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
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- 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.
