Monte Plata Journal 2015

                                                                                                                       

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

 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     It helps to sleep good if not great and usually after the first full day all sleep better than the first night.  And so it is.  It’s not my own bed but still it’s okay when you are tired.

                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. 

                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…..