Steve Trembley 2012 D.R.
I called my wife the other day, to just see what was new.
She also asked me how I was, and what was new here too.
I said “I‘m at the beach right now, and just had beans and rice,
And chicken, fish and pork chops, and it was very nice.
The water at the beach here is clean and warm and wet.
The sun is shining brightly, as good as it can get.
There is a nude beach down the way, (I think I heard her groan.)
And also Happy Birthday! I hate that you’re alone.
And now I’ll put my sunscreen on, and take a little nap”
Then all at once the phone went dead. I heard a little snap!
“Hello, hello,” I said to her. “Are you still there my dear?”
She said “I hit the phone real hard, to hurt your little ear.”
“Thank you for your input!” she said quite high and loud.
“I hope that you are happy, within your little crowd.”
It’s not so nice here. A limb fell from afar,
And knocked off several shingles, and then landed on the car.
The chickens have stopped laying eggs. The dog’s are out of food.
The cat has not been seen for days. Nothing here is good.
The mice are running rampant, invading all our stuff.
And squirrels are in the attic. I say “enough’s enough!”
The horses really miss you. I wave as I drive by.
But I think that they will be okay. I don’t think horses cry.
“Perhaps you’re just exaggerating”, I said. “I can’t believe it’s true.
With all the wildlife problems, it sounds more like a zoo.”
“The plumbing and the wiring”, she said, “have seen much better days.”
“The dishwasher is broken. I eat on plastic trays.”
“The washer and the dryer are shot. We’re even out of wood.
Nothing works around this house, exactly as it should.”
“It must be like the DR. I don’t know what to do.
Can you tell that I’m not happy? What was your initial clue?”
“I’m thinking of a new house and perhaps a car as well.
Mercedes makes some real nice ones. I love that new car smell.”
“I hope your work has gone real well, and you are glad that you have went.
But when you ever get back here home, your money will be spent.”
“So, please come home as soon as you can. I also miss you, too.
You’re needed here in Kansas. You have a lot to do.”
Tuesday, February 14, 2012
Thursday, February 9, 2012
Monte Plata Case Log 2012
General Surgery
Inguinal Herniorraphy 23
Hydrocoelectomy 8
Circumcision 6
Excision of Ganglion 6
Cholecystectomy 4
Epigastric Herniorraphy 4
Breast Biopsy 4
Hemorrhoidectomy 3
Excision of Anal Fistulae 1
Excision of Axillary Mass 1
Aspiration of Thyroid 1
Gynecologic
Hysterectomy 10
Tubal Ligation 10
Anterior Colporraphy 1
Posterior Colporraphy 1
Cervical Conization 1
C. Section 1
Major Surgery 73
Minor Surgery 47
Inguinal Herniorraphy 23
Hydrocoelectomy 8
Circumcision 6
Excision of Ganglion 6
Cholecystectomy 4
Epigastric Herniorraphy 4
Breast Biopsy 4
Hemorrhoidectomy 3
Excision of Anal Fistulae 1
Excision of Axillary Mass 1
Aspiration of Thyroid 1
Gynecologic
Hysterectomy 10
Tubal Ligation 10
Anterior Colporraphy 1
Posterior Colporraphy 1
Cervical Conization 1
C. Section 1
Major Surgery 73
Minor Surgery 47
Interesting Cases for 2012
Cases that didn’t go to the OR
1. 60 year old patient with foot pain that had brought an xray that showed a bone spur on his heal. No ortho instruments or fluoroscopy available.
2. Patient with fibrocystic breast changes. Surgery is not indicated.
3. Patient referred to us from the medical clinic… from last year for a hernia but he really didn’t have a hernia.
4. Patient with a large ventral hernia. Needed a large piece of mesh to repair, too big for us to repair but patient had seen Dr in city and would do surgery but patient had to provide her own mesh (over $1000), so we gave her the mesh for her surgery.
5. Parotid mass- Not able to do surgery with probable facial nerve involvement.
6. Patient with a kidney stone (brought her X-rays)
7. 2 patients with varicocoel of the scrotum… patient were handcuffed from the prison.
8. Patient came in 5’ 4’’ at 200 # and wanted us to take off the excess skin off her arms and thighs since she had lost weight. No we didn’t.
9. Patient with calluses on the bottom of his feet… who doesn’t have these.
10. Patient with burn scars from childhood and keloid.
11. 80 year old lady with a massive ventral incisional hernia for 5 years after a benign ovarian cyst removal. Told her it would require surgery to fix, she replied "heavens me, well I sure don’t want surgery", she then said thank you and gave me 7 eggs out of her purse.
12. Lots of patients with gynecological medical problems don’t ask for details.
13. Patient with prostate enlargement.
14. Patient with crooked toes.
15. Patient with recurrent neck mass found to be cancer last year.
16. Patient came in limping saying he had a hernia. When I asked where he pointed to his back and pulled out an MRI that showed a herniated disc. He said he already saw a neurosurgeon but he wants $200,000RD.
17. Patient wanted surgery to fix his hernia but still had a suprapubic catheter in place since his open prostatectomy
Patients that we did take to OR
1. Multiple patients with high BP as high as 250/150. No prior surgery or treatments. Sent to clinic and or local docs for treatment prior to surgery.
2. 13 year old with undescended testis.
3. Young patient with fibroadenoma. Was able to use a donated Sonosite ultrasound to diagnose.
4. Several patients with ganglion cyst of wrist… didn’t see any reoccurrences maybe since they don’t generally come back.
5. Keloid in multiple locations and patients. Did have steroids to inject to minimize reoccurrences. Patient would chance the reoccurrence for the possibility.
6. Had several patients come in with Preop clearance from cardiologist with ASA and AHA criterion listed. Great Preop workups.
7. Saw 4 patients with gallstones, only one didn’t have stones on ultrasound. Ultrasound quality is marginal at best.
8. Did 10 hysterectomies and 10 tubal ligations.
9. 4 year old child with hernia but at OR hernia couldn’t be found. Mom came back later to thank doc for fixing her son who was better after surgery.
10. First day only 6 minor surgeries due to delay in getting into town from airline cancellation.
11. One day did 3 family members surgeries and all had Postop laryngeal spasms. Maybe some type of environmental allergy or sensitivity.
12. Did one thyroid aspiration with the ultrasound guidance.
13. Had an average of 2-4 patients stay overnight each day except for the first Monday and last Wed. Made Preop and Postop very hectic early in the morning.
14. The open gallbladder surgery patient went home same day and the hysterectomy patients were discharged the following morning.
15. Did one post partum tubal ligation in a lady who had delivered in the night.
16. A 38 year old patient with a hysterectomy for bleeding was found at surgery to be likely due to cervical cancer.
17. Several rectal surgeries with a colorectal specialist in our group.
18. Several very large hydrocoels… some as large as soccer balls.
19. Seems like more adult large hernia patients than in years past.
20. Had a patient that wanted a tubal ligation surgery from us. She had previously been scheduled at another hospital but when she arrived late for surgery, she was told someone else had used her name and had the surgery already so she was turned away.. Identity theft in a 3rd world country.
1. 60 year old patient with foot pain that had brought an xray that showed a bone spur on his heal. No ortho instruments or fluoroscopy available.
2. Patient with fibrocystic breast changes. Surgery is not indicated.
3. Patient referred to us from the medical clinic… from last year for a hernia but he really didn’t have a hernia.
4. Patient with a large ventral hernia. Needed a large piece of mesh to repair, too big for us to repair but patient had seen Dr in city and would do surgery but patient had to provide her own mesh (over $1000), so we gave her the mesh for her surgery.
5. Parotid mass- Not able to do surgery with probable facial nerve involvement.
6. Patient with a kidney stone (brought her X-rays)
7. 2 patients with varicocoel of the scrotum… patient were handcuffed from the prison.
8. Patient came in 5’ 4’’ at 200 # and wanted us to take off the excess skin off her arms and thighs since she had lost weight. No we didn’t.
9. Patient with calluses on the bottom of his feet… who doesn’t have these.
10. Patient with burn scars from childhood and keloid.
11. 80 year old lady with a massive ventral incisional hernia for 5 years after a benign ovarian cyst removal. Told her it would require surgery to fix, she replied "heavens me, well I sure don’t want surgery", she then said thank you and gave me 7 eggs out of her purse.
12. Lots of patients with gynecological medical problems don’t ask for details.
13. Patient with prostate enlargement.
14. Patient with crooked toes.
15. Patient with recurrent neck mass found to be cancer last year.
16. Patient came in limping saying he had a hernia. When I asked where he pointed to his back and pulled out an MRI that showed a herniated disc. He said he already saw a neurosurgeon but he wants $200,000RD.
17. Patient wanted surgery to fix his hernia but still had a suprapubic catheter in place since his open prostatectomy
Patients that we did take to OR
1. Multiple patients with high BP as high as 250/150. No prior surgery or treatments. Sent to clinic and or local docs for treatment prior to surgery.
2. 13 year old with undescended testis.
3. Young patient with fibroadenoma. Was able to use a donated Sonosite ultrasound to diagnose.
4. Several patients with ganglion cyst of wrist… didn’t see any reoccurrences maybe since they don’t generally come back.
5. Keloid in multiple locations and patients. Did have steroids to inject to minimize reoccurrences. Patient would chance the reoccurrence for the possibility.
6. Had several patients come in with Preop clearance from cardiologist with ASA and AHA criterion listed. Great Preop workups.
7. Saw 4 patients with gallstones, only one didn’t have stones on ultrasound. Ultrasound quality is marginal at best.
8. Did 10 hysterectomies and 10 tubal ligations.
9. 4 year old child with hernia but at OR hernia couldn’t be found. Mom came back later to thank doc for fixing her son who was better after surgery.
10. First day only 6 minor surgeries due to delay in getting into town from airline cancellation.
11. One day did 3 family members surgeries and all had Postop laryngeal spasms. Maybe some type of environmental allergy or sensitivity.
12. Did one thyroid aspiration with the ultrasound guidance.
13. Had an average of 2-4 patients stay overnight each day except for the first Monday and last Wed. Made Preop and Postop very hectic early in the morning.
14. The open gallbladder surgery patient went home same day and the hysterectomy patients were discharged the following morning.
15. Did one post partum tubal ligation in a lady who had delivered in the night.
16. A 38 year old patient with a hysterectomy for bleeding was found at surgery to be likely due to cervical cancer.
17. Several rectal surgeries with a colorectal specialist in our group.
18. Several very large hydrocoels… some as large as soccer balls.
19. Seems like more adult large hernia patients than in years past.
20. Had a patient that wanted a tubal ligation surgery from us. She had previously been scheduled at another hospital but when she arrived late for surgery, she was told someone else had used her name and had the surgery already so she was turned away.. Identity theft in a 3rd world country.
2012 Journal
Monte Plata Journal – January 21, 2012 through February 4, 2012
Friday, Jan. 20, 2012
All the packing is done and we are heading to bed early – 10:00 pm. (I can’t believe we got to bed early for the night before leaving on project!)
Saturday, Jan. 21st
Early to rise at 3:30 am to be at the airport by 4:15 am and ready for team to begin arriving at 4:30 am. Five of the team was on at 6:55 am flight and most of the team was on at 7:05 am flight to Dallas. By the time we were all settled in at the gate, the second group began to arrive. Sheri stayed behind and helped the second group check-in. Then she was able to leave and go home.
We boarded the plane and had to de-ice and then taxied to the runway and then we turned back to taxi back. Some kind of hydraulic problem caused us to wait first for a mechanic to come, then for him to fix the problem. Around 9:30 am, we were allowed to get off the plane if we wanted. It is fortunate for one of us because they told us to take our old boarding pass if we got off. One person had put the boarding pass in her passport and slipped in her pants pocket. Both apparently slipped between the seats unbeknownst to her. If she hadn’t gotten off temporarily she wouldn’t have needed to look for the boarding pass and probably not noticed her passport was gone until the flight out of Miami, which would have been too late to find it or to continue on to Santo Domingo. Then finally we were told that we have to all get off. We were told that they must fly a part in to repair the plane and around 10:30 am we were told that the flight was cancelled. All of us would have to return to the ticket counter to rebook. So we slowly made our way to the counter to descend on the agents at the desk. Some with phones were calling to reschedule. Others were online and others just waited. As it turns out, when a flight is officially cancelled the computer will rebook all passengers beginning with First Class customers and then others. Since we did not book as a single group, 10 were able to get flights out on Saturday, but 15 couldn’t get out till Sunday.
Sunday, Jan. 22nd
We returned to the airport in Wichita on Sunday morning to begin the trip to the DR. They routed some of us through Chicago and some through Dallas and then all to Miami and the DR. It was very difficult to keep track of all participants but some made it to DR Saturday and then rest of us arrived Sunday night at midnight. We didn’t clear customs until approx. 1:00 am and then had to load the bus and drive to Monte Plata. It was nice to see the familiar faces of Alex, Noel, and Milton as we arrived. It’s like seeing family again.
Many of us, who arrived on Sunday, lost the 1st day of project but those that did arrive on Saturday separated the supplies that they brought and did some preliminary set up at the hospital.
Monday, Jan. 23rd
Although we arrived at camp around 2:00 am, we were up around 6:00 am to get ready for breakfast and a full day. After breakfast we had our orientation and then separated the remaining supplies. Then we did job specific orientation. I stayed and helped the clinic then on to surgery to complete the set up. The clinic stayed at the school and did their first day there (42 kids and 45 adults).
It was around 1:30 pm when we were ready to start at the hospital and Milton had given 30 general and 15 gyn tickets. The people were NPO and already had come on Sunday but were turned away when we couldn’t get in to the DR.
We were able to do 8 minor procedures to test our system this first day and saw 16 consults (in a half day). Needless to say, we were tired as was the clinic.
Not much evening activity which was fortunate since most of us were exhausted so we went to bed early.
Tuesday, Jan. 24th
We got up early up on Tuesday to try to begin our routine. I presented a devotional on Nehemiah and preparation in the morning and…. We were able to get a devotions coordinator, statistician and activities coordinators so the framework was set.
I have helped as 1st assist with CD with his surgeries. It was fun to be in the OR but still had clinic to see 20 general and 6 gyn clinic patients were scheduled for consultations the day that were seen between ORs.
The hospital has undergone a major renovation both upstairs and down. All of our supplies and equipment was upstairs. They now have a big OR that we were able to put 2 table s in so the OR is all in one room and still have room for lump and bump bed. That still leaves them their own OB/Labor area that we don’t need to use. I met with the hospital director and also the local ob/gyn when I remembered and they also remembered me as well. The local Gyn told us they might have a C Section today or tomorrow.
We had a successful day in OR as did the clinic at El Dion.
I found out after dinner that we would not be going to the Teacher’s Coop at the end of the project, but to another hotel. The last group also went there. The new place is $63.00 per day per person (all inclusive, but higher than the other place). And that ½ was required in advance in cash. I didn’t know about the change and hadn’t been able to tell the participants in advance so they could bring enough cash…ugh! There is always something.
I had an easy evening of reading/relaxing then off to bed.
Wednesday, Jan. 25th
Another busy day scheduled. Yesterday, Tuesday, we gave 30 tickets for general and 15 for gyn. Today we passed out 15 for general and 6 for gyn. Still the gyn clinic was the last to finish. We are doing more complex surgeries that require overnight stays i.e. We did an open gall bladder surgery but she was able to go home the same day. Hysterectomies went home the next morning. We are beginning to plan for weekend activities. And we found out that the resort where we will stay at the end just increased their price by $13.00 per day more. We also have 4 going home on Saturday and 3 on Sunday. But with losing a day last weekend, some are trying to change flights to go on Sunday. Otherwise, Saturday leavers don’t get to see much of the island.
I saw an 84 yr old lady today that was about 4’10” and a fireball. She talked a mile a minute even with no teeth. After a lengthy monologue, we found out that she had a hernia. Exam revealed a large ventral incisional hernia that would be difficult to repair but possible. When presented with that option she said “Oh Heaven’s, I don’t want surgery.” I thought, "why did you come to the surgery clinic?”As I pondered her motives, she smiled and pulled 7 chicken eggs in a baggie out of her purse to give to me as a gift.
I have been assisting with all of the gyn surgeries and they have gone well. It does make the clinic part slower.
Since our OF is new this year, we have both tables in one room. Rhonda got the redecoration but and rearranged the room to see if it works better. The renovation that they this year at the hospital have allowed all of our supplies to be on one level (2nd floor) and that has been nice.
We reported on the statistics each evening after dinner and we have already had 39 people make first time decisions to follow Christ after being presented with the Gospel message. All have been witnessed to by a new Dominican worked by the name of Edva. That is pronounced E-du-vey-uh. She is 4 foot 10 at most but is filled with the boldness of the Holy Spirit. I love talking to her even though she can’t speak any English. We have had a good mix of returning participants (11) and new people (20). Some of the new have been on projects other than MMI but all seem to be having fun.
Thursday, Jan. 26th
Each day’s routine is much like the other in surgery. Clinic gets to go to and see other places. We had our busiest day yesterday in surgery with 12 majors and 9 minors. Even with that we were done by 5:00 pm. Each day we have had 2-4 pts stay overnight and so far have all gone home the next AM. Today we did a hysterectomy on a 38 y/0 patient with a large uterus and fibroids that looks to have a cervical cancer with is particularly lethal. Saw more kids today and as a rule the surgeries have been bigger. One of my patients from Monday returned with a squash the size of a watermelon for me today.
We had a needle stick today and lab on the patient’s sample was sent and returned within one hour as negative for Hepatitis and HIV. Later in the afternoon one of the docs was sitting to do a minor procedure and the iris scissors fell off the mayo table and gave him a stick in his leg. The lab was sent but came back after we got back to camp. It was positive for HBsAg. Fortunately, he has had immunization for HepB. Still it was a nervous moment.
Dinner was good and I was able to do the paperwork early tonight. That involves organizing the consult sheets and making the surgery schedule for the next day. Afterwards, I had a nice easy evening with 1 ½ of reading then off to bed.
Friday, Jan. 27th
It is easy to get into the daily routine until you lose power or run out of water. It teaches patience and dependence which we all need.
The morning at surgery started busy as usual with the song of praise, Alabare. But now the team knows their job. We have had very few no shows this year. I don’t know why. We do have cell phone numbers for almost everyone and they do have to call a few but really we have had good compliance this year. We have had almost no patients that just don’t show up for surgery.
I spent the morning on the phone trying to coordinate the issues around the needle stick. If one gets stuck and the person that was being treated is + for HIV, the protocol is pretty well documented. For hepatitis it is not. If the patient is + for HBsAg and the stickee has had his shots and has normal titer of antibiotics there is no problem. You can however get the vaccination and not get protective antibodies. There in lies the problem. If you don’t’ have antibodies you need a shot of immune globulin to booster your immunity. And it has to be given within 24 hrs I thought. Now we find it is 7 days so after multiple phone calls and education, the crisis was averted.
I asked Milton to pass out 15 tickets for general and 5 for gynecology. That would allow us to finish filling the schedule on Monday. Little did I know that the clinic had referred almost 20 more to show up on Friday. So I saw 30 and finished filling the schedule for the project.
In the evening I had a time of sharing to thank and give time for those leaving to talk. Also, ST brought popcorn and poetry and we all enjoyed popcorn and heard his poems. A couple of others shared as well.
I was able to read till I finished my book. Note to self: don’t bring 1,000 page books. Kindle books are deceptively small looking.
Saturday, Jan. 28th
Got up to wish well to the 3 leaving for the States, back to bed, then up with the group. We stopped at the hospital on the way to the beach. I walked back from the hospital as they left for the beach on the northern coast at Samana.
My day included 2 naps, lots of reading and a walk around town with BS. I was well rested when the crew rolled back in around 7:00 pm. The all had a good time, but no whale watching or feeding.
We got word of some delays and diversions on the travels of those returning to the States but made it back safely.
I seem to be able to communicate a little with the Dominicans on a brief level. Sat and talked to Argentina, the cleaning lady who has been here for years.
Sunday, January 30th
Another group left at 5:15 this am. It’s nice being close enough to the airport to make it to the airport in an hour or so. I had to wake Noel as he overslept a little. Then back to bed for a little and then back up for breakfast then church here in town. We went at 10 and had to sit in the balcony since the first floor was full. There were lots more kids than in years past. At 11 the church broke for “half time” and we were dismissed. Hector on of our translators did translate the sermon for us and we appreciated that.
I had a restful day after church. It included a nap that was interrupted by a call from the hospital. They called Milton and he had LB come into my room but he had trouble waking me from my nap. Milton and I went to the hospital and saw one of our patients who had a gall bladder operation 4 days prior. Her complaint was that she hurt when she coughed. We explained that that was to be expected. She was also constipated and we suggested Milk of Magnesia. The patient thanked us and walked across the street to the pharmacy and bought some (while in her satin nightgown) then walked home by herself.
The group walked to the orphanage and had a talk with Melissa the staff missionary for Kids Alive here at Monte Plata. She struggles as the only missionary in Monte Plata when she has friends with lots of support in Jarabacoa. We have had several Dominican special foods such as sancocho, ahyama, and mufungo. All are pretty good but Ramona the cook tries to also add American favorites as well such as spaghetti and Hot dogs on Sunday night.
Monday January 31st
All the one week participants have returned home and the 24 of us remain behind. I had my leaders together yesterday together afternoon for a meeting to discuss how we would adapt for the changes necessary and how to manage expectations on accomplishments. We North Americans tend to be productivity driven and focused and numbers matter. I presented the changes after breakfast and we were off to the hospital and the medical team to El Cacique. At both the hospital and clinic we had the busiest day yet in spite of decreased team members. God was able to provide….as usual.
I scrubbed all day since we had filled the OR schedule and CD and I are working very well together. We ended up with the highest number of majors yet and still were done by 5 pm. Only had one cancellation even on Duarte Day (a national holiday).
We had planned to count pills for the pharmacy but they were in good shape (after dispensing 345 scripts….almost 60 more the day before. In the evening the Dominicans were all glued to a lap top showing the Caribbean World Series final game. The end of the game was accompanied by the usual fireworks, loud noise and celebration not just here but throughout the island. The only thing that could have stopped the noise was a steady rain (Dominicans aren’t fond of rain).
Tuesday January 31st
To this point all participants have been healthy except for occasional cold, cough, and migraine. We are thankful for that.
The work today was constant and we were able to do a lot of major surgeries and still get done by 4:30. Still have patients coming up to us in the halls and rooms to show and ask for something to be removed. At the end of the day as we were walking a lady and man arrived to the hospital to ask us to do a surgery on the man who had a large thyroid mass. We had actually seen him last year and we did a debulking operation for an obvious malignancy. After surgery last year, we had recommended him to see an oncologist. Apparently, it took this long for him to get to the specialist. Sure enough the specialist recommended chemotherapy but he wanted the tumor debulked (like we had done last year). Unfortunately, we can’t do his surgery this late in the project; the family was saddened as were we. We did refer him to the Santa Hospital in the capital.
Pastor Prenza who is the senior pastor at the church that sponsors us, built the church, school and orphanage, provided our evening program on the history of his ministry here in Monte Plata. Melissa the missionary provided translation for him. His work in the community is amazing and stimulating. His history goes thru both Eva Russell a Canadian missionary to Monte Plata years ago to Elias Santana for whom the MMI hospital is named. I think everyone enjoyed the program and was awed by his Christian witness and devotion to his town and his people.
Wednesday February 1st
Well, this year’s last day being only a half day went out the window last Friday when I saw 30 patients that needed surgery before we left. Sure enough the local Gynecologist felt the need to add a C. Section on the schedule today in addition to the full schedule we already had. At first he said he would like to use all our staff, and then the local anesthesiologist showed up. It was a little crazy, but all was well with a healthy baby. We almost always have people just not show up, but not this year. We did have 3 or 4 cancelled because of elevated blood pressures. The worst had 250/150 and was totally asymptomatic. That level in the US would result in an ICU admission. We ended the day with our busiest day as to major chases even though it was supposed to be a half day. I failed to mention to the staff that it was a short day and no one complained. It is hard to turn people away. We finished our final surgery around 3 pm and the breakdown and packing took until 5 pm. Everything was loaded on the big white truck and we all took a leisurely walk thru town back to the camp.
The clinic went to the jail in town…to see patients. It is referred to as a model jail in the country. It is still prison. It was a good experience for both the participants and the inmates.
We had a good meal then at 8 we had a time of sharing and the official ending of the project work with Steve reading his new poem for the project. We also expressed our appreciation to all the Dominican Staff that provided for us these 2 weeks. There were a total of 9 men and 8 women who helped pull off the project from health education to optometry to meals to drivers to translators. All work endlessly during the two weeks and always are the last to eat at each meal even when we try to make them go first. All have servants’ hearts for sure we cherish their friendship.
Thursday February 2
We had an early morning even though breakfast was a little later (7 instead of the usual 6:30). Then a mad scurry to pack up and load the truck after breaking down the camp and loading everything including the kitchen sink (well not really but we do pack the iron stove, washing machine and propane tanks.)Then we loaded the big yellow bus with our bags and headed to the Colonial Zone in Santo Domingo. The trip is much shorted now with the toll way north/south and it put us at the Mercado by 9:30. The shops don’t change much year to year but occasionally new things appear and they are always ready to barter. It’s hard to find those new things when the lights go out in that section of the city which it did. Some of the shops have generators while others don’t and life just goes on.
At noon, Claudina’s aunt and uncle Margarita and Alejandro Castillo met me at the market with 62 pounds of coffee for my kids and then took me out to lunch at Adrian’s Tropical. It was very nice to sit outside under the palms and eat and visit. Claudina’s uncle speaks a little English and I speak a little Spanish and together we were able to communicate well enough to enjoy our meal and company. Then we took a fast trip to see Nana, Margarita’s sister and their little dogs. After pictures and pleasantries along with a formal invitation to come and stay anytime at their house we left to return to the market. Santo Domingo is very metropolitan with a Metro/subway, malls, restaurants and theaters along with sports venues. It is a very different DR than the one we see on project.
We arrived back at the bus 15 minutes late (well within the normal limits of Dominican time) in time to leave for the hotel. The Talanquera Resort is a Barceló hotel was nice. It was somewhat of an upgrade from the Coop Marina last year. The staff spoke English at the reception area but the repairs and efficiency were still not up to American standards. The beach and pool areas were much nicer than last year. The resort was almost empty on Thursday and Friday since this is still winter (even though its 82 degrees). After a beautiful Caribbean sunset and buffet dinner we turned in for good nights rest.
Friday February 3
Couldn’t sleep much later than 6 but I stayed in bed not to disturb my roommate until almost 7. Got up and began the restful day of lounging around, reading, and napping. I didn’t even get in the ocean or pool today. Later, I returned to the room to repack and prepare for the early morning and travel. We had a nice dinner together for the last time in the DR and then gave it up and fell asleep for a little while. We had to get up a little after 3:30 am to leave by 4:15 for the airport.
Saturday February 4, 2012
Well the beginning of the end occurred at 3:30 am and continued thru 3 flights, 2 layovers and lots of reading. I was able to finish my second book of the trip while in Dallas waiting on the final flight to Wichita that landed a mere 20 hours and 2 countries later. It was a great trip by any standards.
Friday, Jan. 20, 2012
All the packing is done and we are heading to bed early – 10:00 pm. (I can’t believe we got to bed early for the night before leaving on project!)
Saturday, Jan. 21st
Early to rise at 3:30 am to be at the airport by 4:15 am and ready for team to begin arriving at 4:30 am. Five of the team was on at 6:55 am flight and most of the team was on at 7:05 am flight to Dallas. By the time we were all settled in at the gate, the second group began to arrive. Sheri stayed behind and helped the second group check-in. Then she was able to leave and go home.
We boarded the plane and had to de-ice and then taxied to the runway and then we turned back to taxi back. Some kind of hydraulic problem caused us to wait first for a mechanic to come, then for him to fix the problem. Around 9:30 am, we were allowed to get off the plane if we wanted. It is fortunate for one of us because they told us to take our old boarding pass if we got off. One person had put the boarding pass in her passport and slipped in her pants pocket. Both apparently slipped between the seats unbeknownst to her. If she hadn’t gotten off temporarily she wouldn’t have needed to look for the boarding pass and probably not noticed her passport was gone until the flight out of Miami, which would have been too late to find it or to continue on to Santo Domingo. Then finally we were told that we have to all get off. We were told that they must fly a part in to repair the plane and around 10:30 am we were told that the flight was cancelled. All of us would have to return to the ticket counter to rebook. So we slowly made our way to the counter to descend on the agents at the desk. Some with phones were calling to reschedule. Others were online and others just waited. As it turns out, when a flight is officially cancelled the computer will rebook all passengers beginning with First Class customers and then others. Since we did not book as a single group, 10 were able to get flights out on Saturday, but 15 couldn’t get out till Sunday.
Sunday, Jan. 22nd
We returned to the airport in Wichita on Sunday morning to begin the trip to the DR. They routed some of us through Chicago and some through Dallas and then all to Miami and the DR. It was very difficult to keep track of all participants but some made it to DR Saturday and then rest of us arrived Sunday night at midnight. We didn’t clear customs until approx. 1:00 am and then had to load the bus and drive to Monte Plata. It was nice to see the familiar faces of Alex, Noel, and Milton as we arrived. It’s like seeing family again.
Many of us, who arrived on Sunday, lost the 1st day of project but those that did arrive on Saturday separated the supplies that they brought and did some preliminary set up at the hospital.
Monday, Jan. 23rd
Although we arrived at camp around 2:00 am, we were up around 6:00 am to get ready for breakfast and a full day. After breakfast we had our orientation and then separated the remaining supplies. Then we did job specific orientation. I stayed and helped the clinic then on to surgery to complete the set up. The clinic stayed at the school and did their first day there (42 kids and 45 adults).
It was around 1:30 pm when we were ready to start at the hospital and Milton had given 30 general and 15 gyn tickets. The people were NPO and already had come on Sunday but were turned away when we couldn’t get in to the DR.
We were able to do 8 minor procedures to test our system this first day and saw 16 consults (in a half day). Needless to say, we were tired as was the clinic.
Not much evening activity which was fortunate since most of us were exhausted so we went to bed early.
Tuesday, Jan. 24th
We got up early up on Tuesday to try to begin our routine. I presented a devotional on Nehemiah and preparation in the morning and…. We were able to get a devotions coordinator, statistician and activities coordinators so the framework was set.
I have helped as 1st assist with CD with his surgeries. It was fun to be in the OR but still had clinic to see 20 general and 6 gyn clinic patients were scheduled for consultations the day that were seen between ORs.
The hospital has undergone a major renovation both upstairs and down. All of our supplies and equipment was upstairs. They now have a big OR that we were able to put 2 table s in so the OR is all in one room and still have room for lump and bump bed. That still leaves them their own OB/Labor area that we don’t need to use. I met with the hospital director and also the local ob/gyn when I remembered and they also remembered me as well. The local Gyn told us they might have a C Section today or tomorrow.
We had a successful day in OR as did the clinic at El Dion.
I found out after dinner that we would not be going to the Teacher’s Coop at the end of the project, but to another hotel. The last group also went there. The new place is $63.00 per day per person (all inclusive, but higher than the other place). And that ½ was required in advance in cash. I didn’t know about the change and hadn’t been able to tell the participants in advance so they could bring enough cash…ugh! There is always something.
I had an easy evening of reading/relaxing then off to bed.
Wednesday, Jan. 25th
Another busy day scheduled. Yesterday, Tuesday, we gave 30 tickets for general and 15 for gyn. Today we passed out 15 for general and 6 for gyn. Still the gyn clinic was the last to finish. We are doing more complex surgeries that require overnight stays i.e. We did an open gall bladder surgery but she was able to go home the same day. Hysterectomies went home the next morning. We are beginning to plan for weekend activities. And we found out that the resort where we will stay at the end just increased their price by $13.00 per day more. We also have 4 going home on Saturday and 3 on Sunday. But with losing a day last weekend, some are trying to change flights to go on Sunday. Otherwise, Saturday leavers don’t get to see much of the island.
I saw an 84 yr old lady today that was about 4’10” and a fireball. She talked a mile a minute even with no teeth. After a lengthy monologue, we found out that she had a hernia. Exam revealed a large ventral incisional hernia that would be difficult to repair but possible. When presented with that option she said “Oh Heaven’s, I don’t want surgery.” I thought, "why did you come to the surgery clinic?”As I pondered her motives, she smiled and pulled 7 chicken eggs in a baggie out of her purse to give to me as a gift.
I have been assisting with all of the gyn surgeries and they have gone well. It does make the clinic part slower.
Since our OF is new this year, we have both tables in one room. Rhonda got the redecoration but and rearranged the room to see if it works better. The renovation that they this year at the hospital have allowed all of our supplies to be on one level (2nd floor) and that has been nice.
We reported on the statistics each evening after dinner and we have already had 39 people make first time decisions to follow Christ after being presented with the Gospel message. All have been witnessed to by a new Dominican worked by the name of Edva. That is pronounced E-du-vey-uh. She is 4 foot 10 at most but is filled with the boldness of the Holy Spirit. I love talking to her even though she can’t speak any English. We have had a good mix of returning participants (11) and new people (20). Some of the new have been on projects other than MMI but all seem to be having fun.
Thursday, Jan. 26th
Each day’s routine is much like the other in surgery. Clinic gets to go to and see other places. We had our busiest day yesterday in surgery with 12 majors and 9 minors. Even with that we were done by 5:00 pm. Each day we have had 2-4 pts stay overnight and so far have all gone home the next AM. Today we did a hysterectomy on a 38 y/0 patient with a large uterus and fibroids that looks to have a cervical cancer with is particularly lethal. Saw more kids today and as a rule the surgeries have been bigger. One of my patients from Monday returned with a squash the size of a watermelon for me today.
We had a needle stick today and lab on the patient’s sample was sent and returned within one hour as negative for Hepatitis and HIV. Later in the afternoon one of the docs was sitting to do a minor procedure and the iris scissors fell off the mayo table and gave him a stick in his leg. The lab was sent but came back after we got back to camp. It was positive for HBsAg. Fortunately, he has had immunization for HepB. Still it was a nervous moment.
Dinner was good and I was able to do the paperwork early tonight. That involves organizing the consult sheets and making the surgery schedule for the next day. Afterwards, I had a nice easy evening with 1 ½ of reading then off to bed.
Friday, Jan. 27th
It is easy to get into the daily routine until you lose power or run out of water. It teaches patience and dependence which we all need.
The morning at surgery started busy as usual with the song of praise, Alabare. But now the team knows their job. We have had very few no shows this year. I don’t know why. We do have cell phone numbers for almost everyone and they do have to call a few but really we have had good compliance this year. We have had almost no patients that just don’t show up for surgery.
I spent the morning on the phone trying to coordinate the issues around the needle stick. If one gets stuck and the person that was being treated is + for HIV, the protocol is pretty well documented. For hepatitis it is not. If the patient is + for HBsAg and the stickee has had his shots and has normal titer of antibiotics there is no problem. You can however get the vaccination and not get protective antibodies. There in lies the problem. If you don’t’ have antibodies you need a shot of immune globulin to booster your immunity. And it has to be given within 24 hrs I thought. Now we find it is 7 days so after multiple phone calls and education, the crisis was averted.
I asked Milton to pass out 15 tickets for general and 5 for gynecology. That would allow us to finish filling the schedule on Monday. Little did I know that the clinic had referred almost 20 more to show up on Friday. So I saw 30 and finished filling the schedule for the project.
In the evening I had a time of sharing to thank and give time for those leaving to talk. Also, ST brought popcorn and poetry and we all enjoyed popcorn and heard his poems. A couple of others shared as well.
I was able to read till I finished my book. Note to self: don’t bring 1,000 page books. Kindle books are deceptively small looking.
Saturday, Jan. 28th
Got up to wish well to the 3 leaving for the States, back to bed, then up with the group. We stopped at the hospital on the way to the beach. I walked back from the hospital as they left for the beach on the northern coast at Samana.
My day included 2 naps, lots of reading and a walk around town with BS. I was well rested when the crew rolled back in around 7:00 pm. The all had a good time, but no whale watching or feeding.
We got word of some delays and diversions on the travels of those returning to the States but made it back safely.
I seem to be able to communicate a little with the Dominicans on a brief level. Sat and talked to Argentina, the cleaning lady who has been here for years.
Sunday, January 30th
Another group left at 5:15 this am. It’s nice being close enough to the airport to make it to the airport in an hour or so. I had to wake Noel as he overslept a little. Then back to bed for a little and then back up for breakfast then church here in town. We went at 10 and had to sit in the balcony since the first floor was full. There were lots more kids than in years past. At 11 the church broke for “half time” and we were dismissed. Hector on of our translators did translate the sermon for us and we appreciated that.
I had a restful day after church. It included a nap that was interrupted by a call from the hospital. They called Milton and he had LB come into my room but he had trouble waking me from my nap. Milton and I went to the hospital and saw one of our patients who had a gall bladder operation 4 days prior. Her complaint was that she hurt when she coughed. We explained that that was to be expected. She was also constipated and we suggested Milk of Magnesia. The patient thanked us and walked across the street to the pharmacy and bought some (while in her satin nightgown) then walked home by herself.
The group walked to the orphanage and had a talk with Melissa the staff missionary for Kids Alive here at Monte Plata. She struggles as the only missionary in Monte Plata when she has friends with lots of support in Jarabacoa. We have had several Dominican special foods such as sancocho, ahyama, and mufungo. All are pretty good but Ramona the cook tries to also add American favorites as well such as spaghetti and Hot dogs on Sunday night.
Monday January 31st
All the one week participants have returned home and the 24 of us remain behind. I had my leaders together yesterday together afternoon for a meeting to discuss how we would adapt for the changes necessary and how to manage expectations on accomplishments. We North Americans tend to be productivity driven and focused and numbers matter. I presented the changes after breakfast and we were off to the hospital and the medical team to El Cacique. At both the hospital and clinic we had the busiest day yet in spite of decreased team members. God was able to provide….as usual.
I scrubbed all day since we had filled the OR schedule and CD and I are working very well together. We ended up with the highest number of majors yet and still were done by 5 pm. Only had one cancellation even on Duarte Day (a national holiday).
We had planned to count pills for the pharmacy but they were in good shape (after dispensing 345 scripts….almost 60 more the day before. In the evening the Dominicans were all glued to a lap top showing the Caribbean World Series final game. The end of the game was accompanied by the usual fireworks, loud noise and celebration not just here but throughout the island. The only thing that could have stopped the noise was a steady rain (Dominicans aren’t fond of rain).
Tuesday January 31st
To this point all participants have been healthy except for occasional cold, cough, and migraine. We are thankful for that.
The work today was constant and we were able to do a lot of major surgeries and still get done by 4:30. Still have patients coming up to us in the halls and rooms to show and ask for something to be removed. At the end of the day as we were walking a lady and man arrived to the hospital to ask us to do a surgery on the man who had a large thyroid mass. We had actually seen him last year and we did a debulking operation for an obvious malignancy. After surgery last year, we had recommended him to see an oncologist. Apparently, it took this long for him to get to the specialist. Sure enough the specialist recommended chemotherapy but he wanted the tumor debulked (like we had done last year). Unfortunately, we can’t do his surgery this late in the project; the family was saddened as were we. We did refer him to the Santa Hospital in the capital.
Pastor Prenza who is the senior pastor at the church that sponsors us, built the church, school and orphanage, provided our evening program on the history of his ministry here in Monte Plata. Melissa the missionary provided translation for him. His work in the community is amazing and stimulating. His history goes thru both Eva Russell a Canadian missionary to Monte Plata years ago to Elias Santana for whom the MMI hospital is named. I think everyone enjoyed the program and was awed by his Christian witness and devotion to his town and his people.
Wednesday February 1st
Well, this year’s last day being only a half day went out the window last Friday when I saw 30 patients that needed surgery before we left. Sure enough the local Gynecologist felt the need to add a C. Section on the schedule today in addition to the full schedule we already had. At first he said he would like to use all our staff, and then the local anesthesiologist showed up. It was a little crazy, but all was well with a healthy baby. We almost always have people just not show up, but not this year. We did have 3 or 4 cancelled because of elevated blood pressures. The worst had 250/150 and was totally asymptomatic. That level in the US would result in an ICU admission. We ended the day with our busiest day as to major chases even though it was supposed to be a half day. I failed to mention to the staff that it was a short day and no one complained. It is hard to turn people away. We finished our final surgery around 3 pm and the breakdown and packing took until 5 pm. Everything was loaded on the big white truck and we all took a leisurely walk thru town back to the camp.
The clinic went to the jail in town…to see patients. It is referred to as a model jail in the country. It is still prison. It was a good experience for both the participants and the inmates.
We had a good meal then at 8 we had a time of sharing and the official ending of the project work with Steve reading his new poem for the project. We also expressed our appreciation to all the Dominican Staff that provided for us these 2 weeks. There were a total of 9 men and 8 women who helped pull off the project from health education to optometry to meals to drivers to translators. All work endlessly during the two weeks and always are the last to eat at each meal even when we try to make them go first. All have servants’ hearts for sure we cherish their friendship.
Thursday February 2
We had an early morning even though breakfast was a little later (7 instead of the usual 6:30). Then a mad scurry to pack up and load the truck after breaking down the camp and loading everything including the kitchen sink (well not really but we do pack the iron stove, washing machine and propane tanks.)Then we loaded the big yellow bus with our bags and headed to the Colonial Zone in Santo Domingo. The trip is much shorted now with the toll way north/south and it put us at the Mercado by 9:30. The shops don’t change much year to year but occasionally new things appear and they are always ready to barter. It’s hard to find those new things when the lights go out in that section of the city which it did. Some of the shops have generators while others don’t and life just goes on.
At noon, Claudina’s aunt and uncle Margarita and Alejandro Castillo met me at the market with 62 pounds of coffee for my kids and then took me out to lunch at Adrian’s Tropical. It was very nice to sit outside under the palms and eat and visit. Claudina’s uncle speaks a little English and I speak a little Spanish and together we were able to communicate well enough to enjoy our meal and company. Then we took a fast trip to see Nana, Margarita’s sister and their little dogs. After pictures and pleasantries along with a formal invitation to come and stay anytime at their house we left to return to the market. Santo Domingo is very metropolitan with a Metro/subway, malls, restaurants and theaters along with sports venues. It is a very different DR than the one we see on project.
We arrived back at the bus 15 minutes late (well within the normal limits of Dominican time) in time to leave for the hotel. The Talanquera Resort is a Barceló hotel was nice. It was somewhat of an upgrade from the Coop Marina last year. The staff spoke English at the reception area but the repairs and efficiency were still not up to American standards. The beach and pool areas were much nicer than last year. The resort was almost empty on Thursday and Friday since this is still winter (even though its 82 degrees). After a beautiful Caribbean sunset and buffet dinner we turned in for good nights rest.
Friday February 3
Couldn’t sleep much later than 6 but I stayed in bed not to disturb my roommate until almost 7. Got up and began the restful day of lounging around, reading, and napping. I didn’t even get in the ocean or pool today. Later, I returned to the room to repack and prepare for the early morning and travel. We had a nice dinner together for the last time in the DR and then gave it up and fell asleep for a little while. We had to get up a little after 3:30 am to leave by 4:15 for the airport.
Saturday February 4, 2012
Well the beginning of the end occurred at 3:30 am and continued thru 3 flights, 2 layovers and lots of reading. I was able to finish my second book of the trip while in Dallas waiting on the final flight to Wichita that landed a mere 20 hours and 2 countries later. It was a great trip by any standards.
Subscribe to:
Posts (Atom)