May 2011 - Day 5/6 - By Dr. Chris DeLuca - "Yay, An Airplane Trip!"

Well yesterday was a lovely quiet day! We got up and rounded on our patients and then really didn't have much to do. Went through all the supply boxes and donated things and made some sense of them and tried to clean up the clinic room a bit. Pat went "shopping" in my bag full of anesthetic supplies and was very grateful to OMH for all the recently expired goodies (ET tubes, LMAs, epidural supplies, etc)! I think perhaps I am going to start a similar "give away" box in L&D and OOB for missions because that system obviously is working great in the OR.



Got to then get some lunch and spend a little time in the market here in Chichi and then actually went back to the apt, packed up, and got a little nap in! NIce treat! Skyped with my handsome fiance for a bit then headed back to Buen Samaritano and watched Dr Hoak taken care of a walled off appy. Finished my day with a meal with 3 friends of Heidi's, Roy, Kathleen, and Jim, who I thoroughly enjoyed, and one more short talk with my honey before bed! We will discharge the last of our surgical patients today and catch a microbus to Quiche where Dwayne will pick us up in the Cessna and head to Canilla... yay!! We will get to spend some time with the Fickers and help them our tomorrow with one of their clinics, then it will be back home of Saturday!



Another great trip here, but there is always more to do, and more needed. Buen Samaritanos US machine, for example, was stolen recently... big old machine taken from behind locked doors... They are using and old borrowed Sonocyte now that really just doesn't cut it... anyone have an old machine they'd like to get rid of? If it is in working, or near working condition, it could certainly be used here... I'll be glad to help you get it here... just for starters, lets pray for a replacement for them, shall we? :-)



OK, off to start my day, hope everyone at home is doing great... see you all soon!



Chris

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May 2011 - Day 4/5 - Post by Dr. Chris DeLuca - "It's Not a Tumor"

Or at least not a cancerous one probably... YAY! So good morning! Yay for God because the surgery we were worried might be cancer WASN'T! (At least I am about 99% syre pre-pathology results... and speaking of pathology results, anyone else ever seen an olive jar double as a specimen container? Love missionary medicine!) So did 5 cases yesterday, 2 of our own and 3 where I got to play general surgeon with Dr. Hoak (kinda fun!) One non-surgical consult only i the AM... apparently Mother's Day was yesterday in Guatemala and nobody fancied a pap for Mother's Day... crazy I know! ;-) All 3 of our post-op patients are doing very well... it remains to be seen how successful Tomasa's prolapse repair will be seen (may not know until well after we are gone) but we are still praying hard. We did decide NOT to reoperate... just trusting Him. Our first case was a nice mini-lap ovarian cystectomy that ended up being a little dermoid (cool but gross cyst with hair in it) so the correct call there. The one we were worried about, Manuela, appears to just have a HUGE cervical firboid that parasitized some nutrition from the uterine arteries. It was kind of a cool case, we got in to a MILDLY enlarged uterus sitting on top of a softball! Thankfully, the softball acted nothing like cancer... rest of the belly seemed benign, shelled out pretty easily once we took care of the blood supply... praise God for the gift of Dr. Tom Hoak who came down and dissected out our ureters and protected them from harms way after me a Heidi spent about 30 minutes trying to channel Dr Semer and dig them out... *lol* He was AWESOME! Enjoyed working with Him a lot! He is a great teacher and if God ever tells him he is done over here, he should ceratinly teach somewhere! Anyway, did lose a lot of blood, but by the grace of God, she is tolerating her anemia WONDERFULLY and should do great! I also did 3 cases with Dr Hoak.... a femoral and inguinal hernia repair (short and sweet) and an open cholecystectomy that ended up being a common bile duct resection and sphincteroplasty... something I'd never get to see at home... pretty cool!



So a good day yesterday, but another long one... been so happy for God's provision and grace, even if my feet and back are a bit sore! :-) Today whatever comes in we will see, will be our last consulta day and we'll have to see if anything surgical shows up. I know that Tom has 3 or 4 cases on the schedule so if there aren't Gyn patients, we may just help him out some. Tomorrow we will leave for Canilla to spend time with the Fickers, missionary friends of Heidi who I thoroughly enjoyed meeting my first trip here. We will probably do a clinic with them Friday then back to the States Saturday! This trip seems to be going by quickly... good and bad. Good because I certainly miss being around the people I love in the States, but bad because I truly enjoy it here when I come. Praying today for his favor and continued good recovery for our patients. Pray that we wouldn't miss opportunities to help these people, physically or spiritually! Thanks for the prayer! We can CERTAINLY feel it here! This doesn't work without it! Have a great day guys and God bless!!



Chris

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May 2011 - Day 3/4 - Post by Dr. Chris DeLuca - "Leaning on Him"

Good morning all! Well for those who prayed for Heidi and Micah yesterday, Micah did SO much better... she was very good for our friend Aurelli and allowed Heidi to scrub 2 cases with me in the OR yesterday... in general seemed much more content so your prayers worked... THANKS! Yesterday was a very good, very productive day for the most part. Thanks to our other good friend Dr. Sherwood Pope (a family doc who works over at Aselsi, one of the other Christian clinics here in Chichi), we were able to turn NOBODY away for consultas despite a full OR day. He scrubbed the entire first case with me and portions of the second while Heidi did consultas downstairs.



First 2 cases went beautifully! Uncomplicated vaginal hysterectomy with repairs who should do wonderful, and a nice abdominal hysterectomy for fibroids that made this poor lady look NOT pregnant for the first time in years! :-) We started around 8:30 and had those 2 cases done by lunch. Broke for lunch and came back for another vaginal hysterectomy with repairs on a complete prolapse... (btw if you aren't interested in surgery details, now is the right time to skip to the next paragraph)... after 2 hours of patiently trying to work my way down into this inside out anatomy, we had gotten almost nowhere and the uterus (which we'd previously thought farily normal sized), wasn't descending at all. We decided to open the belly, do the hysterectomy abdominally, and then, since neither of us have any real experience the abdominal suspensions, to go below and finish the repairs from there. Get in the belly and its a 14 wk sized fibroid uterus... no wonder its not descending, it doesn't fit. What I had palpated before on exam was her 8cm elongated cervix... *sigh* So we get it out from above, but as we are getting to the bottom, we start looking for uterosacral ligaments to attach the cuff to and her tissue is so bad, we can't definitively ID them... meaning there isn't much to keep this little vagina from fallling right back out when we are done. We close the belly, go below, repair the rest of the vagina and close the cuff, trying to attach to what MIGHT be uterosacrals but knowing that is probably not the case, but finished the closure anyway, and 7 hours later walked out of the OR VERY frustrated. Praying that God finds something to supernaturally scar the top of the vagina in to keep it in place... we are considering going back in to the belly to try again to find some semblance of uterosacrals vs attaching it to the sacrospinous ligament below (something neither of us have technically done). Considered sacrocolpopexy, but again, not much experience between the two of us and its a risky surgery... just praying for wisdom whether re-operating is even the right call... Would LOVE intervention for this lady by my prayer warriors out there... her name is Tomasa.



Today we have 2, maybe 3 cases and some consultas possibly (there are always a few stragglers on Tues/Wed). Again pray for safety and wisdom in selection for our surgeries. And again pray for the Spirit to conitnue to move here. We have one lady who we are a little worried about cancer today, she could use lots of prayer today. Off to shower and round on patients now. THANKS for your prayers!!!! Love you all and will be in touch!



Chris



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May 2011 - Day 2/3 - Post by Dr. Chris DeLuca

Well everyone home is up and about (and poking me on Facebook... Tony Schwering... *lol*) but I am just getting moving... 2 hrs behind here (I PROMISE I am not THAT lazy!). As usual today should be our busy day. Yesterday afternoon we saw 14 consultas, 7 of which were surgical (albeit one was an inguinal hernia that Dr. Hoak did :)). Productive day... We have 3 cases scheduled today, 2 vaginal hysterectomies with repairs (or vagathons as Heidi likes to call them), and a abdominal hysterectomy for a big firboid utures. Also scheduled 3 for tomorrow, one ovarian cystectomy, another abdominal hysterectomy for fibroids, and the slightly scary one, a abdominal hysterectomy to take out the girl parts and a soft a baseball sized mass next to her cvx that we are hoping is only a degenerated fibroid, but a little more worried is cancer... I've seen my share of Gyn Onc as a first assist in residency, but still not terribly comfortable with having to be one... praying for Gods favor in doing an adequate job if that is what it turns out to be. We did have one we couldn't fix... incontinence picture which was ? suspicious for a fistula between the bladder and vagina. Sure enough, when we put in the speculum, urine poured out and continued to pour confirm our suspicions. Dr. Tom Hoak (the general surgeon who is full time here and does a little of everything) is seeing her tomorrow to see if he can take a crack at it... hope he can, because there isn't much in the way of urology or urogyn here obviously... not a lot of options. I definitely don't know how to do it. Her story is sad... delivered a dead term baby at home after a prolonged labor, has leaked ever since... her husband left her as a result and now her brother cares for her. Pray that we are able to fix her issue, or find someone who can. More importantly pray that He start to heal the wounds this must have inflicted on her. We will probably try to work in a few more consultas between cases today as well. One interesting thing that I was asking Heidi about this morning... on the ladies we take care of, we ask them if they are in a church, if they know Jesus, and if they have accepted Him. Increasingly, the answer this time was "Claro" (meaning "Clearly" or "Of Course"). For the 42 y/o who was leaving in 3 months for a 4 yr missionary commitment to Spain (very cool by the way, I found her to be someone I may have been friends with in a different life (one that I spoke Spanish better in... *lol*)) I believe that very much... but sometimes it seemed to come to quickly. I pray that the Spirit is indeed moving here in such a way that people truly know and trust God, but I am nervous. Part of me wonders too if they feel like they need to say that to be cared for because we asked. That is OF COURSE not the case... God rejoices over the one returning son, the one coin found, etc... we would LOVE to opportunity to serve His lost sheep... just hope they understand that. Either way, will love on them and hope somehow through our inadequacies they will still see HIM. Part of me wonders if the Sunday Christianity that is so much a part of our home country (that requires little belief, little life change, and mostly attendance) has spilled over here... who knows I guess. Impossible to see in a 1 wk trip really, but praying for real, saving knowledge. ANYWAY, thanks for the prayers and love... Heidi said Micah did sleep a little better last night. Hopefully she will settle down some today too... she wanted to feed/be held almost continuously yesterday (and I just wouldn't do) which I know was frustrating for Heidi, but she handled it with SO much grace... hoping when my time comes I can find that patience... she definitely was the ultimate mom on MOther's Day, nursing, soothing, and doing consultas all at once. :-) So the OR starts up in an hour so I best be off to get ready! Pray for everything mentioned above and for a good day of patient care, that he would guide or hands and words as we take care of these ladies.... love to you all!



Chris

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May 2011 Trip Day 1 - Posts by Dr. Chris DeLuca

Heidi is on this trip with her 6-week-old daughter, Micah. Those of you who have breastfed babies know that 6-week-olds are completely dependent on Mom 24/7. So it's very challenging for Heidi.

Because of this, we'll be stealing Chris' posts for this trip.
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Good morning again from Chichicastenango! Trip here yesterday was LONG but went easily. I drove from Seneca to Greenville yesterday after work... I think I know better to work the day before I go, but I was taking off a lot of time for the trip, and the wedding, and the Colombia mission trip with TCWC in July, so I was feeling kinda bad about leaving my partners that long, so I stayed. Got on the road at about 1:30... at about 3 I realized that my passport was still in Seneca... *sigh* So drove back and didn't get to Greenville until 10pm. Sat down to a LOVELY meal of mac and cheese (cooked by my favorite daughter to be), watched a little Modern Family, got a REALLY sweet (and completely unexpected) Mother's Day card from Ashley (its true, she is kinda a sweet kid)... and collapsed by 11pm. Woke up at 2AM with my neck in spasm and that was it for sleeping... *sigh* So about 3:30 we hopped in the car and drove to Raleigh and 2 flights and a long car ride later, made it to Chichi. All this to say that I was a bit tired yesterday and feel like it was a bit of an attack but prayerfully went to sleep and had A GREAT nghts sleep last night... SOOOO bring on the week. Heidi (the physician I join here who is an awesome OB/GYN) brought her beautiful little mini-me 6 wk old daughter Micah. Pray for Heidi... its so early right now and Micah isn't quite adjusted to the schedule here... I know she kept her up most of last night and wants to feed every 30 minutes or so which is very frustrating for Heidi who really wants to be able to get things done here. Pray for a cooperative little nina, but mostly for peace for Heidi that whatever Micah may choose, things will get done as God intends and he will provide workers if Heidi has to step away. Today we will head to the gringo church in a little over an hour and then after lunch start our consultas... pray for the women and families that we meet today, that we may be able to bless them physically, emotionally, and spiritually. Pray for the Spirit to move here in Chichi and to soften the hearts of those whose sight is blinded by the enemy. THANKS for your prayer support... I am faithful He will use this week to His glory and can't wait to see how! HAPPY MOTHERS DAY too to all the mom's out there... especially mine, Margaret DeLuca! Love to all of you!



Chris



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Days 5-6 from Dr. Chris

Well, I have gotten a slow start this morning... kinda feelin' cruddy. Looks like I've caught a nasty little Guatemalan cold and spent most of the night up coughing and sneezing and trying to breathe... ugh. :-( So this mornings note may be a little short, but here goes...

We lose Matt today as he has to head back to the States for work... will be sad to see him go as he has been a GREAT help. Yesterday was slow... 1 surgery and 1 patient in clinic... and really wasn't a Gyn patient- she came in with abdominal distention... normal girl parts on exam but LOTS of ascites... US done with some input from Dr. Hoak looked like a GI tumor... ugly and she probably doesn't have a lot of time left. Cancer is such an ugly disease, but especially out here when they are SOOO advanced by the time you get them. Dr. Hoak (the full time American General Surgeon who also does a little of every surgical subspecialty from Plastics to Neurosurg) said that when he asks why they wait so long, they usually say, "well, I thought it would go away.." Anyway, she could use prayer... they did a paracentesis for some symptom relief but there really isn't much more here. Surgery went great at very least.

So today we go and round on our patient and then head to Aselsi, another local mission to help out with their free clinic... hoping I can remember my Gen Med stuff... :-) Tomorrow we will d/c our last lady and get a day to play tourist and head to Pananjel (sp?) which supposedly is a gorgeous little town on a lake. And then FINALLY home on Saturday... I will be ready... pretty tired and this cold is taking it out of me...

Continue to pray for the successful recovery of our patients and the patients we will interact with today. Pray for the health of our team... Brandi is feeling a little better but Victoria and Kent have had some GI stuff and I have this cold... we are all pretty exhausted. Thanks so much for the support... it means the world... God bless!

Chris

(And thanks again to Dr. Chris Deluca for letting me "steal" her blog posts from facebook and repost them here! --heidi)

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...