Cambita Garabito; It's All About The Plans

 

Jeremiah 29:11 begins with "I know the plans I have for you, declares the Lord".  The unfortunate thing is that I am pretty sure that I don't know what His plans are when it comes to the mission trips we make.  You would think that I know that by now after 34 trips, but I just keep learning. Take for instance our recent MMI trip to the Dominican Republic on January 29,2024.  

MY PLANS

It takes quite a while to "plan" for a trip like this.  But this is not just me, it involves coordination with a large number of people over a long time.  Sheri and I and Bill and Pat Waswick are involved throughout the year in advance of the trip.  The challenge is that we don't know how many people will go with us, how many people we will take care of, nor what those conditions will be.  So, making plans in and of itself is complicated by any number of erroneous assumptions.  But we have the benefit of experience and a history of doing this kind of thing.  One of the difficulties is in remembering that this is God's plan and not our own.  We make a prediction of how many we will have and what we will do, then go about trying to achieve that goal.

Peoples

It begins with the people who join us.  We know that to set up and run a clinic we need at least 5-10 participants and in surgery we need 15 to 20 to run two to three surgical tables.  The size of the places we go can limit us also.  So, when we had 33 sign up to go, we thought we might have a few too many.  Most people who go, want to be busy.
  Jim Collins, the author, says it's not enough to have the right number of people on the bus, they have to be sitting in the right seats to make an organization productive.  But when one of our participants had to return home for a family emergency and two more came down with COVID, we ended up with the right amount of people and those were sitting in the right places.

Places

This year we were returning to Yaguate where we went last year.  At least we thought we were until we were told around 2 weeks prior to leaving that the hospital in Yaguate was being remodeled and we couldn't go there after all.  A new hospital had been recently opened in Cambita Garabito.  As we found out, so new that the surgery area had not been used at all.  We were scheduled to go to 5 different villages and set up our medical, dental and vision clinic but not until we arrived did we find out that 3 of the villages could not host us. 
Fortunately, the MMI staff in the DR was at work behind the scenes and replacement sites were found.

Products

What we can do is certainly controlled by who and how many we bring, but also what we bring has an impact on what we do, namely the supplies, equipment, and medications.  In the DR, MMI has a warehouse that can hold the big equipment and supplies such as tables, lights, anesthesia machines and sterilizers that we need for a project since we can't count on all of the hospitals to have what we need.  We are able to set up a "MASH" like hospital in almost any facility.  But, the disposable supplies are more of a problem. 

We generally bring 1,000 to 1,500 pounds worth of supplies as our checked luggage (27-gallon Rubbermaid-like tubs).  We collect those supplies year-round and process them here then take with us.  Medications are purchased from a non-for-profit wholesaler.  We know that we usually see around 500 patients in the clinic so we try to bring enough medications to provide for that number.

  Vitamins are commonly given out to each of the patients as they represent a luxury for the people there.  So, I ordered 18 bottles of 1000 each to take only to find out in November that they couldn't supply the order since there had been so many worldwide needs (Ukraine, Tsunamis, Earthquakes).  So I approached our church and a "Vitamin Sunday" was set up for people to bring vitamins to church on December 3.  Together with what was collected and cash donations made, we were able to take almost 13,000 doses of vitamins.  I have to send a list of each bottle and amount to Customs in the DR 6 weeks in advanced so I sent my list only to find on my front porch three days before Christmas a box that had the full 18,000 vitamins that had been backordered.  God provided abundantly and more that we planned.  The abundance provided for future projects that didn't have vitamins with them to also provide for these needs.

HIS PLANS

I have learned that the best way for me to follow His plans is for me to not get to far ahead and be willing to be flexible if I find that I was wrong about what I thought I heard Him say.  These projects certainly prove that.  Being flexible seems to be one of the most valuable skills that one needs to participate in a mission project.  So, with that view thru the rear-view mirror, I can better see how His Plans have unfolded.

Unity

1 Corinthians 12:25-26 So that there will be no division in the body, but that its parts should have equal concern for each other.  If one part suffers, every part suffers with it; if one part is honored, every part rejoices with it.  We were able to bring 33 people from the US and work with 11 from the Dominican Republic with such diverse backgrounds to include 2 countries, 10 cities, 5 states, multiple jobs at home, and most of who didn't know each other prior to landing in a foreign country.  It was that common purpose that united us all into a cohesive and productive "body" that we equally suffered and equally rejoiced during the project.

Service

John 13:15  I have set you an example that you should do as I have done for you. 

Year of Project	2024
Patients Seen in Clinic	442
Health Education	837
Prescriptions Filled	1,634
Eye Exams	192
Dental Patients	101
Major Surgeries	48
Minor Surgeries	33
Consults	107
Commitments to Christ	10
Project Location	Cambita Garabito

 The wonderful part of going on a mission trip is that everyone who comes does so voluntarily and of their own free will expecting to serve.  Almost every year, I have people share that this type of comradery and environment is why they went into health care in the first place.  Likewise, the responses to us by the patients and families we see is heartwarming.  
Statistics are a poor way of quantifying our impact but still help to underscore the services that we were able to provide to "the least of these" that Jesus talked about.

I received a beautiful hand-written in lovely cursive English from one of our patients that I would love to show you some time as it  hanging on my wall.

  It was interesting that she thanked us not for our medications, our dental work or even our skilled surgical procedures but for our presence.  We just showed up and followed God's plan.  If I stopped my post here, it would be considered just nice heartwarming entertainment.  But there is more.

YOUR PLANS

So now the hard part.  What does this mean for you?  There are many opportunities to serve on mission trips with MMI in over 23 countries annually.  For some, that is not a good option.  For some, going with us to the DR next year around the last week of January may be an option.  Or maybe it's helping with the purchase or packing of the medications and supplies.  And hopefully, it includes praying now for next year.  But the Great Commission, as I read it, doesn't seem to have a "none of the above" option.  So, consider going, giving, praying or maybe all of the above for the least and the lost as we begin to try to figure the Plans He has for us all.

Following and Changing in Yaguate

    We generally tell people who go on a mission trip to a developing country to "Be Flexible" and they usually get it.  But I have found that it is the repeat participants that seem to have more trouble with that flexibility because they were flexible... the first time.  Thereafter, they get used to the new different and then it changes again and we have to be flexible all over again.  We had planned to return to Palenque in January of 2023 for some time but three weeks before we were to leave the US, I got word that we were changing hospitals for the project.  My first thought was "nobody ask or talked to me about this".  Submission is part of the flexibility thing I talked about that I am still working on.  Apparently, the hospital's backup generator was broken, whatever that means.  I should have suspected something since last year, when we were at that hospital, I saw them "jump-start" the hospitals generator with a Honda Accord.    So, we were going to San Gregorio de Yaguate instead of Palenque.

Putting together a Team

    This year we had 37 participants go to the DR.  The process of recruiting a team is both easy and hard.  This was almost the largest group that I have taken to the DR. This is great since we had seen marked decreases in participants since COVID changed the world.  Half to two thirds of the participants are folks who return year after year with us and have become some of my most treasured friends.  Another group are people who have been once or twice before, but don't come every year.  The last group are first timers.  This group is a lot of  fun because they see everything thru new eyes.  The last participant to join us only decided 3 weeks before we left to come.  This year we had 11 physicians, 2 CRNA's, 1 Nurse Practioner, 1 Pharmacist, 12 RNs, 2 Medical Students and 8 general helpers.  Those of us repeaters are constantly talking to others about the mission and I am adding names to my master email list through out the year.  Then, when the project is set I begin by sending out an email to ask people to consider going and begin the planning.  As it turns out this year we had more gynecologist than in years before and that changed the case mix of surgeries we could do.  If we had gone to the original hospital we would have not had the physical room to do all the surgeries that we did.  I had no way of knowing that, but apparently, God did.

Thorns and Roses

   

There are always troubles or difficulties and blessings that present themselves during a mission project and one must be careful to always look closely to see the flower among the Thorns.  We changed our hospital this year because of difficulties with the back up generator at Palenque.  But we didn't anticipate that the "new" hospital would be without running water.  It seems as if there was a problem with their cistern holding water.  That meant that the toilets had to be bucket flushed.

  I was surprised to find that some of our younger participants needed to Google it to learn how (actually we ended up telling them).  That meant that we had to use hand gel for hand cleaning and Avagard for sterile preparation of our hands  for surgery.

    We did have air conditioners in the OR and actually in our sleeping rooms.  Very much a Rose, but the Thorn was that few people came to the Caribbean with a blanket to sleep under.  And when we ran low on gowns toward the end of the week, it was chilly in the ORs. 

    Prior to our arrival on a project, our Dominican director will make site visits to the local community and work out the dates and locations of our surgery and clinic teams.  He will also let them know our team composition and capabilities.  The hospital director then spreads the word to the local people and a list is developed of people that may need our services.  This year they identified 135 people and apparently told them to all show up on the Sunday we arrived to set up so that they could be seen and scheduled for surgery. 

We were able to see 75 patients the afternoon we arrived and we told the rest to return on Monday.  There are many factors that go into scheduling patients for surgery including the number of surgeons, the number of staff members, the number of recovery room beds, the amount of supplies and medications as well as the condition of the patients.  Based on all those factors we anticipated being able to do 100-110 surgeries and ended up at 98 total.  So, the Thorn of having to change hospitals at the last minute became a Rose of  allowing us to do almost 20 more surgeries due to the larger size of the preoperative and postoperative rooms.

    The medical clinics work in the same fashion.  Our director meets with the local sponsor of the project that in this case was a pastor from a local church.  Clinic site locations and dates are picked and then the local pastor spreads the word to the communities and helps arrange the actual locations for the clinic to be held.  Sometimes they meet in a church, sometimes a community center, but this time one was held in a local library. 

    It is an unusual experience for those of us in health care to be welcomed with a "Rose" of applause but not in the DR.  Each morning as we arrive to the clinic and to the hospital all the patients for the day are there with their family. When we are introduced to the crowd, they break into applause. We all begin the day with prayer and a Spanish praise song, Alabare'.  At the hospital, all the patients show up at 8 am for the day and have their preoperative COVID test and then wait their turn for surgery.  When the nurses come to the waiting area to call the next patients name, everyone applauds and congratulates the patient.  There was a long hallway from the OR sites and the postoperative recovery rooms.  In the hospital, people could wait anywhere in the hospital and the waiting area was between the OR and the post op area.  As one young body was being transported from the OR by the waiting area full of people, he was quite sleepy from his surgery but did manage to raise a thumbs up to which the crowd cheered and applauded.

    If there was any question as to whether we were appreciated, it was answered when one happy patient returned the day after his surgery with a pan full of 36 home made empanadas for the whole surgery crew.  They were very good and were made with yucca as the pastry shell.  It is a local favorite as well as some of us.  The hospital staff also served us the last day with a fried Caribbean sea bass and tostones which are twice fried plantain slices.  All were very tasty.  

Earthquake

    I have encountered many different things while in the DR, but this year I was able to add a new experience.  During our teams morning devotional, one of the participants was presenting a devotion on the Hope of God.  In the middle of the presentation, all the people upstairs simultaneously got up from their metal chairs on a tile floor.  It was about that time, I realized that there wasn't anyone upstairs that the building was shaking.  Yes, we experienced an earthquake at exactly 7:11 in the morning.  We were all getting ready to head outdoors when it quit as quickly as it started.  Later, we discovered that a 5.6 earthquake had occurred 30.6 miles away from us. 

Later, I texted my wife and she told me that she had been awakened at 5 am (there is a 2 hour difference between Wichita and the DR) and had felt led to pray for our teams safety at that same time.  What a coincidence! Just kidding.  The scheduled village that day was closer to the epicenter but they didn't see any damage. The school officials had called off school and most everyone stayed home rather that coming out to the clinic. After lunch the people showed up in crowds to be seen.

Struggles of the Patients

    One of the patients needed a hysterectomy because of heavy bleeding. However, her blood count was too low to safely proceed with surgery.  Our doctors recommended that the patient have a transfusion prior to surgery.  For us in the US, that is not a major problem.  But in the DR it is.  The day that she was scheduled for her surgery, she didn't show up.  After we found a number to call her, we were told that she had to travel by moped to another city to buy her blood.  She arrived later (on the moped) with her blood in a Styrofoam dinner container with ice cubes in a plastic bag. We administered the blood to her and then took her to surgery and she was home the next morning. 

    I saw a patient on Monday afternoon as I was filling in the last slots in the schedule.  She was weak and kind of shaky and I ask if she was okay thru the interpreter.  She responded that she hadn't had anything to eat or drink since Saturday in hopes that we would do her surgery.  After we left Sunday and told people to return the next day, she had just stayed at the hospital in hopes to be the seen for sure.  She was willing to do anything to get help.  We gave her some IV fluids and her surgery went well.

    I had a male around his mid 50's who was a neighbor of the hospital director, who arrived late on Tuesday to be seen to see if we could squeeze him on the schedule.  He had an abdominal wall hernia that had been present for 12 years.  I also noticed that he walked with a cane. We saw him and did an evaluation including checking his blood pressure.  We checked it several times and it was 224/129!!  We immediately told him that he couldn't have surgery with that pressure and sent him around the corner to the Emergency Room (yes, it was a room with people in the halls).  As he was going I asked about his limp and he said he has had that since his stroke a year ago, undoubtedly due to high blood pressure.  As we were leaving in the evening, he came by my room and said they got his pressure down with meds to 149/100 and he ask if we could go ahead with the surgery.  The answer was no, as it was still too dangerous to operate in an elective fashion on a non emergent hernia.  We advised him to keep taking his blood pressure medication and to return on our next project to be evaluated.

    It is sometimes not just the patients who are under stress.  For instance, we had two brothers, 2 and 6 years old, that need to be circumcised and their mother wanted them done on the same day.  So, the first one went well and when he was taken to the post operative room mom came in to sit with him until he was ready to go home.  We then did the second boy and when he went to the same room to recover, mom needed help and the boys grandmother came in to help.  When both boys cried we looked over and saw that grandmother had passed out on the second boys bed.  Everything turned out good, but it was a little chaotic in that crowded room for a bit.

Speaking Your Heart

    We had daily devotions during our time in the Dominican Republic beginning on the first day, Sunday morning.  The first day the message highlighted a devotion that I had shared almost 10-15 years ago.  It focused on the concept of doctors needing others around us to make us productive. 

Then another devotion resonated with the person that was sharing that one of us had shared a few years ago.  Neither one of us remembers much of the details that we had shared at that time but it shows how important that it is to share your heart because you never know where people are at the time you share your insights or how important that they are to them.  The devotion times during the projects remain a source of encouragement to each of us and allow us to focus our efforts each day.

"I can do all (these) things"

    Frequently, we hear the verse from Philippians 4:13 quoted and used to encourage us to do anything we want to do.  But, recently I read that this verse must be read in context with the preceding verses, 11 and 12 which go something like this in the NASB. "Not that I speak from need, for I have learned to be content in whatever circumstances I am.  I know how to get along with little, and I also know how to live in prosperity; in any and every circumstance I have learned the secret of being filled and going hungry, both of having abundance and suffering need.  I can do all things through Him who strengthens me."  The "all things"  that he was referring to was the preceding things like being content in any and every circumstance.  That contentment that he learned was thru Him who strengthens me also.  Contentment is what allows us to be strong like these people from the Dominican Republic who don't seem to have a portion of what we materially have but have an abundance of His strength.

Return to Palenque

     The trip down was complicated.  One participant had their flight from Kansas City to Atlanta cancelled last night because of weather so she will not join us till Sunday.  We all went to the airport in Wichita around 4 am to check in.  No one had to pay for their bags and we had not ask to be able to take our baggage for free.  Prayers had been lifted up this year for our supplies and baggage after problems we had had in years gone by.  Unfortunately, bad weather in the east coast had delayed arrival and departure in Wichita and everywhere (all planes had to be de-iced prior to departure).  So we sat on the tarmac in Wichita for 40 minutes waiting to leave after our "on time departure".  Since our connection time in Atlanta was 45 minutes, we were afraid that we would miss our connection (the only flight until late in the evening to the DR).  Nowadays, Delta has Wi-Fi while in the air so you can stay connected to the internet and that allowed me to receive a text from the Delta computer informing me that our flight to Santo Domingo was leaving 5 minutes early.  Great! So, that same helpful computer automatically rebooked me since it was sure I couldn't make the departing plane.  As I looked at the flight info on my new flight I noticed that it was thru Mexico City.  It did have the courtesy to ask if that was OK to which I responded with a polite NO.

     When we landed the flight attendant informed me that the plane to Santo Domingo was being held for us.  We hadn't ask and they almost never do that.  So we all made the connection and arrived 5 minutes late to Santo Domingo as if nothing had happened but God had been working hard behind the scenes.  We had people back home praying for our travels.  Passing thru the Las Americas International Airport is always a surprise.  It is kind of like Kellogg Expressway in Wichita, it is always different and under construction.  After going through the new location and procedure, we came to the baggage and customs ritual.  This year once again, we didn't have a letter from the head of customs (we never found out why) and after 45 minutes of standing around discussing, motioning with our hands and arms and making phone calls, we were able to take all our supplies and baggage without having them go thru them or leave anything behind.

     We arrived at the camp after the 45 minute bus trip to Sabana Grande de Palenque.  The retreat center was much the same as we left it in September.  We did Covid test upon arrival following our new protocols.  We were vaccinated and feeling well but one of the participants tested positive.  So, we placed him in isolation before we had spent much time with him.  He was given a private room and had his meals separate from us as per protocols.

    Sunday was a blur.  We followed the usual routine with breakfast, devotions, orientation and unpacking at the camp as we usually do on these projects.  By 11 am, we were able to head to the small hospital in Palenque.  It was a pleasant drive along the coast for 15-20 minutes.  Upon arrival, there were 75-100 people outside the front door waiting for us.  Being a Sunday, that meant that all of those people were there to see us since the weekends at a small hospital are usually very slow paced.  After a walk thru of the hospital with the nursing director, we were given permission to use certain rooms similar to last year.  While the project director and I were doing that, Edu had the patients and participants deep into prayer and song outside.   

The patients then opened a path to the door and applauded us as we walked into the hospital building.  We then began the unload and set up process.  We did stop briefly for lunch (PBJ or Ham and Cheese on hot dog buns).  While the set up was in process, we set up our consultation clinic at about 1 pm to screen and schedule patients for the week.  There were 2 rooms for gynecology patients and one for general surgery patients and I set up in the hall to set the dates for surgeries after seen by the docs.  The rest of the team continued to set up the rooms including the two ORs, central supply, pre op and post op rooms.  By about 4 pm they had finished as much as they could for the day.   I sent that part of the team back to the camp.  The consult clinic finished seeing 71 patients by 5:30 that afternoon and cleaned up the areas we used and returned to camp by 6:15.

    The dinner bell rang at 6:30 and we had dinner and a debrief of the day's activities.  We had 12 new decisions for Christ reported today alone. God is good!  We retested the participant that had been positive and his test today was equivocal but faintly positive so he will stay in camp in isolation and we will retest him tomorrow.  I completed the paperwork for the surgery schedule and visited with friends to complete my evening.

    Monday was a very busy day as usual.  I awoke early at 5 am with my mind swirling with mostly the things that are unknown ahead of us here.  After breakfast, we were off to the hospital. After doing so much yesterday, we were able to start the first case by 9 am, earlier that most projects.  There was only room on the schedule for 6 patients for the rest of the week, so I saw them during the afternoon.  We were able to do 11 major and 3 minor cases.  Major cases are those that are done under general anesthesia.  The end of the day in surgery did not come till 7 pm.  We had anticipated having some patients cancelled due to Covid or simply not show up, so the schedule was booked heavier than we wanted to actually do.  All patients checked during the week were negative for Covid.  When we got back to camp our participant in isolation tested negative for Covid so he was allowed to rejoin us for dinner.  I didn't last long after evening report and was back in my room by 8:30 and asleep by 9:15.  A great first day for sure.

    We were able to complete our Tuesday schedule and get back to camp by 6:15.  So dinner was on time!  Most of my time this year has been circulating from station to station, answering questions and talking to folks.  Our volume of cases is similar each day.  We did have one patient that we had to cancel due to uncontrolled high blood pressure, that was part of the reason that we got back to camp on schedule.  I am used to pushing a little, but this trip we really can't due to the Covid protocols.  So far it has worked.  Mask wearing in the hospital by the people in town has been very good.  I have had to keep reminding myself that there is a bigger goal with this project compared to our regular projects.  Being able to demonstrate that we can do a larger project safely is very important as a sign to future project participants.  We did get to enjoy ice cream bars after dinner, but I remain pretty tired so I turned in early to be up early.

    Wednesday was another long day.  I had scheduled 14 cases for us thinking that we would have had some cancelations but everyone showed up for surgery.  One elderly (72) gentleman came in with a history of hypertension.  He had taken his med but his blood pressure was still 178/138 (dangerous by our standards).  We worked to lower his pressure with the usual things but not until the Edu (they call her the evangelista) came in and prayed for and with him.  He committed his life right there and when we rechecked his pressure it decreased to a level that we could proceed with his surgery.  We repaired his inguinal hernia and he was able to be dismissed the same day as surgery.  Our last case of the day didn't finish until 6 pm but then we waited and worked with her for an hour and a half after surgery because her pressure was low.  We were concerned that she might have been bleeding but it turned out to be more related to her spinal anesthesia.  I had sent the rest of the team back to camp and a few of us remained with the patient.  We didn't get back until 8 o'clock and everyone had waited dinner on us.

    No cancelations or no show on Thursday so we had a packed scheduled.  We had no one complaining about the busy schedule.  It is amazing to have a group of people who all want to be here and do everything possible to help others.  We had a patient after surgery who was having trouble maintaining her oxygen levels in spite of increasing her nasal O2.  She was beginning to panic and breathing fasted to try to get more air.  Once again Edu was there and prayed for and with the patient.  All of a sudden her oxygen level began to rise to normal and her breathing slowed.  She likewise committed her life to Christ.  Our difficult case from yesterday had turned around by the time we came in and was able to be discharged. 

The final group returned to camp after dark but we celebrated a couple of birthdays in the group with a Dominican cake and some ice cream.  Everyone was a little on edge since tomorrow was the last day of surgery and also the day for us all to be retested for Covid to get a release to go home on Saturday.

    I didn't sleep well, so I was up earlier than others.  I was first in line for my Covid test and yea I passed as did all the other participants.  This was a different project with the mix of 3 General Surgeons and 3 Gynecologists in addition to me.  So, I was not needed in the OR to do surgery with only 2 tables doing surgery.  That made for a lot of sitting around later in the week (think Ecclesiastes 3:1).  Our day went by very fast with 13 major cases completed by 2:30 pm.  None of those would require overnight stays so they were discharged soon after their surgery.  But we had to tear down our "hospital" and load it all onto the big white truck to take back to the warehouse.  That allowed us to be back to the camp in time for some R&R prior to dinner.  Some swam in the pool, some walked to the beach, some to the cliffs.  And all were able to appreciate the beauty of the country.

    Dinner was followed by our sharing time and debriefing for the project.  Many appeared to be deeply touched by our experiences.  The time of sharing was very special.  Then to bed after taking time to casually visit in the cool of the night outdoors with friends.  In the morning, I awoke earlier than I needed to wake, but it's hard to go back to sleep with a thousand things on my mind about this project and about the next ones.  After breakfast, we loaded up and began the drive back to the airport.  We stopped by the MMI warehouse in Los Alcarrisos, a municipality on the east side of Santo Domingo. 

It was good for the team to get a bigger picture of MMI in the DR since most are limited in their experiences to their own projects.

    In the air flying home, I continued to reflect on the project of the last week.  

Defining success looks different to different people.  To the 65 patients we saw and operated, success would be defined in the relief of physical and mental suffering.  For the 32 new followers of Christ, a redefinition of their eternal trajectory.  For some of the 21 other participants, it represented relief from burn out, fulfillment of their God given passion and awareness of a new direction in their life.  But to me it was an affirmation of purpose and a sense of peace.  

And the greatest success was in the glory that was given to God for all he has done and is doing and will be doing.