Journey to Monte Plata

Journey to Monte Plata
29 January, 2011 Sunday
Well its 6 am in the DR and between the roosters that crow way before dawn and the meringue band that plays way after dark, a new day and a new project has begun. Very little changes here, but when I look over 15 years much has really changed. The people though never change. It is good to renew friendships with my broken Spanish and their broken English. Even with my U.S. friends it is the same. Having 2 uninterrupted weeks with someone is almost impossible back home, so I can safely say these are some of my best friends.
Yesterdays travels were largely uneventful, but long. After getting up around 3 am to at the airport at 4:30 our flight left at 6:35 am. We had minor problems with two members’ carryon bags with small soaps and shampoo bottles (2 gallon bags full). We were able to keep track of other participants on different flights with texting when we were on the ground. Barely 12 hours later, we were on the ground in Santo Domingo. It is 2 hours ahead so it was later that it seemed by the time we reached the camp. MMI has 2 new vehicles but the big yellow bus is still creeping along and is being used. They are trying to replace since it has way too many miles on it.
Milton and I were the only ones up this morning so we visited in broken English/Spanish for an hour. Today will be very busy. After breakfast, I’ll lead a devotion time then do orientation of the group. Then we must unload all the tubs and reorganize the supplies. Medical and Surgical orientation will then take place. Right after lunch, the surgery team will go to the hospital to arrange and set up the OR’s. I will then do our first clinic session to screen and schedule surgery patients. I’m told many will be there having been left over from the Nagua/Cabrera project 2 weeks ago.
I packed 2 weeks early this year and as a result, I have found several things that I used to have are not here. Watch, sleep pajamas, beach towel are among the missing. Having some OCD makes the 1st few days hard until a routine can be made.
All the Dominicans want to hear about Mandie, Jason and Edwin, so the pictures on my phone help but I wish I had been more intentional about taking more pictures.

31 January, 2011 Monday
I was blitzed last night. After breakfast yesterday, we circled the white plastic chairs (that would become our constant companions) and shared our introductions then I led a devotion on the unity of the body. That led to the orientation lecture “You’re Not in Kansas Anymore”. We then unloaded all the “plasticos” (blue tubs) and sorted all the contents. Only one tub did not make it with the flight. That person had made connections thru San Juan and they have bumped baggage before because it is a small plane and doesn’t have as much room. We hope it will arrive later today. The pharmacy boxes were then brought to the dining room. We had lunch and then at 1:30 the surgery team left for the hospital. The medical team then sorted all the meds and had their orientation. The surgery team had their orientation at the hospital and then we were met by Francesca. She is like the director of nurses at the hospital and has worked with us each year. She and Alex negotiated space for us to use this year. It never is a done deal until we get here.
After unloading the tubs then the white truck of supplies and equipment, the arduous task of set up and organization begins. It reminds me or the traveling Circus. Dr PL and I then set up to see patients. We saw 18 patients and were able to schedule 11 for Monday. I never know how may to put on as the length of surgeries is difficult to predict. One of the last patients seen was a 25 year old male with a hematoma on his great toe. I was ready to schedule him to incise and drain it when his mother mentioned that he had an ultrasound done. He said he would bring it to me. After a short, 5-10 minute wait he returned from his motorcycle with a nice ultrasound/ Doppler study of his saphenous vein system showing varicosities with incompetent perforators. He didn’t need drainage but to have his veins stripped. That is something that we can’t do here. God protects. We would have done the wrong procedure if I had not seen the study. Another interesting patient had a plum sized mass in the midline of his neck. He as referred from the previous project. He had a prior Thyroidectomy and had normal thyroid studies. I scheduled him for Monday. We’ll see how the new schedule of clinic on Sunday helps the flow of work on Monday.
I was the last back to camp along with Dr PL. Dinner was as usual, beans and rice but I was unusually tired, but usually we have time to rest and recoup prior to starting. After dinner I made the surgical schedule out and then was able to read till 9:30. Everyone had already gone to bed except me. I did sleep better, even without ear plugs (another casualty of early packing). It has been very chilly at night (low 70’s).

1 February, 2011 Tuesday
Yesterday was a full day. It is always crazy on the first day of surgery. Even though we spent the time on Sunday, there is still a lot to do to get ready to start. Every aspect of the team has last minute things to do but we were able to start at an hour earlier that before and we did more major surgeries that usually possible by seeing people the day before.
The hospital was teaming with people all morning so we couldn’t do clinic until after noon. This did allow me the chance to scrub on all the hysterectomy cases. By lunch all of us were getting a little tired. They didn’t allow us a third room for minor surgeries (lump and bumps), but we had our hands full as it is. I started seeing clinic patients around 12 in a small consultation room. It is always interesting to see the diversity of patients. From twins with extra digits to prisoners handcuffed together, there are wide varieties of cases, even though they are prescreened by Milton in the lobby. PL saw 6 or 7 and B and K saw a few as well. I saw a 2 year old with an enormous abdominal wall hernia, probably from an omphalocoel at birth. Also saw an older man with a flank hernia from a bone graft from a broken femur. The crowding and loss of personal space takes a while to get used to here. The building construction seems to make it worse as there are no ADA codes to comply with. The doors are smaller, the hallways narrower and the stairs are all uniform in size or height. Then when you pack people in and the floors are tile, the noise magnifies the sensation.
After bringing up the rear at the hospital we drive back to the camp. Most everyone else walks the mile back to camp, but I enjoy the quiet and lack of conversation on the ride back. The dinner was a traditional Dominican food with beans and rice with a little meat. Afterwards it was game night with cards, dominos and assorted games. Some from the clinic counted vitamins and put them in packets for the next day. I read till 10 and then turned out the camp lights.
Tuesday at the hospital was something else. As we went to the hospital on Monday the team kind of straggled in after their walk to the hospital. I encouraged them to be there on time since we had a full schedule. We meet in the morning in the lobby of the hospital along with all the patients there for us and for other reasons. We sing Alabare (I will Praise) and then pray for the day and the people. My role has been a little different this year whereas I normally would see consults almost the whole first week and let the other surgeons do the surgery. This year with us not being able to do consults until after 11-12 am, due to the hospital being full with their clinics seeing patients. (A new government initiative that gives the hospital extra money if they see patients in their clinic… what a concept?) Therefore, I scrubbed on all the gyn cases and they have been technically difficult so it was good that I was there with extra hands. I have seen in the clinic the usual array of strange cases and situations but seem like more pediatrics than in recent past. Also fewer people with lumps and bumps. Maybe we are getting all of them removed between this project and the one in July.
One of the participants as I found out at eh end of the day wasn’t feeling well last night but felt a little better in the morning. By lunch they had not been drinking (dehydration comes easily here with the heat) and had thrown up their antibiotics that they are on daily. By 4-5 pm, they began to spike a temp to 102 and looked septic with rigors and disorientation. We took them to the OR and started an IV and began IV antibiotics after consulting an Infectious Disease Specialist by phone at LSU.
I then began to learn about the medical evacuation process first hand. Our docs felt like the patient needed to be transported back to the US for studies and advance care. So I began the process of med evacuation for the first time. As I found out it has not been necessary but one other time in all the projects. After an hour or so, and 4 liters of IV fluids the participant perked up and we felt it was safe to take them back to camp, to continue the IV’s and antibiotics under our supervision. I made about 10 phone calls to try to arrange the transport. Thank heavens for cellular phones. The first 3 or 4 people were very helpful but I found out that their company was not servicing the insurance policy that MMI has had for the participants. The actual company was much less helpful and wanted me to fax them a medical report so their medical director could review it. They request occurred at 10 PM. Unfortunately, I was sarcastic and reminded them that it was hard to find a Kinko at 10 PM in a remote village in a third world country. They asked if I could email a report and I said yes. I had to find a computer, get connected to the internet and compose a medical report and then send it off. By 11:30 I still had not heard back from them and I turned in. Fortunately, I had my Kindle and finished reading my first book about the circus, interesting parallel.

2 February, 2011 Wednesday
I never heard back from the evacuation company during the night and the participant did well on her regiment of NPO, IV’s and antibiotics. There was not a reoccurrence of the fever or disorientation. We took the participant with us to the hospital with her IV hep locked. They got their antibiotics during the AM and just lounged around. There was another temp spike in the afternoon but not as high. A short nap and they felt better by evening. No further emesis allowed antibiotics to be given by mouth by the evening dose.
Around 10 am I received a call from a flight nurse in Ft Lauderdale stating that the aircraft was on the tarmac ready to depart for the DR and they need Passport information on the participant to give to customs. I said I had heard nothing for 8 hours and thought they someone had called me to let me know everything was on track. As it turns out the company making the arrangements is based out of London with a Philadelphia phone number. When I told the nurse we didn’t need her, she had London call me. We had a “Medical Staff Meeting” prior to the call and decided that the best course of action was to not evacuate her now but to send her home on commercial airlines on Saturday with several of the participants already returning home since she was doing so much better. One of the participants did volunteer to accompany them so they wouldn’t have to fly alone. In Dallas and Wichita massive snow and ice storms had closed airports back home, so going back today was not even possible. (Prayers had been going up from camp as well as from the MMI office.) We all agreed with changing her ticket to send them back on Saturday with the group of participants that were going home at the end of one week and MMI took care of that for us. That was not easy either since Chicago was snowed in and the travel agency was closed.
Wednesday was our busiest day so far since all of the patients showed up for their surgery. We almost always have a few that don’t show up for one reason or another or their blood pressure is too high. I was jokingly accused of scheduling like the airlines, overbooking. I didn’t have any surgery that they needed me on today so it went slower than usual with only administrative stuff. When they finally let me have a room for clinic, I was placed in a small closet-like area. Each time someone came in or left, we all had to get up and move chairs. The first day I used the ultrasound room. Half way thru the day someone came in and said we had to leave the room. (Everything in Spanish sounds like an emergency.) They then did several sonos. It seems like they would have know that before they let me use the room. The second day and the second room, we were interrupted for an emergency (of course). It turns out to be the cardiology room. They needed to do an EKG. (Yes it was a single long strip on heat sensitive paper, one lead at a time. It had the little suction cups for the leads, also.)
It was a very busy day and we didn’t finish till 6:30 so we all rode back to camp in the van, Dominican style (slightly more people than seats, forget the belts). We enjoyed a dinner with spaghetti and meat sauce. All or our meals prior to this were traditional Dominican. Ramona and her crew of cooks have been on all my projects here in Monte Plata. They try to prepare some traditional American foods for us gringos occasionally.
No new tragedies or problems today. After finishing the schedule for tomorrow, I went to bed early at 9:15 PM.

3 February, 2011 Thursday
The somber tone seems to have died down from having a participant’s illness as they seem to be improving daily. I had to remind people that they need to leave earlier to get to the hospital. It’s not often in the states I have to encourage employees to walk faster to work.
I helped a little in surgery today and did a few lump and bump cases between odd jobs. I still had a fair amount of administrative with talking to MMI about the evac procedures and changing the participant’s ticket home. The front page of the Santo Domingo paper showed the snarled traffic in Chicago. Also, we had a second needle stick injury on a participant so we had to go thru the procedure for that and the counseling necessary. Fortunately both were minor, low risk sticks and no consequences were apparent. Otherwise there have only been 2 or 3 people this year with any medical problems. We only had a couple of participants with mild GI issues and a couple with URI symptoms in addition to the sepsis.
I didn’t get to start consults until almost 1 pm but all went well with that. We had finished surgery by 4 or so, but one of the last patients had nausea and emesis after surgery and couldn’t pee. So the last of the post op crew didn’t leave till 6:30.
We had time to visit with Pastor Ramon and Juana Prenza at dinner tonight as one of the bilingual couples served as our translators. That was very rewarding as they are very interesting people with great vision for their people. Since I waited at the hospital with the last of the crew, I was able to finish my paperwork which involves tabulating numbers for the day, filing consults and then making up the surgical schedule for the next day. It usually takes about an hour, so that freed the evening up.
4 February. 2011 Friday
I am usually the 1st or 2nd one down in the morning and I have time to think and read my devotional before breakfast and also do my journal. We had printed off the flight schedule for the participant’s trip home tomorrow at the hospital on the only printer that they had. Tan Travel had made the arrangements so they could all travel together. After breakfast the participant told me that they were much worse over the night and that they couldn’t fly home tomorrow because they couldn’t sit or lay down … at all. They wanted to walk to work and did some work on a limited basis but were not systemically ill without fever or chills. They had tried pain pills to no avail last night. So my morning was taken up with administration. I remembered that we had done clinic in the ultrasound room and ask if the ultrasound worked. (This same unit last year was turned off and couldn’t be turned back on without a password that they didn’t have.) We waited until late in the morning to find out that the tech wasn’t coming in, but we could use the machine if we could figure out how to use it. We were able to turn it on and use it to find a deep 4 by 6 cm abcess in the participant that was the cause of the pain and fever. Now it was how to deal with the problem. To do an incision and drainage would make transport difficult tomorrow with the dressing and drainage. So we chose to aspirate the contents with a long needle, knowing that it was only a temporizing measure. We found out that MMI had a portable ultrasound and it could be brought in 2 hours from Santo Domingo. We couldn’t use the hospitals because it was so large that it couldn’t be taken upstairs to the OR. The portable unit was not here by 3 so one of the surgeon’s took the participant to the OR and under sedation aspirated 60 ml of purulent infectious material. We couldn’t obtain a culture from the hospital but could take the specimen down the street and have it analyzed. So Alex walked the specimen down the street to the clinic and we paid $10 to have the culture done. It takes 3 days to get the results but we should have results by the time the participant gets back to the states. We had initially made arrangements for admission to Wesley in MICU with a hospitalist to admit but when the evac plans changed, we arranged for a surgery consult back home on Monday morning.
The schedule was the heaviest yet with major cases so the lump and bump cases at the end of the day dragged on till 6:00. So it was6:45 by the time the last patients were out and we were back to the camp.
The evening entertainment was popcorn and poems. Our resident poet revealed his latest poem and one of the clinic providers also had a contribution. The fresh popcorn was great. Afterwards we had a time of sharing so all those who were leaving the next day had a chance to say their goodbyes and we had a chance to say thanks. One of the general helpers from surgery told of an experience with a patient and their family. We had an elderly man with a large thyroid mass that stuck out and caused him swallowing trouble. He had a prior Thyroidectomy. We saw him Sunday and scheduled him for Monday but hid blood pressure was dangerously high. We sent him to the clinic for BP pills. Fortunately the clinic was at the camp on Monday. He was accompanied by a woman who was very caring and concerned. We thought it was his wife but ground out later it was just a good friend since he didn’t have any family. He came back Wednesday and we were able to do the surgery and he stayed overnight and then went home the following day. The lady returned the next day and gave the general helper a gift. It was a comb in a Ziploc bag with a short note that said she was thankful for the kindness the participant had showed them. It had her name and address in the note. She said in the note that they live far away and weren’t prepared for the extra cost of staying in Monte Plata and having meals there while his blood pressure was being treated. They cried together and the participant gave her the earrings that she was wearing as a give and exchanged addresses. It is likely that the mass was malignant but we don’t have pathology available on our cases and other than debulking the mass we have little to offer him. He however was very please when he awoke to find the large mass gone.
I guess that is one of the reasons we are here, to help for today. None of knows about tomorrow.
5 February, 2011 Saturday
The day started early at 4 am. I got up to see our leaving crew off. Six were leaving for home today including the participant with the abcess. They got a great deal of relief immediately with the needle drainage but did say that they noticed the pain was beginning to return a little. I explained that this is the window of opportunity to get them back, so I wished them well and safe travels. I went back to be until 6 as we had plans to drive to the northern coast of the island for a whale watch and some time on the beach.
A stop on the way out of town allowed us to discharge our patient at the hospital who stayed overnight. We got report from Francesca the Dominican nurse that we hire to watch our patients when they stay overnight. The hospital has other patients but we are responsible for our patients care totally. We also hire a watchman to protect our equipment and supplies while we are not there. Then off in the big yellow bus to the northern coast of the island, thru the rain forest (yes, it rained there). We went thru the small fishing village of Samana to a pier with several boats (not ships) to head out on the excursion. The boat had benches on the top and an area below with window and held 40 or so people. In retrospect, whale watching is pretty much over-rated. This was my second trip to see whales. The first on in Maine we didn’t see any and this trip we allegedly saw 2. After an hour and half of very rough up and down and sideways heaving of the little boat, the viewing lasted at best 2-3 minutes. Then we endured another hour and a half of travel time with numerous people leaning way over the edge of the boat, I’m sure they were trying to get a glimpse of the whales. This boat may be where they film some of the “Deadliest Catch”.
Then we went to the island resort to have lunch (no I was not particularly hungry) and lay on the beach (yes I fell asleep but fortunately in the shade). Then back to boat to go back to Samana and back to the bus for the 90 minute ride back to camp. All together we left camp at 7:45 AM and returned at 7:15 PM. So for roughly 12 hours we got maybe 2 minutes of whale time. I might not go back next year to see the whales.
Went to bed at 9:30, was trying to stay up to see new participant arrive for the second week but their flight was delayed and they were coming in later. I couldn’t wait up any longer.

6 February, 2011 Sunday
I awoke at 5:30 to see another of the participant off for the states. I stayed up to have some time to self but others were already up so we talked. Not much else to do but share with others, eat and read. Our new participant arrived last night, but his bags didn’t. His suitcase did get delivered by afternoon but not his tub. Go figure?
My goal was to not do any organization, administration or anything today. Breakfast was at 9, some went to mass at 8 and most of us went to the local Dominican church at 9. We walked to church for the 2 ½ hour service of singing, reading the word, and preaching. Most of it was in Spanish and not understandable bur some was easier to understand. At church, they had a guest preacher from the Work of Life Church. They are now building a camp near Guerra for kids and all of the people from Word of Life were from the USA. It was nice to see other Gringos. During the service an elderly man got up and walked to the front of the church and was ushered by several of the men of the church out with some protest. Later, the pastor came to me and offered his apologies for the man. He is somewhat senile and they didn’t want us to be offended by the disruption.
After the walk home and lunch, some of the group wanted to go to see the Orphanage and some took an extended walk in the country. I chose a nap and some reading. Dinner was American food- Hot Dogs and Coke Cola. After dinner I read some more until our big Super Bowl Party. All of us were just sitting around in white plastic molded chairs, watching the Super Bowl. Before you think this was too normal, The TV was a 19 inch with color (red and yellow only) and the game was in Spanish. It looked kind of like it was snowing in Cowboys stadium. Definitely LD (low definition). The sounds of motorcycles, roosters, and loud Latin music with uninterested people laughing in the background playing cards and visiting punctuated the atmosphere. It’s also not the same without the commercials.
The only crisis of the day was heralded by several people stopping me to tell me that the shower didn’t work and later that one of the toilets wouldn’t flush. Of course, everyone tells everybody. So, when I ask Alex, his response is typical Dominican, “I taken care of it.” Our American response is: How? When? What did you do? What happened? When is it going to be fixed? When the water truck arrives answers became apparent. The school is on city water but that is unreliable. They therefore have a cistern to store extra water. It took two water trucks to fill the cistern. Then the pump sends the water to the tenaka on the roof which then feeds the plumbing in the building. The hospital also has a cistern. They had the cistern filled 2 days before we arrived and had already refilled in mid week. That is why we were being asked to conserve water with our showers and toilets. We just didn’t understand the implications of their asking us to conserve.
The trip to the orphanage revealed that one of the four houses in the pod to be unusable due to a large crack in the wall that developed after the large earthquake in Haiti last year. To this point they have not rebuilt or repaired either due to lack of funds or expertise in structural engineering. They can’t take more kids in anyway because they don’t have enough staff for house parents to care for more kids.
The Super Bowl was kind of boring at halftime so I’m ready for bed. Two guys showed up at bedtime to deliver the participants tub. It had been opened but all the supplies and meds were there. God is good.

7 February, 2011 Monday
I was up and about as usual today. I haven’t walked to work at all this project to conserve energy I guess. Not sure why. The hospital was packed with people today. Just almost couldn’t move downstairs. The schedule started slowly with several no shows so I added a patient for a tubal ligation on for l lady who showed up and had not eaten or drank since midnight in hopes of being able to have her surgery today. As it turns out everybody does show up ultimately. I helped with an open gall bladder surgery and did a couple of cases on my own.
It seems as if we have been busier this year than last and I found out that there was not a project in July here as I thought there was. It was cancelled due to lack of participants. That may explain being slower that last year when they did have a project.
I saw 25 in the clinic this afternoon. One was an 11 year old boy who had been shot in accident. He was paralyzed from the nipples down. They brought his CT scan with them and some of his records. In the DR patients are responsible for keeping their own charts, labs xray and such. The lateral view of the spine showed a hole, hold in T11 and half in T12 thru the middle of the spinal column. They came to see the North Americans to see if we could do anything to help since he was incontinent of bowel and bladder. He had already begun to develop pressure sores on his buttocks. The family had seen us at church and initially had asked if they could bring in to see us today. Unfortunately, there was little we had to offer.
We had numerous referrals from our clinic and by then of the day we had 3 patients that we just didn’t have room to do this year. All were minor but still I hated to turn them away. It is hard to do but we have to realize that we cannot every take care of everyone.
I was the last back to camp again but only one overnight patient was left. Looks like the same for tomorrow. I was able to do all my paperwork and most of the scheduling done while still at the hospital. That allowed me to be able to visit and read in the evening. Then I was off to bed around 9 o’clock. Full days!!
8 February, 2011 Tuesday
Time seems to be increasing in speed as the days go by. After breakfast it was off to the hospital. Our schedule was full today and we had someone show up that wasn’t on the schedule but he had all the proper paperwork. I have had 2 or 3 similar problems with when I write down a day for the surgery, Alex tells the patient and write it in Spanish. I don’t know if it is the subtle differences in translation and understanding or just my hearing. We had one cancellation today so we were able to accommodate the patient and do his surgery today.
I helped on an open Gall Bladder surgery today and the patient went home in the afternoon. It went very well, but it is still amazing to see the patients walk down the hall and down the stairs, smiling ear to ear after just having major surgery. This team has really done well with an extra circulator nurse and 3 in Preop/ post op since we have so many participants with Spanish skills. We were able to finish all the cases by 4:30 without a separate lump and bump room. I was afraid that was really going to diminish our capacity in volume but it does not seem to have hurt us.
I was able to finish the paperwork and scheduling prior to coming home. So, I was able to finish Packing for Mars and begin How Starbucks Changed My Life .We had a final participant leave today. He was unable to take the full 2 weeks but staying thru today was a huge help in the clinic. We said our goodbye as he left for Santo Domingo in the afternoon for an early morning flight.

9 February, 2011 Wednesday
The last day at the hospital is somewhat crazy but we are getting use to it after 2 weeks. Since there is no clinic patients to see, I am able to stay in the OR so that keeps the schedule going. There were the usual people roaming the halls and pulling up their shirt or pointing to their chin in hopes of getting something fixed or removed but otherwise no major problems. We were able to finish around 2 pm. Then the task of tear down and packing the truck. It is amazing to see it happen so quickly especially with all pitching in to help. By 4:30 we were done and back to camp.
This year there were still internet cafes but the telephone stores where you could go to call home were gone. I then realized that the prevalence of cell phones here make the phone store obsolete. In the DR you only have to pay for outgoing calls, where in the states they charge you for minutes for making or receiving a call. So even if they don’t have any minutes, they can receive calls or text. That’s why they jump on every call to answer so they don’t have to call back. The prevalence of cell phones was driven home by the presence of street vendors at the intersections here selling charging cords here like I had seen in Santo Domingo.
We were able to do more than the year before and initially I felt like it was because of the number of participant but now I think it is because of the skills of the people and their flexibility. This year we had 9 docs, 3 med students, 1 CRNA, 2 NP’s and 11 RNs.
I heard today that they are building a new hospital in town but I also heard that have been building it for about 12 years. The current hospital is adding on some space but with only 2 men hand mixing all the concrete it may take a while, but next year is an election year and stuff seems to get done when someone wants to be elected.
I was able to finish my third book with the extra time in camp before dinner. After dinner, we gave gifts to our Dominican friends and helpers then had our sharing time. Another new poem for the trip was also shared to cheers of all present. Then I went back to the room to begin the packing process to go the Colonial Zone tomorrow and then to the Teachers Coop Marina Resort for some relaxation. Then I was off to sleep. I noticed that I haven’t’ had a problem sleeping this year even without earplugs. May because it hadn’t been as warm in the evenings, or maybe I have just been exhausted.
10 February, 2011 Thursday
It’s hard for me not to awaken at 5 AM, so I did. After a quick shower the final packing in the room was done. Then I went downstairs for my quiet time and a cup of Dominican Coffee (yes it is very strong). One of the joys of the trips is the ability to sit and visit with new and old friends over coffee and breakfast each morning without the time pressures of the States. We are still on a time schedule here but it seems different, not so much of urgency with time and more urgency with people.
After breakfast the packing and breakdown of camp happens fast. WE are able to pull out and say goodbye to Monte Plata for another year. By 10 AM we are at eh Mercado to shop and sight see. Part of the reclamation process involved going to lunch at the Hard Rock Café for a Hamburger. The by 3 in afternoon we are back on the school bus for the 45 minute drive to the hotel. The resort should probably be placed in quotation marks. From year to year it doesn’t appear to be changed much, which includes upkeep or upgrading. Every year some of the people are assigned to rooms that the water doesn’t work or the air conditioner is broke, or the bed only has 3 legs. You would think that they would know these things before assigning a room, but…. The beach is largely gone this year, probably due to erosion of the sand. That makes the ocean closer to the retaining wall, but it is still beautiful and peaceful (except for the loud Latin music).
WE had our final meal together at the poolside tonight. Another of our group was leaving in the morning and the rest of us on Saturday.
11 February, 2001 Friday
I was able to sleep until 6:40 this am which is an improvement. Then I went out to the poolside for the breakfast buffet. I have noticed that I am starting to crave my American dishes. It goes with the process of being reintroduced to our culture again. I spend the day by the pool and beech doing the debriefing and rehashing of the project to try to improve the project for next year. Already we have many looking forward to coming next year. We see this a lot, most would like to come but only some will be able to. I was able to include a nap and read my 4th book which was about the Gettysburg address of Lincoln. It was very informative but did seem to drag on a bit. Then I went early to the room for the final packing and to bed for and early morning tomorrow.
12 February, 2011 Saturday
The morning begins way too early, at 3 AM. I didn’t sleep well not being able to see a clock and being afraid of over sleeping. We were on the yellow bus by 4:30 and off to the airport. After the checking and initial screening several of us had a minor problem at customs. It seems as if the agent that checked us into the country stamped our passport, but had messed up the stamp. It is the kind that you have to rotate the dial to get the right date. Well you guessed it, she set the dial for December 29, 2011 as the date we entered the country. So it looked like we didn’t enter the country legally until they noticed the wrong day on several of our passports. As I stood in line to get on the plane, sure enough that called my name to come because they thought my tub might have contraband on it. It was really just 40# of coffee my daughter. So I got to be the last on the plane again this year.
Then we were off to Miami and there I had my first experience with the full body scanners. It seems as if I failed my scan because of “multiple anomalies”. They didn’t define that very well and weren’t too willing to talk about it. It did mean, however, that I got to experience the new pat down technique. It was not nearly as invasive as the news media had made it to be. We flew to Chicago this time instead of Dallas and since we had a delay in Miami on almost an hour on the tarmac that made a tight connection in Chicago. We made it to the gate with 10 minutes to spare. We were all pleased, until we arrived in Wichita to find that all our bags didn’t run as fast thru the airport as we had so none of the bags made it. But still it is nice to be home and by 10:30 our bags were delivered, long after a long hot shower and cool drink of water.
It’s nice to be home, but already looking forward to the next trip….

Case Log for Monte Plata 2011

Here is a listing of the cases done and also a listing of some of the interesting cases seen in surgery.


Gynecology

Tubal Ligation 7
Abdominal Hysterectomy 5
Vaginal Hysterectomy 3
Urethral Sling Procedure 2
Anterior Colporraphy 2
Anterior / Posterior Colporraphy 1
Posterior Colporraphy 1
I & D Bartholin Cyst 1
General
Inguinal Hernia 16
Epigastric Hernia 4
Umbilical Hernia 6
Incisional Hernia 1
Hydrocoelectomy 2
Cholecystectomy 2
Hemorrhoidectomy 3
Breast Biopsy 5
Circumcision 4
Thyroid Cystectomy 1

Minor
Removal of Ingrown toenail 1
Removal of Extra Digit 4
Excision of Ganglion Cyst 6
Excision of Lump and Skin Lesion 43






Notes on Scheduling for 2011
1. 52 of 184 consults did not have or need surgery.
2. No Show analysis by day:

Monday Tuesday Wednesday Thursday Friday Monday Tuesday Wednesday
Scheduled but not done 3 5 2 5 2 0 2 0
Cancelled 3 2 0 0 1 0 0 0
Rescheduled 3 0 1 1 0 0 0 0
Did Not Show 0 3 2 4 1 0 2 0


Interesting Cases
1. An elderly man with a fluid filled cyst over his Thyroid. Had extremely elevated BP. Prior Thyroidectomy probably malignant but no path.
2. 2 year old with large umbilical hernia, turned out to have been an omphalocoel repaired at birth. Entire abdominal wall gone.
3. 2 year old for circumcision, weighed #1 at birth spent 4 months in hosp is Santa Domingo.
4. Lady came in her mid 20’s with a 2 year old for circumcision. She was Haitian with no passport, citizenship card, can’t speak English, Spanish or French. Also she can’t read or write.
5. Follow up visit on patient with Breast Cancer who had mastectomy on last project and drains placed. See 2 times once for drain removal and once for staple removal. I had to aspirate a seroma when she came for staple removal. She had a sister with her who had a lump she wanted removed and it was a cyst.
6. Two patients with neurofibromatosis.
7. Twin 2 year old boys with extra digits on both hands.
8. 16 year old boy with scrotal mass. Turned out to be a varicocoel. Mass disappeared when he was in preop lying down for an hour.
9. Cancelled several men for hypertension, some as high as 110 diastolic but no symptoms.
10. Patient came in to have his hernia fixed. Showed me his CT scan. I looked at it in the window and it was a lumbar spine. Found out his hernia was in his disc in his back.
11. Saw several neck masses including, thyroglossal duct cyst, goiter, parotid tumor, lymph nodes, and submandibular glands.
12. Many patients with keloid scars on ears, face, chest and legs.
13. Lots of umbilical hernia on kids less than 4 years.
14. Several young women with tender breast due to fibrocystic changes.
15. Saddest case was a 12 boy who had an accidental gunshot thru the back. They saw us at church on Sunday and ask if they could see us. Mom and grandma brought him in on Monday to see if we could do anything since he was incontinent of urine and stool and getting pressure sores on his hips. They had his record and CT which showed a hole thru the T 11 and T12 vertebrae from the bullets path. Didn’t have anything t

My 6T's not Sixtys, bySteve Trembley

I am sometimes asked to tell,
what things there I have seen.
Itʼs very hard to understand,
unless youʼve already been.

And Iʼm not a medical person,
so my viewʼs not too clear.
And Spanish is their language,
so my brain must change gear.

And for the ones who are like me
and never treated folks,
This is serious business
and thereʼs not much time for jokes.

Sometimes a smile, or simple hug
is all that we can do.
Some prayer and understanding,
and of course God Bless you.

Medicineʼs not funny,
but we still have some fun.
Because it deals with people
and laughterʼs one on one.

I think Iʼm very lucky,
to help do what we do.
A sense of humor heals the soul
and mind and body too.

Nearly every patient,
has suffered long enough.
With every kind of malady,
the living there is rough.

With very little money,
or job, or food, or skill,
Dominicans have problems.
No wonder that theyʼre ill.

1. Si means yes in Spanish,
and no means no, you know.
But si may also stand for if;
your brain might overflow.

Constipado means congested,
in your nose and head.
Estrenido is constipated,
remember what Iʼve said.

Derecha means your good right hand,
and also turn right too.
Derecho means go straight ahead,
but I am not quite through.

Por que is always used for why,
but also means because
I know that doesnʼt make any sense,
but thatʼs how Latin was.

2. Blood pressure and blood sugar,
are bad when they exceed.
The patients weight in libras;
metforminʼs what they need.

Atenolol and aspirin,
less sugar, exercise.
And daily test your blood because,
I am one of those guys.

3. Not too many hypochondriacs,
are patients that come here.
They have problems we donʼt know,
and yet do not show fear.

A handshake, hug, or warm embrace,
can break the language barrier.
Imagine if you had to switch,
would anything be scarier?

4. Everyone has lombrices,
the young and old and weak.
That might come from their water,
or swimming in a creek.

Internal parasites can be,
round or tape or hook.
Scabies, tinia, and ringworm,
make pale anemic looks.

Watch your weight and blood pressure,
try not to overdue.
Eat less sweets and more vegetables,
no drugs or drinks for you.
Take your anti-parasite meds,
and vitaminas too.

And just drink bottled water,
and you will feel brand-new.
5. Glaucoma and bad cataracts,
that make it hard to see.

Headaches that wonʼt go away,
pains in hips and knees.
Feet with extra toes(es),
eardrums packed with wax.

Hernias in places,
you kind of hate to ask.
6. Skin tags in some areas,
where I donʼt want to look.

Several nasty diseases,
not found in any book.
Eczema and edema,
Iʼm not sure which is which is.

I think one means itʼs swollen;
the other one just itches.
7. There are several stages of pregnancy,
which I donʼt understand.

Translating for this subject,
Iʼm not in great demand.
Regarding urination,
and defecation too.
One should ask “Hace pipi?”,
or else “Hace pupu?”
8. Smoking, drugs, and drinking,
I love to talk about.
I have seen what they can do,
when one canʼt live without.

Poverty is hard enough,
but these three make it worse.
Their family suffers more than them,
and ruins their lives of course.

9. You have to be real careful,
of everything you eat.
Ramonaʼs rice and beans are safe,
and even mystery meat.

Drink water, sanitize your hands,
and keep your body clean,
Because the DCP* bug, can be especially mean.

10. We hope to see the Lord someday,
but while weʼre still around,
Weʼd like to have a better life,
if medicine is found.

To cure our aches and illnesses,
and cure our spirit too.
A pill might make us better,
but the Bible makes us new.

These are observations,
from several medical trips.
But you donʼt need to write my 6 Tʼs down,
The Trembley Top Ten Trip Tips.
*Dominican Colonoscopy Prep

A Bad Day at the Beach, by Steve Trembley

I had a bad day at the beach today.
The beach had too much sand.
A leaf fell from a hanging bough,
and almost hit my hand.

The water was too wet and clear;
itʼs temperature too warm.
The sun was bright and hurt my eyes.
There was no cloud or storm.

My skin got moist and sticky,
because of all the salt.
I left my towel upon the bus.
I know it was my fault.

Too many pretty girls walked by,
while wearing tiny clothes.
My stomach hung above my trunks.
I probably looked gross.

A flip-flop then fell off my foot.
I had to put it back.
Although we ate a while ago,
I need another snack.
We didnʼt get to see a whale,
because none came in close.
And now my skin is turning red,
especially my nose.

I have to choose between taking a nap,
and going back into the sea.
There are so many problems,
I must say “Woe is me”.

And now my feet are wrinkled,
my hair is just a mess.
Could anything be worse than this?
I think the answerʼs yes.

Cause any day spent on the beach,
(I say this with a smirk),
Is better than any other,
especially going to work.

I miss my home in Kansas,
with stranded trucks and cars.
But Iʼd trade that, for where weʼre at.
Good stuff for my memoirs.