Journal for Jaltenango Mexico

Mexico 2013 Journal

This represents a bit of a deviation from my prior blogs in that I have only gone to the DR on projects with MMI in the past. We were asked to do a pilot project to Mexico as they had not had prior general surgery projects in Mexico for MMI. So, Here is a post about my experience to Mexico on a surgery project.

Saturday-

We didn’t have to leave until 10:55 AM so it was an easy morning to finish packing and go to the airport. There were 5 of us on the first flight to Houston. That gave us time to visit at the airport and go over our plans and ideas.

The first leg was an hour and a half and very uneventful. Unfortunately, we had a 6 hour wait until our next flight to Tuxtla. During that time we ate twice and saw the remainder of our group arrive. One from Michigan, one from Phoenix, two from Des Moines and two more from Wichita on a later flight.

The 2 and a half hour flight went quickly due to our anticipation. It is hard to believe you can be in a remote area in Central America in only 4 hours of flight time. The airport in Tuxtla is 45 minutes outside of town in a very remote area. So we boarded the 2 old 15 passenger vans to make the 45 minute trip in the dark to our hotel in the city. Customs in the airport was very simple with us being the only flight in at night. It is a new clean airport with lots of glass and 6 gates. The agents were very helpful. All bags arrived with minimal hassle and just one line to wait in getting our passport stamped.

Tuxtla Gutierrez is the capital of the state of Chiapas, Mexico. It is a town of 500,000, but is bigger than it was designed for. It doesn't have much tourism so dollars aren't taken anywhere. Mexican Pesos are the currency (not to be confused with Dominican Pesos). A dollar is equal to 13.07 pesos. It was almost 1 am by the time we reached the hotel. The hotel didn't look too good but was clean. Nice but simple.

Sunday-

We awoke at 6 am and cleaned up and walked about 4 blocks to Dan's 4th floor apartment to have breakfast of cereal and fruit and coffee. The town is fairly busy, but not on Sunday morning at 7. By 8 we were ready to take our caravan of vans and an open bed truck with a tarp on the road the 120 kilometers to Jaltenango la Paz. Unfortunately, the entire road was barely passable so the trip took 4 and a half hour. Yes, 4 and a half hours. They have had unusually heavy rains over the last 3 weeks on a daily basis. All the rivers and fields are full and the roads have suffered more than usual. This is now towards the end of the rainy season.

The main crop is corn but there are few flat fields like seen in Kansas. The hills, mountains, valleys and even the bar ditches are planted by hand and harvested the same way. We arrive in town around 12:30 pm. The town is also known as Angel Albino Corzo, named after a national hero, politician from the 1800's around their independence from France. The town seems very small but actually is over 25,000. No stop signs or traffic lights in the whole town. The hotel we are to stay at is even more Spartan than last nights. It has Wi-Fi but it doesn't work, somebody is coming tomorrow or Tuesday to check it out. Also, there is no hot water. Dan said they had both hot water and Wi-Fi last time he stayed there. They are going to have someone look into the problems soon, or so the translation went. The room barely has room to walk around the two full size beds and no closet, chest of drawers or place to unpack. So we live out of suitcases. The bathroom has a sink, toilet and shower, all together with no curtain or distinction between the shower and the rest of the small room, so the drain centrally placed in the floor drains the whole room which gets wet during the shower.

We went to a restaurant for lunch and took up the whole small place with our 15 people. We ordered off the menu and it took a while to cook that many meals with one cook. They have mostly traditional Mexican food with corn tacos, burritos quesadillas, etc. Not a very extensive menu.

We then drove to the hospital and spent an hour and a half figuring out the logistics of where to put what. The other surgeon and I then started about 3:30 seeing patients and saw them nonstop till around 7 PM. We did consults on 58 patients by the time they stopped coming. 5 were not candidates for us to do. All the patients had been prescreened by local doctors. They each had lab, X-rays, EKGs, and sonography when indicated. 23 of the patients had gallstones. Very few had the lumps and bumps that we normally see in the DR.

We apparently stepped on some toes politically today. Two municipalities are sponsoring our trip. One is here where the hospital is (Jaltenango); the other Monte Christi is 10-20 kilometers away and doesn't have a hospital so they partnered with Jaltenago to have us come. They were told that we would begin to see patients at 4. We were ready early and started at 3:30. So the local people were told to show up around 5 (since we start at 4?) and all the other communities patients were brought in by bus and got there early. So, by the time the locals showed up we were almost filled up with an unequal numbers being scheduled from Monte Christi. So, we had to add several to the already full schedule to make it fairer.

We went back to same cafe for dinner for more tacos, corn of course. Then a walk in the dark back the 8 blocks back to the hotel. Our room was warm and sticky. Of course the air conditioner didn't work, but by standing on the dresser (without the drawers), we were able to get it to work enough to make noise to crowd out the snoring, fireworks and cannons (celebrating Chiapas Independence from France in 1860's) and the early morning roosters. At least we had an air conditioner along with the ceiling fan, since those on the first floor only had a ceiling fan and no air conditioner.



Monday-

Awake early as usual to find no hot or warm water. It turns out they ran out of propane to heat the water. Also, the Internet didn't work because the modem was "broke". I was able to fix the modem (by unplugging and plugging it back in) but they had cancelled the DSL since the modem didn't work...

First day at the hospital was filled with new challenges and opportunities for growth on our part. We had 8 major cases scheduled to do and after several stutters at starting we began around 9 with the first case. Other issues prevented the second case from starting till 11:15. But even with all that we were able to finish by 5:30 or 6 PM. I did all the cases until the last one so The other surgeon could take care of the administrative and political stuff. We have 2 anesthesia providers so we could alternate between two OR tables in the same room. That allowed us to turn over very quickly. Also, we didn't have to stop to see clinic patients since we had seen all of them yesterday. This project had been designed as an exploratory or pilot project from the beginning since we had never been here before. All the participants were handpicked by The other surgeon and me (along with God). So out intent was not to do a bunch of cases. But, it is still hard to turn anyone away.

Back to another restaurant two doors down (owned by the same person) for dinner with a larger menu but not all things are available. With one waitress and 19 of us, we were not thru with dinner till 8:15 and then the walk home pretty much finishes most of off for the day.

The hot water was fixed but the Internet was not. The air conditioner had to be fixed again but worked to cool the room down ultimately. I am beginning to relax at bit (especially since we do have air conditioning and also that I am not in charge).

Well, the power to the hotel just went out for the whole hotel (16 rooms on 2 stories total). They say that the technician will be here in 30 minutes to hook up the generator, but the air conditioner won’t run on the generator. Glad I brought at least one flashlight. I didn't bring more because Dan says the power is more reliable than in the DR.... Might as well turn in.



Tuesday-

Awoke at my usual 5:30 and figured out the hot water system (the wrong handle controls hot). That helped a bunch. Cold showers are okay as long as they are brief, just not very relaxing. Walked to the restaurant for breakfast this morning and they have started serving a standard meal for all at breakfast and delivering a standard meal for lunch with way too much Mexican food for me. Evening meals are still chosen off the menu although they don't always have what is listed. Somewhat frustrating after trying figure out what each is in Spanish and deciding if I might like it, then it’s not available. All meals are big and come with corn tortillas and the refried beans are always black beans.

Then off to the hospital. Some of the Mexican staff takes the local Moto taxi since we are down to one van. The Moto taxis are 3 wheeled vehicles similar to rickshaws in Japan. It is open air with plastic covering for rainy days. I did the surgeries today with The other surgeon assisting. That allowed him more time for admin stuff. The president of Jaltenango showed up today and wanted everyone to come out for photo ops and speeches. I was busy so The other surgeon had the pleasure of going out to give an unexpected speech thru a translator. He hated that. We did 4 gallbladder surgeries, 2 inguinal hernia surgeries, 1 umbilical hernia repair and removed on lymph node on a young man that may have cancer or TB. I also took off a 6th toe on a 6 month old baby.

We finished the OR around 5:30 after an 8:30 start. The OR does have an air conditioner but it was not working properly and the rooms got so hot that we were drinking 8 to 12 ounces of water between each case to combat dehydration from sweating so much. While 85 degrees doesn't sound real hot, it is miserable with impervious gowns gloves hats and masks under the intense OR lights. It helps some that the OR overhead lights don't work and that I wear a head lamp on all the cases to be able to see.

One of the gallbladder surgery patients had some bleeding problems during the surgery. It made us realize the lack of back up and options we have here. We had no topical hemostatic agents like we have back home but also in the DR because of the warehouse of supplies that they have. There was also the constant strain to do more. We finally remembered that there will always be more patients and more difficult cases to do and that we can only do what we can.

It began to rain for the first time as we went to the restaurant and continued thru dinner. Being on many prior trips, I should have realized that the gentle rain meant that the laundry I dropped off this morning would not be ready as promised this evening, since drying involved hanging on a line without rain, even though it contained my sleep clothes. We had a Mariachi band show up after dinner to entertain us with music and also cake and dessert by two of the ladies from the hospital to celebrate Dan's daughters 18th birthday.

I walked back to the hotel in the rain under an umbrella. It provides time of reflections and relaxation. When we got back we found more governmental officials at the hotel waiting for us. They had missed the ceremony this morning and wanted to thank us personally. So more chit chat, photos and off to bed. This trip has not had much alone or decompression time.



Wednesday-

After waking at 5:15 and showering and getting ready for the day I have time for my devotion and journaling. Fortunately my roommate is also an early morning riser and we haven't had any early morning issues. The town is quiet at 6:50 when we walk to the restaurant to breakfast except for the roosters and dogs. Our room does have a flat screen mounted on the wall but we haven't even turned it on so I don’t know if it works. It’s all in Spanish anyway.

The restaurant asked yesterday what we liked on our pancakes. So we were eager to have pancakes today till they told us they couldn't find syrup. We take Wal-Mart and Dillon's for granted. Each morning in the restaurant we had a short devotional presented by one of the participants.

Since we had the political problems of not doing enough of the on municipalities’ cases, they decided to hire a Mexican surgeon to come for a day and do 5 gallbladder surgeries on people we had to turn away, but they need our anesthesia. Then they needed the other table and the anesthesia machine, etc, etc. etc. He used much larger incisions and didn't use cautery to do his cases. The patients in postop compared notes and noticed the differences in their incisions and pain levels. They then added 2 or 3 more cases for him as the day went on. That slowed us down a bit. All the miscommunication is a common thread here but also in the DR. Here they charge patients nominal fees for their surgery to get the patients to take ownership. The charges were 100 pesos for a minor surgery, 300 pesos for hernia repair and 500 for gallbladder surgery. (With the exchange of 13.07 pesos to the dollar that would be $8, $24 and $38 respectively.) If they didn't have any money they still got to have surgery. The amount collected just about paid the local surgeon.

I did most of the cases with The other surgeon's assistance. We did one epigastric hernia, a femoral hernia, an inguinal hernia and 3 gallbladder surgeries and were getting ready at 4 PM to start the last of 2 umbilical hernia surgeries when the power went out while I was closing an inguinal hernia surgery patient. It had flickered a couple of times during the day, but this time it was out for 30 minutes. They sent for a technician and he came after a bit. We had been on generator power all day because the sector of the city was without power. Being on the generator means that the air conditioner was only intermittent causing the OR temp to rise to the low 90"s. It was very draining physically for the whole crew. The instruments were marginal so that was a struggle as well. No having the right instrument and using what is available makes it more difficult.

Even thou the generator would come on it would stop again. So we stopped the schedule and cancelled the last 2 cases. They had been waiting all day without eating, but never complained. The local surgeon agreed to come back tomorrow and start a 7 am to finish his last 2 cases. We added ours on as well, but for Friday.

We walked to dinner for the 2 hour meal (waiting time plus eating time) of corn enchiladas, refried beans with guacamole salsa. After a brisk walk home we found our laundry all mixed together and still moist from the earlier rain. They forgot to clean our room. So we waited outside, then went into our room and tried to hang our clothes wherever we could. Then to sleep, not much time for anything else.



Thursday

After we walked to breakfast for another full meal we rode the van to the hospital. Our anesthesia provider who worked with the Mexican surgeon went in early to start at 7 am on his last 2 cases and we arrived around 8:15 as usual for us. The surgeon was upset that we didn't stay and finish last night as he was sure the technician was going to fix the generator. We were not that sure and didn't want to risk the patients having the surgery and not being to have electricity to finish the case. The surgeon showed up around 8:30. He said he overslept. So we were without our second anesthesia provider all morning. They finished their 2 gallbladder surgeries and then did a C Section.

The day started slow for us also since the generator was off last night they couldn't launder our scrubs as they had done before. It seems as one of the ladies took everything home to wash. We waited a bid and she returned with our clothes.

The cases were mostly routine with the gallbladder surgeries getting harder as the week goes on. Almost all of our cases were on females this year. We have very few males. It’s hard to tell why. All patients were prescreened by the local docs in the 2-3 weeks prior to our arrival. So everyone had lab, with coagulation studies, X-rays, EKGs and sonography where indicated. They had apparently rejected or turned away the high risk patients and also only sent major cases. We had very few minor surgeries. Very few patients were on medications or had medical co-morbidities.

We stretched the hospitals capacity with all our major surgeries and his majors and then 4 deliveries thru the day. So it was hard to keep moving until somebody left. The hospital only has two patient rooms with 6 beds each, a peds room with 2 cribs and 4 labor beds. Today I did 3 open gallbladder surgeries, 3 umbilical hernias, and 3 inguinal hernia surgeries. At times the OR would get hot (mid 80's) and we were exhausted but the time we finished at 6 pm. We did get a full meal at lunch delivered from the restaurant in a Styrofoam container with corn tortillas. I usually just ate the tortillas.

Since we were sponsored by local municipalities instead of churches, the spiritual focus was different. We still prayed over each patient in Preop area, but there wasn't a gospel presentation in the waiting room. The town has very few churches and that may be due to the influence of the native Mexicans culture as opposed to the Catholic Churches influences. The town was 23000 when surveyed 10 years ago but had grown in population since then. Most all streets are paved, but there are no stop signs or lights. The town sits down in a valley with beautiful mountains all around. The Mexicans are offended by being called third world but their sewer system is the same as the DR and the smell of burning trash is very familiar.

By the time we got to dinner we were all pretty tired. Eating late is hard but the walk home helps some. I was able to sleep well thru the night and awoke at 5 am for the start of the last day of the project.



Friday

Each morning I have awakened at 5 to 5:30 and gotten up to shower and get ready for the day. I have found a chair and table next to a window overlooking the street. It is all open air, so sunrise comes thru the window with a light fog and nice temperatures in the 60s. I have had time each morning for my devotional times and journal. I don't have to make extra time for exercise here since we walk to breakfast and to the hospital, which is nice.

One of our Mexican staff and tow of the participants were sick thru the night. One got IV fluids and meds and is going to stay at the hotel today. With such a small group, they will be missed. The hospital was very busy again today. We had scheduled 14 patients with mostly minor procedures and two umbilical hernia surgeries. All of our major cases had gone home today. The hospital only has 2 patient rooms, one for men and one for women with 6 in a room and a pediatric room with 2 cribs. On the other end of the hospital was the ER with 2 beds, and OB with 3 labor beds, the delivery suite and the OR. While we were there we put 2 OR beds in the OR and used the post op area for our supply room. Then we used the labor beds for Preop and occasional post op overflow.

Even thou we stressed the capacity of the hospital; we had much more cooperation and interaction with the local doctors, nursed and hospital staff. Our sponsorship was the local governmental agencies rather that a church as it is in the DR. They have provided our meals, transportation and housing. The Mexican MMI support staff has been Daniel, his 18 year old daughter, his 14 year old son, and Fernando who was a young man who translated for us and Sergio a Mexican physician from the north of Mexico. The rest of the help was from the local area.

We finished the OR schedule around 1:30 then we had our lunch (provided by the restaurant) and then packed up the supplies. We had a small ceremony by the local hospital director with photos and a gift of locally grown coffee for each of us. After going back to the hotel and checking out, we didn't leave Jaltenago until 4:30 in our caravan of vans and pickups. The 60 mile trip back to Tuxtla took 4 and a half hour!! The roads were largely impassable with wash outs, potholes and one lane segments. We made it to the Hotel Del Carmen in downtown Tuxtla Guterriez around 9 pm. For our three sick ones not much better, it was nice to have a clean, nice and cool room to sleep in.



Saturday

Very restful sleep last night. We awaken and went down to the hotel restaurant for breakfast. The group left at 9 am for the waterfall and shopping at San Christobal de Casa today. I chose to stay back for a day of relaxation and rest. The group returns at 4:30 and we were off to dinner in the evening. They had a good trip up a river into a canyon to see a 700 meter waterfall. They saw lots of animals, crocodiles, vultures and pelicans. They also had a time of tourist shopping. The dinner was to a traditional Mexican fare and was nice. After dinner we went back to the hotel and had a time of sharing and prayer.

The review of the trip showed that we did 59 consults. I did 38 surgeries of a total of 52 cases. The local hospital usually does around 5 surgeries a month. Another of our group got sick over the night but not too bad.



Sunday

We were up at 4:30 to be ready to leave at 5:45 to get to the airport (a 45 minute drive out of town). We got to the airport before it opened to check in. So that allowed us to sit in the airport until our 7:55 departure back to home.



It was a good trip to new places with old and new friends to help others in need and share the love of Jesus with all. The Apostle Paul reminds me in Philippians 4:11-12 that we must learn to be content. This trip helped me to re-focus on the joy that comes in spite of our conditions or circumstances.

Journal for Monte Plata 2013

 

This year’s journaling was a little different. I didn’t sit down and write a daily travel log but issues came up and I reflected on those issues and wrote about them later. I don’t want my journals to become mechanical or rigid but just a way for me to process my thoughts for my benefit and also for others who stumble across them.

 

Stats

 

They always say don’t look at the numbers but everyone asks and it is how the organization maintains accountability with its donors and board. MMI has stopped asking for numbers of people who profess faith for the first time during a project. They say it’s because it’s impossible to truly measure things like deeper understanding, new insights and changed lives which are equally important. Having said that it is still one measurement that most Christians can understand therefore we keep these stats, knowing that only God knows the heart. I am also bothered somewhat by the admonition that the Kings of Old Testament were discouraged from counting their troops and horses. Having said that, here goes:

 

• Health Education 1322
• Clinic Patients
• Adult 518
• Kids 526
• Eye Exams 209
• Glasses 86
• Fluoride Treatment 522
• Prescriptions 2771
• Parasite treatment 1001
•   
• Surgery Patients
• Adult consults 141
• Kids 23
• Major Cases 94
• Minor Cases 29
• Decisions 16

 

 

Tuesday’s Frustration

 

The first Tuesday was a frustrating day from a standpoint of not being adapted to the Dominican way of life. We were all still on our American schedule. The first interruption was one of the local Dominican OB/GYN docs who announced that he had an emergency C Section to do. We had already begun the schedule and a hysterectomy was in progress. He then announced that he had a D&C to add on also. Then another OB shows up and he wants to do a C Section also. The OB docs only come to town on Tuesday, so naturally the emergencies only happen on Tuesday and we happen to have supplies and anesthesia that they don’t normally have access to. We had already put a patient on the schedule for a gall bladder surgery that needed a conization of the cervix by a third OB/GYN surgeon. So now all of a sudden we had 4 OB docs on the schedule in one morning, in addition to our scheduled surgeries (no I didn’t budget time for those emergencies). It was suggested that we might be able to use a different room for our OR, so I went to look and began to feel nauseated at the thought of moving all our equipment and supplies to a different room in the hospital. Most of our staff was oblivious to the dilemma and were just dealing with the constantly changing schedule.

 

Downstairs in the surgery clinic, I was given one room initially and then they changed their mind and I had to move to another room. One was “air conditioned “, the other was not. They use some window units that are loud and either doesn’t work or are too cold. I saw 40 patients and our OB doc saw 16 patients. It was strange in that I had 3 “emergency consults. One was in the ER with a 3 year old that had put a bean up his nose. (No, I don’t know why). It was wedged in so tight that I scheduled him for the OR to put him to sleep to be able to remove it. The second was a palm oil worked that had a foreign body in his arm from a falling palm tree. He was scheduled for surgery the next day. The third emergency was a call from the ER to see a patient with possible appendicitis. Of course, it was at 5:20pm right after the OR had shut down for the day, just like at home. It turned out not to be an appendicitis case, but made for more stress.

 

Half of the OB doc’s were very impatient, (not our OB). Especially, since they only work a half day in Monte Plata on Tuesday. So they said that they didn’t need our help for the D&C, but they changed their mind and wanted us to do it. They said they didn’t need our help on the C Section, but then the Dominican anesthesia that showed up couldn’t do a spinal. So we helped. Then Francesca the Dominican head nurse was not happy. As it turns out her dad was dying of a terminal condition. So one of our nurses had to help with the C Section and had to close the fascia and skin, which was not in her comfort zone. Praise God, we got two beautiful healthy babies.

 

The autoclave stopped working mid day, which is a big deal but was fixed by flipping a reset switch. Almost was a disaster in and of itself. We ended the day with a short program by one of our own to teach us some conversational Spanish. All in all, it was a good day getting us into a Dominican routine.

 

 

 

Thursday, another Day of Frustration

 

Communication continues to be a major problem with me. The schedule was heaviest yet today. We have all but filled the schedule for the rest of the project. Today someone showed up for surgery and I had forgotten to add his name to the surgery schedule. We have had very few no show or cancellations this year. Fortunately for us, the patient forgotten by me had high blood pressure and was cancelled to be rescheduled for later. We had an emergency gyn case today at the end of the day. Generally, all cases are scheduled thru me but Alex went to the gyn surgeon directly because he said he couldn’t find me. Bill found me easily and asked about the case, which I knew nothing about. Even though we have translators with us at all times, there is a difference when two people talking don’t have the same primary language or culture, more importantly.

 

I have been blessed with two different translators this year. One is a 17 year old boy who speaks Spanish as his first language but English very well. He also speaks French and Creole. This is his second MMI project to help as a translator. I have also had a 22 year girl with good English skills. As I now know being a translator involves so much more that converting words from one language to another. This is especially true when one not only has to know the conversational issues but also medical issues and implications. There are many times when what seems to be a straight forward question from me is translated by a lengthy sentence from my translator with a response from the patient and then response from the translator and response from the patient. When I asked the translator what they said, they respond, “she said no!” There are so many cultural differences that can’t be translated or understood by me or them. Having said that, they both did a great job, but they are both very young and were still kids thrown into a very serious arena at times with no background to help them.

 

We have to be so careful here in another culture as guests of a very conservative church organization here in Monte Plata. For instance, in the US wearing scrubs is a common occurrence, even traveling I saw a young man in the airport in blue scrubs. In the DR, scrubs are looked upon as clothing to be used in the hospital only in surgery. There is the perception that wearing the scrubs outside the OR is a compromise in care. While this is probably not true, none the less we respect that. I tell the participants in orientation to avoid wearing scrubs in town for that reason. Today, the clinic finished early and the bus let them off at the hospital so they could see where we work and what we do. I’m sure that they didn’t even think about it. Then they walked home in scrubs. I didn’t respond as at that point there was nothing to do. But it set me on edge.

 

I had called William to tell him that our schedule was full, but still we had patients showing up today from the clinic being referred to us for surgery but the schedule is already full. I hate to turn people down, but I have the responsibility for the big picture on the project. All these things were stressful and bothersome, and they changed my countenance. I tried to hid it but I guess I didn’t do a very good job. I decided to not say anything to anyone until I had journaled the thoughts. During the time I was writing down these thoughts, I was convicted of the thoughts that I had of miscommunication and mistranslations by these 17 year old translators that I remembered the prideful feelings I have had about coming to the DR for 17 years. I was struck with the thought “why am I not fluent enough to speak for myself after all these years?” I need to be learn Spanish for myself, seriously!!

 

Sabbath Rest

 

After working hard for 6 days, I decided to stay at the camp instead of going to the beach with the group. We had worked a full day on the Sunday we arrived in addition to Monday thru Friday. The thought of resting on the 7th day did take on a heavenly aspect. My mind wandered to the book of Leviticus and my devotional readings on the Sabbath rest and year of Jubilee. While we certainly live in a global society today, all are not universally affected by the economy. I wonder how the concept of the year of Jubilee would affect our economy now and how were they able to adjust to something that significant over the years. I guess the biggest difference it that in those days all were on the same page within the people of Israel. We can’t seem to agree on anything today.

 

For the team it was more of a day of vacation (kind of). Five of our group left the camp to go home this morning at 4 am. I saw them off and thanked them. I was able to go back to sleep and get up at 6:30 with the group going to the beach for breakfast then departing at 7:30 for the north coast town of Samana for a day of fun. Five of us stayed back at the camp for naps, reading and a relaxing walk thru town. About 7 pm the group returned from the coast. The trip is 2 hours by school bus both ways. Still it was enjoyable for all who went. My preference was the relaxing day in camp.

 

Politics

 

There were more political issues this year than most. I spent a fair amount of time meeting and taking with people. I doubt that the participants were aware of what goes on behind the scenes and I think it best that way. At this point, I don’t know where we will be doing surgery next year. The current hospital is a secondary level facility or Sub Centro Salud. The building is in terrible shape even though they have done repairs and painting every year. The plumping and electrical systems have significant problems. The government just recently completed in April a brand new hospital in Monte Plata and had the ribbon cutting with the outgoing president there to take all the credit. It was a big deal in their media. It is on several acres and has several buildings and landscaping. After the “grand opening,” the trucks arrived and loaded all the beds, and equipment and supplies and took them off to another new hospital that was opening in another part of the country for their “grand opening”. So now the band new hospital in Monte Plata sits empty. It is supposed to be a provincial referral hospital when it is open and working and provide care for the entire province. They say it may open in maybe 2-3 months. I’m not sure how our team would fit in or work in those surroundings.

 

We had gone in my first few years to a small hospital in Bayaguana, which is about 21 km from Monte Plata. We stayed at the same camp but drove to the hospital each day. The area is even more impoverished that Monte Plata. We stopped going there when a new hospital director indicated that he wanted something personal for his permission to come to the hospital. We obviously refused and started coming to the hospital in Monte Plata. We have been told that the new hospital in Monte Plata with be run by that same director from Bayaguana. All jobs in the hospital including director, nurses and doctors are government jobs. If in fact, he does become the new director, then we undoubtedly will not be going there, and may need to find a new place to operate since the current old hospital is supposed to close. The clinics would be largely unchanged and we would probably also stay in the same camp. The location for our surgery would have to change.

 

It stretches me to have so many unknowns to deal with. We have not even finished this project and issues about next year are already arising. It does cause my faith to grow as I am constantly reminded that I am not in charge and this is not about me.

 

Surgery

 

This year I only did three or four surgeries and assisted on 3 or 4 others in the whole two weeks. As I get older, I don’t feel the need to do the surgery like I used to feel. There is no question that in the past my self worth and value was certainly tied to being a physician and more precisely as a surgeon. I am learning to see that I am more than just a surgeon, but it has taken years. One of the surgeries I did was on a friend who is a doctor in the country that I had met years ago. One hour after his hernia repair he walked down the stairs of the hospital and got in his car and drove back to Santo Domingo. Things are just different here. We also excised a ganglion cyst off of the wrist of one of the helpers with MMI. That same day with his wrist bandaged he helped load the truck as we broke down the surgery. It’s his only job but his only chance to get it fixed. I also aspirated one of the Dominicans knee for effusion but he had to drive a truck 200 miles the next day. Here you just do what you have too.

 

Life and Death

 

Our trip was confronted with life and death contrasts this year. We had 3 C Sections added to our schedule as emergencies. It was very disruptive as we are crammed into a very small space, you know we North Americans like to have our space. Personal space as I have learned in a privilege not a right in a third world country. The communication issues always abound. One of the emergency C. sections was on a 13 year old girl who was 41 weeks pregnant. She had come to the hospital on late Friday night and no one was here to deliver her so she was sent to the capital. (That means she had to get to the capital any way she could.) At the charity hospital, they checked her and said go home to Monte Plata because there will be an OB there on Tuesday. So home she goes and shows up Tuesday. Even though she is not in active labor, since the OB leaves at noon, it is now an emergency. Mom (child) and baby are fine.

 

On the other hand, a patient died and was brought to the hospital. A big crowd arrived to see the body in the morgue which was out back of the hospital in a small out building next to the laundry. When the casket arrived and he was placed in the casket all were there to watch. No one seemed surprised when one of the handles on the casket broke and the men had to just lift the casket with their hands. Francesca our favorite nurse was there again for the first few days but not thereafter. When I asked about her, I was told that her father was in a coma and he later died. He had been ill for some time. Our response was to take up a collection and give it to their church in his memory. We tried to find a sympathy card, but they don’t sell those in Monte Plata. It is far from a necessity. We responded in our culture but I don’t know how it was received. Things common in one culture are not necessarily common to others.

 

The other unexpected death occurred when one of our cooks was informed that her brother had been shot at his business and was killed. She was quite upset as she had lost her mother 20 days ago and also a sister recently. She continued to work at the project as her work is important to her family and transportation is difficult in the DR for most people. We also gave her a gift of money to help with funeral costs. We also prayed with her and for her.

 

Our group of 38 has bonded well and all responded in like mind to the joys and sadness of the project. Many who have gone on trips before commented that the group and project as being one of the best in spirit and action with all working well as a team. It is certainly true that we come to be a servant to the Dominicans but we all receive much in return.

 

Travel Times

 

Once again we had travel problems getting to the DR. The flight out of Wichita with the majority of the participants was delayed then delayed then delayed then canceled even before we checked in at the desk. Also an unrelated United flight at the same time to Chicago was cancelled and that complicated rebooking as very few flights have the capacity to add 100 to 150 extra passengers much less the 40 tubs of supplies that we brought with us. People were scrambling on line, by phone, and in person at the desk. Only 4 participants were not able to get out on Saturday to Santo Domingo. The remaining ones got there Sunday afternoon and evening. All flew American Airlines except 2 who went on Delta and they had one of their flights cancelled but made it there on Saturday anyway. It was pretty much a miracle to get all the team there within 24 hours of the original time. Also, it is much better to have mechanical problems with a plane on the ground. Getting parts at 35,000 feet is a real problem.

 

The process in reverse going home was less eventful although still complex. The first Saturday 5 left the camp at 4 am. Sunday 2 more left at 4 am. Then the next Saturday 28 of us left at 4 am and the last 2 left at noon. All flights went as scheduled all returned home safely to a warm home, good food and family, not to mention a working toilet.

 

Wrap Up

 

All in all, it was another successful project. This seems to be an optimal mix of participants in number (38) and with a great mix of skills in the group. Many blessings were received by patients and participants alike and all was for the Glory of God.

 

 

Case Log for 2013

Monte Plata Case Log 2013

General Surgery

Inguinal Hernia                                          27

Hydrocoel                                                  6

Circumcision                                               3

Excision of ganglion                                     6

Cholecystectomy                                         3

Epigastric hernia                                          2

Excision of axillary mass                              1

Umbilical hernia                                          10

Gynecology

Hysterectomy                                            8

Tubal ligation                                             17

Anterior colporraphy                                 0

Posterior colporraphy                                1

Cervical conization                                     1

C. Section                                                 3

Excision of vag cyst                                   1

Excision of bartholin cyst                           2

D&C                                                        1

Excision of Ovarian Cyst                           1





Major Surgery 94

Minor Surgery 29