monday, arriving in Houston that afternoon. Then he flies back to North Carolina on Tuesday.

We'll try to post some stories from the road once he gets to Guatemala. Hopefully, the trip will be so uneventful that there will be nothing to tell.... But probably not.