Day 1, Saturday, January 24, 2004:
It never seems to happen; that is we are ready early and able to get a good night sleep before leaving. This year we had packed our Rubbermaid tubs three weeks earlier and packed our bags two weeks early, but still had to run around like crazy on the last day. Yesterday, on Friday, we had to pick up last minute medical and dental supplies and we added new participants within the last two weeks, which meant we could send more tubs of supplies and equipment. Sheri and I both ended up staying up late Friday night to finish the packing of all our tubs.
Our flight was to leave at about 10:00 in the morning, so we figured getting to the airport at 7:30 a.m. would be soon enough. M., my partner's wife, picked us up and we stopped to pick up N, who is an RN that was going with us, on the way to the airport. When we arrived at the airport we found J. and M., two of our anesthesia people, finishing the check in process at the ticket counter. No one else was present. There was an 8:30 a.m. in the morning flight and some of the team was to have left on that flight as well. The counter agent said that they had started calling people about 6:00 in the morning to come in early, since there was a heavy fog that morning and they were concerned that the later flights might get canceled, but apparently they didn’t call all the way down the list, because Sheri and I didn’t receive a call.
Sheri and I leisurely stopped, after checking in, for an egg McMuffin and then through security. As we strolled up to the gate, we saw Dr. H., the other surgeon who was coming from Fort Scott, standing in the hall guarding the gate to make sure they didn’t close it. We were in no hurry, since it was only 8:15 and our flight wasn’t to leave until 10:00 a.m…. or so we thought. When we came up to the gate, the agent went ahead and put us on the 8:30 flight, so we ambled into the plane to find all 20 of our team members already on and wondering what had taken us so long. They had failed to tell us at the gate that they had gone ahead and booked us earlier on the 8:30 flight.
The day is always long with the one-hour flight to Dallas/Fort Worth airport and then about an hour and a half wait before we begin the flight to Miami. We met Sheri’s mother in Dallas/Fort Worth to join us on the trip. For some reason they have almost four flights to Miami within 30 minutes and one of our team members found himself on one of those flights, but the other 19 weren’t on that flight. Unfortunately, it was the one who had only traveled once before in 1971, so he was a little unsure about which flight. It is a 3 hour flight to Miami and the airport in Miami is not very passenger friendly. We had to hurry thru the airport to get to the next gate. That of course means going out and having to go through security again.
Here we met up with about 10 more participants. Then we boarded the plane to the DR. It is only a two-hour flight from Miami to Santo Domingo, but by the time we arrive it is well past dark. Clearing customs and finding our 30 large suitcases and 30 Rubbermaid tubs along with our 60 carry on bags filled our next hour. Once each one of us loads all of this up onto our little pushcart we make quite a processional. We, of course, wait until all of those tubs and every one has got all of their bags before we approach the customs agent. As usual, the Health Ministry was expecting us and we went through completely without problems. We bypassed all of the customs stands and took our bags outside. The only bag that had to be opened was one bag that we opened to find some Tylenol, because the Health Minister had a headache and wondered if we had any Tylenol. It was good to be met by friends and now family. Mandy and Jason, my daughter and son-in-law, were there to welcome us. We were all loaded into the bus and took the hour and a half bus ride to Monte Plata in the dark. It is difficult to tell much about the country at night, although the smells tell you that you are not in the United States any longer. The burning of the trash and sugar cane fields makes for quite an odor as we traveled through the countryside. The roads, of course, are quite rough and the ride on the bus was difficulty for most of the folks. Fresh fruit and ham and cheese sandwiches were available as soon as we got to the camp. It was almost midnight by DR time, which is really 2:00 a.m. Wichita time. We had been up for almost 20 hours and were quite tired, but before we could turn in we had to convert our bunkbeds in the dormitory space to our home sweet home. This involved putting up our mosquito nets, finding our sleepwear and turning in. It didn’t take too long for any of us to fall asleep that evening.
Day 2, Sunday, January 25, 2004:
Well, I guess I messed up my alarm and set it for 7:00 a.m., but forgot there was a two hour time difference. I barely got downstairs in time to eat the breakfast that they fixed for us in the morning. Our cooks are the same ones that were present last year and, as such, the breakfast was all that I had hoped for with all of the fresh fruit you could eat.
Sunday morning is always a time of excitement as we begin to meet and acquaint ourselves with our new friends. Last evening, I rode in D.’s jeep to the camp instead of the bus. D. is the Project Director for the Dominican Republic and lives here full time. He and I rode with P. another of the MMI staff he had filled me in on some of the potential challenges that were coming up for the week ahead.
We had a time of devotions that morning, after breakfast, as is scheduled for each morning. After that had been accomplished and the devotional was completed, we set out the team assignments and we began the process of orienting the medical team and the surgical team. S., P.’s wife, was not able to come this year, since her son, N., was sick with a variant of typhoid, fortunately not really a very contagious type, but nonetheless enough to keep her from coming on the project. She has always been a valuable addition to the project and will be missed. P., her husband, D., the surgery team and I then left by means of the big yellow school bus from the camp to take the short drive of about 20 kilometers to Bayaguana. We figured that by going to the hospital on Sunday afternoon we would be able to unload and set up some. We were concerned that we might not be able to work because of the strikes coming up in the coming week and this would give us a chance to get everything set up and scheduled early.
The hospital hasn’t changed much….well; let me put it that it hasn’t changed any since last year. This year we were told that we could use the one operating room and also the one labor and delivery suite, which is right across the hall. The only problem that we encountered was that we could not unlock the operating room door to be able to set it up. The large white transportation truck had already brought, the day before, all of our supplies that are stored at the warehouse in Santo Domingo. That is where all of the supplies are kept during the year and then each project that goes out during the year takes those permanent supplies, which includes the two anesthesia machines, the lights and the tables, as well as large tubs of supplies in addition to what we had brought with us Saturday, when we came in.
We waited for about one hour for the hospital director to arrive, who then told us that she didn’t have a key. We waited for another 30 minutes for the administrator of the hospital, only to find out the administrator said the nursing supervisor has the key. Someone was then sent into town to try to find the nursing supervisor and they returned about an hour and a half later to tell us that she was gone on a mission trip and there was no one who had a key to the operating room.
So, we did what we could, but we left somewhat frustrated, not having been able to get into the operating room. Before we can actually set our supplies up, we have to clean out the room completely and take their supplies out and store them in a different room. The hospital is very small and there is not a whole lot of extra space for doing anything. So, after being there approximately 2 ½ to 3 hours and doing the few things that we could, we turned around and drove back to camp and had dinner. We spent the evening learning about each other by going around in a circle and telling two truths and one lie about each of us. It was fun to try to guess what each one of us had been doing in the past. Then I went to bed quite anxious, but I was also aware of a significant failure on my part; I had forgotten to bring my earplugs and that proved to be quite a bothersome problem.
Day 3, Monday, January 26, 2004:
I was able to get up on time this morning and actually didn’t sleep that well throughout the night because of my earplug problem. There seems to be other men in the room, and I am told that I may be one of them as well, who has a problem with snoring on occasion. I am not sure about me, but I am sure about them. After breakfast, we all loaded on the bus and the clinic team stayed at the camp. The camp that we are staying at is a Christian School and it has dormitory facility that is built over the top of the dinning room. That is where all of us stay, but they also have a small clinic building and the medical clinic this year will stay here at the camp and see the local residents of Monte Plata daily.
After we took the 30-minute bus ride into Bayaguana, we arrived at the hospital to find very few people standing in line. It seems that one of the other obstacles that we were going to have face was the fact that today was a national holiday, referred to in the Dominican Republic as Duarte Day. Duarte Day is named after the gentleman who is like a George Washington to the Dominican people and who was responsible for helping them secure their freedom from Haiti back in the early 1800s. Not too many people knew about us being there and, as such, we only ended up doing 25 consultations during that day. Of that, we ended up only doing five surgeries. When we arrived on Monday morning we found that the electricity was off. It wasn’t just that the electricity was off; it was just that the whole city and that sector of the country had no power. The problems with power in the Dominican Republic are quite critical. The power companies can’t generate enough power to cover the whole country and, therefore, they do what is referred to as rolling blackouts. The problem from our standpoint is that there is no telling when the blackout will roll, when it will start or when it will stop. We were encouraged to find out, however, that the hospital had just ordered, purchased and begun the installation process of a new backup generator, however, it was not finished yet and supposedly tomorrow the gentleman will be back to finish the installation of the generator, but that doesn’t really help us today. We did, fortunately, find that the nursing supervisor came in and unlocked the operating room door, so we could begin the process of unloading the supplies from the OR, bringing ours in and doing everything to set things up.
We seemed to have run into one problem after another throughout the day. The sink in the central supply room was broken and was standing with about 3 ½ inches of water. I might add that this water was not exactly the most pleasant smelling stuff either. D. and J. were two of the gentleman that had accompanied us from Wichita. Both of them are retired, but now are involved in doing home improvement work. They were able to fix the sink without too much difficulty and also went into town and bought a new faucet and put it in for them.
As we set up the anesthesia machines, one of the machines was broken. There was a valve that was not functional and it looked like we were going to be able to operate, but with just one operating bed and anesthesia machine. Fortunately, D. took it all apart and was able to switch a valve around backwards and make it work. We also found that the monitors didn’t work in the operating room and went into a back up mode that allowed us to have only a minimal amount of time of monitor usage, so we took the monitors back to the camp to recharge them later on that night and found that a simple switch had been flipped, bringing in different types of voltage, which caused the monitor to malfunction.
One of the two cautery machines that we had didn’t work, but we were able to call and find out a way to jerry-rig that by putting a piece of tin foil between two contacts to make it work. We couldn’t hook up the autoclave to the power source like last year, because the circuit breaker was broken and they didn’t have a replacement for that. We looked for the postoperative medications to give patients pain medicines afterwards and all we had available last year was Tylenol and Motrin, but we didn’t even have that this year. Once we sent someone back to the camp to look they were able to find a narcotic, which we had not expected to be able to have, giving our patients more flexibility than before. The last straw was when we tried to clean up in the morning and we asked if we could borrow a mop to mop the floors, which were filthy, we were told that they didn’t have any mops in the hospital because they had out-sourced that and ladies in town came in a mopped and brought their own mops with them, so we had to go the hardware store once again to buy a mop to begin to work.
Even after all of the obstacles and problems that we had during the day, we were able to see God’s hand in quite a few of those situations. The power situation was by far and away the most critical and, as such, were only able to begin our first surgery at 1:00 p.m. and limited our surgery to just procedures under local anesthesia because of the fact that we could not get any air conditioning to the rooms and the temperature in the closed up rooms in the would exceed 90-100 degrees without evidence of air conditioning. They do have a small window unit, but it runs with so much electricity they simply can’t run it on the back up generator.
This is the first time that I think we have ever gotten home early from surgery, but with only the five local cases to do we were through and there was nothing much we could do there, so we simply came back to the camp early for dinner and a time of sharing in the evening. Once again, to bed, but this time I had found someone to loan me some earplugs, although, they weren’t quite as effective as I had hoped for.
Day 4, Tuesday, January 27, 2004:
We found that the problem with the power was more significant than we thought. We had tried making some phone calls in to a member of D.’s church, who was with the power company, who said “yes, we can take care of that; we can switch and get your power at a different time,” and in fact they were able to do that, however, we found that then the problem was more severe than we thought. We simply tried to turn the power on, but we found that in Bayaguana someone had hit a power pole the night before and had knocked down the power lines, so it would require the team of power people to come out and replace the line. That was a real problem, but we were able to find out that it was a possibility. We were also encouraged that the person that was going to fix the generator was coming today, however, that didn’t really seem to happen and he didn’t show up. We had called to Santo Domingo and asked for MMI to bring a smaller generator that the mission organization owns and when they brought it out, the gentleman that brought it out was able to look at the old generator of the hospital and able to get it working at least for short-term. It seemed to have problems overheating and we prayed our way through that as it began to work. With the small generator, we could divert that to the air conditioner, so with the combination of the hospital generator and the small generator, we were able to actually do our first major operations. It wasn’t, however, until 3:00 in the afternoon that we actually did our first major surgery, which was an inguinal hernia repair. We were able to accomplish eleven minor procedures and two major procedures during that time and throughout the day we were able to see 56 consultations.
The other thing that presented a problem today was the fact that today was a national doctor’s strike. Most of the physicians in the country are employees of the government and they were told by their union to strike today in protest for the economic problems that are going on within the Dominican Republic. The pay for physicians is extremely low, being somewhere around $500 a month. The physician that was working with us and providing support for us was not able to work today, but he was present because if an emergency came in he would have to take care of that as part of their contract, even though he was on strike. Once again, we were a little concerned because there weren’t really that many people coming in and out. At 4:00 in the afternoon we were told by the local people that we would not be able to work Wednesday and Thursday because of the national strike that was scheduled. The strike is a manifestation of the frustration of the local people in the Dominican Republic over the economic situation and problems. Inflation has run rampant with the peso being devalued almost 100% since last year when we were there. Last year, there were approximately 20 pesos per US dollar and this year it is close to 54 pesos per dollar. Salaries have not increased and, as such the buying capacity of the people has dropped drastically. Gasoline prices center around $2.00 a gallon, making it more and more difficult for people to get by. Once we found out that we were not able to work on Wednesday and Thursday, all of those people that we had seen on Monday and Tuesday and scheduled for Wednesday and Thursday will have to be rescheduled, but we have no way of getting a hold of them and letting them know in advance. Most of the people won’t get out and move around during the strike, because they are concerned about hotheaded people that might cause problems, so we will simply have to wait until we can get back and when the patients show up, we will have to reschedule. As you might imagine, this is a scheduling nightmare for me, as a leader trying to figure out what we can do and how we can fix it. Approximately halfway through surgery during the day the power stopped and the old generator was able to be powered back up. Once again, the air conditioning didn’t work and we had a real day of frustration and difficulties throughout the day on Tuesday.
By the end of this long day, we were all feeling pretty tired and frustrated and the bus ride back was long and dusty. After dinner, I spent quite a bit of time thinking and talking to D. and P., as we tried to plan out what our strategy for the next day was. Some of the local people in Bayaguana had told us that “there is no problem, we want you to come in and we will go up and fight those strikers.”
Obviously, the last thing we want to do is to set up some type of a problem, so we chose to honor the strike and not try to travel. During the strike, what usually occurs is road blocks are set up by the strikers at the entrance and exits to each of the cities and during that time they would burn tires or put trees in the road or something to slow things down and anyone that tries to break through the strike line would get rocks thrown at them or bottles or, in some cases, guns. Apparently, we heard of some problems in Santo Domingo itself and some of the other communities with more violent protests, but it didn’t appear that things in Monte Plata or Bayaguana would be that bad. Still, we couldn’t take the chance on it.
Day 5, Wednesday, January 28, 2004:
After waking in the morning, we had come up with a plan to try to integrate the surgery team members, all 20 of us, into the medical team. The medical team had about 15 or 16 people involved with them, so we tried where possible to bring people in and bring them alongside. The gynecologist that had working with us, Dr. W., set up a clinic to see women and did not have to use our interpreters to do that since she was fluent in Spanish. We had to use some of our people for additional runners getting people back and forth between the doctor’s office, pharmacy area and the health education area. All of the people are given a health education message as a means of trying to improve the quality of their life. Things as simple as washing your hands, cleaning your vegetables and treatment for dysentery are basic for you and I, but are not basic for all of the folks in the third world country. In fact, dysentery still serves as a major cause of death in third world countries, not things like cancers, accidents or illness. Some of the medical students set up a manipulation table and did osteopathic treatments on patients, as well. We were kind of concerned because we had not given any advanced warning to the community itself, so we didn’t know how many people would be showing up, but as it turns out the volume was quite good. We saw almost 218 patients on that day, which are 120 more than they had seen the day before and that was 40 more than they had seen on Monday. They couldn’t have seen that many people without the help of the surgery team and we ended up giving out 539 prescriptions just during this day, so we were able to be productive.
They had some construction projects at the camp we could do, so two of our CRNAs, a lawyer and a cellular phone supervisor made a concrete patio at the orphanage under the supervision of J. and P. When they ended up using four bags for the first half of the patio, most people didn’t think they had enough concrete to do the job they wanted. It looked like they weren’t going to be able to finish, but they still ended up with ½ bag of concrete left at the end of their job. It is almost as if the fishes and loaves were played out once again.
Late Wednesday afternoon we found out that the strike had absolutely no effect in Monte Plata, or in Bayaguana. We talked in consultation with the city leaders and both areas and talked with the strike leaders in both areas and received permission to go ahead and try to go to the hospital tomorrow. After the evening program and to bed, we were concerned about what tomorrow might bring, yet still trusting in what God had told us to do and that was to simply be faithful.
Day 6, Thursday, January 29, 2004:
This was the day that I had chosen to give morning devotionals after breakfast. The food was good, as usual. During the course of all of these obstacles and the frustrations at the hospital, I had done a quite a bit of soul searching and came up with a topic to talk about in the morning for the devotional time. It dealt also with a chapter in Luke 17, verse 11, where Jesus had healed ten lepers. The impotence of the story was that only one of those people came back to thank Jesus and in essence became a convert. The implications of that are that Jesus was not really interested in statistics, as much as individual people and I used that to try to begin the process of my devotional by asking how many people were a little disappointed in the number of patients that we have seen in surgery, to which I found that there were about ¾ of the participants that had never been on a project before and really had nothing to compare to in their evaluation, so it really was more of a problem for those of us who are returners.
It is difficult for some of us who are detail and project oriented and success driven to come to the Dominican Republic and change our orientation to be more people driven. Statistics are not really important from a productivity standpoint and that is not what the mission organization is interested in. It is not how we evaluate or grade the worth of a project. It is only to make us accountable to the Health Ministry for what we do here in the Dominican Republic. Our frustrations over inconsistent electricity, water, facilities and productivity are pale in comparison to the lifelong frustrations the Dominican people endure. You can see why they appear almost somewhat complacent and indifferent to the constant failure of services and infrastructure, as the have never known it any different. That is why the returning participants are a whole lot more bothered by the numbers, than those who are new on the team. To be honest, when I first came in my expectations were that we would easily do 10-12 cases on the first day, getting started by 8:00 or 9:00 at the latest and then be able to average 20 cases a day for a total of 160 for the project. Obviously, we were not able to do that and I had to come to a realization that it was not so much how many people we took care of, as much as the fact that we had come. We didn’t bring Jesus with us to leave him here like the toys that we brought for health education; He is already there in the Dominican Republic and has been at work there for many years. If we have come to start something brand new it would certainly fail, but if we have come to joint God, who is already at work, then our work will be successful. Our hearts and minds are like glasses or containers. When are we able to enjoy most a glass of water? It is when we are empty and thirsty. If we only take in and don’t ever empty out we will never have that desire or enjoy the new water. If we only take in and have a slow loss for evaporation, verses active pouring out or exercise, we will never be able to fully pass on all of those things that we have. We need not only to be refreshed, but also emptied every now and then by stretching ourselves. That is kind of what this project has done for us. In summary, I reminded them of 1st Corinthians 4 verse 2 that pointed out the fact that the most important thing for us is that we be faithful and that we follow what God has told us to do and not that we have expectations on productivity. We simply have to be faithful and available for God to use.
We had an uneventful drive in in the morning, but it was somewhat tense. As we reached the edge of Bayaguana, the administrator of the hospital was standing waiting for us, also with a hospital security guard on a moped. The hospital administrator got into the first car and the moped took out leading us through the town. It was quite a processional seeing this hospital guard on a moped with a big revolver tucked in the belt loop of his pants. We saw nothing that made us even bothered or worry about coming into town, as it appears that the strike has been largely unsupported in this particular town. After we got to the hospital I found that there was almost an unending stream of questions today. The bottleneck developed in the postop room as we began to process our patients. We had quite a few people that didn’t simply show up on Thursday and that is really, I guess, to be expected because of the fact that we had so many people not knowing if we were going to be there, since the strike was technically still on, but we couldn’t tell that in advance. I talked to several people and set up a plan later on in the day on how to shift personnel around to take care of this bottleneck. Surgery went well, until almost the last two hours and once again the power went off prior to us finishing our schedule. We were very fortunate to have power in the morning and didn’t take that for granted. Once the power went off, the generator wouldn’t work with the air conditioner, so we got pretty hot and sweaty during that day. We were able to do eight major cases and six minor cases and we saw approximately 26 new consultations on Thursday. This was in addition to seeing quite a few people that had come in to reschedule their surgeries, having missed them on Tuesday and Wednesday.
The ride back home showed no signs of a protest, except we did see two areas where tires had been burned in the road, but other than that there were no signs of problems in either Monte Plata or Bayaguana. Our evening was quite fun and then into bed with expectations for a busier day on Friday.
Day 7, Friday, January 30, 2004:
Today was the busiest day yet for all of our work at the hospital in Bayaguana. We had 22 procedures scheduled. I saw 44 consults today and let R. and A. take care of most of the surgeries. I also scheduled about 12 patients who had missed their surgery on Wednesday or Thursday. We assumed we wouldn’t work Thursday and we ended up working Thursday, so that did allow us to do some of those cases, but we still had quite a few who had not been scheduled and that made it difficult. We decided to go ahead and work on Saturday, since we had not had the chance of seeing all of the people that we could. As it turns out retrospectively, that was really not fair for our surgery team, although, none of them complained about it. They had worked on Wednesday; it was just that they didn’t work in surgery. I assisted the gynecologist with several tubal ligations and hysterectomies and other than that I ran from consult to OR back and forth all day long. I don’t remember having this much stuff going on, but I had forgotten that S. had been there last year and she took a great deal of the questions and handled those, since she and her husband live there in the country and are fluent in Spanish and can deal with some of those issues. We ended up with 10 major cases and 12 minor cases during that day. By the end of the day, I was extremely tired and run down. The last patient that I saw in the clinic was a gentleman that kind of weaseled his way in, as we had pretty much closed down and told everybody that we were through for the day and we weren’t seeing anymore people. But this gentleman came in with an umbilical hernia and was quite anxious about getting it taken care of. He simply wouldn’t go away, so finally I said “fine, let him come in.” D. was his name. He was a pretty good-sized fellow and Mr. R. was 40-years-old. As I began to talk with him through an interpreter and through a local doctor that was standing at our side helping us, Dr. G., I checked his blood pressure and found that his blood pressure was very high. When we conversed with him about that and explained to him the dangers of high blood pressure and the fact that we may not be able to do his surgery to fix his umbilical hernia if his pressure was still high, he stated that he understood. As I was sitting there listening to the interpreter and the doctor talk back and forth to him, I don’t know a lot of Spanish, but I was able to get jest of the situation and they went from asking about his general health, heart, lungs and kidneys to asking him not only about his physical heart, but also his spiritual heart. In a very short period of time they had come to a point where they had asked him the question about whether or not he knew Jesus as his Lord and Savior and he said “no,” but he had an interest in doing that. Before I knew it, he was praying a prayer of salvation and was beaming from his face with a broad smile. He was scheduled for surgery to come in Wednesday and sent away with his consultation report for fixing his spiritual health, as well as his physical health.
The bus ride home was uneventful and the evening’s activities were fun. We had plenty of time for activities in the evening after our dinner meal. We never had any concerns about the food that we were eating, as R. was our cook last year and this year continued to make meals that were far in excess of what we could eat. Beans and rice is certainly a staple down there, but there was also a lot of variation with vegetables and small amounts of meat. The people there don’t seem to have the same problem with eating too much meat, as we do here in the states. The camp itself is within the center of Monte Plata, as such we were able to wonder out though the community without too much difficulty and after the evenings program some of the kids seem to go out and enjoy listening to the music in the streets and the gazebo in the center of town. Dominican people are extremely relational and enjoy trying to interact with the Americans, even though they can’t speak English and we can’t speak Spanish, but there seems to be a universal language as they come to understand why we are here and what we have come to do for their people.
Day 8, Saturday, January 31, 2004:
The intent was to do a half a day to make up for the lost day. Although it may have been a lost day in surgery, the surgery team still worked Wednesday, so it didn’t really work out well for them.
We started the day with 15 scheduled cases and five of them didn’t show up. I’ll never figure out why they don’t show up, but they usually come later. We began and within two hours the city power was cut off. What could be worse than losing electricity during surgery in a third world country? …. having that happen while one of the patients is an attorney.
Sure enough, one of our patients today is attorney here in Bayaguana and during the middle of his operation the power went out. We were able to complete his operation without any difficulty and he suffered no untoward effects, but it is a little bit unnerving when that happens. We had to cancel the larger surgeries because we couldn’t count on power, which means we need to reschedule those people, which means even more cases scheduled for Monday, Tuesday and Wednesday of next week.
The heat caused tempers to be a little short, but we got through the day without any problems at all. It is amazing when you work with a group of people who are all there with no self-interest. Everyone who came on our trip came with the full expectations that they were going to work under hardships and it is certainly encouraging to work in that type of an environment. I wish I could say that working in a hospital environment in the US is always a pleasant circumstance, but unfortunately there are a lot of people who are just unhappy with their job, situation or whatever, but you rarely ever encounter any of that on a mission trip. Everyone comes with a single focus in mind; to be able to help somebody else and do whatever it takes to take care of that, whether it is an attorney working in central supply washing instruments, whether it is nurse mopping the floor, whether it is a doctor taking out sutures and helping transport patients back and forth, or whatever needs to be done, everyone uniformly wants to help.
After we finished our ‘½ day’, we decided that we would go to a local river, that is kind of interesting in that it has some interesting waterfalls and things like that, giving the team a chance to kind of get out and splash in the water and relieve ourselves of the heat of the day. After we finished in surgery, it is only about another five-minute drive from the hospital, so everyone had brought their bathing suits with them to go to the river. We went down to the river and were supposed to meet the people from the medical team, but after we had been there for almost 2 ½ hours they still hadn’t shown up. Another hour went by and a bus came down and said we thought you were meeting at the other river, and as it turns out there are two local rivers and their driver took them to the wrong river, so we all had fun at different rivers today. Oh well, we did meet up at the camp for dinner.
After dinner, the evening surprise was an ice cream social. They had gone into town and bought ice cream for us, so we were able to have a social during the evening. The evening activities are all set out by one of the team members. This year we had three of the people that decided to put together the evening activities. One evening we had a lecture on Medical Ministry Internation, which just brought us all up to date on the organization as a whole. The icebreaker the first night was lots of fun with two truths and a lie and sharing favorite bible verses night was a favorite for a lot of people on Friday. One of the real highlights was Charades with the surgery team verses the medical team and I can’t even go into some of the weird Charades that were done during the night that left us all laughing for hours on end.
Day 9, Sunday, February 1, 2004
We had a restful day today and after breakfast we walked to the Brethren Church. That church is about 8-10 blocks away and it is this church that owns the camp and school that we are staying at. As well, they are building a small orphanage. The church service lasted from about 9:00 to 11:30 and we heard the sermon presented both in Spanish and in English, which really helped us a great deal. It was very rewarding to worship with other believes, even though we may not all speak the same language. Then, we went back to camp for lunch and I took a nap in the afternoon. I didn’t really feel very well, so I took some medicine and slept most of the afternoon.
S. and her son, N., had begun to improve, so she joined us in the afternoon and I had a nice long meeting with S. and P. and we got things ready for Monday. We had our own church service in the camp just with our local participants with music and a testimony shared by R. from Maine. After that, we actually got to see part of the Superbowl in Spanish and I might admit that it was almost better than having to endure some of the commentators in English. I wasn’t able to watch the whole thing, as I was too tired and by half time I turned in and went to bed.
Day 10, Monday, February 2, 2004:
Well, today we began what looked to be another difficulty day, as a lot of cases were scheduled. It still amazes me when somebody shows up with their baby to have surgery and they feed the baby right before they come in, even though we specifically told them that we need for the baby not to have anything to eat or drink. The only glitch today to start off was that we had no water to the hospital. Fortunately, B. had worked in central supply in past projects and had the foresight of drawing water and leaving it in basins so that we could start the day out; that is the benefit of having people who have been on projects before and know all of the potential things that can happen. We had power all day long, which really helped out with our schedule. We had several cases with unknown problems. In the states we obviously have pathology available on every specimen that we removed. In this country, very few people actually get to find out what it was that is actually removed. We had two cases that were quite difficult today. What we will did on this occasion was give the specimen to the patient and give them the option of taking it to Santo Domingo, which is a two hour drive, to find a local pathologist there who will accept their specimen and given them an answer. One of the patients was a 30-year-old lady with what looked to be a small lipoma, which is a noncancerous tumor, on her forearm. Once I actually got into and looked at it, it looked much more like a sarcoma, which is a very invasive type of cancer. We did give her the specimen, but I have no follow-up as to what actually would have happened with it. The other was a 24-year-old man that had a mass on his thumb that made it almost three times the normal size. We were able to remove it, but not knowing what it is it may or may not be enough.
We had a big surgery today that was kind of a difficult case and by the end of the case they had lost a needle. That is a real problem in the states because of liability issues and it is also a problem here. With a needle lost inside the abdomen, you can’t just simply look to see where it is, because it could be hidden between the folds of the intestines. The problem with just sticking your hand in and reaching around for is that you could poke yourself and unfortunately we live in a society where AIDS is a problem even in third world countries and we don’t want to take unnecessary risks where we can. After prayer we were able to find the needle in a discarded package and that relieved everyone, but it caused a little bit of anxiety for a while. The addition of S. made a big difference in turnaround times today and that made us much more efficient and we were home by 5:45, even though we did 22 procedures today. The operations were quite varied and we had children as young as 18-months-old and adults as old as 69-years-old; quite a gambit of patients today. We did not do any new consults, although I did see one new patient who was a gentleman who came in because he had been hit on the head and had a skull fracture. There was really not a whole lot that we could do for him, so we did refer him on in and had him see a doctor in Santo Domingo.
Day 11, Tuesday, February 3, 2004:
Today is the last full day of work and we have a full schedule. As we are driving to work, the city power went out. This meant that the revolving blackout had hit us again. It is really a nuisance to us, but a fact of life to the people here. P. is connecting the small generator this morning to the air conditioner and the old hospital generator provides us light and cautery, but that means we don’t have any power to the autoclave. The autoclave is necessary, because that is what we use to resterilize and process our instruments. We are limited by the number of instruments we had, since we couldn’t sterilize new ones. We were able to function fairly well without the autoclave by using up all of our instruments that were prepackaged. At night, after dinner, there will be power again, so P. and F., one of the other MMI staff, came back to run the instruments in the evening.
We had another very busy day, but very productive and very efficient. Dr. G. had a 2½-hour surgery early in the day and that tied up a bed, and a patient with a bad gallbladder also proved to be very difficult today without all of the modern conveniences of equipment and supplies. We ended up with 8 major cases and 11 minor.
In the evening, we had a surprise birthday party for one of our participants, B., from Maine and her husband, R., had joined us. Today was her birthday and we took the opportunity to all celebrate. When we had told R. about that earlier, she had made a cake up, so we had cake and ice cream for the birthday party.
Day 12, Wednesday, February 4, 2004:
Today was a short day, so we can pack things back up. Unfortunately, all of the supplies and equipment that we use that are kept here in this country have to be turned around and sent back out on Saturday of this week to Dajabon, for the next project that is coming. We scheduled ten cases and I knew we were in trouble when a patient not scheduled showed up in the morning to ride on the bus with us from Monte Plata to Bayaguana. We ended up with 12 cases and we were able to be done by 1:00 p.m., as planned. All of the cases went very well and we had no major difficulties. We end up with six major and six minor cases in addition to three consultations.
One of the consultations was a lady that was brought to the emergency room there. When I say emergency room, I mean room. It really doesn’t look anything like an emergency room in the states; it is simply a bed and a bedside table. As I walked into the room at the request of the emergency room doctor, I saw an elderly lady with a fixed gaze in her eyes and unable to move her arms and legs. Her blood pressure was in excess of 240/120, which is quite high and this lady was obviously suffering from a stroke. We were able to provide her with some medications that our anesthesiology people had to get her blood pressure down, but shortly after that, her family then took her from Monte Plata where they had very little services available to the capital to try to get help for her. It is very frustrating is some respects, because we are so outcome oriented to take care of people like this, but have no idea of whether what you did actually helped.
After we finished all of our surgeries, our equipment supplies were repacked and loaded onto the big white trunk. It was done in a very short time and then we were able to go back to the camp and help the medical team pack up their supplies, as well loading that onto the white truck. After dinner was a time of sharing. This allowed all of the members of the team the opportunity to simply state what the project had meant to them and the times that they have had. This is always a very special time of sharing for everyone on the team. It is hard to say sometimes whether we had more impact on the people we come to serve or the people that we bring with us.
Day 13, Thursday, February 5, 2004
We were up at our regular time for breakfast this morning and on the bus for an hour and a half ride to Boca Chica. Boca Chica is one of the loveliest beaches in the Caribbean and we take this opportunity every time we have a project to spend a little bit of time for rest and relaxation. Medical Ministry International realizes that if you simply bring people down here and you work them to death, very few would ever want to come back again. We do have a chance to spend some time in the capital and on the beach to at least give them a flavor of the country they have come to serve. This is a new beach that we had not been to before and it was quite pretty. We stayed there from approximately 10 to 3 and got a little bit too much sun. Sheri and her mother, K., and I left with Mandie to go back to stay with Mandie and Jason in their home in Santo Domingo instead of staying at the camp in Santo Domingo with the team. On the evening of Thursday, F. shared his witness and testimony of how he had come as a Compassion International child to know the Lord and now he serves in many capacities with Medical Ministry International, currently training to become a country director for Peru and Bolivia. It was quite a heartwarming story and an encouragement for a lot of people that have wondered about whether or not Compassion International or any of those organizations really helps.
Day 14, Friday, February 6, 2004:
We got up in time to meet the team at the market in Santo Domingo in the colonial zone for shopping. This is always the highlight for a lot of the team members to see all of the trade and the souvenirs that available in the city. The colonial zone is an area that was initially founded in the late 14th and 15th centuries. It has lots of history to be seen. After we went through the usual routine of buying coffee and things for other folks, we left to go back with Mandie and Jason and took H. with us. We were getting ready for dinner at Vesuvio’s, which is a four star restaurant in Santo Domingo. We always take the team to that place to enjoy a last night in the country. When we got to Mandie and Jason’s house, we found that they had no power. Power is not a big problem for us, however, it means no curlers, no hair dryers and also no running water, so instead of being able to clean up, we just spruced up a little bit.
Dinner at Vesuvio’s was very good, as usual. T. and F. came to join us. They are the country directors for the Dominican Republic. After dinner we had our goodbyes and took many pictures. We left to return to Mandie and Jason’s house. The city had the same power problems as the small towns in the country with the rotating blackouts, but there doesn’t seem to be much of a schedule and with no power the water doesn’t pump, so sooner or later you have no running water. Mandie and Jason have an inverter in their house, but it was hooked up wrong and burned out, so they took it in to be repaired and they have no way of knowing how long it will take to fix it.
Day 15, Saturday, February 7, 2004:
We slept in late, until almost 8:00 in the morning, but our team wasn’t able to do that. They were staying at what is referred to the ‘Chicken Hilton” in Santo Domingo, which is near the Santana Hospital, where MMI has their main warehouse. It takes about an hour and a half to get to the airport from there, and when their flight leaves at 10:00 they have to be there at 8:00, which means they have to leave between 5:30 and 6:00 to make sure they get there early. If you are there less than two hours before you leave, they won’t board you, so it becomes important to almost be there three hours early. We kind of missed seeing our new friends and family that had been on the team off, but we don’t get to spend much time with Mandie and Jason since they have moved here, so we chose to stay a couple of extra days to visit. This also allowed Mandie’s grandmother, K., to see her home and get a chance to see more of the community. After a couple of more days visiting and sightseeing in the Santo Domingo area and in Jarabacoa, we were ready to return to the United States and on Wednesday morning Mandie and Jason took us to the airport and we boarded the plane to begin the process to return to what we know as home sweet home.
