What follows are the contents of my journal for our
most recent mission project to the Dominican Republic to the city of Monte
Plata. For the most part it is the
summary of my thoughts. My habit is to
write early in the morning when my mind is clearest, although that is not
always the case. Sometimes nothing
profound happens but I try to look for the events that happen during the mist
of my day and hopefully learn from them.
January
21, 2018 Sunday morning
This
morning we delayed breakfast till 8 am!!
That is a rare luxury here. I
still woke around 5:15 and stayed in bed just listening to the gentle roar of a
hundred roosters. I got up a 6 and took
my shower and the electricity went out at 6:15.
That makes it very dark and very still.
That was a quick reminder that we are not in Kansas anymore and to carry
a flashlight wherever we go. The lights
were back on within 30 minutes, which is longer than it usually takes for the
generator to kick on. 
The
30 of us arrived without too much problem.
We had 25 from Wichita to Atlanta and 2 joined us from Des Moines. Three hours later the last 3 from Grand
Rapids came. One more tonight will
complete our Monday crew. I say it that
way because 2 more join us Wed. afternoon then 3 more next Sunday. We will have 7 leave on next Saturday and 3
on Sunday. Then the following Saturday
the remaining 24 of us will leave. (Yes, I know, we will have two leave next
Thursday). That is a lot of trips to the
airport for our crew. It is fortunate
that the project site is so close to the airport (90 minutes). When we arrive the first order of business is
to claim our sleeping accommodations for the project.
Logistics
are a huge part of this project. The
behind the scene activity is large. All
those coming and goings affect the cooking crew as well. They must plan and feed that constantly
varying number. They will arise every
morning at 4:30 to begin to prepare for our meals.
Today
is all about preparation. We will spend
the day in orientation and team building.
All our supplies must be sorted and the staging will begin for the
clinic. The surgery team will go to the
hospital and do the massive job of set up.
Once we arrive we will be told what rooms we can “have”. We will have one OR, one room for pre op, one
for post op, one for central supply and one or 2 storage rooms all on the
second floor. Downstairs we will get one
or two consultation rooms although they usually change daily as others sometimes
need to use the rooms. We will remove
most of all of their equipment and supplies from the rooms and then replace it
with all of our equipment and supplies.
Some is brought from the MMI warehouse in Santo Domingo (the OR tables,
anesthesia machines, Cautery machines, lights and sterilizers) but also the
disposable supplies we packed and brought from Wichita (27 tubs and boxes of
supplies, medication and equipment). We
should be able to set up so that tomorrow morning, we will be ready to start by
10-11 am. The clinic will go to Otaña
tomorrow to do their primary care clinic along with the dental and vision
clinic.
January 22, 2018, Monday morning
So
much for my infallible internal alarm clock.
I slept longer that I had intended and didn’t get up in time to shower
before breakfast. I just need some quite
time each day to organize my thoughts and without that I seem to scramble
more. Yesterday was quite a challenge
for both teams. Sometimes it seems as if
a not so gentle reminder must be given to us from America on these trips. The reminder is as if God says “you are not
in control, I am”. It is amazing how God can be gentle and stern
at the same time. 
After
we had finished preparing the hospital Sunday afternoon, we met our new
Dominican anesthesiologist. I thought
that she would be there earlier to set her stuff up, but she didn’t so we
realized that we would still have a lot to do Monday am. We saw 27 surgery consults which is ok, but
not too many in the afternoon. We scheduled 9 cases for the 2 OR tables total
for the day. It should be a reasonable
number for the first day. We were told
to expect low numbers for the first day because of the National Holiday, Dia de
Altagracia, the Day of Altagracia, the patron saint for the DR. When we arrived
to the hospital, there was a crowd of people that knew we were coming. The hospital waiting room on weekends is
usually quiet. We all filed in with our
backpacks and supplies and we were announced to the people by one of our
Dominican health educators. To our
surprise they all stood and started applauding us. That was quite humbling and not something we
are used to seeing in the United States.
And this was prior to doing anything for them other that coming to help
if we could. Several of our participants
had more than one tear in their eyes.
We
were able to begin to establish a routine today. Out breakfast is served at 6:30 each morning
and the menu varied daily. At 7 am we
have a short devotional presented by one of the participants and then we try to
leave by 7:30 to 8 for the hospital and the medical clinic. Most of the participants on the surgery team
will walk the one mile thru town to the hospital each morning and back in the
evening if we finish early enough. In
the evening, we try to serve dinner at 6:30 and that is followed by a report
from the hospital and medical clinic and a brief wrap up of our days to keep
both teams together in spirit. Later in
the evening there will usually be some kind of group activity.
In
the late afternoon in town there were parades and fireworks to celebrate that
continued late into the night. That
added fireworks to the music, roosters and barking dogs to the things that keep
us up the first night.
Tuesday 5:15 am
Yesterday
on Monday, the clinic went to Otaña which is a very small
village about 15-30 minutes from camp.
Their numbers were down as last year they saw over a hundred. This year 60 patients were seen. It gave them a chance to build their team and
develop their processes. Quite a few
patients received dental care and vision screening.
Our
American anesthesiologist was to arrive at midnight to the airport and then get
in to the camp around 2 am. He texted me
around 9:30 pm that he had just missed his connection in NYC so he would get
the next flight in the morning. So we
decided to finish getting ready which occurred quickly in the morning and
allowed us to start around 10:30. The
team worked well with a mix of new and experienced participants. I received another text around 9:30 am saying
that our anesthesiologist was on the plane in Atlanta and would be here by 1:30
pm. So the team began our surgery day
with a child with a hernia. We worked
out the logistical bugs as we went along.
I went to the clinic downstairs and began seeing patients. The numbers were down, with only seeing 27
patients but that was probably due to the holidays. The Dominicans don’t do too much on their
national holidays except celebrate.
We
slowly continued thru the surgery schedule which was set up for 2 tables but with
just one anesthesia provider we had to have her switch between the tables. My next text from him was to let me know he
was in Customs and that they had confiscated his medication and bags. Since he didn’t speak Spanish, he was delayed
over an hour. He was able to finally get
all his stuff back. There are certainly
benefits to all arriving at once with papers from Customs and the Health
Ministry to explain all our supplies. He
finally got outside and was picked up by the MMI van. I thought we were over the hump and he would
be there soon to help us finish the day.
That was until he texted to tell me the van had a blow out in the
parking lot of the airport and they couldn’t get the lug nuts off to change the
tire. By the time he got to the hospital
we were doing the last general case and after recovering the last patient and transferring
them to the floor for overnight care, it was 7:15 pm. Pretty long day for us but it was
productive. It will help to keep us
flexible for the coming two weeks so that we can remember who is in charge and
who gets the glory for our work.
Wednesday morning
I
enjoy the quiet of the morning with fresh Dominican coffee and a time to write
and reflect. It was another restful
night for me. Some of the others are not
as accustomed to the DR yet and will take a few days to get used to the
environment. You have to find places for
your stuff so you can find it again. It
also takes time to get accustomed to the different climate and time zone.
Surgery
went better with 2 anesthesia providers.
We had a couple of patients not show up so by the end of the day we
we’re home around 5 which was about the same time as the clinic team. I saw consults in the morning to see if they
needed surgery and scheduled their dates for surgery. Between the gynecologists cases he would see
his gynecologic patients. Taking a
history thru an interpreter is difficult to make sure that you are getting the
whole picture. We had scheduled a
patient for a hysterectomy for tomorrow when we found out the she was on a
blood thinner that takes 7 days of being off the medicine to be able to safely
operate. So we cancelled her surgery and
then found out she had been placed on the medicine for a stroke 6 months ago. That made the surgery too much of a risk for
the project by itself even without the blood thinner. We almost missed this because we ask are you
taking any medicine thru the interpreter and she responded no because she
thought we meant “today”. She didn’t take any medicine today, just
yesterday.
Even
though the hospital is only 4 years old, the air conditioning doesn’t work
consistently. That is an issue in the OR
in gowns and under the intense lights.
The ceiling tiles were stained from water leaks and there were some big
cracks in the walls. Unfortunately,
their abilities and finances up keep up the building are limited.
The
clinic went to Don Juan yesterday and just like last year, when they arrived no
one seemed to know that they were coming.
The church where they were supposed to set up was closed. The medical clinic where they went last year
when the church was closed couldn’t or wouldn’t let them us their facility. The only place in the town available was an
open air bar next to the cock fighting arena.
So they set up there and the people came to them. It actually was a good location being open
air was cooler that being cooped up in a building.
In
the evening after dinner the group enjoyed a rousing game of “Heads UP” which
is a modern version of charades. The
laughter and fun was infectious. Our
free time is mixed between just visiting, going into town for ice cream, cards
and dominoes. The team is bonding well
and great friendships are being formed.
It is good for everyone to interject new participants with our veterans.
We have 19 veterans with 1-26 prior projects and 12 first time participants
this week. Everyone is adjusting to the
routine and the cultural changes well.
The food is always good and plentiful.
January 25, 2018 Thursday morning
Yesterday
was very busy. We haven’t had much rain
but humidity remains high most of the time.
Flies have been bad but not much a problem with the mosquitoes. The open air buildings make it easy for the
flies to bother you all the time even in the OR.
We
had 2 more participants join the team yesterday and our Dominican
anesthesiologist left at the end of the day.
She was very nice and did a great job.
I was anxious about her but no problems were encountered and she fit in
well with the team. The clinic in the
hospital was either crazy or slow. There
never seems to be a level pace. We still
have patients that we can’t care for or don’t actually need surgery, like the
man who responded when we said we took care of patients with hernias. On history and exam his hernia was actually a
herniated disc in his back. Still, he
was not angry or upset. He just said
thanks and moved on with his CT scan.
I
got to help and do 3 or 4 surgeries today and get out of the clinic. It was like I had never left the OR, except
the air conditioner doesn’t work very well and the temp was around 80ish in the
OR. Most of the patients surgeries are
uneventful but there are always things unknown or not translated. One of our patients had some respiratory
issues that we were able to treat successfully but still is a cause for pause
and prayers. The patients and their
families are all so appreciative of what we have come to do. The kids are especially cute when they are
trying to be brave and the staff loves the interaction even the one who woke up
from his circumcision operation and stated loudly “No me gusto los
americanos” which roughly translated
means “I don’t like those Americans”. We
all had to snicker in understanding how he felt at that point in time.
The
medical clinic had an elderly lady who had an amputation and had to be carried
in a plastic chair around the clinic.
The group began to collect funds for buying a wheelchair. They were able to collect more than enough
money within a day. I can imagine how
surprised she will be when the Dominican staff shows up next week with a
wheelchair for her.
The
needs here are sometimes overwhelming.
The team went to an orphanage last night after supper. They were impressed with the set up but were
shocked by the youngest orphan who was only 8 days old. The house was hot without fan or air
conditioner. The orphanage is sponsored
by the same church and school that sponsors us here in Monte Plata.
The
children at our home church in Wichita participate in a program called Awana
and they collected money as a mission gift to the Oansa program here at the
school which is part of the same international group. The director was very grateful and pleased as
his organization has recently had some financial cuts and the donation will
help to offset the shortfall. It was
obviously not expected or anticipated by them but was planned by our church
without knowing there would be a need across the world. Even with being presented with money, he
wanted us to give it to the school director so that everything would be above
board. Even though we never considered
that he wanted all to be above question.
We
got home from the hospital last night in time for dinner a little early that
allowed us to go the orphanage and still have time for a quick trip into town
to have ice cream. It was a good day all
in all.
Early Friday morning 26 January
2018
Another
day in the DR. It has not been hot but
in the 80’s the whole time during the day.
Early in the morning, it drops in the low 70’s so a sheet and sometimes
a fleece feels good in bed. This is
opposed to August and September when it never cools down and I sweat all night
long. We have had the usual midday and
sometimes night time rain to replenish the humidity. Yesterday our medical clinic had its busiest
day as of yet. Crowds were lined up in
Chrino before they arrived and with the new APRN that came yesterday we were
able to have 5 providers seeing patients.
They finished seeing 133 patients and filling 439 prescriptions by 4
o’clock.
I
was so pleased that the team was able to raise the funds to buy the elderly
lady a wheelchair with funds and had more that they needed. The excess will be shared with the Dominican
staff at the end of the project along with gifts that we have brought from
home. It is amazing to see how quickly
God can bring about answers to the needs of his children but at the same time
how long had the lady been in need? We
never know how long God’s plans take to bring about His glory.
The
surgery team was very busy yesterday.
Wednesday and Thursday is usually when we reach our stride as a
team. We had a few patients cancelled
for hypertension but others that were added on to fill out our day with 15
surgeries today. One of our nurses was
walking by the labor room and ran into the room just in time to deliver a
baby. The staffing at the hospital is
not the same as at US hospitals. Another
OB nurse with us got to watch a C Section.
She did note several significant differences from our procedures in the
states. Enough said. All turned out well in both cases.
New
consults are slowing down as we get closer to filling the schedule. There seems to be a lot of stopping and
starting. That allowed me to do some
surgery and that was enjoyable. It looks
like we will be done on time for dinner tonight, but all can change
quickly. The medical students are
enjoying themselves and gaining great experiences with front line
medicine. This is a great experience
since most hospital and clinic rotations occur with groups of students and
residents so the one on one interaction with experienced doctors is great for
them. As I mentioned yesterday, we also
had a new CRNA join us and the Dominican anesthesiologist returned to her home
in San Christobal. That is one of the
challenges of a project when there is turn over in staff. We have to make sure that all are integrated
and oriented as well as included. The
large number of experienced staff helps with the transition that occurs. We have to be vigilant to make sure new
participants are comfortable with our environment and not just assume that
fact. Friday night we will have 2
participants leave for the city and Saturday 4 more leave for the US. Sunday 5 more leave and 3 participants arrive
for the second week to help fill in for the leaving participants. That will
give us 25 participants for the second week of the project. That does make for some difficult staffing
issues for the project.
Saturday afternoon
The
medical clinic was very busy yesterday as was the surgery team. Everyone was ready for some decompression
time today. Today was my day of
rest. We woke for breakfast at the usual
time of 6:30. Twenty two of our group
boarded the big yellow school bus to head for the north coast and a day at the
beach. It is a 2-3 hour drive each way
thru the rain forest, the mountains and the rice fields of the DR. Six of our group will board the plane to head
home today. It was a sad time as the
team began to change. I say change
because 5 more leave tomorrow and 3 arrive to begin the next week. We have to be intentional to meld everyone
into a new team and prevent cliques or others from feeling like outsiders.
A
mission project is very unique in team building because everyone is here voluntarily
and all are truly anxious to help and serve.
Not everyone is of the same faith or even professes faith but everyone
is united in the desire to help and in the spirit of cooperation. We do several team building exercises prior
to coming down with informational meetings, packing events and supply
preparation. That helps but it is not till
everyone arrives that the bonding of all participants occurs. Even though it has been a year and sometimes
more since the participants were last here, the returning participants pick up
with friends like it was only yesterday.
There is very little distinction between doctor, nurse, pharmacist and
general helper. Back in the states those
barriers sometimes inhibit teamwork. It
is truly a unique environment down here.
Last evening we had a time of sharing so everyone could share thoughts
and thanks with others prior to their leaving.
Those times also help with the team building process.
January 23, 2018 Sunday morning
We
were able to sleep in a little today but have plans to go to a Dominican church
at 9:30. The events of the prior day
were certainly noteworthy for some of us.
I stayed back in camp and didn’t go to the coast. That enabled me to walk to the hospital and
discharge the patients that stayed overnight with some of the participants who
were leaving in the afternoon. We had
quite a bit of rain which made for nice sleeping weather in the afternoon.
There
was an accident of sorts. Fortunately,
it turned out okay but one of our participants fell out of the boat while
trying to walk the plank to the dock after they returned from the island. They had spent the afternoon on the beach and
the water was very rough both coming and going.
As the boat pitched, out participant was pitched into the water. The only injury was to his pride (and his I
Pad). But it did make for a great story
and subsequently he wrote a poem to commemorate the occasion.
January 29, 2018 early Monday
morning
The
weekend was very good. Everyone got to
relax somewhat. It rained intermittently
but that really doesn’t slow things down for very long. Even though heavy at times the ground soaks
it up and doesn’t get muddy and mushy like at home when it rains (or when it
used to rain). People were sad to see
their new friends’ leave that had bonded quickly in this environment but the
new ones fit in well. We were able to
worship in a Dominican church yesterday.
We all walked to the church (about 10 blocks). The service lasted an hour and a half and we
didn’t have a translator but with 10-12 songs (some of which were recognizable)
and prayers, offering and communion mixed in, it went by quickly.
I
announced today that a change in plans for the clinic had occurred and they
would be able to visit the prison to bring health care services to the
prisoners on Wednesday of this week. I
had some reservations, but the team didn’t.
In the past when we went to the prison, the experience was rewarding for
the entire team. As a leader your first
concern is always for your participants.
It is of course scriptural (widows, orphans and prisoners are all lumped
together frequently as those in need.)
We will have 2 full days and a half in the OR before packing up to
leave. Once we got started the time
flies by us.
Unfortunately,
2 of our group going home missed the connection in Atlanta and had to stay
overnight there. They will catch a
flight into Wichita this morning at 9.
Such are the risks of international air travel these days.
Tuesday morning 30 January 2018
There
is always some concern with new participants at the start of week two. We have always had fewer participants for the
second week and the patients seem to increase the longer we are here. This year was no exception. The medical clinic stayed in camp today because
school was out for Dia de Duarte. Juan
Pablo Duarte was the patriarch of the DR in the mid 1800’s and his birthday is
celebrated today and is similar to our Presidents’ Day. This gives the team a chance to serve the
local people of Monte Plata since the school was cancelled and we can use the
camp for our clinic. Not to disappoint,
today was the largest volume of patients with the smallest number of
participants.
In
surgery we also had our biggest day in number of patients and surgeries. Even though we were fewer we have become more
efficient but God gets the credit. I
only saw a few patients in the clinic downstairs for Preop consultation since
the schedule is largely full. That was a
good thing since we are down to just 2 surgeons including myself. I was able to do an umbilical hernia, a
bilateral inguinal hernia, 2 tubal ligations, and a hydrocele surgery and
remove 2 lipomas. The other doc was
likewise very busy but we were able to finish the surgery and be back at camp
by 5 pm.
We
have a great multi-generational mix in our team and all have interacted and
worked and played well. Our ages ranged
from 77 to 13 in our 36 member team with a good mix of 20 year old and as well
as 30 year old participants. It is great
to see young people catching the vision for world missions. We’ve played charades, UNO, dominoes, and
cards as well as walking into town together to get ice cream. It appears that everyone has been able to
work hard and yet relax and enjoy sharing the experiences with others. I think that the multi generational mix as
well as the mix of faiths is an integral part of the success of the project. That success is not only in relation to the
patients we serve but also in personal growth and development no matter where
we stand or started from spiritually.
Having our pastor from home on the trip has been great. He has worked as hard as anyone helping in
Central Supply but also has had a good listening ear and heart for the
team. Life is complicated and complex
and is it good to have someone skilled at listening even for the team. A new day will start soon and it should be
another busy one. I am sure our team
will be up for it.
Wednesday 31 January 2018 morning
Well,
we weren’t disappointed by the day on Tuesday.
It was the busiest day yet in surgery and the medical clinic had one of
its busiest days. In surgery we only had
one patient not show up for surgery. It
was a 14 year old boy who had a small hernia that was not causing him any pain. My guess is that 14 year old boys are not any
different in the DR that in the US. He
probably refused. We had several
patients return for us to check their incisions or for more ibuprofen for
discomfort. That is generally all we
give other than maybe 3 or 4 doses of a narcotic even for gall bladder and
hysterectomy surgery patients. Their
pain management is easier that in the states since most of the patients have
never taken any narcotic medicines and rarely take anything, even Tylenol. One patient brought gifts for her doctor
including a coffee mug and bracelet to say thanks for the surgery. One of the patients that had open gall
bladder surgery was discharged to home from the recovery room when in the
states would have been in the hospital 2 or 3 days at the least. He went home with those same ibuprofen
tablets.
The
medical clinic is scheduled to go to the prison today here in town to provide
care to the prisoners. There isn’t a
prison health or dental service so many will want to be seen. When we went there last time the prisoners
were told that they would have to give up one of their monthly family visits for
the privilege of seeing the provider. It
was very rewarding for the team in the past and I’m praying for a similar
experience.
There
wasn’t much activity in the camp last night.
The dining hall is where we eat and meet and visit and play games. It is a large open room with tile and
louvered windows next to the kitchen. It
can get very noisy especially with the laughter and loud dominoes that the
Dominicans play. It is refreshing to see
the interactions of the participants and Dominicans in the evening. Even though it was quiet there were people
all around comparing pictures and air dropping them to each other even without
Wi-Fi access in the camp.
Today
will be a slower day as far as volume is concerned since we have to break down and
pack up all the stuff in surgery to load it on the truck at the end of our
day. We have scheduled light to be able
to do that. It shouldn’t take as much
time to load as it did to set up. There
are always a few patients that show up on the last day wanting surgery but
didn’t get around to coming by till the last day. It is sad to turn them away but we can never
see everyone and do all that could be done, but there is next year.
February 1, 2018 Thursday morning
We
all are sitting here drinking our coffee waiting for breakfast this
morning. Breakfast was set for 8 this
morning instead of the usual 6:30 but my internal clock woke me at the usual 5
am. Today is the day we break camp and
drive to the old Colonial Zone for the beginning of 2 days of sightseeing and
relaxation before return home.
Yesterday
the medical clinic at the prison saw 101 patients. It was a rewarding
experience as we had hoped. Almost 40% of
the patients seen were guards rather that prisoners underscoring the need for
primary care services in the community.
Dental and eye care services were much appreciated as well. We had scheduled light in surgery since we
were leaving today and didn’t want patients to have to stay overnight after we
had gone. We also had to break down and
pack and load all our OR supplies (I am using the “we” very liberally). We finished all the surgeries by noon and
stopped to eat lunch (our usual peanut butter and jelly or ham and cheese on a
hot dog bun) and then went as a team downstairs so that the hospital administration
staff could present us a plaque and we could present them with one also. They were appreciative of all that we do for
Monte Plata and we were humbled by their praise. All the left over supplies from our project
and the stock from MMI will be taken back to Santo Domingo to be organized and
readied for the next project in the north of the island in one week.
Last
evening, we had a kind of debrief or after action report like the military
does. It gives the people a chance to
articulate and begin to process their thoughts and feeling after being
surrounded by such poverty but at the same time such joy and love. We had a chance to give gifts as a team to
our Dominican host and staff. Most just
work by the day for MMI so our gifts and monies we collect to give them are
very much appreciated. It is interesting
to see the point of realization that the participant understands that while
they came to help others, frequently they are the ones touched and helped. The participants leave being impacted and
their hearts touched by a simple fact that touching others sometimes touches
us.
Saturday afternoon, mid-flight to
Atlanta from Santo Domingo
I
came down with a cold (not the flu) during the day on Thursday so I took Dayquil
and Nyquil continuously for 48 hours and slept at every occasion. The days of vacation in the Colonial Zone and
in the resort in Juan Dolio were largely missed by me but by this morning I was
back to baseline for our travels home.
This marked the first year in the last 7 or 8 years that I have not been
taken out of line at the airport while waiting to board the plane to identify
my bags. Each year I generally bring
back 40 pounds of Dominican coffee. It
always looks suspicious on X-Ray so I have to open my tub and show it to
them. I only brought back 20 pounds this
year so maybe that is the secret to not getting stopped and questioned. We were down to 23 at the airport today with
22 of us going to Atlanta. Two will then
leave for Des Moines and we will proceed with 20 back to Wichita.
A
great project by all accounts. The team
meshed together well and had no drama or problems. The mood was joyful and there was not illness
other than a few colds. All were already
talking about next year. Yesterday, I
found out that the cash gift that we gave to our Dominican host was not equally
divided among them as we had expected.
While at the prison on Wednesday they saw a friend of mine and theirs. Dr Julio Gomez is a Dominican Ob/Gyn and a
pastor in his local church. I have known
him for almost 18 years and he has helped in surgery in many of our previous projects. He was at his home in the capital one evening
and a man broke into his home and shot his nephew and threatened his
daughter. Julio defended himself and as
the man ran away Julio’s house, the neighbors caught him and beat him up. He was taken to the hospital and later
died. Julio was then placed in jail,
since the man died. He has been there
over 8 months still awaiting trial as is his nephew. The Dominican staff instead of taking the
money themselves choose to give it to Julio to help pay for an attorney. American justice system may have some
problems, but not in comparison to the rest of the world.
You
can see why we have such a high rate of return participants. When they get to know the Dominican people,
it is hard to forget them. They are such
a loving and grateful people in such a beautiful country. We all like to get back home to our families
and friends, but each time a part of our heart stays there, till next year. The
plans will start soon for the next trip…
