Days 3-4 From Dr. Chris Deluca

"Days 3-4"

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

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

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

Chris

From Dr. Chris...

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

"Guatemala Day 2-3":

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

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

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

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

Chris

February 2011 Trip

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

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

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

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

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

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

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

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

Hasta manana!

Please Pray for Upcoming Trip!

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

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

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

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

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

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

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

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

Home safely... but please keep praying!

Sorry we are a little late with this update, but we did indeed make it home safely-- although quite late!-- on Saturday night.

Please continue to pray especially for those patients that we operated on this week who do NOT know our Lord and Savior Jesus Christ... If you want/need names, here is the rundown for your prayer lists:

From Monday, Satornina who had vaginal surgery

From Tuesday, Gregoria who also had vaginal reconstructive surgery

Also give thanks to God for the other five gynecologic patients that we operated on, who have accepted His salvation. Specifically I was uplifted on this trip in learning that at least two of our patients have accepted Christ through the Catholic Church here, which I generally do not hear any members of the Guatemalan Catholic Churches say. Many of our regular readers know that the Catholic Church here, unfortunately, has suffered really since the days of the Conquistadors from a lot of "syncretism" or blending/melding with traditional pagan religious customs... To the point that the MOST common answer that we are given to the question of "Have you accepted Christ as your Lord and Savior" from a person who goes to a Catholic Church here is, "No-- We're Catholic; we don't do that". Very sad and confusing... and so encouraging to know that maybe-- just maybe!-- there is a positive movement growing in that area here! Two patients don't necessarily make a whole trend, but I will continue to choose to be encouraged by it.

Until next time-- and until the world is reached,

I am signing off.

Thanks again to all of you for your prayers and support this week!

Cyndi is showing off Angelica's MUSC scrubs! Angelica is one of the nurses that has been working with us in the OR for quite some time now and is being trained to eventually take over (most likely) as the head scrub nurse there...

Our clinic room... looks just like your OB/GYN's office, right? (Well, maybe except for the fact that they usually change the bed covering there more than once every two days or so...)



"Meet the Team", continued... (Sorry, these keep kind of posting in random order and I'm scared to mess with them once I finally got them up successfully!) This is Pat with Dr. Calvin Williams, his wife Latrice and daughter Brittany, from the St. Louis area.

Another couple of views of the operating room, for those who haven't seen it before...

I just talked to Cyndi a few minutes ago who happily reported that almost all of our patients have now gone home for the week post-operatively. We will keep an eye on one more (via telephone, local doctors and nurses, and--most importantly-- with the help of Dr. Tom Hoak) until we are sure her incision is okay and not getting infected. She is otherwise doing very well, though, and we expect a smooth recovery. Glory to God for the smooth recoveries that all of our patients have had so far this week!

Pictures Finally!

The first picture is just a general favorite... Cyndi Lawton holding a baby for one of our patients on Sunday in clinic (only after "winning" the dash to help by outrunning Keith to the mom's bedside to help ;-) WHAT a sweet picture and a sweet baby...



The next one was supposed to be posted last Sunday or Monday, as a "meet the team" picture... Heidi Bell, Cyndi Lawton, Keith Nelson, and Pat Peabody (with a little cameo appearance by my three-year-old, Isaac, there in the front)

Here is one of us relaxing outside the operating room between cases with Dr. Tom Hoak.

And an "action shot" in the operating room-- fairly modern for local standards, but it probably looks a little bit different than any operating rooms any of our readers have been visiting lately!

And a view of the Hospital Evangelico El Buen Samaritano (The Good Samaritan Evangelical Hospital) which was our home base for the week...

Picture

Another (failed) attempt at pictures!

Okay, okay... it took me being up in the middle of the night and not being able to sleep (yes, it is 3 am here...) AND Cyndi hinting that her family was continuing to ask about the pictures, so here they are finally! Thanks, Cyndi, for some great shots from the week.

I will report briefly that all of our patients were doing very well at my last checks on them, and I am grateful to Dr. Nelson and Dr. Lawton for finishing up rounds on them in the morning and likely discharging them all since I have come out to the Fickers's farm to fly out to do a little bit more jungly-medicine in the morning.

Also some quick follow-up on our cervical cancer lady-- she did go home yesterday after receiving a bag of blood from a family donor and feeling a bit stronger for it. Thanks again to God for her supportive extended family, which is all she has right now... may they continue to be a light to her in a way that we can not as we walk in and out of her life ever so briefly during such a difficult time. She really personifies many of the struggles of very short-term missions and it hits hard emotionally, but I thank God still for the constant reminders of how very, very blessed we all are to live such wonderful lives with our health, our homes, our supportive spouses, and our medical care system in the U.S.

Now I'd better get to pictures before waxing too political or being too completely cheesy (After all, it is 3 am and a blogger is NOT to be trusted at this hour!) so here goes... Enjoy!

(Okay, four hours later here... the internet connection is NOT cooperating for posting pictures, so it appears as if I have lied and let you all down again... SO sorry! Will try again this afternoon...)

A few more long but wonderful days!

Well, I finally got a couple of pictures to post... but unfortunately I still keep forgetting to get Cyndi's camera card to get the better ones! She has really been the photographer of the week...

The first picture is of a couple whose mother we operated on earlier this week and sent home yesterday. She did great post-operatively, and the family was very supportive and gracious. They were also very nice to let us take some good pictures of them... I explained that I wanted the picture because the "traje" or traditional dress that they wear-- from their hometown area near Solola-- is my favorite in the whole country! Especially since the men are more likely to wear their traditional dress there. I wish we could see more of the men's traditional dress from other areas, but they have mostly been converted to used clothes from the U.S., sadly.




The next picture doesn't do the scene justice, but we really enjoyed a few minutes of watching these young Guatemalan kids playing with bubbles and Isaac. They were waiting on their mother, who I think was waiting to be seen by the local doctor, and had been sitting perfectly still and stone-faced for at least an hour before we remembered to break out the stash of dollar-store wedding bubbles that we had brought down! That certainly livened things up in the courtyard of the hospital, and brought quite a bit of joy to both us and them. They went through every bottle of bubbles I brought before the end... then it was on to Play-Doh! (Thanks, Tana, for sending down your Halloween leftovers...) I had almost forgotten how much fun-- and how cheap-- it is to give small playthings to children here. It is ridiculous to think that Isaac has more toys in his little backpack that we traveled down here with than many of these children will ever even see...



Yesterday's OR cases went very smoothly-- Three vaginal repair surgeries that Dr. Nelson and Dr. Lawton really did with minimal help from me (My favorite kind of day in the OR, for those of you who know me!)-- I learned some new tricks from watching them, and got to take care of paperwork and checking back in on patients and organizing and tying up loose ends and such, which was a huge blessing to me.

We also were asked to do an inpatient consult on a lady that one of the local docs had admitted the night before. In the interest of time I will spare the details, but suffice it to say that telling a 30-year old, mother of four, whose husband left her for another woman during her last pregnancy, that she has inoperable cervical cancer is NOT one of our favorite things we have had to do... Please pray for Juana to be able to get the care that she needs to survive for a while to take care of her children. She has accepted Jesus Christ as her Lord and Savior, thank God!, but her struggles here on this Earth are very significant right now. We are also grateful that she has a supportive family here with her. They were looking for family members that could donate blood to her to help with her weakness from anemia when we left yesterday without any complaining or arguing, which is a minor miracle down here... so please be sure to also thank God in your prayers for them and ask for their continued support and patience.

Now it's off to the hospital to see what else the day holds in store for us... We hope that the patients are doing well and that a few are ready to go home, and will continue to pray for their recovery and salvation.

Breaking my Promises...

... to readers, because I don't have any pictures to post this morning! So sorry... I will try to get some up tonight. We have really, truly been so busy trying to make and keep as many promises to patients as we can that there has been very little time for anything else so far this week. This is, of course, good news, because it means we have been busy and able to (hopefully) help a lot of people... but please pray that our minds and bodies hold out for the week on little rest and lots of pressure.

Sunday was a huge clinic day, starting at about 1:00 in the afternoon after Church and not ending until about 10 minutes before 10 p.m.! Yes, we were tired... drained physically, mentally, and emotionally... but God is good and did give us the patience and wisdom to make what we hope were decisions pleasing to Him for each patient that came in. We saw 18 new patients, setting five of them up for surgery this week and several more up for other procedures that we got done in the office Monday. That may not seem like a lot of patients to many of our readers, but believe us when we say that though the numbers might not be impressive, the complexity of problems this time was unbelievable! I am so very grateful to have two other strong gynecologic minds with me on this trip-- I would really be struggling without their insightful help. Once again, God shows us sovereignty in sending the right patients to the right team, though... simply amazing.

So some of the more interesting patients so far...

Alejandra and Satornina both got their surgeries on Monday for problems with their uterus and/or bladder prolapsing or "falling out", after being nicely prepared pre-operatively either by me in May/August or by Dr. Tom Hoak in the months in between. Both surgeries went very well and we were pleased with the results immediately post-operatively. Both ladies looked great last night, and we are anxious to get down to the hospital to check on them again this morning.

Manuela is a lady that we will operate on today (It is about 5:30 am on Tuesday, for anyone wondering...) She came in yesterday, referred by Dr. Hoak to us, for a diagnosis of blocked ureters (the tubes that go down from your kidneys to your bladder) which are thought to be due to the very significant prolapse (It is turned all the way inside-out, basically, for the non-gyn people, and a complete procidencia for you others!) of her uterus. A urologist in Guatemala City recommended that she wear a catheter in her bladder to try to relieve the pressure until it can be fixed, so she's been walking around with that for over a month now. Despite our best intentions and hormone therapy, her tissues are still very weak to support most types of surgical repair, so today we have opted for a major abdominal procedure to try to correct her problems. This is a surgery that I have never done before so I will once again be thankful that especially Keith Nelson is here, since he has much more experience than I do with it! And again, thanks to God for His provision for her this month.

We also have two other surgeries scheduled for various levels of pelvic prolapse today, so it should be quite a long day in the OR.

Somehow we have also found time to see some ladies with problems other than these, and I remain very encouraged by the handful of women that come back to see me so often-- even though they still don't want surgery for their problems and I am doing little for them, they faithfully seek me out almost every time I am here. Definitely one of the best parts of the job, and one that makes me even more thankful that we have been able to have a continued presence and continuity here for the last two years now!

Thanks to all of you for your continuing prayers as we look forward to another long but hopefully fruitful day today. Our patients that we are operating on are averaging about 50% that know The Lord and 50% that do not, so please join us in continued prayer especially for those who do not know Him-- that they will see a little bit of His love in our hands and work and smiles and hugs and sign-language communication when we don't speak their language this week, and that they ultimately might come to know Him as we are so privileged to...

"Until the world is reached..."

Meet This Month's Team!

Today was our typical looooonnng travel day from Greenville, NC, to Chichicastenango, Guatemala— praises always to God for safe and smooth travels! Today ended in a special treat for me, of course (that would be Heidi, for those of you whom we have confused over the years with mixed blog authorship!) in that I was reunited with Matt and Isaac after being away from them all week! They’ve had a great week out at the Fickers which I am very jealous of, but I am really looking forward to getting to work with Matt again a little more closely in here in Guatemala! It is sure to bring back many amazing memories…

So our group this time is a little bigger than usual, and I am feeling very blessed to be a part of it. I am travelling with Pat Peabody, who regular readers have come to know by now and who will be running anesthesia for us again. She is joined this time by a special surprise in the form of Dr. Calvin Williams, who joins us from the St. Louis area (a friend of the Ficker family and from their home church) with his wife Latrice and daughter Brittany. Cal is an anesthesiologist with a long-term interest in medical missions, and we of course pray that he has a great trip and wants to come back and help out with anesthesia plenty of times in the future. As most of you know, providing anesthesia for surgeries is a major expense if we don’t have someone with us to provide that service, so I continue to stand in awe of the way God provides in this and so many other areas.

Also travelling with me this trip are Drs. Keith Nelson Cyndi Lawton, both co-workers of mine in the OB/GYN Department at ECU. Dr. Lawton is in her last year of residency with us and will be joining a practice next year in her home town outside of Charleston, SC. Please pray especially for her as it is the first time she will be spending any significant amount of time away from both her husband and her one-year old son, Beau, since he was born. Dr. Nelson is a member of our faculty who has quite a bit of experience leading mission trips of his own, mostly to the Dominican Republic over the last several years. He and I work together on medical student education in the department, and he is also very involved in surgical education and administration of the residency program. He is highly regarded as one of the best surgeons in our program, and I look forward to operating with him this week! Many thanks to his wife, Megan, who is once again graciously staying home with their two children while he travels the world to help those in need.

Tomorrow we will start seeing patients in the afternoon and set up surgeries for the week, so we will see what the week brings our way! We will continue to pray that God sends those our way who we most can help, and that we are able to help each and every patient that comes through our doors even if they don’t need our specialized medical care specifically. We are looking forward to a great week, and will keep you posted! Pictures to follow, of course… We were all feeling a little more travel-weary than photogenic today…

Pictures as Promised

Here are the pictures that I promised everyone that were supposed to go with that last post...

First is David and Juanito re-wiring the Dodge so that we could drive it in to Canilla with at least one functioning headlight!

Next is one of our ASELSI patients, with her sweet baby that she brought in...

Here is the front of ASELSI's beautiful facility there in Chichicastenango, for those of you who are less familiar with the area...

Again, you can read more about ASELSI at aselsi.org if you are interested... We have truly been blessed by the opportunity to work with them over the years!

Signing off now until next trip, which will be in November of this year.

Wrapping up the Week

(OK, I will go back and try to re-post the pictures later; for some reason they don't want to upload tonight and I'm getting impatient to go ahead and post this! Sorry...)

Thursday was a very nice “blast from the past” for me this week—I did clinic at ASELSI (read more about their amazing work in Guatemala, if you want, at www.aselsi.org) with Dr. Sherwood Pope, his wife Areli, and my old friend and most excellent of translators, Cecilia or “Ceci” as we have always known her. She is the Quiche to Spanish translator that Matt and I worked with for two years there at ASELSI, and offered a scholarship to when she eventually became interested in going back to nursing school. She now has what is essentially the equivalent of an LPN (Licensed Professional Nurse) degree and has been able to increase her hours and earning potential with it. She is still a great translator, tirelessly educating patients without even being prompted anymore about hygiene, clean water, hydration, proper care of children, and much more.

Ceci and Areli both are showing great interest as well as skill with the ultrasound machine in pregnancy, so I got to be really in my element for a while and do some teaching! Areli has really been helping Dr. Sherwood quite a bit with the prenatals, and is becoming quite handy with the ultrasound machine. That’s something she probably never planned on using her degree in International Studies for, but I am continuously awed by her flexibility and patience. The first two pictures are of ASELSI's main building and one of our first patients and her baby.

In all, we saw about 50 patients between the three of us—I remained worried the whole time that David Ficker would call at any second and say that they were ready to pick me up in Quiche immediately (I was scheduled to ride out with him to Canilla and hated to think about making him wait for me…) Those of you who have ever either been to Guatemala or had many things scheduled on “FST—Ficker Standard Time” are of course now laughing at my seeming naivete in my concern! ;-) It was only after the obligatory seven or eight plan changes that we met up relatively smoothly in Quiche for the long ride over the mountains to Canilla.

I’ll spare you all the details of that trip (we managed to get there having lost only one lug-nut, having stopped only twice to check on the drive shaft, and to re-wire a headlight directly in to the battery so that it would stay on for more than a few seconds at a time after it got dark…), but it was even more adventurous than usual for that trip! Any of you who have known the “adventure” (read: sheer peril and terror) of driving that road during the rainy season in broad daylight will just have to imagine how fun it was after nightfall with no working headlights! David Ficker is truly an amazing mechanic and driver… and even provided for a photo op or two! The next pic is of him and Juanito, a friend of the family, rewiring the headlight—successfully, of course.

Late in to the night Thursday, we greeted a team from Real Life Missions out of Washington state who are there for the week. They are poised to do some great work, teaching and evangelizing in local schools and building a widow a new home out near one of the clinics. Friday was spent helping them settle in and just reconnecting with the Ficker family (check out their new website at adonaiinternationalministries.org). What an amazing opportunity to work with them again! There was even an afternoon beach volleyball game after the usual trek through the river to get to the court… THAT truly felt like home, sweet home again!

This morning we were able to see most of the prenatal patients who were waiting with the help of a local Peace Corps volunteer, Cali, who has also become a great friend over the last two years. My flight out was around ten this morning from Canilla, so we were actually hoping to get through them all before that… but we got of to a late start due to another unexpected change in plans, of course. When we opened the doors to call for the first patient, we were greeted instead by one of the nurses from the Health Center with a patient in her hospital gown that they were asking for help with. They had brought her over in the ambulance because she had reported laboring all night with no baby yet delivered. A quick review of her “prenatal records” (handwritten in the card that she carries with her from the Ficker’s clinic there) revealed that she was full-term and the baby had been in the right position at her last visit, so we hoped for the best as we put the ultrasound on! We were able to confirm a strong heartbeat, head-down or normal position, and about 5 centimeters of cervical dilation before they popped her back in to the ambulance and took her back to the Health Center where there is actually a doctor to attend her delivery. We heard she delivered about an hour later with no problems, so thank God for that.

I am now on the plane headed back to my true home, sweet home—my “boys”!! It has been a long week away from them like it always is, but I am forever thankful for the opportunity to remain connected to Guatemala and her people. Leslie is preparing at least one more patient for us for surgery in November—a lady we have known for a long time with a complete prolapsed of her vagina after a hysterectomy, which re-prolapsed after an attempted surgery many years ago. She has been miserable with this for many years now but has refused further surgery. Leslie mentioned to her that we might be able to help with a different procedure (essentially to close up the vagina completely—reserved for pretty unique cases, of course) and she is now actually considering this, so we pray that she will do well with this surgery in November.

Stay tuned for more updates, we hope, as our November trip draws closer as soon as this one draws to an end… We will continue to pray for Maria and so many others in whom we hope some seeds have been planted this week and over the years, and that God will continue to bless our feeble efforts in His Name in Guatemala and the U.S. Thank you all for your support and prayers over the years and during this week!

Clinic Day with Agape!

Today was definitely a special treat-- I got to go out on the road to one of the remote clinics that Dr. Sherwood Pope and his wife Areli are now running with Agape in Action! They have been working down here essentially in the role that Matt and I played full time back in 2006-2008, and you can always read more about them at missionarydoc.com, nbri.net, or agapeinaction.org. They are a young couple, full of faith and patience and medical skills (Dr. Pope is a US-licensed Family Practitioner, and Areli-- although with no formal medical training-- is VERY good at picking up on small details from the patients during consults and picking up some ultrasound skills very quickly!) The first picture today is of us turning off of the main road from Quiche, which thoroughly disoriented me at first because I had no clue where we were! I didn't remember there being another tunr-off from that road, which is because it was never PAVED when we drove it for two years... A pretty good stretch of it now is although there is still a long way to go before it is completely paved out to where the Fickers live in Canilla... but time indeed does march on.

The next picture is of the Church where we set up our mobile clinic-- that's it, the little white speck in the middle of the picture! This picture is, unfortunately, taken from our "parking spot" where the truck could pass no further in the current road conditions. Rainy season has really been rough this year for ground transportation.

Luckily two strong-backed Church members came to our aid and lugged (and lugged... and lugged... and lugged...) our stuff down and then back up the hill on their backs! These truly are amazing people here. Areli and I between the two of us could barely make it with just ONE of these trunks on the way back!

About the time we were crossing over this "bridge" was when I figured that-- because I KNOW myself quite well, I should probably put the camera away before it went in the river or the mud where the rest of my body was likely headed...

Unfortunately, though, I forgot to ever get it out again to take any pictures during clinic or of the patients! Well, except technically the two guys carrying our stuff did ask for consults-- one said that his shoulders hurt a lot and feel tight all the time! Go figure. I tried massaging his back for him for a little while, but he said that hurt so we gave him some ibuprofen instead!

The patients we saw were pretty routine today for the most part-- lots of gastritis/gastric reflux, prenatal patients or women for pregnancy tests, body aches and pains, and kids with colds mostly. Please pray for our most interesting (and hopefully most fruitful) patient of the day, Maria Vicente. She had been in several times for aches and pains, ibuprofen and vitamins and such. Today, though, her chief complaint was that ever since a horse down by the river had charged after her a few weeks ago, she is very anxious and afraid all of the time. The translator was explaining to us that this animal has scared lots of people and runs a little wild, but after ruling out the possibility of prescribing a rope or chain to tie it up (a joke somewhat lost on the patient and our translator but nonetheless amusing to us!) we delved deeper into her issues.

Here in clinics, we have very little access to psychiatric medications generally speaking. This has led us over the years to probably a more effective treatment of anxiety and depression issues than I give many of my patients in the U.S., as we are left to witness to them of the only effective anxiety relief we know of-- the assurance of eternal life with our Lord and Savior by acceptance of Jesus Christ's gift of salvation for us. She was in the "Catholic" Church here (really often just a traditional Mayan religion, especially out in smaller villages) and claimed she had never even heard of Jesus Christ. Surely what we shared with her today and the prayer we prayed with her are just a tiny little "starter seed" planted, but we will continue to pray that it grows in her heart until she can share in the peace that we possess only through Him.

The area we were in today, called Tabil, is largely unreached by the Gospel in general and I am thankful for Agape's continued efforts there. Please pray for their continued strength, patience, and perseverance as they try to chip away at the darkness there one "Maria" at a time.

Tomorrow I will be back at ASELSI, another old "stomping grounds" from when we lived here, which will be another special privilege. I haven't even made it by there on most of my recent trips down here, so I am excited to see how much it has grown. I made Dr. Pope a deal that I would see all of the prenatal patients if he would see at least most of the men tomorrow, so I hope he holds up that bargain! Every now and then it's good to play the "gynecologist" card...

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.