Monday January 26, 2015 am
Today was the
orientation and set up day. We all eased
into the DR life. Each of yesterday’s
flights were smooth and we all were together as a group. We left at 7:45 in the morning and had a 2
hour layover in DFW and another 2 hour layover in Miami and then we arrived
almost 30 minutes early in Santo Domingo.
All our bags and luggage made it unscathed. Then Alex and Compadre were 30 minutes late
and the bus to take up to the camp was another hour before we could load and
leave the airport.
We arrived in Monte Plata only to find the back gate to the property to be locked so the bus and our bags couldn’t get in to unload. After another 45 minutes of unsuccessful attempts to find the key and get the rusted lock opened (WD 40, hammers and hacksaw), we finally went around the to the front of the property. So, in spite of all the smooth travel we still didn’t get to bed till almost 1 am (Dominican time which is 11 Wichita time).
I
slept fairly well with the heat, fan noise and rooster because of
earplugs. I finally arose at 6:30 for an
8 am breakfast. After breakfast, I
shared a short devotion on losing sight of Jesus from Luke 2:31-42. Then we had orientation, then unpacked and
organized the tubs filled with medical and surgical supplies.
Even
thought we had been to this hospital only one year ago all was different. We have a new Director of Surgery and Quality
at the hospital who is one month out of residency. New rooms to use and a new work flow with new
participants. After almost an hour and a
half of negotiating the plan was in place to begin the set. When the team had completely set the OR up,
we were informed that the room we were using had a problem with the air
conditioner and we would have to move clean and start the set up all over. The team was a little frustrated but had been
warned to stay flexible. Around 2:45 PM,
the gynecologist and I went down to the lobby to find our rooms that we could
use to do consults. We found our rooms
and also over 50 patient waiting to be seen.
We saw all who would wait and ended up seeing 35 patients and set up
their OR times. The docs were the last
to arrive at comp for dinner, and most had finished before we got there which
is unusual to not eat together.
I
think I’m overwhelmed more by those we turn away than those we schedule. Those who come out of hope only to be
disappointed. Still no outward visible
signs of their frustration. I saw a
mother of a 3 year old girl who couldn’t walk or straighten her arm came to see
me so I could make her baby normal. What
was obvious to me to be a birth injury, could not be undone. The young man who had most of his front teeth
broken off at the gum line in an accident a month ago hoped I could fix it with
a surgery. Then were those who had
surgical problems but that were beyond our scope.
I/we
in the United States have no justification or reason to complain about anything
as the people here wait for hours in rain and heat and power outages not for
concrete solutions for their problems but for only a hope that something can be
done to help them or their family and this is by far not the worst place to be
in the world.
Tuesday January 27,
2015 AM
The
first Monday was not too bad. I is
Duarte Day here which is like Presidents Day for us. So the crowds are smaller and activity is
lessened. School is out so we used that
reason to have our clinic at the camp school grounds). There were a few changes to the property this
year. The front fence was changed to a
cinder block wall. A new building for
more class rooms is under construction in the back of the property. (No, they still haven’t gotten the back gate
opened.)
The
hospital hasn’t changed much but a leak they had last year is still leaking
this year. I fear this beautiful
building will suffer the same fate as others in the area with a lack of
infrastructure upkeep.
We
were able to start the first case by 9:15 which is great. I was assuming 10:30 or 11am. So we didn’t have too much to do with one
cancelled case due to increased blood sugar.
I was able to add 4 more minor procedures out of the clinic so surgery
was completed by 3 and clean up put everyone back to camp by 4. We did 5 majors and 6 minors the first day
and the clinic saw almost 100 patients.
With a smaller team we had that was great. No major personnel or logistics problems
today. We have had Alfred and Reyes
working in CS to help with instruments.
I didn’t know of that resource. I
have often worried about people and jobs but this year is showing me that MMI
can backfill almost any role with staff but in the past they have just faded
back and allowed us to do what we want.
The
usual paperwork for me in the evening and cards and ice cream for the staff.
Wednesday morning January
28, 2015
Yesterday
we got into more of a routine. Surgery
seemed to work well with very few disruptions.
The hospital lobby commons area was very crowded and loud. With the tile floors, it can become
deafening. Edu L did health education
and evangelism in that crowded area to over 350 people with 29 making faith
commitments. So different that in the
US- wouldn’t be able to teach or preach in the waiting room of a government
building. The 350 were far more that
came to see us. They were there for lab
x-rays and consults as well as well baby checks provided in the hospital by
Dominicans. Our
patient were grateful, compliant and loving.
Anxious to thank us and show their appreciation. We did 11 major cases and saw 39 consults
today and all were tired by the time we finished.
The
clinic went to El Dion. It is a familiar
stop for us. It was still hot and
dusty. Even though we are smaller this
year in numbers of participants, the clinic worked well together and was very
productive seeing and treating over 100 patients.
Our
evening program was by a young Dominican that we have worked with in years past
who was back in Country after a year in Guatemala Bible College. It was good to hear his testimony of what God
has been doing in his life.
I
slept better last night and awoke to rain.
Some asks who no thunder and I realized that I hadn’t heard any
before. I don’t’ think I’ve seen
lightening either?
I
had a chance to meet and visit with the Hospital Director, Dr. Cruz. He as here last year and we had visited thru
the year. He proudly showed me the
changes and progress of the Hospital since last year. He was pleased that we had come back this
year.
Thursday morning
January 29, 2015
It
sure helps to sleep well. But it takes
3-4 days to get into a routine pattern of both sleep and activity and both
benefit then. The sounds and the temperature
seem to make a difference
I was tired by the end of the day yesterday. We saw 49 patients in the clinic but still have more slots left for the next week. 10 were OB/GYN and I saw 4-5 of those. We still have the problem of seeing patients that don’t need surgery or that need things we cannot do. That is in spite of telling then in announcements what we can see and do and what we can’t. I guess the benefit is in the time that they wait to see me (sometinmes6-8 hours), they hear health education and gospel messages from Edu. She is a ball of fired with a booming voice that can be heard over the masses. She has given health ed to over 350 people each of the days in the large open lobby.
I was tired by the end of the day yesterday. We saw 49 patients in the clinic but still have more slots left for the next week. 10 were OB/GYN and I saw 4-5 of those. We still have the problem of seeing patients that don’t need surgery or that need things we cannot do. That is in spite of telling then in announcements what we can see and do and what we can’t. I guess the benefit is in the time that they wait to see me (sometinmes6-8 hours), they hear health education and gospel messages from Edu. She is a ball of fired with a booming voice that can be heard over the masses. She has given health ed to over 350 people each of the days in the large open lobby.
The
director of Surgery, Dr Guzman ask me to assist her with an open gallbladder
surgery in the middle of clinic today and of course I did. The OR culture is different but similar. The actual operation technique was the same
and she did a good job. They don’t use
trained OR technicians or nurses, so there were 4 docs scrubbed in and one
passed the instruments. The organization
was lacking by US standards. But they
function in their environment. Minimal
if any disposable supplies are used and the gallbladder surgery was done under
a spinal anesthetic. Interestingly, we
did begin our procedure by holding our scrubbed hands and praying.
The
clinic team has bonded and gelled well.
It may be the size or maybe
just the individuals. Unfortunately we
will have to cancel the clinic for next week since our Doc and their docs must
leave at 1 week. We have not had to do
that before. The remaining 3 North
Americans will move to the hospital.
While all are repeaters, none have been in the hospital before.
In
the evening, we heard from a lady (girl) who is a missionary with Kids Alive,
International, and here in the camp. She
told her story and that of the kids at risk here in Monte Plata, It was very
moving. After the program, I finished
the paperwork. It seems to increase
yearly with more forms for their government and for MMI. (I see where this is going!!)
Friday morning, January
30, 2015
Another
good night’s sleep. We welcomed a new
participant last night who joins us from Wichita for the rest of the
project. The other big activity last
night was that one of the 3 bathroom doors became locked and they there is no
key. So, 6-7 people were able to outsmart the door ultimately, with brute force
after wisdom, knowledge and the application of advanced tools had failed. We now don’t have to worry about anyone
getting locked in the bathroom again.
Yesterday,
at the hospital I was able to finish the schedule out for the next week as they
continued to work upstairs in the OR. We
removed a portacath that had been placed in Italy. The patient was only 50 but had aged much by
the trials and treatment of ovarian cancer.
She had been brought home to the DR by daughters after nothing further
could be done. With much difficulty the
daughters had brought her in to see if her port could be “washed” as they had
been told it needed to be done every 21 days.
What had been meant was that it needed to be flushed to deep it
functional. I explained that since it
was no longer being used, it was not necessary to keep patent and she explained
that it hurt her all the time. So as a
palliative measure we agreed to remove it.
It was late Wednesday when she was brought in by wheelchair and it was
very difficult to mover her due to the severe edema and her debility. I asked Dr. Guzman if she would admit her,
then Thursday morning we brought her to the OR and under local anesthesia we
removed the Port. The family then later
transported her home but not before our team had a chance to pray over her and
provide counsel her and the family.
Toward
the end of the day the clinic saw a patient that was severely septic. They were able to begin treatment but she
need to be hospitalized but couldn’t arrange transportation. So the yellow school bus became the ambulance
traversing the one hour trip down a one lane road in 30 minutes to get the
patient to our hospital on their way back to camp.
Our
evening meal was a traditional beans and rice meal and was good as usual. Then the group loaded on the bus again and
traveled to the orphanage sponsored by our host church to see their facilities
and meet some of the children.
All
in all a very full day.
Saturday morning
It’s
nice to have a break and a slow day to recover.
All of the team is on the way to Samana to the beach for the
afternoon. 3 are leaving to go back to
the States and stayed back to go the airport at 11 am.
Yesterday
was very long in surgery. We had 14
major cases which a lot since at least 3 of the cases were 2 hours each. A new participant arrive Thursday night and
is added to our team, one of the OB/GYN’s went down to do clinic and I stayed
in the OR to operate. I think the other
surgeon was relieved to have some help.
We did a bunch of varied cases from frenulectomies, to circumcisions to
hernias, breast and gall bladder surgeries and closed the day out with minor
procedures (lipoma and ganglions). The
gyn team did 3 hysterectomies and a tubal and posterior repair.
The
clinic went to KM 12 and worked out of 2 rooms at the school. They had a cramped but busy day. Even though the team was small in numbers
they worked together well and very efficiently.
Same is true for the whole project.
Small but productive. Preliminary
data show 119 new believers have accepted Christ in the first week alone. Quite a few more than in past.
I
had been frustrated by the increased numbers of consults for people who didn’t
need surgery. I saw that as inefficiency
of my time and the team. It was
partially a change in the Dominican staff this year who had not done screening
and crowd control here before but she is a much more gifted evangelist so those
patients that didn’t need surgery heard health, education an gospel messages during
their wait just like those who did need an operation. With the increase in decision of faith it is
likely that some of those are ones who heard the truth.
I
took a leisurely walk to the hospital this morning with a translator and clinic
doc. All our patients were doing well
who need to stay overnight. All were
ready to go home so all were able to be discharged. We were able to find the patient that the
clinic transported and were able to see her and her family. We were encouraged to see her progress and we
saw Edu slip the lady some money to help with her care and food, trying to hide
it from us. It is not hard to love these
people who have little but willingly share with those less fortunate than
they.
Walking
home to the camp made me see thru different eyes something that had bothered
me. The new Hospital is beautiful and
fenced with manicured ground but the “street’’ around it is not paved. This to me as an American seems crazy. I kept thinking each day as we hurried to the
hospital in our van, how could you have a beautiful hospital and terrible
roads? Then, as I walked back I noticed
that the pot holes are not a concern if you are walking or riding a motorbike,
its only if you are traveling thru life at a rapid speed in a car, that the
potholes are a bother, but as you slow down they become less and less a bother
which gives one time to enjoy the pace of the surroundings and the people. Really the time slows and yet becomes
fuller.
Sunday morning
Well
it is still raining and has been for almost 24 hours straight. It is not like Kansas rain because there is
no lightening thunder or wind. Just
gentle rains. The group went the beach
yesterday and it is a 3 and half hour drive both ways. They did have some sun there but also some
rain.
While
we have plenty of water coming out of the sky, the cistern ran dry late in the
afternoon so we have not running water in the bathrooms. The group was not pleased about not being
able to shower after a day at the beach or to not be able to flush the toilets. The things we take for granted. Sometime today the water truck will arrive to
refill the cistern and we are back to our routine unlike millions of people
around the world with no access to clean water…ever.
Yesterday
went by fast even though there was no agenda or schedule other than to make out
the schedule for Monday’s surgeries. We
are supposed to go to church this am but don’t have a bus since one went to SDQ
with yesterday’s returning people and the other with this morning’s returners.
And the second
week begins with new opportunities and challenges.
Monday morning,
February 1, 2015
Not
many early risers in this group. I’m
pretty much the first to the coffee pot each morning. Most file in a few minutes before the bell
rings at 6:30. I usually awake before
the alarm that is set for 5:25. An early
shower and shave then coffee and journaling.
Our cooks are usually up by 4 am to begin breakfast and also prepare our
lunches.
Yesterday
we sent home 2 at 6:30 am and 2 at 11:00 from camp with best wished. I felt bad that temperatures were in teens
back home. It rained on and off most of
the day but did break long enough to go to church. There we heard a great message translated for
us by a cousin of Alex’s. It synced with
the mornings devotions.
Did
get to walk into town for an ice cream and sightseeing. Most if not all of the stores are closed on
Sunday like they used to be in the old days back home. We had a good meal with
Tacos for dinner. They try to give us at
least one or two Americanized meals while we are here. Then the big event in the evening was the
Super Bowl Part. We popped popcorn on
the open stove and had sodas. Actually
on 2 people stayed up till the end since we were 2 hours different that Wichita,
and it was in Spanish with no American commercials only ones for the Spanish
channel.
The
rest and Sabbath is necessary and beneficial to recharge and start again. Some of the group are a little anxious about
new jobs with us closing the clinic and having to move them to the
hospital. We still have 2 full and busy
days and a half day Wed with surgeries and then to pack up all the
supplies. Even though it is a short week
it will be busy.
Tuesday morning,
February 2, 2015
Oh my, what a busy day. Our schedule was very full and we didn’t get
back for dinner till around 7:30. I hate
doing that because it gives no time to recharge.
We
had 19 cases on the schedule and 3 patients cancelled. On because his blood sugars was too high
(275). This was after cancelling him
last week and sending him back to his do.
One was because his BP was still too high, he also had been back to his
doc. BP’s in the 220/160 range here her
not unusual in asymptomatic patients here.
The third was cancelled because she couldn’t get off work to come to
have surgery.
Two
other cases slow us down. One was a 1
and a half year old with a hernia. WE
were able to breathe him down but couldn’t get an IV. It took almost 30 minutes with multiple
sticks and multiple people trying. We
couldn’t start the second table since both CRNA’s were working on the baby. A second patient later in the day dropped her
pressure and pulse during the latter half of a case and caused a code like
status. Very unusual and distressing for
all involved but fortunately had a good outcome. Even though I try to set the
schedule, it is still largely “on the fly” because of who shows up and
when. We tell them when to be here but
that doesn’t always happen as we plan.
I
was able to spend the whole day in the OR since we had filled the schedule and
they were minimal administrative duties today.
The new members of the team functioned well although there was some down
time for them that was boring. I did a
circumcision, 2 umbilical hernias, an inguinal hernia, hydrocele, gall bladder
and removed lipomas on 3 patients. A
pretty busy day. Looks like Tuesday will
hold much of the same.
Wednesday morning
In
some ways the project has gone fast and some ways it has been slow. In any event, today is the last day to work
here in Monte Plata for the year.
Our
schedule was very heavy for yesterday but as usual we had several no shows and
cancellations. They seem to be more of
those as the week progresses. Sometimes
it’s because they are people we try to do but wait till late in the project
because earlier their BP or sugar is too high.
Sometimes it think the longer you wait the more nervous you get. But still we stayed busy.
We
had to take a boy back to OR today for post op circumcision bleeding. The boy was very bright and spoke English
well at the age of 10 in addition to his native Spanish. We had taken care of his father and brother
last year. There were several no shows for
gyn surgery but was also 2 this year that preop pregnancy test were positive to
their surprise. No clinic was done but
4-5 patients returned for wound checks or follow up visits after x-rays or labs
were done at our request.
Overall
the level of health care available here has improved over the years. And we hope our efforts at health education
in having an impact. Hypertension still
seems to me to be the most urgent needs with there being little or no symptoms
early on. Our whole group has been remarkably
free of sickness this year. A big
blessing for sure. Also, not many mosquitoes
either.
We
were able to get back to camp by 5 pm after the two prior days till 7 pm. Everyone appreciated that. A highlight for me was hearing from Pastor
Prenza. He came after dinner to speak to
the group about God’s work thru him here in Monte Plata with kids and
orphans. He has had an incredible impact
in this small community over the past years.
I need to keep him in my prayers year round not just while I’m here. There is such an openness to things of faith
yet such a need. The hospital lets us
pray and share openly and also they ask women from Pastor Prenza’s church to
come on Tuesday to the hospital for visitation and prayer for all the
patients. They can distribute their
tracts openly. They publish their own tracts in Santo Domingo.
Wednesday night
Tomorrow
with be crazy. Today was to be a full
day of surgery with 16 cases, mostly minor in nature but we had 6 no
shows/cancellations. That would normally
mean a very short day bur we were told that we were to “all” come to the large
lobby for a presentation. So Dominicans
came in to preop and post op so all 18 of us could go down. I was asked to sit at the dais that was set
up with 6 other official people including doctors, administrators with the
mayor and governor. It turned into an
hour long time of speeches from all the officials with the usual applause. Each of us received an official medal with
our name on it along with the thanks of the community to commemorate our time
and service. Also it was the first anniversary
of the opening of the hospital. Then we
went back upstairs to finish the schedule for eh project by 3 pm.
While
this was one of the smoothest projects we have been part of, we did have 4 or 5
difficult patient problems. From post op
bleeding to intra operative bradycardia and short time of chest compressions,
to a patient with a seizure and transport to ER. Then there was the patient with a hydrocele
that stayed overnight due to decrease hemoglobin and swelling post
operatively. Those things are bothersome
and remind us that we are not home and our backup is not the same here. Even though we still maintained a much better
and expanded relationship with the local medical doctors and staff, it still
makes you uncomfortable.
At
4 pm we all went by bus to a restaurant in the country with lots of flowers and
palms for a dinner sponsored by eh hospital doctors and politicians that had
been at the presentation. It was very
apparent that the work we did was appreciated.
A great Dominican meal was served and everyone enjoyed themselves. Then back to camp and time of debriefing and
sharing. It appears all were pleased
with the project. Early to bed and early
to rise to eat, pack and travel to the city.
Friday Morning February
6, 2015
Sunrise
on the ocean is always beautiful!!
Yesterday went without problems.
I gave the devotional yesterday and moved out of my comfort zone. We have talked for eh last two weeks of how
great is is to see 159 decisions of faith from the Dominicans we have come to
serve and how that must be pleasing to God.
But that is in Spanish to those that we don’t know. Thursday I detailed what had been presented to
our Dominican friends and offered the same to our team. As we don’t require a decision of faith from
the Dominicans to receive health care, we also don’t require our team members
to make public decision only that they are openness to the Gospel. So I offered the gospel to the team, I did my
part….
The
pack up was quick after breakfast and we were able to watch the children line
up for school then pray and sing their national anthem. Then they filed into their classes before we
left. It looked like 165 kids from
anywhere in the US laughing, pushing and being corroded by their teachers Just kids from anywhere, yet in the midst of
poverty almost unheard of in the US.
It
doesn’t take too long from Monte Plata to the Colonial Zone with the tow road
(it is 2-4 years old). We had time to
shop and barter a little (I’m not so good at that). Then to a restaurant across from the oldest Cathedral
in the western hemisphere for lunch with good friends from the DR. It was good to see them and catch up from
last year. Then off to the resort to
check in and take a nap.
Each
year, but more so recently, I struggle with whether to return next year. It seems as if it becomes more difficult to
get here but yet it gets nicer when do get here. What I mean is the preparation becomes more
complex with recruitment and procuring eh supplies and meds for the
project. Plus, the organization MMI is
undergoing administrative changes.
Nobody really likes change, it makes them feel uncomfortable. The
new hospital in Monte Plata is very nice and our interactions with local docs
have improved. It seems like our mission
had changes from the early years of providing care in very primitive settings. They now are talking about obtaining
laparoscopic equipment to do laparoscopic procedures. The cam is familiar and comfortable. The company is familiar and comfortable. The food is familiar and comfortable. So it hardly feels “like a mission trip”. It is almost as if I have to “suffer” in
order to feel comfortable about coming.
Maybe the two weeks in the past of roughing it somehow makes the 50
weeks of luxury we live in easier to live with after seeing how people around
the world live.
But
then, I hear how the surgeries we do changes people’s lives by Pastor
Prenza. I hear how grateful the people
of Monte Plata are from the mayor and governor.
How happy the Medical Director is at the hospital and how they look
forward to our visits. Then, tallying
our stats to show how many people that receive surgical and medical care, how many heard health education messages and
the good news of Christ love and I realize that each of us are only charged
with what we can do. We are asked to
live one day at a time and not worry about more than that. Maybe, just maybe my true mission trip last
50 weeks out of the year, and the two weeks we spend in the DR is home…..
